We report a case of primary cutaneous cryptococcosis on Rt. forehead and perioral area of 57 year old woman with non-insulin dependent diabetes mellitus and Lt. cerebral infarction. She had large ulcers with yellowish purulent exudates on Rt. forehead and perioral area for 2months. A histopathological examination from the lesion showed numerous encapsulated, round spores and the organisms were identified as Cryptococcus neoformans in a series of fun-gal studies. The patient received a 5-week course of IV and oral fluconazole with resolution of her skin lesion. The patient is free of any lesion several months after completing therapy. This experience supports the use of fluconazole as initial and single therapy in primary cutaneous cryptococcosis.
Cerebral Infarction ; Cryptococcosis* ; Cryptococcus neoformans ; Diabetes Mellitus ; Exudates and Transudates ; Female ; Fluconazole* ; Forehead ; Humans ; Skin ; Spores ; Ulcer

As the arthroscopic surgery of the knee joint has taken rapid strides recently, the knowledge of the structure and deveIopment of the joint are getting needed more and more. An embryological study about the development of the human knee joint was carried out using a total of 23 knees of human embryos. Serial sections of 23 embryos aged 5-8 postovulatory weeks (12-31 mm C.R.) and 3-dimensional reconstruction were examined. The embryos have been staged according to Carnegie's 'developmental stages'. The femur, tibia and fibula had begun to undergo chondrification by stage 18. The patella had commenced chondrification at stages 23. As the mesenchymal model began to chondrify, concomitant changes occurred in the region of the presumptive knee joint to create the interzone (stage 19-20). The following structures became condensed successively: patellar tendon (18-19), lateral collateral ligament and popliteus tendon (19-20), cruciate ligaments (20-22), meniscus (21-22). In summary, the differentiation from a generalized cellular blastema to a joint resembling the adult in form and arrangement occurred in only a relatively few days. By the end of the embryonic period proper (stage 23, 8 postovulatory weeks), all the elements of the knee joint were present in a form and arrangement closely resembling those of the adult. It seems that the embryological studies are more required to clarify the structures having many variants such as synovial plica, meniscus, and the development of the joint cavity through this study.
Adult ; Arthroscopy ; Embryonic Structures ; Femur ; Fibula ; Humans* ; Joints ; Knee Joint* ; Knee* ; Lateral Ligament, Ankle ; Ligaments ; Patella ; Patellar Ligament ; Tendons ; Tibia

A complete fracture dislocation at the cervicothoracic junction is rare and accompanied by severe spinal cord injury. This region is difficult to image with plain radiography, and to immobilize with external orthosis due to the biomechanical forces exerted in this transitional portion of the spinal column. We experienced a rare case in 52-year-old male victim of a car accident. He sustained paraplegia, and complained of dyspnea and neck pain of 10 days duration at another hospital. The delayed clinical rediagnosis was a C6 and 7 spinous process fracture and a cervicothoracic fracture dislocation, with complete transection of spinal cord, which was based on a clinical examination, simple radiography, CT and MRI. Skeletal traction was immediately applied, followed by a posterior pedicle screw to stabilize the spine and secure the grafts. Rehabilitation was initiated and the dysphagia and dyspnea, due to aspiration pneumonia, were improved, but no neurologic recovery was made after the 1st postoperative year.
Deglutition Disorders ; Dislocations ; Dyspnea ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neck Pain ; Orthotic Devices ; Paraplegia ; Pneumonia, Aspiration ; Radiography ; Rehabilitation ; Spinal Cord ; Spinal Cord Injuries ; Spine ; Traction ; Transplants

STUDY DESIGN: We report two cases of symptomatic spinal epidural lipomatosis (SEL) associated with long-term use of steroid medication OBJECTIVES: The purpose of this study was to assess the clinical characteristics, diagnosis and treatment of symptomatic spinal epidural lipomatosis. SUMMARY OF LITERATURE REVIEW: Spinal epidural lipomatosis is a condition in which excess adipose tissue is deposited circumferentially about the spinal cord in the epidural space. It can present neurologic symptoms including back pain, radiculopathy or cauda equina. Magnetic resonance imaging is the most helpful dignostic means and should be used initially if suspected. Treatment is decompressive laminectomy and debulking of fat. MATERIALS AND METHODS: Two cases of lumbar epidural lipomatosis with neurologic symptoms were discussed and evaluated by physical examination, postmyelography CT and MRI. RESULTS: Two cases were treated with decompressive laminectomy and debulking of fat. Increased accumulation of the fatty tissue was seen predominently in posterior and posterolateral epidural space of the spinal canal, displacing and compressing the lumbar spinal cord anteriorly. Both gross and histologic evaluation revealed overgrowth of unencapsulated normal appearing fat consistent with spinal epidural lipomatosis. One case was demonstrated gradual improvement in symtoms after operation but the other was died due to medical problems. CONCLUSION: The authors reviewed the literature and reported the results of operative treatment of patients with lumbago, radicular pain and intermitent claudication caused by epidural lipomatosis of lumbar spine and degenerative spinal stenosis.
Adipose Tissue ; Back Pain ; Cauda Equina ; Diagnosis ; Epidural Space ; Humans ; Laminectomy ; Lipomatosis* ; Low Back Pain ; Magnetic Resonance Imaging ; Neurologic Manifestations ; Physical Examination ; Radiculopathy ; Spinal Canal ; Spinal Cord ; Spinal Stenosis ; Spine

Fiberoptic bronchoscopy is a valuable diagnostic and therapeutic procedure in many clinical situations and is relatively simple to perform with proper technique. Local anesthetic technique is often preferable to general anesthesia for bronchoscopies since these examinations are mostly undertaken as outpatient procedures. Inhaled topical lidocaine, used to produce anesthesia of the repiratory tract prior to bronchoscopy, may cause anaphylactoid reaction in patients. However lidocaine hypersensitivity reaction is uncommon. We report the case of death due to hypersensitivity to topical lidocaine spray given during routine premedication for this procedure. The possibility of bronchospasm secondary to an adverse reaction to premedication or anesthesia must also be considered.
Anaphylaxis* ; Anesthesia* ; Anesthesia, General ; Bronchial Spasm ; Bronchoscopy* ; Humans ; Hypersensitivity ; Lidocaine* ; Outpatients ; Premedication

BACKGROUND: The aim of this study was to investigate the effect of a botulinum toxin type A (BTX-A) injection in the masseter muscle using electromyography (EMG) in an animal model. METHODS: Ten male adult (>3 months of age) New Zealand white rabbits were used. Muscle activity was continuously recorded from 8 hours before to 8 hours after BTX-A injection. The rabbits received unilateral BTX-A injections of either 5 units (group 1, n = 5) or 20 units (group 2, n = 5). RESULTS: The masseter muscle activity of the rabbits was significantly reduced immediately after BTX-A injection (P < 0.05 for both groups). When the results from group 1 were compared with those from group 2, only the peak voltage was significantly decreased in group 2 (P = 0.013). CONCLUSION: Masseter muscle activity measured by EMG was immediately decreased after a BTX-A injection.
Adult ; Botulinum Toxins, Type A* ; Electromyography ; Humans ; Male ; Masseter Muscle* ; Models, Animal* ; Rabbits

Catecholamine-induced cardiomyopathy associated with neuroblastoma is rarely reported. We report a case of catecholamine-induced cardiomyopathy associated with neuroblastoma in a 33-month-old female that was treated with extracorporeal membrane oxygenation (ECMO). She was tentatively diagnosed with acute myocarditis and presented with hypertension. Because of rapid patient deterioration despite pharmacological treatments, ECMO was applied. ECMO can be helpful in cases of catecholamine-induced cardiomyopathy associated with neuroblastoma.
Cardiomyopathies* ; Catecholamines ; Child, Preschool ; Extracorporeal Membrane Oxygenation* ; Female ; Humans ; Hypertension ; Myocarditis ; Neuroblastoma*

Cephalosporins are B-lactam antibiotics. They are usually bactericidal in action and act by inhibiting mucopeptide synthesis in the bacterial cell wall. Cephalosporins have been used widely in Korea. However, allergic contact dermatitis to cephalosporins has not been reported in the Korean dermatologiy literature. We report a case of allergic contact dermatitis due to cephalosporins in a 23-year-old nurse who suffered from itchy, erythematous patches and plaques with numerous fissures on both hands. A patch test with ceftriaxone and a prick test with cefotiam were positive.
Anti-Bacterial Agents ; Cefotiam ; Ceftriaxone ; Cell Wall ; Cephalosporins* ; Dermatitis, Allergic Contact* ; Hand ; Humans ; Korea ; Patch Tests ; Young Adult

BACKGROUND: Using biochemical and immunohistochemical studies, alterations of cytokeratin expression has been reported in seborrheic keratosis. OBJECTIVE: To further investigate the cytokeratin expression in seborrheic keratosis, we have done immunohistochemical staining using a panel of specific anti-keratin antibodies in this study. We also observed the cytokeratin expression in the hair, sebaceous gland and sweat gland of the some epidermis. METHODS: Twenty cases of seborrheic keratosis were collected from the pathologic files. The histological types included acanthotic type (13 cases), hyperkeratotic type (5 cases), and pigmented type (2 cases). All tissues had been fixed in formalin and then paraffin-embedded according to conventional procedures. Each section was mounted on a gelatin-coated glass slide, and incubated with various anti-keratin antibodies. The sections were then immunostained using the avidin-biotin-peroxidase complex system. The peroxidase reaction was visualized with diaminobenzidine (DAB). RESULTS: 1. Cytokeratin expression in seborrheic keratosis lesions On staining with 34βB4 (K1), several staining patterns in the suprabasal layers of the epidermis were observed in 10 out of 20 cases. Using the AE1 (K10,14,15), we observed focal staining in 2 cases. We observed several positive staining patterns in 5 cases with K13,16 antibody. On staining with K10 antibody, we observed focal or irregular staining patterns in 14 cases. Focal staining was also observed with K5,8 antibody in one case. 2. Cytokeratin expression in the hair, sebaceous gland and sweat gland On immunoperoxidase staining of hair, there were positive reactions with CAM5.2 (K8,18) in 2 cases. There were positive reaction with K13,16 antibody in one case, with 34βB4 (K1), and K10 antibody in 3 cases, and with K17 antibody in 2 cases. On immunoperoxidase staining of sebaceous glands, there was one positive reaction with CAM5.2 (K8,18) in the suprabasal cells of sebaceous glands and with K13,16 antibody in sebaceous ducts. There were positive reactions with K17 antibody in the sebaceous ducts in 2 cases, and with K1 antibody in the sebaceous glands in one case. Using 34βB4 (K1), 4 out of 20 cases showed positive reactions in sweat glands. On staining with AE1 (K10,14,15), positive reactions were observed in 8 cases. Staining with CAM5.2 (K8,18) showed positive reactions in 14 cases. There were positive reactions with K19 antibody in 9 cases. CONCLUSION: Our data suggests that the predominant keratin expression in the tumor cells of seborrheic keratosis is high molecular weight keratin (K1/K10) rather than other lower molecular weight keratin. Tumor cells show some proliferative activity and monoclonal antibody K19 could be a marker for eccrine sweat glands like CAM5.2 (K8,18).
Antibodies ; Epidermis ; Formaldehyde ; Glass ; Hair ; Keratins* ; Keratosis, Seborrheic* ; Molecular Weight ; Peroxidase ; Sebaceous Glands ; Sweat Glands

We report herein a case of subcutaneous granuloma annulare occured in a 3-year-old girl who had 7 subcutaneous nodules on the scalp, lumbar area, buttock, right tibial area and both ankles. liistopathologically, multiple foci of complete and incomplete collagen degeneration surrounded by histiocytes in a palisading arrangement were seen in the subcutaneous layer. Some vessel walls were thickened and infiltrated with inflammatory cells and many eosinophils were scattered among the inflamrnatory cell infiltrate around the palisaiing granuloma. Five of the lesions disappeared spontaneously and other s decreased in size without specific treatment in 2 months.
Ankle ; Buttocks ; Child, Preschool ; Collagen ; Eosinophils ; Female ; Granuloma Annulare* ; Granuloma* ; Histiocytes ; Humans ; Scalp