Elsberg syndrome is a rare disease of lumbosacral myeloradiculitis, mostly caused by herpes simplex virus type 2 (HSV-2). It frequently has concomitant myelitis, and immunocompromised patients can be fatal with ascending myelitis. Since anti-viral agents might lead to good recovery, clinicians need to be suspicious for conditions of cauda equina syndrome. Detection of viral DNA from cerebrospinal fluid ensures the diagnosis. We report a case of Elsberg syndrome caused by HSV-2 and are to delineate the clinical and radiologic spectrum.

BACKGROUND: Psoriasis is a chronic inflammatory skin disorder affecting approximately 1~3% of the general population. Ustekinumab is a recently developed human monoclonal antibody for psoriasis that binds to the p40 subunit shared by the interleukins IL-12 and IL-23. OBJECTIVE: The purpose of this study was to evaluate the effect of combination treatment with ustekinumab and topical agents in 30 Korean patients with psoriasis regarding different clinical parameters. METHODS: We retrospectively searched to identify patients with moderate-to-severe plaque-type psoriasis who had initiated treatment with ustekinumab between January 2012 and January 2016. Among them, our study was conducted in 30 patients with psoriasis who were treated with ustekinumab and topical agents for at least 16 weeks by analyzing their clinical charts and photographs. RESULTS: Overall, 16.7%, 93.3%, and 96.2% patients achieved PASI 75 response rates at weeks 4, 16, and 40, respectively. Furthermore, fifteen patients achieved 90% improvement in their PASI score at 100 weeks and five patients maintained their PASI score at 160 weeks. The efficacy of treatment with ustekinumab was different in sub-group analysis. Non-smokers enjoyed a higher therapeutic effect than did smokers. In addition, the therapeutic effect of ustekinumab was lower in the groups with psoriatic arthritis and nail psoriasis. However, it was not statistically significant. None of the patients experienced serious adverse events requiring the interruption of treatment. CONCLUSION: Combination treatment with ustekinumab and topical agents provides effective treatment results for Korean patients with psoriasis.
Arthritis, Psoriatic ; Follow-Up Studies* ; Humans ; Interleukin-12 ; Interleukin-23 ; Interleukins ; Psoriasis* ; Retrospective Studies* ; Skin ; Ustekinumab*

Palmoplantar keratoderma is characterized clinically by excessive thickening of the skin and histologically by hyperkeratosis on the palms and soles. It can be classified based on inheritance patterns, causes, clinical presentation, and extent of involvement. Acquired palmoplantar keratoderma shows multifactorial etiology including exposure to certain chemicals or drugs, metabolic disorders, malnutrition, systemic disease, malignancy, dermatosis, and/or infection. We report a rare case of acquired palmoplantar keratoderma induced by malnutrition.
Inheritance Patterns ; Keratoderma, Palmoplantar* ; Malnutrition ; Skin ; Skin Diseases

No abstract available.
Melanoma* ; Paget Disease, Extramammary*

Objective: An essay test is difficult to carry out because of the effort for hand scoring and the concerns about inter-rater reliability, even though the use of a rubric can increase inter-rater reliability. This study examined the feasibility of an essay test in medical school students and whether the use of a rubric increases inter-rater reliability. Methods: An essay test was given to 51 undergraduate students in the third grade of emergency medicine clinical clerkship. Three raters assessed the essay test independently with a prepared rubric immediately after the test. They then did the same essay test without a rubric three months later. The researchers compared the Pearson’s correlation coefficients between raters. The researchers analyzed the validity comparing the correlation coefficient between the essay test and previous multiple-choice questions (MCQ) and feasibility by acceptance. Results: Fifty-one students took the essay test. The Pearson’s correlation coefficient using rubric between raters 1 and 2, 1 and 3, and 2 and 3 were 0.898 (P<0.001), 0.896 (P<0.001), and 0.856 (P<0.001), respectively. Without a rubric, the correlation coefficients were 0.838 (P<0.001), 0.888 (P<0.001), and 0.824 (P<0.001), respectively. The new essay test showed a positive correlation (0.367) with the previous MCQ, and the evidence for validity and feasibility was acceptable. Conclusion In this study, the rubric did not increase the inter-rater reliability of the essay test. On the other hand, the inter-rater reliability was higher than 0.8, even without a rubric. In addition, the essay test showed evidence of validity and feasibility.

The artery of Percheron is a rare anatomical variant, in which a common trunk arises from one posterior cerebral artery and then branches to supply each of the thalami and the midbrain separately. Occlusion of this artery triggers a bilateral thalamic infarction. The most commonly reported clinical findings are an altered mental status, vertical gaze palsy, and memory impairment. A 51-year-old man was transferred to the emergency department with a sudden loss of consciousness after drinking alcohol. He appeared to be sleeping deeply. His wife insisted that he had not drunk a quantity of alcohol that would render him unconscious. Magnetic resonance imaging of the brain revealed an acute, bilateral, paramedian thalamic infarction. He was admitted and treated with antiplatelet agents. On the following day, four-vessel cerebral angiography revealed stenosis of the left, distal vertebral artery. Three weeks after admission, he was discharged with persistent hypersomnia, memory impairment, and behavioral changes.
Alcoholic Intoxication ; Arteries ; Brain ; Cerebral Angiography ; Coma* ; Constriction, Pathologic ; Disorders of Excessive Somnolence ; Drinking ; Eating* ; Emergency Service, Hospital ; Humans ; Infarction* ; Magnetic Resonance Imaging ; Memory ; Mesencephalon ; Middle Aged ; Paralysis ; Platelet Aggregation Inhibitors ; Posterior Cerebral Artery ; Spouses ; Thalamus ; Unconsciousness ; Vertebral Artery

No abstract available.
Acneiform Eruptions* ; Dasatinib* ; Drug Eruptions ; Humans ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive* ; Pleural Effusion*

No abstract available.
Humans ; Myositis*

PURPOSE: We sought to investigate the effects of Graves' orbitopathy (GO) and orbital decompression on lamina cribrosa depth (LCD) using spectral-domain optical coherence tomography. METHODS: Forty eyes that underwent orbital decompression to relieve compressive optic neuropathy or correct disfiguring exophthalmos in the context of GO were included. Subjects were imaged with spectral-domain optical coherence tomography before surgery and at 1 and 3 months after surgery, at which the examiner measured the LCD (distance from the anterior surface of the lamina cribrosa to the Bruch membrane opening line) and peripapillary retinal nerve fiber layer thickness. Subjects were divided into two groups—a muscle-dominant group composed of patients who had extraocular muscle enlargement on preoperative orbital computed tomography scan and a fat-dominant group composed of patients who did not show extraocular muscle enlargement on preoperative orbital computed tomography scan—and subgroup analysis was performed. Preoperative and postoperative intraocular pressure, exophthalmos, LCD, and retinal nerve fiber layer thickness were evaluated. RESULTS: At baseline, LCD was remarkably shallower in the muscle-dominant group than in the fat-dominant group (95% confidence interval, p = 0.007). In the muscle-dominant group, LCD showed no definite change after surgery. However, the fat-dominant group showed temporary posterior displacement of the lamina cribrosa at 1-month postoperation that was reversed to baseline at 3 months postoperation (95% confidence interval, p < 0.01). CONCLUSIONS: The lamina cribrosa was anteriorly displaced preoperatively, and its position was nearly unchanged after the surgery, especially in association with extraocular muscle enlargement. An enlarged extraocular muscle could reduce the pressure-relieving effect of orbital decompression around the scleral canal in patients with GO.
Bruch Membrane ; Decompression ; Exophthalmos ; Graves Ophthalmopathy ; Humans ; Intraocular Pressure ; Nerve Fibers ; Optic Nerve ; Optic Nerve Diseases ; Orbit ; Retinaldehyde ; Tomography, Optical Coherence