Bilateral Traumatic Abducens Nerve Palsy Associated with Hangman's Fracture: Case Report

Bilateral traumatic abducens nerve palsy is a rare condition. We report a case associated with Hangman's fracture without skull fracture. Seventeen cases of bilateral traumatic nerve palsy were found in the literature and only four cases had bilateral traumatic abducens nerve palsy associated with cervical spine fracture without skull fracture. In case of head and neck injury, the abducens nerve may be damaged at the point of fixation to the dura mater. The pathogenesis, the clinical conditions and the radiological findings are presented.

The Outcome of Urgent Surgery for Hunt-Hess Grade IV Patients with Ruptured Intracranial Aneurysm

OBJECTIVE: About 40% of patients who admit to the hospital after subarachnoid hemorrhage are poor clinical grade(Hunt-Hess grade IV, V). The majority of these patients have been excluded from early, aggressive treatment. The current study was undertaken to evaluate the outcome of urgent surgery for Hunt-Hess grade IV aneurysmal subarachnoid hemorrhage. MATERIALS AND METHODS: We reviewed hospital records and radiographic studies of 36 patients who were Hunt-Hess grade IV among 201 cases with ruptured intracranial aneurysm admitted between Sep. 1995 and Dec. 2000. Operated patients were treated with urgent angiography and surgery within 24 hours of presentation, except six patients, and medical records of these patients were reviewed for the clinical course and Glasgow outcome scale(GOS). RESULTS: Overall management results of the 36 patients were good recovery in 13(36.1%), moderate disability in 12 (33.3%), severe disability in 1(2.8%), vegetative state in 1(2.8%) and 9(25.0%) of surgically treated patients had died. CONCLUSION: Although with limited number of patients, we conclude that urgent surgery for Hunt-Hess grade IV patients results in a better neurologic outcome and urgent surgery combined with aggressive postoperative management can minimize mortality.

Metastasis of Intracranial Hemangiopericytoma to Thoracic Spine

We report a case of meningeal hemangiopericytoma presenting as metastasis in the vertebral body and pedicle of the thoracic spine. Hemangiopericytoma is a rare vascular neoplasm. Although the tumor has a strong propensity for both local recurrence and extracranial metastasis, metastasis to thoracic spine is very rare and only two cases were found in the literature. A 44-year-old woman with paraparesis and pain in the thoracic and lower legs was examined by plain radiographs and magnetic resonance imaging. The intracranial hemangiopericytoma was operated 3 years ago. Magnetic resonance imaging demonstrated a tumor invading the left vertebral body and pedicle of the 11th thoracic spine, and compressing the dural sac. The patient was gradually improved after surgical removal of the lesions and the histologic findings were characteristics of hemangiopericytoma.

Classification of the Skin Phototype According to UVB Induced Minimal Erythema Dose in Young Korean Adults / 대한피부과학회지

BACKGROUND: We predicted that the self-reporting questionnaire proposed by Fitzpatrick might not be appropriate for classifying the skin phototype in Korean people. OBJECTIVE: We classified the skin phototypes in Korean people by measuring the minimal erythema dose (MED) of UVB on the basis of MEDs of skin type proposed by Pathak and Fitzpatrick. METHODS: Two hundred and eighty-four male Korean medical students participated in this study. We irradiated UVB with Waldmann UV 800 and measured MEDs after 24 hours. RESULTS: The mean MED was 70.1+/-21.3 mJ/cm2. Most of the MEDs were 70, 60, 50 mJ/cm2 in the order of frequency. On the basis of the skin type proposed by Pathak and Fitzpatrick, the most frequent phototype was the skin type V(56.3%) by MED. 20.8% and 13.8% of the subjects corresponded to the skin types UV and III, respectively. 9.1% of the subjects fell into the UV sensitive group, skin type l and II. CONCLUSION: Using these results as groundwork, simple and precisely applicable classification of skin phototype in Korean people needs to be established.

Generalized pustular psoriasis, Clinical study, Psoriasis / 대한피부과학회지

BACKGROUND: Generalized pustular psoriasis(GPP) is an uncommon from of psoriasis in which a widespread eruption of sterile oustules occurs. In Korea some cases of generalized pustular psoriasis have been reported, but clinical reviews on generalized pustular psoriasis are not available. OBJECTIVE: We investegated the clinical and laboratory findings in some patients with generalized pustular psoriasis in Korea. METHODS: We studied the clinical and laboratory findings in 27 patients with generalized pustular psoriasis who visited Seoul National University hospital during the past 10 years. All the data were analyzed in total of patients with generalized pustular psoriasis, and analyzed after the patients were separated into 4 clinical types. RESULTS: 1. The male to female ratio was 1:2, and the average age of the first onset of GPP was 27.1 years. 2. The number of patients with previous history of psoriasis vulgaris were 19(70.4%). In these patients, the average age at the onset of psoriasis vulgaris was 23.4 years, and average age at the onset of GPP was 34.3 years. 3. The number of patients with a family history of psoriasis were 2(7.4%) 4. The number of patients with possible provocative factors were 16(59.3%). Systemic corticosteroid therapy was done before the onset of GPP in 7 patients, and was the most common provocative factor. 5. Fever(70.4%), chill(33.3%), and arthralgia(18.5%) were common systemic symptoms associated with GPP. 6. In laboratory tests, leukocytosis(63%), elevated ESR(62.5%), hypoalbuminemia(40.7%), and decreased cortisol(32.5%) were often found. 7. With the clinical types, the acute generalized type was 59.3%, juvenile and infantile type 25. 9%, annular and circinate type 7.4%, and GPP during pregnancy was 7.4%. In juvenile and in fantile type, patients with a previous history of psoriasis vulgaris and possible provocative factors of GPP were much less common than in the other types. CONCLUSION: In patients with GPP in Korea, a family history of psoriasis is much less frequent than in western countries. In the possible provocative factors of GPP, systemic corticosteroid therapy was the most common, so it is recommended that systemic steroid therapy should be avoided in the treatment of psoriasis vulgaris. In the comparison of the 4 clinical types, juvenile and infantile type showed a marked iifference in that GPP occurred spontaneously without any previous history of psoriasis and with no provocative factors.

Generalized pustular psoriasis, Clinical study, Psoriasis / 대한피부과학회지

BACKGROUND: Generalized pustular psoriasis(GPP) is an uncommon from of psoriasis in which a widespread eruption of sterile oustules occurs. In Korea some cases of generalized pustular psoriasis have been reported, but clinical reviews on generalized pustular psoriasis are not available. OBJECTIVE: We investegated the clinical and laboratory findings in some patients with generalized pustular psoriasis in Korea. METHODS: We studied the clinical and laboratory findings in 27 patients with generalized pustular psoriasis who visited Seoul National University hospital during the past 10 years. All the data were analyzed in total of patients with generalized pustular psoriasis, and analyzed after the patients were separated into 4 clinical types. RESULTS: 1. The male to female ratio was 1:2, and the average age of the first onset of GPP was 27.1 years. 2. The number of patients with previous history of psoriasis vulgaris were 19(70.4%). In these patients, the average age at the onset of psoriasis vulgaris was 23.4 years, and average age at the onset of GPP was 34.3 years. 3. The number of patients with a family history of psoriasis were 2(7.4%) 4. The number of patients with possible provocative factors were 16(59.3%). Systemic corticosteroid therapy was done before the onset of GPP in 7 patients, and was the most common provocative factor. 5. Fever(70.4%), chill(33.3%), and arthralgia(18.5%) were common systemic symptoms associated with GPP. 6. In laboratory tests, leukocytosis(63%), elevated ESR(62.5%), hypoalbuminemia(40.7%), and decreased cortisol(32.5%) were often found. 7. With the clinical types, the acute generalized type was 59.3%, juvenile and infantile type 25. 9%, annular and circinate type 7.4%, and GPP during pregnancy was 7.4%. In juvenile and in fantile type, patients with a previous history of psoriasis vulgaris and possible provocative factors of GPP were much less common than in the other types. CONCLUSION: In patients with GPP in Korea, a family history of psoriasis is much less frequent than in western countries. In the possible provocative factors of GPP, systemic corticosteroid therapy was the most common, so it is recommended that systemic steroid therapy should be avoided in the treatment of psoriasis vulgaris. In the comparison of the 4 clinical types, juvenile and infantile type showed a marked iifference in that GPP occurred spontaneously without any previous history of psoriasis and with no provocative factors.

Changes of Serum Lipid Concentration and Serum Liver Enzyme Levels During Etretinate Treatment in Patients with Psoriasis / 대한피부과학회지

BACKGROUND: Oral etretinate treatment is associated with the changes in serum lipid concentration and the elevation of serum liver enzymes. In Korea, chronic degenerative diseases like diabetes and hypertension are increasing and the prevalences of HBsAg and chronic liver diseases are much higher than those in western countries. Therefore these changes in serum lipids and liver enzymes during etretinate treatrment are important in Korea as risk factors for atherosclerosis and aggravation of preexisting liver diseases. OBJECTIVE: We tried to observe the sequential pattern, frequency, severity, and relationship between pretreatment value and posttreatment values in the changes of serum lipids and liver enzymes in patients with psoriasis luring etretinate treatment. METHODS: Fourty-one patients with psoriasis were studied during etretinate treatment with the starting dose of 0.5-1.0mg/kg/day. The levels of serum triglyceride, serum cholesterol, HDL-cholesterol, and sGOT, sGPT was repeatedly determined until the 16th week of etretinate treatment. RESULTS: l. In serum triglyceride and cholesterol, the average of concentrations in each treatment period was usually higher than pretreatment value during the 16 weeks of treatment, but no sequential pattern of changes was observed 2. The number of patients with the maximum of posttreatment values higher than the normal limit were 12(29.3%) in triglyce side, 6(14.6%) in cholesterol, 0 in sGOT, and 5(12.5%) in sGPT. The number of patients with the minimum of posttreatment values lower than the normal limit were 15(36.6%) in HDL-cholesterol. 3. In serum cholesterol, patients with an abnormal pretreatment value are more prone to elevation above the normal limit duriing etretinate treatment than patients with a normal pretreatment value. CONCLUSION: In patients with psoriasis the increases in serum triglyceride, serum cholesterol, sGOT, sGPT and the decrease in HDL-cholesterol were occurred frequently during etretinate treatment. Therefore monitoring of serum lipid concentration and serum liver enzyme levels on a regular basis during etretinate treatment is essential for its safe use in patients with psoriasis, es- pecially in cases of long term etretinate treatment.

A Study on the Blood Lipid , Lipoprotein , Apoliporotein Measurement and the Difference According to Family History in Psoriasis Patients / 대한피부과학회지

BACKGROUND: Psoriasis is a disease of unknown etiology. Disturbances in lipid metabolism have been suggested as a possible pathogenetic mechanism. OBJECTIVE: The study was performed to investigate the blood lipid, lipoprotein and apolipo-protein levels and their difference according to family history in Korean psoriasis patients. METHODS: Blood samples from seventy three psoriasis patients and twenty three normal persons were measured for total ciolesterol(TC), VLDL-cholesterol(VLDL-C), LDL-cholesterol(LDL-C), HDL-cholesterol(HDL-C), lipoprotein(a) (LPA), triglyceride(TG), apolipoprotein A-I(APO-AI), and apolipoprotein B(AFO-B). Psoriasis patients were divided according to their family history of psoriasis. RESULTS: Compared to ccntrols, TC, LDL-C, LPA, TG, APO-B were significantly elevated in psoriasis patients. Mean varues of LPA and APO-B in psoriasis group were above normal range. VLDL-C were significasitly elevated only in female patients. There was a tendency for psoriasis patients with family history to have higher values than those without family history. CONCLUSION: TC, LDL-C, L,PA, TG, APO-B was increased in psoriasis, especially in the patients with family history, cornpared to control. It is recommended that we must pay attention to the possible risk for the development of cardiac or cerebral vascular disease in psoriasis patients, especially in the presence of family history of psoriasis.

A Case of Actinic Reticuloid / 대한피부과학회지

Actinic reticuloid is a rare, chronic photosensitivity dermatosis with clinical and histologic femtures resembling a cutaneous T cell lymphoma. Phototesting in these patients typically reveals extreme sensitivity to UVB, to UVA, and sometimes to visible light. has site of lymphomatoid histologic appearance, actinic reticuloid is now regarded as a histologic arant of chronic actinic dermatitis, which is the spectriam of several photosensitivity dermatosis, delet to its benign course and transition to or from other photosensitivity dermatosis. We present a case of actinic veticuloid in 58-year-old male, who has severely edematous infiltrated lichenified erytherratous patches on sun-exposed skin, lynptmatoid histologic features with selective T cell infiltrat,ion, and selective photosensitivity to UV.