No abstract available.
Adaptation, Psychological* ; Conversion Disorder* ; Somatoform Disorders*

No abstract available.
Adaptation, Psychological* ; Conversion Disorder* ; Somatoform Disorders*

A 56-year-old woman presenting a 10-year history of atrophic discoid patches with underlying subcutaneous nodules was seen. These skin lesions were distributed on the upper arms bilaterally. Biopsy specimens taken from the lesional skin showed epidermal and dermal changes consistent with the discoid lesions of the cutaneous lupus erythematosus. Deep dermis and subcutaneous fat tissue revealed sclerosis and fibrinoid alterations of the collagen and necrosis of fat cells, the features corresponding to the lupus ei ythematosus profundus. She had no laboratory evidences suspective of systemic lupus erythematosus or other connective tissue diseases. This patient with lupus erythernatosus profundus which cleveloped subsequent to the discoid lesion is consiclered to be a rarely encounteririg observation in lupus erythematosus.
Adipocytes ; Arm ; Biopsy ; Collagen ; Connective Tissue Diseases* ; Connective Tissue* ; Dermis ; Female ; Humans ; Lupus Erythematosus, Cutaneous ; Lupus Erythematosus, Systemic ; Middle Aged ; Necrosis ; Panniculitis, Lupus Erythematosus* ; Sclerosis ; Skin ; Subcutaneous Fat

No abstract available.

Ossification of the ligamentum flavum(OLF) is a well recognized cause of acquired spinal canal stenosis resulting in myelopathy, radiculopathy, or a combination of both. OLF is extremely rare in caucasian patients, but is one of the most common causes of compression of the posterior thoracic spinal cord in Japan. In most cases, it has been found in the thoracolumbar regions, and rarely in the cervical region. It is frequently but not alwalys found in association with ossification of the posterior longitudinal ligament(OPLL) and may cause cumulative damage, if comhined with OPLL. We experienced a case of ossification of the ligamentum flavum and posterior longitudinal ligament with sacral radiculopathy, which was treated hy posterior decompressive laminectomy and removal of the ossified ligamentum flavum and posterior longitudinal ligament. The day after operation, the radiating pain and paresthesia dramatically improved.
Constriction, Pathologic ; Humans ; Japan ; Laminectomy ; Ligamentum Flavum* ; Longitudinal Ligaments* ; Paresthesia ; Radiculopathy* ; Spinal Canal ; Spinal Cord ; Spinal Cord Diseases

We describe herein four cases of childhood dermatomysitis of Brunsting type. The ages of these patients were between 7 to 10 years at the time of the disease. All four patients had pathognomOnic cutaneous changes, such as heliotrope erythema and Gottron's papules, which are not seen frequently in adult type dermatomyositis. These patients did not show any marked serologic abnormalities suggestive of having other connective tissue diseases or autoimmune diseases. All patients were initially treated with prednisolone and chloroquine, and have been under control with low dose prednisolone, or chloroquine alone.
Autoimmune Diseases ; Chloroquine ; Connective Tissue Diseases ; Dermatomyositis* ; Erythema ; Humans ; Prednisolone

Typical features of Ankylosing spondylitis are progressive ankylosis of the sacroiliac joint and ossification of the annulus fibrosus of discs, interlaminar & interspinous ligaments. Fixed kyphotic deformity in ankylosing spondylitis causes many problems, such as difficulty in looking forward, gastrointestinal problems, restricted cardiopulmonary functions and psychotic depression. There are limitations of conservative treatment to delay progression of the disease. So surgical osteotomy for the correction is inevitable. Osteotomy is indicated in poor horizontal vision, poor cardiopulmonary & gastrointestinal function and psychological & social problem. The purpose of this study is to assess the results of posterior closed wedge osteotomy in ankylosed kyphotic deformity. The posterior closed wedge osteotomy was performed for 30 patients in ankylosed kyphotic deformity between April 1995 and February 1997, who were 29 male and 1 female and whose average age at the time of operation was 35.7 years (17-54 yrs). Mean duration of the symptoms was 18 years (11-23 yrs). The level of correction was fully evaluated preoperatively with anterior and lateral radiographs of whole spine. The patient was placed pronely on an operating table which could be angulated in reverse direction. The determined correction level of the spine was exposed through the posterior midline approach. Following the insertion of pedicle screws, transpedicular decancellation was performed with curret and punch forceps. Posterior bony element and pedicle were completely removed. The correction was achieved by gradual extension of the operating table angulated previously and by opposing the surface of osteotomy. Then prebent rod was applied. Walking brace was applied in 2 weeks postoperatively. The osteotomy was performed at single level in 28 cases, double level in 2 cases. The level of osteotomy was distributed as follows; T10: 1 case, T12: 1 case, L2: 3 cases, L3: 14 cases, and L4: 13 cases. Mean correction angle was 48.7degrees (13degrees-72degrees ), and mean increment of height 13.7cm (4-23.5cm). There was no fatal complication. But 5 patients had paralytic ileus and 3 patients visual loss; one was permanent, the others were temporary. Temporary neurologic deficit was also noted in 5 cases. Posterior closed wedge osteotomy with transpedicular decancellation in ankylosed kyphotic deformity is relatively safe and simple procedure.
Ankylosis ; Braces ; Congenital Abnormalities* ; Depression ; Female ; Humans ; Intestinal Pseudo-Obstruction ; Ligaments ; Male ; Neurologic Manifestations ; Operating Tables ; Osteotomy* ; Sacroiliac Joint ; Social Problems ; Spine ; Spondylitis, Ankylosing* ; Surgical Instruments ; Walking

INTRODUCTION: The fixation strength of transpedicular screw system in the vertebral hody relied on bone quality and anatomical characteristics of vertebral pedicle, designs of screw and types of connection(rod or plate) with screw. The purpose of this study is to verify the biomechanical nature of the transpedicular fixation in spine under various conditions with porcine vertebrae. MATERIAL AND METHOD: Fresh porcine vertebrae and the custom-made screws were used in this experiment. To reduce the errors caused by vertebral bodies of different size and quality, vertebral bodies having regular range of pedicular width(10.0 to 11.5mm) and hone density(more than 1.0 gm/cm2) were used. The pedicle screws were inserted in the same procedure and axial pull out test was performed with using the Material Testing System(lntron8511, Canton, USA). The experiments were performed in four types to assess the difference of strength accroding to designs of the screw hy using two group of screws. The first group of screw was designed according to the outer and inner diameter and the second group was designed according to the shape, pitch, and thread profile of screw. Experiment I was perfomed to evaluate the effect of screw diameters on the biomechanical pull-out strength hy using the first group of custom-made pedicle screw which fixed all other factors except the diameter of screw. Experiment I was to verify the effect of screw shape, experiment III to verify the effect of pitch and experiment IV to verify the effect of thread profile. RESULTS: The results of experiments were summarized as follows: Experiment I showed that the screw of larger outer diameter had greater holding strength. Experiment II showed that the holding strength of cylindrical shaped screw is superior to that of conical shaped screw. Experiment III showed that there is no statistical significance between different modes of pitch. Experiment IV showed that the holding strength of buttress shape of thread profile is superior to that of V-shape. CONCLUSION: It seemed that the fixation strength of the screw was more powerful with 1 mm increment of outer diameter in 4-7mm of outer diameter, 3mm of pitch and buttress shape of thread of the screw with the same operation technique.
Spine

No abstract available.
Intracranial Thrombosis*

OBJECTIVE: To describe normal postoperative MR findings and MR findings of postoperative discitis in patients who underwent operation due to herniated intervertebral disc. MATERIALS AND METHODS: We retrospectively reviewed normal postoperative MR findings and MR findings of discitis in 30 patients(21-61yrs.) (13 cases dignosed as discitis and 17 cases as normal) who previonsly underwent laminectomy and discectomy, or bony fusion. We analyzed signal intensity of end plate and disc, end plate destruction, and enhancement of end plate and disc on T1- and T2-weighted images(WI) of 1.5T MRI. RESULTS: Among 14 out of 17 patients with no evidence of discitis, 7 patients showed high signal of the posterior portion of disc on T1- and T2-WI and 11 patients revealed enhancement at the same sites. In all 13 patients suspected of having discitis, end plate and disc showed low signal on T1-WI, high signal on T2-WI, heterogeneous enhancement, and irregular destruction of end plate. Meanwhile, 3 cases with no evidence of postoperative discitis clinically who underwent bony fusion showed similiar findings to those of the above 13 patients, except for homogeneous enhancement of end plate and vertebral body. CONCLUSION: The MR findings of postoperative discitis were low signal on T1-WI, high signal on T2-WI, and heterogeneous enhancement of and plate and disc, and destruction of end plate.
Discitis* ; Diskectomy ; Humans ; Intervertebral Disc* ; Laminectomy ; Magnetic Resonance Imaging ; Retrospective Studies