Three cases of giant pituitray adenoma are reported. Two cases were operated by transsphenoidal approach and a case by transcranial approach. Transsphenoidal approach showed satisfactory results despite of marked suprasellar extension of tumors. We report rare giant pituitary adenomas with review of relevant literatures.
Adenoma ; Pituitary Neoplasms*

We report a case of prenatal diagnosis of fetal congenital goiter at 31weeks of gestation by ultrasonogram and fetal hypothyroidism confirmed at birth as thyroid function test by umbilical cord blood sampling. Maternal Graves' disease and the drugs used to treat hyperthyroidism in pregnant women can affect the fetus, causing hyperthyroidism or hypothyroidism and goiter. Fetal hypothyroidism may be caused by transplacental passage of either maternal thyrotropic-binding inhibitory immunoglobulin(TBII) antibodies or maternal treatment with propylthiouracil(PTU). Untreated fetal hypothyroidism may result in mental retardation, perceptual-motor, visual-spatial, and language developmental problems. In this article fetal thyroid function was not assessed by cordocentesis, but fetal congenital goiter was detected ultrasound. Ultrasound should be used to detect fetal goiter from 20 weeks onward. Fetal goiter should resolve when maternal PTU treatment is decreased. We have diagnosed fetal hypothyroidism in utero by ultrasonography. Significance of in utero management of fetal hypothyroidism is discussed.
Antibodies ; Congenital Hypothyroidism ; Cordocentesis ; Female ; Fetal Blood ; Fetus ; Goiter* ; Graves Disease ; Humans ; Hyperthyroidism* ; Hypothyroidism ; Intellectual Disability ; Language Development ; Mothers* ; Parturition ; Pregnancy ; Pregnant Women ; Prenatal Diagnosis* ; Thyroid Function Tests ; Thyroid Gland ; Ultrasonography

BACKGROUND/AIMS: Lamivudine, an oral nucleoside analogue, effectively inhibits hepatitis B virus replication and reduces hepatic necroinflammation in patients with chronic hepatitis B. This study investigated the effect and safety of 12 week lamivudine therapy in Korean patients with chronic hepatitis B (CHB). METHODS: In an open clinical trial, 113 patients with CHB were enrolled. They received 100 mg of lamivudine orally once daily for 12 weeks, and they were followed until 2 weeks after cessation of lamivudine. HBV DNA (by bDNA assay), liver enzymes, creatine phosphokinase, creatinine and CBC were checked at 0, 2, 4, 8, 12 and 14 weeks. Compliance and side effects were evaluated at the same time. RESULTS: After receiving lamivudine 100 mg, serum HBV DNA levels fell rapidly, remaining in 94.3% below baseline values at 2 weeks and 99.8% below baseline values at 12 weeks. Serum HBV DNA was cleared in 75.2% and alanine aminotransferase level (ALT) was normalized in 64.8% at 12 weeks. Cumulative percentage of HBeAg clearance (defined by clearance of serum HBV DNA and HBeAg) was 14.4%. Clearance of HBV DNA was more frequent in patients with lower pretreatment serum HBV DNA and higher ALT. During the treatment periods, adverse effects were negligible and transient. Two weeks after cessation of lamivudine, serum HBV DNA reappeared in 70.6% of responders. CONCLUSION: It is suggested that lamivudine is effective and safe in the treatment of CHB in Korean patients, but further study for adequate duration of treatment is needed because of high recurrence after 12 weeks therapy.
Alanine Transaminase ; Compliance ; Creatine Kinase ; Creatinine ; DNA ; Hepatitis B e Antigens ; Hepatitis B virus ; Hepatitis B, Chronic* ; Hepatitis, Chronic* ; Humans ; Lamivudine* ; Liver ; Recurrence

The posterior fossa arterivenous malformation(AVM) is uncommon and different from other intracranial AVM in its natural history, diagnosis, treatment, prognosis, and other features. The authors present 3 cases of posterior fossa AVM. A 26-year-old woman with supravermian AVM and a 17-year-old woman with right cerebellopontine angle AVM were treated with surgical removal in good result. And another was occurred in the pons of 20-year-old woman, that was treated with intersecting beam radiation of 5040 rads in cumulative dosage.
Adolescent ; Adult ; Arteriovenous Malformations* ; Cerebellopontine Angle ; Diagnosis ; Female ; Humans ; Natural History ; Pons ; Prognosis ; Young Adult

BACKGROUND/AIMS: Spontaneous bacterial peritonitis (SBP) is a major problem associated with liver cirrhosis which has high mortality. Increased production of inflammatory mediators, such as tumor necrosis factor-a (TNF-a) and interleukin- (IL-) may be associated with development of renal impairment, one of the most important prognostic parameters in SBP. The aim of this study is to investigate the changes of these cytokines in ascitic fluid and plasma in patients with SBP and the relationship between these cytokines and development of renal impairment. METHODS: Forty patients with liver cirrhosis and ascites were studied 21 with SBP and 19 with sterile ascites. TNF-a and IL- levels in ascitic fluid and plasma were determined by ELISA at the time of diagnosis in both groups and 48 hours after antibiotics treatment in SBP patients. RESULTS: TNF-and IL- levels in ascitic fluid and plasma were significantly higher in patients with SBP than those without SBP (ascitic fluid TNF-a: 2.5+/-0.5 vs. 1.6+/-0.2; plasma TNF-a: 2.3+/-0.5 vs. 1.5+/-0.2; ascitic fluid IL-: 3.8+/-0.5 vs. 3.0+/-0.4; plasma IL-: 3.4+/-0.5 vs. 2.3+/-0.3, log pg/mL)(p<0.001). In patients with SBP, levels of TNF-a and IL- in ascitic fluid and plasma decreased 48 hours after antibiotics treatment. Eleven patients with SBP (11/21, 52%) developed renal impairment. Patients with renal impairment had significantly higher ascitic fluid and plasma TNF-a levels than those without renal impairment (median 2.5 vs. 2.1 for ascitic fluid, p=0.006; median 2.4 vs. 2.0, log pg/mL for plasma, p=0.04). Although four out of eleven (36%) patients who developed renal impairment died during hospitalization, all the patients without renal impairment survived (p=0.09). CONCLUSION: Our results suggest that the levels of TNF-a and IL- in ascitic fluid and plasma are increased in SBP and elevated levels of TNF-a in ascitic fluid and plasma may be associated with development of renal impairment, thus indicating poor prognosis in patients with SBP.
Anti-Bacterial Agents ; Ascites ; Ascitic Fluid* ; Cytokines ; Diagnosis ; Enzyme-Linked Immunosorbent Assay ; Hospitalization ; Humans ; Liver Cirrhosis ; Mortality ; Necrosis* ; Peritonitis* ; Plasma* ; Prognosis

Crossed testicular ectopia is a rare anomaly, in which both testes migrate toward the same hemiscrotum. Fewer than 100 cases of this condition have been reported in the literature worldwide. Occasionally, conditions initially suspected to be crossed testicular ectopia have proven to be other anomalies, including hypospadias, renal agenesis, and seminal vesicle cysts. In this case, we diagnosed ganglioneuroblastoma in a patient with testicular ectopia.
Congenital Abnormalities ; Cryptorchidism ; Female ; Ganglioneuroblastoma ; Humans ; Hypospadias ; Kidney ; Kidney Diseases ; Male ; Seminal Vesicles ; Testis

This study was carried out in order to clarify the selection criteria of the surgical approaches and validate their efficacy in patients with vestibular schwannoma. The evolution and modification of the transpetrosal approach was evolved into combined approaches to vestibular schwannomas. These approaches have been advocated to reduce the mortality and morbidity as well as to improve the surgical results especially in large acoustic neurinoma. Having been stimulated with the fascinating preliminary surgical results of the suboccipital and combined transpetrosal approaches, we have builded up a decision making policy based on the tumor size and the preoperative hearing status for the surgical approaches to vestibular schwannomas. Between May 1996 and September 1997, 21 patients with vestibular schwannoma including one case of NF II underwent either suboccipital or various transpetrosal approaches. There was no surgical mortality. Gross total removal was achieved in 20 patients(95%). Facial nerve function was preserved in 19(90%) and hearing function in 6(46%) among the 13 patients who underwent hearing preservation surgery. The authors confirmed the validity of various transpetrosal approaches in this study and conclude that our policy on the surgical approaches to vestibular schwannomas is quite reasonable.
Decision Making ; Facial Nerve ; Hearing ; Humans ; Mortality ; Neuroma, Acoustic* ; Patient Selection*

STATEMENT OF PROBLEM: Branemark or ITI are two currently most widely used implant systems but with contrasting design, surgical and restoration methods. PURPOSE: The purpose of this study was to compare changes and its statistical significance in bone height and shape which may rise due to the differences between two implant systems. Also to analyse the effect of inter-implant distance on annual bone height changes. MATERIAL & METHOD: Those patients who were treated with two or more of either Branemark or ITI implants at posterior mandibular area at Yonsei University Dental Hospital, Implant Clinic were selected. At annual examination appointments, standardised radiographs using parallel technique were taken. Marginal bone and inter-implant crestal bone changes were measured and following results were obtained. RESULTS: 1) When ITI and Branemark system were compared, both annual marginal and inter-implant crestal bone height changes in ITI system in the first two years were smaller than Branemark and they were statistically significant. On the third year, however, there was no statistical difference between two implant systems on their annual bone level changes (p>0.05). 2) The Marginal and inter-implant crestal bone changes were compared when inter-implant distance was less than 4mm. Statistically significant bone level changes were noted on the first year only for ITI implants but in the first and second year for Branemark implants (p>0.05). 3) When comparing angulation changes between marginal bone and implant fixture, ITI system had smaller angulation changes but the annual changes were not statistically significant (p>0.05). CONCLUSION: Within the limitation of this study, it could be concluded that Branemark implant systems had more changes in marginal and inter-implant crestal bone level in the first and second year after loading with statistical significance. Further studies are recommended to see the effects of these bone loss during the first and second year after loading on the long term prognosis of Branemark Implants.
Appointments and Schedules ; Humans ; Prognosis

OBJECTIVE: Despite advance in the surgical treatment of the skull base lesions, reaching the ventral brain stem is not familiar to us yet. No traditional complex skull base approaches have a value not only in treating complex and unusual skull base pathology but also in providing a better and safer exposure to traditional pathology. However, a more widespread use of these complex skull base approaches is predicated on a clear understanding of the topographical areas of the skull base exposed and on how these complex approaches can improve the exposure afforded by more conventional surgical routes. PATIENTS AND METHODS: The study was performed on 43 surgical dissection with 20 embalmed cadevaric heads in which the cephalic vascular system had been injected with colored silicone material. RESULTS AND CONCLUSIONS: This paper provides an visual anatomical understanding of the areas of the skull base exposed by the approaches examined using the same cues(CT and MRI) that the surgeons use in selecting an approach when confronted with a real lesion and makes them to apply to the clinical situations properly and intimately for the optimal treatment. In addition, with the modular concept, the neurosurgeon may better understand how complex skull base approaches are derived and modified from, and improve the exposure of basic, well known conventional neurosurgical approaches as building block.
Brain Stem ; Head ; Humans ; Pathology ; Silicones ; Skull Base* ; Skull*

BACKGROUND: Elderly patients with underlying cardiovascular or respiratory diseases are more susceptible to anesthesiologic risks or serious complications following laparoscopic operations. We evaluated the safety of laparoscopic radical nephrectomy in elderly patients to compensate for the lack of Korean data on the subject in the field of urology. METHODS: From March 2003 and March 2009, 73 patients with localized renal cell cancer underwent laparoscopic radical nephrectomy. They were divided into two groups according to age; 75 years or older (elderly group, n=21) and under 75 years (young group, n=52). Operative parameters as well as oncological outcomes were evaluated. RESULTS: The mean age was 77.7+/-2.5 years for the elderly group and 55.9+/-10.5 years for the young group. No significant differences existed between the groups in terms of mean operative time, intraoperative blood loss, complications, and hospital stay. However, American Society of Anesthesiologists (ASA) score, co-morbidities (p<0.05), and rate of transfusion (p<0.05) were significantly higher in the elderly group. In overall analyses, we conclude that in elderly patients undergoing laparoscopic radical nephrectomy, close monitoring of hemoglobin level as well as intraoperative transfusion for maintenance of hemoglobin level at 10 mg/L or higher is necessary in elderly patients to achieve adequate circulation. CONCLUSION: Laparoscopic radical nephrectomy can be considered a safe and effective procedure for most elderly patients.
Aged ; Carcinoma, Renal Cell ; Hemoglobins ; Humans ; Laparoscopy ; Length of Stay ; Nephrectomy ; Operative Time ; Urology