BACKGROUND: Some of the deficiencies in anterior pituitary function identified in subjects with macroadenomas appear to represent irrevemible necrosis of normal pituitary cells, and in addition reversible damage to viable glandular tissue and/or incomplete interruption of local circulation by compression of pituitary stalk may also contribute significantly to hypopituitarism. So anterior pituitary function may actually improve in some patients undergoing successful tumor resection or reduction in tumor size. Although direct comparisons of pituitary function among the various pituitary tumors are not presently available it was reported that there is some difference in the degree of pituitary impairment between patients with nonfunctioning macroadenoma(NFMA) and those with GH-secreting macroadenoma(GHMA).In this study, to investigate the difference in the degree of hypopituitarism we compared anterior pituitary function in subjects with NFMA to that in patients with GHMA. METHODS: In this retrospective study, preoperative and postoperative anterior pituitary function was assessed by clinical findings, basal hormone levels and/or combined pituitary stimulation test in 29 subjects with NFMA and in 24 subjects with GHMA. RESULTS: 1. There was no difference in age, sex, tumor size distribution between the two groups. 2. Preoperatively, NFMA patients had a higher prevalence of secondary hypothyroidism(34% vs. 5%; p(0.02) compared to subjects with GHMA. Patients with NFMA also had a higher prevalence of more severe pituitary failure compared with acromegalic patients; 48% of the patients in this group had more than one pituitary hormone axis impaired compared to 17% in the acromegalic group(p0.03). 3. Postoperatively, NFMA patients also had a higher prevalence of secondary hypoadrenalism (52% vs. 11%; p 0.01) compared with acromegalic patients. Additionally, the prevalence who had more than one pituitary hormone axis impaired was still greater in NFMA patients than in the acromegalic group(57% vs. 22%; p=0.054). 4. No correlation was found between the severity of pituitary failure and tumor size or extension in both groups before and after surgery. CONCLUSION: These findings suggest that anterior pituitary function is relatively better preserved in patients with GHMA than those with NFMA and that this difference is independent of tumor size and extension. The mechanism underlying the lower rate of hypopituitarism in acromegalics with macroadenoma remains to be elucidated.
Adrenal Insufficiency ; Axis, Cervical Vertebra ; Humans ; Hypopituitarism ; Necrosis ; Pituitary Gland ; Pituitary Neoplasms ; Prevalence ; Retrospective Studies

No abstract available.
Aminosalicylic Acid* ; Cycloserine* ; Prothionamide* ; Retreatment* ; Tuberculosis, Pulmonary*

No abstract available.
Humans

PURPOSE: To evaluate the protective effects of epigallocatechin gallate (EGCG) against UV irradiation of cultured human lens epithelial cells. METHODS: We irradiated cultured human lens epithelial cells with a 30-second pulse from a UV lamp with an irradiance of 0.6 mW/cm2. Five minutes and 1 hour after UV irradiation, we administered 0, 5, 10, 15, 25, 50, or 100 uM EGCG. The cell number was measured with a microscopic counting chamber and cell viability was evaluated using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay. RESULTS: Compared to untreated cells, the total number of cultured human lens epithelial cells was markedly higher after UV irradiation. In a dose-dependent manner, viability was also higher in EGCG-treated cells. CONCLUSIONS: EGCG increased the cell count and cell viability after UV irradiation of cultured human lens epithelial cells, indicating that EGCG can protect lens epithelium against UV damage.
Antioxidants/*pharmacology ; Catechin/*analogs & derivatives/pharmacology ; Cell Count ; Cell Survival/drug effects ; Cells, Cultured ; Coloring Agents/diagnostic use ; Dose-Response Relationship, Drug ; Epithelial Cells/radiation effects ; Humans ; Lens, Crystalline/cytology/*radiation effects ; Radiation Injuries/*prevention & control ; Radiation-Protective Agents/*pharmacology ; Tetrazolium Salts/diagnostic use ; Thiazoles/diagnostic use ; *Ultraviolet Rays

PURPOSE: To evaluate the value and the radiologic findings of CT discography in the diagnosis of the far lateral disk herniation. MATERIALS AND METHODS: We retrospectively reviewed 7 cases of surgically proven far lateral lumbar disc herniation. CT discography was performed for all cases. Four cases underwent conventional CT and three cases MRI as a primary diagnostic imaging method. Far lateral diac herniation was divided into 3 groups by location;Intraforaminal herniation, extraforaminal herniation, and mixed type. We analyzed the findings of CT discography including location and extent of far lateral disc herniation. RESULTS: In all 7 cases, CT discography clearly demonstrated the filling of contrast media in laterally-protruded disc material. Intraforaminal and extraforminal types were seen in 2 cases each, and mixed type in 3 cases. Subligamentous herniated nucleus pulposus was present in 6 cases and extruded disc in 1 case. Far lateral disc herniation was located at L4-5 in 5 cases and L5-S1 in 2 cases. CONCLUSION: CT discography can help establishing accurate preoperative diagnosis for far lateral disc herniation.
Contrast Media ; Diagnosis ; Diagnostic Imaging ; Magnetic Resonance Imaging ; Retrospective Studies

We found an error in this article. The author's name should be corrected as following: from "Younsuk Koh" to "Younsuck Koh".

BACKGROUND: Critical care physician staffing is a crucial element of the intensive care unit (ICU) organization, and is associated with better outcomes in ICUs. Adult ICUs in Korea have been suffering from inadequate full-time intensivists and nurses because of insufficient reimbursement rates (<50% of the original critical care cost) from the National Health Insurance System. Recently, full-time intensivists have been introduced as a prerequisite for adult ICUs of tertiary hospitals in Korea. The purpose of this study was to examine the perception of intensivist staffing among critical care program directors regarding the barriers and solutions when implementing an intensivist model of critical care in Korea. METHODS: An email survey of critical care program directors in designated teaching hospitals for critical care subspecialty training by the Korean Society of Critical Care Medicine was performed. The survey domains included vision, culture, resources, barriers, and potential solutions to implementing intensivist physician staffing (IPS). RESULTS: Forty-two critical care program directors were surveyed. A total of 28 directors (66.7%) responded to email queries. Of these, 27 directors (96.4%) agreed that IPS would improve the quality of care in the ICU, although half of them reported a negative perception of relevant clinical colleagues for the role of full-time intensivists and poor resources for IPS in their hospitals. Increased financial burden due to hiring full-time intensivists and concerns regarding exclusion from the management of their critically ill patients in the ICU, together with loss of income for primary attending physicians were stated by the respondents to be major barriers to implementing IPS. Financial incentives for the required cost from the health insurance system and enhancement of medical law relevant to critical care were regarded as solutions to these issues. CONCLUSIONS: Critical care program directors believe that intensivist-led critical care can improve the outcome of ICUs. They indicated the financial burden due to IPS and underestimation of a full-time intensivist's role to be major barriers. The program directors agreed that a partnership between hospital leaders and the Ministry of Health and Welfare was needed to overcome these barriers.
Adult* ; Critical Care ; Critical Illness ; Electronic Mail ; Hospitals, Teaching ; Humans ; Insurance, Health ; Intensive Care Units ; Jurisprudence ; Korea ; Motivation ; National Health Programs ; Personnel Staffing and Scheduling ; Surveys and Questionnaires ; Tertiary Care Centers

Interferon-alpha is known to inhibit the vascular endothelial cell proliferation and migration in vitro.It has been used systemically for the treatment of choroidal neovascular membrane proliferation.However, significant side effects in systemic administration limit the dosage and duration of its use. It has been suggested that reducing systemic side effects and maintenance of high intraocular concentration would be achieved with the direct intravitreal injection of Interferon-alpha.Thus, this study was undertaken to estimate the toxicity and safe dose of Interferon-alpha when it is given intravitreally in rabbits. Normal saline, Interferon-alpha 50, 000IU, 100, 000IU, 200, 000IU and 300, 000 IU were given intravitreally to 10 rabbit eyes.Toxicity was assessed by serial ERGs after 7 and 14 days.Animals were sacrificed at 14 days after injection for histopathologic study. The ERG was flattened at 14 days in 300, 000IU of Interferon-alpha group.On histologic examination, inflammatory reaction of vitreous and retina remained at an insignificant level upto 200, 000IU, but increased in dose dependent manner above this dose, resulting in prominent reaction in 300, 000IU group. Therefore, we suggest that 200, 000IU of Interferon-alpha may be the safe dose when administered intravitreally in rabbits, and 300, 000IU may be the toxic dose.
Choroid ; Endothelial Cells ; Interferon-alpha ; Intravitreal Injections ; Membranes ; Rabbits* ; Retina

The treatment of choice for Cushing's disease is surgical removal of tumor, the source of ACTH overproduction. In occasional patients in whom a surgical approach including total adrenalectomy is not feasible or surgical removal of tumor is not complete, medical treatment may be necessary because pituitary irradiation requires a long 1ag time to remission. Although ketoconazole, an imidazole derivative with inhibitory activity on adrenal steroidogenesis has been reported to be effective in the treatment of Cushing's disease, the limited effectiveness in lowering very high level of cortisol and occasional hepatotoxicity restrains its wide use. In this report, we describe a woman with Cushing's disease due to pituitary microadenoma. Transsphenoidal pituitary adenomeetomy followed by ketoconzole treatment had been unsuccessful in achieving remission of the disease, but combined treatment with ketoconazole and octreotide accomplished successful reduction in cortisol production.
Adrenalectomy ; Adrenocorticotropic Hormone ; Female ; Humans ; Hydrocortisone ; Ketoconazole* ; Octreotide* ; Pituitary Irradiation

Heparin is commonly used to prevent and treat of thromboembolic events during the endovascular intervention. Rarely, heparin-induced thrombocytopenia (HIT), which is characterized by moderate thrombocytopenia and paradoxical vascular thromboses, complicates systemic heparinization given during endovacular procedures. We present a case of an endovascular treatement of the anterior communicating artery aneurysm complicated by HIT. This case of HIT manifested thromboembolic event and intracerebral hemorrhage simultaneously.
Aneurysm ; Cerebral Hemorrhage ; Embolization, Therapeutic* ; Heparin ; Intracranial Aneurysm* ; Thrombocytopenia* ; Thrombosis