Pure Red Cell Aplasia in Pregnancy / 대한주산의학회잡지

Pregnancy is normally a state of erythroid hyperplasia. Increased erythropoiesis during pregnancy is controlled by erythropoietin, which is augmented by the action of placental lactogen and inhibited by high levels of estrogen. We described a case of a patient with pure red cell aplasia during pregnancy that resolved completely in the postpartum period.

The Relationship of Positive Antimicrosomal Antibody and Postpartum Thyroiditis / 대한주산의학회잡지

Postpartum thyroiditis is a common but frequently unrecognized disorder, affecting approximately 5% of women during the first 12 months after delivery. It is characterized by transient hyperthyroidism occurring about 14 weeks postpartum followed by transient hypothyroidism at 19 weeks postpartum. Our aim is to investigate the prevalence of positive antimicrosomal antibody in women 3 months postpartum and an association of antimicrosomal antibody with symptomatic and biochemical thyroid disorders. We used data collected from 205 women who visited Dankook University Hospital in 3 months postpartum, Our results showed that the rate of positive antithyroid microsomal antibody was 12.7% in women 3 months postpartum and the prevalence of biochemical hyperthyroidism and biochemical hypothyroidism with positive antithyroid microsomal antibody women 3 months postpartum were 26.9% and 19.2%, respectively. The prevalence of postpartum biochemical thyroid dysfuncion 3 months postpartum was 13.7%. There was no relationship between any of the following factors and thyroid antibody status: fetal distress, birth weight and infant sex, matemal age, experiences and mode of delivery, previous medical disease(such as pstrointestinal and psychotic diseases), experiences of previous abortions, gestational age and past history of thyroid diseases.

A Case of Nerve-Root Anomaly Associated with Herniated Intervertebral Disc in Lumbar: Case Report

Nerve-root anomalies are very uncommon, and there symptoms and signs are nearly similar with those of disc herniation. So we can misdiagnois them for intervertebral disc herniation. The negative Lasegue' sign is the only distinct feature of the nerve root anomalies. The authors report a case of Nerve-Root Anomaly associated with disc herniation in lumbar 4-5 interspace, which was diagnosed preoperatively in myelogram and confirmed surgically.

Drainage of Severe Brain Abscesses(2 Cases)

Encapsulated and free pus in the substance of the brain tissue following an acute purulent infection is known as brain abscess, and which is uncommon. The brain abscess arise either as direct extention from infections within the cranial cavity or as hematogenous metastasis from infections elsewhere in the body. Since 1945, the antibiotics associated use of steroid and mannitol have been available for the treatment of brain abscess, and the result are very hopeful. The common method of surgical treatment are consist of excision and drainage and the problem of the best operative procedure has been disputed on the many neurosurgical literatures for many years. Recently we had treated 2 cases of severe otogenic brain abscesses with semicomatose patient by drainage, and good was the result compared with the other literatures. Result; 1. One case with semicoma recovered completely without any neurologic sequelae, and the other case recovered with visual disturbance. 2. The best operative procedure for the severe brain abscess considered a drainage.

The Clinical Consideration for Spinal Epidural Abscess

Infection involving the spinal cord and cauda equina are much less common than intracranial infection. Among the above, bacterial infection in spinal epidural space are relatively uncommon but well recognized entity in adult and children. More than 300 cases with spinal epidural abscess are described in the literatures. Because of its rarity, there is delay in diagnosis and irreversible neurological sequelae in high percentage of cases. Infection of the spinal epidural space are accompanied by fever, tachycardia, headache, pain and tenderness in the back, weakness of the lower extremities and finally a complete paraplegia. The modes of infection are 1) direct extension from inflammatory process in adjacent tissues 2) perforating wounds or lumbar puncture 3) hematogenous route from the remote origin. The most frequent causative organism is staphylococcus aureus always, but pneumococcus, streptococcus, pseudomonas, typhoid bacillus, pyocyanus, oidium coccidioides and fungus are causative organisms occasionally. In spinal epidural abscess with complete paraplegia, the neurologic sequelae are permanent and unhappy. So the spinal epidural abscess is neurosurgical emergency in which early diagnosis and prompt surgery are necessary to avert permanent cord damage. Recently, the spinal epidural abscess has increasing tendency. We have treated 5 cases with spinal epidural abscesses from Nov. 1974 to Apr. 1976. The followings are results ; 1) Sex incidence showed male 2, female 3 and age incidence ranged from 21 years to 38 years, but 4th decade was most common. 2) Most common mode of infection was unknown though all cases have been applied the acupunture for the back pain several times. 3) Most avaliable procedures of diagnosis were the usual infectious symptoms, leukocytosis, increased erythrocyte sedimentation rate, obstructive responce by Queckenstedt test and findings of myelography, including increased protein and pleocytosis in cerebrospinal fluid. 4) All 5 cases had been performed total laminectomy from T3-L3, according to the lesions commonly in thoracic spine with spinal epidural abscess and had been treated with penicillin G, Methicillin and Geopen. 5) The prognosis was poor in 4 cases with complete paraplegia but 1 case with incomplete paralysis recovered completely.

The Clinical Consideration for Intracranial Epidural Abscess

The intracranial epidural abscess is a not indenpendent disease which is practically always secondary to osteitis or osteomyelitis of overlying bone. Also it was developed from complication of frontal sinusitis, middle ear or mastoiditis, incomplete debridement of compound comminuted depressed fracture and post-operative complications. Occasionally it was derived from dural sinus thrombophlebitis especially cavernous sinus. It was frequently developed frontal and temporal region. We have experienced 5 cases of intracranial epidural abscesses for this one year. Followings are the results ; 1. The causes were complication of compound depressed fracture, chronic osteomyelitis and post-operative complications. 2. The usual symptom was headache, fever and increased lethargy. 3. The laboratory findings of CBC were the increased WBC count and ESR. The CSF findings revealed occasionally increased the cell count and sugar. 4. The pus culture revealed proteus, coliform bacilli and paracolon bacili. 5. Treatment was surgical removal of overlying diseased bone, drainage of the purulent materials and instillation of antibotics irrigation. 6. The prognosis of the 5 cases of the intracranial epidural abscess was good. There was not appeared any complication or sequelae.

A Case of the Metastatic Hepatocellular Hepatoma to the Skull

The majority of metastatic lesions involving the skull arise from carcinoma of the breast and lung. Bone metastass from a wide speculum of malignant neoplasms may be discussed in general as osteoblastic or osteoclastic in type. In osteoblastic from there are carcinoma of the prostate, carcinoma of the breast, carcinoma of the urinary bladder and rarely hypernephroma and cholangiocellular hepatoma. Osteoclastic metastass are characteristically produced by carcinoma of the lung, uterus, gastrointestinal tract, and thyroid and malignant melanoma, and rarely hepatocellular hepatoma, Osteoclastic or osteolytic lesions are much more frequent. Osteolytic metastass to the skull typically present as multiple radiolucenices with ill-defined margin. Metastases may affect any portion of the skull, not only the calvaria but also the base. Recently we experienced a rare case of metastatic hepatocellular carcinoma to the skull. A 51 year old Korean male was admitted to the Dept. of neurosurgery, on Jan. 18, 1975. Patient had complained of headache and mass on the right frontoparietal region for ca 6 weeks and motor weakness on the left extremities for 2 weeks prior to admission. No jaundice and weight loss were complained. The mass on the right frontoparietal region had increased its size gradually and showed adult fist in its size on admission. Neurological examination on admission disclosed that the adult-fist sized mass on the right frontoparietal region was non-tender and palpated soft, and deep tendon reflexes were hyperactive, on the left, and Lt. Superficial reflexes were diminished. No spasticity was noted, and left grasping power was markedly weak. Hypersthesia was felt on the left of the body. No icterus was found. Nor palpable liver neither spleen was found. No tenderness on the abdomen and no palpable masses were noted. Complete blood cell counting was normal. The blood chemistry including the liver function test revealed normal except increased alkaline phosphatase(10.5 Bodansky units). (-feto-protein was negative. Urinalysis and stool examination were normal. X-ray films of simple skull series revealed multiple radiolucencies with ill-defined margins on the right fronto-parietal bone. Right carotid angiograms showed the left square shifting of the right anterior cerebral artery to the left and compressed downward the Rt. Middle cerebral artery, and abnormal vessels in tumor mass were supplied by only the Rt. External carotid artery extracranially and intracranially. Liver scanning was normal. A decompression craniectomy was performed. Extracranially the tumor mass was brownish yellow and soft, which seemed to be the lipoma in character. The skull bone was destroyed multiply. Intracranilly same mass was found. They were removed totally without any bleeding. The operation was finished in usual way, and biopsy was attempted. The post-operative course was usual one except no recovery of the neurologic deficit for 2 weeks. Microscopic examination revealed a metastatic hepatocelluar hepatoma.