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

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

It has been reported that the cause of the bacterial endophthalmitis following cataract extraction and intraocular lens implantation was G(+) organisms in most cases. However, the endophthalmitis caused by G(-) organisms has worse prognosis than that by G(+)organisms. We experienced a case of Stenotrophomonas maltophilia endophthalmitis which has not yet been reported in Korea. A 77-year-old female presented with blurred vision, conjunctival injection and ocular pain 5 days after cataract extraction and intraocular lens implantation. Ocular findings such as corneal edema, hypopyon and thick posterior capsular opacity were consistent with infectious endophthalmitis. Culture of vitreous aspirate isolated Stenotrophomonas maltophilia 15 days after cataract extraction.
Aged ; Cataract Extraction ; Cataract* ; Corneal Edema ; Endophthalmitis* ; Female ; Humans ; Korea ; Lens Implantation, Intraocular ; Prognosis ; Stenotrophomonas maltophilia* ; Stenotrophomonas*

No abstract available.
Microsurgery* ; Radiosurgery* ; Trigeminal Neuralgia*

Vertebral artery(VA) and posterior inferior cerebellar artery(PICA) have complex and variable anatomic configuration of origin and running course in its exctracranial and intracranial pathway. VA has four main segments: the first portion from their origin to the entry into the foramen transversarium of C6, V1; the second portion from the C6 foramen to the C1 foramen, V2; the third portion from the exit from the C1 foramen to their entry through the atlanto-occipital membrane, V3; and the fourth portion from the entry through the dura to the vertebrobasilar junction, V4 after usual origin from proximal subclavian artery. Anatomic variations including aplasia, hypoplasia, duplication, and fenestration have been reported and careful consideration and examination must be needed because these variations tend to have another vascular anomalies such as arteriorvenous malformation or aneurysm. Tortuosity of VA is not a unusual finding especially in the aged people and the branches of VA are composed of meningeal, spinal, muscular, and radicular artery. PICA is most prominent artery from VA and its trunk is divided into five segments: anterior medullary, lateral medullary, tonsilomedullary, telovellotonsillar, and cortical. The running pathway of this vessel is pretty various in each person. The branches of this vessel are composed of perforating, terminal (cortical), choroidal, and meningeal artery. The extradural origin of PICA is infrequent; however, awareness of the presence of such an anatomic variation may be a helpful adjunct to avoid injury to this vessel. Around the vertebrobasilar junction (VBJ), the anatomy of the main arteries was variable. In contrast, the perforators penetrated the adjoining brain stem at specific locations regardless of caliber of the main artery. The four major point of entry to brain stem are the lateral medullary area just caudal to the posterior olivary sulcus (Group I), the posterior olivary sulcus(Group II), the small lateral fossa at the superior olivary groove(Group III), and the foramen caecum(Group IV). Despite a small VA or its major branches, the perforators penetrating the brain stem are very important and may effect the outcomes of operation or neurointerventional procedure of VBJ unless careful manipulation and consideration was performed.
Anatomic Variation ; Aneurysm ; Arteries* ; Brain Stem ; Choroid ; Humans ; Membranes ; Meningeal Arteries ; Pica ; Running ; Subclavian Artery ; Vertebral Artery

Vertebral artery(VA) and posterior inferior cerebellar artery(PICA) have complex and variable anatomic configuration of origin and running course in its exctracranial and intracranial pathway. VA has four main segments: the first portion from their origin to the entry into the foramen transversarium of C6, V1; the second portion from the C6 foramen to the C1 foramen, V2; the third portion from the exit from the C1 foramen to their entry through the atlanto-occipital membrane, V3; and the fourth portion from the entry through the dura to the vertebrobasilar junction, V4 after usual origin from proximal subclavian artery. Anatomic variations including aplasia, hypoplasia, duplication, and fenestration have been reported and careful consideration and examination must be needed because these variations tend to have another vascular anomalies such as arteriorvenous malformation or aneurysm. Tortuosity of VA is not a unusual finding especially in the aged people and the branches of VA are composed of meningeal, spinal, muscular, and radicular artery. PICA is most prominent artery from VA and its trunk is divided into five segments: anterior medullary, lateral medullary, tonsilomedullary, telovellotonsillar, and cortical. The running pathway of this vessel is pretty various in each person. The branches of this vessel are composed of perforating, terminal (cortical), choroidal, and meningeal artery. The extradural origin of PICA is infrequent; however, awareness of the presence of such an anatomic variation may be a helpful adjunct to avoid injury to this vessel. Around the vertebrobasilar junction (VBJ), the anatomy of the main arteries was variable. In contrast, the perforators penetrated the adjoining brain stem at specific locations regardless of caliber of the main artery. The four major point of entry to brain stem are the lateral medullary area just caudal to the posterior olivary sulcus (Group I), the posterior olivary sulcus(Group II), the small lateral fossa at the superior olivary groove(Group III), and the foramen caecum(Group IV). Despite a small VA or its major branches, the perforators penetrating the brain stem are very important and may effect the outcomes of operation or neurointerventional procedure of VBJ unless careful manipulation and consideration was performed.
Anatomic Variation ; Aneurysm ; Arteries* ; Brain Stem ; Choroid ; Humans ; Membranes ; Meningeal Arteries ; Pica ; Running ; Subclavian Artery ; Vertebral Artery

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

OBJECTIVE: The presence of an intracerebral hematoma from a ruptured aneurysm is a negative predictive factor and it is associated with high morbidity and mortality rates even though clot evacuation followed by the neck clipping is performed. Endovascular coil embolization is a useful alternative procedure to reduce the surgical morbidity and mortality rates. We report here on our experiences with the alternative option of endovascular coil placement followed by craniotomy for clot evacuation. MATERIALS AND METHODS: Among 312 patients who were admitted with intracerebral subarachnoid hemorrhage during the recent three years, 119 cases were treated via the endovascular approach. Nine cases were suspected to show aneurysmal intracerebral hemorrhage (ICH) on CT scan and they underwent emergency cerebral angiograms. We performed immediate coil embolization at the same session of angiographic examination, and this was followed by clot evacuation. RESULTS: Seven cases showed to have ruptured middle cerebral artery (MCA) aneurysms and two cases had internal carotid artery aneurysms. The clinical status on admission was Hunt-Hess grade (HHG) IV in seven patients and HHG III in two. Surgical evacuation of the clot was done immediately after the endovascular coil placement. The treatment results were a Glasgow Outcome Scale score of good recovery and moderate disability in six patients (66.7%). No mortality was recorded and no procedural morbidity was incurred by both the endovascular and direct craniotomy procedures. CONCLUSION: The results indicate that the coil embolization followed by clot evacuation for the patients with aneurysmal ICH may be a less invasive and quite a valuable alternative treatment for this patient group, and this warrants further investigation.
Treatment Outcome ; Tomography, X-Ray Computed ; Retrospective Studies ; Middle Aged ; Male ; Intracranial Aneurysm/radiography/*therapy ; Humans ; Hematoma/radiography/*therapy ; Female ; Embolization, Therapeutic/*methods ; Drainage/*methods ; Cerebral Angiography ; Aneurysm, Ruptured/radiography/*therapy ; Adult

No abstract available.