PURPOSE: Primary hyperparathyroidism is the most frequent cause of hypercalcemia and due to the routine examination of serum calcium levels, the number of patients with primary hyperparathyrodism has increased. METHODS: We reviewed sixty patients treated by surgery over the 20-year period at the Department of Surgery, Seoul National University Hospital and retrospectively analyzed both the clinicopathologic and bio-chemcal features of the presented cases and the effective methods of treatment and diagnosis retrospectively. RESULTS: The study group consists of 60 patients with primary hyperparathyroidism comprised of 18 males and 42 females. The most common presenting clinical manifestations were associated with bone pain in 38 (63%), and recurrent urinary stone in 27 (45%) patients; And 11 patients were asymptomatic. All patients showed hypercalcemia and the serum parathyroid hormone (PTH) level was elevated in all 49 patients after 1992. A preopeative localization study was performed with ultrasonography (USG), computed tomography (CT), Thallium-Technecium (Tl-Tc) substraction scan and Methoxylisobutyl isonitrile (MIBI) scan. Positive localization was made in 71%, 71%, 77% and 71% respectively. Histopathologic findings revealed solitary adenoma in 56 patients and carcinoma in 4 patients. Transient hypocalcemia following surgery occurred in 50 patients and they were treated with calcium. There were no recurrent cases with the exception of one who displayed carcinoma. CONCLUSION: In this study, most of the patients were discovered with an advanced clinical and biochemical status but the number of the asymptomatic patients is increasing. Through an accurate preoperative localization, they were successfully treated with parathyroidectomy without major complications.
Female ; Male ; Humans ; Adenoma

PURPOSE: Primary hyperparathyroidism is the most frequent cause of hypercalcemia and due to the routine examination of serum calcium levels, the number of patients with primary hyperparathyrodism has increased. METHODS: We reviewed sixty patients treated by surgery over the 20-year period at the Department of Surgery, Seoul National University Hospital and retrospectively analyzed both the clinicopathologic and bio-chemcal features of the presented cases and the effective methods of treatment and diagnosis retrospectively. RESULTS: The study group consists of 60 patients with primary hyperparathyroidism comprised of 18 males and 42 females. The most common presenting clinical manifestations were associated with bone pain in 38 (63%), and recurrent urinary stone in 27 (45%) patients; And 11 patients were asymptomatic. All patients showed hypercalcemia and the serum parathyroid hormone (PTH) level was elevated in all 49 patients after 1992. A preopeative localization study was performed with ultrasonography (USG), computed tomography (CT), Thallium-Technecium (Tl-Tc) substraction scan and Methoxylisobutyl isonitrile (MIBI) scan. Positive localization was made in 71%, 71%, 77% and 71% respectively. Histopathologic findings revealed solitary adenoma in 56 patients and carcinoma in 4 patients. Transient hypocalcemia following surgery occurred in 50 patients and they were treated with calcium. There were no recurrent cases with the exception of one who displayed carcinoma. CONCLUSION: In this study, most of the patients were discovered with an advanced clinical and biochemical status but the number of the asymptomatic patients is increasing. Through an accurate preoperative localization, they were successfully treated with parathyroidectomy without major complications.
Adenoma ; Calcium ; Diagnosis ; Female ; Humans ; Hypercalcemia ; Hyperparathyroidism, Primary* ; Hypocalcemia ; Male ; Parathyroid Hormone ; Parathyroidectomy ; Retrospective Studies ; Seoul ; Ultrasonography ; Urinary Calculi

OBJECTIVE: The aim of the present study was to investigate differences in discontinuation time among antidepressants and total antidepressant discontinuation rate of patients with depression over a 6 month period in a naturalistic treatment setting. METHODS: We reviewed the medical records of 900 patients with major depressive disorder who were initially prescribed only one kind of antidepressant. The prescribed antidepressants and the reasons for discontinuation were surveyed at baseline and every 4 weeks during the 24 week study. We investigated the discontinuation rate and the mean time to discontinuation among six antidepressants groups. RESULTS: Mean and median overall discontinuation times were 13.8 and 12 weeks, respectively. Sertraline and escitalopram had longer discontinuation times than that of fluoxetine, and patients who used sertraline discontinued use significantly later than those taking mirtazapine. No differences in discontinuation rate were observed after 24 weeks among these antidepressants. About 73% of patients discontinued antidepressant treatment after 24 weeks. CONCLUSION: Sertraline and escitalopram tended to have longer mean times to discontinuation, although no difference in discontinuation rate was detected between antidepressants after 24 weeks. About three-quarters of patients discontinued antidepressant maintenance therapy after 24 weeks.
Antidepressive Agents* ; Citalopram ; Depression ; Depressive Disorder, Major* ; Fluoxetine ; Humans ; Medical Records ; Sertraline

BACKGROUND: Patients undergoing brain surgery have a high risk of developing a number of perioperative coagulation disorders. Anesthesia and surgical stress may affect blood coagulation and fibrinolysis. The aim of this study was to evaluate perioperative changes in hemostatic parameters of patients undergoing clipping of cerebral aneurysms with a thromboelastograph (TEG) in combination with simple laboratory tests. METHODS: Twenty adult patients who had cerebral aneurysms and no history of coagulation disorders were studied. Isoflurane and N2O were used for all anesthetic proceedings. Preanesthetic, intraoperative (after skin incision and after clipping of cerebral aneurysms) and postanesthetic measurements included a TEG and simple laboratory tests. The TEG variables included r time (reaction time for clot formation), k time (clot formation time), alpha angle (rate of clot growth), MA (maximal amplitude of clot strength) and LY30 (fibrinolytic index). RESULTS: In simple laboratory tests, prothrombin time (PT) and partial thromboplastin time (PTT) at intraoperation and postanesthesia were longer than those at preanesthesia (p < 0.05). In the TEG, r and k time at intraoperation and postanesthesia were shorter than those at preanesthesia (p < 0.05). However the alpha angle at intraoperation and postanesthesia was longer than that at preanesthesia (p < 0.05). There was no significant difference in MA and LY30 except an increase in MA after the skin incision (p < 0.05) compared to the MA at preanesthesia. CONCLUSIONS: These results indicate a general hypercoagulability during and after a cerebral aneurysms operation in terms of TEG, although, the level of the PT and PTT can be at the upper limits within normal. Therefore perioperative use of coagulants in cerebral aneurysms may increase the risk of a thromboembolism because of accelerating blood coagulability. By early intraoperative and postoperativeevaluation of the hemostatic abnormality with a TEG, appropriate measures might be initiated to prevent postoperative complications due to hypercoagulability.
Adult ; Anesthesia ; Blood Coagulation* ; Brain ; Coagulants ; Fibrinolysis ; Humans ; Intracranial Aneurysm* ; Isoflurane ; Partial Thromboplastin Time ; Postoperative Complications ; Prothrombin Time ; Skin ; Thromboembolism ; Thrombophilia

OBJECT: To gather information concerning ontogeny, the authors present the results of immunohistochemical stainings of neuronal and glial markers and the reverse transcriptase-prolongation chain reaction (RT-PCR) of nestin for three intraventricular tumors located around the foramen of Monro. METHODS: Seven cases of central neurocytomas(CN), three subependymomas(SE) and eight subependymal giant cell astrocytomas(SEGA), were included in this study. Antihuman monoclonal antibodies of synaptophysin(SNP)(DAKO, 1:20), chromogranin A(ChrA)(DAKO, 1:100), neuron specific enolase (NSE)(DAKO, 1:500) and nerve cell adhesion molecule(NCAM)(Zymed, 1:500) were utilized for neuronal markers and glial fibrillary acidic protein(GFAP)(DAKO, 1:300) functioned as a glial marker in immunohistochemical(IHC) stainings. Reverse transcriptase polymerase chain reaction(RT-PCR) for nestin was performed in all cases. RESULTS: For chromogranin A, positive reaction was found in three of the seven CN cases but none of the SE and SEGA cases. For IHC staining of synaptophysin, positive reaction was revealed in all CN cases but in none of the SE and SEGA cases. For NCAM, positive reaction was demonstrated in five of the eight SEGA cases and in all SE and CN cases. For NSE, positive reaction was exhibited in seven of the eight SEGA cases and in all SE and CN cases. Positive reactions for NSE and NCAM in the SEGA cases were manifested mainly in the cytoplasms of giant cells and their background. For IHC staining of GFAP, positive reaction was demonstrated in one of the seven CN cases, in three of the eight SEGA cases, and in all SE cases. RT-PCR product of nestin was expressed in two of the seven CN cases, in two of the three SE cases, and in one SEGA case. CONCLUSION: Many cells of CN, SE and SEGA, had expressed positive reactions for both neuronal and glial markers in IHC study and nestin in RT-PCR. It is suggested that origin cells of these tumors might express both neuronal and glial differentiation.
Antibodies, Monoclonal ; Astrocytoma* ; Cerebral Ventricles* ; Chromogranin A ; Cytoplasm ; Giant Cells ; Glioma, Subependymal* ; Immunohistochemistry ; Nestin ; Neural Cell Adhesion Molecules ; Neurocytoma* ; Neurons ; Phosphopyruvate Hydratase ; RNA-Directed DNA Polymerase ; Synaptophysin

Vertebrobasilar junction entrapment due to a clivus fracture is a rare clinical observation. The present case report describes a 54-yr-old man who sustained a major craniofacial injury. The patient displayed a stuporous mental state (Glasgow Coma Scale [GCS]=8) and left hemiparesis (Grade 3). The initial computed tomography (CT) scan revealed a right subdural hemorrhage in the frontotemporal region, with a midline shift and longitudinal clival fracture. A decompressive craniectomy with removal of the hematoma was performed. Two days after surgery, a follow-up CT scan showed cerebellar and brain stem infarction, and a CT angiogram revealed occlusion of the left vertebral artery and entrapment of vertebrobasilar junction by the clival fracture. A decompressive suboccipital craniectomy was performed and the patient gradually recovered. This appears to be a rare case of traumatic vertebrobasilar junction entrapment due to a longitudinal clival fracture, including a cerebellar infarction caused by a left vertebral artery occlusion. A literature review is provided.
Basilar Artery/*injuries ; Humans ; Male ; Middle Aged ; Skull Fractures/*complications/radiography ; Tomography, X-Ray Computed ; Vertebral Artery/*injuries

OBJECTIVE: This study was designed to evaluate the feasibility and clinical implications of CT angiography (CTA) in patients with acute ischemic stroke. METHODS: From August 2004 to July 2005, 24 cases of acute ischemic stroke were prospectively included in this study. We checked location of ischemic parenchymal lesion, location of vascular occlusion, degree of collateral supply, and presence of other accompanying vascular lesions on CT and CTA, and assessed the usefulness of CTA by comparing the findings with those of diffusionweighted MR imaging and digital subtraction angiography. RESULTS: Average time required for performing CT and CTA and getting reconstructed images was 30 minutes. Location of the parenchymal lesions and the corresponding occluded or stenosed artery could be clarified in 16 cases (67%) and 20 cases (83%), respectively. There were 13 cases of severe stenosis and 7 cases of occlusion. In 7 cases of major arterial occlusion, degree of collateral circulation could be assessed as good in 5, and moderate in 2. Incidental unruptured intracranial aneurysms were identified in 5 cases. CONCLUSION: CTA could provide valuable information regarding locations of parenchymal lesion and vascular occlusion, degree of collateral supply, and presence of accompanying intracranial aneurysm in cases of acute ischemic stroke without significant time delay, thereby guiding therapeutic plan.
Angiography* ; Angiography, Digital Subtraction ; Arteries ; Collateral Circulation ; Constriction, Pathologic ; Humans ; Intracranial Aneurysm ; Magnetic Resonance Imaging ; Prospective Studies ; Stroke*