STUDY DESIGN: We report two cases of symptomatic spinal epidural lipomatosis (SEL) associated with long-term use of steroid medication OBJECTIVES: The purpose of this study was to assess the clinical characteristics, diagnosis and treatment of symptomatic spinal epidural lipomatosis. SUMMARY OF LITERATURE REVIEW: Spinal epidural lipomatosis is a condition in which excess adipose tissue is deposited circumferentially about the spinal cord in the epidural space. It can present neurologic symptoms including back pain, radiculopathy or cauda equina. Magnetic resonance imaging is the most helpful dignostic means and should be used initially if suspected. Treatment is decompressive laminectomy and debulking of fat. MATERIALS AND METHODS: Two cases of lumbar epidural lipomatosis with neurologic symptoms were discussed and evaluated by physical examination, postmyelography CT and MRI. RESULTS: Two cases were treated with decompressive laminectomy and debulking of fat. Increased accumulation of the fatty tissue was seen predominently in posterior and posterolateral epidural space of the spinal canal, displacing and compressing the lumbar spinal cord anteriorly. Both gross and histologic evaluation revealed overgrowth of unencapsulated normal appearing fat consistent with spinal epidural lipomatosis. One case was demonstrated gradual improvement in symtoms after operation but the other was died due to medical problems. CONCLUSION: The authors reviewed the literature and reported the results of operative treatment of patients with lumbago, radicular pain and intermitent claudication caused by epidural lipomatosis of lumbar spine and degenerative spinal stenosis.
Adipose Tissue ; Back Pain ; Cauda Equina ; Diagnosis ; Epidural Space ; Humans ; Laminectomy ; Lipomatosis* ; Low Back Pain ; Magnetic Resonance Imaging ; Neurologic Manifestations ; Physical Examination ; Radiculopathy ; Spinal Canal ; Spinal Cord ; Spinal Stenosis ; Spine

BACKGROUND: The objective responses of cisplatin and etoposide (PVP) combination chemotherapy as second-line therapy following CAV was high (40~50%) and, in several reports, PVP yields survival results that are at least as good as those obtained with cyclophosphamide or doxorubicin-based regimens and with less host-related toxicity in chemotherapy-naive patients. We conducted a phase II study to evaluate the effect of a combination of cisplatin and etoposide as a first-line therapy in patients with small cell lung cancer. METHODS: Sixty-one previously untreated small cell lung cancer patients with measurable lesion(s) received cisplatin(30 mg/m2 IV, day 1~3) and etoposide(100 mg/m2 IV, day 1~3). In patients with limited disease, after completion of 6 cycles of PVP chemotherapy, chest and prophylatic brain irradiation was performed in case of complete responder, chest irradiation only in partial responder. RESULTS: 1) Of 55 evaluable patients, 13(24%) had a complete response and 29(53%) had a partial response. 2) The median survival time was 55.8 weeks for all patients(N=55), 61.1 weeks for limited disease(N=31), 51.3 weeks for extensive disease(N=24). 3) The response duration was 29.1 weeks for responders(N=42). 4) There was no significant prognostic factors iufluencing response rates. 5) The toxicity was tolerable and there was no treatment-related deaths. CONCLUSION: The PVP combination chemotherapy as a first-line therapy was effective and well-tolerated in patients with small cell lung cancer.
Brain ; Cisplatin* ; Cyclophosphamide ; Drug Therapy ; Drug Therapy, Combination* ; Etoposide* ; Humans ; Small Cell Lung Carcinoma* ; Thorax

BACKGROUND: Post-operative shivering is one of the potential complications for any surgical patient. Its incidence varies from 5% to 65%, and many preventive and treatment modalities have been reported. For the effective prevention of post-anesthetic shivering by using intravenous clonidine or meperidine, randomized controlled studies were reviewed. The overall incidence of shivering after clonidine or meperidine administration, and the anti-shivering effect of clonidine and meperidine were evaluated. METHODS: DATA SOURCES: Medline search from 1978 to March 1998. DATA SELECTION: We selected studies that had investigated the preventive anti-shivering effect of intravenous clonidine or meperidine by randomized controlled trials. Ten clinical trials were evaluated. RESULTS: The pooled odd ratio of the patients who received clonidine was 0.32 (95% confidence interval, 0.22~0.47) and it seemed to be effective. But these studies showed little evidence of significant homogeneity (P=0.01). In the subgroup analysis, the pooled odd ratio of group A (early administration or intra-operative infusion group) was 0.47 (95% CI 0.31~0.72) evidenced effectiveness but failed to prove homogeneity (P=0.047). But group B (the late intra-operative administration group) had a pooled odd ratio of 0.10 (95% CI 0.05~0.22) and showed homogeneity (P=0.98). In meperidine trials, the pooled odd ratio was 0.20 (95% CI 0.07~0.55). CONCLUSION: We present quantitative evidence based on a meta-analysis of pooled effect size from randomized trials that clonidine is more beneficial for the prevention of post-anesthetic shivering and more effective than meperidine when it is administrated during later period of surgery.
Clonidine* ; Information Storage and Retrieval ; Humans ; Incidence ; Meperidine* ; Shivering*

BACKGROUND: Pulmonary Langerhans cell histiocytosis forms part of a spectrum of diseases that are characterized by a monoclonal proliferation and infiltration of organs by Langerhans cells. Several organ systems may be involved in Langerhans cell histiocytosis, including the lungs, bone, skin, pituitary gland, liver, lymph nodes and thyroid. Pulmonary histiocytosis X represents 2.8% of interstitial lung disease. Here we present the clinical, radiological, therapeutic aspects of pulmonary histiocytosis X. METHOD: Fourteen cases of biopsy-proven pulmonary histiocytosis X patients who were diagnosed in Seoul National University Hospital during the period from January 1990 to December 1998 were analyzed retrospectively. RESULT: There were 12 men and 2 women in this study. The initial presenting symptoms were dyspnea, cough, chest pain, which was associated with the pneumothorax, and chest radiography abnormalities. Only 8 patients (57%) were smokers. There were 5 patients with extra-pulmonary histiocytosis (pituitary, bone, skin). Eight patients had received the chemotherapy. There were no mortalities and only one patient experienced an aggravation of symptom during the follow-up period. CONCLUSION: In contrast to previous reports from other countries, the patients with pulmonary histiocytosis X in this study presented with several different clinical characteristics, such as a male predominance, relatively low smoker's rate, and a better prognosis.
Chest Pain ; Cough ; Drug Therapy ; Dyspnea ; Female ; Follow-Up Studies ; Histiocytosis ; Histiocytosis, Langerhans-Cell* ; Humans ; Langerhans Cells ; Liver ; Lung ; Lung Diseases, Interstitial ; Lymph Nodes ; Male ; Mortality ; Pituitary Gland ; Pneumothorax ; Prognosis ; Radiography ; Retrospective Studies ; Seoul ; Skin ; Thorax ; Thyroid Gland

No abstract available.
Pregnancy*

An anomalous systemic arterial supply to the normal basal segments of the left lower lobe without sequestration is a rare congenital anomaly. It differs from classical bronchopulmonary sequestration in that the involver lung retains a normal connection to the bronchial tree, although some place this entity exists within the broad framework of pulmonary sequestration. We experienced a case of a woman who presented with a nodular lesion on a chest X-ray. Contrast-enhanced CT diagnosed her as having an anomalous systemic arterial supply to the normal basal segments of the left lower lobe. This case is reported with a brief literature review.
Bronchopulmonary Sequestration ; Female ; Humans ; Lung* ; Thorax ; Tomography, X-Ray Computed ; Trees

Headache disorders, one of most common disease in general population, have been developed according to many versions of international classifications. The primary headaches are those in which no consistently identified organic cause can be determined. It is divided into the following categories: (1) migraine, (2) tension-type headache, (3) cluster headache and other trigeminal autonomic cephalalgias, (4) other primary headaches. This review described a diagnosis of primary headache disorders based on International Classification of Headache Disorders (ICHD)-3 beta criteria.
Classification ; Cluster Headache ; Dental Clinics* ; Diagnosis* ; Headache Disorders ; Headache Disorders, Primary ; Headache* ; Migraine Disorders ; Temporomandibular Joint Disorders ; Tension-Type Headache ; Trigeminal Autonomic Cephalalgias

A femoral neck stress fracture in child is rare, particularly in bilateral case. It is easy to miss initially or may be misdiagnosed. The authors experienced a case of bilateral femoral neck stress fracture in a 10-year-old boy with bilateral hip. The patient was successfully healed by conservative treatment. We report this rare case with a review of the literature. A femoral neck stress fracture should be included in the differential diagnosis in children who present with sustained hip or groin pain.
Child* ; Diagnosis, Differential ; Femur Neck* ; Fractures, Stress* ; Groin ; Hip ; Humans ; Male

Allergic bronchopulmonary aspergillosis(ABPA) is a syndrome seen in patients with asthma and cystic fibrosis. It is characterized by chronic cololinization of the airways with a ubiquitous fungus, Aspergillus fumigatus. Clinically, it is a syndrome characterized by recurrent episodes of wheezing, mucus production, pulmonary infiltrates, and elevated levels of serum IgE. ABPA patients are also accompanied with bronchiectasis in 89% and observed in 10% of cystic fibrosis that show the features of end-stage lung pattern. There are few reports of ABPA associated with bullae. We will report here a case of ABPA developing in an old cicartrical and bullous lesion of a lung.
Aspergillosis, Allergic Bronchopulmonary* ; Aspergillus fumigatus ; Asthma ; Blister ; Bronchiectasis ; Cystic Fibrosis ; Fungi ; Humans ; Immunoglobulin E ; Lung* ; Mucus ; Respiratory Sounds

BACKGROUND: Although lung involvement has been reported in 5 to 46% of dermatomyositis/polymyositis (DM/PM) patients, reports of the condition in Korea are rare. This study evaluated the clinical features of lung involvement in DM/PM patients. METHODS: The medical records, laboratory results and radiologic findings of 79 DM/PM patients, who attended the Seoul National University Hospital (SNUH) between 1989 and 1999, were reviewed retrospectively. RESULTS: A total 79 patients of whom 24 patients(33%) showed lung involvement, were enrolled in this study. More patients with lung involvement were female(F:M=11:1), and older compared with those without lung involvement. Patients with lung involvement presented with dyspnea(79%), coughing(67%), an elevated ESR, and CK/LD. Anti-Jo 1 antibody test was positive in 30%, which is significantly higher in patients with lung involvement. A simple chest X-ray of the patients with lung involvement exhibited reticular opacity(50%), reticulonodular opacity(30%), patchy opacity(29%), nodular opacity(13%) and linear opacity(4%). HRCT(n=24) showed ground glass opacity(75%), linear or septal thickening(50%), patchy consolidation(42%), honey-combing(33%) and nodular opacity(17%). The pulmonary function test showed a restrictive ventilatory pattern(77%) and a lower diffusing capacity(62%). The patients were followed up during a mean duration of 30±28 months. They were treated with steroid only(50%) or a combination of steroids and cytotoxic agents(46%). Muscle symptoms were improved in 89% with treatment, but an improvement in the respiratory symptoms or in the pulmonary function test was rare. Patients with lung involvement had a higher mortality rate(21%) than those without lung involvement(10%) during the follow-up periods. CONCLUSION: DM/PM patients with lung involvement were mostly female, older and had a higher positive rate Anti-Jo 1 antibodies, but there was no significant difference in prognosis.
Antibodies ; Dermatomyositis ; Female ; Follow-Up Studies ; Glass ; Humans ; Korea ; Lung Diseases, Interstitial ; Lung* ; Medical Records ; Mortality ; Polymyositis ; Prognosis ; Respiratory Function Tests ; Retrospective Studies ; Seoul ; Steroids ; Thorax