ULTRASOUND MEASUREMENT OF SKIN THICKNESS IN SYSTEMIC SCLEROSIS

Sclerotic skin change in systemic sclerosis (SSc) usually accompaniesincreased skin thickness. In order to quantify the cutaneouschanges and to clarify the changes in the ‘uninvolved’skin in systemic sclerosis (SSc), we measured the skin thicknesson the chest, the forearms and the hands of 79 patients withSSc and 81 healthy controls with a B-mode ultrasound (30 MHz)apparatus. The thickness of the ‘uninvolved’, aswell as the ‘involved’ skin in patients with SScwas significantly greater than that of healthy controls. Increasedskin thickness on the forearms and/or the hands showed a 64.6%sensitivity and a 100% specificity for SSc. These results indicatedthat the skin which appears to be ‘uninvolved’ inpatients with SSc is already pathologic, as shown by increasedthickness. Moreover, measurement of skin thickness may be beneficialin the diagnosis of this disease at an early stage. KEY WORDS: Systemic sclerosis, Skin thickness, ‘Uninvolved’ skin, Ultrasound measurement     

A case of petrotentorial meningioma presented as an acute subdural hemorrhage

The authors report a rare case of petrotentorial meningioma presenting as acute subdural hematoma. A 60-year-old female was introduced to our hospital complaining of sudden headache and gait disturbance. CT and MRI demonstrated a petrotentorial tumor with a subdural hematoma in the posterior fossa. The tumor was enhanced intensively on MRI and showed the dural tail sign. The patient developed progressive impairment of consciousness along with hydrocephalus. After ventricular drainage, emergency intracranial decompression through hematoma evacuation and partial tumor resection was performed. One month later, she improved clinically and the tumor resected totally in the second craniotomy. Histological examination showed a meningothelial meningioma with high vascularity in part. She recovered uneventfully and was discharged on foot. We discussed the etiology of an acute subdural hematoma caused by intratumoral hemorrhage and reviewed past literatures.     

A case of multiple dural arteriovenous fistulas treated by multiple modalities

The authors report a rare case of multiple intracranial dural arteriovenous fistulas (DAVF) at separate sinuses. A 70-year-old man was introduced to our hospital complaining of visual disturbance due to bilateral choked disk, headache, and tinnitus. Initial angiography showed DAVFs involving the superior sagittal sinus and bilateral transverse-sigmoid sinuses, and the occlusion of the right jugular vein. The patient developed progressive impairment of visual activity and had high intracranial pressure (ICP) caused by venous hypertension. No cerebral alteration was seen on magnetic resonance imaging. To decrease the high ICP, surgical sinus isolation of the superior sagittal sinus was performed. After the surgery, transvenous embolization was performed to the right transverse-sigmoid sinus DAVF. Headache and tinnitus improved after these treatments, but visual activities rapidly declined and he experienced blindness in just a few months. Gamma knife radiosurgery was performed to the residual DAVFs. We discussed the etiology and treatment of the multiple DAVF, and reviewed past literatures.     

流行性乙型脑炎病毒NS5蛋白的表达

目的 在大肠杆菌中表达并纯化流行性乙型脑炎病毒NS5蛋白,为进一步研究乙脑病毒NS5蛋白的结构与功能奠定基础。方法 根据乙脑病毒NS5蛋白的基础序列,设计两对PCR引物,采用RT-PCR法分别扩增乙脑病毒JaOH0566株部分及全长NS5基因。将扩增产物分别克隆到表达载体pQE30。筛选重组质粒,转化大肠杆菌表达重组蛋白。重组蛋白经金属柱亲和层析纯化。结果与结论 获得了含部分及全长乙脑病毒NS5基因的重组质粒,重组质粒经限制性酶双酶切、DNA序列分析及PCR扩增筛选证实。在大肠杆菌中表现出了带6个组氨酸头的部分及全长的重组乙脑病毒NS5蛋白。经SDS-PAGE及Western-blot分析证实表达蛋白确定是重组乙脑病毒NS5蛋白。     

Weber-Christian disease with benign cytophagic histiocytes in the skin lesion

We describe an 8 year old female with Weber-Christian disease who manifested erythema on her legs and an intermittent high fever. A wedge skin biopsy revealed lobular panniculitis and bean-bag cells, which were characteristic to cytophagic histiocytic panniculitis (CHP). However, she showed no evidence of liver dysfunction, hyperlipidemia, or coagulation disorders usually seen in CHP. Moreover, she responded well to oral corticosteroids therapy with resultant advanced subcutaneous fat atrophy.     

Color Doppler ultrasonography as a routine clinical examination in male infertility

AIM: We assessed the value of scrotal color Doppler ultrasonography as a routine examination in infertile men. METHODS: Color Doppler ultrasonography was performed in 545 infertile men with a mean age of 35.8 years to detect intrascrotal abnormalities. Findings were compared with those of physical examination. RESULTS: Intrascrotal abnormalities were detected by ultrasonography in 65.3% of patients. Of 374 abnormalities, 58.3% were undetected by physical examination. Left varicocele was found in 313 patients (57.4%); testicular microlithiasis in 30 (5.5%); epididymal cyst in 21 (3.9%); right varicocele in 4 (0.8%); and testicular cysts in 3 (0.6%). One occurrence each (0.2%) was found for testicular tumor, intrascrotal hemangioma, and hydrocele of the spermatic cord. Compared to ultrasonography, sensitivity in detecting left varicocele by physical examination was 58.4%; specificity, 79.3%; accuracy, 67.3%; and positive predictive value, 79.3%. Venous diameters in the pampiniform plexus were 3 mm or more in 61.5% of 130 subclinical left varicoceles. Of 30 patients with testicular microlithiasis, 14 had varicocele, 2 had epididymal cyst,s 3 had a history of mumps orchitis, 1 had retractile testis, and 1 had a history of orchiectomy for contralateral testicular tumor. CONCLUSIONS: The routine Color Doppler ultrasonography is valuable for diagnosing scrotal abnormalities in infertile men, frequently detecting non-palpable lesions.     

Laparoscopic adrenalectomy in patients with large adrenal tumors

OBJECTIVES: The maximum size of adrenal tumors that should be removed by laparoscopic adrenalectomy is controversial. We conducted a retrospective comparison of the results of laparoscopic adrenalectomy between patients with adrenal tumors > or =6 cm ('large tumors') and patients with adrenal tumors <6 cm ('small tumors'). METHODS: The participants in the study were 16 patients with large tumors and 111 patients with small tumors. The patients comprised 59 men and 68 women (mean age, 49.0 years; age range, 23-79) with varying diagnoses. Of the 16 patients with large tumors, five had Cushing's syndrome, four had pheochromocytomas, six had a non-functional tumor and one had malignant lymphoma. Adrenal tumors were confirmed by hormonal assays, biochemical tests and computed tomography. Of the 16 large tumors, five tumors were on the right and 11 were on the left. RESULTS: We found no significant differences in general demographic parameters between patients with large and small tumors. The mean duration of surgery was not significantly different between two groups. (large tumors, 210 min; small tumors,175 min). The mean volume of blood loss was 212 mL for large tumors and 30 mL for small tumors (P < 0.001, significant difference). There was no significant difference in time until walking, duration of hospitalization or number of using analgesics used. The time to first oral intake of group 1 (<6 cm) was significantly shorter than group 2 (> or =6 cm). Tumor size (> or =7.5 cm) was an independent predictor of a longer operation and greater blood loss in large tumors. CONCLUSIONS: Laparoscopic adrenalectomy for large tumors was safe and minimally invasive.