We observed the histopathological findings in 16 patients with nevus flammeus according to the time sequence after argon laser therapy. The results were as follows : 1. Immediately after treatment There was nonspecific damage to the epidermis, upper part of the dermis and upper portion of the pilosebaceous unit to a depth of 0.4~0.5mm depth. The specific damage to the vessels, which showed thrombi formation and partial disruption of the vessel walls was seen to a depth of 0.8~0.9mm. 2. One week after treatment Crust was formed and the epidermis regenerated almost completely. The thrombi still persisted and there was partial disappearance of the vessel walls. 3. Four to 10 months after treatment The epidermis appeared normal except the rete ridge flattening. The upper dermis was diffusely fibrotic, with relatively few residual vessels, many of them with slit-like contour.
Argon* ; Dermis ; Epidermis ; Humans ; Laser Therapy ; Nevus* ; Port-Wine Stain*

Immunohistochemial staining was performed in metastatic skin cancer using a variety of antistera. Both carcinoembrytonic antigen(CEA) and epithelial membrane antigen(EMA) were demonstrated in large cell carcinoma of the lung, adenocarcinoma of the stomach and skin adnexal cancer with eccrine differentiation. Although papillary carcinoma of the thyroid, squamous cell carcinoma of the skin and squamous cell carcinoma of the lung showed positive staining for CEA and EMA, these were weak or focal reactions in the keratinizing area. In rectal adenocarcinoma, staining for CEA was significantly positive, but staining for EMA was negative. Epiderrnal cytokeratin was observed in squamous cell carcinoma of the lung, squamous cell carcinoma of the skin and skin adnexal cancer with eccrine differentiation. Epidermal cytokeratin was also demonstrated in well differentiated adenocarcinoma of the gastrointestinal tract. By using a variety of tumor markers, the authors tried to locate possible primary sites in six metastatic skin cancers of unknown origin.
Adenocarcinoma ; Carcinoma, Large Cell ; Carcinoma, Papillary ; Carcinoma, Squamous Cell ; Gastrointestinal Tract ; Keratins ; Lung ; Membranes ; Skin Neoplasms* ; Skin* ; Stomach ; Thyroid Gland ; Biomarkers, Tumor

Ossification of the ligamentum flavum(OLF) is a well recognized cause of acquired spinal canal stenosis resulting in myelopathy, radiculopathy, or a combination of both. OLF is extremely rare in caucasian patients, but is one of the most common causes of compression of the posterior thoracic spinal cord in Japan. In most cases, it has been found in the thoracolumbar regions, and rarely in the cervical region. It is frequently but not alwalys found in association with ossification of the posterior longitudinal ligament(OPLL) and may cause cumulative damage, if comhined with OPLL. We experienced a case of ossification of the ligamentum flavum and posterior longitudinal ligament with sacral radiculopathy, which was treated hy posterior decompressive laminectomy and removal of the ossified ligamentum flavum and posterior longitudinal ligament. The day after operation, the radiating pain and paresthesia dramatically improved.
Constriction, Pathologic ; Humans ; Japan ; Laminectomy ; Ligamentum Flavum* ; Longitudinal Ligaments* ; Paresthesia ; Radiculopathy* ; Spinal Canal ; Spinal Cord ; Spinal Cord Diseases

BACKGROUND: It is known that QT dispersion represents asynchronous repolarization of ventricle which is related to ventricular fibrillation. The incidence of ventricular arrhythmia is increased after acute myocardial infarction. So this study compared QT dispersion and other repolarization indexes for detection of asynchronous repolarization in acute myocardial infarction. We also investigated which portion of repolarization is the key portion of the asynchrony. METHODS: In 37 acute myocardial infarction patients and 38 angina patients dispersion of QT, JT, JTpeak and QTpeak were measured. We also measured maximum adjacent dispersion of same parameters in precordial leads. In 20 survived patients and 17 dead patients after acute myocardial infarction were also compared. We also investigated correlation of PVC's on Holter monitoring with these repolarization parameters. RESULTS: 1) All ventricular repolarization indexes(QT, QTc, JT, JTpeak, QT peak and TpeakTend dispersion) were significantly increased in acute myocardial infarction group than compared with those of angina group(p<0.05). 2) Maximal precordial dispersion(QT, QTc, JT, JTpeak and QTpeak) were also significantly increased in acute myocardial infarction group than angina group(p<0.05). 3) Dead patient group after myocardial infarction showed significantly increased QTc and TpeskTend dispersion compared with those of survived patient group(p<0.05). 4) Multivariate linear correlation showed that TpeakTend dispersion and JT dispersion was correlated with QT dispersion. CONCLUSIONS: There were asynchronous myocardial repolarization changes in acute myocardial infarction. Our study demonstrated that T wave change was major determinant of dispersion of myocardial repolarization.
Arrhythmias, Cardiac ; Electrocardiography, Ambulatory ; Humans ; Incidence ; Myocardial Infarction* ; Ventricular Fibrillation

PURPOSE: We evaluated the contralateral patent processus vaginalis(CPPV) by transinguinal laparoscopy in boys with unilateral inguinal hernia, to determine its incidence and the association with various clinical parameters. We also investigated the factors responsible for the development of a metachronous inguinal hernia. MATERIALS AND METHODS: One hundred sixty seven boys with unilateral inguinal hernia were analyzed. The morphology of the ring was classified into four patterns(type 1, 2a, 2b, and 3). We analyzed the morphology of the internal ring and the variables related to a CPPV by age, laterality and the size of the ipsilateral and/or bilateral hernia sac. RESULTS: The incidence of a CPPV was 33.9%. The positive predictive value was 94.9%(56/59). There was no statistical difference in the incidence of a CPPV by laterality. The incidence of a CPPV was significantly higher in the group with a larger size(>or=1cm) compared to the smaller abnormalities(<1cm). The incidence of the type 3 pattern was higher than the type 2b pattern in the group with larger abnormalities. With increasing age, type 1 and 2a patterns increased in frequency, but type 2b decreased and the type 3 pattern was stable. The size of the contralateral hernia sac was significantly larger with the type 3 pattern than the type 2b. CONCLUSIONS: The results of our study showed that the size of the hernia sac and patient age were related to the presence of a CPPV. A type 3 pattern was associated with a more primitive morphology, a wider hernia sac and no change in the incidence with advancing age. Therefore, the findings of this study suggest that a metachronous inguinal hernia develops more commonly in patients with a type 3 pattern internal ring.
Diagnosis ; Hernia* ; Hernia, Inguinal* ; Humans ; Incidence ; Laparoscopy* ; Risk Factors*

No abstract available.
Emergencies ; Humans

Background: Ultrasound-guided caudal epidural injection (CEI) is limited in that it cannot confirm drug distribution at the target site without fluoroscopy. We hypothesized that visualization of solution flow through the inter-laminar space of the lumbosacral spine using color Doppler ultrasound alone would allow for confirmation of drug distribution. Therefore, we aimed to prospectively evaluate the usefulness of this method by comparing the color Doppler image in the paramedian sagittal oblique view of the lumbosacral spine (LS-PSOV) with the distribution of the contrast medium observed during fluoroscopy. Methods: Sixty-five patients received a 10-mL CEI of solution containing contrast medium under ultrasound guidance. During injection, flow was observed in the LSPSOV using color Doppler ultrasonography, following which it was confirmed using fluoroscopy. The presence of contrast image at L5-S1 on fluoroscopy was defined as “successful CEI.” We then calculated prediction accuracy for successful CEI using color Doppler ultrasonography in the LS-PSOV. We also investigated the correlation between the distribution levels measured via color Doppler and fluoroscopy. Results: Prediction accuracy with color Doppler ultrasonography was 96.9%. The sensitivity, specificity, positive predictive value, and negative predictive value were 96.7%, 100%, 100%, and 60.0%, respectively. In 52 of 65 patients (80%), the highest level at which contrast image was observed was the same for both color Doppler ultrasonography and fluoroscopy. Conclusions Our findings demonstrate that color Doppler ultrasonography in the LS-PSOV is a new method for determining whether a drug solution reaches the lumbosacral region (i.e., the main target level) without the need for fluoroscopy.

Background: Ultrasound-guided caudal epidural injection (CEI) is limited in that it cannot confirm drug distribution at the target site without fluoroscopy. We hypothesized that visualization of solution flow through the inter-laminar space of the lumbosacral spine using color Doppler ultrasound alone would allow for confirmation of drug distribution. Therefore, we aimed to prospectively evaluate the usefulness of this method by comparing the color Doppler image in the paramedian sagittal oblique view of the lumbosacral spine (LS-PSOV) with the distribution of the contrast medium observed during fluoroscopy. Methods: Sixty-five patients received a 10-mL CEI of solution containing contrast medium under ultrasound guidance. During injection, flow was observed in the LSPSOV using color Doppler ultrasonography, following which it was confirmed using fluoroscopy. The presence of contrast image at L5-S1 on fluoroscopy was defined as “successful CEI.” We then calculated prediction accuracy for successful CEI using color Doppler ultrasonography in the LS-PSOV. We also investigated the correlation between the distribution levels measured via color Doppler and fluoroscopy. Results: Prediction accuracy with color Doppler ultrasonography was 96.9%. The sensitivity, specificity, positive predictive value, and negative predictive value were 96.7%, 100%, 100%, and 60.0%, respectively. In 52 of 65 patients (80%), the highest level at which contrast image was observed was the same for both color Doppler ultrasonography and fluoroscopy. Conclusions Our findings demonstrate that color Doppler ultrasonography in the LS-PSOV is a new method for determining whether a drug solution reaches the lumbosacral region (i.e., the main target level) without the need for fluoroscopy.

The purpose of this study is to assess the usefulness of digital infrared thermographic image(DITI) in patients with surgically treated lumbar disc disease. A series of 480 patients with lumbar herniated disc was studied. The mean age of the patients was 37 years, with a range of 18 to 64 years. Of which 126 cases of chemonucleolysis. 18 cases of percutaneous endoscopic laser discectomy, and 336 cases of laminectomy with discectomy were performed. Among these patients, 336 cases of laminectomy were assessed by DITI preoperatively. The thermal differences(delta T) between the symptomatic and asymptomatic limbs were evaluated. We have categorized the types of herniations into 3 classes: 200 protruded, 99 extruded, and 37 sequestered. The thermal differences were classified into 3 groups: 177 patients had delta T < 0.5 degrees C, 74 patients had 0.5 degrees C < or = delta T < 0.8 degrees C and 85 patients had delta T > or = 0.8 degrees C. Among the group of patients with the sequestered disc, 30(i.e. 80%) had delta T > or = 0.8 degrees C. Among the surgically treated 336 patients, non-visualization of a part of the sciatic limb on preoperative DITI was the condition used to coin the term amputation sign by the authors. In the sequestered group, the "amputation sign" was observed in 28 cases(75%). We conclude that DITI can predict a sequestered disc disease, and it allows more precise indication regarding open surgery.
Amputation ; Diskectomy ; Extremities ; Humans ; Intervertebral Disc Chemolysis ; Intervertebral Disc Displacement ; Laminectomy ; Numismatics

BACKGROUND: Fatigue is one of the common chief complaints in primary care setting. It causes disability in daily activity and lowers quality of life. This study was intended to investigate the information about fatigue useful in outpatient clinic. METHODS: The data was obtained from the Korean Health and Nutrition Survey 2001. Logistic regression analysis was performed to examine the association between self- reported fatigue and several factors including sociodemographic factors, life style factors, stress, depression, and worry about health. RESULTS: The prevalence of fatigue was low in unmarried status, more significantly in men when compared with those in married status. No significant association was found between fatigue and occupation, education level, monthly income, smoking, and alcohol consumption. The risk of fatigue in the exercising group more than 4 times per week was significantly low in women. The risk of fatigue in the group of sleeping duration less than 5 hours was significantly higher than the group of sleeping more than 9 hours. Compared with unemployed state, the daily working duration of more than 9 hours increased the risk for fatigue significantly. Stress perception, sadness or depression during the past 1 year and worry about health were strongly associated with fatigue. CONCLUSION: When evaluating and managing patients with fatigue, we should search for information about the patients' lifestyle such as exercise, daily work hours, sleeping as well as stress perception and depressive mood. Especially among the lifestyle, inquiring about regular exercise and promoting it may be important in order to manage patients with fatigue.
Alcohol Drinking ; Ambulatory Care Facilities ; Depression ; Education ; Fatigue* ; Female ; Humans ; Life Style ; Logistic Models ; Male ; Nutrition Surveys* ; Occupations ; Prevalence ; Primary Health Care ; Quality of Life ; Single Person ; Smoke ; Smoking