Cryptogenic chorea.

A total of 40 cases of cryptogenic chorea were studied over a period of 4 years in JIPMER Hospital which serves the population of Pondicherry and adjoining regions of South India. Analysis of our cases showed the highest incidence for the 10-15 year age group with no sex predilection. Arthralgia and non-specific fever preceded the onset of chorea in most patients. The majority had generalized chorea of variable severity. Laboratory evidence of rheumatic fever was absent in all cases. The socioeconomic, environmental and cultural factors contributing to persistently high rate of infections together with the absence of evidence of a rheumatic process indicate a non-rheumatic aetiology.     

Antiphospholipid antibody-associated chorea

OBJECTIVE: To describe the clinical features, treatment, and outcomes of patients with antiphospholipid antibody (aPL)-associated chorea. METHODS: The study cohort consisted of consecutive patients with chorea evaluated between 1990 and 2005 with documented aPL at time of their neurologic diagnosis. RESULTS: Eighteen patients were identified, 4 with systemic lupus erythematosus (SLE). The 14 non-SLE patients experienced 1.6 vascular thromboses/pregnancy losses per person, while patients with SLE experienced 0.5 events/person. Four non-SLE patients (29%) and no SLE patients met criteria for antiphospholipid antibody syndrome (APS). None of these 4 tested positive for IgM anticardiolipin antibody (aCL). In contrast, 10 (71%) non-APS patients tested positive for IgM aCL. Chorea was most often bilateral, mild to moderate, and occurred once with a median age at onset of 44 and 33 years in non-SLE and SLE patients, respectively. Therapy included immunosuppression in 3 (21%) non-SLE patients and in all SLE patients. Antidopaminergic agents were used in 7 (39%). All patients responded to treatment. Five patients received anticoagulation for thrombosis and 2 died of bleeding complications, both non-SLE patients. CONCLUSION: aPL-associated chorea occurs most often in women and severity is mild to moderate. Clinical expression of chorea does not differ between those with and without SLE. Anticoagulation should be reserved for thrombosis treatment and not simply for chorea in the presence of aPL, as 2 patients died of bleeding. The absence of IgM aCL in patients with APS supports prior evidence that IgG aCL and lupus anticoagulant may be the more clinically relevant antibodies for thrombosis. However, IgM aCL may be important in patients with chorea.     

Geriatric Urology

Urology is one of the surgical specialties that has been most affected by the growing demographic of older adults in the United States. Urological problems are common in elderly people, and care of patients aged 65 and older represents a large proportion of many urologists' practices. However, this has also presented unique challenges to the development of the field of geriatric urology as an identified subspecialty. Until recently, formal educational requirements and opportunities in geriatric urology were limited. In addition, there is a paucity of basic science and clinical research related specifically to urological problems in older adults, despite the growing numbers of patients in this age group. This article reviews recent efforts to increase the activity, content, and visibility of the field of geriatric urology. Curriculum materials have been developed for urology training programs, research needs have been assessed and targeted, and a new professional organization (the Geriatric Urology Society) has been established. Current activities in the field of geriatric urology at the local, regional, and national levels, and goals for the future are reviewed.