Severe neurologic complication after epidural anesthesia is very rare. We experinced a case of cauda equina syndrome following epidural anesthesia with 2% lidocaine 20 ml, alkalinized with sodium bicarbonate and 1: 200,000 epinephrine added in female patient underwent abdominal hysterectomy. She complained hypoesthesia of buttock, perineum, left leg and weakness of left leg. She also suffered from urinary retension and defecation difficulty and abdominal discomfort 2 days after epidural block. In MRI taken 4 days after block, spinal stenosis (L4-5) and mild disc bulging (L3-4) were noted. She was treated with medication, bladder training and physical therapy and recovered slowly but gradually, finally discharged 2 months after block with mild weakeness of left leg. We suggest the causative factors are the temporary neural compression due to spinal stenosis and the spinal cord ischemia due to vascular spasm because of added epinephrine.
Anesthesia, Epidural* ; Buttocks ; Cauda Equina* ; Defecation ; Epinephrine ; Female ; Humans ; Hypesthesia ; Hysterectomy ; Leg ; Lidocaine ; Magnetic Resonance Imaging ; Perineum ; Polyradiculopathy* ; Sodium Bicarbonate ; Spasm ; Spinal Cord Ischemia ; Spinal Stenosis ; Urinary Bladder

A case of Wegener's granulomatosis is described, with special attention focused on the typical histologic findings and involvement of both middle ear and lung. The patient is a 37-year-old man presented with four-month history of cough and sputum. He had a past history of surgery of both ears because of otitis media followed by left facial palsy. Chest radiographs showed variable sized ill defined nodules in both lower lobes with internal airspace consolidation. Histologic preparations of the open lung biopsy specimens demonstrated a diffusely scattered palisading micro and macrogranulomas with central focus of neutrophils and necrotic collagen surrounded by histiocytes, histiocytic giant cells. Fibrinoid necrosis involved blood vessels and lung parenchyma. Chronic inflammation, diffuse granulation tissue formation and irregular fibrosis are also found in the lung parenchyma. The histologic findings of middle ear which was previously biopsied showed scattered palisading ill defined microgranulomas mixed with fibrotic tissue.
Adult ; Biopsy ; Blood Vessels ; Collagen ; Cough ; Ear ; Ear, Middle* ; Facial Paralysis ; Fibrosis ; Giant Cells ; Granulation Tissue ; Granuloma ; Histiocytes ; Humans ; Inflammation ; Lung* ; Necrosis ; Neutrophils ; Otitis Media ; Radiography, Thoracic ; Sputum ; Vasculitis ; Wegener Granulomatosis*

Localized primary cutaneous amyloidosis consists of three types: nodular, macular, and lichenoid amyloidosis. Lichen amyloidosis is characterized by the appearance of paroxysmally itchy lichenoid papules on the shins. Although the origin of the amyloid is controversial and can not provide any definite answer, some of amyloid substances can be derived from epidermal cells and others from degenerative collagen fibers. We suggested the origin of amyloid in our cases as epidermal keratinocyte and collagen degenerations. Because degeneration of basal keratinocyte is observed on electron microscopy and degeneration of collagen is in H&E and Masson's trichrome stain although amyloid materials are negatively stained against pankeratin antibody and collagen antibody. The skin lesion was improved after triamcinolone intralesional injections which reduce collagen synthesis. We report two cases of lichen amyloidosis which stained negatively for antikeratin antibodies and improved with triamcinolone intralesional injection.
Amyloid ; Amyloidosis* ; Antibodies* ; Collagen ; Injections, Intralesional ; Keratinocytes ; Lichens* ; Microscopy, Electron ; Skin ; Triamcinolone

The Ehlers-Danlos syndromes(EDS) are a heterogenous group of inherited connective tissue disorders characterized clinically by skin fragility, skin hyperextensibility, joint hypermobility, and excessive bruising. At least 11 different subtypes of EDS have been classified based on genetic, biochemical, and clinical characteristics. We report a 25-year-old man with EDS type II who presented mild extensibility of skin and joint, skin fragility, and "cigarette paper" like atrophic scar. The EDS type II is more common than other different subtypes. While it may present with subtle clinical features, recognition is important so that good advice can be given to reduce the risks associated with certain careers and sports and to prevent the potential complications of pregnancy and surgery.
Adult ; Cicatrix ; Connective Tissue ; Ehlers-Danlos Syndrome ; Humans ; Joint Instability ; Joints ; Molecular Biology ; Pregnancy ; Skin ; Sports

BACKGROUND: E-cadherin is the prime mediator of cell-cell adhesion in epithelial cells and the beta-catenin is the associated protein with E-cadherin in the formation of adhesion complexes in normal and tumor cells related with tumor spread. The present study aimed to find the distribution of E-cadherin and beta-catenin in fetal skin during development. OBJECTIVE: The purpose of this study was to observe the distribution of above two adhesion related proteins in the fetal skin during development, to find its relationship by expression and their distribution patterns. METHODS: Skin was obtained from the scalp, chest, and sole of 21 human fetuses, ranging from 13 to 37 weeks of gestational age. Immunohistochemical staining was performed by avidin biotin peroxidase complex method on paraffin embedded tissue using anti-human monoclonal antibody against the human E-cadherin and beta-catenin. RESULTS: E-cadherin and beta-catenin were expressed in cell membrane of intermediate cell layer of epidermis at 13th week followed by increased basal cell expression at 15th week and adult pattern in 24th week of gestation. Both showed similar distribution pattern in skin. Difference was that E-cadherin was expressed only in cell membrane, but beta-catenin was expressed in both cell membrane and cytoplasm, stronger in cell membrane. beta-catenin also expressed in mesenchymal tissue. In the skin adnexae, E-cadherin and beta-catenin were also expressed very similar distribution pattern both in hair follicular development and eccrine duct epithelium. CONCLUSION: Both E-caherin and beta-catenin showed the same expression in the fetal stage and distribution pattern suggesting that both adhesion molecules are highly related each other in function and development of epidermis and adnexae of the skin in fetal stage, though their expression are not noted in all epithelial cells.
Adult ; Avidin ; beta Catenin ; Biotin ; Cadherins* ; Cell Membrane ; Cytoplasm ; Epidermis ; Epithelial Cells ; Epithelium ; Fetus ; Gestational Age ; Hair ; Humans ; Paraffin ; Peroxidase ; Pregnancy ; Scalp ; Skin* ; Thorax

In patients with pupil-involving isolated oculomotor nerve palsy (IOP), compressive lesions, meningitis, and midbrain infarction can usually be excluded if the responsible lesions are not verified on a brain MRI, catheter angiography, and cerebrospinal fluid examination. However, we experienced a 11-year-old boy with pupil-involving IOP whose initial investigations had been normal and whose symptoms had been stationary over 3 months but was eventually confirmed to have germinoma. This case suggests that a patient with IOP without improvement for a prolonged period needs re-evaluation regardless of normal initial investigations. (J Korean Neurol Assoc 19(4):423~426, 2001)
Angiography ; Brain ; Catheters ; Cerebrospinal Fluid ; Child ; Germinoma* ; Humans ; Infarction ; Magnetic Resonance Imaging ; Male ; Meningitis ; Mesencephalon ; Oculomotor Nerve Diseases* ; Oculomotor Nerve*

BACKGROUND: Neuropathic pain produced by nerve injury has the characteristics of enhanced pain responses - allodynia. To understand the pathophysiology of the neuropathic pain, We evaluated the effect of NMDA antagonists and chemical sympathectomy on the c-fos mRNA expression. METHODS: We have divided rats(Sprague-Dawley, N=24) that their left L5 and L6 nerve were tightly ligated into two groups. In NMDA antagonist group(N=17), We injected 10 g MK801 and 10 g 5-amino-phosphonovalerate in three ways, intrathecally before the ligation, after ligation and subcutaneous continuously. Then behavioral tests for mechanical allodynia and cold allodynia were performed. After the test of allodynia,the expression of c-fos were assessed by Northern blot hybridization. In chemical sympathectomy group(N=7), We injected 70 mg/kg guanethidine into the peritoneum in two ways, before the ligation and after ligation. Then same methods were performed in NMDA antagonist group as well. RESULTS: Intrathecal NMDA antagonists before the ligation supressed the elevation of c-fos mRNA expression. Intrathecal NMDA antagonists on the 7 days after the ligation reduced the c-fos mRNA expression and neuropathic pain. Continuous treatment of subcutaneous NMDA antagonists supressed the development of neuropathic pain and the elevation of c-fos mRNA expression. Chemical sympathectomy before the ligation did not supress the elevation of c-fos mRNA expression. Chemical sympathectomy on the 7 days after the ligation reduced neuropathic pain and the elevation of c-fos mRNA expression. CONCLUSIONS: NMDA receptor is related to the induction and maitenance of neuropatic pain, and sympathetic nervous system has a main role in the already induced neuropathic pain.
Animals ; Blotting, Northern ; Dizocilpine Maleate ; Guanethidine ; Hyperalgesia ; Ligation ; N-Methylaspartate* ; Neuralgia ; Peritoneum ; Rats* ; RNA, Messenger* ; Sympathectomy* ; Sympathectomy, Chemical ; Sympathetic Nervous System

Retroperitoneal schwannomas are rare tumors difficult to diagnose preoperatively. It may originate at the cranial nerves or nerves of the upper extremities, but origin along the nerves of the retroperitoneal space is very rare. Most of the retroperitoneal schwannomas are benign neoplasm. These tumor can be misdiagnosed as adnexal mass or carcinoma. Venous thromboembolism or pulmonary embolism is increasingly recognized as a common complication in patients with malignant disease. We report a 37-year-old woman presented with pulmonary thromboembolism and a pelvic mass which was incidentally found and misdiagnosed as ovarian cancer. Histopathologic results of the extirpated mass turned out to be a benign schwannoma.
Adult ; Cranial Nerves ; Female ; Humans ; Neurilemmoma ; Ovarian Neoplasms ; Pulmonary Embolism ; Retroperitoneal Space ; Thromboembolism ; Upper Extremity ; Venous Thromboembolism

Phase and Amplitude Image were developed to overcome the subjective nature of interpretation for cinematic endless loop display of radionuclide gated blood pool scan. To evaluate the usefulness of color coded phase image in coronary artery disease, we conducted a clinical study with coronary angiography and phase image in 23 patients, and compared the results of those studies. 1) The results of coronary angiography revealed normal coronary artery in 6, 1 vessel disease in 11, 2 vessel disease in 4, and 3 vessel disease in 2 patients. 2) Color-coded Phase Image revealed abnormal phase area in 2/2(100%) of 3 vessel disease patients and in 3/4(75%) of 2 vessel disease patients, in 5/11(45%) of 1 vessel disease patients, and only 1/6(16%) of normal coronary artery. 3) Among the patients who disclosed abnormal phase image, 5 patients of 2-or3-vessl disease revealed abnormal phase through whole left ventricular area, but 3 patients with right coronary artery lesion and 2 patients with left antrior descending artery lesion showed localized abnormal phase area, infero-apical and anterior portion respectively, which were in accord with each coronary lesion. We concluded that the phase image may be useful in evaluation of the regional wall motion abnormalities in the patients of coronary artery disease. Further studies seem to be neccessary to clarify the sensitivity and specificity of the phase image in the each disease entity group.
Arteries ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Humans ; Sensitivity and Specificity

Spontaneous intraperitoneal hemorrhage from uterine leiomyomas is rarely encountered. The cause of hemorrhage is mainly trauma and torsion of myoma. Massive intraperitoneal hemorrhage from spontaneous rupture of a superficial uterine vein overlying a subserous myoma is extremely rare. A 48-year-old woman complained general weakness, lower abdominal discomfort and lower back pain. On admission to the hospital, hypovolemic shock, severe anemia and ascites were noticed. Ultrasonography and CT scan showed huge pelvic mass and much amount of fluid in the pelvic cavity. During emergent laparotomy, 3,500 mL of blood were drained from the abdominal cavity and a ruptured superficial vein was noted, located on the serosal surface of a fundal myoma. We report one case of massive intraperitoneal hemorrhage and hypovolemic shock due to spontaneous rupture of a superficial uterine vein overlying a subserous myoma.
Abdominal Cavity ; Anemia ; Ascites ; Female ; Hemoperitoneum ; Hemorrhage ; Humans ; Laparotomy ; Leiomyoma ; Low Back Pain ; Middle Aged ; Myoma ; Rupture ; Rupture, Spontaneous ; Shock ; Veins