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*

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

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

Cytologic findings from five cases with variable types of Hodgkin's disease were reviewed with special emphasis on the Reed-Sternberg (R-S) cells and their variants, Typical R-S and Hodgkin's cells were mono- or binucleated, and nuclei had rounded smooth con- tour. Acidophilic prominent nucleoli with perinucleolar halo were conspicuous. In comparison to typical Reed-Sternberg cells, L & H (lymphocytic and histiocytic) cells in the lymphocyte predominant type tended to show pop-corn like irregular nuclear contour and to lack the prominent nucleoli. Lacunar cells in the nodular sclerosis type had multilobated nuclei with prominent acidophilic nucleoli. There was no prominent perinucleolar halo in L & H and lacunar cells. In conjuction with the number of Reed-Sternberg cells and back ground findings observed on the smears, the characteristic features of R-S cells and their variants allowed to make typing of Hodgkin's disease.
Epidemiologic Studies* ; Hodgkin Disease ; Lymphocytes ; Multiple Myeloma ; Nephrotic Syndrome* ; Reed-Sternberg Cells ; Sclerosis

The clinical and urodynarnic studies for urinary dysfunction were performed in 35 patients with idiopathic parkinson's disease who admitted at Hanyang University Hospital from January, 1988 to June, 1990. The results are as follows; 1. Urinary dysfunction was noted in 9 patients (25.7%) with idiopathic parkinson's disease Their cysto / uroflowmetry showed detrusor hyperreflexia in 6 patients, and detrusor hyporeflexia in 3 patients. The common urinary symptoms were frequency, incontinence, hesitency, decreased urinary force, and retention in that order. 2. The mean time-interval from the onset of initial parkinsonian symptoms to the development of urinary symptoms was 22.6 months (ranged from 3 to 48 months). Urinary dysfuncion showed no correlation with clinical severity of parkinson's disease. 3. The frequency of urinary dysfunction was greater in rigidity-predominant parkinsonian group than patients with tremor. Cysto / uroflowmetry in the former showed detrusor hyperreflexia more frequently than detrusor hyporeflexia. 4. It was suggested that urinary dysfunction in idiopathic parkinson's disease probably result from multifactorial causes such as the change of neuronal effect, dysautonomia, and skeletal rigidity.
Humans ; Neurons ; Parkinson Disease* ; Primary Dysautonomias ; Reflex, Abnormal ; Tremor

The occurrence of ovarian cancer during pregnancy is a very rare, and the incidence is 1:10,000 to 1:50,000. However, this number is likely to increase since childbearing is more and more frequently delayed. The clinical outcome of patients with ovarian cancer is the same regardless of whether the diagnosis of ovarian carcinoma is done during pregnancy or in non-pregnant women; therefore, the same surgical staging procedures are recommended in the two groups. However, it should be considered to performed a diagnostic operation and preservation of pregnancy, advantage of the administration of chemotherapy, what time give birth to, what time perform a staging operation. We here report our experience with a case of advanced ovarian carcinoma during pregnancy, which was managed conservative surgery with chemotherapy until delivery.
Adenocarcinoma, Mucinous ; Female ; Humans ; Imidazoles ; Incidence ; Mucins ; Nitro Compounds ; Ovarian Neoplasms ; Ovary ; Parturition ; Pregnancy ; Pseudomyxoma Peritonei ; Rupture

The term Proteus syndrome was coined in 1983 to describe a disorder of skeletal, hamartoinatous and other mesodermal malformations. The syndrome was named after the Greek god Proteus, whose name means "the Polymorphous". Major manifestations are hemihypertrophy, macrodactyly, exostoses, epidermal nevi, characteristic cerebriform masses involving the plantar or palmar surfaces, a variety of subcutaneous masses and scoliosis. We report a 12-year-old boy with Proteus syndrome who had the unique features of this syndrome.
Child ; Exostoses ; Humans ; Male ; Mesoderm ; Nevus ; Numismatics ; Proteus Syndrome* ; Proteus* ; Scoliosis

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