A case of dysplasia eplphyseaalis hemlmelica (Fairbank, 1956) in a 8 years old boy, showlng typical clinical and roentgenographical appearance, is reported together wlth a brief review of literature in this paper. This condition is a rare developmental disorder of childhood in which there is a asymmetrical cartilaginous overgrowth of one or more than one epiphysis, or of a tarsal or carpal bone. Thls disorder is usually Iimited to elther the medial or lateral half of a single extremity. The disease is characterised radiographically by delay in the appearance of the epiphyseal nucleus, which is mottied and of irregular density. The most common deformities were genu valgum or varum and valgus or equinus deformity of the ankle. These deformities tended to increased wlth growth but the size of the lesion increased in proportion to the growth of the normal bone. Concomitant involvement of the knee and ankle is the rule, and in those cases the affected limb Is usually longer than Its mate. The lesion Is often microscopically indistingulshable from an osteochondroma.
Ankle ; Carpal Bones ; Congenital Abnormalities ; Epiphyses ; Equinus Deformity ; Extremities ; Genu Valgum ; Humans ; Knee ; Male ; Osteochondroma

Our aim was to identify histologic changes in cervical carcinoma tumor cells due to chemotherapy,by electron microscopic examination. Cisplatin and 5-fluorouracil were used between March 1, 1994 and February 28, 1995 on a total of 16 patients. The treatment schedule consisted of 75 mg/m2 cisplatin via iv with hyperhydration on Day 1, in combination with 1000 mg/m2 5-fluorouracil via continuous iv on Day 1 to 5. The treatment was repeated every 4 weeks with a maxinum of 3 courses. Ultrastructurally, chemotherapy induced apoptosis,indicated by condensation of nucleus and cytoplasm,fragmentation of nuclei, and apoptotic bodies. Due to repeat chemotherapy, increased levels of desmosomes were noted and parts of tumor nests were replaced by mature squamous cells. Tumor nests were reduced in size, mitochondria exhibited swelling, the endoplasmic reticulum was dilated, and infiltration of inflammatory cells increased after chemotherapy. These results suggest that chemotherapy induces apoptosis and injury to the cytoplasm and nuclei of tumor cells. However, the exact selection mechanism of the biochemical pathway of cell death is not fuUy understood. Further study of the molecular biologic actions of cell death after chemotherapy is warranted.
Apoptosis ; Appointments and Schedules ; Cell Death ; Cisplatin ; Cytoplasm ; Desmosomes ; Drug Therapy* ; Endoplasmic Reticulum ; Fluorouracil ; Humans ; Mitochondrial Size

No abstract available.
Constriction, Pathologic*

The Clinical analysis of 130 spontaneous intracebral & cerebellar hematoma confirmed by brain CT & admitted to this neurosurgical clinic past years & 5 months were made with literature review. 1) The age incidence showed increase over fourth decade and male to female ratio was 56.1:43.9. 2) 50.4% of total patients showed hypertension but 40.3% did not checked their B.P. & 9.3% had normal B.P. before cerebral hemorrhage. Among 50.4% of hypertension cases, 72% received antihypertensive treatment intermittently, 2.9% regularly and the rest 24.3% did not. 3) 69.7% of hematoma located in basal ganglia & thalamus. In nonoperated patients, the morbidity & mortality showed no marked difference in their location except pontine & cerebellar hematomas. In operated patients the morbidity & mortality was prominent in putaminal hemorrhage than in thalamus and cerebellum. Most of putaminal hematoma had semicomatose or comatose mental state and ventricular hemorrhage in 87.5%. 4) The morbidity & mortality increased in proportion to size of hematomas, grade of unconsciousness in admisson and state of intraventricular hemorrhage. 5) About time interval from ictus to operation, the patients within first 24 hours are 29 cases(51.1%) and the next 24 hours are 13 cases(26.5%). The mortality rate of two groups were 55.1% & 53.8% respectively but no death in the patients with operation performed after 48 hours. 6) The morbidity & mortality rate were as follows. In the non operated patients (90 patients), no or mild neurological deficits:22.2% moderate:21.1% severe:20% and moribund or death:36.6%. In the operated patients no or mild neurological deficits:16.3% moderate:18.4% severe:18.4% and moribund or death:46.9%. The results of total patients showed no or mild neurological deficits:20.1%, moderate:20.1%, severe:19.4% and moribund or death:40.2%.
Basal Ganglia ; Brain ; Cerebellum ; Cerebral Hemorrhage ; Coma ; Female ; Hematoma* ; Hemorrhage ; Humans ; Hypertension ; Incidence ; Male ; Mortality ; Putaminal Hemorrhage ; Thalamus ; Unconsciousness

BACKGROUND: Epidural anesthesia became most popular for a cesarean section, but it is more time consuming and involves a higher incidence of insufficient or superficial blockade, especially of the motor root, despite large doses of local anesthesia. Combined spinal epidural anesthesia has gained an increasing interest as it combines the reliability of the spinal block and the flexibility of an epidural block. A dural puncture using the combined spinal epidural technique making an early sacral blockade might be a solution to disadvantages in epidural anesthesia. We investigated the efficacy of combined spinal epidural anesthesia and epidural anesthesia with prior dural puncture for a cesarean section. METHODS: Sixty pregnant women at full term were divided into three groups. Group I (EPI, n = 20) received epidural anesthesia with 100 mg of 0.5% bupivacaine. Group II (CSE, n = 20) received combined spinal epidural anesthesia with 1.2 1.4 ml of 0.5% hyperbaric bupivacaine intrathecally, followed by sensory block at T10 after by 7 8 ml of 0.5% bupivacaine through the epidural catheter. Group III (DP, n = 20) received epidural anesthesia with prior dural puncture. A dural puncture with a 27 G whitacre needle was done before an infusion of 20 ml of 0.5% bupivacaine through the epidural catheter. The quality and side effects of surgical anesthesia were compared between the three groups. RESULTS: Time to T10 (P< 0.001) and surgical onset time (P< 0.001) were significantly shorter in the CSE group. Maximal sensory block level (P< 0.001) was significantly higher in the CSE group. Muscle relaxation (P< 0.05) and motor block (P< 0.001) were much better in the CSE group. Hypotension occurred in 25% (EPI group), 40% (CSE group) and 20% (DP group) of the patients. While 65% of the EPI group and 50% of the DP group complained of intraoperative pain, only 25% of CSE group did (P< 0.05). CONCLUSIONS: We can conclude that combined spinal epidural anesthesia has great efficacy and less side effects for a cesarean section than epidural anesthesia and epidural anesthesia with prior dural pucture.
Anesthesia ; Anesthesia, Epidural ; Anesthesia, Local ; Anesthetics ; Bupivacaine ; Catheters ; Cesarean Section* ; Female ; Humans ; Hypotension ; Incidence ; Muscle Relaxation ; Needles ; Pliability ; Pregnancy ; Pregnant Women ; Punctures*

Background: Definitive knowledge of the 24-hour cardiac autonomic activity in patients with allergic rhinitis (AR) is lacking. Thus, we aimed to evaluate heart rate variability (HRV), which is used to measure cardiac autonomic activity by 24-hour Holter monitoring in patients with AR. Methods: We enrolled 32 patients who visited our clinic and were diagnosed with AR. The control group was selected four-fold (n = 128) by matching (age, sex, hypertension, and diabetes) in the AR group from a Holter registry in the cardiology department. The HRV results, which were measured using 24-hour Holter monitoring, were compared between the AR and control groups. Results: All time-domain parameters of HRV revealed no differences between the groups.However, among the frequency domain parameters of HRV, the low-frequency to highfrequency ratio and low-frequency power in normalized units were significantly lower in the AR group. Conversely, high-frequency power in normalized units was significantly higher in the AR group. In the multiple regression analysis, AR was independently associated with sympathetic withdrawal (adjusted odds ratio = 3.393, P = 0.020) after adjusting for age, sex, hypertension, diabetes mellitus, and hyperlipidemia. Conclusions The present findings suggest differences in cardiac autonomic activity which are related with sympathetic withdrawal in patients with AR compared with that in the normal population over 24 hours.

Laminar flow within large vessels or organs can cause artifact that may simulate thrombus during computed tomographic study. The degree of venous enhancement depends on the size of blood pool and cardiac output in relation to the time of scanning. When venous structures are scanned too fast after injection of contrast material, poor mixing of enhanced and unenhanced blood creates flow artifact that gives an appearance of deep venous thrombosis. As compared with dynamic computed tomography (CT), because of a shorter acquisition time of spiral CT, vascular and organ enhancement on spiral CT scan are more dependent on factor that affect delivery of contrast material into the blood stream. Differentiation from true thrombus can be made by use of delayed scan as well as increased density and finding of relatively poor margination of artifact. In addition, both angiography and echocardiography could complement CT to assure that false-positive results are minimized. We experienced a case of artifact mistaken for intracardiac mass on spiral CT, but it was not noted on echocardiography.
Angiography ; Artifacts* ; Cardiac Output ; Complement System Proteins ; Echocardiography ; Heart Neoplasms* ; Rivers ; Thrombosis ; Tomography, Spiral Computed ; Venous Thrombosis

BACKGROUND: Although actinic keratoses is the most common precancerous cutaneous lesion, there has been no clinical and histopathological study about actinic keratoses in Korea. OBJECTIVE: Our purpose was to carry out a clinical and histopathological study about actinic keratoses in Korea. METHODS: 158 patients, diagnosed with actinic keratoses from 1987 to 1995 in Korea, were analyzed clinically and histopathologically. RESULTS: 1. The ratio of males to females was 1:2.4 and the most frequent age groups were the 6th(29.1%) and 7th decade(33.5%). 2. The duration of the lesions was more than 1 year in most cases. 3. The most commonly involved sites were the face, in which the cheek, nose and forehead were the most common sites. 4. Clinically, the size of the lesions was less than 1cm in many cases(66.8%). The color was erythematous in 57.9%, brownish in 26.7%, and dark brownish in 15.3%. Crust and scale were noted in 28.7% and 25.2%, respectively. In 4% of patients, cutaneous horn also was noted. 5. Squamous cell carcinoma was associated with actinic keratoses in 5.7%, basal cell carcinoma in 3.2%, and keratoacanthoma in 1.3%. 6. Histopathologically, hypertrophic types of actinic keratoses were noted in 25.0%, atrophic types in 21.3%, hypertrophic and atrophic types in 18.1%, bowenoid types in 17.6%, acantholytic types in 13.3%, and pigmented types in 4.7%. 7. The most commonly used methods of treatment for actinic keratoses were cryotherapy, surgical excision, 5 FU ointment, and electrodesiccation with good effect. CONCLUSION: Actinic keratoses in Koreans was present on the face most commonly over 50 years of age. It showed a more frequent incidence in females than males. The clinical course of the lesions was chronic and the association with other cutaneous malignancies was noted to be less than 6%. The various histopathological types were noted, including hypertrophic, atrophic, hypertrophic and atrophic, bowenoid, acantholytic, and pigmented. The most commonly used methods of treatment. for actinic keratoses were cryotherapy, surgical excision, 5-FU ointment, and electrodesiccation.
Actins* ; Animals ; Carcinoma, Basal Cell ; Carcinoma, Squamous Cell ; Cheek ; Cryotherapy ; Female ; Fluorouracil ; Forehead ; Horns ; Humans ; Incidence ; Keratoacanthoma ; Keratosis, Actinic* ; Korea* ; Male ; Nose

BACKGROUND: Coronary sinus(CS) electrode catheter has been used ad a very useful mapping and guiding tool in catheter ablation of the left-side atrioventricular pathway(AP). Recently, it was reporter that single catheter approach of catheter ablation of the manifest left-side AP was feaside with a comparable success rate but shorter fluoroscopy time, compared with the standard approach. This study was performed to evaluate the role of CS electrode catheter in catheter avlation of the lefr-side AP. SUBJECTS AND METHODS: Sixty-five consecutive patients(43 men, 22 women) with a single left-side AP were included in this study. The first 32 patients underwent catheter ablation with an eletrode catheter in CS(CS+ group: 19 men, 13 women: 42.3+/- 14.6 years) and the later 33 patients with no electrode catheter in CS(CS- group: 24 men, 9 women: 38.8+/- 14.1 years). APs were localized by mapping the CS in CS+ group or by mapping the mitral valve annulus in CS- group with a 4mm-tipped deflectable catheter(7F, Webster or EPT). Radiofrequency energy(RF) was delivered unipolarly at a fixed power of 30-50 volts or 30-60 seconds. AP location, succes rate, number of RF applications, fluoroscopy time, and complications were compared between 2 group. RESULTS: APs were located at the left posteroseptal wall in 2(6.2%), left posterior wall in 5(15.5%), left posterolateral wall in 3(9.3%), left lateral wall in 18(56.3%), left anterolateral wall in 4(12.5%) in CS+ group. In CS- group, there were 6(18.2%) left posteroseptal, 2(6.1%) left posterior, 5(15.2%) left posterolateral, 12(36.4%) left lateral, 8(24.2%) left anterolateral AP with no significant difference in the distribution of the APs between 2 groups. The proportions of concealed and manifest APs wrer similar in 2 groups(17/15 vs. 19/14). Twenty-eight(87.5%) of 32 APs in CS+ group and 30(90.9%) of 33 APs in CS- group were successfully ablated showing no signigicant difference in the succes rates between 2 groups. The numbers of RF applications to ablate the APs were similar between 2 groups(3.9+/-3.4 vs. 3.5+/-2.9). Total fluoroscopy times wrer also similar between 2 groups(54.3+/-33.5 minutes vs. 47.2+/-21.4 minutes). There were no major conplications in both groups. CONCLUSIONS: Radiofrequency catheter ablation of the left-side APs may be successfully performed without using a CS electrode catheter as a guide in diagmosing and localizing left-side APs.
Catheter Ablation* ; Catheters* ; Coronary Sinus* ; Electrodes* ; Female ; Fluoroscopy ; Humans ; Male ; Mitral Valve

The Lambert-Eaton myasthenic syndrome (LEMS) heralds the occurrence of malignancy, especially small-cell lung cancer (SCLC), but it can also occur in the absence of cancer. Twelve patients were diagnosed as LEMS by clinical features and the classical electrophysiological triad, which includes a low amplitude of compound muscle action potentials (CMAP), decremental responses on low-rate stimulation, and incremental responses on high-rate stimulation on the repetitive nerve stimulation (RNS) test. There were 6 male and 6 female patients, ranging in age from 49 to 66 years. Malignancy(all were SCLC) was found in 7 patients. Males predominantly expressed the paraneoplastic form; whereas the primary autoimmune form was found only in women, who showed a good response to corticosteroid treatment. The neurological features were similar in both groups: proximal lower limb weakness, depressed muscle stretch reflexes, and dryness of mouth in nearly all patients. Bulbar dysfunction and limb paresthesia were a little more frequent in the paraneoplastic form. In RNS tests, the characteristic electrophysiological abnormalities were found in all patients and were more profound in the paraneoplastic form. We concluded that LEMS is commonly associated with malignancy, especially SCLC, but it should also be stressed that there are many female LEMS patients who do not harbor any malignancy at all, and that other treatment strategies such as immunotherapy should be considered for these patients.
Aged ; Carcinoma, Small Cell/complications ; Female ; Human ; Lambert-Eaton Myasthenic Syndrome/therapy ; Lambert-Eaton Myasthenic Syndrome/physiopathology* ; Lung Neoplasms/complications ; Male ; Middle Age ; Paraneoplastic Syndromes/physiopathology