Even though the incidence of traumatic anterior dislocation of the hip is approximately 15% of all traumatic dislocation, the incidence of bilateral traumatic anterior dislocation is extremely rare. In a review of literature, the authors could find only one case report of bilateral traumatic anterior dislocation of the hip and no case in Korea. The mechanism of traumatic anterior dislocation of the hip is forced abduction. This paper is a case report of a traumatic bilateral anterior dislocation of the hips in a 36 year old labor who injured by fall down from about 5 meter in height. The case was treated by means of closed reduction, traction and physical therapy. Follow up study was performed for one year and obtained good result.
Dislocations ; Follow-Up Studies ; Hip Dislocation ; Hip ; Incidence ; Korea ; Traction

Giant cavernous malformations (GCMs) occur very rarely and little has been reported about their clinical characteristics. The authors present a case of a 20-year-old woman with a GCM. She was referred due to two episodes of generalized seizure. Computed tomography and magnetic resonance image demonstrated a heterogeneous multi-cystic lesion of 7 x 5 x 5 cm size in the left frontal lobe and basal ganglia, and enhancing vascular structure abutting medial portion of the mass. These fingings suggested a diagnosis of GCM accompanying venous angioma. After left frontal craniotomy, transcortical approach was done. Total removal was accomplished and the postoperative course was uneventful. GCMs do not seem differ clinically, surgically or histopathologically from small cavernous angiomas, but imaging appearance of GCMs may be variable. The clinical, radiological feature and management of GCMs are described based on pertinent literature review.
Basal Ganglia ; Caves ; Craniotomy ; Female ; Frontal Lobe ; Gas Chromatography-Mass Spectrometry ; Hemangioma ; Hemangioma, Cavernous ; Humans ; Magnetic Resonance Spectroscopy ; Seizures ; Young Adult

Cavernous malformations (CMs) arising from the optic nerve and chiasm are extremely rare. The authors present a case of 39-year-old woman with CMs of the optic chiasm. She was referred due to sudden onset of bitemporal hemianopsia and headache, the so-called 'chiasmal apoplexy'. MRI findings suggested a diagnosis of hemorrhage and vascular malformation of the optic chiasm. Pterional craniotomy revealed an intrachiasmatic cavernous malformation with hemorrhage. The malformation was totally excised, but field deficits remained unchanged after surgery.
Adult ; Caves ; Craniotomy ; Female ; Headache ; Hemianopsia ; Hemorrhage ; Humans ; Optic Chiasm ; Optic Nerve ; Stroke ; Vascular Malformations

OBJECTIVE: The purpose of this study is to evaluate the clinical characteristics and surgical outcome of cerebellopontine angle (CPA) epidermoids presenting with trigeminal neuralgia. METHODS: Between 1996 and 2004, 10 patients with typical symptoms of trigeminal neuralgia were found to have cerebellopontine angle epidermoids and treated surgically at our hospital. We retrospectively analyzed the clinico-radiological records of the patients. RESULTS: Total resection was done in 6 patients (60%). Surgical removal of tumor and microvascular decompression of the trigeminal nerve were performed simultaneously in one case. One patient died due to postoperative aseptic meningitis. The others showed total relief from pain. During follow-up, no patients experienced recurrence of their trigeminal neuralgia (TN). CONCLUSION: The clinical features of TN from CPA epidermoids are characterized by symptom onset at a younger age compared to TN from vascular causes. In addition to removal of the tumor, the possibility of vascular compression at the root entry zone of the trigeminal nerve should be kept in mind. If it exists, a microvascular decompression (MVD) should be performed. Recurrence of tumor is rare in both total and subtotal removal cases, but long-term follow-up is required.
Cerebellopontine Angle ; Follow-Up Studies ; Humans ; Meningitis, Aseptic ; Microvascular Decompression Surgery ; Recurrence ; Retrospective Studies ; Trigeminal Nerve ; Trigeminal Neuralgia

A 49 years old male patient who suffered from deterioration of posterior neck pain, left hand numbness, left lower limb pain and gait disturbance for 3 years visited our outpatient department. He had been diagnosed as non-dysraphic cervical intradural lipoma and operated in August 1990. On the radiologic images, we found the regrowth of non-dysraphic cervical intradural lipoma from C2 to C7 level, which surrounds and compresses the cervical spinal cord. Previous subtotal laminectomy from C2 to C7 and severe cervical lordosis were also found. Appropriate debulking of lipoma mass without duroplasty was successfully done with intraoperative neurophysiological monitoring (IONM). We are following up the patient for 24 months via outpatient department, his neurologic symptoms such as hand numbness, gait disturbance, left lower limb pain and posterior neck pain have improved. We describe a rare case of regrowth of non-dysraphic cervical intradural lipoma.
Animals ; Gait ; Hand ; Humans ; Hypesthesia ; Intraoperative Neurophysiological Monitoring ; Laminectomy ; Lipoma* ; Lordosis ; Lower Extremity ; Male ; Neck Pain ; Neurologic Manifestations ; Outpatients ; Spinal Cord ; Spinal Dysraphism*

Cholangiocarcinoma has been associated with various fibrocystic diseases of liver and biliary tract, but cholangiocarcinoma in polycystic liver disease (PLD) was extremely rare. It was reported that the prognosis of cholangiocarcinoma associated PLD was very poor and distant metastases were common. We report a rare case of intrahepatic cholangiocarcinoma associated with PLD in 58- year- old female who presented vague abdominal pain. She had also polycystic kidneys with normal renal function. MRI showed well demonstrated tumor with central scar and a adjacent large cyst in the left lobe of the liver. She underwent extended left lobectomy. On microscopic examination, the tumor was moderately differentiated cholangiocarcinoma having abundant fibrous stroma and necrosis and the adjacent cyst showed focal in situ carcinomatous changes in the lining epithelium.
Abdominal Pain ; Biliary Tract ; Cholangiocarcinoma* ; Cicatrix ; Epithelium ; Female ; Humans ; Liver Diseases* ; Liver* ; Magnetic Resonance Imaging ; Necrosis ; Neoplasm Metastasis ; Polycystic Kidney Diseases ; Prognosis ; Cholangiocarcinoma

Sacroiliitis is a prototyical feature of the seronegative spondyloarthropathies. It has been reported rarely in patients with systemic lupus erythematosus. We report a case of bilateral sacroiliitis in a 26 year-old female who presented 5 out of 11 ARA criteria for systemic lupus erythematosus. She complained of right low back pain since 1 week after delivery. Plain roentgenogram, computed tomogram and magnetic resonance imaging revealed no evidence of subluxation or pyogenic infection that may be possibly related to delivery, but bilateral sacroiliitis especially more severe in the right side that showed concordantly increased uptake on bone scan. Also she had neither HLA DR-3 nor B-27 antigens and had no other clinical findings of limitation of motion of spine and chest expansion, which suggest that there is a less likelihood of coexistent ankylosing spondylitis. In this case, we suggested that sacroiliitis may be a infrequent manifestation of systemic lupus erythematosus.
Adult ; Female ; Humans ; Low Back Pain ; Lupus Erythematosus, Systemic* ; Magnetic Resonance Imaging ; Sacroiliitis* ; Spine ; Spondylarthropathies ; Spondylitis, Ankylosing ; Thorax

Superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis is often performed for the management of the patients wth chronic cerebral ischemic lesions or moyamoya disease. Postoperative aneurysm formation at the anastomosis site or its close proximity is a very rare complication. A 44-year-old female underwent bilateral STA-MCA bypass due to moyamoya disease. Approximately 2 years after bypass surgery, an aneurysm of the recipient cortical artery near the site of the anastomosis was found. Surgical exploration of the region demonstrated an 5.4 x 6.4 x 5 mm aneurysm arising near the site of the anastomosis. The aneurysm was clipped, taking care to keep the bypass flowing. This aneurysm had a thick wall and appeared to be a true saccular aneurysm caused by hemodynamic stress. The author present a case of this unusual complication and provide a brief review of literature.
Adult ; Aneurysm ; Arteries ; Cerebral Arteries* ; Cerebral Revascularization ; Female ; Hemodynamics ; Humans ; Middle Cerebral Artery* ; Moyamoya Disease

Anisakiasis is a parasitic disease following eating raw fishes infected with Anisakis larvae. The endoscopic features of the gastric mucosa are edema, erosion, ulceration and hemorrhage. Gastric anisakiasis forming submucosal tumor is rare. Twenty six-year-old man who complained of severe epigastric pain was admitted. The pain began approximately three hours after eating slices of raw Astroconger myriaster. Gastric endoscopy revealed a submucosal tumor with central erosion on the gastric fundus. Endoscopic ultrasonography detected a thickening of the gastric wall made of mainly thickened submucosal layer. Abdominal CT scan showed a gastric mass lesion with hypodensity in the gastric fundus and subsequently wedge resection was performed. The pathologic finding of the resected mass was eosinophilic abscess in the submucosal layer. We report a case of gastric submucosal tumor which seems to be caused by Anisakis, with a review of relevant literature.
Abscess ; Anisakiasis ; Anisakis* ; Eating ; Edema ; Endoscopy ; Endosonography ; Eosinophils ; Fishes ; Gastric Fundus ; Gastric Mucosa ; Hemorrhage ; Larva ; Parasitic Diseases ; Tomography, X-Ray Computed ; Ulcer

The objective of this study was to compare changes in the simplified disease activity index (SDAI) between biologic (b) and conventional (c) disease-modifying antirheumatic drugs (DMARD) users with seropositive rheumatoid arthritis (RA) in daily clinical practice. Methods: This was a nationwide multicenter observational study. Patients who had three or more active joint counts and abnormal inf lammatory marker in blood test were enrolled. The selection of DMARDs was determined by the attending rheumatologist. Clinical parameters, laboratory findings, and Health Assessment Questionnaire (HAQ) scores were obtained at baseline and at 6 and 12 months. Serial SDAI changes and clinical remission rate at 6 and 12 months were assessed. Results: A total of 850 patients participated in this study. The mean baseline SDAI score in bDMARD group was higher than that in cDMARD group (32.08 ± 12.98 vs 25.69 ± 10.97, p < 0.0001). Mean change of SDAI at 12 months was –19.0 in the bDMARD group and –12.6 in the cDMARD group (p < 0.0001). Clinical remission rates at 12 months in bDMARD and cDMARD groups were 15.4% and 14.6%, respectively. Patient global assessment and HAQ at 12 months were also significantly improved in both groups. Multivariate logistic regression showed that baseline HAQ score was the most notable factor associated with remission. Conclusions: There was a significant reduction in SDAI within 12 months after receiving DMARDs in Korean seropositive RA patients irrespective of bDMARD or cDMARD use in real-world practice. Clinical remission was achieved in those with lower baseline HAQ scores.