Cauda equina syndrome (CES) is often defined as a complex of symptoms and signs consisting of low back pain, bilateral sciatica, lower extremity weakness, saddle anesthesia, and bowel and bladder dysfunction. CES is considered to be neurosurgical emergency. Delayed or missed diagnosis of CES can result in serious morbidity and neurological sequelae. However, the diagnosis of CES is often difficult when one or more of these symptoms are absent or when these symptoms develop asymmetrically or incompletely. We report a case of urinary retention and sphincter dysfunction without sciatica or motor weakness following an L3 burst fracture in a 52-year-old male and discuss the atypical presentation of CES and treatment of traumatic CES.
Anesthesia ; Cauda Equina* ; Diagnosis ; Emergencies ; Humans ; Low Back Pain ; Lower Extremity ; Lumbar Vertebrae ; Male ; Middle Aged ; Polyradiculopathy* ; Sciatica ; Spine* ; Urinary Bladder ; Urinary Retention

Gas-containing (emphysematous) infections of the abdomen, pelvis, and extremities are well-known disease entities, which can potentially be life-threatening. They require aggressive medical and often surgical treatment. In the neurosurgical field, some cases of gas-containing brain abscess and subdural empyema have been reported. Sometimes they progress rapidly and even can cause fatal outcome. However, gas-containing spinal epidural abscess has been rarely reported and clinical course is unknown. We report on a case of rapidly progressive gas-containing lumbar spinal epidural abscess due to Enterococcus faecalis in a 72-year-old male patient with diabetes mellitus.
Abdomen ; Aged ; Brain Abscess ; Diabetes Mellitus ; Empyema, Subdural ; Enterococcus faecalis ; Epidural Abscess* ; Extremities ; Fatal Outcome ; Humans ; Male ; Pelvis ; Spine

No abstract available.
Humans ; Inpatients*

A congenital coronary artery fistula is a rare condition, which is an abnormal communication of the coronary artery with the ventricles or atriums or the pulmonary artery. A case of 69 year-old man, complaining of recent aggravating chest pain for 5 months is reported. The coronary angiography shows coronary artery-pulmonary artery fistula. Multidetector row CT shows coronary artery-pulmonary artery fistula combined with aortopulmonary fistula via common channel and the fistulas were surgically ligated.
Aged ; Arteries* ; Chest Pain ; Coronary Angiography* ; Coronary Vessels ; Fistula* ; Humans ; Pulmonary Artery

Langerhans cell histiocytosis (LCH) is related diseases characterized by proliferation of Langerhans cell with involvement of bone, skin, lung and other organs. LCH usually occurs in childhood and are presented as multiple small papules or eczematoid lesion mostly. We report a 50-year-old man with 3 brown lichenoid patches on left dorsal foot. He was diagnosed pulmonary LCH 5 years ago. Typical LC cells on skin lesion and CD1 complex positive staining confirm the diagnosis of LCH. We consider brown lichenoid patches may be a previously unreported cutaneous presentation in cutaneous or multisystem LCH.
Foot ; Histiocytosis, Langerhans-Cell ; Humans ; Lung ; Middle Aged ; Skin

Idiopathic hypertrophic pachymeningitis (IHP) is a rare disease, and it is characterized by chronic progressive inflammatory fibrosis and thickening of the dura mater with resultant compression of the spinal cord or neural structure without any identifiable cause. It can occur in the intracranial or spinal dura mater alone or as a craniospinal form. The spinal form is rarer than the cranial form and the craniospinal form is extremely rare. We report a rare case of IHP in the craniocervical junction involving both the cranial and spinal dura mater and discuss the diagnosis and management of the disease.
Diagnosis ; Dura Mater ; Fibrosis ; Meningitis* ; Rare Diseases ; Spinal Cord

PURPOSE: To evaluate whether factors related to lipid and glucose metabolism have a potential role in the progression of prostate cancer, we measured the mRNA levels of the peroxisome proliferator-activated receptor (PPAR), fatty acid elongase (ELOVL), and two glycolytic enzymes in prostate cancer (CaP) tissues. MATERIALS AND METHODS: Prostate tissues, obtained from radical prostatectomy (n=10) and transurethral resection of prostate (n=18), were quickly frozen in liquid nitrogen for RNA measurements. Transcript signals of PPAR alpha, PPAR gamma, ELOVL2, ELOVL5, phosphoglycerate kinase 1 (PgK1) and phosphoglycerate mutase 2 (PgM2) were measured using a reverse-transcription polymerase chain reaction. RESULTS: The transcript signals of PPAR alpha and PPAR gamma were down-regulated in CaP tissues. In addition, the mRNA level of PgM2 in CaP tissues was lower than that in benign prostatic hyperplasia (BPH) tissues. However, the messages for ELOVL2, ELOVL5, and PgK1 were not significantly changed. CONCLUSIONS: These results suggest that lowering of the PPARalpha, PPARgamma and PgM2 messages may be involved in aberrant and uncontrolled prostate cell growth and differentiation.
Down-Regulation* ; Glucose ; Metabolism ; Nitrogen ; Peroxisome Proliferator-Activated Receptors ; Peroxisomes* ; Phosphoglycerate Kinase ; Phosphoglycerate Mutase* ; Polymerase Chain Reaction ; PPAR alpha ; PPAR gamma* ; Prostate* ; Prostatectomy ; Prostatic Hyperplasia ; Prostatic Neoplasms* ; RNA ; RNA, Messenger ; Transurethral Resection of Prostate

Leg swelling in patients with paraplegia due to spinal cord injury (SCI) occurs for various reasons, including heterotopic ossification (HO), deep vein thrombosis (DVT), fracture, or cellulitis. The clinical presentations of these conditions may overlap in part or in whole and it may occasionally be difficult to distinguish. Of these conditions, DVT and subsequent pulmonary embolism remain significant causes of morbidity and mortality in patients with SCI. Therefore, a prompt diagnostic work-up, particularly for DVT, is essential in patients with SCI, who present with leg swelling. Here, we report a case of leg swelling in a paraplegic patient, resulting from HO mimicking DVT and discuss the differential diagnosis.
Cellulitis ; Diagnosis, Differential ; Humans ; Leg* ; Mortality ; Ossification, Heterotopic* ; Paraplegia ; Pulmonary Embolism ; Spinal Cord Injuries ; Venous Thrombosis*

OBJECTIVE: Methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase negative staphylococci (MRCNS) are major causes of neurosurgical infection. Nasal colonization of MRSA is the most important risk factor and MRSA screening can be a screening method to identify MRSA and MRCNS colonization. We retrospectively evaluated prophylactic effect of vancomycin on MRSA or MRCNS surgical site infection (SSI) after cranioplasty following decompressive craniectomy (DC) after traumatic brain injury (TBI) in MRSA carriers. METHODS: The study included 21 patients who were positive in MRSA screening before cranioplasty. These patients underwent DC after TBI and subsequent cranioplasty with autologous bone. The patients were separated into SSI group and no SSI group according to the development of SSI due to MRSA or MRCNS after cranioplasty. Mean follow-up period after cranioplasty was 23.5+/-22.8 months (range, 3 to 73 months). The rate of MRSA or MRCNS SSI and factors including the prophylactic preoperative antibiotics were compared between groups. RESULTS: The rate of MRSA or MRCNS SSI was 23.8% (5/21 patients). Mean time from cranioplasty to confirm the SSI was 19.6+/-10.9 days (6 to 63 days). The rate of MRSA or MRCNS SSI was significantly different from the use of preoperative prophylactic antibiotics (p=0.047). MRSA or MRCNS SSI developed in 1 of 13 patients (7.6%) who received vancomycin and in 4 of 8 patients (50%) who received 3rd generation cephalosporin. CONCLUSION: Preoperative MRSA screening and administration of vancomycin as a preoperative prophylactic antibiotic should be considered in MRSA carriers who are scheduled to cranioplasty to reduce MRSA or MRCNS SSI.
Anti-Bacterial Agents ; Brain Injuries* ; Coagulase ; Colon ; Decompressive Craniectomy ; Follow-Up Studies ; Humans ; Mass Screening ; Methicillin Resistance* ; Methicillin-Resistant Staphylococcus aureus* ; Retrospective Studies ; Risk Factors ; Staphylococcal Infections ; Staphylococcus ; Surgical Wound Infection ; Vancomycin*

PURPOSE: For tachycardic patients not in need of immediate cardioversion, the International Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care emphasize specific rhythm diagnosis and avoidance of simplistic overuse of adenosine. The purpose of this study was to identify the rhythms for which adenosine was inappropriately prescribed at the emergency department after the International Guidelines 2000 had been adopted. METHODS: We retrospectively investigated 128 tachycardic patients who had been prescribed adenosine at the emergency department from September 2000 to March 2003. Patients were divided into two groups. The Appropriate Use Group was comprised of patients for whom had been prescribed for narrow QRS-complex tachycardia on the initial ECG. The Inappropriate Use Group was comprised of patients for whom adenosine had been prescribed for atrial fibrillation, atrial flutter, atrial tachycardia, sinus tachycardia, and wide QRS-complex tachycardia of unknown origin on the initial ECG. RESULTS: Of the 128 patients, 31 (24.2%) were in the Inappropriate Use Group. Among them, atrial fibrillation was involved in 15, atrial flutter in 3, atrial tachycardia in 2, sinus tachycardia in 8, and wide QRS-complex tachycardia of unknown origin in 3. CONCLUSION: Approximately 24% of the emergency department patients who were treated with adenosine received the medication unnecessarily for atrial fibrillation, atrial flutter, atrial tachycardia, sinus tachycardia, and wide QRS-complex tachycardia of unknown origin. Additional education on electrocardiographic recognition of tachyarrhythmias, and the Tachycardia Algorithms of Guidelines 2000 may be necessary for residents of emergency department.
Adenosine* ; Atrial Fibrillation ; Atrial Flutter ; Cardiopulmonary Resuscitation ; Diagnosis ; Education ; Electric Countershock ; Electrocardiography ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Retrospective Studies ; Tachycardia ; Tachycardia, Sinus