Chorea is an uncommon movement disorder of systemic lupus erythematosus (SLE) and/or antiphospholipid syndrome (APLS). It frequently develops early in the course of SLE and is not recurrent in most patients. In this report, we presented the clinical features of two cases of recurrent chorea secondary to APLS associated with SLE. A 24 year-old woman with SLE for 10 years was admitted because of choreic movement involved both extremities, facial and neck muscles. She had the same episode 1.5 years ago. Laboratory investigation showed increment in SLE activity, prolongation of aPTT without correction by mixing with normal plasma, and positive lupus anticoagulant. Brain MRI and SPECT revealed no evidence of ischemic change. The second case, a 36-year-old lady with SLE for 8 years, was admitted due to recurrent dysarthria. On physical examination, she had choreic movement involved neck and tongue. The activity of her disease increased and lupus anticoagulant was positive. Brain MRI showed infarct in insular cortex and multiple high signals in the frontal and occipital lobes. In both cases, haloperidol rapidly brought their symptom under control. We describe the first cases of secondary APLS-related recurrent movement disorder in Korea and review the literatures.
Adult ; Antibodies, Antiphospholipid ; Antiphospholipid Syndrome* ; Brain ; Chorea* ; Dysarthria ; Extremities ; Female ; Glycogen Storage Disease Type VI ; Haloperidol ; Humans ; Korea ; Lupus Coagulation Inhibitor ; Lupus Erythematosus, Systemic* ; Magnetic Resonance Imaging ; Movement Disorders ; Neck ; Neck Muscles ; Occipital Lobe ; Physical Examination ; Plasma ; Tomography, Emission-Computed, Single-Photon ; Tongue ; Young Adult

OBJECTIVE: The purpose of this study is to determine the efficacy of anterior lumbar interbody fusion(ALIF) for the patients with focal type of degenerative flat back. METHODS: The authors reviewed clinical and radiologic data of 16 patients with focal type of degenerative flat back who underwent ALIF during the period between December 1999 and November 2000. The operation procedure was ALIF using titanium or carbon fiber cages of lordotic angle, which were filled with allograft or autograft mixed with allograft through minilaparotomy. RESULTS: The majority of the patients were female(15 female: 1 male) and the mean age was 60.1 years. Six patients were operated on one level, ten on two levels. The mean follow up period was 10.7 months. The mean operation time was 131minutes and the average estimated blood loss was 133ml. Transfusion was not needed in any case. The mean preoperative lumbar lordotic angle was 4.1 degree(-7.4-41.6) and improved to 17.5 degree(-4.5-41.9) postoperatively. Radiological fusion was achieved in 13 patients(81%). The Oswestry disability index score improved from 62.5% to 23.9% and the patient's subjective improvement rate was 80%. Complications were infection in one patient, incisional hernia in one, symptomatic pseudoarthrosis in one and transient sympathetic disturbance in left leg in three. CONCLUSION: In a subset of the patients with degenerative flat back who showed disc degeneration in one or two levels, ALIF using cages improved patient's symptoms effectively. It seems that ALIF through minilaparotomy can be one of the surgical options in the treatment of the focal type of degenerative flat back.
Allografts ; Autografts ; Carbon ; Female ; Follow-Up Studies ; Hernia ; Humans ; Intervertebral Disc Degeneration ; Laparotomy ; Leg ; Pseudarthrosis ; Titanium

The mucosal surfaces are constantly exposed to incoming pathogens which can cause infections that result in severe morbidity and/or mortality. Studies have reported that mucosal immunity is important for providing protection against these pathogens and that mucosal vaccination is effective in preventing local infections. For many years, the sublingual mucosa has been targeted to deliver immunotherapy to treat allergic hypersensitivities. However, the potential of vaccine delivery via sublingual mucosal has received little attention until recently. Recent studies exploring such potential have documented the safety and effectiveness of sublingual immunization, demonstrating the ability of sublingual immunization to induce both systemic and mucosal immune responses against a variety of antigens, including soluble proteins, inter particulate antigens, and live-attenuated viruses. This review will summarize the recent findings that address the promising potential of sublingual immunization in proving protection against various mucosal pathogens.
Hypersensitivity ; Immunity, Mucosal ; Immunization ; Immunotherapy ; Mucous Membrane ; Proteins ; Vaccination ; Vaccines

Authors reviewed 37 cases of 25 patients with carpal tunnel syndrome treated surgically at Department of Neurosurgery of Kyung Hee University Hospital from January 1981 to February 1992. The sex ratio was 1:24 showing female predominancy. Distribution of age ranged from 26 years to 65 years. Duration of symptoms ranged from 15 days to 20 years. Tinel's sign was positive in 24 patients ans 10 patients had muscle atrophy. Twelve patients were operated on both hands, 7 patients on the right and 6 patients on the left. Operations were performed under the general anesthesia in 4 patients, under the axillary block in 3 patients and under the local lidocaine infiltration in 18 patients. In postoperative periods, 5 patients experienced transient aggravation of numbness of fingers, 1 patient had wound problem, 1 patient hypalgesia and 1 patient transient motor weakness which was thought to be due to residual effect of axillary block. Surgical outcomes were good in 35 cases(94.6%), fair in 1 case(2.7%) and poor in 1 case(2.7%).
Anesthesia, General ; Carpal Tunnel Syndrome* ; Electromyography ; Female ; Fingers ; Hand ; Humans ; Hypesthesia ; Lidocaine ; Median Nerve ; Muscular Atrophy ; Neurosurgery ; Postoperative Period ; Sex Ratio ; Wounds and Injuries

Interhemispheric approach has been accepted as a standard method approaching distal anterioir cerebral artery(DACA) aneurysm. In the approach, most authors use the surgical method retracting the superior sagittal sinus(SSS) after dural reflection. However, it results in limited surgical space and makes the surgical procedure difficult technically. To overcome the limitation, we tried to ligate and cut SSS in 13 patients out of 23 patients of DACA aneurysm from Mar. 1983 to Feb. 1993. Out of total 583 intracranial aneurysms operated on in that period, the proportion of DACA aneurysm was 3.95%. Mean age was 52.7 years ranging from 32 to 66 years. The sex ration was 7:16, showing female predominancy. As presenting symptoms, twenty two patients had subrachnoid hemorrhage and one patient had a third nerve palsy due to an unruptured posterior communicating artery aneurysm. On admission, 4 patients(17.4%) were in grade I, 10(43.5%) in grade II, 6(26.1%) in grade III, 3(13%) in grade IV according to the Hunt and Hess grading system. In 18 patients(78.3%), aneurysms were located at bifurcation of pericallosal and callosomarginal artery and in 5(21.7%) at bifurcation of frontopolar and pericallosal artery. Associated vascular anomalies were A1 hypoplasia(2 cases), multiple aneurysms(5 cases), fenestration of anterior cerebral(1 case) and arteriovenous malformation(1 case). Thirteen cases were operated on with ligation of the SSS and 10 without ligation. Overall surgical outcomes scored by Glasgow outcome scale were : 11 patients(47.8%) in Grade I, 6(26.1%) in Grade II, 2(8.7%) in Grade III, 4(17.4%) in Grade V. The outcomes in ligation group were : 8 patients(61.5%) in Grade I, 4(30.8%) in Grade II, 1(7.7%) in Grade III, and no death. The outcomes in non-ligation group were : 4 patients(40%) in Grade I, 1(10%) in Grade II, 1(10%) in Grade III, and 4(40%) in Grade V. These results showed that the patients operated on with ligation of SSS had more favorable outcomes than the patients without ligation. It seems that the SSS in the interhemispheric approach might provide several advantages and better operative outcome over the conventional method.
Aneurysm ; Anterior Cerebral Artery* ; Arteries ; Female ; Glasgow Outcome Scale ; Hemorrhage ; Humans ; Intracranial Aneurysm* ; Ligation* ; Oculomotor Nerve Diseases ; Superior Sagittal Sinus

OBJECTIVE: Computed tomography (CT), rather than conventional 2-dimensional radiography, was used to scan and measure pelvic parameters. The results were compared with measurements using X-ray. METHODS: Pelvic parameters were measured using both CT and X-ray in 254 patients who underwent both abdomino-pelvic CT and X-ray at the pelvic site. We assessed the similarity of the pelvic parameters between the 2 exams, as well as the correlations of pelvic parameters with sex and age. RESULTS: The mean values of the subjects’ pelvic parameters measured on X-ray were: sacral slope (SS), 31.6°; pelvic tilt (PT), 18.6°; and pelvic incidence (PI), 50.2°. The mean values measured on CT were: SS, 35.1°; PT, 11.9°; and PI, 47.0°. PT was found to be 4.07° higher on X-ray and 2.98° higher on CT in women, with these differences being statistically significant (p < 0.001, p < 0.001). PI was 4.10° higher on X-ray and 2.78° higher on CT in women, with these differences also being statistically significant (p < 0.001, p=0.009). We also observed a correlation between age and PI. For men, this correlation coefficient was 0.199 measured using X-ray and 0.184 measured using CT. For women, this correlation coefficient was 0.423 measured using X-ray and 0.372 measured using CT. CONCLUSION: When measured using CT compared to X-ray, SS increased by 3.5°, PT decreased by 6.7°, and PI decreased by 3.2°. There were also statistically significant differences in PT and PI between male and female subjects, while PI was found to increase with age.
Age Factors ; Female ; Humans ; Incidence* ; Male ; Posture* ; Radiography ; Sex Factors

OBJECTIVE: Distal anterior cerebral artery (dACA) aneurysms are uncommon, and they require special treatment because of the narrow exposure in the interhemispheric fissures, the dense adhesions between the cingulate gyri and their association with multiple aneurysms or traumatic pseudoaneurysm. The aim of this study was to assess the characteristics and surgical outcomes of dACA aneurysms. METHODS: Among the 520 cases of cerebral aneurysms that were operated on from 1997 to April 2007, we experienced 31 cases of dACA aneurysms that developed in 30 patients. The medical records and radiological findings were retrospectively reviewed. RESULTS: The clinical characteristics of the patients with dACA aneurysms included the following. (1) The incidence of the dACA aneurysm was 5.9% of the total 520 cases, and the dACA aneurysms displayed a female predominance. (2) The most common location of the dACA aneurysms was the junction of the pericallosal and callosomarginal arteries. (3) Multiple aneurysms were found in 12 patients (40%), and the most concomitantly found aneurysm was MCA aneurysm. (4) The larger aneurysms more than 10 mm size all had thrombus in the sac, and their angiographic findings were underestimated compared with their findings on the operative fields. (5) dACA aneurysms shows frequent intracerebral hemorrhage (ICH) and subdural hemorrhage on the initial brain CT scan (28.5%). They also had a higher rate of intraoperative rupture (12.9%) than the rupture rate for the aneurysm at other locations (7.9%). (6) Traumatic pseudoaneurysms on the dACA were observed in two cases, and one of these cases showed massive ICH shortly after head trauma. (7) Twenty-six out of 30 patients (86.7%) showed a good outcome with a mortality rate of 3.3%. CONCLUSIONS: The dACA aneurysms are uncommon and they have unique characteristics compared to intracerebral aneurysms at other sites. Especially, a very careful surgical approach must be used for dACA aneurysms because they have a higher rate of intraoperative rupture. Yet the surgical outcome for dACA patients was good for the ruptured or unruptured aneurysm cases in our study. Therefore, dACA aneurysms have to be treated with considering their special characteristics.
Aneurysm ; Aneurysm, False ; Anterior Cerebral Artery ; Arteries ; Brain ; Cerebral Hemorrhage ; Craniocerebral Trauma ; Female ; Hematoma, Subdural ; Humans ; Incidence ; Intracranial Aneurysm ; Medical Records ; Retrospective Studies ; Rupture ; Subarachnoid Hemorrhage ; Thrombosis

Sump syndrome is a rare late complication of choledochoenteric anastomosis, and this caused by the accumulation of food debris, choledocholithiasis, bile sludge and cholesterol crystals in the distal common bile duct. This syndrome is characterized by symptoms such as abdominal pain and fever. The treatment modality for this syndrome has been surgery in the past. However, endoscopic treatment such as endoscopic sphinterotomy is currently regarded as the primary therapeutic approach for this condition. We experienced a patient with a history of choledochoduodenostomy and who developed sump syndrome as a complication of the surgery. Endoscopic sphinterotomy was performed for treatment, but this only produced the recurrence of the disease. The recurrent sump syndrome was eventually successfully controlled by performing endoscopic papillary balloon dilatation.
Abdominal Pain ; Bile ; Choledocholithiasis ; Choledochostomy ; Cholesterol ; Common Bile Duct ; Dilatation ; Fever ; Humans ; Postcholecystectomy Syndrome ; Recurrence ; Sewage

True non-parasitic splenic cysts are rare. Series have reported over 30 cases of true splenic cysts producing elevated serum CA 19-9 levels. A 27-year-old woman presented with a painless mass in her left upper abdomen. Computed tomography (CT) of the abdomen showed a 16-cm cyst in the spleen. The serum CA 19-9 and CEA levels were 432 U/mL and 1.67 ng/mL, respectively. The cystic fluid CA 19-9 and CEA levels were markedly elevated. A splenectomy was performed. The pathology showed a benign true epidermoid cyst, which was negative for CEA. The serum CA 19-9 level returned to normal after removing the splenic cyst. This is the first reported case of a true benign splenic cyst producing high levels of CA 19-9 and CEA in Korea.
Abdomen ; Adult ; Epidermal Cyst ; Female ; Humans ; Korea ; Spleen ; Splenectomy

OBJECTIVE: Residual aneurysm from incomplete clipping or slowly recurrent aneurysm is associated with high risk of subarachnoid hemorrhage. We describe complete treatment of the lesions by surgical clipping or endovascular treatment. METHODS: We analyzed 11 patients of residual or recurrent aneurysms who had undergone surgical clipping from 1998 to 2009. Among them, 5 cases were initially clipped at our hospital. The others were referred from other hospitals after clipping. The radiologic and medical records were retrospectively analyzed. RESULTS: All patients presented with subarachnoid hemorrhage at first time, and the most frequent location of the ruptured residual or recurrent aneurysm was in the anterior communicating artery to posterior-superior direction. Distal anterior cerebral artery, posterior communicating artery, and middle cerebral artery was followed. Repositioning of clipping in eleven cases, and one endovascular treatment were performed. No residual aneurysm was found in postoperative angiography, and no complication was noted in related to the operations. CONCLUSION: These results indicate the importance of postoperative or follow up angiography and that reoperation of residual or slowly recurrent aneurysm should be tried if such lesions being found. Precise evaluation and appropriate planning including endovascular treatment should be performed for complete obliteration of the residual or recurrent aneurysm.
Aneurysm ; Angiography ; Anterior Cerebral Artery ; Arteries ; Follow-Up Studies ; Humans ; Intracranial Aneurysm ; Medical Records ; Middle Cerebral Artery ; Reoperation ; Retrospective Studies ; Subarachnoid Hemorrhage ; Surgical Instruments