There are various complex formations between immunoglobulin and serum enzymes in the body. Of these, LD-Immunoglobulin complex is most common. It has reported that LD-IgG or LD-IgA complex existed in the serum of healthy person or many patients who have various clinical disorders. The clinical significance of complexes is not known, but it results in the increase of total LD activity and interference to the LD isoenzyme electrophoresis interpretation due to its anomalous pattern. We have reported a case of LD-Immunoglobulin complex in AILD(Angioimmunoblastic lymphadenopathy with dysproteinemia) with reference. The patient was admitted with fever, chills and cervical LN enlargement, in LN biopsy, diagnosed AILD, and during treatment expired by sepsis. Since admission, serum total LD activities were increased and serum LD isoenzyme EP showed that LD3-5 fractions was not separated in broad single band. Its pattern was due to LD-immunoglobulin complex, LD-bound immunoglobulin was IgG ,lamda. For the identification of immunoglobulin, we at first did serum protein immunoelectrophoresis. then stained the plate with tetrazolium dye for LD activity.
Biopsy ; Chills ; Electrophoresis ; Fever ; Humans ; Immunoblastic Lymphadenopathy* ; Immunoelectrophoresis ; Immunoglobulin G ; Immunoglobulins ; Lactic Acid* ; Lymphatic Diseases ; Sepsis

A 38-year-old man visited our Emergency Department for sudden onset paraplegia that occurred 1 hour ago. He felt a piercing pain in the posterior neck and became paraplegic while he was watching television, lying down on a sofa. Neurological examination showed motor power grades II–III in both arms and grade 0 in both legs. His cervical magnetic resonance imaging (MRI) showed a large ruptured disc at the C5–6 level, severely compressing the spinal cord. Emergency anterior cervical discectomy and fusion at C5–6 were performed. Because extensive cord swelling was observed on postoperative MRI, laminoplasty from C3 to C6 was performed 3 days after the initial operation. At a postoperative 8-month follow-up, the motor power was improved to grade III–IV- for both hands and grade IV- for both legs. Nontraumatic cervical disc rupture causing acute paraplegia is a very rare but possible event. Immediate neurologic assessment and thorough imaging studies to allow accurate diagnosis are crucial. Emergency surgical decompression is important and may lead to good neurological outcomes.
Adult ; Arm ; Deception ; Decompression, Surgical ; Diagnosis ; Diskectomy ; Emergencies ; Emergency Service, Hospital ; Follow-Up Studies ; Hand ; Humans ; Laminoplasty ; Leg ; Magnetic Resonance Imaging ; Neck ; Neurologic Examination ; Paraplegia* ; Rupture* ; Spinal Cord ; Television

A 48-year-old woman presented with acute voiding difficulty, numbness and weakness of both lower extremities. Magnetic resonance imaging (MRI) showed an intramedullary hemorrhagic mass that extended from T9 to T10. T8-T10 laminotomy and surgical removal of the hemorrhagic mass was performed. The pathological diagnosis was hematoma. Her neurological status remained the same after the operation. At 5 days post-operation, the patient suddenly became paraplegic, and MRI that was immediately performed revealed a recurrent intramedullary hemorrhage. Emergent surgical evacuation was performed. Again, histological examination showed only hematoma, without any evidence of abnormal vessels or a tumor. A postoperative MRI revealed no abnormal lesions other than those resulting from postoperative changes. At a 9-month follow up, the patient could walk a short distance with the aid of a walker. Because spontaneous intramedullary hemorrhage with unknown etiology is very rare, it is essential to perform a meticulous inspection of the hemorrhagic site to find the underlying cause. Repeated hemorrhage can occur; therefore, close observation of patients after surgery is important in cases without an apparent etiology. Urgent surgical evacuation is important to improve outcomes in these cases.
Diagnosis ; Female ; Follow-Up Studies ; Hematoma ; Hemorrhage* ; Humans ; Hypesthesia ; Laminectomy ; Lower Extremity ; Magnetic Resonance Imaging ; Middle Aged ; Spinal Cord ; Spinal Cord Vascular Diseases ; Walkers

STUDY DESIGN: Case report. OBJECTIVES: We report a case of pure epidural cavernous hemangioma located at the thoracolumbar spine in a 53-year-old woman that mimicked a neurogenic tumor on magnetic resonance imaging (MRI). SUMMARY OF LITERATURE REVIEW: A pure spinal epidural cavernous hemangioma without bony involvement is a very rare lesion about which limited information is available in the literature. MATERIALS AND METHODS: A 53-year-old woman visited our clinic for hypoesthesia with a tingling sensation in the left anterolateral thigh that had begun a month ago. No other neurologic symptoms or signs were present upon a neurologic examination. MRI from an outside hospital showed a 2.0×0.5 cm elongated mass at the T11-12 left neural foramen. The tumor was completely removed in piecemeal fashion. RESULTS: The histopathologic examination revealed a cavernous hemangioma, which was the final diagnosis. The outcome was favorable in that only operation-related mild back pain remained, without any neurologic deficits, after a postoperative follow-up of 2 years and 3 months. No recurrence was observed on MRI at 2 years postoperatively. CONCLUSION: Pure epidural spinal cavernous hemangioma is very rare, and it is very difficult to differentiate from other epidural lesions. However, we believe that it should be included in the differential diagnosis of spinal epidural tumors due to its favorable prognosis.
Back Pain ; Diagnosis ; Diagnosis, Differential ; Epidural Neoplasms ; Female ; Follow-Up Studies ; Hemangioma, Cavernous ; Humans ; Hypesthesia ; Magnetic Resonance Imaging ; Middle Aged ; Neurologic Examination ; Neurologic Manifestations ; Prognosis ; Recurrence ; Sensation ; Spine ; Thigh ; Thoracic Vertebrae

OBJECTIVES: We report a case of pure epidural cavernous hemangioma located at the thoracolumbar spine in a 53-year-old woman that mimicked a neurogenic tumor on magnetic resonance imaging (MRI).SUMMARY OF LITERATURE REVIEW: A pure spinal epidural cavernous hemangioma without bony involvement is a very rare lesion about which limited information is available in the literature. MATERIALS AND METHODS: A 53-year-old woman visited our clinic for hypoesthesia with a tingling sensation in the left anterolateral thigh that had begun a month ago. No other neurologic symptoms or signs were present upon a neurologic examination. MRI from an outside hospital showed a 2.0×0.5 cm elongated mass at the T11-12 left neural foramen. The tumor was completely removed in piecemeal fashion. RESULTS: The histopathologic examination revealed a cavernous hemangioma, which was the final diagnosis. The outcome was favorable in that only operation-related mild back pain remained, without any neurologic deficits, after a postoperative follow-up of 2 years and 3 months. No recurrence was observed on MRI at 2 years postoperatively. CONCLUSION Pure epidural spinal cavernous hemangioma is very rare, and it is very difficult to differentiate from other epidural lesions. However, we believe that it should be included in the differential diagnosis of spinal epidural tumors due to its favorable prognosis.

Two M-protein peaks in serum protein electrophoresis are rarely present in patients with plasma cell discrasia. We describe a 72-year-old male patient with multiple myeloma secreting biclonal M-proteins, which were confirmed by immunofixation. Immunoelectrophoresis has some difficulties to dectect M components when a very small amount of M-protein develops an equivocally abnormal precipitation arc. In this case, serum protein electrophoresis revealed two M peaks, one in beta and the other in gamma globulin region. An immunoelectrophoresis revealed unequivocally abnormal precipitation arcs in IgA and K light chain regions, but the arc in IgG region was equivocal. We performed an immunofixation and confirmed biclonal gammopathy, IgA-K and IgG-K types. This result supports the view that immunofixation is an useful confirmatory test when immunoelectrophoresis results are equivocal.
Aged ; Electrophoresis ; gamma-Globulins ; Humans ; Immunoelectrophoresis ; Immunoglobulin A ; Immunoglobulin G ; Male ; Multiple Myeloma* ; Myeloma Proteins ; Plasma Cells

OBJECTIVE: The surgical clipping of paraclinoid segment internal carotid artery aneurysms is considered difficult because of the complex anatomical location and important neighboring structures. Our experiences of pterional craniotomy and extradural anterior clinoidectomy (EAC) to clip paraclinoid aneurysms are reported herein. METHODS: We present two patients with paraclinoid aneurysms who underwent surgical clipping using pterional craniotomy and EAC. The clinical results and operative techniques were reviewed from the patients' medical records. RESULTS: EAC improves the surgical field in the suprasellar and periclinoid regions. Clinically, a good outcome was obtained in both cases. No surgical complications directly resulting from the EAC were observed. CONCLUSION: Favorable surgical results can be obtained with pterional craniotomy and EAC for the clipping of paraclinoid aneurysms. EAC is advocated for the clipping of paraclinoid aneurysms.
Aminocaproic Acids ; Aneurysm ; Carotid Artery, Internal ; Craniotomy ; Humans ; Surgical Instruments

In most intracranial surgery cases, a drain catheter is inserted to prevent the collection of the wound hematoma or seroma. A drain catheter is also inserted to drain the hematoma or the cerebrospinal fluid. The drain catheter itself does not cause complications; but many complications occur during its removal, such as hematoma, seroma, air collection and pseudomeningocele formation. To prevent these complications, neurosurgeons perform a suture on the catheter to remove the site. In this study, an additional horizontal mattress suture and an anchoring suture to the drainage catheter are proposed. This method maintains negative pressure in the catheter insertion site during the catheter removal, compresses the catheter tunnel site and attaches the external wounds strongly. The technique is easy and safe to perform, and does not require an additional suture to remove the catheter.
Catheters* ; Cerebrospinal Fluid ; Drainage* ; Hematoma ; Seroma ; Sutures* ; Wounds and Injuries

The most common complication of coil embolization for cerebral aneurysms is thrombo-embolic stroke; in rare cases, these strokes, can present with central retinal artery occlusion. At our institution, a 53-year-old woman underwent stent-assisted coiling of the aneurysm. The patient's vision was improved immediately after intra-arterial thrombolysis and had further improved 8 months later. This report describes our experience of a rare case of central retinal artery occlusion after coil embolization that was successfully treated by intra-arterial thrombolysis.
Aneurysm* ; Embolization, Therapeutic* ; Female ; Humans ; Intracranial Aneurysm ; Middle Aged ; Retinal Artery Occlusion* ; Retinal Artery* ; Stroke

A 79-year-old man visited our clinic complaining of lower back and left leg radiating pain that began 1 month prior to his presentation. He underwent surgery for lumbar disc herniation 20 years ago at another hospital. Magnetic resonance imaging revealed left-sided foraminal stenosis at L4-5. In addition, a paraspinal mass occupying the L4 spinous process and left lamina was observed. We subsequently performed an L4-5 decompression and fusion. During the operation, retained surgical gauze with granulation tissue was found. The term gossypiboma is used to define a mass lesion consisting of retained surgical gauzes and an adjacent foreign body reaction. Gossypibomas are uncommon in the paraspinal area and are mostly asymptomatic in chronic cases. Because there are no specific clinical or radiological signs, they can be confused with other tumorous conditions. Gossypibomas should be included in the differential diagnosis of paraspinal soft-tissue masses detected in patients with a history of prior spinal surgery.
Aged ; Constriction, Pathologic ; Decompression ; Diagnosis, Differential ; Foreign Bodies ; Foreign-Body Reaction ; Granulation Tissue ; Humans ; Leg ; Magnetic Resonance Imaging ; Young Adult*