PURPOSE: To determine the extent to which magnetic resonance(MR) imaging findings can help differentiate between tuberculous arthritis (TA) and rheumatoid arthritis(RA). MATERIALS AND METHODS: This study involved sixteen patients with pathologically proven arthritis of the knee. In eight patients(mean age, 29.6 years; M:F=4:4) this was of the tuberculous variety, while eight (mean age, 47.5 years; M:F=2:6) suffered from the rheumatoid variety, which was monoarticular. For 14 patients, contrast enhancement studies were available. We retrospectively analyzed MR findings according to the demonstrated pattern of synovial thickening (regular and even, or irregular and nodular), bone erosion or abscess,bone marrow(BM) edema, the sites at which bursae were present, para-articular mass formation, and lymphadenopathy. RESULTS: In five of eight TA cases (62.5 %), irregular and nodular enhanced synovial thickening was present, while in six of eight RA cases (75%), thickening was regular and even. Bone erosions or subarticular abscesses were found in six TA cases (75%) and small erosions in three cases (37.5%) of RA. BM edema surrounding the erosion was found in four cases of TA (50%) and two of RA (25 %). In TA, edema was more extensive. In both TA and RA, all suprapatella bursae were distended while popliteal bursae were present in two cases of TA(25 %) and four of RA (50%). Para-articular masses with rim like enhancement were found in six cases of TA (75%) and in one case of RA (12.5 %). In particular, para-articular lymphadenopathy was seen in six cases of TA(75%), but not in RA. CONCLUSION: MR findings of irregular and nodular synovial thickening, extensive bone erosion, extensive BM edema, particular, para-articular abscess formation and ymphadenopathy, may help differentiate tuberculous arthritis of the knee from the rhumatoid variety.
Abscess ; Arthritis* ; Arthritis, Rheumatoid* ; Diagnosis, Differential* ; Edema ; Humans ; Knee* ; Lymphatic Diseases ; Magnetic Resonance Imaging* ; Retrospective Studies

Plexiform neurilemmoma is a relatively rare, benign peripheral nerve sheath tumor, whieh usually arises in either the dermis or subcutaneous tissue. These tumors may occur singly or as multiple lesions (plexiform neurilemmomatosis), We report an unusual case of plexiform neurilemmomatosis associated with cafe au lait spots reminiscent of neurofibromatosis clinically and another case of plexiform neurilemmoma on the finger. A Biopsy revealed the characteristic palisaded arrangement of spindle cells within well circumscribed elongated nodules, The skin lesions were completely excised without recurrence thereafter.
Biopsy ; Cafe-au-Lait Spots ; Dermis ; Fingers ; Neurilemmoma* ; Neurofibromatoses ; Peripheral Nerves ; Recurrence ; Skin ; Subcutaneous Tissue

We experienced conversion of supraventricular arrhythmia to normal sinus rhythm in three patients during general anesthesia using propofol and remifentanil. This may be related to direct inhibition of the cardiac conduction system or activation of the parasympathetic system. The literature review suggests that propofol and remifentanil have antiarrhythmic potential, reverting supraventricular arrhythmia during anesthesia.
Anesthesia ; Anesthesia, General ; Arrhythmias, Cardiac* ; Humans ; Propofol*

Dermatofibrosarcoma protuberans is a rare, slowly growing, locally invasive spindle-cell tumor characterized by a protuberant cutaneous mass with a pronounced tendency to recur and by a prominent storiform histopathologic pattern'-'. We present a case of dermatofibrosarcoma protuberans with myxoid area on the chest of a 57-year-old man. The histopathological study showed a dermal tumor of uniform spindle-shaped cells with storiform pattern. Immunohistochemically, the tumor was stained positively to anti-CD34 antibody and negatively to anti-factor XIIIa antibody.
Dermatofibrosarcoma* ; Factor XIIIa ; Humans ; Middle Aged ; Thorax

BACKGROUND: Lupus erythematosus profundus (LEP) is an unusual clinical variant of lupus erythematosus (LE). It is unclear which part LEP occupied in the disease spectrum of LE. OBJECTIVE: Clinical and histopathological studies were performed on 19 patients with LEP in order to further define the clinical patterns, know the various serological findings, and review the histopathological features. METHODS: A retrospective review was carried out of the clinical records and histopathological specimens of 19 patients with LEP. RESULTS: The most common clinical features were indurated nodules or plaques on the cheek. There was a 37% positivity in the ANA test. Histopathogically epidermal changes as well as subcutaneous involvements were common. There were no cases of newly developed SLE during the follow up period of 41 months. CONCLUSION: Most patients with LEP have a relatively benign disease course, although a few develop systemic abnormalities and have abnormal laboratory findings.
Cheek ; Follow-Up Studies ; Humans ; Panniculitis, Lupus Erythematosus ; Retrospective Studies

BACKGROUND: Pseudo-Kaposi sarcoma mimicks Kaposi sarcoma, both clinically and histopathologically. These conditions are due to congenital (Stewart-Bluefarb syndrome) or acquired (Mali) vascular malformations. OBJECTIVES: The purposes of this study were aimed at evaluating the clinical and histopathological characteristics of pseudo-Kaposi sarcoma and finding differential diagnostic tools from Kaposi sarcoma. METHODS: Clinical information of 7 patients with pseudo-Kaposi sarcoma diagnosed in Asan Medical Center from 1989 to 1999 was obtained from the medical records and clinical follow-ups. We re-evaluated 10 biopsy specimens obtained from them and immunohistochemical studies for cutaneous lymphocyte antigen (CLA), CD34, vimentin, and factor VIII were performed with the standard streptavidin-biotin method using paraffin-embedded tissue specimens of 7 pseudo-Kaposi sarcomas and 3 Kaposi sarcomas. In addition, we examined whether human herpesvirus 8 (HHV8) was detected in 3 patients by polymerase chain reaction (PCR). RESULTS: Six male and one female patients were included. Mean age was 36.3 years. Three patients were classified into Mali type and the other four patients were into Stewart-Bludfarb type. Histopathological examinations revealed capillary proliferation in the upper dermis, perivascular infiltrate of inflammatory cells, extravasated red blood cells, and fibrosis of dermis. Anti-factor VIII and CD34 stained endothelial cells only. CLA was expressed in lymphocytic infiltrate in the epidermis and dermis of pseudo-Kaposi sarcoma, whereas it was negative in Kaposi sarcoma. PCR for HHV 8 showed negative results. CONCLUSIONS: Pseudo-Kaposi sarcoma is an uncommon entity with characteristic clinical and histopathological features. Differential diagnosis between Pseudo-Kaopsi sarcoma and Kaposi sarcoma is important. We suggest that detection of HHV 8 by PCR and imunohistochemical study for CLA may be effective tools in the differential diagnosis between them.
Biopsy ; Capillaries ; Chungcheongnam-do ; Dermis ; Diagnosis* ; Diagnosis, Differential ; Endothelial Cells ; Epidermis ; Erythrocytes ; Factor VIII ; Female ; Fibrosis ; Follow-Up Studies ; Herpesvirus 8, Human ; Humans ; Lymphocytes ; Male ; Mali ; Medical Records ; Polymerase Chain Reaction ; Sarcoma ; Sarcoma, Kaposi* ; Vascular Malformations ; Vimentin

Polymyositis is a inflammatory connective tissue disorder of unknown etiology involving predominantly skeletal muscle, characterized by progressive symmetrical proximal muscle weakness, elevated serum muscle associated enzymes, characteristic pattern of electromyography, mononuclear cell infiltration in muscle, and skin lesions in dermatomyositis. Interstitial lung disease in association with polymyositis occurs in 5~10% of cases, with generally a poor prognosis and its subclassification may be a useful predictor of survival. We have experienced a case of polymyositis associated with bronchiolitis obliterans with organizing pneumonia (BOOP). The patient was a 54 year-old woman presented with progressive weakness of both lower extremity and weight loss during 6 months. She had been diagnosed as BOOP by transbronchial lung biopsy 2 years ago. She had typical symptoms, physical signs and elevated serum muscle associated enzymes with characteristic findings of myositis on electromyography and muscle biopsy. Her chest roentgenogram showed slightly improvement of underlying BOOP as compared with that of 2 years ago. Because wound infection was developed at the skin biopsy site, steroid was not used. She finally expired due to sudden cardiopulmonary arrest.
Biopsy ; Bronchiolitis Obliterans* ; Bronchiolitis* ; Connective Tissue ; Cryptogenic Organizing Pneumonia ; Dermatomyositis ; Electromyography ; Female ; Heart Arrest ; Humans ; Lower Extremity ; Lung ; Lung Diseases, Interstitial ; Middle Aged ; Muscle Weakness ; Muscle, Skeletal ; Myositis ; Pneumonia ; Polymyositis* ; Prognosis ; Skin ; Thorax ; Weight Loss ; Wound Infection

This report describes a rare case of postoperative hyperventilation attack after an endoscopic third ventriculostomy in a 46-year-old woman. About 60 min after the termination of the operation, an intractable hyperventilation started with respiratory rate of 65 breaths/min and EtCO2, 16.3 mm Hg. Sedation with benzodiazepine, thiopental sodium, fentanyl, and propofol/remifentanil infusion was tried under a rebreathing mask at a 4 L/min of oxygen. With aggressive sedative challenges, ventilation pattern was gradually returned to normal during the 22 hrs of time after the surgery. A central neurogenic hyperventilation was suspected due to the stimulating central respiratory center by cold acidic irrigation solution during the neuroendoscopic procedure.
Benzodiazepines ; Cold Temperature ; Female ; Fentanyl ; Humans ; Hyperventilation ; Masks ; Middle Aged ; Oxygen ; Respiratory Center ; Respiratory Rate ; Thiopental ; Ventilation ; Ventriculostomy

Craniosynostosis is a congenital anomaly characterized by premature closure of cranial sutures. Surgical intervention should be performed during infancy. However, surgical correction of craniosynostosis remains bone defect and secondary angle occasionally. Currently, publications investigating solutions to bone defect and secondary angle created by cranioplasty are getting much interest. We have used BoneSource(R) which is relatively safe as an implantable substance for providing solutions for this problem. From June 2002 to January 2004, five children with craniosynostosis underwent frontocalvarial contouring using BoneSource(R) and concurrent cranial vault remodeling. The patient ages ranged from 8.0 months to 4.9 years(mean, 2.5 years). The quantity of BoneSource(R) implanted ranged from 10 to 25g, with a mean of 13g. This paper presents the first series of children treated with BoneSource(R) for frontocalvarial contouring in the surgical correction of craniosynostosis. No patients experienced any complications. Our results shows excellent retention of contour without causing asymmetry or irregularity. No visible evidence of interference with craniofacial growth were observed. Through our experiences, BoneSource(R) is found to be very useful for frontocalvarial contouring in children undergoing correction of craniosynostosis.
Child ; Cranial Sutures ; Craniosynostoses* ; Humans

Laryngotracheal injury following endotracheal intubation has been extensively described in the literature, but most discussion has centered around the sequela of prolonged intubation. Little however, has been reported regarding the lesions from short-term endotracheal intubation to ensure the safe practice of anesthesia. In this regard, 72 healthy, male patients undergoing general anesthesia for surgical procedures were randomly assigned to have an endotracheal tube of 7.0, 8.0, or 9.0 mm in internal diameter and were evaluated for the upper airway symptoms by questionnaire within 4-8 hours following extubation. The larynx and trachea were examined and scored for extent and severity of lary- ngotracheal damage by fiberoptic laryngotracheoscopy, and risk factors causing laryngotracheal injury were studied. The results were as follows; The incidence of upper airway symptoms were 13 of 72 (18.1%), of which 10 (13.9%) were throat discomfort and 3 (4.2%) were sore throat. The incidence of laryngeal and tracheal injury was 52 of 72 (72.2%) and 20 of 72 (27.8%), respectively. 20 patients (27.8%) did not reveal any lesion in the laryngotracheal system. The common sites of intubation injury were vocal cords (65.3%, all erythema) and arytenoids (44.4%, erythema 37.5%, edema 6.9%). No correlation could be drawn between the injured and uninjured groups with respect to smoking and length of intubation. However, bucking was associated with severity and extent of laryngeal damage (p<0.05), and with the extent of tracheal damage only (p<0.05). Also, the increase in internal diameter of the tube used was associated with severity and extent of laryngeal damage (p<0.05), but not with tracheal damage.
Anesthesia ; Anesthesia, General ; Edema ; Erythema ; Humans ; Incidence ; Intubation ; Intubation, Intratracheal* ; Larynx ; Male ; Pharyngitis ; Pharynx ; Surveys and Questionnaires ; Risk Factors ; Smoke ; Smoking ; Trachea ; Vocal Cords