Spontaneous fracture of the Silastic shunt catheter is a rare complication of lumboperitoneal shunt. A review of the literature revealed only one case in which spontaneous fracture occurred after this procedure. The authors report a case in which fracture of a lumboperitoneal shunt catheter occurred within the interspinous ligament probably due to repeated tension caused by flexion and extension during lumbar motion. The fractured proximal catheter was located entirely within the intrathecal space exclusively from the level of L1 to S1, and caused incomplete cauda equina syndrome.
Catheters* ; Fractures, Spontaneous* ; Ligaments ; Polyradiculopathy

No abstract available.
Lymphoma, Large-Cell, Anaplastic*

Guanine aminohydrolase(GAH;EC 3. 5. 4. 3.) was partially purified 122-fold from rat cerebrum to a specific activity of 7.22 in its per mg protein with a recovery of 7.47% by fractionation with ammonium sulfate, chromatography on DEAE-cellulose and hydroxyapatite, gel filtration on Sephadex G-200, and isoelectric focusing(pH4-6). The molecular weight of partially purified rat cerebral guanine aminohydrolase was estimated to be 110,000. But, in the cerebral cytosol, a rather higher molecular weight form of the enzyme was identified. The activity of the higher molecular weight form of guanine aminohydrolase was increased by dialyzing the cytosol, and it was converted into the lower molecular weight form(M.W.110,000) by addition of 2-mercaptoethanol. The reaction velocity of partially purified guanine aminohydrolase of rat cerebrum disclosed a hyperbolic curve, with its KM being 6.0uM at pH 8.0. The preparation showed high substrate specificity:among the purine nucleotides, nucleosides and bases with amino group, only guanosine and guanine were deaminated by the enzyme, and the reaction rate of the enzyme displayed by guanosine was less than 10% of that by guanine. When observed under the equimolar concentration of the substrate, hypoxanthine as well as inosine inhibited the activity of the rat cerebral guanine aminohydrolase by 9.4 and 7.8%, respectively, while 5-aminoimidazole-4-carboxamide inhibited the activity of it by 38%. The activity was inhibited by p-hydroxymercuric benzoate as well. Complete loss of its activity was observed after 30 minutes incubation at 60 degrees C, suggesting the preparation was heat labile.
Ammonium Sulfate ; Animals ; Benzoates ; Cerebrum* ; Chromatography ; Chromatography, Gel ; Cytosol ; DEAE-Cellulose ; Durapatite ; Filtration ; Guanine Deaminase* ; Guanine* ; Guanosine ; Hot Temperature ; Hydrogen-Ion Concentration ; Hypoxanthine ; Inosine ; Mercaptoethanol ; Molecular Weight ; Nucleosides ; Purine Nucleotides ; Rats* ; Xanthine Oxidase

Chilblain lupus erythematosus (CLE) is a subtype of lupus erythematosus. It is characterized by cutaneous lesions located on the fingers, toes, nose, ears, elbows, heels and knees and is induced or aggravated by exposure to a cold or damp climate. Various laboratory alterations including antinuclear antibody (ANA), anti-dsDNA antibody, anti-SSA/SSB antibody, rheumatoid factor, and cryoglobulin have been reported in CLE patients. Especially, SSA/Ro antibodies may be especially associated with CLE. Approximately 20% of patients presenting with CLE later develop systemic lupus erythematosus (SLE). A 28-year-old man diagnosed with SLE presented with a 2-year history of pruritic erythematous plaques on the ears and dorsa of his hands and feet. The lesions developed or were aggravated the cold weather. In the summer, they were reported to improve, but they did not heal. ANA anti- SSA/SSB antibodies, and anti-dsDNA antibodies were found to be present. He was treated with a topical steroid and advised to avoid the cold.
Adult ; Antibodies* ; Antibodies, Antinuclear ; Chilblains* ; Climate ; Ear ; Elbow ; Fingers ; Foot ; Hand ; Heel ; Humans ; Knee ; Lupus Erythematosus, Systemic ; Nose ; Rheumatoid Factor ; Toes ; Weather

SAPHO syndrome is characterized by sternocostoclavicular osteoarthritis and hyperostosis in the anterior chest wall, and skin changes such as palmoplantar pustulosis and acne. Despite the higher frequency of psoriasis in this syndrome, its inclusion in the psoriatic arthropathy spectrum is not yet clearly established to date. According to a familial series of the SAPHO syndrome, both sacroiliac and sternoclavicular joints could be involved. We report a case of SAPHO Syndrome in a palmoplantar pustulosis patient who had on associated osteoarticular manifestation. A 47-year-old woman had been treated for palmoplantar pustulosis for 15 months. Pain and tenderness then developed abruptly on the chest and neck, and multiple erythematous papules and pustules broke our over the whole body. Laboratory tests were negative for serum RA factor and ANA, and positive for HLA-B27. An X-ray showed a hyperostosis, osteolytic and osteosclerotic lesions in the costo-sterno-clavicular junction. 99mTc isotope scan showed the typical "Bull's head sign" in the anterior chest wall due to increased uptake in the manubrium and both sternoclavicular joints.
Acne Vulgaris ; Acquired Hyperostosis Syndrome* ; Arthritis, Psoriatic ; Female ; Head ; HLA-B27 Antigen ; Humans ; Hyperostosis ; Manubrium ; Middle Aged ; Neck ; Osteoarthritis ; Psoriasis ; Skin ; Sternoclavicular Joint ; Thoracic Wall ; Thorax

Aureobasidium pullulans is classified among dematiaceous fungi, characterized by the production of melanin pigments. It is widely distributed throughout the environment. It has occasionally been infected on the skin and nails of humans. We report a case of onychomycosis due to Aureobasidium pullulans developed in an 49-year-old female after trauma.
Female ; Fungi ; Humans ; Melanins ; Middle Aged ; Onychomycosis* ; Skin

BACKGROUND: In malignant melanoma, the regional nodal status is acknowledged as the most powerful indicator of prognosis. Sentinel lymph node status was formally adopted in 2002 AJCC melanoma staging system. However, there has been no clinical study on sentinel lymph node evaluation, especially using lymphoscintigraphy and gamma probe in melanoma patients in Korea. OBJECTIVE: Our purpose was to assess the usefulness of lymphoscintigraphy and intraoperative gamma probe for the detection of sentinel lymph node in melanoma patients. METHODS: In eight malignant melanoma patients (7 stage I/II, 1 stage III), a lymphoscintigraphy with 99mTc-radiocolloids were injected peritumoral area and the identified first lymph node was considered to be a sentinel node. Once the sentinel lymph node was identified using a hand-held gamma probe for intraoperative mapping, it was excised. And the sentinel node was examined by routine hematoxylin-eosin and immunohistochemical stain (HMB45, S-100). RESULTS: Sentinel nodes were identified in 8 patients all using lymphoscintigraphy and intraoperative gamma probe. Nine sentinel nodes were found in 8 patients, and sentinel lymph node biopsies showed micrometases in 5(55.5%). The location of sentinel nodes was that 3(33.3%) were located in axilla, and 6(66.6%) in groin. The case that had melanoma on back revealed dual lymphatic pathway with 2 sentinel nodes on axilla and inguinal area. CONCLUSIONS: We conclude that preoperative lymphoscintigraphy and intraoperative gamma-probe guided sentinel lymph node biopsy is useful for acute staging and prediction of prognosis for melanoma patients.
Axilla ; Biopsy ; Groin ; Humans ; Korea ; Lymph Nodes ; Lymphoscintigraphy* ; Melanoma* ; Prognosis ; Sentinel Lymph Node Biopsy*

We report a case of type IIa hyperlipoproteinemia with xanthoma tendinosum associated with coronary artery disease in a 51 year-old male. Multiple hard nodules appeared firstly on both achilles tendon area 30 years ago and the lesions gradually spread to the dorsa of hands and feet. On past history, he had been diagnosed as unstable angina with atherosclerosis of three vessels in coronary arteries, 2 years ago. His family history revealed nothing contributory. Serum lipid profile including lipoprotein electrophoresis showed an increase in total cholesterol and LDL-cholesterol with increased beta-lipoprotein fraction, which suggested type IIa hyperlipoproteinemia. Histopathologic finding of a nodule from the dorsum of right hand showed many foamy histiocytes and cholesterol clefts in the dermis. Most of the xanthoma cells were mononuclear, but many Touton type giant cells were seen also. He died suddenly of heart failure with unstable angina.
Achilles Tendon ; Angina, Unstable ; Atherosclerosis ; Cholesterol ; Coronary Artery Disease* ; Coronary Vessels* ; Dermis ; Electrophoresis ; Foot ; Giant Cells ; Hand ; Heart Failure ; Histiocytes ; Humans ; Hyperlipoproteinemia Type II* ; Hyperlipoproteinemias ; Lipoproteins ; Male ; Middle Aged ; Xanthomatosis*

PURPOSE: It is necessary to eliminate the highest point of reflux originating at the saphenofemoral junction (SFJ) and the great saphenous vein (GSV) to treat varicose veins. Minimal invasive alternatives in the treatment of varicose veins due to the SFJ and GSV incompetence have been tried over the years, resulting in various degrees of success depending on the method. Recently, endovenous laser occlusion using a diode laser has been introduced, with initial successful clinical reports. The present study was conducted to evaluate long-term follow-up results of endovenous laser treatment for closing the incompetent GSV at its junction with the femoral vein. METHOD: Forty limbs (thirty one patients) with reflux at the SFJ into the GSV were treated with 810nm or 940nm diode laser energy, administered endovenously through a bare-tipped laser fiber (600micrometer). The parameters were 12~15 W in a continuous mode, with a pulse of laser energy every second. A duplex doppler ultrasound (DDUS) was used to mark the location of the GSV from the knee to the SFJ. Vein access was achieved by using either the stab wound Mueller hook approach or ultrasound-guided needle puncture. Exact placement of the fiber was determined by direct observation of the aiming beam through the skin or ultrasound confirmation. Where necessary, a standard ambulatory phlebectomy was performed to remove remaining varicosities. Clinical and duplex evaluation was carried out at regular intervals (1, 3, 6, 12 months) following the initial treatment. RESULTS: Successful occlusion of the GSV, defined as absence of flow on the DDUS, was noted in 39 of 40 GSV (97.5%) during the last visit. Recanalization of GSV occurred in two limbs, 3 and 6 months after treatment. The GSV junction of 7 limbs had remained closed for 2 years. Side effects were minimal, with 21 limbs showing significant purpura, 6 limbs developing palpable fibrous cord and 4 limbs showing transient hyperpigmentation within less than 2 weeks to one month after treatment. CONCLUSION: Long-term results obtained from treatment of 40 limbs with endovenous laser treatment demonstrate a recurrence rate of less than 6% after 29 months of follow-up. These results are comparable or superior to those available for treatment of GSV reflux, including surgery, US-guided sclerotherapy, and radiofrequency ablation. Endovenous laser treatment appears to offer the benefit of lower rates of complication and the avoidance of general anesthesia.
Anesthesia, General ; Catheter Ablation ; Extremities ; Femoral Vein ; Follow-Up Studies ; Hyperpigmentation ; Knee ; Lasers, Semiconductor ; Needles ; Punctures ; Purpura ; Recurrence ; Saphenous Vein ; Sclerotherapy ; Skin ; Ultrasonography ; Varicose Veins* ; Veins ; Wounds, Stab

PURPOSE: Although the mechanism of virus-induced, aspirin-exacerbated respiratory disease (AERD) is not known fully, direct activation of viral components through Toll-like receptor 3 (TLR3) has been suggested. TLR3 recognizes double-stranded RNA (dsRNA), and activates nuclear factor-kappaB and increases interferon-gamma, which signals other cells to induce airway inflammation in asthma. Considering the association of TLR3 in viral infections and AERD, we investigated whether promoter and non-synonymous variants of TLR3 were associated with AERD. METHODS: The three study groups, 203 with AERD, 254 with aspirin-tolerant asthma (ATA), and 274 normal healthy controls (NC) were recruited from Ajou University Hospital, Korea. Two polymorphisms, -299698G>T and 293391G>A [Leu412Phe], were genotyped using primer extension methods. RESULTS: Genetic associations were examined between two genetic polymorphisms of TLR3 (-299698G>T and 293391G>A [Leu412Phe]) in the three study groups. AERD patients that carried the GG genotype of 293391G>A showed a significantly lower frequency compared with ATA in both co-dominant (P=0.025) and dominant models (P=0.036). Similarly, in the minor allele frequency, the A allele was significantly higher (P=0.023) in AERD compared with ATA for this polymorphism. AERD patients who carried HT2 [GA] showed a significantly higher frequency than other haplotypes in co-dominant (P=0.02) and recessive (P=0.026) models. CONCLUSIONS: Our findings suggest that the -299698G>T and 293391G>A [Leu412Phe] polymorphisms of the TLR3 gene are associated with the AERD phenotype.
Alleles ; Asthma ; Gene Frequency ; Genotype ; Haplotypes ; Humans ; Inflammation ; Interferon-gamma ; Korea ; Phenotype ; Polymorphism, Genetic ; RNA, Double-Stranded ; Toll-Like Receptor 3 ; Toll-Like Receptors ; Viral Structures