We presented a case of Reiters syndrome consisting of conjunctivitis, arthritis, and skin lesions, occurring in 20-year-o1d male. He had neither an episode of dysentery nor a history of sexual exposure before onset of syndrome. The skin lesions had begun with erythernatous scaly patches on the inguinal region and scalp, and later followed by generalized pustular, psoriasiform and/or hyperkeratotic crusted lesions on the erythematous base. Yellowish discoloration and onycholysis of nails and shallow ulcer of glans penis were observed. Arthritis of the knee and shoulder joints were developed, accompanied by pain, swelling, limited motion, wasting and weakness of both lower extremities. In laboratory investigation, urinalysis, stool examination for parasites and occult blood, renal function test, blood VDRL, and X-ray of chest, both knee. joints, shoulder joint and thoracolumbar spine were within normal limit or negative except for leukocytosis(24, 500/mm), increased ESR(90 mm/hr) and hypoalbuminemia(2.6 g/dl), and he was associated with HLA-A3, A 9, B5, and Rw 49 Histopathologically skin biopsy specimen showed extensive hyperkeratosis, paralceratosis, elongated rete ridges, spongiform macropustule of Kogoj. He was treated effectively with antibiotics, corticosteroid, and methotrexate for two months without recurrence till now.
Anti-Bacterial Agents ; Arthritis ; Biopsy ; Conjunctivitis ; Dysentery ; Hematologic Tests ; HLA-A3 Antigen ; Humans ; Joints ; Knee ; Lower Extremity ; Male ; Methotrexate ; Occult Blood ; Onycholysis ; Parasites ; Penis ; Recurrence ; Scalp ; Shoulder Joint ; Skin ; Spine ; Thorax ; Ulcer ; Urinalysis

It is likely that the peroneus longus tendon acts as a structure resisting the varus force upon the first column of the foot. Our study was designed to examine the possibility that absence of the peroneus longus insertion into the first metatarsal and first cuneiform will destabilize the first metatarsal. The fresh frozen cadaveric specimens of the lower leg were obtained. There were six right feet. The specimens appeared normal visually and roentgenographically. The tibial remnant was rodded by an intramedullary rod and the sprcimen was positioned in a specially designed rig so that standing position of the foot was simulated. The tibia was then loaded with twenty pounds. To obtain reproducible radiographic landmarks radioopaque beads were implanted underneath the level of the cortex through small drill holes in the following location : First metatarsal (one bead in the head, another bead in the base). The second metatarsal (again one bead in the head, on e bean in the base). To simulate the contraction of the peroneus longus muscle a suture was placed into the proximal end of the tendon, brought through two pulleys and loaded with a five pound weight. To create a varus force on the first metatarsal a stab incision was made over the base of the first metatarsal at its medial aspect and a suture was passed through the base of the first metatarsal. The suture was guided over a pulley and loaded with ten pounds. The second metatarsal head was fixed to the bottom of the rig with a smooth Steinmann pin. At this point an AP roentgenogram was taken of the footto assure proper positioning of the foot. Thereafter, the soft tissue between the first and second toe were cut sequentially : (1) Transection of the skin of the first web space both dorsally and plantarly. (2) Transection of the adductor hallucis tendon and the intermetatarsal ligament. (3) Transection of the peroneus longus tendon at its insertion. Each step in the transaction of the soft tissues was followed by another X-ray examination. In each roentgenogram the proximal and distal beads in the first and second metatarsal were connected by a line and the angles between those lines were measured. The results were statistically analyzed with the Friedman Chi square test between each step of the ten feet. Following the first and second step angular changes are not significant. Following the final step, adding release of the tendon insertion of the peroneus longus, the angle changes from 15.95 to 20.55 degrees (difference 4.60 degrees) and this is significant (p < 0.05).
Cadaver ; Foot ; Head ; Leg ; Ligaments ; Metatarsal Bones ; Metatarsus ; Posture ; Skin ; Sutures ; Tendons ; Tibia ; Toes

We present a case of mycosis fungoides of an 52-year-old woman who showed multiple pruritic erythematous papules, plaques with ulcers on the trunk, extremities and face. Her skin biopsy specimens were studied irnmunohistochemically with, monoclonal antibodies against T cells(80%, Leu-4, OKT11), T-cell subsets (60% Leu-3a, OKT4a, 40% OKT8) and Langerhans cell(OKT6). We think that this case should be considered in the differential diagnosis of adult T-cell leukemia/lymphoma. The proliferating cells were negative for anti-Tac.
Adult ; Antibodies, Monoclonal ; Biopsy ; Diagnosis, Differential ; Extremities ; Female ; Humans ; Middle Aged ; Mycosis Fungoides* ; Skin ; T-Lymphocyte Subsets ; T-Lymphocytes ; Ulcer

No abstract available.
Cerebrospinal Fluid* ; Diagnosis* ; Enzyme-Linked Immunosorbent Assay* ; Mycobacterium tuberculosis* ; Mycobacterium* ; Tuberculosis, Meningeal*

A 61-year-old female had neurofibromas situated on the right side of upper trunk, shoulder and neck in the distribution of dermatomes C3 and C4(right), which developed 3 years ago. There were not cafe-au-lait spots, axillary frecklings, or Lisch nodule (iris pignented hamartoma). Biopsy specimen showed collagenous wavy fibrils among which spindle-shaped and round cells were embedded as seen in the typical neurofibroma. This case was considered to be a segmental form of von Recklinghausen's disease.
Biopsy ; Cafe-au-Lait Spots ; Collagen ; Female ; Humans ; Middle Aged ; Neck ; Neurofibroma ; Neurofibromatoses* ; Neurofibromatosis 1 ; Shoulder

The authors reviewed surgical materials from 20 patients with carcinoma of the extrahepatic biliary system, and a correlation between macroscopic appearance of the tumors with various clinical features and histopathologic findings was made. Microscopically, the tumors were classified into four types; Four (21%) patients had polypoid tumors, six (32%) had nodular growths, five (26%) were scirrhous constricting in type, and four (21%) had diffusely infiltrating type. Histologically all the differentiation in two cases. The degree of differentiation of the tumors was classified into 3 types: 11 (55%) patients were well differentiated, 3(15%) were moderately well and 6(30%) were poorly differentiated. All polypoid tumors were well differentiated and had low stage. No correlation in the degree of differentiation of the tumor with the stage was present. No correlation in clinical symptoms, duration of symptoms, laboratory findings with morphologic findings of the tumors was noted.

Keratosis punctata of palmar creases has been considered an uncommon variant of keratosis punctata, which itself is considered rare condition. Clinically our case, 32-year-old seaman, shows cup-shaped depression of the epidermis of varying size, from 1-3mrn in diameter, limited to the large flexor creases of the palms and digit. The histologic features are hyperkeratotic and slight acanthotic central epidermal depression without parakeratosis and loss of granular layer. A sparse mononuclear infilterate are seen arround the capillaries in the dermal papillas. No relationship to arsenical agents, syphilis, or genetic factors can be ascertained by history.
Adult ; Capillaries ; Depression ; Epidermis ; Humans ; Keratosis* ; Parakeratosis ; Syphilis

Cutaneous larva migrans(CLM) is a ubiquitous self-limiting skin eruption which has intensely pruritic, serpiginous, raised, sharply demarcated, red lesions. It is most frequently caused by larvae of dog and cat hookworms. We report two typical cases of cutaneous larva migrans that appeared as pruritic exanthems in two people after they had travelled in Southeast Asia. It is suggested one should consider cutaneous larva migrans in the differential diagnoses of erythematous pruritic lesions.
Ancylostomatoidea ; Animals ; Asia, Southeastern ; Cats ; Diagnosis, Differential ; Dogs ; Exanthema ; Larva ; Larva Migrans* ; Skin

No abstract available.
Diagnosis* ; Epilepsy*

No abstract available.
Cholecystectomy* ; Common Bile Duct* ; Humans