Tethered cord syndrome is a kind of spinal dysraphism with low-lying conus frequently associated with intraspinal lipoma, diastematomelia or fibrous band. The clinical manifestations varies from long periods of no overt symptoms to back pain, scoliosis, progressive neurological deficit of legs and incontinence. Therefore the diagnosis requires a strong clinical suspicion and aggressive investigation. It shows various cutaneous manifestations including hyperpigmentation, skin dimple, dermal sinus or hypertrichosis. This 34-year-old female patient has had a lozenge shaped hair tuft with terminal hair on the lumbosacral area since her birth. Her MRI scan showed dermal sinus and a low-lying conus at the lower border of L5. The filum terminale was also thickened. These findings are compatible for tethered cord syndrome.
Adult ; Back Pain ; Cauda Equina ; Conus Snail ; Diagnosis ; Female ; Hair ; Humans ; Hyperpigmentation ; Hypertrichosis ; Leg ; Lipoma ; Magnetic Resonance Imaging ; Neural Tube Defects* ; Parturition ; Scoliosis ; Skin ; Spina Bifida Occulta ; Spinal Dysraphism

No abstract available.
Humans ; Infant, Newborn*

The authors present 12 cases of far lateral disc herniation(FLDH) diagnosed and treated in our institution from march, 1992 to February, 1994. In the author's series the incidence of far lateral disc herniation was 5% of all lumbar disc herniations. The average age of the patients was 4 years and there were 7 men and 5 women. The L4-5 intervertebral disc level was the most commonly involved level. All patients initially presented with symptoms of radiculopathy. Cases with double herniations at the same level and on the same side seemed to have the most potential source of misdiagnosis and mismanagement, and a careful surgical consideration was needed for such cases. In 4 cases, a combined intraspinal and extraforaminal approach was performed with preservation of facet joints and in 2 cases, paramedian muscle splitting approach was performed. Chemonucleolysis and the usual partial hemilaminectomy were undertaken in 5 cases and in 1 case, respectively. The combined approaches proved to be an effective means of treatment for cases with double herniations, but misdiagnosis of such lesion can lead to an inappropriate and an ineffective treatment and poor surgical results. Furthermore, in the diagnosis of far lateral disc herniation, differentiation must be made from symptoms of conjoined nerve root and congested epidural vein.
Diagnosis ; Diagnostic Errors ; Estrogens, Conjugated (USP) ; Female ; Humans ; Incidence ; Intervertebral Disc ; Intervertebral Disc Chemolysis ; Male ; Radiculopathy ; Veins ; Zygapophyseal Joint

Background: TSH binding inhibiting imunoglobulins(TBII) are autoimmune antibody causing autoimmune thyroid diseases such as Graves disease or Hashimoto's thyroiditis, while intercellular adhesion molecule-1(ICAM-1) is known as a substance expressed at the site of autoimmune reaction in relation with lymphocyte infiltration. The serum TBII activity is used as an index of the disease course and prognosis of Graves disease treated with antithyroid drugs, propylthiouracil or methimazole. The aim of this study is to understand the change of serum ICAM-1 level according to the change of the degree of autoimmunity and clinical course of Graves disease. Methods: In order to study the change of soluble ICAM-1 and relationship to the immune mechanism of Graves' disease, we measured serum levels of TBII and ICAM-1 in patients(n 35) with Graves disease before and after treatment with antithyroid drugs and in relapsed patients using a highly sensitive ELISA method. Results: The serum levels of TBII and ICAM-1 were markedly elevated in patients with Graves disease before treatment than normal controls and there were good correlation between TBII and ICAM-1 level. In patients with normalized TBII levels after 22 months antithyroid drug treatment, the ICAM-1 levels became normal but in the patients with high serum TBII level showed high serum level of ICAM-1 even with clinical remission with same treatment. The serum levels of TBII and ICAM-1 in relapsed patients were elevated as those of patients before treatment. Conclusion: With the above results, we can conclude that not only the TBII level but seru ICAM-1 level also reflect the degree of autoimmune activity of Graves disease and may be used as an index of the disease course and prognosis of Graves disease treated with antithyroid drugs.
Antithyroid Agents ; Autoimmunity ; Enzyme-Linked Immunosorbent Assay ; Graves Disease ; Humans ; Intercellular Adhesion Molecule-1 ; Lymphocytes ; Methimazole ; Methods ; Prognosis ; Propylthiouracil ; Thyroid Diseases ; Thyroid Gland ; Thyroiditis

After von Rokitansky's description in 1984 of a calcified chronic subdural hematoma, the number of such lesions has reached so far a total of 108. The majority of patients reported have been children and young adults. On review of the literature, elderly patients reported over the age of sixty five years are only 5, so far as we know. A 68-year-old Korean male with a calcified chronic subdural hematoma is reported. He was admitted to our department because of a status epilepticus. During Korean war (1950), abut 37 years before admission, he had been suffered from a blunt head injury, but mistreated then, and afterwards th had several episodes of convulsion. Neurological examination on admission revealed only a drowsy consciousness and mild papilledema on the left. Plain skull X-ray films and brain CT scan demonstrated a left sided biconvex type of intracranial calcification. A left frentoparietal craniotomy was performed. After opening the dura mater, the thickened outer membrane, the subdural hematoma and the thin bone like plate were removed thoroughly. Content of the subdural hematoma was brown muddy substance. In the eight months following the operation, the generalized seizure did not appear. Postoperative CT scan demonstrated complete re-expansion of the brain parenchyme.
Aged* ; Brain ; Child ; Consciousness ; Craniotomy ; Dura Mater ; Head Injuries, Closed ; Hematoma, Subdural ; Hematoma, Subdural, Chronic* ; Humans ; Korean War ; Male ; Membranes ; Neurologic Examination ; Papilledema ; Seizures ; Skull ; Status Epilepticus ; Tomography, X-Ray Computed ; X-Ray Film ; Young Adult

Prirnary sclerosing cholangitis, a chronic progressive cholestatic hepatobiliary disorder of unknown etiology, is characterized by inflammation, scarring and obliteration of bile duct leading to biliary cirrhosis and liver failure. Because histologic finding has only a limited role in the diagnosis, the gold standard for establishing the diagnosis is cholangiographic demonstration of typical diffuse biliary stricutre or beading. The natural history is extremely variable. We report two cases of primary sclerosing cholangitis diagnosed by repeated endoscopic retrograde cholangiographies. They were followed up for 7 and 2 years, respectively.
Bile Ducts ; Cholangiography ; Cholangitis, Sclerosing* ; Cicatrix ; Diagnosis ; Inflammation ; Liver Cirrhosis, Biliary ; Liver Failure ; Natural History

We report a case of intratumoral fat in neurofibroma and coexistance of eccrine hidrocystoma on the occipital area of the scalp for one year duration. There are several diseases showing fatty change histopathologically. Among them, few cases of neurofibroma showing fatty change had been reported. The mechanism of fatty change is unclear, but several hypotheses are proposed. Here we report a case of neurofibroma showing fatty change and coexistence of eccrine hidrocystoma, and discuss the pathomechanism of fatty change and its relationship with disease.
Hidrocystoma* ; Neurofibroma* ; Scalp

Epidermodysplasia verruciformis(EV) is a rare, often familial disease, associated with human papilloma virus. It is characterized by long-lasting, wide-spread wart-like or pityriasis versicolor-like lesions from early childhood and in about one-third patients, cutaneous carcinomas develop in adult life. We report a case of 57-year-old male with EV, with lesions only on the left forearm and the hand, who had been exposed to Agent Orange during Vietnam War.
Adult ; Citrus sinensis* ; Epidermodysplasia Verruciformis* ; Forearm ; Hand ; Humans ; Male ; Middle Aged ; Papilloma ; Pityriasis ; Vietnam

A 9-year-old girl presented with fever, conjunctival injection, desquamation following erythema and edema of the fingers and toes, strawberry tongue, polymorphous rash and cervical lymphadenopathy. She showed palpable purpura on the lower extremities after 7 days of the onset of the above symptoms. She showed typical Henoch-Schonlein purpura concurrent with Kawasaki disease. There is no known report of a case of Henoch-Schonlein purpura concurrent with Kawasaki disease and evaluation of the same pathogenesis of the two diseases. We've got a clue from the facts that human parvovirus B19 could develope both of the diseases. But Human parvovirus B19 PCR was negative. We, herein, report an unusual case of Henoch-Schonlein purpura concurrent with Kawasaki disease.
Child ; Edema ; Erythema ; Exanthema ; Female ; Fever ; Fingers ; Fragaria ; Humans ; Lower Extremity ; Lymphatic Diseases ; Mucocutaneous Lymph Node Syndrome* ; Parvovirus B19, Human ; Polymerase Chain Reaction ; Purpura ; Purpura, Schoenlein-Henoch* ; Toes ; Tongue

Dermatofibroma is a small, firm, red to purple-brown colored dome-shaped or flat papule or nodule, occurring more commonly in women. Majority of dermatofibromas are solitary, but multiple lesions can sometimes occur. The etiology is unclear, but an association with various immunosuppressed conditions has been proposed. We report a case of multiple eruptive dermatofibromas on the lower extremities in a patient with AIDS.
Female ; Histiocytoma, Benign Fibrous* ; Humans ; Lower Extremity