No abstract available.
Thyroid Gland* ; Thyroid Nodule*

The authors presented 9 cases of surgically treated CSF rhinorrhea, two of which were spontaneous and 7 were traumatic delayed. The duration of leakage was longer than 1 month in most cases and seven of the nine cases were complicated by meningitis. The leakage site was most accurately detected by metrizamide computed tomographic cisternography(MCTC) and the most frequent leakage site was the cribriform plate. Good surgical results were obtained by direct repair and/or shunt without recurrence during follow-up period from 7 months to 2 years.
Cerebrospinal Fluid Rhinorrhea ; Ethmoid Bone ; Follow-Up Studies ; Meningitis ; Metrizamide ; Recurrence

No abstract available.
Osteoporosis* ; Radionuclide Imaging*

Tuberculosis of the thyroid gland is extremely rare with few cases reported in recent years. Tuberculosis may involve the thyroid gland in two main forms. The more common of theses is miliary spread to the thyroid as part of generalized dissemination and less commonly focal or caseous tuberculosis of the thyroid may occur, presenting as a nodule, as a thyroiditis, as a abscess, or as carcinoma like.We experienced two cases of tuberculosis of the thyroid gland presenting with palpable thyroid nodule in 26 year-old female and 65 year-old female patients. They have been clinically and biochemically euthyroid and their thyroid scans demonstrated a cold nodule at right thyroid gland. We found no evidence of tuberculosis elsewhere. The goiter was removed surgically and confirmed to be tuberculosis. They were medicated antituberculous agents after operation and followed up regulary out patient department.We report the cases of two patients with tuberculosis involving thyroid with reviews of literature.
Abscess ; Female ; Goiter ; Humans ; Thyroid Gland ; Thyroid Nodule ; Thyroiditis ; Tuberculosis

BACKGROUND: The aim of the study was to evaluate the biochemical effects of recombinant human thyroid stimulating hormone (rhTSH) as an adjunct to radioiodine (RI) treatment of a differentiated thyroid carcinoma (DTC). We retrospectively reviewed the clinical response rates of DTC patients treated with RI after thyroid hormone withdrawal and compared with those after rhTSH stimulation. METHOD: We included the patients treated with RI for locally recurrent DTC from February 1, 2002 to August 31, 2005 and followed with diagnostic studies at our hospital. Forty totally (or near totally) thyroidectomized adults were included in this study. Nine patients underwent RI treatment after rhTSH stimulation while euthyoid on L-thyroxine (LT4), and 31 patients were treated with RI after thyroid hormone withdrawal. The clinical response was defined as >25% decrease in serum thyroglobulin (Tg) level on LT4 3 months after the RI treatment. RESULTS: In each group, serum Tg levels were significantly decreased 3 months after the RI treatment. And we found that 77.8 and 71.0% of those prepared by rhTSH and LT4 withdrawal, respectively, had clinical responses 3 months after the RI treatment by our criteria and there was no significant difference in response rates between two groups (P=0.238). CONCLUSIONS: Given the biases that exist in retrospective studies, at the current time we cannot recommend the routine use of rhTSH to prepare RI treatment of DTC. However, our study provided preliminary evidence that rhTSH effectively aided RI treatment of DTC at least to an equivalent degree as LT4 withdrawal.
Adult ; Bias (Epidemiology) ; Humans* ; Retrospective Studies* ; Thyroglobulin ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyrotropin ; Thyrotropin Alfa ; Thyroxine

BACKGROUND: The aim of the study was to evaluate the biochemical effects of recombinant human thyroid stimulating hormone (rhTSH) as an adjunct to radioiodine (RI) treatment of a differentiated thyroid carcinoma (DTC). We retrospectively reviewed the clinical response rates of DTC patients treated with RI after thyroid hormone withdrawal and compared with those after rhTSH stimulation. METHOD: We included the patients treated with RI for locally recurrent DTC from February 1, 2002 to August 31, 2005 and followed with diagnostic studies at our hospital. Forty totally (or near totally) thyroidectomized adults were included in this study. Nine patients underwent RI treatment after rhTSH stimulation while euthyoid on L-thyroxine (LT4), and 31 patients were treated with RI after thyroid hormone withdrawal. The clinical response was defined as >25% decrease in serum thyroglobulin (Tg) level on LT4 3 months after the RI treatment. RESULTS: In each group, serum Tg levels were significantly decreased 3 months after the RI treatment. And we found that 77.8 and 71.0% of those prepared by rhTSH and LT4 withdrawal, respectively, had clinical responses 3 months after the RI treatment by our criteria and there was no significant difference in response rates between two groups (P=0.238). CONCLUSIONS: Given the biases that exist in retrospective studies, at the current time we cannot recommend the routine use of rhTSH to prepare RI treatment of DTC. However, our study provided preliminary evidence that rhTSH effectively aided RI treatment of DTC at least to an equivalent degree as LT4 withdrawal.
Adult ; Bias (Epidemiology) ; Humans* ; Retrospective Studies* ; Thyroglobulin ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyrotropin ; Thyrotropin Alfa ; Thyroxine

BACKGROUND: Resting ankle brachial pressure index is a non-invasive method to assess the patency of lower extremity arterial system and it can be measured using traditional Doppler method or photoplethysmography. Automated blood pressure measurement is a easy and quick method for measurement of ankle brachial pressure index, but usefulness of this method have not been investigated. So we evaluated the accuracy of Automated blood pressure measurement device as flow detector in determining the ankle brachial pressure index in comparison to photoplethysmography. METHODS: A total 136 subjects containing 117 diabetic patients and 19 volunteers were included in the study. With each subject in the supine position, dorsalis pedis arterial pulses were palpated by examiner. And the brachial and ankle systolic blood pressure were recorded using photoplethysmography (Rheoscreen, Medis, Germany) and automated blood pressure measurement device (MD-800, Meditec, Korea). Ankle brachial pressure index for each leg was separately calculated by dividing the ankle systolic pressure by the higher brachial systolic pressure. Statistical analyses were performed by SPSS for Windows (version 10.0 SPSS Inc.) RESULTS: Brachial and ankle systolic pressure measured using automated blood pressure measurement device were higher than photoplethysmography and correlations between both method were significant (r=0.886, r=0.844). Ankle brachial pressure index derived using automated blood pressure measurement have a better correlation with photoplethysmography method (r=0.622) than pulse palpation (r=0.255). The subject was considered to have peripheral arterial disease if either leg ABI was 0.9 or less. Peripheral arterial disease was more frequent when it was defined using photoplethysmography (13.8%) vs automated blood pressure measurement device (6.3%). The sensitivity of the automated blood pressure measurement is 32.4%, the specificity is 97.8% and the accuracy is 88.8% for peripheral arterial disease defined using photoplethysmography. CONCLUSION: Automated blood pressure measurement was easier and quicker and less expensive as compared with photoplethysmography. Automated blood pressure measurement was not sensitive but more accurate as compared with pulse palpation. So we recommend that it be used on a routine screening basis of peripheral arterial disease in primary care.
Ankle* ; Blood Pressure* ; Humans ; Leg ; Lower Extremity ; Mass Screening ; Palpation ; Peripheral Arterial Disease ; Photoplethysmography* ; Primary Health Care ; Sensitivity and Specificity ; Supine Position ; Volunteers

To evaluate the effectiveness and to find out which grade(clinical and computed tomography) of subarachnoid hemorrhage(SAH) patients are most effected with the medication of the calcium antagonist, we did this study. We selected 339 cases(study cases) among a total of 603 cases of SAH who were admitted to our hospital from Sept. 1982 to Aprial 1991. The criteria of study cases are patients who were admitted and who had a brain computed tomography(CT) taken within 3 days after the SAH and who had a clinical grade(Hung & Hess) on admission between I-IV. We divided study cases into 3 groups. Group I:surgery was done more than 7 days after the SAH and together with non-surgical patients, no medication was used(N=126). Group II:surgery was done more than 7 days after teh SAH and together with non-surgical patients medication of the calcium antagonist was given orally(N=120). Group III:surgery was done more than 7 days after the SAH and together with non-surgical patients, medication of nimodipine intravenously was given, and also patients, medication of nimodipine intravenously was given, and also patients who received surgery did within 3 days after the SAH were given intravenous injection and cisternal irrigation of nimodipine(N=93). We compared the overall management outcome and the incidence of delayed ischemic dificit(DID) and unfavorable outcome due to DID in each group. We also analyzed the causes of unfavorable outcome according to the clinical grade on admission and the amount of blood in the cistern seen on the brain CT in each group. The results of this study showed that overall management outcome was improved by using the calcium antagonist. The calcium antagonist reduced the incidence of DID as well as the unfavorable outcome related to DID. In clinical grade III patients on admission, the unfavorable outcome due to DID was significantly lower in group II and III than in I(group I vs. II:p<0.05, group I vs. III:P<0.01). In cases with a large amount of blood in the cistern seen on the brain CT, the unfavorable outcome was significantly lower in groups II and III than in I(group I vs. II:p<0.01, group I vs. III:p<0.05). We conclude that the overall management outcome of aneurismal SAH patients may be improved by using a calcium antagonist and the effect of the calcium antagonist is prominent in clinical grade III patients on admission and patients with a large amounts of blood in the cistern seen on the brain CT.
Aneurysm* ; Brain ; Calcium* ; Humans ; Incidence ; Injections, Intravenous ; Nimodipine ; Subarachnoid Hemorrhage*

In order to find out the relationship between blood viscosity and the development of an ischemic symptom(clinical vasospasm) following an aneurysmal subarachnoid hemorrhage(SAH), was checked daily the hematocrit(Hct), blood viscosity and plasma viscosity from admission day to 14 days after SAH in 33 patients. Twelve patients with diseases except those with a SAH were selected as a control group. We analyzed the difference of the average hematocrit, blood viscosity, and plasma viscosity between the control group, non-spasm group and spasm group on admission, and then the period of preoperative, postoperative with mannitolization, and postoperative without mannitolization. We also analyzed the change of those according to the SAH day, and the relationship between the blood viscosity and the level of hematocrit in each group. As a result, aneurysmal SAH patients with clinical vasospasm showed a higher plasma viscosity than the control(1.82+/-0.21 vs. 1.55+/-0.14, respectively : p<0.01) and clinical non-spasm(1.82+/-0.21 vs. 1.66+/-0.12, respectively : p<0.05) group of patients on admission statistically. In the spasm group, the blood viscosity was raised during the spasm risk period(SAH 7-10 days). The level of the hematocrit in the spasm group was lower than the non-spasm group and most of them checked below 30% after surgery. In the relationship between the level of hematocrit and the blood viscosity, the spasm group showed a relatively higher blood viscosity than the non-spasm group. These results suggest that the blood viscosity has some role in the development of ischemic symptoms after a subarachnoid hemorrhage, but major determinants such as erythrocyte aggregation, plasma fibrinogen concentration and platelet aggregation which affect the microcirculation have a more important role. Therefore, when hemodilution are used for prevention or improvement of ischemic symptoms after subarachnoid hemorrhage, the level of the hematocrit and the focus on decreasing the major determinants of the viscosity in microcirculation should be considered.
Aneurysm* ; Blood Viscosity* ; Erythrocyte Aggregation ; Fibrinogen ; Hematocrit* ; Hemodilution ; Humans ; Mannitol ; Microcirculation ; Plasma* ; Platelet Aggregation ; Spasm ; Subarachnoid Hemorrhage* ; Viscosity*

Central diabetes insipidus caused by pineal gland neoplasm is rare. Here, we describe a case of central diabetes insipidus and pineal germinoma with seeding to pituitary stalk along CSF pathway. A 27 year-old male patient was admitted due to polyuria, polydipsia, headache, vomiting, diplopia, and decreased visual acuity for recent two months. Urine osmolality measured after water deprivation was below 100mOsm/kg. However, urine osmolality increasd above 300 mOsm/kg with pitressin administration. Brain MRI showed a 2cm sized mass with seeding into pituitary stalk along CSF in pineal region. Surgical biopsy revealed pineal germinoma. Two cycles of chemotherapy with etoposide and cis-platin were done followed by brain irradiation(2,500cGy). Follow up brain MRI after second chemotherapy showed complete remission. The patient had no neurologic and endocrinologic deficit after the treatment.
Adult ; Biopsy ; Brain ; Diabetes Insipidus* ; Diabetes Insipidus, Neurogenic ; Diplopia ; Drug Therapy ; Etoposide ; Follow-Up Studies ; Germinoma ; Headache ; Humans ; Magnetic Resonance Imaging ; Male ; Osmolar Concentration ; Pineal Gland ; Pinealoma ; Pituitary Gland ; Polydipsia ; Polyuria ; Vasopressins ; Visual Acuity ; Vomiting ; Water Deprivation