We presented here a case of an 80-year-old male patient who was, confirmed in the typical tumor stage of Mycosis fungoide by skin biopay. Relatively well-defined, brown-colored, round patches were found about 3 years ago on the chest, abdomen and inguinal area. He had received some treatment at several private clinics uder the impression of seborrheic dermatitis, paoriaais and eczematoid dermatitis. However, the skin manifestations were not improved t.ut rarther increased in eize, similarly to tinea corporis. Two months ago, firm nodules and tumors developecl a new on the lesinn sites, assoviated with intense pruritus and ulcerative tendency. We tried radiation therapy, but due to old age the patient chose to discontinurue.
Abdomen ; Aged, 80 and over ; Dermatitis ; Dermatitis, Seborrheic ; Humans ; Male ; Mycosis Fungoides* ; Pruritus ; Skin ; Skin Manifestations ; Thorax ; Tinea ; Ulcer

BACKGROUND: Tracheal intubation commonly results in sympathetic stimulation manifested by increased heart rate and arterial blood pressure. This study was carried out to determine whether lightwand would result in less hemodynamic changes than direct laryngoscopy. METHODS: With informed consent, fourty healthy female patients scheduled of elective surgical procedures were randomly allocated into two groups; lightwand (LW) or direct laryngoscopy (DL) group. Mean arterial pressure (MAP) and heart rate (HR) were recorded upon arrival. Under a standardized anesthetic technique, the patients were intubated either with no. 3 curved blade direct laryngoscopy (DL group) or with lightwand (LW group). The MAP and HR were recorded before intubation and every 1 minutes following intubaion. Time to intubation (TTI) was also recorded. All patients were intubated by a same fourth grade resident. RESULTS: Fourty patients were studied. Every intubation was successed in first attempt. The TTI was significantly shorter in LW group. Even while there was no significant difference in HR changes, there was significant difference in the increase of MAP following intubation. The increase of MAP was significantly greater with DL than with LW. CONCLUSIONS: This study suggests that lightwand intubation requires shorter TTI and may give rise to less blood pressure change than direct laryngoscopy. So we found no difference in disadvantage and may offers advantage in terms of hemodynamic stability.
Arterial Pressure* ; Blood Pressure ; Female ; Heart Rate* ; Heart* ; Hemodynamics ; Humans ; Informed Consent ; Intubation ; Intubation, Intratracheal* ; Laryngoscopy* ; Surgical Procedures, Elective

No abstract available.
Central Nervous System*

OBJECTIVE: The goal of study is the evaluation of clinicofunctional outcomes and fusion success rates of unilateral posterior lumbar interbody fusion(PLIF) using cages. METHODS: The authors conducted retrospective study of 81 patients who underwent unilateral PLIF using cages. The outpatient notes, standard hospital charts, and pre-and postoperative imaging studies were analyzed. In this study pre-and postoperative back pain, radiating pain, fusion success rates, pseudoarthrosis, clinicofunctional outcome, and complications were evaluated. Follow-up duration ranged from 3 to 8 years. RESULTS: Eighty-one patients underwent unilateral PLIF using 98 cages(TFC:37, CH cage:25, Novus cage 36). Two-level fusion was performed in 17 patients. There were 48 men(59%) and 33 women(41%). Seventh decade was most common(47%). The most common site of PLIF was at L4-5 space(69.4%) and left side(58%) was prevalent. Fusion was successful in 91 out of 98 levels(92.8%) and pseudoarthrosis was observed in five patients(7 level, 7%). The clinicofunctional results by Prolo scale were as follows:good(score 8-10):80.3%, moderate(score 6-7):14.8%, poor(score 5 or less 5):4.9%. Device migration was observed in six cases:5(20%) of 25 CH cages and 1(2.8%) of 36 Novus cages. CONCLUSION: Unilateral PLIF using cage is one of method to decrease the rates of iatrogenic complications in patient of unilateral symptomatic spinal instability while preserving normal anatomic structures with good fusion success rates and clinicofunctional results after surgery.
Back Pain ; Follow-Up Studies ; Humans ; Outpatients ; Pseudarthrosis ; Retrospective Studies

Monoclonal gammopathy occurs in one-third of the patients with mucosa-associated lymphoid tissue lymphoma (MALT lymphoma). However, monoclonal gammopathy has been rarely reported in Korea. Paraprotenemia accompanying MALT lymphoma is strongly correlated with involvement of the bone marrow, and this involvement leads to the progression of the disease. Here, we present a case of a 66-yr-old man diagnosed with IgM monoclonal gammopathy and stage IV extranodal marginal zone lymphoma of the small intestine, with the involvement of the bone marrow.
Aged ; Antineoplastic Agents/therapeutic use ; Bone Marrow/pathology ; Drug Therapy, Combination ; Electrophoresis, Polyacrylamide Gel ; Humans ; Immunoglobulin M/analysis ; Intestinal Neoplasms/complications/drug therapy/*pathology ; Lymphatic Metastasis ; Lymphoma, B-Cell, Marginal Zone/complications/drug therapy/*pathology ; Male ; Neoplasm Staging ; Paraproteinemias/blood/complications/*pathology ; Positron-Emission Tomography ; Tomography, X-Ray Computed

Background: Impaired diastolic heart function has been observed in persons with non-alcoholic fatty liver disease (NAFLD) and/or with type 2 diabetes mellitus (T2DM). However, it is unclear whether NAFLD fibrotic progression, i.e., non-alcoholic steatohepatitis, poses an independent risk for diastolic dysfunction in T2DM. We investigated the association between liver fibrosis and left ventricular (LV) diastolic dysfunction in T2DM. Methods: We analyzed 606 patients with T2DM, aged ≥50 years, who had undergone liver ultrasonography and pulsed-wave Doppler echocardiography. Insulin sensitivity was measured by short insulin tolerance test. Presence of NAFLD and/or advanced liver fibrosis was determined by abdominal ultrasonography and NAFLD fibrosis score (NFS). LV diastolic dysfunction was defined according to transmitral peak early to late ventricular filling (E/A) ratio and deceleration time, using echocardiography. Results: LV diastolic dysfunction was significantly more prevalent in the NAFLD versus non-NAFLD group (59.7% vs. 49.0%, P=0.011). When NAFLD was stratified by NFS, subjects with advanced liver fibrosis exhibited a higher prevalence of diastolic dysfunction (49.0%, 50.7%, 61.8%; none, simple steatosis, advanced fibrosis, respectively; P for trend=0.003). In multivariable logistic regression, liver fibrosis was independently associated with diastolic dysfunction (odds ratio [OR], 1.58; 95% confidence interval [CI], 1.07 to 2.34; P=0.022) after adjusting for insulin resistance and cardiometabolic risk factors. This association remained significant in patients without insulin resistance (OR, 4.32; 95% CI, 1.73 to 11.51; P=0.002). Conclusions Liver fibrosis was associated with LV diastolic dysfunction in patients with T2DM and may be an independent risk factor for diastolic dysfunction, especially in patients without systemic insulin resistance.

BACKGROUND: The aim of this study was to evaluate the positive rates of hepatitis B surface antigen (HBsAg) and antibody to hepatitis C virus (anti-HCV) in patients with hepatocellular carcinoma (HCC), and to estimate the risk of developing HCC in association with HBsAg or anti- HCV positivity. METHODS: HBsAg and anti-HCV (anti-c22-3 and anti-c200) were tested by enzyme immunoassay in 892 patients with HCC from 1991 to 1994. Data regarding the prevalence of these hepatitis markers in 4,269 healthy blood donors were obtained from the Central Blood Center of the Korea Red Cross and used for case-control study. RESULTS: The positive rate of HBsAg was 72.3% (645/892) in patients with HCC and 2.7% (117/ 4,269) in blood donors, while that of anti-HCV was 7.6% (68/892) in patients with HCC and 0.3% (11/4,269) in blood donors. Six hundreds and thirty-six among 892 patients with HCC (71.3%) were only positive for HBsAg, 59 (6.6%) were only anti-HCV positive, and 9 (1.0%) were positive for both HBsAg and anti-HCV. The odds ratio (with 95% confidence interval: CI) comparing patients with HCC to healthy blood donors were 17.8 (CI: 4.7-61.5) for HBsAg positive, 11.9 (CI: 2.8-52.2) for anti-HCV positive, and 208.9 (CI: 18.6-2,345.7) for both HBsAg and anti-HCV positive. The risk estimates for both HBsAg and anti-HCV positve were not different from those for HBsAg positive or anti-HCV positive because the confidence interval of patients with both HBsAg and anti-HCV positive overlapped that of patients with HBsAg positive, or that of patients with anti-HCV positive. CONCLUSIONS: Our results suggested that HBsAg was more important risk factor of HCC than anti-HCV and there was no interaction between HBsAg and anti-HCV in the development of HCC.
Blood Donors* ; Carcinoma, Hepatocellular* ; Case-Control Studies ; Hepacivirus ; Hepatitis ; Hepatitis B Surface Antigens* ; Humans ; Immunoenzyme Techniques ; Korea ; Odds Ratio ; Prevalence* ; Red Cross ; Risk Factors

OBJECTIVE: The aim of this retrospective clinical study is to provide a proper management strategy for patients who present spontaneous subarachnoid emorrhage(SAH) with negative initial angiogram by investigating the clinical features, long-term outcomes and radiologic characteristics. METHODS: One hundred and twenty-eight out of 2887 SAH patients who were admitted to neurosurgery department from 1986 to 2002 had negative initial angiogram. We classified the 128 patients into 3 groups(Group I: no evidence of SAH on CT but confirmed by lumbar puncture, Group II: perimesencephalic(PM) SAH pattern, Group III: non-perimesencephalic(NPM) SAH pattern), and reviewed the radiologic findings, the clinical features, the rebleeding rate, the long-term outcome, and the results of repeated angiogram. Factors related to the false negative initial angiogram were also reviewed. RESULTS: The patients were 9(7.0%) in Group l, 85(66.4%) in Group ll, and 34(26.6%) in Group lll. There was no difference in long-term clinical outcome. Ninety-two out of 128 patients underwent a repeated angiogram in which 18 patients were found to have ruptured aneurysms that were not detected on the initial angiogram(false negative rate: overall 19.6%, 1.8% in Group II, 50.0% in Group lll). Small size( < 6mm) aneurysms, spasms, hematomas, and anterior communicating aneurysms were the factors affecting false negative initial angiogram. CONCLUSION: In SAH patients with negative initial angiogram, espeacially those who had a non-perimesencephalic SAH pattern on initial CT findings, a repeated angiogram should be considered for identifying the hidden ruptured aneurysm.
Aneurysm ; Aneurysm, Ruptured ; Hematoma ; Humans ; Neurosurgery ; Retrospective Studies ; Spasm ; Spinal Puncture ; Subarachnoid Hemorrhage*

A case of nonsecretory multiple myeloma in a 66 year-old-woman is reported. At first, she complained severe neck pain and radiologic finding showed C2 pathologic fracture. She complained severe low back pain 4 month later and L1 compression fracture was found. The lumbar MRI showed a 1.4cm-sized round enhancing lesion in the body of T12. Bone marrow aspiration biopsy at L1 spine showed a few polymorphous and small nests of mononuclear cell. L1 lamina bone biopsy showed many abnormal plasma cells. Pathologic diagnosis was multiple myeloma. However, plasma electrophoresis and protein immunoelectrophoresis of serum and urine of patient were normal. So, it is a nonecretory multiple myeloma case and the incidence of nonsecretory multiple myeloma is known to about 1% of all multiple myeloma.
Biopsy ; Biopsy, Needle ; Bone Marrow ; Diagnosis ; Electrophoresis ; Fractures, Compression ; Fractures, Spontaneous ; Humans ; Immunoelectrophoresis ; Incidence ; Low Back Pain ; Magnetic Resonance Imaging ; Multiple Myeloma* ; Neck Pain ; Plasma ; Plasma Cells ; Spine*

The dorsolateral medullary syndrome (Wallenberg's syndrome) is produced by infarction of a wedge of lateral medulla posterior to the inferior olivary nucleus, and is usually caused by vertebral artery occlusion. Ipsilateral axial lateropulsion as an initial symptom of vertebral artery occlusion is rare, and the responsible anatomical structure is still uncertain. Here we describe a patient presenting with ipsilateral axial lateropulsion as an initial symptom of vertebral artery occlusion.
Humans ; Infarction* ; Lateral Medullary Syndrome ; Magnetic Resonance Imaging ; Olivary Nucleus ; Vertebral Artery