A global increase in the incidence of tuberculosis has prompted the need for earlier diagnosis, treatment, and isolation of the disease. In tuberculosis, concomitant tuberculous meningitis and vascular complications such as intracranial aneurysms and subarachnoid hemorrhage are very rare. Because of the poor prognosis of tuberculous meningitis as well as intracranial aneurysm and subarachnoid hemorrhage, early diagnosis and management are crucial. We present the case of a 76-year-old woman who had two intracranial aneurysms complicated by subarachnoid hemorrhage, who had concomitant tuberculous meningitis. She remained well with medical management.

No Abstract Available.
Case-Control Studies*

PURPOSE: To report a rare case of lymphocytic hypophysitis in a 31-year-old woman who presented with gradually progressive bilateral visual loss during the third trimester of pregnancy. METHODS: Ophthalmologic examination revealed best corrected visual acuity of 0.02 OD and counting fingers at 20 cm OS. Pupil examination revealed no relative afferent pupillary defect in either eye and intraocular pressure was normal in both eyes. A visual field test revealed nearly total visual defect sparing superotemporal area OD and total defect OS. An MRI of the head was performed. RESULTS: At the time of transsphenoidal surgery following the patient's delivery, a frozen biopsy of the lesion revealed diffuse lymphocytic infilteration and fibrosis of the pituitary gland consistent with the diagnosis of lymphocytic hypophysitis. Postoperatively the patient was treated for hypopituitarism. At 5 weeks postoperative, her best corrected visual acuity was 1.0 OU, and visual field defects resolved in both eyes. On follow-up by telephone for postoperative 7 months, the patient remained visually asymptomatic. CONCLUSIONS: The clinical presentation of lymphocytic hypophysitis may mimic pituitary adenoma, lymphoma, germinoma, and histiocytosis. The diagnosis should be suspected in any pregnant or postpartum patient with an intrasellar or suprasellar mass.
Adult ; Biopsy ; Diagnosis ; Female ; Fibrosis ; Fingers ; Follow-Up Studies ; Germinoma ; Head ; Histiocytosis ; Humans ; Hypopituitarism ; Intraocular Pressure ; Lymphoma ; Magnetic Resonance Imaging ; Pituitary Gland ; Pituitary Neoplasms ; Postpartum Period ; Pregnancy Trimester, Third ; Pregnancy* ; Pupil ; Pupil Disorders ; Telephone ; Visual Acuity ; Visual Field Tests ; Visual Fields

BACKGROUND: The study aimed to determine the type of capsular insertion and the extent of capsular elongation in anterior shoulder instability by quantitatively evaluating their computed tomography arthrographic (CTA) findings, and to investigate the correlation of these parameters with surgical outcomes. METHODS: We retrospectively reviewed 71 patients who underwent CTA and arthroscopic capsulolabral reconstruction for anterior shoulder instability between April 2004 and August 2008. The control group comprised 72 patients diagnosed as isolated type II superior labrum anterior to posterior (SLAP) lesion during the period. Among the 143 patients, 71 were examined with follow-up CTA at an average 13.8 months after surgery. It was measured the capsular length and cross-sectional area at two distinct capsular regions: the 4 and 5 o'clock position of the capsule. RESULTS: With regards to the incidence of the type of anterior capsular insertion, type I was more common in the control group, whereas type III more common than in the instability group. Anterior capsular length and cross-sectional area were significantly greater in the instability group than in the control group. Among patients of the instability group, the number of dislocations and the presence of anterior labroligamentous periosteal sleeve avulsion lesion were significantly associated with anterior capsular redundancy. Postoperatively, recurrence was found in 3 patients (4.2%) and their postoperative capsular length and cross-sectional area were greater than those of patients without recurrence. CONCLUSIONS: Capsular insertion type and capsular redundancy derived through CTA may serve as important parameters for the management of anterior shoulder instability.
Arthrography* ; Dislocations ; Follow-Up Studies ; Humans ; Incidence ; Joint Instability ; Recurrence ; Retrospective Studies ; Shoulder*

Purpose: This study was performed to evaluate the incidence of vasovagal reactions (VVRs) and the efficacy of lidocaine injection for prevention. Methods: One hundred seventeen patients diagnosed with hemorrhoids and scheduled to undergo a stapled hemorrhoidopexy (SH) were randomly divided according to submucosal injection to the rectum: lidocaine group (n = 53, lidocaine injected just before full closure of the stapler) and control group (n = 58). Outcomes included baseline patient characteristics (American Society of Anesthesiologists physical status classification, body mass index, diabetes mellitus, hypertension, and previous VVR history), vital signs during the operation, incidence of VVRs (hypotension, bradycardia, dizziness, diaphoresis, and nausea/vomiting), and postoperative complications (pain, bleeding, and urinary retention). Results: Baseline characteristics were similar between groups. The number of patients with lower abdominal pain after firing the stapler and incidence of dizziness were lower for the lidocaine group than for the control group (9.4% vs. 25.9%, P = 0.017; 0% vs. 8.6%, P = 0.035, respectively). However, there were no significant between-group differences in incidence of nausea and diaphoresis (0% vs. 3.4%, P = 0.172) and syncope (1.9% vs. 3.4%, P = 0.612). Fewer patients in the lidocaine group complained of postoperative pain (41.5% vs. 58.6%, P = 0.072), and these patients used analgesics less frequently than those in the control group (28.3% vs. 36.2%, P = 0.374). Conclusion Patients who received a submucosal lidocaine injection prior to SH experienced less lower abdominal pain and dizziness compared with those who received standard treatment. A larger, more detailed prospective study is needed for further analysis.

PURPOSE: To compare the surgical results of lacrimal surgery for nasolacrimal duct obstruction with and without canalicular stenosis. METHODS: We surveyed 175 eyes which underwent external dacryocystorhinostomy with silicone tube intubation from January 1996 through December 2000 retrospectively. Group 1 included 126 eyes in nasolacrimal duct obstruction without canalicular or commoon canalicular stenosis and group 2 included 47 eyes with canalicular or common canalicular stenosis. We checked the statistical significance with Chi-squre Test. RESULTS: Anatomical success rate was 96.0% (121/126) in group 1 and 85.7% (42/49) in group 2; It was statistically significant (p<0.05). And functional success rate was 91.3% (115/126) in group 1 and 73.5% (36/49) in group 2; it had statistic significance (p<0.05). The surgical success rate depending on the size of sac was not statstically significant in goup 1, but it had statstic significance in total group (p<0.05). In site of stenosis, anatomical and functional success rate ware 93.1% (27/29) and 79.37% (23/29) in common canalicular stenosis. It was higer surgical success rate than the other site, but it had no statistic significance. CONCLUSIONS: The canalicular or common canalicular stenosis is important factor in success of lacrimal surgery. Therefore it is recommendable to open the canalicular stenosis by probing prior to performing dacryocystorhinostomy.
Constriction, Pathologic* ; Dacryocystorhinostomy ; Intubation ; Nasolacrimal Duct ; Retrospective Studies ; Silicones

No abstract available.
Gallbladder Neoplasms* ; Gallbladder*

No abstract available.
Pregnancy* ; Ultrasonography*

Treatment of fecal incontinence still remains a challenge to modern medicine due to many specific sides of this problem. The diversity of causes of fecal incontinence and different modes of action of the various treatment modalities mandate a tailored, individualized approach in each case. Surgery is the last treatment modality for patients suffering from severe fecal incontinence. Recent studies have shown poor late results after primary sphincter repair and low predictive value for most preoperative diagnostic tests. New surgical options such as artificial devices and electrically stimulated muscle transpositions are reported by acceptable success rates and unacceptably frequent complications. That is why current attention has focused on non- or minimally invasive therapies such as sacral nerve stimulation and temperature-controlled radio-frequency energy delivery to the anal canal. However, all these innovative techniques remain experimental untill enough high- evidence data are gathered for their objective evaluation.
Anal Canal ; Diagnostic Tests, Routine ; Fecal Incontinence* ; History, Modern 1601- ; Humans

PURPOSE: Tanilast has been clinically used for various allergic diseases. Recently, it has also been found to inhibit excessive scarring in wound healing process. The purpose of this study is to investigate the inhibitory effect of Tranilast on the proliferation of human conjunctival epithelial cells and subconjunctival fibroblasts. METHODS: Human conjunctival epithelial cells and subconjunctival fibroblasts were exposed for 24 hours to Tranilast 0.05, 0.2, 0.4, 0.8, and 1.6 mg/ml. MTT based calorimetric assay was performed to assess the metabolic activity and inhibition of cellular proliferation. RESULTS: As the concentration of Tranilast increased, the absorbance of spectrometer decreased. Inhibitory effect of cellular proliferation was stronger in subconjunctival fibroblasts than in conjunctival epithelial cells. The inhibitory effect of celluar proliferation in conjunctival epithelial cells was 75%, 66%, 64%, 59%, and 39% at 0.05, 0.2, 0.4, 0.8, and 1.6 mg/ml, respectively (LD50 was 0.9 mg/ml). In subconjunctival fibroblasts, the inhibitory effect of celluar proliferation was 66%, 62%, 47%, 33%, and 23% at 0.05, 0.2, 0.4, 0.8, and 1.6 mg/ml, respectively (LD50 was 0.3 mg/ml). CONCLUSION: Tranilast may prevent excessive proliferation of both human conjunctival epithelial cells and subconjunctival fibroblasts. This inhibitory effect on cellular proliferation was higher in subconjunctival fibroblasts than in conjunctival epithelial cells, suggesting the possibility of being used after glaucoma filtering surgery or pterygium excision.
Cell Proliferation ; Cicatrix ; Epithelial Cells* ; Fibroblasts* ; Filtering Surgery ; Glaucoma ; Humans* ; Pterygium ; Wound Healing