No abstract available.
Muscular Diseases*

There is a great variety of abdominal calcifictions of varying etiology. Among them, calcification in gastriccarcinoma is rare. To the best of our knowledge, there has been no previous report of calcifying mucinousadenocarcinoma of the stomach in Korea. In the present communication, we report two cases of this rare tumor. Thefirst case was 27 years old female who had anorexia and palpable mass in the epigastrium. By palpation, a firmnon-tender large mass ws felt in the epigastrium. A plain abdominal film showed numerous pnuctate calcificationsin the left upper quadrant. Film from an upper G-I series demonstrated findings of advanced gastric carcinoma withmultiple punctate calcifications involving the antrum and body. Gastroscopic biopsy proved the lesion to bemucinous adenocarcioma(signet ring cell type). The second case was 38 years old female who compained of nausea,vomiting and weight loss. On physical examination, she appeared normal. Routine laboratory tests were withinnormal limits. A plain abdominal film revealed stippled calcifications in the left upper quadrant medial to thesplenic shadow. The film from an upper G-I series showed a mass in the fundus and upper body of stomach withmultiple stippled calcifications along the lesser curvature. Subtotal gastrectomy was perfomred and the pathologicfindings was calcifying mucinous adenocarcinoma(signet ring cell type).
Adenocarcinoma, Mucinous ; Anorexia ; Biopsy ; Female ; Gastrectomy ; Humans ; Korea ; Mucins ; Palpation ; Physical Examination ; Stomach ; Weight Loss

We report a case of a solitary plasmacytoma of the skull base in an otherwise asymptomatic patient. The patient was investigated with plain x-ray films, computed tomography(CT), MRI. The solitary plasmacytoma of bone has a certain relationship to multiple myeloma and rarely been described in the skull base.
Humans ; Magnetic Resonance Imaging ; Multiple Myeloma ; Paraproteinemias ; Plasmacytoma* ; Skull Base* ; Skull* ; X-Ray Film

Chemical neurolysis can be an extremely effective intervention for reducing spasticity. Phenol nerve block as a method of chemical neurolysis has been used over 40 years, nevertheless, many clinicians remain reluctant to perform this procedure. This is largely due to the fear of its side effects and complications such as excessive muscle weakness or increased spasticity of antagonistic muscles. The purpose of this study was to titrate the nerve block effects of phenol with different concentrations and different volumes of the phenol solution. Left tibial nerves of forty eight adult rabbits were injected with phenol solution of different concentrations(5%, 4%, 3%) and volumes(0.3 ml, 0.2 ml, 0.1 ml) into the epineural sheath. Nerve conduction study of the gastrocnemius muscle was performed before and after the nerve blocks(1day, 1week, 2weeks, 4weeks, 8weeks). The proportion of compound muscle action potential(CMAP) amplitudes and areas before and after the nerve blocks was used for the evaluation of nerve block effect. There was a statistically significant difference in the proportion among three volumes of phenol solution(p<0.05). However there was no statistical difference in the proportion among three concentrations of phenol solution(p>0.05) although the higher concentration of phenol solution showed the tendency for smaller proportion. The area of histological degeneration appeared at 2 weeks following nerve block alongside the perineurium. The depth of degeneration area of nerve fascicle varied according to the distance from injection point. These data suggest that the nerve block effect of phenol can be titrated more easily with the volume of phenol solution rather than the concentration until 8 weeks after the nerve block. The variation of the extent of degeneration with different volumes of phenol solution seems to be the mechanism for the titration.
Adult ; Humans ; Muscle Spasticity ; Muscle Weakness ; Muscle, Skeletal ; Muscles ; Nerve Block* ; Neural Conduction ; Peripheral Nerves* ; Phenol* ; Rabbits ; Tibial Nerve

A 59-year-old woman was admitted to our hospital because of occipital headache and multiple cranial nerve dysfunction. The patient had been suffered from chronic otitis media. MRI of the brain showed a thickened and markedly enhanced dura mater in the temporal lobe. The patient underwent a left temporal craniectomy and dural biopsy. Histopathological examination revealed thickened duar amter infiltrated with giant cell, lymphocytic and plasma cell infiltration. The fungus, acid-fast and PAS stains were all negative. After administraion of steroid, cranial nerve disturbances and headache improved. The cause of the hypertrophpic intracranial pachymeningitis in this patient was thought to be related with the chronic otitis media, although the clinical course of the patient was similar to the idiopathic hypertrophic pachymeningitis.
Biopsy ; Brain ; Coloring Agents ; Cranial Nerves ; Dura Mater ; Female ; Fungi ; Giant Cells ; Headache ; Humans ; Magnetic Resonance Imaging ; Meningitis* ; Middle Aged ; Otitis Media* ; Otitis* ; Plasma Cells ; Temporal Lobe

PURPOSE: The purpose of our report was to evaluate the result of operative treatment of hallux valgus in old age patients. MATERIALS AND METHODS: We studied about the clinical & radiologic results of the 31 patients over 55 years old, who had operative treatment of hallux valgus. Clinical evaluation, such as pain, activity limitation, footwear requirement, 1st metatarsophalangeal joint motion, and callosity, was done using AOFAS scale and preoperative and postoperative radiologic parameters, such as hallux valgus angle, intermetatarsal angle, tibial sesamoid position, 1st metatarsal shortening, were evaluated by conventional methods. RESULTS: Objectively, according to AOFAS, the score improved from average of 57.8 to 71.5 postoperatively. The range of motion of first metatarsophalangeal joint was decreased from average of 60.7 to 56.8 degrees. Radiologically, the hallux valgus angle improved from average of 35 to 6.5 degrees and the first intermetatarsal angle improved from average of 14.2 to 4.4 degrees. The position of sesamoid was collected from an average of grade 3.6 to grade 2.2. CONCLUSION: The combination of proximal metatarsal osteotomy, distal soft tissue procedure and Akin osteotomy may yield rather satisfactory clinacal result in severe elderly hallux valgus patients with massive degenerative change and poor soft tissue condition.
Aged ; Callosities ; Hallux Valgus* ; Hallux* ; Humans ; Metatarsal Bones* ; Metatarsophalangeal Joint ; Middle Aged* ; Osteotomy* ; Range of Motion, Articular

PURPOSE: The purpose of our report was to evaluate the result of operative treatment of hallux valgus in old age patients. MATERIALS AND METHODS: We studied about the clinical & radiologic results of the 31 patients over 55 years old, who had operative treatment of hallux valgus. Clinical evaluation, such as pain, activity limitation, footwear requirement, 1st metatarsophalangeal joint motion, and callosity, was done using AOFAS scale and preoperative and postoperative radiologic parameters, such as hallux valgus angle, intermetatarsal angle, tibial sesamoid position, 1st metatarsal shortening, were evaluated by conventional methods. RESULTS: Objectively, according to AOFAS, the score improved from average of 57.8 to 71.5 postoperatively. The range of motion of first metatarsophalangeal joint was decreased from average of 60.7 to 56.8 degrees. Radiologically, the hallux valgus angle improved from average of 35 to 6.5 degrees and the first intermetatarsal angle improved from average of 14.2 to 4.4 degrees. The position of sesamoid was collected from an average of grade 3.6 to grade 2.2. CONCLUSION: The combination of proximal metatarsal osteotomy, distal soft tissue procedure and Akin osteotomy may yield rather satisfactory clinacal result in severe elderly hallux valgus patients with massive degenerative change and poor soft tissue condition.
Aged ; Callosities ; Hallux Valgus* ; Hallux* ; Humans ; Metatarsal Bones* ; Metatarsophalangeal Joint ; Middle Aged* ; Osteotomy* ; Range of Motion, Articular

OBJECTIVE: The purpose of this study is to review retrospectively 28 patients with re-operation due to complications related to instrumentation from thoracic and lumbar spinal fusion surgery. METHODS: A total of 285 patients underwent spinal fusion surgery with instrumentation between 1996 and 2000. Of these, 11 men and 17 women(mean age 46 years, range 21 to 69 years) presented with complications related to instrumentation. Previous surgery was preformed for vertebral column instability secondary to fracture(4), spondylolisthesis(12), failed back surgery syndrome(7), osteomyelitis(1), herniated nuclus pulposus(4). All patients underwent repeated spinal surgery including removal of instrument, new instrument fixation, or I & D. The mean follow-up period after second operation was 19 months. RESULTS: The complications related instrumentation system include six interbody fusion system retropulsion, eight screw loosenings, five screw fractures, three screw malpositions, three osteomyelitis, and one donor site infection. After repeated surgery, eight became asymptomatic and did not require further treatment, but eleven showed persistent low back pain without neurological deficits and the remaining nine continued to have nerve root deficits. CONCLUSION: In conclusion, spinal fusion surgery with instrumentation offers an immediate postoperative stability of the thoracic and lumbar spine and enhances early fusion. However, it may be associated with few, but significant, complications which may permanantly. The proper selection of patients and meticulous surgical technique for surgery are probably the most important factors associated good outcomes and prevention of complications.
Follow-Up Studies ; Humans ; Low Back Pain ; Male ; Osteomyelitis ; Retrospective Studies ; Spinal Fusion* ; Spine ; Spondylolisthesis ; Tissue Donors

Hashimoto's encephalopathy (HE) is a steroid-responsive disorder of persistent or relapsing neurological or neu-ropsychological deficits associated with elevated serum concentrations of antithyroid antibody that frequently presents with myoclonus, seizures, and stroke-like episodes. We report a 55-year-old woman who presented with an altered men-tality associated with generalized tonic-clonic seizure. She was diagnosed with Hashimoto's thyroiditis 3 years prior. Serum antithyroglobulin antibody and antimicrosomal antibody were elevated. Electroencephalography (EEG) showed generalized slowing. Brain magnetic resonance imaging (MRI) with T2-weighted sequence and fluid-attenuated inver-sion- recovery (FLAIR) image revealed a high signal intensity in both mesial temporal areas. Single photon emission computed tomography (SPECT) demonstrated decreased perfusion in multiple areas. With the impression of HE, she was placed on high dose steroid and thyroid hormone replacement therapy which ameliorated her neurological symp-toms. We suggest that HE should be included in the differential diagnosis of decreased mentality, especially when patients with Hashimoto's thyroiditis show altered consciousness, seizure disorder, or cognitive decline.
Brain ; Consciousness ; Diagnosis, Differential ; Electroencephalography ; Epilepsy ; Female ; Hormone Replacement Therapy ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Myoclonus ; Perfusion ; Seizures ; Thyroid Gland ; Thyroiditis ; Tomography, Emission-Computed, Single-Photon

BACKGROUND: The H-reflex has been used to assess the proximal nerve conduction in radiculopathy or peripheral neuropathy. The purpose of this study was to evaluate the clinical usefulness of the H-reflex in the diagnosis of subclinical diabetic polyneuropathy. METHOD: Thirty-four diabetic patients (17 women and 17 men) who had neither motor nor sensory symptoms were selected (mean age 57.6 +/- 12.9 years). The duration of diabetes varied from 0.5 to 24 years (mean 6.2 +/- 5.1 years). None of the patients had any known cause of peripheral neuropathy other than diabetes. Twenty-seven healthy subjects (16 women and 11 men) were evaluated as an age-matched control group. H-reflex studies were performed using Braddom and Johnson's methods. The presence and latencies of the H-reflexes were examined in both legs. RESULTS: Twenty-four of the 34 patients (70.6%) had abnormal H-reflex responses (absent H-reflex in 17, prolonged latency in 7). However, only three out of the 27 control subjects (11.1%) had abnormal H-reflex responses (absent H-reflex in 1, prolonged latency in 2). CONCLUSIONS: Abnormalities in H-reflex studies have often been seen in diabetic subjects without overt neurological symptoms. This study suggests that the H-reflex study may be a useful screening tool in the diagnosis of subclinical diabetic polyneuropathy.
Diabetic Neuropathies* ; Diagnosis ; Female ; H-Reflex* ; Humans ; Leg ; Mass Screening ; Neural Conduction ; Peripheral Nervous System Diseases ; Radiculopathy