No abstract available.
Acanthosis Nigricans* ; Growth Hormone*

BACKGROUND: In orthostatic headache (OH) associated with low cerebrospinal fluid (CSF) pressure, loss of CSF vol-ume reflected by pachymeningeal enhancement (PCE) on brain magnetic resonance image (MRI) has been suggested as a pathogenenesis according to Monro-Kellie rule. We attempted to test the following hypotheses; 1) OH is caused by loss of CSF volume, 2) CSF volume loss in OH is caused by hyperabsorption of CSF or 3) by decreased production of CSF. METHODS: Nineteen patients with OH were recruited. Lumbar puncture, brain MRI and radioisotope cisternogra-phy (RIC) were performed in all of them. We evaluated duration of headache from onset to first evaluation, presence of PCE on MRI and CSF leakage (CSFL) on RIC. Firstly, we compared duration of headache between patients with and without PCE. Secondly, between those with and without PCE, we analyzed presence of CSF fistula and demonstration of CSFL on RIC. RESULTS: Mean duration (16.1 +/-19.6) of headache in 13 patients with PCE (66.7%) was significantly longer than in those without PCE (P=0.036). Among 19 patients, CSF fistula was detected in 13 patients (72%) and CSFL in 16 patients (88.9%). There was no significant difference in CSF fistula presence (P=0.114) and in demonstra-tion of CSFL between those with and without PCE. In 16 patients, delayed appearance of radioisotope along cerebral interhemispheric and sylvian regions was shown on RIC. CONCLUSIONS: Pain in OH may be caused by CSF volume loss, however, whether CSF volume loss is caused by CSF hyperabsorption or decreased production remains to be clarified.
Brain* ; Cerebrospinal Fluid ; Fistula ; Headache* ; Humans ; Magnetic Resonance Imaging* ; Spinal Puncture

Two cases of giant cell tumor of bone diagnosed by fine needle aspiration cytology are described. Case 1 was a 28-year-old male who had pain sense for one year at the right distal thigh. His radiologic finding revealed a destructive cortical lesion with soft tissue extension at medial side of epiphysis of the distal femur. Case 2 was a 21-year-old female complaining pain at left distal forearm for eight months and showed a well-demarcated expansile osteolytic lesion with multiseptation, and cortical destruction at epiphysis and metaphysis of the left distal radius on the X-ray. Fine needle aspiration of each lesion was performed. The aspirate of the case 1 revealed moderate cellularity, which was composed of scattered giant cells of osteoclastic type and small round to oval monotonous stromal cells in large areas. Giant cells were evenly distributed in single or small groups and had irregular but abundant cytoplasms with 10 to 20 nuclei in the center. The nuclei showed ovoid shape, fine granular chromatin, and a small but conspicuous nucleolus. Stromal cells were dispersed in isolated pattern or sometimes aggregated in clusters and showed the same nuclei as those of giant cells and scanty cytoplasms. Comparing to case 1, case 2 had a more translucent abundant cytoplasm in the giant cells and more spindled stromal cells. All two cases revealed neither nuclear atypism nor increased abnormal mitoses in both giant and stromal cells, suggesting no evidence of malignancy. Thereafter the lesions were treated with excision and curettage, and histologically confirmed as giant cell tumors of the bone.
Adult ; Biopsy, Fine-Needle ; Chromatin ; Curettage ; Cytoplasm ; Epiphyses ; Female ; Femur ; Forearm ; Giant Cell Tumor of Bone ; Giant Cell Tumors ; Giant Cells ; Glomerulonephritis* ; Humans ; Hypertensive Encephalopathy* ; Magnetic Resonance Imaging* ; Male ; Mitosis ; Osteoclasts ; Radius ; Stromal Cells ; Thigh ; Young Adult

Many surgeons have noted that when the visual field is markedly constricted, immediate and permanent loss of central vision may follow otherwise successful glaucoma surgery. The present study was undertaken to assess the relative risk of surgical therapy in the loss of central vision in patients with advanced glaucoma. We reviewed the records of 44 eyes(including 8 macular split eyes) of 36 patients who had undergone trabeculectomy. The patients were followed for a minimum of 4 months with an average follow-up of 4.1 years. None of the patients suddenly lost visual field following surgery when central vision was spared at the time of the operation. There was good preservation of preoperative visual acuity except in 3 eyes which developed lens opacity. There was no progression of visual field loss when the intraocular pressure was controlled below 21 mmHg. There was good control of intraocular pressure in 43 out of 44 operated eyes. However, in one of the 2 reoperated eyes, we could not control the intraocular pressure below 21 mmHg.
Cataract ; Follow-Up Studies ; Glaucoma* ; Humans ; Intraocular Pressure ; Prognosis* ; Trabeculectomy ; Visual Acuity ; Visual Fields

Actinic reticuloid as a manifestation of chronic actinic dermatitis (CAD) is a rare dermatosis whose clinical and histologic features resemble other types of pseudolymphomas including mycosis fungoides and Jessner's lymphocytic infiltration, and it is regarded as an eventual stage of various photodermatoses like photosensitive eczema or persistent light reaction or chronic photoallergic contact dermatitis and so on. Phototests in the patients with actinic reticuloid usually reveal hypersensitivity to UVB, UVA, and sometimes to visible light. We present a case of actinic reticuloid in a 65-year-old male, whose skin lesions developed as erythematous lichenified infiltrating plaques on the face at first, and then spread themselves onto the upper trunk later. Histologically those skin lesions showed the aggregation of atypical lymphocytes and photobiologically the results of phototests revealed photosensitivity to UVB and UVA.
Actins* ; Aged ; Dermatitis, Photoallergic ; Eczema ; Humans ; Hypersensitivity ; Light ; Lymphocytes ; Male ; Mycosis Fungoides ; Photosensitivity Disorders ; Pseudolymphoma ; Skin ; Skin Diseases

BACKGROUND: Since 1985 when ILAE proposed its first classification system of epilepsy, many studies have reported the practical applicability of the system. However, its limitations have been elucidated. In order to find out the applicability and limitations of the ILAE classification system and the role that diagnostic parameters (semiology, EEG and MRI) take in the anatomical localization of localization-related epilepsies (LREs), we investigated the clinical data of adult patients with LRE in step-wise way. METHOD: We recruited 173 patients with newly-referred/diagnosed LRE from our departmental data registry. Idiopathic epilepsies were excluded. We evaluated the anatomical localization rate(LR) according to each diagnostic parameter, the concordant localization rate(CLR) between two parameters and between three parameters. LR in total patients by any one of three diagnostic parameters was also evaluated. MRI abnormalities were evaluated in those patients showing concordant localization between semiology and EEG. RESULTS: The highest anatomical LR(67.1%) was reported in the semiological parameter. CLR between semiology and EEG was 28.9%. CLR between three parameters was 16.2%. MRI abnormalities were seen in 60% of patients with concordant localization between semiology and EEG. Fifty six percent of electroclinically concordant patients showed concordant localization with an MRI and 79% of them were concordantly localized in the temporal lobe. The LR in total patients was 71.7%. In each of the evaluation steps, the temporal lobe LR was the highest. CONCLUSIONS: Total lobar LR by any one diagnostic parameter in all the patients was high according to the ILAE diagnostic criteria. Semiology was the best localizing parameter, however, combined evaluation with either EEG or MRI reduced the localizability. Even though the MRI study showed a significant discordance rate in patients with electroclinical localizations, it could identify the underlying etiology in a major proportion of the patients. This study showed the importance of an imaging study in the lobar localization of LREs combined with an electroclinical localization by the ILAE classification system.
Adult* ; Classification* ; Electroencephalography ; Epilepsies, Partial* ; Epilepsy* ; Humans ; Magnetic Resonance Imaging ; Temporal Lobe

BACKGROUND: Although the incidence of stroke does not decrease after 80 years of age. The significance of ischemic stroke (IS) after octogenarian age has not attracted the attention of neurologists. As a first step to investigate the significance of IS during that period, we compared the clinical characteristics of IS between OIS (octogenarian ischemic stroke group, ??80 years of age) and NOIS (non-octogenarian ischemic stroke group, 65-79 years of age). METHOD: Forty-nine OIS patients and 141 NOIS patients were recruited. Clinical characteristics including risk factors, IS subtype, Canadian Neurological Scale (CNS) score, treatment modality and short-term prognosis were evaluated and described. RESULTS: ypertension (65.3%) was the most common risk factor followed by smoking (28.6%) and previous stroke history (28.6%) in OIS. There was no significant difference in proportion of each IS risk factors between he two groups. OIS was more associated with subtypes of mixed etiology and cardiogenic embolism than NOIS (P<.05). Subclassification by the vascular territory of IS was similar between the two groups and the middle cerebral arterial territory was the most common site (71.1%) in OIS. CNS scores on the initial neurological examination was similarly associated with both OIS (8.0 3.3) and NOIS (7.5 2.8)(P>.05). IS was more associated with poor outcome at discharge (52.2%) than NOIS (18.2%)(P<.05). CONCLUSIONS: Ischemic stroke after octogenarian age is characterized by different etiopathogenesis and poor short-term outcome compared to IS under that age. OIS is more frequently caused by cardiogenic embolism or combined underlying etiology, however, the relationship between differences in etiopatho-genesis and poor short-term outcome remains to be clarified.
Aged, 80 and over* ; Embolism ; Humans ; Incidence ; Neurologic Examination ; Prognosis ; Risk Factors ; Smoke ; Smoking ; Stroke*

Many surgeons have noted that when the visual field is markedly constricted, immediate and permanent loss of central vision may follow otherwise successful glaucoma surgery. The present study was undertaken to assess the relative risk of surgical therapy in the loss of central vision in patients with advanced glaucoma. We reviewed the records of 44 eyes (including 8 macular split eyes) of 36 patients who had undergone trabeculectomy for intraocular pressure (IOP) control. The patients were followed for a minimum of 4 months with an average follow-up of 4.1 years. None of the patient suddenly lost visual field following surgery when central vision was spared at the time of operation. There was good preservation of preoperative visual acuity except in 3 eyes which developed lens opacity. There was no progression of visual field loss when the IOP was controlled below 21 mmHg. There was good control of IOP of 43 eyes in 44 eyes operated. However, in one of the 2 reoperated eyes, we could not control the IOP below 21 mmHg.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Glaucoma/physiopathology/*surgery ; Humans ; Male ; Middle Aged ; Postoperative Complications/physiopathology ; Prognosis ; Trabeculectomy ; *Visual Acuity

No abstract available.
Posterior Cruciate Ligament* ; Tendons*

No abstract available.
Interleukin-4* ; Interleukins* ; Receptors, Interleukin-4* ; Rheumatic Diseases*