Mucormycosis is a rare invasive fungal infection of the nose and paranasal sinus, which often has an acute fulminant course and distinctive clinical findings. It usually occurs in diabetics or immunocompromised patients and shows rapid progression with a high mortality rate. Slow, silent progression is a highly unusual presentation of this disease. Herein, we report a case of mucormycosis with a chronic course of invasion into the hard palate and the maxillary sinus.
Diabetes Mellitus ; Immunocompromised Host ; Maxillary Sinus ; Mortality ; Mucormycosis* ; Nose ; Palate, Hard ; Rare Diseases* ; Sinusitis

There are not many reports of a spontaneous acute subdural hematoma (ASDH) without the presence of a subarachnoid hemorrhage as a result of a ruptured aneurysm. A 66-year-old woman presented with acute subdural hematoma secondary to a ruptured intracranial aneurysm. She was admitted with an acute onset of bursting headache and nausea. There was no past history of head trauma. The CT scan demonstrated a left subdural hematoma with extension along the tentorium in the absence of subarachnoid or intraparenchymal hemorrhage. CT angiography revealed an aneurysm of the left posterior communicating aneurysm, which was directed posterolaterally. Uneventful clipping was performed without any neurological deficits. The possibility of aneurysmal subdural hemorrhage should be considered in all cases of ASDH that present with a sudden bursting headache without any history of trauma. Therefore, CT angiography can be an indispensable tool for detecting the aneurysm that has an unusual pattern of subdural hematoma.
Aged ; Aneurysm ; Aneurysm, Ruptured ; Angiography ; Craniocerebral Trauma ; Female ; Headache ; Hematoma, Subdural ; Hematoma, Subdural, Acute ; Hemorrhage ; Humans ; Intracranial Aneurysm ; Nausea ; Subarachnoid Hemorrhage

OBJECTIVE: Meningiomas represent 18-20% of all intracranial tumors and have a 20-50% 10-year recurrence rate, despite aggressive surgery and irradiation. Hydroxyurea, an inhibitor of ribonucleotide reductase, is known to inhibit meningioma cells by induction of apoptosis. We report the long-term follow-up result of hydroxyurea therapy in the patients with recurrent meningiomas. METHODS: Thirteen patients with recurrent WHO grade I or II meningioma were treated with hydroxyurea (1000 mg/m2/day orally divided twice per day) from June 1998 to February 2012. Nine female and 4 male, ranging in age from 32 to 83 years (median age 61.7 years), were included. Follow-up assessment included physical examination, computed tomography, and magnetic resonance imaging (MRI). Standard neuro-oncological response criteria (Macdonald criteria) were used to evaluate the follow-up MRI scans. The treatment was continued until there was objective disease progression or onset of unmanageable toxicity. RESULTS: Ten of the 13 patients (76.9%) showed stable disease after treatment, with time to progression ranging from 8 to 128 months (median 72.4 months; 6 patients still accruing time). However, there was no complete response or partial response in any patients. Three patients had progressive disease after 88, 89, 36 months, respectively. There was no severe (Grade III-IV) blood systemic disorders and no episodes of non-hematological side effects. CONCLUSION: This study showed that hydroxyurea is a modestly active agent against recurrent meningiomas and can induce long-term stabilization of disease in some patients. We think that hydroxyurea treatment is well tolerated and convenient, and could be considered as an alternative treatment option in patients with recurrent meningiomas prior to reoperation or radiotherapy.
Apoptosis ; Disease Progression ; Female ; Follow-Up Studies ; Humans ; Hydroxyurea ; Magnetic Resonance Imaging ; Male ; Meningioma ; Physical Examination ; Recurrence ; Reoperation ; Ribonucleotide Reductases

OBJECTIVE: This study is performed to evaluate the clinical manifestations and prognostic factors among patients with pyogenic spinal infections. METHODS: The records and radiologic data of 27 patients treated between 2001 and 2003 were retrospectively evaluated. RESULTS: All patients (mean age, 55.2yrs) were treated with i.v. antibiotics and 13(48.1%) required surgical treatment. Mean follow up duration was 38.9 weeks. The sixteen patients(59.2%) had previous surgical procedure on spine and six patients(22.0%) had local injections. The ten patients had predisposing factor (such as, diabetes mellitus, UTI, liver cirrhosis, septic condition). The most common symptoms are lower back pain and motor weakness. Causative organisms determined only in ten patients(37%) and Staphylococcus aureus(50%) was most common. C-reactive protein(CRP) and white blood cell(WBC) count were more correlated with clinical outcome than erythrocyte sedimentation rate(ESR). CONCLUSION: CRP and WBC level can be significant parameters of treatment and prognosis in pyogenic spinal infection.
Anti-Bacterial Agents ; Blood Sedimentation ; Causality ; Diabetes Mellitus ; Follow-Up Studies ; Humans ; Liver Cirrhosis ; Low Back Pain ; Prognosis ; Retrospective Studies ; Spine ; Staphylococcus

PURPOSE: We compared the clinical features of the ankle fractures treated by operation between the elderly and the young, and reviewed the principles of treatment of the ankle fractures in the elderly. MATERIALS AND METHODS: We reviewed 49 cases of the ankle fractures, which were treated by open reduction from August 1991 to July 2002. Patients aged more than 60 were designated as the elderly, and patients aged between 15 and 33 were designated as the young. The average follow-up period was 13.2 months. Using the Lauge-Hansen classification, We defined stage I or II fractures as low stage and stage III or IV fractures as high stage fractures. RESULTS: There were 15 cases of high stage fractures (78.9%) in the elderly and 11 cases (36.7%) in the young. High stage fracture rate was significantly higher in the elderly (P=0.004). Hospital day, period between primary injury and operation, and union time were significantly longer in the elderly (P<0.001). However, there was no statistical difference in immobilization time between the two groups. The results of treatment were satisfactory clinically and radiologically by the Meyer's criteria in both groups. CONCLUSION: In the elderly, high stage fractures were more common and longer hospitalization and union time were needed than the young. However, the result of surgical treatment was satisfactory.
Aged* ; Ankle Fractures* ; Ankle* ; Classification ; Follow-Up Studies ; Hospitalization ; Humans ; Immobilization

Lumbar intervertebal disc herniation is common in the fourth to fifth decades because the intervertebral disc undergoes degenerative change. However juvenile lumbar intervertebal disc herniation (under 12 years old) is rare because there is no degenerative change, and the clinical symptoms and treatments are different from those of adults. Herein, our experience of five juvenile lumbar intervertebal disc herniation cases are analyzed and reported.
Adult ; Humans ; Intervertebral Disc*

The purpose of this study was to evaluate the migration of medical image data stored thorough mini-PACS to full-PACS at Yonsei University Medical Center (YUMC). The image data to be migrated were 2.7 TB stored through approximately 4,500 CD archives at Yongdong Severance hospital and 4.7 TB (2:1 compression) stored through 196 digital linear tape (DLT) archives at Severance hospital. Prior to carrying out the migration, principles, methods and expected practical affairs for the migration were discussed and planned to optimize the migration work by considering the cost and the effectiveness of migration work. Migration gateway workstations were set up and a migration software tool was developed. Real migration works were performed based on the results of several migration simulations. Severance hospital decided to migrate all stored image data. The CD image data of 2.7 TB were estimated total 2,250 hr (about 94 days) migration time, but the practical migration work was completed within 3 months by using maximum 5 workstations. The DLT data of 4.7 TB were estimated total 100 days migration time by applying 16 hr working time per day with single workstation, however, the practical migration work was taken 5 months. Meanwhile, 20% of the DLT image data were not able to migrate because the DLT were partially damaged due to frequent access. In conclusion, a migration plan should be carefully prepared by considering the individual hospital environments because the server system, archival media, the network, and the policy of data management may be unique.
Academic Medical Centers

Background/Aims: The optimal systolic blood pressure (SBP) goal for elderly patients with hypertension, especially to reduce cardiovascular disease (CVD) incidence and improve outcome, is unclear. This study aimed to evaluate the beneficial effects of intensive treatment for hypertension on the incidence of CVD in elderly Korean patients. Methods: The HOW to Optimize eLDerly systolic Blood Pressure (HOWOLD-BP) trial is a multicenter, parallel-design, open-label, randomized controlled trial designed to evaluate whether intensive treatment (SBP ≤ 130 mmHg) will provide more benefits in lowering the incidence and mortality associated with CVD than standard treatment (SBP ≤ 140 mmHg) in elderly patients with hypertension aged ≥ 65 years. For this study, eleven university hospitals in Korea will enroll approximately 3,176 elderly patients with hypertension between 2019 and 2022. Patients will be requested to visit the clinic every 4 months for the first year and every 6 months thereafter for 36 months. Parameters, including clinic and home blood pressure, anthropometric and laboratory findings, and frailty assessments, will be collected according to the standardized protocol. The primary outcome is a composite of CVD (acute coronary syndrome, stroke, and heart failure) incidence and cardiovascular deaths. Results: As of December 2021, 1,655 participants had been enrolled in the study, including 831 patients in the standard group and 824 patients in the intensive group. Conclusions The HOWOLD-BP trial is the first study performed in Korea to evaluate the beneficial effects of intensive blood pressure treatment on CVD in elderly patients with hypertension. The results of this study will help clarify the appropriate target SBP for this population.