No abstract available.
Osteoarthritis*

PURPOSE: To characterize MRI findings of central nervous system(CNS) granulocytic sarcoma (chloroma) and to analyse the points which differentiate it from other CNS tumors. MATERIALS AND METHODS: We evaluated MRI in six patients with CNS granulocytic sarcoma proven by surgery or bone marrow biopsy (intracranical, one case and spine five cases). A 0.5T superconductive MR machine was used for diagnosis and, axial, coronal and sagittal T1- and T2-weighted spin echo images and Gd-DTPA enhanced T1-weighted images were obtained. We retrospectively analized the location, signal intensity, margin, contrast enhancement and homogeneity, and bony change around the tumor. RESULTS: MRI findings of CNS granulocytic sarcomas were as follows : one tumor was seen to be an extra-axial mass in the posterior fossa of the brain, four were epidural, and one was an epidural and presacral masses in the spine ; tumor magins were lobulated and three were smooth. On T1-weighted images, all tumors were of isoignal intensity; on T2-weighted images, four were of isosignal intersity and two were of high signal intensity. Contrast enhancement was inhomogeneous in five of six cases. Bony change around the tumor was seen in two cases. CONCLUSION: On T1-weighted images, CNS granulocytic sarcomas (chloromas) were of isosignal intensity, relative to brain parenchyma or spinal cord ; on T2-weighted images, they were of iso or high signal intensity, with relative contrast enhancement. These points could be useful in differentiating them from other CNS tumors.
Biopsy ; Bone Marrow ; Brain ; Central Nervous System* ; Diagnosis ; Gadolinium DTPA ; Humans ; Magnetic Resonance Imaging* ; Retrospective Studies ; Sarcoma, Myeloid* ; Spinal Cord ; Spine

Osteosarcoma is the most frequently encountered primary malignant tumor of the bone. But sarcoma of the skull are rare tumor to be observed even in an extensive neuropathological practice. We presents a case of skull neoplasm identified as osteosarcoma. A twelve year old male patient was admitted to our department because of the large palpable mass on the posterior parietal and occipital region with headache, nausea and vomiting. On admission moderate papilledema was noted in the both eyes. Other neurologic finding were within normal limits. Chest film and long bone series showed no evidence of abnormality. Skull films revealed a large round destructive area on the posterior parietal and occipital region and the right carotid angiogram revealed patch densities in the mass lesion which was supplied by the right occipital artery and possibly the right middle meningeal artery. Serum Alkaline Phosphatase was 14 BL Units. The findings on the pathology side was compatible with osteosarcoma.
Alkaline Phosphatase ; Arteries ; Headache ; Humans ; Male ; Meningeal Arteries ; Nausea ; Neurologic Manifestations ; Osteosarcoma* ; Papilledema ; Pathology ; Rabeprazole ; Sarcoma ; Skull Neoplasms ; Skull* ; Thorax ; Vomiting

OBJECTIVES: The aim of this study was to evaluate the appropriate position of the forearm for measuring the BMD (Bone Mineral Density). MATERIAL & METHODS: CT scanning was performed in 21 men to determine the appropriate position for the forearm. Twenty one healthy volunteers who were without any history of operations, anomalies or trauma were enrolled. CT scanning was used to evaluate the cross sectional structures and the rotation angle on the horizontal plane of the distal radius. The rotation angle was measured by the m-view program on the PACS monitor. The DXA was used for measuring 20 dried radii of cadaveric specimens in pronation and supination with 3degrees, 5degrees, 7degrees and 10degrees of rotation respectively, including a neutral position (0degrees) to evaluate the changes of BMD according to the rotation. RESULTS: The mean rotation angle of the distal radius on the CT scan was 7degrees of supination (76%, n=16), 3.3degrees of pronation (15%, n=3), and 0degrees at the neutral position (9%, n=2), respectively. The total average rotation angle in the 21 people was 5.2degrees of supination. In the cadaveric study, the BMD of the distal radius was different according to the rotational angles. The lowest BMD was obtained in 1.4degrees of pronation. CONCLUSION: In the case of the measuring of the BMD in the forearm in a neutral position, the rotational angle of the distal radius is close to supination. Therefore, pronation is needed for the constant measurement of BMD in the forearm. We recommend measuring the lowest BMD of the distal radius at about five degrees of pronation.
Cadaver ; Forearm ; Humans ; Male ; Organothiophosphorus Compounds ; Pronation ; Radius ; Supination

Type 1 Neurofibromatosis(von Recklinghausen's disease) characterized by cafe-au-lait spot and multiple skin nodules, may involve any part of the body. The incidence of multiple spinal neurofibromas is about 15% of all spinal neurofibromas and the majority of them are located in cauda equina. However, thoracic spine is uncommon site of multiple spinal neurofibrmas in type 1 neurofibromatosis. The authors describe a case of bilateral large neurofibromas of the thoracic spine associated with type 1 neurofibromatosis in a 27-year-old man.
Adult ; Cafe-au-Lait Spots ; Cauda Equina ; Humans ; Incidence ; Neurofibroma ; Neurofibromatoses* ; Neurofibromatosis 1 ; Skin ; Spine

The incidence of paraplegia following drain of cerebrospinal fluid(CSF) by lumbar puncure below a spinal block is rare, and most of them occurred in spinal tumor. We report a case of acute paraplegia following lumbar puncture for computed tomography myelography(CTM) in a 42-year-old man who sustained a cervical disc herniation. Four hours after lumbar puncture for CTM, sudden paraplegia was developed. After emergent anterior cervical discectomy and fusion with cervical plating, the patient recovered completely. To the authors' knowledge, this is the first case of spinal shock complicating lumbar puncture for routine myelography in a patient with cervical disc herniation. The prompt recognition of this unusual complication of lumbar puncture may lead to good clinical outcome. Instead of CTM requiring lumbar puncture, MRI should be considered as the initial diagnostic procedure in a patient of cervical disc herniation associated with myelopathy. We discuss the possible mechanisms of acute paraplegia following lumbar puncture with literature review.
Adult ; Diskectomy ; Humans ; Incidence ; Magnetic Resonance Imaging ; Myelography ; Paraplegia* ; Shock ; Spinal Cord Diseases ; Spinal Puncture*

Retroperitoneal neurilemmoma is relatively rare and benign tumor. We report a case of a benign retroperitoneal pelvic neurilemmoma that presented with constipation and an adnexal mass and brief review of literatures.
Constipation ; Neurilemmoma*

BACKGROUND: Interruption of efferent sympathetic fibers is the mainstay of therapy in reflex sympathetic dystrophies(RSD) and be accomplished by temporary or permanent anesthetic blockade of sympathetic ganglia, surgical lesions of the sympathetic trunk, intravenous injecton of guanethidine or reserpine, or by systemic administration of adrenergic blocking drugs. In this study, the effects and the side effects of intravenous regional bretylium for the treatment of RSD were studied. METHODS: Seven patients have been administered with 2.0 mg/kg bretylium in 0.25% lidocaine with 100U of heparin three times weekly. A standard intravenous regional technique was used with 250~300 mmHg tourniquet pressure for 30 minutes. Blood pressure and pulse rate were monitored before injection, 1 minute and 5 minutes after injection, immediately before deflation of tourniquet, 1 minute, 5 minutes and 30 minutes after deflation of tourniquet. Pain and temperature evaluations were made before injection and at 1 week after every injection. RESULTS: The increase in skin temperature and decrease in pain score of the affected limb were noted after the use of bretylium in 5 patients out of 7 patients. These clinical effects probably resulted from bretylium,s ability to accumulate in adrenergic nerves and block norepinephrine release. One patient had hypotension immediately after tourniquet deflation. CONCLUSIONS: Intravenous regional bretylium provides significant pain relief for treatment of RSD.
Adrenergic Fibers ; Blood Pressure ; Extremities ; Ganglia, Sympathetic ; Guanethidine ; Heart Rate ; Heparin ; Humans ; Hypotension ; Lidocaine ; Norepinephrine ; Pharmacology ; Reflex Sympathetic Dystrophy* ; Reflex* ; Reserpine ; Skin Temperature ; Tourniquets

Pulmonary hemangiomatosis is a rare disease of unknown etiology characterized by diffuse proliferating microvessels that infiltrate not only the lung but also all of the thoracic tissues. The disease is rapidly progressive and usually results in death due to complications of pulmonary hypertension and pulmonary hemorrhage. There are two histologic patterns of pulmonary hemangiomatosis : capillary and cavernous. We describe a 21-year-old man with cavernous-type pulmonary hemangiomatosis presented with right side shoulder pain. He was treated with percutaneous transarterial embolization and then followed with interferon alfa-2a for one year with favorable clinical and radiological response.
Capillaries ; Hemorrhage ; Humans ; Hypertension, Pulmonary ; Interferons ; Lung ; Microvessels ; Rare Diseases ; Shoulder Pain* ; Shoulder* ; Young Adult

The diffuse form of supravalvar aortic stenosis represents a surgical challenge when the ascending aorta, aortic arch, proximal descending thoracic aorta and arch arteries are involved. It can be treated by a variety of surgical approaches. We report a case of severe diffuse supravalvar aortic stenosis combined with an aortic valve anomaly and occlusion of the right coronary artery ostium in a 14-year-old boy with Williams syndrome. We enlarged the aortic root (Nick's procedure), ascending aorta, aortic arch, proximal descending thoracic aorta, and innominate artery with patches and replaced aortic valve with 19 mm St. Jude valve. Deep hypothermic circulatory arrest and retrograde cerebral perfusion were used during repair of the arch and arch artery.
Adolescent ; Aorta ; Aorta, Thoracic ; Aortic Stenosis, Supravalvular* ; Aortic Valve* ; Arteries ; Brachiocephalic Trunk ; Circulatory Arrest, Deep Hypothermia Induced ; Coronary Vessels ; Humans ; Male ; Perfusion ; Williams Syndrome