A 55-year-old male was admitted to emergency department with a hypoglycemic shock of unknown origin. He was presented with tonic seizure activity after admission. Initial diagnostic procedure could exclude diabetes mellitus, drug side effects, and exogenous insulin application. Detailed evaluation of the patient's history revealed that the patient had experienced repeated hypoglycemic episodes for 2 years. He was diagnosed with hypothyroidism six years ago. Initial laboratory investigations revealed hypoglycemia, hyponatremia, and low plasma cortisol level (0.18 microg/dL). Sellar magnetic resonance imaging showed empty sella. Replacement therapy with hydrocortisone resulted in the improvement of clinical symptoms. Combined pituitary stimulation test with exception of hypoglycemia induced growth hormone and cortisol stimulation test was performed. The response of thyroid stimulating hormone, prolactin, follicle-stimulating hormone, and luteinizing hormone was normal. We report the case of empty sella syndrome associated with hypoglycemic shock due to with multiple anterior pituitary hormone deficiencies.
Coma* ; Diabetes Mellitus ; Emergency Service, Hospital ; Empty Sella Syndrome* ; Follicle Stimulating Hormone ; Growth Hormone ; Humans ; Hydrocortisone ; Hypoglycemia ; Hyponatremia ; Hypothyroidism ; Insulin ; Luteinizing Hormone ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Plasma ; Prolactin ; Seizures ; Shock ; Thyrotropin

PURPOSE: To describe a patient who developed left subconjunctival air and pneumocephalus without definite finding of skull fracture after facial trauma. METHODS: A 16-year-old man developed headache, upper eyelid swelling and decreased visual acuity after facial trauma. Ophthalmic examinations revealed left subconjunctival hemorrhage, air and corneal abrasion. Computed tomography and simple X-ray showed huge orbital emphsema. It extends into the left posterior sclera, around the optic nerve and optic canal. Diagnosis of pneumocephalus of basal cistern with no bony fracture of face, orbits and skull was made. RESULTS: In clinical practice, physician should be kept in mind that the possibility of pneumocephalus resulted from orbital or subconjunctival emphysema through optic nerve sheath in case of no definite evidence of basal skull fractures.
Adolescent ; Diagnosis ; Emphysema ; Eyelids ; Headache ; Hemorrhage ; Humans ; Optic Nerve ; Orbit ; Pneumocephalus* ; Sclera ; Skull ; Skull Fractures ; Visual Acuity

PURPOSE: To evaluate the amount and pattern of change in deviation angle with time course after surgical correction of intermittent exotropia and to evaluate the effect of pre-operative deviation and operation age on post-operative deviation change. METHODS: 54 patients who followed more than 60 months (60~120 months, mean 71.7 months) after surgical correction of intermittent exotropia were selected. We defined 'satisfactory results' that alignment of orthotropia, under 10delta esotropia and under 10delta exotropia. RESULTS: Of 54 patients, satisfactory results obtained in 96.2%(52 patients), immediate post-operation day and decreas with time course to 35.1% (19 patients) at post-operative 5 years. To quantification of change of deviation, author defined exotropic drift as +, esotropic drift as -, and no change as 0. The change of deviation between immediate post-operation and 2 years after operation is +14.55delta, between 2 years after and 5 years is +2.70delta. The change of deviation developed between immediate post-operation and 2 years after operation has statistical significance in comparison with change of deviation developed between after 2 years and 5 years after operation (P=0.0001). Pre-operative deviation has no effect on post-operative deviation change (P=0.4472) and operation age was same (P=0.3461). CONCLUSIONS: The results of surgical correction of intermittent exotropia is significantly deteriorated with time course. Exotropic drift was more pronounced between immediate post-operation and 2 years after operation and then decreased. Therefore we recommend that after surgery of intermittent exotropia patients should be followed by schedule more than 2 years and thereafter the tendency for exotropic drift will more stable. After 2 years, however, small amount exotropic drift can be possible.
Appointments and Schedules ; Esotropia ; Exotropia* ; Humans

PURPOSE: To report and review 2 cases of Klebsiella Pneumoniae endogenous endophthalmitis showing multi drug resistance that were treated with sulperazone. METHODS: Sulperazone was administered to two patients with Klebsiella Pneumoniae endogenous endophthalmitis: a 51-year-old male with orbital cellulitis who showed no response to vancomycin, ceftazidime, and amikacin for 6days; and a 67-year-old female who showed no response to cefotaxime, and amikacin. RESULTS: Proptosis and inflammation began to improve after changing to sulperazone. Therefore, enucleation and debridement could be avoided. CONCLUSIONS: Good results were obtained by use of Sulperazone which inactivates beta-lactamase irreversibly and which showed bactericidal effect to multi drug resistant Klebsiella Pneumoniae endogenous endophthalmitis.
Aged ; Amikacin ; beta-Lactamases ; Cefotaxime ; Ceftazidime ; Debridement ; Drug Resistance ; Endophthalmitis* ; Exophthalmos ; Female ; Humans ; Inflammation ; Klebsiella pneumoniae* ; Klebsiella* ; Male ; Middle Aged ; Orbital Cellulitis ; Vancomycin

OBJECTIVES: We conducted a study to investigate the normal range for TSH and within-individual variations of TSH according to temperature and aging. PATIENTS AND METHODS: We enrolled patients who underwent periodic medical examinations five times over a six year period (2007.8~2013.6). Anthropometric data and thyroid ultrasonography were evaluated, and serum TSH, T3, and T4 were assayed. RESULTS: Subjects were 19-64 years old, 120 were female, and 208 were male. Reference ranges for TSH were 0.53-4.94 mIU/L in the first test, 0.49-5.61 mIU/L in the second test, 0.46-6.06 mIU/L in the third test, 0.48-5.99 mIU/L in the fourth test, and 0.52-6.3 mIU/L in the fifth test. When the TSH level was analyzed according to temperature and sex, mean TSH was higher in months in which the average monthly temperatures were below 10degrees C in Jinju, Gyeongnam and female. The aging and low temperatures are associated with increased serum TSH concentrations in the within-individual. CONCLUSIONS: This study showed that aging is associated with increased serum TSH concentrations in the within-individual and serum TSH concentrations are different in the within-individual according to the temperature.
Aging* ; Female ; Gyeongsangnam-do ; Humans ; Male ; Reference Values ; Thyroid Gland ; Thyrotropin* ; Ultrasonography

BACKGROUND AND OBJECTIVES: Abnormal thyroid function influences the cardiovascular system. In particular, brief thyroid functional change due to levothyroxine (LT4) suppression therapy and withdrawal in papillary thyroid cancer (PTC) patients can affect cardiovascular system and other biochemical markers. However, the effect of brief thyroid functional change on arterial stiffness has not been evaluated. Therefore, we evaluated the changes in arterial stiffness according to short-term thyroid hormone levels in patients who underwent total thyroidectomy and radioactive iodine (RAI) therapy for PTC. MATERIALS AND METHODS: Patients with PTC (n=17; 15 females, mean age 52 years) who underwent total thyroidectomy and RAI therapy were enrolled in this study. The arterial stiffness was evaluated using the corrected augmentation index for heart rate (AI@75) and brachial-ankle pulse wave velocity (BaPWV). Serum thyroid hormone levels and arterial stiffness parameters were checked three times consecutively: the day before thyroidectomy (Visit 1; baseline euthyroid state), after LT4 withdrawal (Visit 2; pre-RAI hypothyroid state) and 4 weeks after RAI (Visit 3; post-RAI thyrotoxic state). Biochemical markers, which can influence the arterial stiffness, were also measured. RESULTS: The heart rate, AI@75 and serum thyroid hormone levels changed significantly at each visit. BaPWV was not significantly changed. Changes in AI@75 correlated with systolic blood pressure (SBP), serum thyroid hormone levels, total cholesterol and high density lipoprotein cholesterol in univariate analysis. In multivariate analysis, SBP was the independent factor for AI@75 changes. CONCLUSION: These results suggest that brief thyroid functional changes can influence AI@75. And SBP was important factor for AI@75 change.
Biomarkers ; Blood Pressure ; Cardiovascular System ; Cholesterol ; Cholesterol, HDL ; Female ; Heart Rate ; Humans ; Iodine* ; Multivariate Analysis ; Pulse Wave Analysis ; Thyroid Function Tests ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroidectomy ; Thyroxine ; Vascular Stiffness*

Henoch-Schonlein purpura(anaphylactoid purpura) is a necrotizing vasculitis of small vessels in which systemic manifestation include palpable purpura on the lower extremities and buttocks due to leukocytoclastic vasculitis of dermal vessels; arthralgia of large joints, usually the knees and ankles; gastronitestinal involvement with colic and bleeding; and renal ievolvement, usually with a focal necrotizing glomerulonephritis. Gastrointestinal involvement occurs in about two thirds of all pediatric cases and in about,one third of adult cases, Any bowel segment may be involved, but the jejunum and ileum are most frequently affected. With a brief review of the literature, we report a case of H-S purpura involving stomach and duodenum.
Adult ; Ankle ; Arthralgia ; Buttocks ; Colic ; Duodenum ; Glomerulonephritis ; Hemorrhage ; Humans ; Ileum ; Jejunum ; Joints ; Knee ; Lower Extremity ; Purpura* ; Stomach ; Upper Gastrointestinal Tract* ; Vasculitis

BACKGROUND: Data on the clinicopathologic features of hair follicle tumors in Korea are limited. OBJECTIVE: The purpose was to investigate the clinical and histopathologic characteristics of hair follicle tumors in Korea. METHODS: Two hundred sixty four cases of hair follicle tumors seen from 1999 to 2001 in Korea were analyzed clinically and histopathologically. RESULTS AND CONCLUSION: The most common hair follicle tumor in Korea was pilomatricoma(81.0%), followed by trichoepithelioma(6.4%), dilated pore of Winer(3.8%), and proliferating trichilemmal tumor(2.2%). Hair follicle tumors usually occurred as a solitary skin-colored nodule. The most commonly involved site was the face, and the peak age of presentation was 10 to 19. Pilomatricoma usually occurred as a solitary skin-colored nodule. The most commonly involved site was the arm, and more than 50% of tumors occurred before the age of 20. Histopathologically, the tumor was often surrounded by fibrous capsule and was composed of basophilic and shadow cells. It was usually located in the dermis and extended into the subcutis. Retraction spaces between tumor nests and stroma were frequently observed. Trichoepithelioma usually occurred as multiple skin-colored papules on the face. Histopathologically, the tumor was usually located in the dermis with sometimes connected to the epidermis. It frequently showed peripheral palisading. Dilated pore of Winer usually occurred as a solitary brownish to pigmented papule on the face in middle-aged persons. Proliferating trichilemmal tumor occurred as a solitary or multiple tumors. Histopathologically, the tumor was usually surrounded by incomplete fibrous capsule. Tumor cells frequently showed clear cell formation, nuclear atypia, mitosis, peripheral palisading, trichilemmal keratinization, and individual keratinization.
Arm ; Basophils ; Dermis ; Epidermis ; Hair Follicle* ; Hair* ; Humans ; Korea ; Mitosis ; Pilomatrixoma

BACKGROUND: Since the bioavailability of itraconazole capsule is influenced by patients gastric acidity, it results in treatment failure due to its low dissolution and subsequent low absorption when administered in fasting. Itraconazole Melt-Extrusion tablet has been lately developed in order to improve its dissolution profile. It is the first clinical study to evaluate the efficacy and safety of itraconazole Melt-Extrusion tablet in Korea. OBJECTIVE: This study was conducted to evaluate the efficacy and safety of itraconazole melt-extrusion tablet 400mg daily for 1 week(pulse therapy) for hyperkeratotic type of tinea pedis and manus. METHODS: A clinical and mycological investigation was made of 812 outpatients with hyperkeratotic type of tinea pedis and/or tinea manus who had visited at 52 general hospitals under the lead of the Korean Dermatological Association from June to December, 1998. Patients confirmed by clinically and microscopically as hyperkeratotic type of tinea pedis and/or tinea manus were administered 2 tablets twice a day for one week and followed up for 8 weeks from the start of the medication. RESULTS: The results were summarized as follows; 1. Clinical symptoms of hyperkeratotic type of tinea pedis and/or tinea mauns were significantly improved at the end of study, week 8(p<0.001). 2. Clinical response rate, defined as more than 50% decrease of the sum of the clinical symptom scores, was 79.3%(512/646). 3. Mycological cure rate, dafined as both culture and KOH negative at week 8, was 78.2%(244 /312). 4. 40(5.5%) patients, of the 727 patients evaluable for drug safety evaluation, were reported to have adverse event. CONCLUSION: Itraconazole Melt-Extrusion tablet 400mg/day for 1 week (pulse therapy) is effective and safe in the treatment of hyperkeratotic type of tinea pedis and/or tinea manus.
Absorption ; Biological Availability ; Fasting ; Gastric Acid ; Hospitals, General ; Humans ; Itraconazole* ; Korea ; Outpatients ; Tablets ; Tinea Pedis* ; Tinea* ; Treatment Failure