Determinants of Central Nervous System Involvement in Herpes Zoster

BACKGROUND: Herpes zoster is a viral disease characterized by a painful skin rash with blisters in a limited area on one side of the body, often in a stripe. Central nervous system(CNS) involvements are uncommon complications of herpes zoster. The exact mechanism and risk factors are still unknown. METHODS: We retrospectively reviewed the clinical data of patients who was admitted at our hospital due to herpes zoster from 2003 to 2013. The patients under age 15, herpes zoster infection without skin lesions, and cases not confirmed by a dermatologist were excluded. CNS involvements are defined as meningitis, encephalitis, single or multiple cranial neuropathies and all cases were evaluated with brain magnetic resonance imaging, spinal tapping, serological tests and confirmed by a neurologist. We compared the herpes zoster patients with CNS involvement to those without CNS involvement. Age, sex, body mass index, associated chronic medical illnesses, site and extent of skin lesion and development of post herpetic neuralgia were compared between two groups. RESULTS: Total 1,131 subjects (male 460, female 671) were recruited. A group with CNS involvement was 91(8.04%). Sex, body mass index, associated chronic medical illnesses, extent of skin lesion were not different between two groups. A group with CNS involvement showed younger age(p<0.01), more facial and cervical skin lesions(p<0.01), lesser development of post herpetic neuralgia(p=0.048). CONCLUSIONS: CNS involvement is not a rare complication of herpes zoster and more frequent in patients with younger age and faciocervical zoster.

Atypical Posterior Reversible Encephalopathy Syndrome after Cervical Facet Joint Steroid Injection

Posterior reversible encephalopathy syndrome (PRES) is characterized by headache, altered mental function, seizures, and loss of vision predominantly affecting the bilateral parieto-occipital area. Most cases of PRES are associated with hypertension, or use of immunosuppressants or cytotoxic drugs; associated brainstem and cerebellar lesions are uncommon. We report herein a case of PRES that developed in a patient after injecting a steroid for cervical pain management. The presence of a territorial lesion along the vertebral artery on the same side as the pain-management procedure suggests an association between injectable steroid suspension and PRES.

Treatment of a Chronic Gouty Ulcer on the Lateral Malleolus with Vacuum-Assisted Closure (VAC) Therapy

Gouty ulceration is a clinical manifestation of gout, which is a metabolic disease induced by disturbed purine metabolism. In general, protruded gout tophus and secondary infection made a gouty ulceration. It was generally treated with surgical debridement of the tophus and infected tissue. Inevitably, we make the skin defect if needed the wide surgical debridement. We waited for granulation tissue healing of the defect, then finished with a skin graft. However, larger sized gouty ulcerations require a longer period of healing time. We commonly used the vacuum assisted wound closer device (VAC) for shortening the healing time in diabetic foot ulceration. Use of VAC for a gouty ulceration was not nearly reported in literature. We report on the use of VAC after surgical debridement to heal a chronic gouty ulceration around the lateral malleolus.

Fine Structure and Albumin Gene Expression in Intrasplenically Transplanted Hepatocytes / 대한내과학회지

BACKGROUND: The morphological characteristics of hepatocytes transplanted into the spleen have been studied. However few attempts has been made to determine the expression of genes in intrasplenically transplanted hepatocytes. The aim of this study was to explore whether the pattern of expression of albumin gene in intrasplenically transplanted hepatocytes is similar to that in adult liver, resulting in the long-term expression of this hepatocyte-specific gene. METHODS: Hepatocytes isolated from liver of syngeneic Fischer 344 rats and transplanted into the spleen of rats from the same strain survived for 12 months in the absence of immunosuppressive drugs. Microscopic examination of intrasplenic hepatocytes and Northern blotting for albumin gene expression of RNA extracted from liver and spleen was performed. RESULTS: Microscopy demonstrated that hepatocytes attached themselves only in the red pulp of the spleen and isolated hepatocytes preserved the fine structures characteristic of normal hepatic parenchymal cells. Throughout the 12 months period, intrasplenically transplanted hepatocytes expressed albumin mRNA. CONCLUSIONS: Intrasplenically transplanted hepatocytes represent a unique in vivo system of extrahepatic maintenance of hepatocytes. This novel transplantation system could be used to investigate hepatocyte engraft, proliferation and gene expression.