Sellar arachnoid cysts are rare; an infected arachnoid cyst is extremely rare as only one case has been reported to date in the literature. Here, we report a patient with an infected or inflamed sellar arachnoid cyst that was successfully treated with transsphenoidal surgery (TSA). A 53-year-old female with a history of chronic sinusitis developed a headache 5 months ago, and one month before admission polyuria, polydipsia, and abnormal vaginal bleeding occurred. The magnetic resonance imaging (MRI) showed a sellar cystic mass with a thickened pituitary stalk. Preoperative hormonal study revealed normal pituitary hormone levels except for a moderate elevation of prolactin. She was diagnosed with diabetes insipidus of the central nervous system origin based on a water-deprivation test. TSA was performed under an impression of symptomatic Rathke's cleft cyst according to the MRI findings. Intraoperative findings showed confirmation of turbid intracystic contents, but micro-organisms were unidentified on microbial culture. Pathology of the cyst wall revealed inflamed meningoepithelial lining cells compatible with an arachnoid cyst.
Arachnoid Cysts ; Arachnoid* ; Central Nervous System ; Diabetes Insipidus ; Female ; Headache ; Humans ; Inflammation ; Magnetic Resonance Imaging ; Middle Aged ; Pathology ; Pituitary Gland ; Polydipsia ; Polyuria ; Prolactin ; Sinusitis ; Uterine Hemorrhage

The delayed rupture of the flexor tendons is a rare complication of malunited distal radius fractures after nonoperative management. The known cause of a flexor tendon rupture is attrition between the palmarly displaced ulnar head and the involved tendons. Sharp bony spurs on the volar side of the malunited distal radius can also cause flexor tendon rupture. About 30 cases have been reported in literature. There were only four case reports about the delayed rupture of the 2nd, 3rd, 4th, and 5th flexor tendons. In this case, we experienced flexor digitorum superficialis and flexor digitorum profundus tendon ruptures of the index, middle, ring, and little fingers, after 8 months following the malunion of a distal radius fracture. At two years follow-up after tendon graft and corrective osteotomy, the range of motion and motor weakness of the 2nd, 3rd, 4th, and 5th fingers improved.

Purpose: The purpose of this study was to examine the clinical outcomes and efficacy of hip resurfacing arthroplasty (HRA) in patients with osteonecrosis of the femoral head after the failure of porous tantalum rod insertion without rod removal. Materials and Methods: Conversion to hip resurfacing arthroplasty was performed in 10 patients (11 hips) with a mean period of 14.9 months after the primary surgery. The mean follow-up period was 73.7 months. Analysis of pre and postoperative range of motion (ROM), University of California at Los Angeles (UCLA) activity score, modified Harris hip score, and visual analog scale (VAS) pain score was performed. Radiographic analysis of component loosening and osteolysis was performed. Results: The postoperative ROM showed significant improvement (P<0.05), excluding flexion contracture. The modified Harris hip score showed improvement from 65.82 to 96.18, the UCLA score showed improvement from 4.18 to 8.00, and the VAS pain score was reduced from 6.09 to 1.80. All scores showed statistically significant improvement (P<0.05). No component loosening or osteolysis was detected by radiographic analysis. Conclusion Satisfactory results were obtained from conversion hip resurfacing arthroplasty after failure of porous tantalum rod insertion without rod removal. The findings of this study demonstrate the advantages of HRA, including no risk of trochanteric fracture and no bone loss around the tantalum rod. In addition, the remaining porous tantalum rod provided mechanical support, which reduced the potential risk of femoral neck fracture or loosening. This technique can be regarded as a favorable treatment option.

BACKGROUND: Fatigue is one of the common chief complaints in primary care setting. It causes disability in daily activity and lowers quality of life. This study was intended to investigate the information about fatigue useful in outpatient clinic. METHODS: The data was obtained from the Korean Health and Nutrition Survey 2001. Logistic regression analysis was performed to examine the association between self- reported fatigue and several factors including sociodemographic factors, life style factors, stress, depression, and worry about health. RESULTS: The prevalence of fatigue was low in unmarried status, more significantly in men when compared with those in married status. No significant association was found between fatigue and occupation, education level, monthly income, smoking, and alcohol consumption. The risk of fatigue in the exercising group more than 4 times per week was significantly low in women. The risk of fatigue in the group of sleeping duration less than 5 hours was significantly higher than the group of sleeping more than 9 hours. Compared with unemployed state, the daily working duration of more than 9 hours increased the risk for fatigue significantly. Stress perception, sadness or depression during the past 1 year and worry about health were strongly associated with fatigue. CONCLUSION: When evaluating and managing patients with fatigue, we should search for information about the patients' lifestyle such as exercise, daily work hours, sleeping as well as stress perception and depressive mood. Especially among the lifestyle, inquiring about regular exercise and promoting it may be important in order to manage patients with fatigue.
Alcohol Drinking ; Ambulatory Care Facilities ; Depression ; Education ; Fatigue* ; Female ; Humans ; Life Style ; Logistic Models ; Male ; Nutrition Surveys* ; Occupations ; Prevalence ; Primary Health Care ; Quality of Life ; Single Person ; Smoke ; Smoking

PURPOSE: Young infants with suspected sepsis routinely undergo laboratory evaluation. In particular, when an infant is a newborn baby, evaluation of the cerebrospinal fluid (CSF) has been frequently included, because the prognosis is poor, irrespectively of the etiology of meningitis. We aimed to examine the clinical predictors of CSF pleocytosis among the newborns. METHODS: We retrospectively reviewed the records of all infants, aged 30 days or younger, requiring lumbar puncture. Electronic data sources provided the demographic data of the newborns, the clinical manifestations, and all laboratory values. After a univariate analysis, logistic regression analysis was performed to predict newborns at increased risk for CSF pleocytosis. RESULTS: One hundred thirteen newborns were studied; 20 of whom (17.7%) had CSF pleocytosis. Fever was significantly associated with CSF pleocytosis (P=0.008, OR=5.08, 95% CI, 1.39-18.54). The infants with lethargic appearance also had an increased risk for CSF pleocytosis. Blood urea nitrogen level was higher in patients with pleocytosis. Logistic regression analysis revealed that other clinical features and laboratory data were not significant, except for fever and lethargy. A total of 45% of the infants with CSF pleocytosis were diagnosed with serious bacterial infection, as opposed to 19.4% of those without CSF pleocytosis. CONCLUSION: In case of neonates, it would be better to perform lumbar puncture, when the infant has fever or lethargic appearance, although, the results of routine laboratory tests were nonspecific.
Aged ; Bacterial Infections ; Blood Urea Nitrogen ; Information Storage and Retrieval ; Electronics ; Electrons ; Fever ; Humans ; Infant ; Infant, Newborn ; Lethargy ; Leukocytosis ; Logistic Models ; Meningitis ; Prognosis ; Retrospective Studies ; Sepsis ; Spinal Puncture

Meningiomas are the most common benign intracranial tumors and make up 13-26% of all primary intracranial tumors. Clinical presentation of hemorrhage is rare in these tumors occurring in approximately 1.3% of cases and subdural hemorrhages are even more uncommon. The mechanism of hemorrhage is still unclear and may vary according to histologic type, location and the type of hemorrhage. We experienced a case of 61-year-old woman with a benign meningioma presenting as a subdural hemorrhage. She developed sudden onset of headache right after aggressively coughing. Her headache persisted for a week before she was admitted to the emergency room of National Cancer Center. She had a past medical history of ovarian cancer which had been treated and was allegedly recurrence-free for 2 years. At the time of admission, a headache was the only symptom and imaging studies showed a right frontal hemorrhagic subdural mass lesion accompanying an ipsilateral subdural hematoma. Elective surgery was performed and intraoperative findings revealed the hallmark characteristics of a meningioma with mixed stage diffuse subdural hematoma. Permanent pathology result determined it was a conventional meningioma (World Health Organization grade I). From this case, we discuss the rare presentation of subdural hemorrhage in meningioma and related points by reviewing the literature of previous studies.
Cough ; Emergency Service, Hospital ; Female ; Headache ; Hematoma, Subdural* ; Hemorrhage ; Humans ; Meningioma* ; Middle Aged ; Ovarian Neoplasms ; Pathology ; World Health Organization

INTRODUCTION: During an acute myocardial ischemia, maintenance of overall ventricular function may depend on remote nonischemic myocardium. Whereas fentanyl has minimal hemodynamic effects, volatile anesthetics, including halothane and isoflurane cause negative inotropic and lusitropic effects in normal myocardium. This investigation examined the effects of volatile anesthetics in comparision with fentanyl on compensatory responses to brief left anterior descending coronary artery (LAD) occlusion in remote normal myocardium (left circumflex coronary artery (LCX) supply) in an open-chest canine model. METHODS: Thirty-six mongrel dogs, acutely instrumented for measurement of pressure (left ventricle (LV) and aorta), flows (pulmonary trunk and LCX) and dimensions in ischemic and non-ischemic myocardium, were subjected to a 10-min LAD occlusion during fentanyl (n=10), halothane (n=13), or isoflurane (n=13) anesthesia. Regional contractile function was assessed using percent systolic shortening (%SS) and the preload recruitable stroke work slope (Mw). Diastolic function was evaluated using a regional time constant for intramyocardial pressure decline of LV (IMPtau), peak lengthening rate (dL/dtmax) and a regional chamber stiffness constant (Kp). RESULTS: Acute LAD occlusion caused immediate deterioration of anterior wall function similarly without changes in cardiac index, mean arterial pressure and dP/dtmax in all three groups. LV end-diastolic pressure (LVEDP), LVPtau, and heart rate increased and dP/dtmin decreased to the same extent with regional myocardial ischemia in all groups. During fentanyl anesthesia, acute myocardial ischemia was associated with an increase in %SS (26%) and Mw (48%) in LCX area without changes in IMPtau and dL/dtmax. With halothane or isoflurane anesthesia, %SS, Mw and IMPtau showed similar changes as those in fentanyl in response to LAD occlusion. However, dL/dtmax was increased (47 and 45% in the halothane and isoflurane groups, respectively) and Kp was increased (34 and 33% in the halothane and isoflurane groups, respectively) less compared to fentanyl (78%). Enhanced function in LCX zone was associated with a comparable increase (21~28% from baseline) in LCX flow in all groups. CONCLUSION: Enhanced regional contractility following acute coronary occlusion in nonischemic myocardium during fentanyl anesthesia is well-preserved with volatile anesthetics in an open-chest canine model. In addition, diastolic functions are also enhanced rather than depressed during anesthesia with volatile anesthetics. Halothane and isoflurane, however, do not differ in the compensatory responses to acute regional ischemia.
Anesthesia ; Anesthetics ; Animals ; Arterial Pressure ; Coronary Occlusion ; Coronary Vessels ; Dogs* ; Fentanyl ; Halothane ; Heart Rate ; Hemodynamics ; Ischemia ; Isoflurane ; Myocardial Ischemia* ; Myocardium* ; Stroke ; Ventricular Function

BACKGROUND: Many epidemiological studies suggest the pathogenic role of serum uric acid level in development of hypertension. Several cross-sectional studies have shown the relationship between uric acid and development of hypertension in Korea. We investigated whether uric acid associates with the development of hypertension in a retrospective cohort study. METHODS: We included 2,353 people who did not have hypertension initially and underwent general medical examination between 1997 and 1998 and were re-examined after 10 years later. Study people divided into three groups according to serum uric acid level tertiles. RESULTS: The incidences of hypertension in tertile groups were 14.1% (108/764), 22.0% (175/769), and 24.3% (193/793) and they showed statistically significant difference. We performed multivariable logistic regression with serum uric acid and other risk factors of hypertension. The incidence of hypertension in second and third tertile group were significantly higher than first tertile group (odds ratio [OR], 1.53; 95% confidence interval [CI], 1.11 to 2.10; P = 0.009 in second tertile group and OR, 1.66; 95% CI, 1.17 to 2.37; P = 0.005 in third tertile group). CONCLUSION: Serum uric acid level is associated with the development of hypertension.
Cohort Studies ; Epidemiologic Studies ; Hypertension ; Incidence ; Korea ; Logistic Models ; Retrospective Studies ; Risk Factors ; Uric Acid

BACKGROUND/AIMS: The aim of this study was to elucidate the antiviral efficacy of lamivudine (LMV)-adefovir (ADV) combination therapy in chronic hepatitis B patients who showed resistance to LMV and ADV consecutively. METHODS: A retrospective review was performed in eighteen patients with chronic hepatitis B who developed virologic breakthroughs during LMV-ADV sequential mono-therapy and treated with LMV-ADV combination therapy. RESULTS: The median duration of follow up was 17 months (range, 6-27) after the start of LMV-ADV combination therapy. Mean HBV DNA level in log10 IU/mL was 6.08+/-0.95, 4.05+/-1.66, 3.17+/-1.58, 3.18+/-2.16, and 2.35+/-1.52 at 0, 3, 6, 12, and 24 months, respectively. Sixteen patients (88.9%) showed HBV DNA reduction below detection limit (<20,000 IU/mL). HBeAg seroconversion was observed in one patient (7.1%) after 8 months of combination therapy. Virologic breakthrough occurred in only one patient after 21 months of combination therapy. Viral rebound occurred in two patients at 12 months and 14 months of combination therapy. Normalization of serum ALT was achieved in twelve patients (66.7%). Primary non-response was observed in two cases (11.1%). CONCLUSIONS: LMV-ADV combination treatment was effective in 88.9% of patients with resistance to LMV and ADV in a short-term follow up. It may be applied as a bridge therapy until another effective antiviral regimen becomes available.
Adenine/*analogs & derivatives/therapeutic use ; Adult ; Antiviral Agents/*therapeutic use ; DNA, Viral/analysis ; Drug Resistance, Viral ; Drug Therapy, Combination ; Female ; Genotype ; Hepatitis B, Chronic/*drug therapy ; Humans ; Lamivudine/*therapeutic use ; Male ; Middle Aged ; Phosphonic Acids/*therapeutic use ; Time Factors