We experienced one case of severe pituitary dwarfism in a 10 years old female girl. Magnetic resonance image (MRI) revealed transection of the pituitary stalk stalk with the formation of high intensity ectopic posterior lobe located at the median eminence and agenesis of an anterior lobe of pituitary gland. The serum growth Hormone (GH) response to clonidine and L-dopa revealed severe GH deficiency. The patient had responses to TRH, normal TSH and partial prolactin response, respectively. There was not response LH and FSH to GnRH. The morning cortisol concentration and serum T4 concentration were decreased below the normal range. These findings and no hyperprolactinemia suggested the presence of a vascular connection between the pituitary gland and hypothalamus, which is not visible on MRI. Sofar, the primary cause of idiopathic pituitary dwarfism in many patients is injury to hypothalamus by perinatal insults. In this patient, there was no history of perinatal insults and postnatal head trauma but transection of the pituitary stalk. We report a case of severe pituitary dwarfism due to agenesis with brief review of related litereature.
Child ; Clonidine ; Craniocerebral Trauma ; Dwarfism, Pituitary* ; Female ; Gonadotropin-Releasing Hormone ; Growth Hormone ; Humans ; Hydrocortisone ; Hyperprolactinemia ; Hypothalamus ; Levodopa ; Magnetic Resonance Imaging ; Median Eminence ; Pituitary Gland* ; Pituitary Gland, Anterior* ; Prolactin ; Reference Values

PURPOSE: This study was to determine the effect of DHEA administration before, during, and after dexamethasone treatment on body weight and TypeI,II muscle weight of rat receiving dexamethasone treatment. METHOD: Wistar rats were divided into 6 groups: control(C), dexamethasone(D), DHEA administration for 3days after dexamethasone treatment for 7days(7D+3DH), dexamethasone treatment for 7days after DHEA administration for 3days(3DH+7D), DHEA administration during dexamethasone treatment for 4days after dexamethasone treatment for 3days(3D+4DDH), DHEA administration during dexamethasone treatment for 7days(7DDH). Dexamethasone was injected by subcutaneously daily at a dose of 5mg/kg. DHEA was orally administered daily at a dose of 5mg/kg for 7 days. Soleus(TypeI) muscle, and both plantaris and gastro- cnemius(TypeII) muscles were dissected on the 7th day of experiment. RESULT: Body weight of both 3DH+7D group and 3D+4DDH group increased significantly compared with that of 7D group. Body weight of 7D+3DH group decreased significantly compared with that of 7D group, 7DDH group, 3DH+7D group and 3D+4DDH group. Muscle weight of both plantaris and gastro- cnemius tended to decrease compared with that of 7D group. Muscle weight of 7DDH group, 3D+4DDH group and 3DH+7D group increased significantly compared with that of 7D+3DH group. Muscle weight of gastrocnemius of both 3DH+7D group and 3D+4DDH group increased significantly compared with that of 7D group. CONCLUSION: Based on these results, it can be suggested that DHEA administration before and during dexamethasone treatment can increase both body weight and mass of atrophied TypeII muscle induced by dexa- methasone treatment.
Animals ; Body Weight* ; Dehydroepiandrosterone* ; Dexamethasone* ; Muscles* ; Rats* ; Rats, Wistar

No abstract available.
Candidemia* ; Humans

Background: Postoperative sore throat is a complaint after general anesthesia of multifactorial etiology. The laryngeal mask airway (LMA) reduces sore throat and discomfort during maintenance of the airway and make patients more comfortable. The purpose of this study was to compare effect of patient's position during operation on postoperative sore throat after the use of LMA. Methods: The fifty three patients were randomly divided into two groups. Group 1 (n=30) was underwent general anesthesia with supine position and group 2 (n=23) with prone position. After the LMA was positioned in the hypopharynx and the cuff inflated, fiberoptic laryngoscope was immediately passed down through the LMA. Number of attempts, degree of postoperative sore throat and other complications were also noted. Results: The incidence of postoperative sore throat after the use of LMA was 10% in supine position and 4% in prone position. But the difference between the groups was not statistically significant. All of the reported sore throats were rated as mild. Conclusions: Postoperative sore throat after the use of LMA is mild and the incidence is not affected by the prone position during the operation.
Anesthesia, General ; Humans ; Hypopharynx ; Incidence ; Laryngeal Masks* ; Laryngoscopes ; Pharyngitis* ; Prone Position* ; Supine Position

PURPOSE: This study was conducted to determine whether low intensity regular exercise following dexamethasone treatment could attenuate steroid-induced muscle atrophy. METHOD: 36 Wistar-rats(90-110g) were divided into six groups: control group(C), dexamethasone treatment group(D), sedentary group after normal sedentary period(C+S), sedentary group after dexamethasone treatment period(D+S), exercise group after normal sedentary period(C+E), and excercise group after dexamethasone treatment period(D+E). D, D+S, and D+E groups received dexamethasone injection(5mg/Kg) for seven days whereas C, C+S, and C+E groups received normal saline injection. Both C+E and D+E groups ran on a treadmill for 60 minutes/day(20minutes/4hours) at 15m/min and a 10degreegrade for seven recovery days. RESULT: Post-weight(body weight before muscle dissection) of D group significantly decreased by 16.03%, and that of D+E group significantly increased by 15.51% compared with pre-weight(body weight before steroid treatment). Type II muscle(plantaris and gastrocnemius) weights of D group were significantly lower than those of C group. Myofibrillar protein contents of type II muscles of D group tended to decrease comparing with C group. In D+E groups, body weights and relative weights of typeII muscles(muscle weight(mg)/post-weight(g)) tended to increase comparing with D+S group. CONCLUSION: It is suggested that steroid- induced muscle atrophy can be ameliorated through low intensity regular exercise after dexamethasone treatment.
Animals ; Body Weight ; Dexamethasone ; Muscle Fibers, Fast-Twitch ; Muscles* ; Muscular Atrophy ; Rats* ; Weights and Measures

BACKGROUND: The treatment of post-inflammatory hyperpigmentation (PIH) remains challenging. Tranexamic acid, a well-known anti-fibrinolytic drug, has recently demonstrated a curative effect towards melasma and ultraviolet-induced PIH in Asian countries. However, the precise mechanism of its inhibitory effect on melanogenesis is not fully understood. OBJECTIVE: In order to clarify the inhibitory effect of tranexamic acid on PIH, we investigated its effects on mouse melanocytes (i.e., melan-a cells) and human melanocytes. METHODS: Melan-a cells and human melanocytes were cultured with fractional CO2 laser-treated keratinocyte-conditioned media. Melanin content and tyrosinase activity were evaluated in cells treated with or without tranexamic acid. Protein levels of tyrosinase, tyrosinase-related protein (TRP)-1, and TRP-2 were evaluated in melan-a cells. Signaling pathway molecules involved in melanogenesis in melanoma cells were also investigated. RESULTS: Tranexamic acid-treated melanocytes exhibited reduced melanin content and tyrosinase activity. Tranexamic acid also decreased tyrosinase, TRP-1, and TRP-2 protein levels. This inhibitory effect on melanogenesis was considered to be involved in extracellular signal-regulated kinase signaling pathways and subsequently microphthalmia-associated transcription factor degradation. CONCLUSION: Tranexamic acid may be an attractive candidate for the treatment of PIH.
Animals ; Asian Continental Ancestry Group ; Humans ; Hyperpigmentation ; MART-1 Antigen ; Melanins ; Melanocytes ; Melanoma ; Melanosis ; Mice ; Microphthalmia-Associated Transcription Factor ; Monophenol Monooxygenase ; Phosphotransferases ; Tranexamic Acid*

BACKGROUND: In the acute phase of myocardial infarction, the hemostatic mechanism is known to be activated. However, it remains unclear whether increased activity of the hemostatic mechanism is only a marker of the acute thrombotic episode or precedes its appearance. It is also inapparent whether a hypercoagulable state persist for a prolonged period after the apparent resolution of these disorders. METHODS: In a group of 23 patients with acute myocardial infarction who received fibrinolytic therapy with urokinase(group A) or tPA(group B), the plasma level of fibrinogen, antithrombin compared to those of the 10 normal controls. RESULTS: The plasme level of fibrinogen was significantly decreased in both group A and B before and 4 to 24 hours after thrombolytic therapy compared to that of normal controls. But it was increased 7 to 14 days after thrombolytic therapy. In a few of the patients, the plasma level of FDP and D-dimer were positive before thrombolytic therapy and in the most patients they were positive 4 hours after thrombolytic therapy. The plasma level of AT-III was significantly increased in both group A and B before thrombolytic therapy compared with that of normal controls, but, after thrombolytic therapy, there was no significant change in its level. CONCLUSIONS: In the patients with acute myocardial infarction, the thrombolysis occurred before thrombolytic therapy and it lasted for 24 hours after thrombolytic therapy.
Antithrombin III* ; Fibrinogen ; Humans ; Myocardial Infarction* ; Plasma ; Thrombolytic Therapy*

There are many reports which show that contraction of the extraocular muscles results in an increase in intraocular pressure(IOP). Goldmann tonometer was used to record IOP after Tensilon injection in 22 patients, 10 myasthenics and 12 patients with other neurologic disease. There was a significant difference in IOP measured at 30 seconds after injection between two groups; 1-7(mean: 3.4) mmHg increase in myasthenics but no change, or 1-6 (mean: 1.7) mmHg decrease in patients with other neurologic disease. It is concluded that Tensilon tonometry is a valuable, sensitive and objective method in the diagnosis of myasthenia gravis.
Diagnosis* ; Edrophonium* ; Humans ; Manometry* ; Muscles ; Myasthenia Gravis*

BACKGROUND/AIMS: Hypoxemia is often associated with liver cirrhosis without cardiopulmonary diseases. Pulmonary vascular impairments including intrapulmonary shunt have been considered as a major mechanism of hypoxemia. The aim of this study was to determine the incidence and pathophysiologic basis of hypoxemia in cirrhotic patients without respiratory symptoms. METHODS: In fourty three cirrhotic patients without heart and lung diseases, we performed the arterial blood gas analysis and calculated alveolar arterial oxygen gradient (A-aO2). According to the A-aO2, the patients were divided into hypoxemic and normoxemic groups. In each group, a Tc-99m-macroaggregated albumin (Tc-99m-MAA) scan, a contrast-enhanced echocardiography and a pulmonary function test were performed. RESULTS: Twenty-eight of 43 patients (65%) showed hypoxemia. Hypoxemic patients showed significantly more increased shunt fraction of 3.1 1.4% than normoxemic one of 2.1 1.1% in the Tc-99m-MAA scan (p<0.05). However, only two of hypoxemic patients had shunt fraction above physiologic shunt range. By contrast-enhanced echocardiography, an intrapulmonary shunt was confirmed in one patient. There was no significant correlation between the shunt fraction and the hepatic reserve based on the Child-Pugh classification in hypoxemic patients. In the results of pulmonary function test, only DLco decreased more significantly in hypoxemic group than in normoxemic group (58.4 14.2 % vs 75.3 16.5% of predicted, p<0.05). CONCLUSIONS: Hypoxemia is not infrequently observed in cirrhosis, but incidence of significant intrapulmonary shunt is low. Therefore, other mechanism such as diffusion defect may be suggested to play a role in the development of hypoxemia in cirrhotic patients without respiratory symptoms.
Anoxia ; Blood Gas Analysis ; Classification ; Diffusion ; Echocardiography ; Fibrosis ; Heart ; Humans ; Incidence ; Liver Cirrhosis* ; Liver* ; Lung Diseases ; Oxygen ; Respiratory Function Tests ; Technetium Tc 99m Aggregated Albumin

OBJECTIVE: The detection rate of traumatic subdural hygroma(TSH) has increased after the development of computed tomography and magnetic resonance imaging. The treatment method and the mechanism of development of the TSH have been investigated, but they are still uncertain. This study is performed to evaluate the effectiveness of subduroperitoneal shunt in traumatic subdural hygroma. METHODS: Five hundred thirty six patients were diagnosed as TSH from 1996 to 2002, among them, 55 patients were operated with subduroperitoneal shunt. We analyzed shunt effect on the basis of clinical indetails, including the patient's symptoms at the diagnosis, duration from diagnosis to operation, changes of GCS, hygroma types. We classified the TSH into five types (frontal, frontocoronal, coronal, parietal and cerebellar type) according to the location of the thickest portion of TSH. RESULTS: The patients who have symptoms or signs related to frontal lobe compression (irritability, confusion) or increased intracranial pressure (headache, mental change), had symptomatic recovery rate above 80%. However, the patients who have focal neurological sign (hemiparesis, seizure and rigidity), showed recovery rate below 30%. The improvement rate was very low in the case of the slowly progressing TSH for over 6weeks. We experienced complications such as enlarged ventricle, chronic subdural hematoma, subdural empyema and acute SDH. CONCLUSION: Subduroperitoneal shunt appears to be effective in traumatic subdural hygroma when the patients who have symptoms or signs related to frontal lobe compression or increased ICP and progressing within 5weeks.
Diagnosis ; Empyema, Subdural ; Frontal Lobe ; Hematoma, Subdural, Chronic ; Humans ; Intracranial Pressure ; Lymphangioma, Cystic ; Magnetic Resonance Imaging ; Rabeprazole ; Seizures ; Subdural Effusion*