Neurilemmomatosis is a clinical entity consisting of multiple cutaneous neurilemmomas, central nervous system tumors, and neurologic disorders. Since Shishiba et al first described the disorder in 1984, several cases have been reported. We report a Korean case of neurilemmomatosis showing multiple neurilemmomas of the skin and spinal cord, with associated motor and sonsory nerve disturbance. Histologic, immunohistopathologic and electron microscopic studies confirmed the diagnosis.
Central Nervous System Neoplasms ; Diagnosis ; Nervous System Diseases ; Neurilemmoma ; Skin ; Spinal Cord

Painful stiff shoulder after trauma may be one of the difficult situation. Incomplete brachial plexus palsy may cause painful stiff shoulder. Symptoms and signs of this entity are vague. It is not rare to miss detecting subtle damage of the brachial plexus. We analysed these cases to identify specific clues on history and physical examination that help making the diagnosis of this entity. We have experienced 14 cases of incomplete brachial plexus palsy that showed painful stiff shoulder in Asan Medical Center from March 1995 to February 1996. All the charts and letters from primary care hospitals were reviewed. Initial diagnosis of the primary hospital, duration of delay of diagnosis after initial trauma, clues for the diagnosis in history and physical findings, patterns of the nerve injuries were analyzed. Average age was 48 years (from 25 to 84). Nine cases were male, and five cases were female. The most common primary diagnosis was proximal humerus fracture. Delayed diagnosis was the most remarkable feature. Average duration of delayed diagnosis was about three months (from one to thirteen months). Tentative diagnosis was made on the base of history and physical examination. The most frequent clue on the history was long standing painful stiff shoulder inappropriate to the initial diagnosis. The most common physical finding was tenderness at the brachial plexus area. Definite diagnosis was confirmed with electromyography. Careful history taking and thorough physical examination are essential for every shoulder injury. Incomplete brachial plexus palsy is one of the cause of painful stiff shoulder. It is important to keep in mind this entity to arrive correct diagnosis. Eletromyography should be done for the suspected cases.
Brachial Plexus ; Chungcheongnam-do ; Delayed Diagnosis ; Diagnosis ; Electromyography ; Female ; Humans ; Humerus ; Male ; Paralysis* ; Physical Examination ; Primary Health Care ; Shoulder*

No abstract available.
Adenoma, Pleomorphic*

Epidermal growth factor(KGF) and transforming growth factor arpha(TGF-a) are polypeptides of 53 amd 50 amino acid residuies. Both bind to epidermal growth factor receptor (EGR-R) leading to phosphorylation of the receptor, enhancement of its tyrosine-specific kinase activity and ultimately to stimulation of cell growth. To study he role of EGF, TGF-a, and EGF-R in differentiation and hyperproliferation of cell, we se lected psoriasis vulgaris, because the affected keratinocyte may house both an abnormally increased proliferative capacity and an abnormally differentiated state. The biopsy specimens were taken from involved and uninvolved skin of 20 patients with psoriasis and immunoperoxidase studies with formalin-fixed paraffin-embedded tissues were performed with EGF, TGF-a and EGF-R useing the Vectastain ABC irnmunoperoxidase stain system. The antibodies were used at a concentration of 6 ug/ml In involved psoriatic skin, distributions of TGF-a and EGF-R were increased in all layers of epidermis as compared to normal, uninvolved psoriatic skin, in which chev were showed to the basal and parabasal layers. However, distribution of EGF was weekly positive in the basal layers of epidermis in both involved and uninvolved skin with no difference between toem. These results suggest that increased distribution of TGF-a and EGF-R may be involved in hypoproliferative state of epidermal keratinocytes in psoriatic lesion.
Antibodies ; Biopsy ; Epidermal Growth Factor ; Epidermis* ; Humans ; Keratinocytes ; Peptides ; Phosphorylation ; Phosphotransferases ; Psoriasis ; Receptor, Epidermal Growth Factor ; Skin ; Transforming Growth Factors

We report herein a case of tethered cord syndrome with recurrent ulcerations of the skin in a 17-year-old girl. The patient presented an asymptomatic punched-out deep ulcer on the right buttock and right heel. The lesions were noticed as bullae on the sites, which developed into ulceration. At birth, a reddish nodule was noted on the lower back, which was excised when she was 3 years old at a private clinic. Neurological examination revealed hypoesthesia below the LS dermatome. We suspected a simple neurotrophic ulcer which was treated with zinc oxide dressing and oral antibiotics. 1 month later, the ulcers had healed, but tense bullae had developed on the same right buttock. Spina bifida with intraspinal lipoma was revealed by plain X-ray film and magnetic resonance imgaing. Tethered cord syndrome was diagnosed, and treated with a surgical excision of the lipoma, and repair of the dura. This is a vary rare etiology of a neurotrophic ulcer due to a central nervous system disease, and is the first reported case in the Korean dermatologic literature.
Adolescent ; Anti-Bacterial Agents ; Bandages ; Buttocks ; Central Nervous System ; Female ; Heel ; Humans ; Hypesthesia ; Lipoma ; Neural Tube Defects* ; Neurologic Examination ; Parturition ; Skin ; Spinal Dysraphism ; Transcutaneous Electric Nerve Stimulation ; Ulcer* ; X-Ray Film ; Zinc Oxide

Myositis Ossificans progressiva is a very rare disease and not more than five cases have been reported in this country. The symptoms usually appear before the age of six and no case has ever been reported in medical literature in which patient is older than the age of twenty. This author reports here that a 52 years old male was diagnoed as a myositis ossificans progressiva. The patient developed his symptoms when he was lynched by a club during the Korean conflict at the Korean conflict at the age of thirty. Another interesting fact is that is that his daughter has also developed similar symptoms which appeared following an accident when she was run over by an angry cow at the age of six.
Humans ; Korean War ; Male ; Myositis Ossificans ; Myositis ; Nuclear Family ; Rare Diseases

The ultraviolet radiation (UVR) is known to be a potent modulator of many host immune functions and the exposure of experimental animals to the inflammatory effects of UVR induces depressions in their ability to initiate and effectuate various types of cellular immune responses. In this study, the effects of UV-B (280 320 nm) radiation on resistance to a facultative intracellular bacterium, Listeria monocytogenes (LM), were examined at the cellular level. The numbers of cultivable LM recovered from the spleens of UV-B-irradiated mice were decreased at 2 days postinfection compared with those of untreated control mice. However, the acquired immunity, developed 7 days after immunization with streptomycin (SM)-sensitive LM, in either UV-irradiated, LPS- or IL-1-pretreated mice was less stronger than that developed in untreated, control mice. To elucidate the possible mechanisms underlying the observation that UVR did increase innate immunity but decreased acquired immunity of mice to the infection with LM, the effects of UVR of mice on the production of IFN-r by activated splenocytes and TNF-a by peritoneal macrophages were assessed. Activated splenocytes from UV-irradiated mice exhibited a reduced capacity to produce IFN-r and cultured peritoneal macrophages produced more TNF-a in the presence of LPS during 24 hours after UV radiation. Though TNF-r activity was not detected in the sera of LM-infected mice, intravenous LPS injection induced TNF-r production and UVR decreased TNF activity in sera obtained from LM-infected mice with LPS induction 9 days after irradiation. Although Ia-negative macrophages were predominant in the peritoneal macrophages from untreated control mice, the infection of mice with LM caused a marked increase in Ia expression on peritoneal macrophages. However, UVR resulted in decreased expression of Ia molecule on the peritoneal macrophages during the LM infection. These findings suggest that the dual effects of UVR on the innate and acquired immunity of mice to the LM infection may be associated with altered capacities of splenocytes and peritoneal macrophages of the mice to produce cytokines, in addition to decrease of la molecule expression on the macrophages.
Adaptive Immunity ; Animals ; Cytokines ; Depression ; Immunity, Cellular ; Immunity, Innate ; Immunization ; Listeria monocytogenes* ; Listeria* ; Macrophages ; Macrophages, Peritoneal ; Mice* ; Spleen ; Streptomycin ; Tumor Necrosis Factor-alpha*

The effect of general anesthesia for cesarean section, before and after the delivery, varies according to the anesthesia type, drug dosage and concentration of the anesthetics. If a light plane of general anesthesia using a minimal concentration of anesthetics is chosen for fetal safety and rapid recovery, there is an increased incidence of maternal awareness and/or unpleasant dreams. in general, however, for cesarean section a lighter depth of anesthesia is indicated than that for non-obstetric operations because of the change in humoral factors such as increased levels of progestrone and beta-endorphin. We studied the effects of general anesthesia for 100 healthy parturients. The method used consisted of administration of thiopental (group l) or a combination of thiopental and 66% N2O(group ll) before delivery. For maintenance after delivery we used 66% nitrous oxide and a small dose of meperidine The results are as follows: 1) Apgar scores below 8 at one minute after delivery in group l and group ll were 4cases and 5cases, respectively. At 5 minutes after delivery 98% of both groups had Apgar scores of above 8. 2) The incidence of maternal awareness during anesthesia in group l was 10%, and group ll, 6%. 3) During the maintenance phase of the anesthesia after delivery, the systolic pressures, diastolic pressure and pulse rate increased as much as 2~11%, 5~13% and 14~16% respectively. 4) The duration of operation, on the average, was 64 minutes, and the average dosage of meperidine administered was 120mg.
Anesthesia ; Anesthesia, General ; Anesthetics ; beta-Endorphin ; Blood Pressure ; Cesarean Section* ; Dreams ; Female ; Heart Rate ; Incidence ; Intraoperative Awareness ; Meperidine ; Nitrous Oxide ; Pregnancy ; Thiopental

No abstract available.

We report two cases of cellulitis on the saphenous venectomy scar which developed after a coronary artery bypass graft(CABG). A 68-year-old male and a 62-year-old female developed acute cellulitis in the saphenous vein donor extremity after CABG. The repeated bacterial cultures were negative in both cases. However, onychomycosis was confirmed in one patient. The intervals between CABG and the initial bout of cellulitis in the male and female patient were 10 and 22 months, respectively. Although the exact pathogenesis remains obscure, factors such as direct bacterial infection, hypersensitivity to streptococcal exotoxins, a local compromise of lymphatic and venous drainage, and fungal infection might have contributed to the development of cellulitis in these patients.
Aged ; Bacterial Infections ; Cellulitis* ; Cicatrix* ; Coronary Artery Bypass* ; Coronary Vessels* ; Drainage ; Exotoxins ; Extremities ; Female ; Humans ; Hypersensitivity ; Male ; Middle Aged ; Onychomycosis ; Saphenous Vein ; Tissue Donors