STUDY DESIGN: The authors analysed the recovery of clinical symptoms after percutaneous drainage and irrigation in pyogenic vertebral osteomyelitis. OBJECTIVES: To determine the role of percutaneous drainage and irrigation in pyogenic vertebral osteomyelitis. SUMMARY OF LITERATURE REVIEW: Pyogenic vertebral osteomyelitis is a relatively rare condition but its incidence is recently increasing due to common use of intravenous access devices and resultant nosocomial bacteremia. Management of the disease is not uniform and is controversial regarding the role of surgery and duration of use of antibiotics. At present, the role of percutaneous drainage of involved spines in treatment of pyogenic vertebral osteomyelitis is not well-known. MATERIALS AND METHODS: We report 3 cases of pyogenic vertebral osteomyelitis which were treated by continuous drainage with automated percutaneous lumbar discectomy device(APLD device) and draining tube after they haute failed to conservative treatment. APLD device, fluoroscopic guide, contrast media and continuous percutaneous draining tubes were used for this procedure. The percutaneous draining tubes were maintained for 7 to 11 days and each case was followed up for 6 to 10 weeks under admission. RESULTS: Symptoms were relieved 3 to 5 weeks after this procedure. The patients were followed up to 12 to 39 months and experienced no recurrence. CONCLUSIONS: Percutaneous drainage and irrigation with APLD device brought prompt and marked clinical recovery. It is indicated as a supplementary method to conservative treatment or in case of high operative risk patient due to poor general conditions. It has minimal invasiveness, short clinical course and low recurrence rate.
Anti-Bacterial Agents ; Bacteremia ; Contrast Media ; Diskectomy ; Drainage* ; Humans ; Incidence ; Osteomyelitis* ; Recurrence ; Spine

BACKGROUND: Diabetes mellitus is a heterogeneous group of disorders characterized by high serum glucose levels and by disturbances of carbohydrate and lipid metabolism. There are many cutaneous signs of this common endocrinopathy, such as nercobiosis lipoidica diabeticorum, diabetic bullosis, shin spot, diabetic pruritus, etc. OBJECTIVE: In this study, we investigated whether extracellular matrix gene expression in cultured skin fibroblast is influenced by insulin and Insulin-like growth factor-I(IGF-I). METHOD: Total RNA was isolated from insulin or IGF-I treated human skin fibroblasts. The Northern blot and slot-blot hybridization were then conducted. RESULTS: The mRNA levels of pro α1(I) collagen, pro α1(I11) collagen, fibronectin in insulin and IGF-I treated normal skin fibroblasts increased compared with untreated normal skin fibroblasts. CONCLUSION: Our results show that insulin and IGF-I stimulate collagen formation in normal skin fibroblast at physiological concentrations. Therefore, these demonstrate that insulin can modulate the expression of extracellular matrix gene.
Blood Glucose ; Blotting, Northern ; Collagen ; Diabetes Mellitus ; Extracellular Matrix* ; Fibroblasts* ; Fibronectins ; Gene Expression ; Humans ; Insulin* ; Insulin-Like Growth Factor I ; Lipid Metabolism ; Methods ; Pruritus ; RNA ; RNA, Messenger ; Skin*

Cutaneous metastases from internal carcinornas are relatively rare. The frequency of metastases to the skin varies from 0.5-4.4%. We report a case of cutaneous metastasis suspected to originat from stomach cancer. A 44-year-old female, who had an episode of total gastrectony under diagnosis of stornach cancer three years ago, had multipe painless erythernatous nodules on the case and neck for one year. Histologic findings shows atypical anaplastic cell infiltration at the derr is and subcutaneous tissues. Cells with hyperchrornatic and erally displaced nuclei were recogniz d PAS staining shows positive reactions within the cells of glarid like structure. She died twelve month after the appearance of the cutaneous lesions.
Adult ; Diagnosis ; Female ; Humans ; Neck ; Neoplasm Metastasis* ; Skin ; Stomach Neoplasms ; Stomach* ; Subcutaneous Tissue

No abstract available.
Aneurysm, False*

No abstract available.
Posterior Cruciate Ligament* ; Tendons*

BACKGROUND: The diagnostic significance of ECG ergonovine test and the incidence of vasospastic angina in patients with chest pain are still uncertain. METHODS: From May 1998 to June 1999, 133 consecutive patients with chest pain were admitted for diagnostic coronary angiography. ECG ergonovine provocation tests were performed in 64 patients who have a clinical history suggesting vasospatic angina, including 27 of 28 patients with vasospastic angina documented electrocardiographically, or who's coronary angiographic findings could not be explained by their clinical history. Ergonovine was administered intravenously in incremental dose of 0.05, 0.1, 0.2, 0.3, 0.4 mg up to total cumulative dosage of 1.0mg during coronary angiography(41 cases), in the exercise laboratory(21 cases) or both(2 cases). RESULTS: Of 133 patients with chest pain, vasospastic angina was documented in 32(24%), unstable angina in 52(34%), stable angina in 10(8%), and others in 39(29%). Angiography demonstrated coronary spasm in 4 additional patients as well as 22 patients with vasospastic angina documented electrocardiographically, but ergonovine tests in the exercise laboratory showed positive response in 5 of 6 patients with vasospastic angina documented. Among the 25 patients with coronary spasm proved angiographically during ergonovine test, ECG findings at the time of coronary spasm were ST segment elevation in 21(84%), depression in 1(4%) and no change in 3(12%) patients, who had branch vessel spasm, 3 vessel spasm or incomplete spasm on coronary angiogram. Of the 31 patients with vasospastic angina who underwent ergonovine tests, positive response occurred in 24(77%) after a cumulative dose of < or = 0.4mg and in additional 3(10%) after the higher dose of >0.4mg. However the other 4(13%) had no ECG changes even after the higher dose(>0.4mg) of ergonovine. CONCLUSION: This results suggest that vasospastic angina appear to be a common cause of chest pain, and ECG ergonovine test with high dose can improve diagnostic sensitivity but cannot detect some patients with vasospastic angina.
Angina, Stable ; Angina, Unstable ; Angiography ; Chest Pain ; Coronary Angiography ; Depression ; Electrocardiography* ; Ergonovine* ; Humans ; Incidence ; Spasm

BACKGROUND: Neurofibroma, the hallmark of neurofibromatosis, is a cutaneous or subcutaneous lesion, with a variable clinical presentation. Histologically, neurofibroma consists of proliferation of nerve derived cellular elements, together with an abundant, collagenous extracellular matrix. Specifically, neurofibroma has been shown to contain 30-50% collagen in its matrix. Objective 5. METHODS: We examined the expression of extracellular matrix genes (collagen, fibronectin, laminin), TGF-b mRNA and Ha-ras oncogene mRNA by using Northern and slot-blot hybridization and immunoperoxidase stains. Result: In Northern blot analysis, Ha-ras and TGF-b genes revealed respectively, 8.8kb and 2. 5kb sized mRNA transcripts in neurofibroma. These parameters were normal in the control. The expression of these genes were 1.9, 2.0 fold increased in neurofibroma. In slot-blot analysis, expression of type I collagen showed fibronectin genes to be 2,401+210, 540+43, respectively, in neurofibroma. So there were 3.7 fold, 2.1 fold, differences respectively, compared to the normal control. However, there were no significant changes of type IV collagen and laminin Bl mRNA levels between neurofibroma and normal skin tissues. Irnmunoperoxidase staining by rnonoclonal anti type IV collagen antibody in neurofibroma showed type IV collagen to be diffusely and weakly stained in tissue. On staining by monoclonal anti-laminin antibody, laminin was stained in a matrix and around vessels. CONCLUSION: The increased expression of extracellular matrix genes may suggest that there is a subpopulation of fibroic cells in neurofibroma which are stimulated by TGF-b. Ha-ras genes which might have accumulated with the differentiation of neural tissue may be related to the pathogenesis of neurofibroma tissue formation. Further studies are needed to determine whether the other factors are related to the pathogenesis of neurofibroma.
Blotting, Northern ; Collagen ; Collagen Type I ; Collagen Type IV ; Coloring Agents ; Extracellular Matrix* ; Fibronectins ; Genes, ras* ; Laminin ; Neurofibroma ; Neurofibromatoses* ; RNA, Messenger ; Skin

An 41-year-old woman with chronic active hepatitis developed multible asymptomatic erythematous papules, plaques and purpuras on the both lower leg, feet, forearms and hands. Some lesions progressed to ulcers with central black colored necrotic eschars. Biopsies and cultures demorrstrated a fungus, aspergillus fumigatus a the etilogic agent. No evicience of involvement of other organs by aspergillus fumigatus was found. Intravenous amphotericin B therapy was discontinued because of he immediate adverse effects. The patient received treatment with oral itaconazole(200mg/day) and intravenous fluconazole(400mg/day), but skin lesions have been recurring repeatedly.
Adult ; Amphotericin B ; Aspergillosis* ; Aspergillus fumigatus ; Biopsy ; Female ; Fluconazole ; Foot ; Forearm ; Fungi ; Hand ; Hepatitis* ; Hepatitis, Chronic ; Humans ; Leg ; Purpura ; Skin ; Ulcer

PSTT has been established as a separate entity distinct from choriocarcinoma since 1983, because of its different morphological features, biologic behavior and response to chemotherapy. Most cases of PSTT have indolent clinical courses, but there have been several reports showing malignant behavior resulted in death of the patient. We report a case of PSTT showing vaginal metastatis. In biopsy specimen, it was difficult to make differential diagnosis from squamous cell carcinoma of uterine cervix due to uniform and mononuclear cytologic characteristics. Immunohistochemical stains for hPL and hCG were not typical for either PSTT or choriocarcinoma. We suggest that poorly differentiated PSTT may synthesize the lesser amount of hPL than typical PSTT and it may behave more aggressively.
Diagnosis, Differential ; Biopsy

Lupus vulgaris is most prevalent on exposed parts, especially the face but can also develop on exetremities. Lupus vulgaris originates from tuberculosis elsewhere in the body by hematogenous, lymphatic, or contiguous spread. A 19-year-old male patient came to our department. The patient had had many recurrent oozing and verrucous plaques and crusts on the left foot for one year. A skin biopsy from the lesion on the left dorsum of the foot showed scattered well defined granulomas consisting of the epithelioid cell clusters with Langerhans and foreign body type giant cells in the mid dermis. Caseation necrosis was slight. There were no bacilli on AFB staining. The multi test CMI for tuberculin was highly positive. A chest X-ray did not show any abnormal findings. The presence of Mycobacterium tuberculosis DNA was demonstrated by polymerase chain reactions (PCR) for detection of mycobacterial DNA from a routinely prepared paraffin-embedded skin specimen. Herein we report a very atypical case of lupus vulgaris confirmed by PCR.
Biopsy ; Dermis ; DNA ; Epithelioid Cells ; Foot ; Giant Cells, Foreign-Body ; Granuloma ; Humans ; Lupus Vulgaris* ; Male ; Mycobacterium tuberculosis ; Necrosis ; Polymerase Chain Reaction ; Skin* ; Thorax ; Transplants* ; Tuberculin ; Tuberculosis ; Young Adult