A case of cystic neurilemmoma of cauda equina similar to ruptured lumbar disc herniation was brought to our attention. The patient, because of pain in lower back and in both legs, underwent acupuncture and herbal treatment without obtaining any result. In March 79, Lumbar myelography revealed meniscus sign at the level of the lower margin of L-4 body and thus total laminectomy was performed on the patient to remove the tumor. After the operation, the patient showed quick recovery.
Acupuncture ; Cauda Equina* ; Humans ; Laminectomy ; Leg ; Myelography ; Neurilemmoma*

OBJECTIVE: The purpose of this study was to describe the MR imaging appearance of the dural ligaments which is connected between the anterior dura mater and the posterior longitudinal ligament. MATERIALS AND METHODS: In 10 cadavers with formalin fixation, the dural ligaments were evaluated and photographed after removal of the posterior element of the spinal canal. MR studies of 12 patients who had distinct dural ligaments were evaluated. Spin-echo MR images were obtained on a 1. 5T unit. RESULTS: In seven of the ten cadavers, the midline dural ligament was observed; the lateral dural ligament was observed in 3 cadavers. On MR, the dural ligaments were imaged as thin lines of low signal intensity between the anterior dural margin and the posterior longitudinal ligament. Dural ligaments were well-visualized at the level of the lower lumbar spine which had a more prominent anterior epidural space than that of the upper level of the spine. Eight of 12 cases had well developed midline dural ligaments. Two cases showed distinct lateral dural ligaments and the remaining 2 cases had distinct midline and lateral dural ligaments. CONCLUSION: MR images of the dural ligament demonstrate a thin low signal line at the anterior epidural space.
Cadaver* ; Dura Mater ; Epidural Space ; Formaldehyde ; Humans ; Ligaments ; Longitudinal Ligaments ; Magnetic Resonance Imaging* ; Spinal Canal ; Spine

After acute interruption of cerebral blood flow, various hemodynamic, morphologic and metabolic changes ensue in the occluded area. Such changes and subsequent brain damage are of great concern in the course of temporary arterial occlusion during aneurysmal surgery. Many experimental studies investigating the processes of cerebral infarction have been done through selective occlusion of intracranial vessels, and it has been known that 4 to 8 minutes interruption of cerebral blood flow results in irreversible brain damage. Cerebral resistance following vascular occlusion may be influenced by collateral circulation, hypothermia and hyperventilation. Recently we experienced two patients with right middle cerebral artery aneurysms, who were operated upon under normothermia, slight hypotension, and hyperventilation using microsurgical technique. The technique of temporary occlusion of middle cerebral artery was applied as an adjunctive method.
Aneurysm ; Brain ; Cerebral Infarction ; Collateral Circulation ; Hemodynamics ; Humans ; Hyperventilation ; Hypotension ; Hypothermia ; Intracranial Aneurysm* ; Middle Cerebral Artery*

Disturbances of the surrounding vascular system and the severe cicatrical entrapment of the injured plexus should be considered, with its neural damage, in brachial plexus injury by Gun-Shot. Therefore, Subclavian arteriography and Subclavian venography before operation should be essential and the correction of the deficit of the vascular system may be a factor in the determination of prognosis in relation to pain control. We have reported 2 cases of the brachial plexus injury by Gun-shot and discussed the importance of Subcalvian arteriography and Subclavian venography. External neurolysis seems to be beneficial in Causalgia caused by brachial plexus injury.
Angiography ; Brachial Plexus* ; Causalgia ; Phlebography ; Prognosis

Sebaceous epithelioma is a rare skin appendage tumor with sebaceous differentiation and appears as yellow papules, nodules, or plaques, most commonly in areas with large numbers of sebaceous glands, such as the face. Histopathologically, sebaceous epitheliomas are composed of circumscribed nodules consisting predominantly of basaloid cells and foci of sebaceous differentiation. We report a case of sebaceous epithelioma which appeared as a yellowish to erythematous patch on the forehead in a 55-year-old woman.
Female ; Humans

INTRODUCTIONThere is no consensus on the extent of lymphadenectomy and the appropriate patients for lymphadenectomy in low-risk patients with endometrial cancer. This study aimed to evaluate the feasibility and effectiveness of laparoscopic lymphadenectomy for low-risk patients with endometrial cancer.

MATERIALS AND METHODSFrom January 2004 to May 2008, we reviewed the medical records of 28 patients with low-risk, endometrial cancer; endometrioid type, grade 1 or 2, and with a depth of myometrial invasion of less than one-half of the myometrium. All patients underwent laparoscopically-assisted staging surgery.

RESULTSThe median age and body mass index were 56 years (range, 28 to 75) and 25.5 kg/m(2) (range, 21.3 to 37.2). The median operating time, estimated blood loss, and length of hospital stay were 142 minutes (range, 110 to 410), 215 mL (range, 100 to 700), and 7 days (range, 3 to 19), respectively. No conversion to laparotomy was noted. The median number of harvested lymph nodes was 21 (range, 10 to 48) pelvic nodes and 12 (range, 4 to 21) para-aortic nodes. One (3.6%) patient presented pelvic lymph node metastasis and 2 (7.1%) presented isolated para-aortic lymph node metastasis. The complication rate was 14.3%. No recurrence in the vaginal vault, distant metastasis, port site metastasis was noted up to the last follow-up.

CONCLUSIONSystemic pelvic and para-aortic lymphadenectomy should be considered in all low-risk patients with endometrial cancer until it is concluded to be clinically insignificant through large-scale prospective research in the future. However, it will be difficult to explain statistical differences in survival rates according to lymphadenectomy, because the increase of the survival rate resulting from lymphadenectomy will fall within the margin of statistical error.

Adult ; Aged ; Carcinoma, Endometrioid ; pathology ; surgery ; Endometrial Neoplasms ; pathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Lymph Node Excision ; methods ; Middle Aged ; Neoplasm Staging ; Retroperitoneal Space ; surgery ; Retrospective Studies

PURPOSE: This study was to determine the relationships between C-reactive protein (CRP) level of acute perforated and nonperforated appendicitis. METHODS: We retrospectively investigated 200 patients who was diagnosed to appendicitis in emergency medical center from January 2005 to August 2005. All patients were operated for suspected acute appendicitis and diagnosis was confirmed by histology after operation. The patients were divided two groups: group A with nonperforated appendicitis and group B with perforated appendicitis. We assessed and compared epidemiologic, clinical and laboratory data between two groups. For comparison of diagnostic value, the receiver operating characteristic (ROC) curve and the logistic regression analysis were done. RESULTS: Of the 200 patients, 149 patients were group A, and 51 patients were group B. The mean CRP level in the group B was higher than in patients with group A (109.25+/-87.18 mg/L vs 20.39+/-39.34 mg/L, p<0.05). Also WBC counts was higher in the group B (15.43+/-5.58x1000/microliter vs 12.47+/-4.5x1000/microliter, p<0.05). Though the area under the ROC curve (AUC) of CRP level was greater than WBC counts (0.853 vs 0.659), so CRP level was found to be significantly superior to WBC count in predicting perforated appendicitis. In logistic regression analysis, CRP level (odds ratio 1.024, 95% CI 1.016 to 1.035) was only independent predictor of perforated appendicitis. CONCLUSION: Increased CRP level in patients who were suspected appendicitis in emergency medical center was valuable in predicting perforated appendicitis. In such circumstances, we should consider the necessities of preoperative antibiotics, the surgical techniques and the early aggressive management for postoperative complications.
Anti-Bacterial Agents ; Appendicitis* ; C-Reactive Protein* ; Diagnosis* ; Emergencies ; Humans ; Logistic Models ; Postoperative Complications ; Retrospective Studies ; ROC Curve

Basal cell epithelioma(BCE) is the most common malignant tumor of the skin, and locally invasive neoplasm, rarely metastatic, yet capable of significant local destruction and disfigurement. Radiotherapy has been reported to have high local cure rate and good cosmetic results in the treatment of BCE, and therefore may be an alternative treatment when excision is not functionally or cosmetically feasible, especially in the high risk areas. We report a 73-year-old female with locally invasive BCE presented as a subcutaneous mass on the left nasolabial fold area.
Aged ; Carcinoma, Basal Cell* ; Female ; Humans ; Nasolabial Fold ; Radiotherapy ; Skin

Purpura annularis telangiectodes is an uncommon pigmented purpuric eruption that is seen more commonly in young adult females, and it is one of the subgroups of pigmented purpuric dermatoses. Clinically, the disease is characterized by symmetrical telangiectatic, purpuric, annular patches with a predilection for the lower extremities and buttock. We report a case of purpura annularis telangiectodes (Majocchi disease) on the lower extremities of a 31-year-old male patient.
Adult ; Buttocks ; Female ; Humans ; Lower Extremity ; Male ; Purpura* ; Skin Diseases ; Young Adult

Wells' syndrome or eosinophilic cellulitis is a recurrent inflammatory dermatosis, characterized clinically by acute dermatitis resembling cellulitis. The histopathologic findings show diffuse dermal eosinophilic infiltration and characteristic `flame figures'. The etiology and pathogenesis are unknown, however, various associated disorders such as hematological diseases, infections, arthropod bites, drugs, and surgery have been documented. Wells' syndrome has previously been reported in only 4 cases of non-hematological malignancy. A 57-year-old man with esophageal squamous cell carcinoma developed recurrent, mildly tender, urticarial plaques on the trunk and left forearm. A skin biopsy specimen revealed histopathologic findings compatible to Wells' syndrome. Skin lesions resolved with systemic corticosteroids therapy without recurrence until now. We report a case of Wells' syndrome associated with esophageal squamous cell carcinoma
Adrenal Cortex Hormones ; Arthropods ; Biopsy ; Carcinoma, Squamous Cell* ; Cellulitis ; Dermatitis ; Eosinophils ; Forearm ; Hematologic Diseases ; Humans ; Middle Aged ; Recurrence ; Skin ; Skin Diseases