Multiple endocrine neoplasia type 1 (MEN1) is an autosomal dominant inherited syndrome with characteristic clinical and radiological manifestations. Many reports on MEN1 have been published; however, no cases of radiologically diagnosed MEN1 have been reported. Therefore, we report on a radiologically diagnosed case of MEN1 with clinical symptoms of gastroduodenal ulcer.
Multiple Endocrine Neoplasia ; Multiple Endocrine Neoplasia Type 1 ; Peptic Ulcer ; Pituitary Neoplasms

Anti-N-methyl D-aspartate receptor (anti-NMDAR) encephalitis, recently recognized as a form of paraneoplastic encephalitis, is characterized by a prodromal phase of unspecific illness with fever that resembles a viral disease. The prodromal phase is followed by seizures, disturbed consciousness, psychiatric features, prominent abnormal movements, and autonomic imbalance. Here, we report a case of anti-NMDAR encephalitis with initial symptoms of epilepsia partialis continua in the absence of tumor. Briefly, a 3-year-old girl was admitted to the hospital due to right-sided, complex partial seizures without preceding febrile illness. The seizures evolved into epilepsia partialis continua and were accompanied by epileptiform discharges from the left frontal area. Three weeks after admission, the patient's seizures were reduced with antiepileptic drugs; however, she developed sleep disturbances, cognitive decline, noticeable oro-lingual-facial dyskinesia, and choreoathetoid movements. Anti-NMDAR encephalitis was confirmed by positive detection of NMDAR antibodies in the patient's serum and cerebrospinal fluid, and her condition slowly improved with immunoglobulin, methylprednisolone, and rituximab. At present, the patient is no longer taking multiple antiepileptic or antihypertensive drugs. Moreover, the patient showed gradual improvement of motor and cognitive function. This case serves as an example that a diagnosis of anti-NMDAR encephalitis should be considered when children with uncontrolled seizures develop dyskinesias without evidence of malignant tumor. In these cases, aggressive immunotherapies are needed to improve the outcome of anti-NMDAR encephalitis.
Anti-N-Methyl-D-Aspartate Receptor Encephalitis* ; Antibodies ; Anticonvulsants ; Antihypertensive Agents ; Cerebrospinal Fluid ; Child* ; Child, Preschool ; Cognition ; Consciousness ; D-Aspartic Acid ; Diagnosis ; Dyskinesias ; Encephalitis ; Epilepsia Partialis Continua* ; Female ; Fever ; Humans ; Immunoglobulins ; Immunotherapy ; Korea* ; Methylprednisolone ; Rituximab ; Seizures ; Virus Diseases

BACKGROUND: Although secondary cervicothoracic scoliosis frequently occurs in patients with congenital muscular torticollis (CMT), the relationship between scoliosis and CMT has not been evaluated. This study aims to evaluate the effects of surgical release of sternocleidomastoid (SCM) muscle on secondary cervicothoracic scoliosis in patients with CMT and determine factors affecting the improvement of scoliosis after surgical release of SCM muscle. METHODS: Eighty-seven of the 106 patients, confirmed as having secondary cervicothoracic scoliosis with CMT with a minimum 1-year follow-up, were included in this study. Preoperative and last follow-up radiologic outcomes were assessed for the cervicomandibular angle (CMA), Cobb angle of the cervicothoracic scoliosis, and direction of convexity in the scoliosis curve. Patients were divided into two groups to assess the improvement of Cobb angle according to residual growth potential; age ≤ 15 years and > 15 years. The improvement of Cobb angle after surgical release was compared in the two groups. Correlation analysis and multivariable regression analysis were performed to determine the factors affecting the improvement of scoliosis. RESULTS: All the radiologic parameters, such as the Cobb angle and CMA, improved significantly after surgical release (p < 0.001). The improvement of Cobb angle was significantly higher in age ≤ 15 years than in age > 15 years (p < 0.001). The improvement of Cobb angle was significantly correlated with age (r = −0.474, p < 0.001) and the preoperative Cobb angle (r = 0.221, p = 0.036). In multivariable regression analysis, age and preoperative Cobb angle were shown to be predisposing factors affecting the improvement of scoliosis. CONCLUSIONS: The results showed that SCM release can be a beneficial treatment for secondary cervicothoracic scoliosis. The improvement of scoliosis was greater when the SCM release was performed before the patient reached the end of growth.
Causality ; Follow-Up Studies ; Humans ; Scoliosis ; Torticollis

Objectives: This study was conducted to demonstrate the reliability of mini-open anterior lumbar interbody fusion (ALIF) combined with lateral lumbar interbody fusion (LLIF) followed by 2-stage posterior fixation in patients with adult spinal deformity (ASD).Summary of Literature Review: Although the correction of ASD using LLIF has become more widespread, the amount of sagittal plane correction has been reported to be suboptimal.Materials and Method: Thirty ASD patients who underwent ALIF with LLIF followed by 2-stage posterior fixation (AP group) were compared to 60 patients who underwent posterior-only surgery (PO group) and were matched according to age, sex, diagnosis, fusion level, pelvic incidence, and follow-up duration. Spinopelvic parameters, hospitalization data, clinical outcomes, and complications were compared between the 2 groups. Results: Postoperative lumbar lordosis was greater in the AP group than in the PO group (p<0.001). The reduction in the sagittal vertical axis was also greater in the AP group than in the PO group (p=0.005). Postoperatively, 90.0% of the AP group had a pelvic incidence– lumbar lordosis value within 9°, whereas only 50.0% of the PO group met that criterion (p<0.001). The operation time of the AP group was longer than that of the PO group, while estimated blood loss and red cell transfusion were lower in the AP group. Postoperative medical complications and delayed surgical complications developed more frequently in the PO group. Conclusions Mini-open ALIF with LLIF followed by 2-stage posterior fixation can restore sagittal balance more appropriately, with a lower rate of complications, than posterior-only surgery for the correction of ASD.

BACKGROUND: Atrial fibrillation(AF) is the common and importand arrhythmia in the eldery. Because the distribution of cardiovascular disease changes according to age group and era, the distribution of underlying diseases in patients with AF also tends to change. The purpose of this study is to identify the difference between the eldery(> or = 65yr) and the young adult(<65yr) patients with AF in distribution of underlying disease. METHODS: 218 patients with AF diagnosed by routine EKG and Holter minitoring from Jan. 1996 to Dec 1998 in National Medical Center was evaluated. Their medical records were reviewed retrospectively in aspect of age, sex, developmental form & underlying disease of AF. In detail. last two subjects were investigated in two separate age group and at the same time, relation between them studied. RESULTS: The majority of age group with AF was 65~74yr(40.4%) and the eldery patient was 59.7%. Acute paroxysmal form and chronic persistent form was 21.1% and 78.9% respectively. There was no significant difference in development form of AF between the eldery and young adult group(chi2=1.45, p=0.227) The common underlying disease were hypertension(33.4%), congestive heart failure(32.1%), rheumatic valvular heart diseas(20.2%). ischemic heart disease(14.2%), hyperthyroidism(6.9%), COPD(4.1%), and lone AF(10.1%). In the eldery patients. hypertension is the most common underlying disease(42.3%) and congestive heart failure, ischemic heart disease, rheumatic valvular heart disease, and COPD were 36.2%, 21.5%, 10.8%, 6.9% respectively. In the young adult group-, rheumatic valvular heart disease was the most common(34%), and congestive heart failure, hypertension, ischemic heart disease, and hyperthyroidism were 26.1%, 20,5%, 3.4%, 10.2% respectively(chi2 = 62.71, p = 0.000). wheares ischemic heart disease, COPD, hyperthyroidism, stress, trauma, acute alcohol intoxication and lone AF were more common in acute paroxysmal AF, but hypertension, congestive heart failure, reumatic valvular heart disease were more common in chronic persistent AF(chi2 = 93.75, p = 0.000). CONCLUSION: Among underlying disease of AF. hypertension, congestive heart failure, ischemic heart disease were markedly increased and rheumatic valvular heart disease was decreased than previous reports in Korea. Hypertension, congestive heart failure, ischemic heart disease, COPD were more common in the eldely and as to rheumatic valvular heart disease, hyperthyroidism, and lone AF were in the young adult. Thus it showed significant difference in underlying desease between the eldery & the young adult as well as acute paroxysmal & chronic persistent form.
Aged* ; Arrhythmias, Cardiac ; Cardiovascular Diseases ; Electrocardiography ; Estrogens, Conjugated (USP) ; Heart ; Heart Failure ; Heart Valve Diseases ; Humans ; Hypertension ; Hyperthyroidism ; Korea ; Medical Records ; Myocardial Ischemia ; Pulmonary Disease, Chronic Obstructive ; Retrospective Studies ; Young Adult

STUDY DESIGN: Prospective observational study. PURPOSE: To introduce the techniques and present the surgical outcomes of mini-open anterior lumbar interbody fusion (ALIF) at the most caudal segments of the spine combined with lateral lumbar interbody fusion (LLIF) for the correction of adult spinal deformity OVERVIEW OF LITERATURE: Although LLIF is increasingly used to correct adult spinal deformity, the correction of sagittal plane deformity with LLIF alone is reportedly suboptimal. METHODS: Thirty-two consecutive patients with adult spinal deformity underwent LLIF combined with mini-open ALIF at the L5–S1 or L4–S1 levels followed by 2-stage posterior fixation. ALIF was performed for a mean 1.3 levels and LLIF for a mean 2.7 levels. Then, percutaneous fixation was performed in 11 patients (percutaneous group), open correction with facetectomy with or without laminectomy in 16 (open group), and additional pedicle subtraction osteotomy (PSO) in 5 (PSO group). Spinopelvic parameters were compared preoperatively and postoperatively. Hospitalization data and clinical outcomes were recorded. RESULTS: No major medical complications developed, and clinical outcomes improved postoperatively in all groups. The mean postoperative segmental lordosis was greater after ALIF (17.5°±5.5°) than after LLIF (8.1°±5.3°, p <0.001). Four patients (12.5%) had lumbar lordosis with a pelvic incidence of ±9° preoperatively, whereas this outcome was achieved postoperatively in 30 patients (93.8%). The total increase in lumbar lordosis was 14.7° in the percutaneous group, 35.3° in the open group, and 57.0° in the PSO group. The ranges of potential lumbar lordosis increase were estimated as 4°–25°, 23°–42°, and 45°–65°, respectively. CONCLUSIONS: Mini-open ALIF combined with LLIF followed by posterior fixation may be a feasible technique for achieving optimal sagittal balance and reducing the necessity of more extensive surgery.
Adult* ; Animals ; Congenital Abnormalities* ; Hospitalization ; Humans ; Incidence ; Laminectomy ; Lordosis ; Observational Study ; Osteotomy ; Prospective Studies ; Spine

BACKGROUND: The changes in the epidemiology of native valve endocarditis have been known in western countries recent years due to the decrease in the inci-dence of rheumatic heart disease, increased longevity of patients with valvular or congenital heart diseases, and the increase in degenerative heart disease due to the in-crease in the average life span of the general popula-tion. In this study, we analyzed and compared the epide-miological and clinical characteristics of patients with na-tive valvular endocarditis fro two different time periods. METHODS: We compared native valve endocarditis patients diagnosed from 1979 - 1984(group I) with those diagnosed from 1991 - 1996(group II). We used modified Duke' s criteria for the diagnosis and statistical analysis was done using SPSS window program. RESULTS: In our study, mean age of the population was higher in group II and significantly larger number of patients were over the age of 50 in group II. Involve-ment of multiple valves with vegetations and peri-valvular abscess were found more frequently in group II. Also, significantly higher percentage of patients from group II underwent surgical treatment. CONCLUSION: The results of this study suggest that the epidemiolocaland clinical characteristics of infective endocarsitis in Korea may change to resemble those in western countries. Further studies regarding this subject are needed.
Abscess ; Diagnosis ; Endocarditis* ; Epidemiology ; Heart Diseases ; Humans ; Korea ; Longevity ; Rheumatic Heart Disease

PURPOSE: In arthroscopic rotator cuff repairs there are generally weak link in tendon suture interface, arthroscopic rotator cuff repairs can have higher retear rates than open repairs. The purpose of this study was to compare the strength of UU (Ulsan University) suture than open modified MA (Mason-Allen) suture when suture anchored into bone. MATERIALS AND METHODS: The human supraspinatus tendons were harvested from the shoulder of the cadaver and split in 2 times, producing four tendons per one shoulder, for a total of 24 specimens. Two suture configurations (UU, MA) were randomized and checked on each set of tendons. Specimens were cyclically loaded under force control between 5 and 30 N at 0.25 Hz for fifty cycles. Each specimen was loaded to failure under displacement control at 1 mm/sec. Cyclic elongation, peak to peak displacement, stiffness, ultimate tensile load, mode of failure were checked. RESULTS: No significant difference was found between two suture configuration with respect to peak to peak displacement, cyclic elongation, and stiffness. With regard to ultimate failure load, there were no significant difference statistically between the UU suture and modified MA suture (109.4 N, 110.6 N). The most common mode of failure between both sutures was suture pull-out through the tendon. CONCLUSION: The UU suture and modified MA suture produced similar biomechanical properties.
Aluminum Hydroxide ; Biomechanics ; Cadaver ; Carbonates ; Displacement (Psychology) ; Humans ; Rotator Cuff ; Shoulder ; Suture Anchors ; Sutures ; Tendons

BACKGROUND: Arbekacin was introduced to treat methicillin-resistant Staphylococcus aureus (MRSA) infection. It is an aminoglycoside with proven in vitro activity against MRSA strains. Pharmacokinetic advantages such as concentration-dependant bactericidal activity, prolonged post-antibiotic effect are its feature of aminoglycoside like others. But there are only few clinical data of this new kind of antibiotics outside of Japan, the first country approved its use against MRSA infections. We studied the clinical and bacteriological efficacy and safety of arbekacin in the treatment of infections caused by MRSA. METHODS: During the period between December 2001 and October 2002, we prospectively enrolled 21 patients with culture proven MRSA infection and evaluated the clinical and bacteriological efficacy and adverse events of arbekacin. Patients were treated with arbekacin sulphate 100 mg intravenously twice daily for 14 days. RESULTS: Patients were included if they had signs and symptoms of active MRSA infection including bacteremia, soft tissue infection, urinary tract infection, pneumonia etc. A total of 21 patients with MRSA infection were enrolled. Four patients experienced adverse events; 3 nephrotoxicities, 1 hepatotoxicity. One of them with elevated creatinine was unable to continue the study. Efficacy were evaluated on 19 patients with duration of arbekacin longer than 9 days. A favorable bacteriological response (eradicated or presumed eradicated) occurred in 13 (68.5%) patients. CONCLUSION: Although this clinical study was limited in number and in proper randomization, arbekacin alone was less effective than combination therapy with glycopeptides for the treatment of MRSA infection. However, our limited data suggested the efficacy of arbekacin alone for the treatment which needs shorter duration. The combination treatment of arbekacin and glycopeptide appeared to be less nephrotoxic than other aminoglycosides. The combination therapy of arbekacin and glycopeptide appeared to be less nephrotoxic than other aminoglycoside.
Aminoglycosides ; Anti-Bacterial Agents ; Bacteremia ; Creatinine ; Glycopeptides ; Humans ; Japan ; Methicillin Resistance* ; Methicillin-Resistant Staphylococcus aureus* ; Pneumonia ; Prospective Studies ; Random Allocation ; Soft Tissue Infections ; Urinary Tract Infections

Pulmonary embolism from metallic mercury is rare. It may occur after a deliberate intravenous injection of mercury as a suicide gesture, in the presence of drug abuse or severe psychiatric disturbance, with the hope of increasing athletic and sexual performance, and accidentally during right heart catheterization while sampling blood with mercury containing syringes. We have experienced the first case of pulmonary embolism associated with intravenous mercury injection in Korea. The blood mercury level remain elevated within the toxic range to date. This may be due to the continued absorption of embolized mercury. Multifocal areas of patchy perfusion defects are in both upper lung fields on perfusion scan of lung. Few of the abnormalities of respiratory or renal function reported previously were demonstrated. We report the case of a young male patient presenting with a clinical picture of pulmonary embolism, in whom widespread deposit of metallic mercury were demonstrated throughout both lungs and elsewhere in the body.
Absorption ; Cardiac Catheterization ; Cardiac Catheters ; Gestures ; Hope ; Humans ; Injections, Intravenous ; Korea ; Lung ; Male ; Perfusion ; Pulmonary Embolism* ; Sports ; Substance-Related Disorders ; Suicide ; Syringes