PURPOSE: To report a rare case of lymphocytic hypophysitis in a 31-year-old woman who presented with gradually progressive bilateral visual loss during the third trimester of pregnancy. METHODS: Ophthalmologic examination revealed best corrected visual acuity of 0.02 OD and counting fingers at 20 cm OS. Pupil examination revealed no relative afferent pupillary defect in either eye and intraocular pressure was normal in both eyes. A visual field test revealed nearly total visual defect sparing superotemporal area OD and total defect OS. An MRI of the head was performed. RESULTS: At the time of transsphenoidal surgery following the patient's delivery, a frozen biopsy of the lesion revealed diffuse lymphocytic infilteration and fibrosis of the pituitary gland consistent with the diagnosis of lymphocytic hypophysitis. Postoperatively the patient was treated for hypopituitarism. At 5 weeks postoperative, her best corrected visual acuity was 1.0 OU, and visual field defects resolved in both eyes. On follow-up by telephone for postoperative 7 months, the patient remained visually asymptomatic. CONCLUSIONS: The clinical presentation of lymphocytic hypophysitis may mimic pituitary adenoma, lymphoma, germinoma, and histiocytosis. The diagnosis should be suspected in any pregnant or postpartum patient with an intrasellar or suprasellar mass.
Adult ; Biopsy ; Diagnosis ; Female ; Fibrosis ; Fingers ; Follow-Up Studies ; Germinoma ; Head ; Histiocytosis ; Humans ; Hypopituitarism ; Intraocular Pressure ; Lymphoma ; Magnetic Resonance Imaging ; Pituitary Gland ; Pituitary Neoplasms ; Postpartum Period ; Pregnancy Trimester, Third ; Pregnancy* ; Pupil ; Pupil Disorders ; Telephone ; Visual Acuity ; Visual Field Tests ; Visual Fields

No abstract available.
Catheters*

The authors experienced 52 patients with myasthenia gravis who were diagnosed at the Department of Neurology, Yeungnam University Hospital from August 1985 to January 1996. The following results were obtained through diagnostic evaluation and treatment. 1. The ratio of male to female was 1:1.7 and the most prevalent age group was second decade. 2. The most common initial presentation symptom was ocular(71.2%) and the peak incidence group was stage I (69.3%) according to the modified Osserman's classification. 3. In 16 patients(30.8%), it took more than a year to diagnose due to symptoms which were relapsed and remitting. 4. Of 52 patients, 2 cases were associated with thyroid disease(3.8%) and 2 with insulin-dependent diabetes mellitus(3.8%). 5. All of those who received anticholinesterase and corticosteroid therapy were improved with the exception of 5 cases which were improved after thymectomy and/or plasmapheresis.
Classification ; Female ; Humans ; Incidence ; Male ; Myasthenia Gravis* ; Neurology ; Plasmapheresis ; Thymectomy ; Thyroid Gland

The authors presented a family whose 4 siblings had been suffered from oculopharyngeal muscular dystrophy of autoscmal recessive trend, with symptoms of progressive ptosis, external ophthalmoplegia, dysarthria, dysphagia and facial muscle atrophy, and we performed HLA study on these 9 family members which showed no interrelationship between oculopharyngeal muscular dystrophy and HLA Haplotypes.
Atrophy ; Deglutition Disorders ; Dysarthria ; Facial Muscles ; Haplotypes ; Histocompatibility Testing* ; Humans ; Muscular Dystrophy, Oculopharyngeal* ; Ophthalmoplegia ; Siblings

No abstract available.
Fistula* ; Humans ; Infant*

OBJECTIVE: The authors reviewed experience with patients harboring intracerebral hematoma (ICH) treated by stereotactic computed tomography (CT) guided thrombolysis and aspiration and evaluated feasibility, safety and prognostic factors of this procedure. METHODS: One hundred and ten patients with supratentorial ICH >25 ml without underlying structural etiology or coagulopathy were recruited. The patients with Glasgow Coma Scale (GCS) <5 were excluded. A catheter was directed stereotactically into the ICH under CT guidance. Hematoma aspiration was followed by instillation of urokinase. This was repeated every 6 hours until less than half of its initial volume remained. For analysis of prognostic factors, we classified them into two groups;good (Glasgow Outcome Scale (GOS) > or =4) and bad (GOS<4) prognosis group, and performed comparative analysis between two groups. RESULTS: Mean age was 59.8 years. The baseline hematoma size ranged from 15 to 72 mL. ICH volume reduced by an average of 74.2%. At 6 months after the procedure, 56 patients had achieved a good recovery, 29 patients were dependent, and 10 remained vegetative. Fifteen patients died in hospital. The main good prognostic factors were young age, small ICH volume, high GCS, absence of rebleeding, underlying disease and complications. CONCLUSION: CT-guided thrombolysis and aspiration appears safe and effective in the reduction of ICH volume. Patients of ICH presenting with bad prognostic factors should require frequent radiological investigation and more meticulous procedure. Further studies are needed to assess optimal thrombolytic dosage and must include controlled comparisons of mortality, and disability outcome.
Catheters ; Glasgow Coma Scale ; Hematoma* ; Humans ; Mortality ; Prognosis ; Urokinase-Type Plasminogen Activator

Sertoli-Leydig cell tumor or Brenner tumor is a relatively rare ovarian tumor. Other associated elements in the form of epithelial, mesenchymal, and tumor components of each tumor have been reported. The Sertoli-Leydig cell tumor with a Brenner tumor element has not been documented in the literature, so we are reporting on a case of Sertoli-Leydig cell tumor coexisting with a Brenner tumor. This 62-year-old woman presented with a 4 year history of lower abdominal mass and vaginal bleeding. Exploratory laparotomy was done. The left ovary showed a multiseptated, cystic, yellow-white solid mass, measuring 17.0x13.0x5.0 cm and weighing 985.0 gm. Microscopic examination revealed a tubular or trabecular arrangement of the Sertoli cells and variable numbers of Leydig cells. There were several tumor nests with cystic spaces composed of ovoid cells showing longitudinal nuclear grooving. Sarcomatoid or heterologous elements were not found.
Female ; Humans

The incidence of conjoined twins is so rare that few anesthesiologists have an opportunity of managing them. Especially in Korea, there are only a few reports describing the anesthetic management for surgical separation of newborn conjoined twins. We experienced the successful anesthetic management for surgical separation of thoraco-xiphopagus conjoined twins without any particular problems. After applying the noninvasive monitors (ECG, pulse oximeter), one of the twins (twinA) with congenital heart disease was administered with intravenous ketamine for induction of anesthesia and intubated without neuromuscular blocker. Anesthesia was maintained with N2O-O2 and hand ventilation using Mapleson D breathing circuit. After maintaining airway of the twinA, the twinB was intubated and maintained with the same manner. Eighteen days after the separation procedure, the twinA with congenital heart disease died and the other one, twinB has been alive with normal growth and development.
Anesthesia ; Growth and Development ; Hand ; Heart Defects, Congenital ; Humans ; Incidence ; Infant, Newborn ; Ketamine ; Korea ; Neuromuscular Blockade ; Respiration ; Twins, Conjoined* ; Ventilation

Malignant degeneration of mature cystic teratoma has been reported in 1~3% of cases, usually between the age of 30 and 70 years with a peak incidence of 40~60 years. The most common malignancy developing in such tumors is squamous cell carcinoma arising in a mature cystic teratoma. Hirakawa reported two patients with benign teratomas diagnosed 25 and 32 years prior to surgery for malignancy and Dorothea reported a patient who was diagnosed as benign teratoma 50 years prior to operate for carcinoma. But there has been no report of squamous cell carcinoma arising in the mature cystic teratoma with direct invasion to gastrointestinal tract. We report a case of squamous cell carcinoma with direct invasion to transverse colon and jejunum in 62-year-old female who was diagnosed as mature cystic teratoma 20 years ago.
Carcinoma, Squamous Cell* ; Colon, Transverse* ; Female ; Gastrointestinal Tract ; Humans ; Incidence ; Jejunum* ; Middle Aged ; Teratoma*

A clinical study was done on 29 cases of spontaneous pontine hemorrhage which were confirmed by brain CT scan at Keimyung university Dongsan hospital from Jan. 1981 to Feb. 1986. The results are summarized as follows. 1. The incidence of pontine hemorrhage was 7.4% of all spontaneous intracranial parenchymal hemorrhage. 2. The most prevalent age group were 40th and 50th decades and male to female ratio was 2.2:1. 3. The most common precipitating factor was hypertension and most of pontine hemorrhage occurred during daily routine or increased activities. 4. Symptoms on onset were headache, altered consciousness, vomiting, dizziness, motor weakness, dysarthria, sensory disturbance and generalized convulsion, in order of frequency. 5. Cardinal neurologic signs on admission were loss of consciousness, ocular signs e.g. Pinpoint or miotic pupil absent horizontal doll's eye movement ocular bobbing skew deviation MLF syndrome, motor weakness e.g. quadriparesis hemiparesis decerebrate rigidity, positive Babinski sign. 6. Mean size of hematoma on CT was 6.8cc and 44% was under 5cc. Hematoma of 4th ventricle was seen in 36% of pontine hemorrhage. 7. 25 cases of pontine hemorrhage were divided into 3 groups according to the location of hematoma on CT-basilar (2 cases), tegmental (15 cases), diffuse (8 cases). 8. All 29 cases of pontine hemorrhage were treated medically, 21% were improved, and 79% hopeless discharge or death. 9. Mild disturbance of consciousness on admission, small size (under 5cc) of hematoma and absence of hematoma in the 4th ventricle seem to be good prognostic indicators.
Brain ; Consciousness ; Decerebrate State ; Dizziness ; Dysarthria ; Eye Movements ; Female ; Headache ; Hematoma ; Hemorrhage* ; Humans ; Hypertension ; Incidence ; Male ; Neurologic Manifestations ; Ocular Motility Disorders ; Paresis ; Precipitating Factors ; Pupil ; Quadriplegia ; Reflex, Babinski ; Seizures ; Tomography, X-Ray Computed ; Unconsciousness ; Vomiting