We experienced a patient who manifested Miller-Fisher syndrome initially, and progressed relapsing ataxia later, There was electrophysiologic evidence of distal sensory polyneuropathy with completely sparig of somatic motor nerves. Sural nerve biopsy showed severe segmental demyelination. All the symptoms improved by intravenous immunoglobulin dramatically but after a period of remission, progressive ataxia reappeared. Plama exchange had some effect and prednisolone alone showed no definite improvement. High dose of prednisolone combined with IVIgG made remission for a long time. We believe that this patient had an unusual form of inflammatory polyneuropathy, a relapsing variant of the Miller-Fisher syndrome of acute idiopathic polyneuritis. In this case, IVIgG was the most effective therapy and prednisolone was added as a long term therapy successfully.
Ataxia* ; Biopsy ; Demyelinating Diseases ; Humans ; Immunoglobulins ; Miller Fisher Syndrome* ; Neuritis ; Polyneuropathies ; Prednisolone ; Sural Nerve

STUDY DESIGN: Retrospective study. OBJECTIVES: To evaluate the effectiveness of microdiscectomy under local anesthesia in comparison with general anesthesia. SUMMARY OF LITERATURE REVIEW: No co RESULTS: Between both groups there is no significant operation time difference. However, the average hospital stay duration in the general anesthesia group was 7.3 days, while it was 4.7 days in the local anesthesia group (P<0.05). The VAS and ODI scores were improved in both groups. Thirty-two cases (84.2%) of the general anesthesia group and 40 cases (80%) of the local anesthesia group showed satismparative studies regarding the outcomes of microdiscectomy under local and general anesthesia could be found in the literature. MATERIALS AND METHODS: Between May 2000 and June 2004, 88 patients who underwent microdiscectomy under local anesthesia (n=50, local anesthesia group) or under general anesthesia (n=38, general anesthesia group) were selected and included in this study with a follow up period more than 3 years. The operation time and duration of hospital stay were documented. The Visual Analogue Scale (VAS) and the Oswestry Disability Index (ODI) were used to evaluate the degree of symptom relief. The patient satisfaction was evaluated using the MacNab's criteria and postoperative complications.fied results by the MacNab's criteria with no statistically significant difference (P>0.05). Three patients in the general anesthesia group and 7 patients in the local anesthesia group needed a reoperation. CONCLUSIONS: A microdiscectomy under local anesthesia shows faster recovery period. But it shows also a relative high revision rate. In patients with old age and underlying disease, local anesthesia can be used for the microdiscectomy selectively and careful exploration of the herniated disc is required.
Anesthesia, General* ; Anesthesia, Local ; Diskectomy* ; Follow-Up Studies ; Humans ; Intervertebral Disc Displacement ; Length of Stay ; Patient Satisfaction ; Reoperation ; Retrospective Studies

No abstract available.
Lung*

We report a case of secretory carcinoma with axillary lymph node metastasis in a 21-year old woman. She was aware of a mass in her breast for 10 years and noticed a rapid growth of the preexisting mass during the last years. Histologically, the tumor was composed of micropapillary and microcystic or cribriform glandular structures which contained eosinophilic, mucinous, intraluminal secretions. The center had a dense hyalinized strama with a solid infiltrative growth of tumor cells with intracytoplasmic secretory vacuoles at the periphery. In addition, marked intraductal papillary epithelial proliferations were present at the superficial portions of the tumor near the nipple. Prognostic factors and their relationship to juvenile papillomatosis are discussed with a review of the literature.
Female ; Humans ; Neoplasm Metastasis ; Breast Neoplasms

Membranous lipodystrophy is a peculiar type of fat necrosis, present in patients with various types of skin diseases. It is charaeterized by the presence of microcysts and macrocysts lined by amorphous eosinophilic material with a crenelated arabesque appearance and microgranules in the subcutis with massive fat necrosis. The eosinophilic lining and microgranules stain positively with periodic acid-Schiff, are resistant to diastase, and also stain with Sudan black B. We report three cases of subcutanous membranous lipodystrophy in patients with erythema induratum, posttraumatic panniculitis and morphea with typical clinical and histopathologic findings.
Amylases ; Eosinophils ; Erythema Induratum ; Fat Necrosis ; Humans ; Lipodystrophy* ; Panniculitis ; Scleroderma, Localized ; Skin Diseases ; Sudan

Eosinophilic panniculitis is characterized by a prominent infiltration of numerous eosinophils in subcutaneous fat, and has been identified in patients with a variety of associated clinical conditions. A case of eosinophilic panniculitis in a 20-year-old woman with a history of atopic dermatitis is reported. She later developed superior sagittal sinus thrombosis, and we stress the importance of systemic evaluations in patients with eosinophilic panniculitis.
Dermatitis, Atopic ; Eosinophils* ; Female ; Humans ; Panniculitis* ; Subcutaneous Fat ; Superior Sagittal Sinus* ; Thrombosis* ; Young Adult

The congenital renal cystic disease encompasses a complex group of pathologic and clinical entities. We retrospectively reviewed 42 cases of congenital renal cystic lesions classified into four Potter types in a series of 2,063 consecutive autopsies from 1981 to 1996. According to our study based on morphologic, clinical, genetic features and associated anomalies, type I and III are relatively compatible with Potter's original definition. However, it was reasonable that type II and IV are classified to the same group because of: 1) very similar histologic findings representing dysplastic kidney, 2) many associated anomalies, 3) no evidence of inheritance, and 4) presence of a combined type. Syndrome associated cysts, such as Meckel-Gruber syndrome, were also separately classified. If the dysplastic evidence was insufficient for diagnosis to the dysplastic kidney in type II and IV, then these cases would be better classified into a cystic disease associated with congenital hydronephrosis. We propose a classification of the congenital cystic disease of the kidney to be: 1) dysplastic kidney, 2) cystic disease associated with congenital hydronephrosis, 3) polycystic kidney, and 4) syndromic cystic disease.
Autopsy ; Classification* ; Diagnosis ; Hydronephrosis ; Kidney* ; Polycystic Kidney Diseases ; Retrospective Studies ; Wills

Three patients with complex partial seizures had dysembryoplastic neuroepithelial tumor (DNET) in temporal lobe. In all cases, longterm video-EEG monitoring showed epileptogenic focus in left temporal lobe where small mass lesion was located. For further seizure localization and functional mapping, subdural grids were placed on left temporal lobe including lesions. Lateral temporal lobectomy with lesionectomy was performed in two cases. Lateral temporal lobe resection and amygdalohippocampectomy was done in one case. The pathological findings of all lesions were characterized by intracortical location, multiple nodular architecture, foci of dysplastic cortical disorganization and the presence of a specific glioneuronal element. All patients have been seizure free.
Epilepsy, Temporal Lobe* ; Humans ; Neoplasms, Neuroepithelial* ; Seizures ; Temporal Lobe*

BACKGROUND: The prevalence of metabolic syndrome in Korean is gradually increasing. Metabolic syndrome shows different patterns depending on gender and socioeconomic status. We investigated the differences in incidence of metabolic syndrome according to gender and socioeconomic status using a community cohort of middle-aged Korean. METHODS: The study included 5,544 subjects (2,733 men and 2,811 women) aged 40-69 years without metabolic syndrome, diabetes, or history of cardiovascular disease at baseline. The incidence of metabolic syndrome was estimated according to gender and socioeconomic status, and the association between socioeconomic status and incidence of metabolic syndrome was examined using Cox's proportional hazard regression analysis. RESULTS: The incidence density of metabolic syndrome was 53/1,000 person-years in men and 52/1,000 person-years in women during the mean follow-up period of 6.01 years. After adjusting for common risk factors, the hazard ratios (HRs) for metabolic syndrome for those with high, middle, and elementary school education levels compared to the college graduate or higher group (referent) were 1.07 (95% CI, 0.76-1.51), 1.73 (95% CI, 1.23-2.44), and 1.74 (95% CI, 1.23-2.46) in women, respectively, and compared to the more than 400 (10,000 won) group (referent), the HRs for metabolic syndrome according to income level were 1.56 (95% CI, 1.06-2.29), 1.86 (95% CI, 1.28-2.71), and 2.74 (95% CI, 1.87-4.00) in women, respectively. However, the association between socioeconomic status and incidence of metabolic syndrome was not significant in men. CONCLUSION: The association between incident metabolic syndrome and socioeconomic status was significant in middle-aged Korean women.
Adult ; Cardiovascular Diseases ; Cohort Studies ; Education ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Prevalence ; Risk Factors ; Social Class

OBJECTIVE: The maturation in the central nervous system and the myelination of visual pathway were shown to be reflected by the visual evoked potential (VEP) response recordings. The purpose of this study was to establish normal value of flash visual evoked potentials in preterm infants, especially left to right difference. METHOD: Forty-one preterm infants from 31 to 40 weeks of corrected age had been made VEP records using Cadwell Excel EMG/EP system. Some in whom weekly VEP records had been made at least 3 times were included in longitudinal study and others in occasionally VEP records were included in cross-sectional study. Infants with neurological problems or anomalies, perinatal infectious and other severe systemic disease were excluded. RESULTS: 1) In the VEP study, we were able to establish the reference ranges for N300 peak latency at various corrected ages. 2) The latency of N300 peak latency was not significantly correlated with birth weight, sex, head circumference. 3) The latency of N300 peak decrease linearly, the age increased and also the decrement of N300 peak latency was accelerated at 37 weeks of gestational ages. CONCLUSION: Although VEPs from preterm infants have several peaks, N300 latency is the most prominent and the most reproducible. It has been considered the most important component of the preterm VEPs.
Birth Weight ; Central Nervous System ; Cross-Sectional Studies ; Evoked Potentials, Visual* ; Gestational Age ; Head ; Humans ; Infant ; Infant, Newborn ; Infant, Premature* ; Longitudinal Studies ; Myelin Sheath ; Reference Values ; Visual Pathways