The occurrence of fistulous tract between the thoracic subarachnoid space and the pleural cavity due to injury is uncommon. The one was developed after traffic accident and treated by surgical repair of the fistula : The other was post-operative complication of costotransversectomy for T2 sympathectomy. The complication was realized by the surgeon who was aware of the small leakage of cerebrospinal fluid from the dura propria of the T2 nerve root at the time of surgery. Intermittent pleural punctures for drainage and semisitting position were followed by spontaneous closure of the fistula. These cases were reported so that the uncommon condition might be added to the differential diagnosis of pleural effusion.
Accidents, Traffic ; Cerebrospinal Fluid ; Diagnosis, Differential ; Drainage ; Fistula* ; Pleural Cavity ; Pleural Effusion ; Punctures ; Subarachnoid Space ; Sympathectomy

To compare the results of the chemonucleolysis and the automated percutaneous lumbar discectomy(APLD) for symptomatic lumbar disc herniation, retrospective study of 19 chemonucleolysis and 20 APLD was done from July, 1984 to February, 1993. Number of male patients was 23 and female 16. The patients ranged in age from 14 to 56 years. L4-5 was the most commonly involved level comprising 73.6%, and 2 level involvement was 20.5%. Clinical results were evaluated according to Mcnab s criteria. Excellent and Good result were 31.6% and 47.3% in chemonucleolysis with an average follow up period of 6.2 years, and those were 35% and 45% respectively in APLD with an average follow up period of 18.7 months. Among 19 chemonucleolysis, there were loss of disc height in 8, and lateral recess stenosis in 1. Among 20 APLD, there were loss of disc height in 2, and nerve root irritation symptoms in 2. Chemonucleolysis and APLD have a low morbidity, can be performed under the local anesthesia and are simple, rapid and less traumatic procedure.
Anesthesia, Local ; Constriction, Pathologic ; Diskectomy ; Female ; Follow-Up Studies ; Humans ; Intervertebral Disc Chemolysis ; Male ; Retrospective Studies

No abstract available.
Drug Eruptions ; Humans ; Melanoma

The Ewing's sarcoma comprises approximately less than 10 percent of malignant bone tumors and 5 percent of allbone tumors, occures in almost all bones of the body, and presents a widely divergent roentgenographicmanifestations. The tarsal bones are involved only 2 percent in the Ewing's sarcoma. Two cases experienced byauthors and ten cases published in literatures of Ewing's sarcoma of the tarsal bone were analizedretrospectively. The result were as follows; 1. Of tarsal bones, the calcaneus was 7 cases, the talus 4 cases,cuneiform 1 case. 2. Female was affected more commonly than male, the ratio being 4 to 1 in the tarsal bones. 3.About sixty percent of total case in the tarsal bones had evidence of diffuse sclerotic pattern. All the cases ofthe talus had evidence of diffuse sclerotic pattern. 4. The diseases to be considered in differential diagnosisare as follows: avascular necrosis, tuberculous osteomyelitis, osteosarcoma, and pyogenic osteomyelitis. 5. Thediffuse sclerosis radiographically showed a close relation with dead bone resulting from avascular necrosis due totumor infiltration histologically. Periosteal reactive new bone and osteoid deposition on the dead bone were alsocorrelated with diffuse sclerosis. 6. Because it is difficult to differentiate sclerotic lesions in the tarsalbones by radiographic methods alone, all such lesions should be subject to biopsy as early as possible.
Biopsy ; Calcaneus ; Female ; Humans ; Male ; Necrosis ; Osteomyelitis ; Osteosarcoma ; Sarcoma, Ewing ; Sclerosis ; Talus ; Tarsal Bones

27 Myelographies with Iopamidol and 27 myelographies with metrizamide were performed in order to compare adverse reactions, radiographic quality and effects on vital signs of the two contrast media after injection into the spinal subarachnoid space. Headache and nausea were less severe using Iopamidol. The most striking difference was found in adverse neurobehavioral reactions and associated electroencephalographic abnormalities which were noted in 7.4% of the metrizamide group but were not seen with the use of Iopamidol. Iopamidol was more stable than metrizamide in CSF. Image quality and diagnostic accuracy of Iopamidol myelography was equivalent to metrizamide for intrathecal application.
Contrast Media ; Headache ; Iopamidol* ; Metrizamide ; Myelography* ; Nausea ; Strikes, Employee ; Subarachnoid Space ; Vital Signs

Basal cell carcinoma(BCC) and squamous cell carcinoma (SCC) are very prevalent neoplasms of the human skin. Ultraviolet radiation in sunlight is a well-established mutagen of the p53 gene and is one of basal cell carcinoma and squamous cell carcinoma. The newly-formed vascular network is important for neoplasms to grow beyond a size of about 1 mm2. Recent reports have suggested the hypothesis that a mutant p53 protein is closely related with capillary density. Immumohistochemistry for p53 protein and CD34 was performed in 20 cases of BCCs and 14 SCCs to evaluated the relationship between p53 protein and capillary density. The results were as follows:1. The microvessels stained by CD34 were mainly located in the interface of tumor cells and stroma. 2. There was no difference in the microvessel density according to the histologic types and age of the patients, but a higher microvessel density was noted in male patients. 3. The aggressive BCCs and the less-differentiated SCCs showed higher p53 immunostaining. 4. The mean microvessel density of cases showing strong positive immunostaining of the p53 gene(54.73+/-17.75) was higher than that of others(39.75+/-18.30). These results suggested that p53 protein expression and microvessel density are not related to the histologic types and age of the patients, but that differentiation and biologic behavior such as the infiltrating property of tumors and the microvessel density are closely related to p53 protein expression.
Capillaries ; Carcinoma, Basal Cell ; Carcinoma, Squamous Cell* ; Genes, p53 ; Humans ; Male ; Microvessels* ; Skin* ; Sunlight

PURPOSE: Neisseria gonorrhea is usually identified in neonatal conjunctivitis, but rare in adult keratoconjunctivitis. We report a rare case of bilateral gonococcal conjunctivitis combined with keratitis. METHODS: A 29-year-old male with a history of sexual contact with a prostitute 17 days ago referred to our hospital with acute keratoconjunctivitis. Ocular discharge was examined by Gram stain, culture, and sensitivity test to antibiotics, resulting in the identification of penicillin-resistant Neisseria gonorrhea. RESULTS: This patient was treated with intramuscular ceftriaxone for 5 days and topical cefmenoxime 0.5% for 2 weeks. Following 24 hours after antibiotics medication, the clinical symptoms were improved, and follow-up culture was negative. No evidence of serious complication was left in the cornea and conjunctiva. CONCLUSIONS: As adult gonococcal keratoconjuctivitis is relatively rare, the clinical diagnosis may be delayed. When one suspects an adult gonococcal keratoconjunctivitis, immediate gram staining and confirmatory culture for isolation of gram-negative intracellular diplococci are mandatory. It should be remembered that intramuscular ceftriaxone and topical cefmenoxime are an effective treatment for this condition.
Adult* ; Anti-Bacterial Agents ; Cefmenoxime ; Ceftriaxone ; Conjunctiva ; Conjunctivitis ; Cornea ; Diagnosis ; Follow-Up Studies ; Gonorrhea ; Humans ; Keratitis ; Keratoconjunctivitis* ; Male ; Neisseria ; Sex Workers

PURPOSE: Neisseria gonorrhea is usually identified in neonatal conjunctivitis, but rare in adult keratoconjunctivitis. We report a rare case of bilateral gonococcal conjunctivitis combined with keratitis. METHODS: A 29-year-old male with a history of sexual contact with a prostitute 17 days ago referred to our hospital with acute keratoconjunctivitis. Ocular discharge was examined by Gram stain, culture, and sensitivity test to antibiotics, resulting in the identification of penicillin-resistant Neisseria gonorrhea. RESULTS: This patient was treated with intramuscular ceftriaxone for 5 days and topical cefmenoxime 0.5% for 2 weeks. Following 24 hours after antibiotics medication, the clinical symptoms were improved, and follow-up culture was negative. No evidence of serious complication was left in the cornea and conjunctiva. CONCLUSIONS: As adult gonococcal keratoconjuctivitis is relatively rare, the clinical diagnosis may be delayed. When one suspects an adult gonococcal keratoconjunctivitis, immediate gram staining and confirmatory culture for isolation of gram-negative intracellular diplococci are mandatory. It should be remembered that intramuscular ceftriaxone and topical cefmenoxime are an effective treatment for this condition.
Adult* ; Anti-Bacterial Agents ; Cefmenoxime ; Ceftriaxone ; Conjunctiva ; Conjunctivitis ; Cornea ; Diagnosis ; Follow-Up Studies ; Gonorrhea ; Humans ; Keratitis ; Keratoconjunctivitis* ; Male ; Neisseria ; Sex Workers

BACKGROUND: Antituberculous therapy is set a short-term therpy used isoniazid(INH), rifampin(RFP), ethambutol(EMB), pyrazinamide(PZA) from 1970s' and treatment rate has been very improved. But drug interruption or irregular medication due to side effects and resistance of drug are serious problem to retreatment cases, specially. Ofloxasine(OFX), developed from Quinolone at 1980's is effective not only other respiratory infectious disease but also pulmonary tube rculosis. And this is useful drug instead of injection agents for retreatment patients who have side effects to other drugs, lived far distance from medical clinics. So, we will evaluate theffectiveness as four oral drags involving OFX. METHOD: A retrospective study was made through the regular follow up of smear positive cases,who treated by four drag, namely, prothionamide (PTA) cycloserine(CS), OFX, paraminosalicylic acid(PAS). RESULTS: 1) Out of 66case with positive sputum AFB smear, 42(64%)cases achieved the negative conversion. 2) Considering the negative conversion in all group, 34 case (52%) of sputum conversion occured within first 6 months, on the extent of diease was minimal, moderate, far advavanced pulmonary tuberculosis, sputum AFB smear negative response to treatment was 100%, 78% , 46% respectively. 3) The roentgenological improvement occured in 38(58%), extent of diease was minimal, moderately, far advanced pulmonary tuberculosis, Roentgenological improvement to retreatment was 75%, 64%, 46%. 4) When the duration of patients illness was less than 1 year, 1 to 3 years, 3 to 5 years and more than 5 years, sputum AFB smear negative response to retreatment was 100%, 88%, 80%, 52%. 5) On side effects, major problems are gastrointestinal troubles, mild liver function abnormality, psychotic problemes, and skin problem(urticaria, itching sensation). CONCLUSION: The duration & extents of patients illness was shorter & minimal, sputum AFB smear negative response rate was better. Radiologic response is better as shorter duration and minimal extent of diease. But, as diease is longer duration & far advanced, sputum negative conversion & Roentgenological improvement is poor and limited. The adverse reaction was mainly observed gastrointestinal troubles(indigestion, abdominal pain, nausea, vomiting, diarrhea) and are well controled by symptomatic management in most patients, as regard to tolerance to the secondary drugs.
Abdominal Pain ; Aminosalicylic Acid* ; Communicable Diseases ; Cycloserine* ; Follow-Up Studies ; Humans ; Liver ; Nausea ; Prothionamide ; Pruritus ; Retreatment* ; Retrospective Studies ; Skin ; Sputum ; Tuberculosis, Pulmonary* ; Vomiting

BACKGROUND: Antituberculous therapy is set a short-term therpy used isoniazid(INH), rifampin(RFP), ethambutol(EMB), pyrazinamide(PZA) from 1970s' and treatment rate has been very improved. But drug interruption or irregular medication due to side effects and resistance of drug are serious problem to retreatment cases, specially. Ofloxasine(OFX), developed from Quinolone at 1980's is effective not only other respiratory infectious disease but also pulmonary tube rculosis. And this is useful drug instead of injection agents for retreatment patients who have side effects to other drugs, lived far distance from medical clinics. So, we will evaluate theffectiveness as four oral drags involving OFX. METHOD: A retrospective study was made through the regular follow up of smear positive cases,who treated by four drag, namely, prothionamide (PTA) cycloserine(CS), OFX, paraminosalicylic acid(PAS). RESULTS: 1) Out of 66case with positive sputum AFB smear, 42(64%)cases achieved the negative conversion. 2) Considering the negative conversion in all group, 34 case (52%) of sputum conversion occured within first 6 months, on the extent of diease was minimal, moderate, far advavanced pulmonary tuberculosis, sputum AFB smear negative response to treatment was 100%, 78% , 46% respectively. 3) The roentgenological improvement occured in 38(58%), extent of diease was minimal, moderately, far advanced pulmonary tuberculosis, Roentgenological improvement to retreatment was 75%, 64%, 46%. 4) When the duration of patients illness was less than 1 year, 1 to 3 years, 3 to 5 years and more than 5 years, sputum AFB smear negative response to retreatment was 100%, 88%, 80%, 52%. 5) On side effects, major problems are gastrointestinal troubles, mild liver function abnormality, psychotic problemes, and skin problem(urticaria, itching sensation). CONCLUSION: The duration & extents of patients illness was shorter & minimal, sputum AFB smear negative response rate was better. Radiologic response is better as shorter duration and minimal extent of diease. But, as diease is longer duration & far advanced, sputum negative conversion & Roentgenological improvement is poor and limited. The adverse reaction was mainly observed gastrointestinal troubles(indigestion, abdominal pain, nausea, vomiting, diarrhea) and are well controled by symptomatic management in most patients, as regard to tolerance to the secondary drugs.
Abdominal Pain ; Aminosalicylic Acid* ; Communicable Diseases ; Cycloserine* ; Follow-Up Studies ; Humans ; Liver ; Nausea ; Prothionamide ; Pruritus ; Retreatment* ; Retrospective Studies ; Skin ; Sputum ; Tuberculosis, Pulmonary* ; Vomiting