Ewing's sarcoma, originating primarily in the spinal epidural space is exceptionally rare. There are only 6 case reports in English literature until 1986. We experienced a case of epidural Ewing's sarcoma originated in thoracic spinal canal at T6~T7 level with myelopathy. Initial neural decompression was very effective and complete recovery was achieved. But local recurrence occurred in relatively short follow up period(8 months). Subsequent radiotherapy showed us dramatic tumor regression and improvement of neurologic deficit. The problems that concerned in this tumor are its accurate diagnosis and appropriate therapeutic modality. We reviewed the literatures that deal with exceptional locations of Ewing's sarcoma and current therapeutic approaches with their outcomes.
Decompression ; Diagnosis ; Epidural Space ; Follow-Up Studies ; Neurologic Manifestations ; Radiotherapy ; Recurrence ; Sarcoma, Ewing* ; Spinal Canal ; Spinal Cord Diseases

In 2008 at least five complete genome sequences are available. It is known that there are over 15,000,000 genetic variants, called SNPs, in the dbSNP database. The cost of full genome sequencing in 2009 is claimed to be less than $5000 USD. The genomics era has arrived in 2008. This review introduces technologies, bioinformatics, genomics visions, and variomics projects. Variomics is the study of the total genetic variation in an individual and populations. Research on genetic variation is the most valuable among many genomics research branches. Genomics and variomics projects will change biology and the society so dramatically that biology will become an everyday technology like personal computers and the internet. 'BioRevolution' is the term that can adequately describe this change.
Biology ; Computational Biology ; Genetic Variation ; Genome ; Genomics ; Humans ; Internet ; Microcomputers ; Polymorphism, Single Nucleotide ; Vision, Ocular

OBJECTIVE: The purpose of this study was to analyze in detail the relationship between outcome and time course of effect in medically refractory primary cervical dystonia (CD) with phasic type that was treated by bilateral globus pallidus internus (Gpi) deep brain stimulation (DBS). METHODS: Six patients underwent bilateral implantation of DBS into the Gpi under the guide of microelectrode recording and were followed for 18.7 +/- 11.1 months. The mean duration of the CD was 5.8 +/- 3.4 years. The mean age at time of surgery was 54.2 +/- 10.2 years. Patients were evaluated with the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) and relief scale using patient self-reporting. RESULTS: The TWSTRS total scores improved by 64.5%, 65.5%, 75.8%, and 76.0% at 3, 6, 12 months, and at the last available follow-up after surgery, respectively. Statistically significant improvements in the TWSTRS scores were observed 3 months after surgery (p = 0.028) with gradual improvement up to 12 months after surgery, thereafter, the improvement was sustained. However, there was no statistically significant difference between the scores at 3 and 12 months. Subjective improvement reported averaged 81.7 +/- 6.8% at last follow-up. Mild dysarthria, the most frequent adverse event, occurred in 3 patients. Conclusions: Our results show that the bilateral Gpi-DBS can offer a significant therapeutic effect from 3 months postoperatively in patients with primary CD with phasic type, without significant side effects.
Deep Brain Stimulation ; Dysarthria ; Follow-Up Studies ; Globus Pallidus ; Humans ; Microelectrodes ; Torticollis

The authors present a case of solitary dural plasmacytoma. A 43-year-old woman was admitted our department due to headache. Brain magnetic resonance(MR) image showed homogeneous enhanced lesion at the left occipital area. We performed surgical excision and it was confirmed plasmacytoma, histologically. The solitary dural plasmacytomas are exceedingly rare. Before this case report, only 17 cases had been reported in the literature
Adult ; Brain ; Dura Mater ; Female ; Headache ; Humans ; Multiple Myeloma ; Plasmacytoma*

OBJECTIVE: The aim of this study is to investigate the clinical outcomes of surgery and coiling and analyze the predicting factors affecting the clinical outcomes of ruptured posterior inferior cerebellar artery (PICA) aneurysms. METHODS: During the last 15 years, 20 consecutive patients with ruptured PICA aneurysms were treated and these patients were included in this study. The Fisher's exact test was used for the statistical significance of Glasgow Outcome Scale (GOS) according to initial Hunt-Hess (H-H) grade, treatment modalities, and the presence of acute hydrocephalus. RESULTS: Eleven (55%) and nine (45%) patients were treated with surgical clipping and endovascular treatment, respectively. Among 20 patients, thirteen (65.0%) patients had good outcomes (GOS 4 or 5). There was the statistical significance between initial poor H-H grade, the presence of acute hydrocephalus and poor GOS. CONCLUSION: In our study, we suggest that initial H-H grade and the presence of acute hydrocephalus may affect the clinical outcome rather than treatment modalities in the ruptured PICA aneurysms.
Aneurysm ; Arteries ; Glasgow Outcome Scale ; Humans ; Hydrocephalus ; Pica ; Subarachnoid Hemorrhage ; Surgical Instruments

The stereotactic surgical target for dystonic tremor is the subject of ongoing debate. Targeting the subthalamic area using deep brain stimulation has been regaining interest as a therapy for various types of involuntary movements. We describe the efficacy of stimulation of the subthalamic area in a patient with intractable dystonic tremor. Excellent control without neurological complications was achieved. This case report demonstrates that the subthalamic area is a valuable target for the control of dystonic tremor.
Deep Brain Stimulation ; Dyskinesias ; Humans ; Tremor

OBJECTIVES: Bipolar disorder is characterized by repetitive relapses that result in psychosocial dysfunctions. The functioning of bipolar disorder patients is related to the severity of symptoms, quality of sleep, drug compliance, and social support. The purpose of this study was to investigate the association between sociodemographic and clinical factors and functional status in bipolar disorder patients. METHODS: A total of 52 bipolar disorder patients participated in the study. The following scales were utilized: Korean version of personal and social performance scale (K-PSP), Korean version of Hamilton rating scale for depression (K-HDRS), Korean version of young mania rating scale (K-YMRS), Korean version of pittsburgh sleep quality index (PSQI-K), Korean version of drug attitude inventory (K-DAI), mood disorders insight scale (MDIS), and multidimensional scale of perceived social support (MSPSS). RESULTS: The K-PSP score showed a negative relationship with K-HDRS score (r = −0.387, p = 0.005), but not with K-YMRS score (r = −0.205, p = 0.145). The K-PSP score showed a negative relationship with global PSQI-K score (r = −0.378, p = 0.005) and overall sleep quality (r = −0.353, p = 0.010). The K-PSP scores were positively associated with the KDAI score (r = 0.409, p = 0.003) and MSPSS score (r = 0.334, p = 0.015). The predictive factors for K-PSP were overall sleep quality and social support from family. CONCLUSION: Our study showed that depressive symptoms were related to overall function in bipolar disorder. Also, our study suggested that improving sleep quality is important in maintaining functional status. Appropriate social support and positive perception toward the drug may lead to the higher level of functioning. This study is meaningful in that the functional status of bipolar disorder patients is analyzed in a multivariate manner in relation to various variables in psychosocial aspects.
Bipolar Disorder ; Compliance ; Depression ; Humans ; Mood Disorders ; Recurrence ; Weights and Measures

BACKGROUND/AIMS: Nontuberculous mycobacteria (NTM) infection has been increasing worldwide in both general population and immunocompromised patients, which has also been reported in rheumatoid arthritis (RA) patients. This study aimed to identify the incidence and clinical characteristics of NTM infection in RA patients living in tuberculosis (TB) infection endemic area. METHODS: We performed a retrospective analysis of NTM infection cases in our RA registry at a tertiary referral center from January 1995 to December 2013. The clinical features of them were compared to those of 52 TB infection patients from same registry. RESULTS: Among 1,397 patients with RA, NTM infection was newly developed in 26 patients and the incidence of NTM infection was 164.8 per 100,000 patient-years. The Mycobacterium avium complex was the most frequent isolate (76.9%). None of the NTM infections had extrapulmonary involvement, which was rather common in TB infection (26.9%). Patients with NTM infection were older, received higher cumulative steroid doses, and had higher rates of past TB infection history and concomitant interstitial lung disease (ILD) than cases with TB infection. CONCLUSIONS: In South Korea, NTM infection is not rare in RA patients, and infection rates are growing. Physicians should be cautious about NTM infection in patients with a history of TB infection or concomitant ILD, even living in TB endemic area.
Arthritis, Rheumatoid* ; Humans ; Immunocompromised Host ; Incidence ; Korea* ; Lung Diseases, Interstitial ; Mycobacterium avium Complex ; Mycobacterium tuberculosis ; Nontuberculous Mycobacteria ; Retrospective Studies ; Tertiary Care Centers ; Tuberculosis

BACKGROUND/AIMS: Acute transverse myelitis (ATM) is a severe complication of systemic lupus erythematosus (SLE). This study evaluated the clinical factors related to outcome in patients with SLE-associated ATM. METHODS: The medical records of patients diagnosed with SLE-associated ATM between January 1995 and January 2015 were reviewed. The patients were divided into two groups based on improvement of neurological deficits after treatment: favorable response group and unfavorable response group. During follow-up, the recurrence of ATM was also analyzed. RESULTS: ATM was identified in 16 patients with SLE. All of the patients were treated with high doses of methylprednisolone (≥ 1 mg/kg daily). Although 12 patients (75%) recovered (favorable response group), four (25%) had persistent neurologic deficits (unfavorable response group) after the treatment. Compared to the favorable response group, significantly higher Systemic Lupus Erythematosus Disease Activity Index-2000, lower complement levels and initial severe neurologic deficits were found in the unfavorable response group. Among the 12 favorable response patients, five (41.7%) experienced recurrence of ATM during the followup. Patients (n = 5) who experienced relapse had a shorter duration of high-dose corticosteroid treatment (13.2 days vs. 32.9 days, p = 0.01) compared to patients who did not relapse. The mean duration of tapering-off the corticosteroid until 10 mg per day was significantly longer in non-relapse group (151.3 ± 60.8 days) than in relapse group (63.6 ± 39.4 days, p = 0.013). CONCLUSIONS Higher disease activity in SLE and initial severe neurologic deficits might be associated with the poor outcome of ATM. Corticosteroid slowly tapering-off therapy might be helpful in preventing the recurrence of ATM.