STUDY DESIGN: A case report. OBJECTIVES: To report a rare case of remote cerebellar hemorrhage (RCH) as a complication of spinal surgery. SUMMARY OF LITERATURE REVIEW: Remote cerebellar hemorrhage is rare but lethal as a complication of spinal surgery. Interestingly, dural tears and cerebrospinal fluid (CSF) leakage are reported in all published cases of RCH. MATERIALS AND METHODS: A 67-year-old man had posterior lumbar decompression and posterolateral fusion for spinal stenosis at L4/5/S1. Intraoperatively, the dura was torn and there was a loss of CSF. The dural tear was sutured immediately in a water-tight manner. After surgery, the patient complained of headache and dizziness. On postoperative day 44, brain magnetic resonance imaging (MRI) showed meningeal enhancement suggesting meningitis. On postoperative day 54, brain computed tomography (CT) showed cerebellar edema and hemorrhage, and external ventricular derivation was performed. RESULTS: The patient died. CONCLUSIONS: Special attention should be paid to prevent dural damage during spinal surgery or minimize CSF leakage in the case of dural damage and tears during spinal surgery, and CT and MRI should be promptly performed for symptomatic patients.
Aged ; Brain ; Cerebrospinal Fluid* ; Decompression ; Dizziness ; Edema ; Headache ; Hemorrhage* ; Humans ; Magnetic Resonance Imaging ; Meningitis* ; Spinal Stenosis ; Tears

STUDY DESIGN: A case report. OBJECTIVES: To report a rare case of epidermoid cyst in the spinal canal. SUMMARY OF LITERATURE REVIEW: Epidermoid cyst in the spinal canal is rare. Idiopathic epidermoid cyst in the spinal canal not associated with a trauma or infection is even rarer. MATERIAL AND METHODS: A 73 year-old female presented with a 1 year history of progressive paresthesia and motor weakness of both lower extremeties. MRI showed a cystic mass on the 7th thoracic canal. We performed total laminectomy at the T6-T8 level. The cystic mass was excised after durotomy using a posterior approach. RESULTS: We confirmed the presence of an epidermoid cyst for histopathology. CONCLUSION: Idiopathic epidermoid cyst in the spine is very rare and requires accurate differential diagnosis. Preoperative MRI scans are necessary to differentiatie epidermoid cysts from other intradural masses. Confirmative diagnosis can be done by histopatholoty.
Diagnosis ; Diagnosis, Differential ; Epidermal Cyst* ; Female ; Humans ; Laminectomy ; Magnetic Resonance Imaging ; Paresthesia ; Spinal Canal ; Spine

T-helper (Th)17 cell responses are important for the development of neutrophilic inflammatory disease. Recently, we found that acetyl salicylic acid (ASA) inhibited Th17 airway inflammation in an asthma mouse model induced by sensitization with lipopolysaccharide (LPS)-containing allergens. To investigate the mechanism(s) of the inhibitory effect of ASA on the development of Th17 airway inflammation, a neutrophilic asthma mouse model was generated by intranasal sensitization with LPS plus ovalbumin (OVA) and then challenged with OVA alone. Immunologic parameters and airway inflammation were evaluated 6 and 48 h after the last OVA challenge. ASA inhibited the production of interleukin (IL)-17 from lung T cells as well as in vitro Th17 polarization induced by IL-6. Additionally, ASA, but not salicylic acid, suppressed Th17 airway inflammation, which was associated with decreased expression of acetyl-STAT3 (downstream signaling of IL-6) in the lung. Moreover, the production of IL-6 from inflammatory cells, induced by IL-17, was abolished by treatment with ASA, whereas that induced by LPS was not. Altogether, ASA, likely via its acetyl moiety, inhibits Th17 airway inflammation by blockade of IL-6 and IL-17 positive feedback.
Animals ; Aspirin/pharmacology/*therapeutic use ; Cell Polarity/drug effects/immunology ; Feedback, Physiological/*drug effects ; Interferon-gamma/deficiency/metabolism ; Interleukin-17/*metabolism/pharmacology ; Interleukin-6/biosynthesis/*metabolism ; Lipopolysaccharides/pharmacology ; Lung/drug effects/metabolism/pathology ; Mice ; Mice, Inbred C57BL ; Pneumonia/*drug therapy/*immunology/pathology ; Th17 Cells/drug effects/*immunology/pathology ; Transforming Growth Factor beta1/pharmacology

Congenital undescended scapula is congenital structural abnormality which affects only one side usually. Scapula located higher than the usual and rotating deformity that inferior angle to medial side, superior angle to lateral side is common. This report presents one case of the surgical therapy of a sprengel deformity patient who passed an optimal operation period with age 3~7years old, and includes brief review of the literature. 7 years old boy whose chief complaint was the limitation of left scapular-thoracic movement and he had an omovertebral bone bridge and periscapular muscle atrophy. There was improvement of motion ranges and cosmetic problems after surgical treatment.
Child ; Congenital Abnormalities* ; Humans ; Male ; Muscular Atrophy ; Scapula

BACKGROUND: Metastatic cancer of unknown primary site occupies 0.5~10% of all diagnosed cancer patients and includes various tumors with diverse responses to systemic chemotherapy. Adenocarcinoma of unknown primary site (ACUPS), the most common subtype, has no standard treatment, rarely responds to conventional treatment and has a poor survival rate. METHODS: The retrospective study was performed to investigate the clinical characteristics and the treatment outcomes of ACUPS. RESULTS: Eighty-one patients with ACUPS diagnosed at Samsung Medical Center from May 1995 to July 1999 were included. The median age was 58 years (range, 29~77). The common sites of metastases were the lymph node, liver, lung and bone in order. In 49 of 81 patients (60.5%), the dominant tumor location was below the diaphragm. The majority of patients (76 of 81) were initially treated with systemic chemotherapy including cisplatin. Responses were evaluable in 70 of 76. Eighteen of 70 patients (25.7%) responded to chemotherapy and complete remission was observed in 6 patients. The overall median survival of 81 patients was 5.6 months. The median survival of the responding patients was 18.3 months but the median survival of the nonresponding patients was 4.6 months (p<0.01). In univariate and multivariate analysis, age, performance status and response to initial chemotherapy were significant prognostic factors for overall survival. CONCLUSION: We observed poor response to the treatment and survival rate in ACUPS, but complete remission and long-term survival were observed in a small number of patients.
Adenocarcinoma/*drug therapy/*secondary ; Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols/*therapeutic use ; Female ; Human ; Male ; Middle Aged ; Neoplasms, Unknown Primary/*drug therapy/*pathology ; Retrospective Studies ; Survival Analysis ; Treatment Outcome

No abstract available.
Myocarditis*

BACKGROUND: The quality of sexuality is significantly affected by physical changes following hematopoietic stem cell transplantation (HSCT) and the dissatisfied and/or dysfunctional sexuality may cause deterioration in the quality of life (QOL). METHODS: With two models of questionnaires, we interviewed thirty-eight patients who remained in the disease-free status after HSCT and had sex partners, to assess: 1) the changes in sexuality, 2) QOL in physical, psychological, social and spiritual domains and 3) the correlation between sexuality and QOL. RESULTS: The common physical changes that may affect sexuality in women were secondary amenorrhea (69.2%), loss of sexual interest (53.8%), diminished vaginal secretion (50%), menopausal syndrome (34.6%), dyspareunia (30.8%) and failure to orgasm (23.1%), while men complained of impotence (41.7%) and difficulty in ejaculation (16.7%). For sexuality, satisfaction of sexual activity, attainment of orgasm and frequency of intercourse decreased significantly after HSCT as compared with the pre-transplant levels. A score measuring QOL after HSCT marked 5.91 on a full score of 10; social domain ranked the lowest (5.01) while physical domain the highest (6.70). Among the items of sexuality, only sexual desire was significantly correlated with QOL; satisfaction, orgasm and frequency were not significantly correlated with QOL. CONCLUSION: Although sexuality is affected by the physical changes following HSCT, we should not overlook the psychological and social effects on the sexuality of post-transplant patients. Therefore, educational and counseling programs are very important to restore and improve their sexuality.
Adult ; Female ; Hematopoietic Stem Cell Transplantation/*adverse effects/psychology ; Human ; Male ; Middle Age ; Quality of Life ; Questionnaires ; Sex Disorders/*etiology ; *Sexuality

BACKGROUND: Mucosa-associated lymphoid tissue(MALT) lymphoma has an indolent natural course. However, extra-gastric MALT lymphoma has been reported to have more frequent relapses and shorter time to progress than gastric MALT lymphoma. We performed this study to analyze clinical features of extra-gastric MALT lymphoma. METHODS: We retrospectively reviewed the medical records of the patients who were diagnosed as extra-gastric MALT lymphoma at the Samsung Medical Center from March 1995 to January 1999. The survival was analyzed by Kaplan-Meier method. RESULTS: During the study period, extra-gastric MALT lymphoma was diagnosed in 50 patients. The median age was 51(28-87)yaers. The male to female ratio was 22:28. Commonly involved sites were conjunctiva (25/50, 50%), lung (6/50, 12%) and intestine(6/50, 12%). Histopathologically, low to high grade ratio of extra-gastric MALT lymphoma was 47:3. Among 41 patients who were staged, 32 patients(78%) had stage I or II and 9 patients(22%)had stage IV. B symptoms were seen in only 3 patients. Bone marrow involvement was observed in 4 patients. The duration of median follow up was 22 months. The 1-year and 2-year survival rates were 95.1% and 91.4% retrospectively. CONCLUSION: Majoity of our cases with extra-gastric MALT lymphoma had low grade, early stage, good treatement reponse and good prognosis.
Bone Marrow ; Conjunctiva ; Female ; Follow-Up Studies ; Humans ; Lung ; Lymphoma ; Lymphoma, B-Cell, Marginal Zone* ; Male ; Medical Records ; Prognosis ; Recurrence ; Retrospective Studies ; Survival Rate

Bone scintigraphy is a very sensitive and cost-effective diagnostic method for detecting bony metastases of malignant neoplasm. However it has been reported that bone scan is less sensitive for early bony metastases, especially vertebral metastases. PET is a non-invasive clinical imaging methodology that can be used to assess such biochemical disturbance in tissue in vivo quantitatively with high resolution.We experienced two cases of small cell lung cancer with multiple bony metastases which were detected on PET imaging but not on planar bone scan. This case report suggests that FDG-PET will be a very effective diagnostic tool for bony metastases especially in clinically suspected case despite a normal planar bone scan.
Bone and Bones ; Neoplasm Metastasis* ; Radionuclide Imaging ; Small Cell Lung Carcinoma*

PURPOSE: To evaluate prospectively the results of interventional radiologic placement of tunneled centralve-nous catheters, and subsequent complications. MATERIALS AND METHODS: Between April 1997 and April 1998, a totalof 557 tunneled central venous catheters were percutaneously placed in 517 consecutive patients in aninterventional radiology suite. The indications were chemotherapy in 533 cases, total parenteral nutrition in 23and transfusion in one. Complications were e-valuated prospectively by means of a chart review, chest radiography,central vein angiography and blood/catheter culture. RESULTS: The technical success rate for tunneled centralvenous catheter placement was 100% (557/557 cases). The duration of catheter placement ranged from 4 to 356 (mean,112 +/-4.6) days; Hickman catheters were re-moved in 252 cases during follow-up. Early complications included 3cases of pneumothorax(0.5%), 4 cases of local bleeding/hematoma(0.7%), 2 cases of primary malposition(0.4%), and 1case of catheter leakage(0.2%). Late complications included 42 cases of catheter-related infection(7.5%), 40 casesof venous thrombosis (7.2%), 18 cases of migration (3.2%), 5 cases of catheter / pericatheter of occlusion(0.8%),and 1 case of pseudoa-neurysm(0.2%) . The infection rate and thrombosis rate per 1000 days were 1.57 and 1.50,respectively. CONCLUSIONS: The technical success rate of interventional radiologic placement of tunneled centralvenous catheters was high. In comparison to conventional surgical placement , it is a more reliable method andleads to fewer complications.
Angiography ; Catheters ; Central Venous Catheters* ; Drug Therapy ; Follow-Up Studies ; Humans ; Parenteral Nutrition, Total ; Prospective Studies ; Thorax ; Thrombosis ; Veins ; Venous Thrombosis