ABSTRACT
OBJECTIVE: Ventriculoperitoneal (VP) shunt complication is a major obstacle in the management of hydrocephalus. To study the differences of VP shunt complications between children and adults, we analyzed shunt revision surgery performed at our hospital during the past 10 years. METHODS: Patients who had undergone shunt revision surgery from January 2001 to December 2010 were evaluated retrospectively by chart review about age distribution, etiology of hydrocephalus, and causes of revision. Patients were grouped into below and above 20 years old. RESULTS: Among 528 cases of VP shunt surgery performed in our hospital over 10 years, 146 (27.7%) were revision surgery. Infection and obstruction were the most common causes of revision. Fifty-one patients were operated on within 1 month after original VP shunt surgery. Thirty-six of 46 infection cases were operated before 6 months after the initial VP shunt. Incidence of shunt catheter fracture was higher in younger patients compared to older. Two of 8 fractured catheters in the younger group were due to calcification and degradation of shunt catheters with fibrous adhesion to surrounding tissue. CONCLUSION: The complications of VP shunts were different between children and adults. The incidence of shunt catheter fracture was higher in younger patients. Degradation of shunt catheter associated with surrounding tissue calcification could be one of the reasons of the difference in facture rates.
Subject(s)
Adult , Child , Humans , Age Distribution , Catheters , Hydrocephalus , Incidence , Retrospective Studies , Ventriculoperitoneal ShuntABSTRACT
A malignant peripheral nerve sheath tumor (MPNST) is a type of sarcoma that arises from peripheral nerves or cells of the associated nerve sheath. This tumor most commonly metastasizes to the lung and metastases to the spinal cord and brain are very rare. We describe a case of young patient with spinal cord and brain metastases resulting from MPNST. An 18-year-old man presented with a 6-month history of low back pain and radiating pain to his anterior thigh. Magnetic resonance imaging showed a paraspinal mass that extended from the central space of L2 to right psoas muscle through the right L2-3 foraminal space. The patient underwent surgery and the result of the histopathologic study was diagnostic for MPNST. Six months after surgery, follow-up images revealed multiple spinal cord and brain metastases. The patient was managed with chemotherapy, but died several months later. Despite complete surgical excision, the MPNST progressed rapidly and aggressively. Thus, patients with MPNST should be followed carefully to identify local recurrence or metastasis as early as possible.
Subject(s)
Humans , Axis, Cervical Vertebra , Brain , Follow-Up Studies , Low Back Pain , Lung , Magnetic Resonance Imaging , Neoplasm Metastasis , Nerve Sheath Neoplasms , Peripheral Nerves , Psoas Muscles , Recurrence , Sarcoma , Spinal Cord , ThighABSTRACT
Lumbar microdiscectomy (MD) is the gold standard for treatment of lumbar disc herniation. Generally, the surgeon attempts to protect the facet joint in hopes of avoiding postoperative pain/instability and secondary degenerative arthropathy. We believe that preserving the facet joint is especially important in young patients, owing to their life expectancy and activity. However, preserving the facet joint is not easy during lumbar MD. We propose several technical tips (superolateral extension of conventional laminotomy, oblique drilling for laminotomy, and additional foraminotomy) for facet joint preservation during lumbar MD.
Subject(s)
Humans , Foraminotomy , Laminectomy , Life Expectancy , Zygapophyseal JointABSTRACT
Spindle cell lipoma is an unusual and benign neoplasm, which normally occurs in middle age to older individuals oh the posterior neck, shoulders, and upper part of the back in the form of a solitary, slowly growing, painless, and subcutaneous nodule. We report a case of spindle cell lipoma on the right forearm of a 49-year-old female. Histopathologic examination revealed that the subcutaneous tumor was composed of mature fat cells and uniform spindle cells within a mucinous matrix. In some areas, the spindle cell proliferation was dominant due to variation in the ratio of spindle cells to mature fat cells. Vascularity was prominent in many parts of the tumor, and there were numerous mast cells scattered throughout the tumor. Immunohistochemically, the spindle cells were positive for vimentin and CD34, while S-100 protein and actin were not expressed.
Subject(s)
Female , Humans , Middle Aged , Actins , Adipocytes , Cell Proliferation , Forearm , Lipoma , Mast Cells , Mucins , Neck , S100 Proteins , Shoulder , VimentinABSTRACT
BACKGROUND: One of the most important steps in neoplastic progression is represented by invasion of surrounding normal tissues by neoplastic cells. Enzymes such as the metalloproteinases(MMPs) are thought to be involved in the process of destruction of basement membranes and stromal invasion by tumor cells. OBJECTIVE: We investigated the expression patterns of MMP-2 and MMP-9 in acquired and congenital melanocytic nevi, and malignant melanoma by immunohistochemical technique. METHOD: Formalin-fixed and paraffin-embedded tissues from 4 junctional nevi, 4 compound nevi, 5 intradermal nevi, 6 congenital melanocytic nevi, and 6 malignant melanomas were immunolabelled with monoclonal antibodies directed against MMP-2 and MMP-9. RESULT: The benign melanocytic nevi showed negative or low expression for MMP-2 and MMP-9 with the exception of positive staining in involuting neuroid intradermal nevus, and the expression of MMP-9 was detected in 3 cases of congenital melanocytic nevi. The malignant melanoma exhibited high expression of MMP-2 with variable intensity of reactivity in different areas of the tumors and MMP-9 was found to be focally expressed by the tumor cells in intraepidermal and dermoepidermal junction. These findings suggest that the expression of MMP-2 and MMP-9 may be related to tumorigenesis of melanocytic tumors and MMP-9 may be involved in the early stage of tumor progression.
Subject(s)
Antibodies, Monoclonal , Basement Membrane , Carcinogenesis , Melanoma , Metalloproteases , Nevus , Nevus, Intradermal , Nevus, PigmentedABSTRACT
We report here a case of angioimmunoblastic lyinphadenopathy with dysprote inemia(AILD) in a 65-year-old male associated with skin nodules on the face. Physical examina.tion showed generalized lymphadenopathy, hepatosplenomegaly, erythematous maculopapular eruptions on the trunk and extremities, and er the matous nodules on the face. Lahoratory findings showed hemolytic anernia, arid polyclonal gammopathy. Histopathological findings of lymph node revealed typical features of AILD. I-iistopathological findings of maculopapules revealed lymphohistiocytic infiltra tion and extravasated erythrocytes around the blocked vessels, whereas histological picture of nodules on the face mirrorred that of the lymph node. After taking systemic chemotherapy, his general condition and skin lesions were improved.
Subject(s)
Aged , Humans , Male , Drug Therapy , Erythrocytes , Extremities , Immunoblastic Lymphadenopathy , Lymph Nodes , Lymphatic Diseases , SkinABSTRACT
The clinical and histopathologic study of 26 cases with tsutsugamushi disease seen at the Department of Derrnatology, Kosin Medical Center, Pusan, Korea from October 1986 to December 1988 was performed. The results were summarized as follows : 1. Age distribution was from 12 to 73 years and male to female ratio was 1: 1.2 (1P, males 14 females). 2. The disease occurred from September to December in a year. The peak incidence was in October (61.5%). 3. Major clinical manifestations were as follows : Chill, fever and headache (100 %), maculopapular eruption (90.2%), eschar (88.5%) and myalgia (84.6%). 4. Eschars were distributed on the abdomen (34.8%), chest (30.4%), leg (7.4%) and ot.her sites. 5. Histopathologic findings of the erythernatous macules in 24 patients showed epiderrnal changes including exocytosis of rnononuclear cells (66.7%), liquefaction degeneration of basal cells (54.2%), spongiosis (33.3%) and epidermal cell necrosis (29.2%). Dermal changes revealed vascular dilatation and perivascular infiltration of rnononuclear cells (100%), extravasated RBC (50%), and edema of papillary dermis (45.8%). Epidermal changes around the eschar were liquefaction degeneration of basal cells (52.2%), spongiosis (43.5%) and exocytosis of mononuclear cells (30.4%). Dermal changes included vascular dilatation and perivascular mononuclear cell infiltration (100%), vessel wall necrosis (73.9%), ederna of papillary dermis (65.2%) and endothelial cell swelling (65.2%).
Subject(s)
Female , Humans , Male , Abdomen , Age Distribution , Dermis , Dilatation , Edema , Endothelial Cells , Exocytosis , Fever , Headache , Incidence , Korea , Leg , Myalgia , Necrosis , Scrub Typhus , ThoraxABSTRACT
We report a case of Kyrles disease occuring in a 19-year-old man with chronic renal failure. The patient had multiple hyperkeratotic papules with central plug on the upper extremities, lower extremities and buttocks. Histopathological findings showed epidermal invagination filled with parakeratotic column and basophilic debris. Many dyskeratotic and vacuolated cells were present below the keratotic plug, and penetration of the parakeratotic column into the dermis was seen.
Subject(s)
Humans , Young Adult , Basophils , Buttocks , Dermis , Kidney Failure, Chronic , Lower Extremity , Upper ExtremityABSTRACT
We report a case of eosinophilic fasciitis occurring in a 48-year-old man who showed tender, edemstous, indurated, and tight skin on the left forearm and elbow joint. Laboratory findings showed peripheral blood eosinophilia and hypergammaglobulinemia. Other laboratory tests were negative or within normal limits including ANA and anti-DNA. Histopathological findings revealed sclerosis of dermis and thickening of fat and fascia with intense infiltrations of lymphocytes, histiocytes and eosinophils. He was treated successfully with oral prednisolone for 2 weeks.
Subject(s)
Humans , Middle Aged , Dermis , Elbow Joint , Eosinophilia , Eosinophils , Fascia , Fasciitis , Forearm , Histiocytes , Hypergammaglobulinemia , Lymphocytes , Prednisolone , Sclerosis , SkinABSTRACT
We report a case of paraneoplastic acrokeratosis(Bazex syndrome) occurring in a 70 year old man with small cell carcinoma of the lung. The skin lesions showed violaceous erythema and psoriasiform scaling of the face, aural helices, scalp, and palmoplantar regions with severe nail dystrophy, Histcipathological findings revealed hyperkeratosis, acanthosis and spongiosis in the epiderrnis, and lyrnphocytic infiltration in the upper dermis. He was treated with cis-diamine dichloroplanum(Cisplan), 4 o-demethy-l-o-epipodo- phyllotoxin (Etoposide ) and steroid onitrnent. But eight months later, he died of lung carcinoma.
Subject(s)
Aged , Humans , Carcinoma, Small Cell , Dermis , Erythema , Lung , Scalp , SkinABSTRACT
We report a case of Wells' syndrome consisting chiefly of papular, vesicular, pustular and vegetative lesions on the trunk, lower extremities and palms in a 48-year-old female, though characteristic lesions of this syndrome are known to be cellulitis or urticaria like plaques. Only a few cases with such lesions as ours have been reported until now. Histologic finding showed spongiotic vesicles in the epidermis and diffuse dense infiltration of eosinophils with characteristic flame figures in the dermis. In addition, marked blood eosinophilia was noted. We tried oral prednisolone for 3 weeks, and the skin lesions improved almost completely.
Subject(s)
Female , Humans , Middle Aged , Cellulitis , Dermis , Eosinophilia , Eosinophils , Epidermis , Lower Extremity , Prednisolone , Skin , UrticariaABSTRACT
A 47-year-old male patient presented us with erythematous, telangiectatic, purpuric or hyperpigmented patqhes, recurrent painful ulceration and ivory white atrophic scars on the lower portions of his legs, ankles and dorsal surfaces of both feet exacerbating on every summer for 5 years. The histopathalogical findings of an atrophic patch showed endothelial proliforetiion, partial occlusion of the dermal capillaries and fibrinoid material) on the superficial blood vessels, This patient was treated with aspirin and dipyriclamole for 4 months, and the skin lesions were improved significantly.