Dermatofibroma with granular cells is composed mainly of spindle shaped cells mixed with in-conspicuous foamy cells that contain granular cytoplasm. We present a case of dermatofibroma with granular cells in a 36-year-old male who visited our clinic to evaluate a slow-growing nodule on the medial side of the left lawer leg. He have had the nodule for five years and sometimes felt an itching sensation. Biopsy of the nodule identified a dermal nodular tumor showing cellular spindle cell proliferation admixed with peripheral foamy histiocytes. With the immunohistochemical staining, the granular cell was positive for alpha-1-antitrypsin and CD68, and negative for S-100. A few electron-dense granules were seen in the cytoplasm on the electronmicroscopic study. These results suggested that the granular cells originated from histiocytes.
Adult ; Biopsy ; Cell Proliferation ; Cytoplasm ; Histiocytes ; Histiocytoma, Benign Fibrous* ; Humans ; Leg ; Male ; Pruritus ; Sensation

No abstract available.
Giant Lymph Node Hyperplasia* ; Paraproteinemias*

No abstract available.
Spine*

No abstract available.
Cataract* ; Chlorpromazine* ; Skin Pigmentation* ; Skin*

It has been known that right ACA occlusions can cause callosal disconnection syndrome. A 61-year old right-handed man was admitted because of a left ACA occlusion. MRI showed infarction of the medial frontal cortex and the anterior two-thirds of the corpus callosum. He presented with weakness and gait initiation failure in the right leg with grasp reflex, suspicious alien hand sign, and tactile anomia in the right hand. He was diagnosed with transcortical motor aphasia. He was unable to successfully complete written tasks in response to dictations and writing down spontaneous answers. He wrote down incorrect words and demonstrated paragraphism with his left hand. He could copy simple items but not written words and complex items with his left hand. Finally, he had difficulties in writing answers in response to complex verbal and written commands with his left hand, but preserved the ability to simple verbal commands, somato-sensory, and visually guided tasks. We attribute these results to the anterior callosal disconnection of the right sensorimotor cortex from the left language area.
Anomia ; Anterior Cerebral Artery ; Aphasia, Broca ; Corpus Callosum ; Emigrants and Immigrants ; Gait ; Hand ; Hand Strength ; Humans ; Infarction ; Leg ; Magnetic Resonance Imaging ; Middle Aged ; Reflex ; Writing

BACKGROUND: The neuroprotective effects of 1,25-dihydroxyvitamin D3 on neurotoxicity have already been documented. However, the mechanisms underlying these effects are not fully understood. Extracellular signal-regulated kinase (ERK), one of the mitogen-activated protein kinases (MAPKs), is a serine-threonine kinase activated by phosphorylation in response to a variety of extracellular mitogenic or stress signals. The ERK signaling cascade plays an important role in the regulation of several cellular processes that include mainly proliferation, but differentiation, survival and ERK activation has also been linked to neuroprotection. We explored whether 1,25-dihydroxyvitamin D3 protects against kainic acid-induced toxiticy on neurons and, if so, whether the 1,25-dihydroxyvitamin D3 protection is mediated by ERK. METHODS: Experiments were carried out on Sprague-Dawley rats. Under anesthesia, a solution containing the drug being investigated (e.g. 1.25-dihydoxyvitamin D3) was stereotaxically infused into the hippocampus or ventricle. In the rat hippocampus, brain slices were stained with cresyl violet for the visualization of neuronal cell bodies and ERK phophorylation was assayed. RESULTS: The injection of kainic acid into the hippocampi of male rats produced a loss of cresyl violet-stained neurons. Pretreatment with U0126, an inhibitor of MAPK/ERK kinase, inhibited the rapid activation of ERK by 1,25-dihydroxyvitamin D3 in the rat hippocampus. Moreover, the neuroprotective effects of 1,25-dihydroxyvitamin D3 against kainic acid toxicity were blocked by the pretreatment with U0126. CONCLUSIONS: These results indicate that ERK mediates 1,25-dihydroxyvitamin D3 neuroprotection after kainic acid toxicity in the rat hippocampus.
Anesthesia ; Animals ; Brain ; Calcitriol ; Hippocampus* ; Humans ; Kainic Acid ; Male ; Mitogen-Activated Protein Kinases ; Neurons ; Neuroprotective Agents ; Phosphorylation ; Phosphotransferases ; Protein-Serine-Threonine Kinases ; Rats* ; Rats, Sprague-Dawley ; Viola

Postpartum hemorrhage is a common cause of maternal mortality; its main cause is placenta accreta. Therapeutic hypothermia is a generally accepted means of improving clinical signs in postcardiopulmonary resuscitation patients. A 41-year-old pregnant woman underwent a cesarean section under general anesthesia at 37 weeks of gestation. After the cesarean section, the patient experienced massive postpartum bleeding, which led to cardiac arrest. Once spontaneous circulation returned, the patient underwent an emergency hysterectomy and was placed under therapeutic hypothermia management. The patient recovered without neurological complications.
Adult ; Anesthesia, General ; Cesarean Section ; Emergencies ; Female ; Heart Arrest* ; Hemorrhage ; Humans ; Hypothermia ; Hypothermia, Induced* ; Hysterectomy* ; Maternal Mortality ; Placenta Accreta ; Postpartum Hemorrhage* ; Postpartum Period* ; Pregnancy ; Pregnant Women ; Resuscitation

Medico-legal investigations in Korea depend mostly on postmortem inspection without autopsy. Both untrained physicians and experienced forensic pathologists may not be able to determine the cause and manner of death only by postmortem inspection. The aim of our study was to show the limitations of postmortem inspection by evaluating the discrepancy between the results of postmortem inspection and autopsy after natural death. The manner of death by postmortem inspection changed to unnatural death in 9.4% of the cases (12 cases/127 cases) after autopsy. The cause of death in most cases was consumption of alcohol, agricultural chemicals, and antipsychotic intoxication. The cause of death by postmortem inspection changed in 24.3% of the cases (26 cases/107 cases) among cases of confirmed natural death after autopsy. The positive predictive value of cause of death by postmortem inspection was higher for cardiovascular disease (79.0%) and lower for chronic alcoholism and/or chronic liver disease (28.6%). This study shows that forensic pathologists could make considerable errors in determining the cause and manner of death without autopsy and emphasizes the necessity to refine medico-legal investigations in Korea by introducing the limited autopsy with toxicologic study and supportive postmortem imaging.
Agrochemicals ; Alcoholism ; Autopsy ; Cardiovascular Diseases ; Cause of Death ; Korea ; Liver Diseases

The posterior tibial nerve was partially blocked with 7% phenol solutions for the relief of severe spasticity in cerebral palsy and brain injured patients. Forty patients were included in this study. Among them thirty five patients were cerebral palsy and five patients were brain injured. A phenol injection was performed to the posterior tibial nerve at the popliteal fossa with the patients in a prone position. Total injected dose in each patient was 0.40 to 4.00 cc (average 2.06 0.96 cc). The dose was far below the toxic level and no significant side effects were noted except for a few cases of local paresthesia and tenderness. The range of dorsiflexion of the ankle was increased and the gait pattern improved in most of the patients one month after the injection. The H-reflex latency was prolonged after the injection compared with the pre-injection latency. The phenol injection can greatly facilitate the rehabilitation process of the patient by reducing the need for physical therapy and bracing, increasing the patient's ambulation ability, and decreasing the development of secondary leg deformities. In conclusion, with the easiness, simplicity, safety, low cost, and a selective reduction of spasticity in the group of muscles, the remarkable therapeutic benefits of posterior tibial nerve blocked with 7% phenol solutions warrant the more widespread use of this technique in younger cerebral palsy patients before developing fixed soft tissue contractures.
Ankle ; Braces ; Brain ; Cerebral Palsy ; Congenital Abnormalities ; Contracture ; Gait ; H-Reflex ; Humans ; Leg ; Muscle Spasticity ; Muscles ; Paresthesia ; Phenol* ; Prone Position ; Rehabilitation ; Tibial Nerve* ; Walking

BACKGROUND: Hypertension is the major risk factor for cardiovascular disease. The increased left ventricular mass has been recognized as an independent predictor of morbidity and mortality in hypertensive patients. The assessment of the regression of left ventricular(LV) mass after antihypertensive therapy offers prognostic information. 2D echocardiography has proved a sensitive tool for the detection of the change of LV mass. METHOD: LV mass and LV mass index were measured by area-length method of 2D echocardiography in 26 hypertensive patients and 10 normal control to evaluate the effect of betablocker(group I, n=16) and angiotensin converting enzyme(ACE) inhibitor(group II, n=10) on the regression of LV mass. RESULT: There was a significant increase of LV mass and LV mass index in the hypertensive patients(199.0+/-37.7gm, 119.2+/-21.2gm/m2) compaired to the control(129.7+/-11.7gm, 87.4+/-8.8gm/m2)(p<0.01, p<0.01). After 13.1 week treatment, LV mass was significantly decreased in group I(200.9+/-35.3gm vs 164.7+/-25.4gm)(p<0.01) and group II(195.9+/-43.3gm vs 152.4+/-27.1gm)(p<0.01). The LV mass index was also significantly decreased in group I(120.3+/-20.7gm/m2 vs 98.8+/-15.5gm/m2)(p<0.01) and group II(117.5+/-22.9gm/m2 vs 91.5+/-13.6gm/m2)(p<0.01). CONCLUSION: This results showed that LV mass can be reduced in hypertensive patients who receive beta blocker and ACE inhibitor. The effect of antihypertensive therapy on LV mass should be considered in treatment of the hypertensive patients who had hypertrophied LV.
Angiotensins ; Cardiovascular Diseases ; Echocardiography ; Humans ; Hypertension ; Mortality ; Risk Factors