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

BACKGROUND: To assess the incidence of venous thromboembolism (VTE) following shoulder surgery and to evaluate the role of postoperative duplex ultrasonography. METHODS: The study comprised a total of 224 patients who underwent shoulder surgery, including 180 shoulder arthroscopic surgeries, 28 shoulder arthroplasties, and 16 plate fixations for proximal humerus fracture between January 2014 and December 2014. The mean age of patients was 59.0 years, and there were 81 men and 143 women. Clinical data, including body mass index, blood tests, metabolic work-up for liver and renal function, previous, and present medical history, were evaluated. Duplex ultrasonography in the operative arm was performed on 2 to 4 days after surgery. RESULTS: The overall incidence of VTE following shoulder surgery was 0.45% (1/224). One patient with open reduction and plate fixation for proximal humerus fracture had asymptomatic deep vein thrombosis that showed complete remission after anticoagulant medication during a 2-month period. Four patients had asymptomatic superficial cephalic vein thrombosis and complete remission without any treatment. There was no case of pulmonary embolism. CONCLUSIONS: The incidence of VTE following shoulder surgery was extremely low in Asians. Duplex ultrasonography may be not considered a routine follow-up of shoulder surgery and can be selectively performed in high-risk or symptomatic patients for VTE.
Arm ; Arthroplasty ; Arthroscopy ; Asian Continental Ancestry Group ; Body Mass Index ; Female ; Follow-Up Studies ; Hematologic Tests ; Humans ; Humerus ; Incidence* ; Liver ; Male ; Pilot Projects* ; Pulmonary Embolism ; Shoulder* ; Thrombosis ; Ultrasonography ; Veins ; Venous Thromboembolism* ; Venous Thrombosis

PURPOSE: Although staged operations have been thought a main treatment for obstructive left colon cancer, their disadvantages make one-stage operations popular. We tried to identify technical feasibility and oncologic safety of one-stage operation with intra-operative lavage (IOL) for the treatment of obstructive left colon and rectal cancer. METHODS: From June 1996 to May 1999, of 456 colorectal cancer patients, 25 with obstructive left colon or rectal cancer underwent surgery. In 18 of those, we intended to do a one-stage operation with IOL. Male (n=14) were predominant to female (n=4). Mean age was 61.2 (29~78) years. Lesions were located on the sigmoid colon in 8, rectum in 4, descending in 3, and rectosigmoid junction in 3 cases. Operative technique: Lymphovascular division was initiated at the origin of IMA followed by mobilization of the left colon up to the splenic flexure and distal transverse colon. Thereafter antegrade irrigation of the proximal colon with warm normal saline was done by using a corrugated tube. Anastomoses were made by hand or stapler in end-to-end or side-to-end fashion. RESULTS: Mean operative time was 221 (185~360) min. No significant post-operative complications occurred except for two wound infections and one pulmonary atelectasis. There was one unexpected conversion to Hartmann's procedure due to intra-operative fecal soilage during the lavage. Within 18 months follow-up period, 4 recurrences occurred with two of them expiring. CONCLUSIONS:: One-stage operation for the treatment of obstructive left colon cancer with IOL could avoid colostomy or reoperation, and, was technically feasible, safe, and oncologically acceptable.
Colon* ; Colon, Sigmoid ; Colon, Transverse ; Colonic Neoplasms* ; Colorectal Neoplasms ; Colostomy ; Female ; Follow-Up Studies ; Hand ; Humans ; Male ; Operative Time ; Pulmonary Atelectasis ; Rectal Neoplasms ; Rectum ; Recurrence ; Reoperation ; Therapeutic Irrigation* ; Wound Infection

BACKGROUND: The erythromycin-resistance rate and phenotype distribution of Streptococcus propenes are quite different by geographical variation and study period. The aim of the present study was to determine the evolution of resistance to erythromycin and the frequency of erythromycin resistance phenotype of S. pyogenes isolated from Wonju Christian Hospital. METHODS: The minimal inhibitory concentrations (MICs) of erythromycin and clindamycin for 94 S. pyogenes isolated from clinical specimens between 1990 to 1998 were investigated. Double disk test of erythromycin (78microgram) and clindamycin (25microgram) were performed for 15 isolates of erythromycin resistant S. pyogenes to evaluate the erythromycin resistance phenotype. RESULTS: The resistance rates of 94 isolates of S. pyogenes were 16%(15/94) to erythromycin and 4%(4/94) to clindamycin. The frequency of erythromycin resistance phenotype in decreasing order were M phenotype (47%), inducible resistance phenotype (40%), and constitutive resistance phenotype (13%). Erythromycin-resistant S. pyogenes did not exist until 1993, but was isolated since 1994, and ranged from 14.0% to 24.0% during the period of 1994-1998. CONCLUSIONS: Our finding documents the emergence of high resistance rates to erythromycin in S. pyogenes at Wonju area since 1994. The M phenotype (47%) and inducible resistance phenotype (40%) account for the majority of erythromycin-resistant S. pyogenes.
Clindamycin ; Erythromycin* ; Gangwon-do ; Phenotype* ; Streptococcus pyogenes* ; Streptococcus*

No abstract available.
Spondylolysis*

No abstract available.
Ankle* ; Dislocations* ; Tendons*

Acute subdural hematoma (ASDH) induced by a bridging vein (BV) rupture is considered a catastrophic head injury, especially in the elderly. Epidemiological studies have shown a much higher incidence rate of BV-induced ASDH in the elderly compared to younger adults, along with elevated morbidity and mortality, and poor outcomes. Brain atrophy can be a risk factor contributing to the increased risk of ASDH in elderly trauma patients. Considering this, prophylactic ligation of the impending breakage in the BV may reduce the risk of rebleeding and treat the ASDH. Here, we report a relevant case.

No abstract available.
Animals ; Antibodies, Neutralizing* ; Immunization* ; Mice*

No abstract available.
Bacteremia* ; Female ; Humans ; Pregnant Women*

No abstract available.
Lymphangioma, Cystic* ; Turner Syndrome* ; Ultrasonography*