We experienced a rare case of sacral meningeal cyst so called sacral perineurial cyst(Tarlov cyst). A 15 years old girl was admitted to the hospital because of sudden severe low back pain and Lt. sciatica for about one week. We performed delayed myelography and spinal computeized tomographic myelography(C.T.M) for differential diagnosis. Delayed filling of contrast media in the cyst was significant in diagnosis of sacral meningeal cyst type II. Laminectomy of sacrum(S1) was performed for partial excision of cystic wall and plastic suture. Operative finding was typical sacral perineurial cyst(Tarlov cyst) which was recently clssified as sacral meningeal cyst type II. The classification of spinal meningeal cysts in the literature was indistinct and confused. We also agree with Nabors et. al, in current classificcation of spinal meningeal cysts, in which the spinal meningeal cysts, in which the spinal meningeal cysts were divided into 3 groups as extradural spinal Mcs Type I(Diverticulum), Type II(perineurial cyst), intradural spinal Mcs(arachnoid cyst).
Adolescent ; Classification ; Contrast Media ; Diagnosis ; Diagnosis, Differential ; Female ; Humans ; Laminectomy ; Low Back Pain ; Myelography ; Plastics ; Sciatica ; Sutures

No abstract available.
Hepacivirus* ; Hepatitis C* ; Hepatitis* ; Myositis*

Background: To test the hypothesis that Galphas gene mutation may suppress the expression of TRH-R gene, we investigated whether hTRH-R gene expression is lower in human GH-secreting pituitary adenomas with Galphas mutation than in tumors without the mutation. Method: TRH-induced paradoxical response of GH was observed in 8 acromegalic patients. The mutation of gene was identified by direct sequencing of the genomic DNA prepared from GH-secreting pituitary adenomas. The expression of hTRHT mRNA was quantitated by RT-PCR. Results: The transcript of hTRH-R gene was detected in 6 of 8(75%) tumors. Three of these(50%) showed the paradoxical GH response to TRH and the other three patients did not show the response. The relative expression of hTRH-R mRNA in the tumors from patients with the paradoxical response of GH to TRH did not differ from that in the tumors from patients without the paradoxical response. Direct PCR sequencing of Galphas disclosed a mutant allele and a normal allele only at codon 201 in 4 of 8 tumors. The paradoxical response to TRH was observed in 2 of 4 patients without the mutation, and 2 of 4 patients with the mutation. The hTRH-R gene expression of pituitary adenomas did not differ between the tumors without the mutation and those with mutation. Conclusion: This study suggests that the expression of TRH-R gene is not likely to be a main determinant for the paradoxical response of GH to TRH, and that Galphas mutation does not seem to suppress the gene expression of TRH-R in GH secreting adenoma.
Acromegaly ; Adenoma* ; Alleles ; Codon ; DNA ; Gene Expression ; Growth Hormone-Secreting Pituitary Adenoma ; GTP-Binding Proteins ; Humans ; Pituitary Neoplasms ; Polymerase Chain Reaction ; Receptors, Thyrotropin-Releasing Hormone* ; RNA, Messenger

The peripheral neuroblastomas are malignant neoplasms that originate from the adrenal gland and sympathetic nervous tissues. They usually occur in childhood. They exhibit such malignant features that they metastasize early to lung, liver, bone, rarely skull and other structures. The patients with peripheral neuroblastoma have short duration of symptom and short survival period. They reveal the characteristic light microscopic features that resemble other small cell carcinomas. The establishment of final diagnosis of peripheral neuroblastoma needs various special stainings for small cell carcinomas, and the electron microscopic findings are the most reliable. The authors recently experienced a case of peripheral neuroblastoma in a 26-year-old man which involved right frontoparietal skull vault. The only chief complaint was a local non-tender mass at right frontoparietal scalp. Neither headache nor any neurological deficits was detected. Simple skull X-ray revealed a punched out radiolucency at right frontoparietal bone and brain CT showed a superficial elliptical high density mass that enhanced strongly. The mass was totally removed by wide craniectomy. The tumor invaded and penetrated the dura but the arachnoid membrane. At the tumor bed was not invaded by the tumor. The tumor was confirmed as peripheral neuroblastoma by various special stainings for small cell carcinomas. Following surgical resection of the mass, post-operative radiotherapy was offered(4800 rads for about 5 weeks). The patient aggrevated progressively and showed numerous metastases to such bones as lumbar vertebrae, pelvis and humerus to became paraplegic. 8 months after the operation, the patient died.
Adrenal Glands ; Adult ; Arachnoid ; Brain ; Carcinoma, Small Cell ; Diagnosis ; Headache ; Humans ; Humerus ; Liver ; Lumbar Vertebrae ; Lung ; Membranes ; Neoplasm Metastasis ; Neuroblastoma* ; Pelvis ; Radiotherapy ; Scalp ; Skull

Mediastinal teratomas are rare and represent less than 10 per cent of all mediastinal tumors. Almost all arise in the anterosuperior mediastinal compartment, and most symptoms, when present, result from compression of adjacent structures. They contain different tissues derived from all three germinal layers, with the prevalence of ectodermal elements which can include hair, teeth and sebaceous material. Benign teratomas may rupture into adjacent organs. Up to 36% of all mediastinal teratomas rupture, most frequently into the lung and bronchial tree, followed by the pleural space, pericardial space, or great vessels. The signs and symptoms of a ruptured teratoma vary with the structures involved. We report a case of mediastinal teratoma ruptured spontaneously in a 18 year old female who experienced 4 or 5 times of hemoptysis for 1 year and sudden onset of pleural effusion, pericardial effusion and pneumonia.
Adolescent ; Ectoderm ; Female ; Hair ; Hemoptysis ; Humans ; Lung ; Mediastinum ; Pericardial Effusion ; Pleural Effusion ; Pneumonia ; Prevalence ; Rupture ; Rupture, Spontaneous* ; Teratoma* ; Tooth

Among many kinds of internal fixation techniques for the transverse fracture of the patella, AO modified tension band wiring technique and Pyrford technique have been widely used. However, it seems that those techniques are not strong enough to withstand immediate full weight bearing and full range of motion exercise postoperatively. Instead, a load sharing wiring technique seems to be more effective fixation technique. A comparative study was performed to evaluate the load sharing wiring technique using porcine patellae. Transverse fractures of thirty knees were made and were fixed with 3 different fixation technique. 1) AO modified tension band wiring technique, 2) Pyrford technique, and 3) Load sharing wiring technique. Then, those knees were mounted on the material testing system (Instron 4204(R)) and longitudinal traction was applied. The result showed that the separation of the fracture fragments was much less with the load sharing wiring technique than with the AO modified tension band wiring technique and the Pyrford tehchnique when 5 kg to 25 kg of traction was applied(P<0.05). The load sharing wiring technique showed less than 0.4mm of separation at 25~50kg of traction, where other techniques led specimen to failure. From this study, it was suggested that the load sharing wiring technique was proved to be more effective fixation technique compared to other techniques.
Knee ; Patella* ; Range of Motion, Articular ; Traction ; Weight-Bearing

PURPOSE: Icodextrin in peritoneal cavity is absorbed via the lymphatics to the blood and metabolized to maltose and maltriose which may interfere with correct measurement of glucose. In an attempt to evaluate the effects of icodextrin on the erroneous results of blood glucose, we measured blood glucose by different methods. METHODS: Peripheral capillary blood and venous blood were obtained from 12 patients using icodextrin and from 12 patients not using icodextrin. Venous blood glucose was measured by using the laboratory technique (glucose oxidase method), and capillary blood glucose was measured by using a Surestep (glucose oxidase method) and an Acucheck (GDH-PQQ method). To estimate icodextrin and its metabolites indirectly, we calculated osmolal gap. We measured blood icodextrin and its metabolites with amyloglucosidase in icodextrin group. RESULTS: In icodextrin group, glucose was overestimated in the results of the GDH-PQQ method (delta= GDH-GOD=56.2+/-30 mg/dL [vein] 58+/-32 mg/dL [capillary]), but in the control group, there were no significant differences in the results between the glucose oxidase method and the GDH-PQQ method. There was a correlation between the osmolal gap and the differences in the results (delta=GDH-GOD) (r=0.741, p=.006 [vein], r=0.671, p=.017 [capillary]). Blood icodextrin and its metabolites were related with the differences in the results (delta=GDH-GOD) (p=.026, r=0.635), but there was no significant correlation between the osmolal gap and the icodextrin and its metabolites (p=0.086, r=0.515). CONCLUSION: Icodextrin and its metabolites may lead to erroneously high blood glucose levels when measured by GDH-PQQ method. It is necessary to be aware of this factor in order to prevent overlooking dangerous hypoglycemia.
Blood Glucose* ; Capillaries ; Glucan 1,4-alpha-Glucosidase ; Glucose ; Glucose Oxidase ; Humans ; Hypoglycemia ; Maltose ; Oxidoreductases ; Peritoneal Cavity ; Peritoneal Dialysis, Continuous Ambulatory*

PURPOSE: To evaluate normal tonsillar position at different ages, using MR images. MATERIAL AND METHODS: We measured the position of the cerebellar tonsils with respect to the inferior aspect of the foramen magnum on middle sagittal MR T1 weight images in 210 patients(9 days to 83 years) who were not considered to have any disorder that would affect tonsillar position. RESULTS: The mean distance between tonsillar tip and inferior aspect of the foramen magnum was 0.0 +/-1.9mm in the first decade of life, 0.7 +/-2.8mm in the fourth decade, and3.4 +/-2.3 mm in the eighth and ninth decades. The tonsillar position is significantly lower in youth(first and second decades) than in old age(seventh to ninth decades). CONCLUSION: We believe that a single reference standard that indicates the normal distance of the cerebellar tonsils from the foramen magnum is inappropriate unless age is considered. We suggest that the following distance below the foramen magnum(more than 2 standard deviations out of the normal range) be used as criteria for ectopia of the cerebellar tonsils in koreans : firstand second decades, 5mm ; third to sixth decades, 4mm ; seventh and eighth decades, 3mm.
Foramen Magnum ; Palatine Tonsil*

Erlotinib (Tarceva(R)) has been considered to be a new, promising oral chemotherapy agent for local advanced or metastatic non-small cell lung cancer (NSCLC). Erlotinib is regarded as relatively safe, but interstitial lung disease (ILD) related to erlotinib has been reported on an infrequent basis in Asia. We report an histologically confirmed case of recurrent erlotinib-induced ILD. Although, the patient was highly responsive to the first erlotinib treatment, the therapy was discontinued due to erlotinib-induced ILD. After intravenous high dose methylpredinisolone treatment, ILD was improved rapidly by radiologic studies, but the particular lung cancer re-emerged. We restarted the patient erlotinib on low-dose oral methylpredinisolone, resulting in a recurrence of erlotinib-induced ILD. Our case suggests that re-administration of erlotinib should be performed on a limited basis in patients that have developed ILD on previous use, even if a therapeutic effect can be estimated.
Asia ; Carcinoma, Non-Small-Cell Lung ; Humans ; Lung Diseases, Interstitial ; Lung Neoplasms ; Quinazolines ; Recurrence ; Erlotinib Hydrochloride

Erlotinib (Tarceva(R)) has been considered to be a new, promising oral chemotherapy agent for local advanced or metastatic non-small cell lung cancer (NSCLC). Erlotinib is regarded as relatively safe, but interstitial lung disease (ILD) related to erlotinib has been reported on an infrequent basis in Asia. We report an histologically confirmed case of recurrent erlotinib-induced ILD. Although, the patient was highly responsive to the first erlotinib treatment, the therapy was discontinued due to erlotinib-induced ILD. After intravenous high dose methylpredinisolone treatment, ILD was improved rapidly by radiologic studies, but the particular lung cancer re-emerged. We restarted the patient erlotinib on low-dose oral methylpredinisolone, resulting in a recurrence of erlotinib-induced ILD. Our case suggests that re-administration of erlotinib should be performed on a limited basis in patients that have developed ILD on previous use, even if a therapeutic effect can be estimated.
Asia ; Carcinoma, Non-Small-Cell Lung ; Humans ; Lung Diseases, Interstitial ; Lung Neoplasms ; Quinazolines ; Recurrence ; Erlotinib Hydrochloride