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A 19-year-old man noticed a very slowly spreading erythematous macular lesion on his cheek when he was 5 years old. This asymptomatic and well circumscribed patch was covered with fine scales. He sought first medical attention at the age of 12 years and diagnosis was cutaneous tuberculosis was made by skin biopsy. Seven years after the second biopsy was made and it revealed a few spores within giant cells in the upper dermis. By mycologic study, it was identified as Paecilomyces lilacinus. The patient was put on the treatment of topical and oral antifungal agents. The skin lesion showed signs of improvement after 12 weeks of treatment.
Aneurysms arising from the posterior circulation are·5-10% of total intracranial aneurysms. Although many neurosurgeons have challended with various innovations but the confined surgical space, complicated anatomical structure and many small perforators to vital organ of brain were remained the barrier that we have to overcome. From July 1987 to December 1994, we have been operated on 23 cases of posterior circulation aneurysms among 409 cases of surgically treated all intracranial aneurysms. The present 5.6% of all intracranial aneurysm, the average age of these patients was 49 years old. The ratio of male to female was 1 : 1.8. The number of basilar bifurcation artery aneurysms(BBAA) were 14(61%), the posterior cerebral artery(PCA) aneurysms3(13%), the upper basilar trunk aneurysm 1, posterior inferior cerebellar artery (PICA) aneurysm 3(13%), anterior inferior cerebellar artery(AICA) aneurysm 1 and vertebral artery aneurysm 1. Five patients had accompanined with anterior circulation aneurysm and one patient had concomitant arteriovenous malformation. We have successfully clipped 12 cases and wrapped 2 cases of BBAA aneurysms through modified pterional approach and subtemporal approach according to the hight of basilar bifurcation and the other posterior circulation aneurysms are all clipped through most available approaches including lateral, far-lateral suboccipital and interhemispheric approach. Surgical outcome was good in 15 cases, fair in 4 cases, poor in 3 cases and one patient expired.
Ia antigen (HLA-DR in rnan) is confined to the Langerhans cells and indeterminate cells in the normal epidermis in man. However the keratinocyte express la antigen in a variety of dermatoses. IFN-γ (irnmune interfcron), known as macrophage activating factor, has been shown to induce Ia antigen expression in a wide variety of cell types. However the Ia antigen induced by 1FN-γ is inhibited PGE₂, a product of cyclooxygenase pathway of arachidonic acid metabolism. LTB₄, a product of lipoxygenase pathway, can replace the IL-2 requirement for IFN-γ production in the lymphocytes. There are three main morphalogical patterns of Ia antigen staining in the epidennis. Staining of the basal cells, staining in the mid epidermis in Malphigian layer and staining throughout the epidermis. The staining of Ia' keratinocyte was found to be confined to the lesional area of contact hypersensitivity reaction, graft vs host disease, and lichen planus. la+staining to extend beyond the lesional area was also seen in the study on turberculosis and leporsy.