OBJECTIVE: The prolactinoma is the most common pituitary tumor and sometimes shows severe invasiveness to the adjacent cavernous sinus, especially in the male patient. The dopamine agonist can be used as an alternative treatment modality to surgery. But, the transsphenoidal or transcranial approach for tumor removal has been more preferred treatment option of neurosurgeons in invasive prolactinoma. Especially rapid decompression of mass effect and resolution of the neurologic deficit is demanded. The prospective study is done in order to identify the therapeutic efficacy of bromocriptine as an initial treatment option for the invasive prolactionomas. METHODS: Twenty patients with invasive prolactinoma were studied. Preoperative neurological and endocrinological evaluations were done, and size and invasiveness of the tumor was estimated on MRI. Bromocriptine was administrated by increasing dose planning reaching maximum dose at 1month of treatment, with close neurological and endocrinological monitoring. At 3months after treatment, MRI was taken and decision was made whether to continue bromocriptine or to have surgical intervention. RESULTS: Thirteen patients showed excellent result with only bromocriptine treatment. These patients showed not only marked reduction of tumor volume and prolactin level, but also, improving clinical symptoms and other hormonal deficits. 13patients who had visual field defect and decreased visual acuity had all improved visual symptoms. But, the remaining 4patients required surgical treatment due to insufficient reduction of tumor size inspite of normalized prolactin level within 3months. Remaining 2patients had 20~30% of tumor size reduction, but prolactin level was not normalized. One patient required radiation therapy. CONCLUSION: Bromociptine can be used as initial treatment for the invasive prolactinomas with careful monitoring of the neurological and endocrinological status. It should be carefully followed up for tumor size reduction within 3 months after initiation of treatment.
Bromocriptine* ; Cavernous Sinus ; Decompression ; Dopamine Agonists ; Humans ; Magnetic Resonance Imaging ; Male ; Neurologic Manifestations ; Pituitary Neoplasms ; Prolactin ; Prolactinoma* ; Prospective Studies ; Tumor Burden ; Visual Acuity ; Visual Fields

BACKGROUND: TiUnite(TM) is a highly crystalline and phosphate enriched titanium oxide surface which has a unique porous surface structure. This improved implant surface enhances bone response and reduces healing period. It also assures early stability of implant. These help to increase the success of implant. The aim o f this s tudy i s to e valuate the survival r ate of TiUnite TM surfaced single implant. MATERIALS AND METHODS: A retrospective analysis of 89 TiUnite(TM) surfaced implants replacing a single tooth was assessed according to their dental record. The age of the patients ranged from 17 to 82 years (mean age: 45.8 +/- 14.6). Data were recorded regarding the survival rate of these implants. RESULTS: Fifty-two implants (57%) were placed in the maxilla, and 37 (43%) in the mandible. Over 75% were placed in the posterior area. Of the placed implants, 67% were the wide type, while 25% were the regular type and only 8% were of the narrow type. The single implants produced an overall clinical survival rate of 96.6% over the observation period (mean 17.9 months). Among 89 implants, only 2 implants were removed and one implant was submerged. CONCLUSION: According to t he se data, TiUnite(TM) surfaced implant in a single tooth restoration showed favorable survival rate although this study was done in a short term period.
Crystallins ; Dental Records ; Humans ; Mandible ; Maxilla ; Retrospective Studies ; Survival Rate* ; Titanium ; Tooth

We experienced a rare case of sacral meningeal cyst so called sacral perineurial cyst(Tarlov cyst). A 15 years old girl was admitted to the hospital because of sudden severe low back pain and Lt. sciatica for about one week. We performed delayed myelography and spinal computeized tomographic myelography(C.T.M) for differential diagnosis. Delayed filling of contrast media in the cyst was significant in diagnosis of sacral meningeal cyst type II. Laminectomy of sacrum(S1) was performed for partial excision of cystic wall and plastic suture. Operative finding was typical sacral perineurial cyst(Tarlov cyst) which was recently clssified as sacral meningeal cyst type II. The classification of spinal meningeal cysts in the literature was indistinct and confused. We also agree with Nabors et. al, in current classificcation of spinal meningeal cysts, in which the spinal meningeal cysts, in which the spinal meningeal cysts were divided into 3 groups as extradural spinal Mcs Type I(Diverticulum), Type II(perineurial cyst), intradural spinal Mcs(arachnoid cyst).
Adolescent ; Classification ; Contrast Media ; Diagnosis ; Diagnosis, Differential ; Female ; Humans ; Laminectomy ; Low Back Pain ; Myelography ; Plastics ; Sciatica ; Sutures

PURPOSE: Cerebrovascular disease in children is more common than was once recognized and the etiology and prognosis of the disease in children are quite different from those of adults. Recently according to medical reports and clinical experiences, the incidence of childhood cerebrovascular disease is increasing in Korea. To clarify the clinical features of childhood cerebrovascular disease and to analyze its prognostic factors, retrospective study was perinatal problem, trauma or hypoxia. METHODS: We reviewed clinical records of the patients who had admitted to Seoul National University Children's Hospital during 5 years from Jan. 1989 to Dec. 1993. RESULTS: There were 82 cases(66.8%) of ischemic cerebrovascular disease as well as 41cases(33.3%) of hemorrhagic cerebrovascular disease. Various predisposing causes were known in 108 cases(87.8%); vasculopathy was frequent in ischemic group while hemato-oncologic disease was frequent in hemorrhagic group. The presenting symptoms and signs of childhood cerebrovascular disease were seizure, motor paralysis, headache, altered consciousness, etc. Transient ischemic attack and bulbar palsy were relatively common in ischemic group while ltered consciousness was more frequent in hemorrhagic group. The overall mortality of childhood cerebrovascular disease in this study was 11.4%, and deaths were frequent in hemorrhagic group(24.4%) than in ischemic group(4.9%) (p<0.005). Patients with a hemato-oncologic disease as a predisposing cause, and with an alteration of consciousness as a presenting sign were at increased risk for death (p<0.0005). Only 37 cases(33.9%) of the 109 patients surviving stroke were recovered completely while 72 cases(66.1%) had one or more residual deficits. Residual deficits occurred more often following ischemic stroke(71.8%), than after hemorrhagic stroke (51.6%), and complete recovery vice versa. Motor deficit was the commonest of the residual deficits. But the majority of motor deficits were mild and disability in fine motor control is common. Unlike in adults, seizure, mental retardation and learning disability were common as residual deficits in children. CONCLUSIONS: Considering above results childhood cerebrovascular disease is not so rare in Korea. And the clinical features and prognosis of cerebrovascular disease in children were somewhat different from those in adults. Since the outcome of childhood cerebrovascular disease is not so good, further exact and inclusive studies on this subject are required for early diagnosis and treatment which are important in decreasing mortality and morbidity of the disease.
Adult ; Anoxia ; Bulbar Palsy, Progressive ; Child ; Consciousness ; Early Diagnosis ; Headache ; Humans ; Incidence ; Intellectual Disability ; Ischemic Attack, Transient ; Korea ; Learning Disorders ; Mortality ; Paralysis ; Prognosis ; Retrospective Studies ; Seizures ; Seoul ; Stroke

Purpura fulminans is one of rare consumptive coagulopathy in children. The most common predisposing conditions of purpura fulminans are infectious disease like streptococcal infection and chickenpox. This disease is characterized by ecchymotic lesions that are usually distributed symmetrically on the lower extremities and buttocks. These ecchymotic lesions undergo necrosis, unless there is effective treatment. We experienced 3 cases of purpura fulminans which improved almost completely after early heparin administration. In the case 1, a 12 month old girl, purpura fulminans developed during sepsis and gastroenteritis. In the case 2, a 4 month old boy, purpura fulminans developed during acute sepsis. We reported 3 cases with a brief review of related literature.
Buttocks ; Chickenpox ; Child ; Communicable Diseases ; Dacarbazine ; Female ; Gastroenteritis ; Heparin ; Humans ; Infant ; Lower Extremity ; Male ; Necrosis ; Purpura Fulminans* ; Purpura* ; Sepsis ; Streptococcal Infections

No abstract available.
Behavior Therapy* ; Self-Injurious Behavior*

No abstract available.
Drainage* ; Heart Septal Defects, Atrial*

The purposes of this study were to analyze the gap between foodservice personnel and inpatients, to urge foodservice providers to reconsider by identifying the problems in service delivery for customer satisfaction, and to deduce the priority for foodservice quality improvement. The results of this study can be summarized as follows : the average perception score of personnel (4.32 out of 5) was higher than that of customers (3.90). In particular, the customers' perceptions of 17 attributes, which included 'removal service of tray by foodservice personnel', 'nutrition and health-related information service', 'handling inpatient's complaint ASAP', 'delicious meals' and 'salty enough meals' and so on, was significantly lower than personnel's. Both service providers and customers perceived that 'personnel attitude' was the highest and 'meal quality' was the lowest among the 4 factors, but there was significant difference on 'meal quality' (p<.001), 'customer reception' (p<.001) and 'personnel attitude' (p<.05) between the two groups. As a results of quadrant analysis, 'removal service of tray by foodservice personnel', 'handling inpatient's complaints ASAP' and 'meal service according to doctor's orders were categorized into Quadrant A with meaning of high personnel's perceptions and low customers'. Therefore service providers have to perceive the gap between the two viewpoints and grant priority to these attributes in improving foodservice quality.
Financing, Organized ; Humans ; Inpatients ; Quality Improvement

The treatment of facial bone fractures aims at restoring normal anatomical feature and obtaining the physiologic function by accurate fracture reduction and adequate stability. Among various facial bone fractures, displaced mandibular angle and subcondylar fractures are common injuries. Their structural problems such as increased risk of oromasticatory dysfunction and aesthetic drawbacks can be corrected by surgical treatment. In case of displaced comminuted fracture of zygoma, the zygomatic arch should be reduced and rigidly fixed, because it can be used as a key landmark for reconstruction. In case of these fractures, we performed external incision and conventional bicoronal incision to repair mandibular fractures and expose zygomatic arch. However, there are some disadvantages associated with these extensive incisions: a possible facial nerve injury, prolonged massive swelling, noticeable external scarring and increased risk of blood loss. On the other hand, the intraoral incision approach for mandibular angle, subcondyle and zygomatic arch makes possible the anatomic reduction and rigid internal fixation by using a trocar method concomitantly, which requires only an additional small skin incision over the perpendicular point of the fracture site. Additionally, this approach has several advantages, including decreased possibility of facial nerve injury, decreased blood loss, early subsidence of postoperative swelling and minimal external scarring. From March 1997 to November 1999, we used the trocar method for the treatment of various facial bone fractures of 15 males and 3 female patients (age ranged from 17 to 60 years). In this approach, operative endoscope or C-arm was used concomitantly in order to improve the limited operative visual field and to allow surgical access. The use of trocar method through the intraoral and tiny skin incisions provides the accurate reduction and rigid internal fixation. It is considered a good method to minimize the disadvantages of external approaches for the treatment of various facial bone fractures.
Cicatrix ; Endoscopes ; Facial Bones* ; Facial Nerve Injuries ; Female ; Fractures, Comminuted ; Hand ; Humans ; Male ; Mandibular Fractures ; Skin ; Surgical Instruments* ; Visual Fields ; Zygoma

Forty-four ovairan tumors were immunohistochemically studied for the presence of broad-spectrum keratin, vimentin, desin, carcinoembryonic antigen (CEA), alpha-fetoprotein (AFP), and alpha 1-antitrypsin (AAT) in formalin-fixed, paraffin-embedded tissues. 1) Among the common epithelial tumors, all the serous carcinomas (4) expressed keratin and AAT, and one additionally CEA. Six mucinous carcinomas exhibited keratin-positivity in two. One endometrioid carcinoma coexpressed keratin and vimentin as well as AAT, but one clear cell carcinoma expressed only keratin. Keratin-and CEA-positivity in epithelial cell nests and vimentin-positivity in stromal cells were observed in two Brenner tumors. Two undifferentiated carcinomas showed keratin-positivity in one and focal CEA positivity in the other. 2) In sex cord-stromal tumors, four out of six granulsa cell tumors, all four thecomas and three fibromas expressed vimentin, and two granulosa cell tumors and two thecomas showed AAT-positivity. The others were negative. 3) Among germ cell tumors, four dysgerminomas showed focal vimentin-positive cells in two and diffuse staining for AAT. Seven endodermal sinus tumors expressed AAT in all. Additionally, AFP were positive in two and CEA in three out of them. One embryonal carcinoma expressed CEA, AAT and AFP. 4) In four metastatic carcinomas, three exhibited keratin-and CEA-positivity, whereas one exhibited keartin-and vimentin-positivity. All showed AAT-positivity. 5) There was no positive case for desmin among ovarian tumors.
Neoplasm Metastasis