PURPOSE: It is important to diagnose and treat newborn patients with congenital hypothyroidism as soon as possible because of neurodevelopmental outcome. If we can detect more severe forms of congenital hypothyroidism with neonatal screening test, the results of treatment will improve. METHODS: Sixty-four term infants whose TSH levels in neonatal screening test had been higher than 20 micro-International Unit were recalled. Their serum levels of T3, T4, TSH and thyroid scans were checked. They were divided into two groups according to the results, in which T group had transient thyroid disease and P group had permanent congenital hypothyroidism. The TSH levels in neonatal screening test between the two groups were compared and correlated with T3, T4 and TSH levels in their serum. RESULTS: The number of patients of T and P groups were 43 and 13 respectively. The mean TSH level of both group in neonatal screening test was 28.6 micro-International Unit/mL and 55.7 micro-International Unit/mL respectively. The mean TSH level in neonatal screening test is significantly higher in P than T group(P<0.05). If we choose 48 micro-International Unit/mL as a cutoff value, the sensitivity of detecting the P group is 77% and the specificity is 100%. The TSH levels in neonatal screening test had a positive correlation with the serum TSH levels and a negative correlation with the serum T4 levels(r=0.56 P<0.01, r=-0.53 P<0.01). CONCLUSION: If the TSH level in neonatal screening test is greater than 48 micro-International Unit/mL, there is a greater possibility of the permanent and severe congenital hypothyroidism. So we should try to diagnose and treat them more quickly.
Congenital Hypothyroidism* ; Humans ; Infant ; Infant, Newborn ; Neonatal Screening* ; Prognosis* ; Sensitivity and Specificity ; Thyroid Diseases ; Thyroid Gland

The objective of this study is to report on a case of a huge epidermoid cyst in the conus medullaris and cauda equina in a 43 year-old lady with the characteristic MRI and histologic findings. She suffered from low back pain, hypoesthesia around the anus and urinary incontinence for over 20 years. Since 15 years previously, she gradually developed right foot drop and muscle atrophy. She underwent surgery and unfortunately, she developed complete paralysis below T12 after complete tumor excision. At postoperative 4 weeks, evidence of partial neurological recovery down to the L3 roots was observed, but as yet there has been no further neurological recovery. Although total surgical excision is thought to be the only radical treatment, we recommend partial tumor excision to avoid damaging the spinal cord and cauda equina during the surgical procedure, than the radical excision, because this cyst is a very slowly growing benign tumor.
Adult ; Anal Canal ; Cauda Equina* ; Conus Snail* ; Epidermal Cyst* ; Foot ; Humans ; Hypesthesia ; Low Back Pain ; Magnetic Resonance Imaging ; Muscular Atrophy ; Paralysis ; Spinal Cord ; Urinary Incontinence

No abstract available.
Animal ; Bone and Bones/blood supply* ; Bone and Bones/innervation ; Bone and Bones/physiology ; Comparative Study ; Dogs ; Human ; Joints/blood supply* ; Joints/innervation ; Joints/physiology ; Muscle Contraction ; Oxygen Consumption ; Rabbits ; Rats

Cranioplasty has long been performed by many physicians with different materials from the prehistoric era. Among the materials, methyl methacrylate has been known to be the superior to any other substitutes since 1940s in biologic, chemical and physical characteristics and its availability. So the authors review 72 patients who underwent cranioplasty with methyl methacrylate at out hospital from 1985 to 1989. The clinical analyses were as follow : 1) There was male predominance and epidural hematomas, compound, comminuted depressed fractures by traffic accidents or fall down injuries were the main causes of craniectomy. 2) The location of defects was mainly frontal and/or parietal area and average size of defects was 17cm2 in plain skull film measurements. 3) The cosmetic results were satisfactory. 4) Complication rate was 6% and there was no mortality.
Accidents, Traffic ; Hematoma ; Humans ; Male ; Mortality ; Rabeprazole ; Skull

PURPOSE: Recognition of impending death is crucial not only for efficient communication with the caregiver of the patient, but also determination of the time to refer to a separate room. Current studies simply list the events 'that have already occurred' around 48 hours before the death. This study is to analyze the predictability of each event by comparing the time length from 'change' to death. METHODS: Subjects included 160 patients who passed away in a palliative care unit in Incheon. The analysis was limited to 80 patients who had medical records for the last week of their lives. We determined 9 symptoms and 8 signs, and established the standard of 'significant change' of each event before death. RESULTS: The most common symptom was increased sleeping (53.8%) and the most common sign was decreased blood pressure (BP) (87.5%). The mean time to death within 48 hours was 46.8% in the case of resting dyspnea, 13.6% in the ease of low oxygen saturation, and 36.9% in the case of decreased BP. The symptom(s) which had the highest positive predictive value (PV) for death within 48 hours was shown to be resting dyspnea (83%), whereas the combination of resting dyspnea and confusion/delirium (65%) had the highest negative PV. As for the most common signs before death within 48 hours, the positive PVs were more than 95%, and the negative PV was the highest when decreased BP and low oxygen saturation were combined. The difference in survival patterns between symptoms and signs was significant. CONCLUSION: The most reliable symptoms to predict the impending death are resting dyspnea and confusion/delirium, and decline of oxygen saturation and BP are the reliable signs to predict the event.
Blood Pressure ; Caregivers ; Dyspnea ; Humans ; Medical Records ; Oxygen ; Palliative Care ; Prognosis ; Terminally Ill

The pituitary gland develops from two different parts of the brain. The anterior pituitary gland originates from the Rathke pouch and the posterior one from the infundibulum. Therefore, the pathologic findings of congenital hypopituitarism can be different in each case. Congenital hypopituitarism is a rare disorder. The characteristic clinical features of the affected newborns are prolonged jaundice, persistent or recurrent hypoglycemia without hyperinsulinism and microphallus. Their genitalia are usually underdeveloped and sexual maturation may be delayed or absent. In adulthood, patients retain childish feature, short stature with normal body proportion. We experienced a case of congenital hypopituitarism in a 12-year-old female patient with short stature and delayed sexual maturation(Tanner stageI). The endocrinological studies revealed growth hormone, FSH, LH and TSH deficiencies. Magnetic resonance imaging indicated a hypoplastic anterior pituitary and an ectopic posterior pituitary gland located within the tuber cinereum of the hypothalamus.
Brain ; Child ; Female ; Genitalia ; Growth Hormone ; Humans ; Hyperinsulinism ; Hypoglycemia ; Hypopituitarism* ; Hypothalamus ; Infant, Newborn ; Jaundice ; Magnetic Resonance Imaging ; Pituitary Gland ; Pituitary Gland, Anterior ; Pituitary Gland, Posterior* ; Sexual Maturation ; Tuber Cinereum

The pituitary gland develops from two different parts of the brain. The anterior pituitary gland originates from the Rathke pouch and the posterior one from the infundibulum. Therefore, the pathologic findings of congenital hypopituitarism can be different in each case. Congenital hypopituitarism is a rare disorder. The characteristic clinical features of the affected newborns are prolonged jaundice, persistent or recurrent hypoglycemia without hyperinsulinism and microphallus. Their genitalia are usually underdeveloped and sexual maturation may be delayed or absent. In adulthood, patients retain childish feature, short stature with normal body proportion. We experienced a case of congenital hypopituitarism in a 12-year-old female patient with short stature and delayed sexual maturation(Tanner stageI). The endocrinological studies revealed growth hormone, FSH, LH and TSH deficiencies. Magnetic resonance imaging indicated a hypoplastic anterior pituitary and an ectopic posterior pituitary gland located within the tuber cinereum of the hypothalamus.
Brain ; Child ; Female ; Genitalia ; Growth Hormone ; Humans ; Hyperinsulinism ; Hypoglycemia ; Hypopituitarism* ; Hypothalamus ; Infant, Newborn ; Jaundice ; Magnetic Resonance Imaging ; Pituitary Gland ; Pituitary Gland, Anterior ; Pituitary Gland, Posterior* ; Sexual Maturation ; Tuber Cinereum

OBJECTIVE: The aims of this study were to investigate the extent to which specific known polymorphisms of fibrinogen, factor VII (FVII) and PAI-1 genes are associated with their respective plasma levels. And also we examined whether these genotypes were linked to coronary artery disease (CAD). METHOD: We performed a case-control study of 165 patients which included 156 CAD and 9 peripheral artery obstructive disease and 188 healthy controls without a history of cardiovascular disease. The four polymorphisms of fibrinogen (Beta-455G/A, beta448Arg/Lys), FVII (353Arg/Gln) and PAI-1 (4G/5G) gene were measured, together with their plasma levels. RESULTS: There was a difference between patients and controls in the frequency of the fibrinogen beta448Lys allele (0.206 vs 0.106, P< 0.001), but there were no significant frequency differences in fibrinogen beta-455A (0.537 vs 0.529), FVII 353Gln (0.079 vs 0.080) and PAI-1 4G (0.146 vs 0.113) Allele. Plasma fibrinogen level was higher in patients (372.8+/-112.0 mg/ dL) than in controls (300.4+/-70.9 mg/dL) and patients with genotype beta448LysLys (457.8+/-134.4 mg/dL) or beta448ArgLys (397.3+/-120.8 mg/dL) had higher fibrinogen levels than those with 448ArgArg (354.9+/-102.3 mg/dL). Using multivariate logistic regression, the beta448 ArgLys or LysLys genotype was associated with over twice the risk of CAD (odds ratio 2.25) compared with the beta448ArgArg genotype. Hypertension is more potent risk factor for the person who has the beta448Lys allele of fibrinogen. CONCLUSION: These data provide evidence that a polymorphism of the fibrinogen beta488Arg/ Lys is associated with an increased risk of CAD and that hypertension is more potent risk factor for CAD in person who have the beta488Lys allele of fibrinogen.
Alleles ; Arteries ; Cardiovascular Diseases ; Case-Control Studies ; Coronary Artery Disease* ; Coronary Vessels* ; Factor VII* ; Fibrinogen* ; Genotype* ; Humans ; Hypertension ; Logistic Models ; Plasma ; Plasminogen Activator Inhibitor 1 ; Plasminogen Activators* ; Plasminogen* ; Risk Factors

Although guidelines and protocols are available for central venous access, existing methods lack specificity and sensitivity, especially when placing peripherally inserted central catheters (PICCs). We evaluated the feasibility of catheter detection in the right atrial cavity using transthoracic echocardiography (TTE) during PICC placement. Methods: This single-center, retrospective study included consecutive patients who underwent PICC placement between January 2022 and March 2023. TTE was performed to detect the arrival of the catheter in the right atrial cavity. Catheter misplacement was defined as an aberrant catheter position on chest x-ray (CXR). The primary endpoint was predicting catheter misplacement based on catheter detection in the right atrial cavity. The secondary endpoint was optimizing catheter placement and examining catheter-associated complications. Results: Of the 110 patients identified, 10 were excluded because of poor echogenicity and vein access failure. The remaining 100 patients underwent PICC placement with TTE. The catheter was visualized in the right atrial cavity in 90 patients. CXR exams revealed catheter misplacement in seven cases. Eight patients with catheter misplacement underwent the same procedure in the other arm. In two patients, PICC placement failed due to anatomical reasons. Catheter misplacement was detected using TTE with sensitivity, specificity, positive predictive value, and negative predictive value of 97% confidence interval (CI; 91.31%–99.36%), 90% CI (55.50%–99.75%), 99%, and 75%, respectively. Conclusions: TTE is a reliable tool for detecting catheter misplacement and optimizing catheter tip positioning during PICC placement.

Although guidelines and protocols are available for central venous access, existing methods lack specificity and sensitivity, especially when placing peripherally inserted central catheters (PICCs). We evaluated the feasibility of catheter detection in the right atrial cavity using transthoracic echocardiography (TTE) during PICC placement. Methods: This single-center, retrospective study included consecutive patients who underwent PICC placement between January 2022 and March 2023. TTE was performed to detect the arrival of the catheter in the right atrial cavity. Catheter misplacement was defined as an aberrant catheter position on chest x-ray (CXR). The primary endpoint was predicting catheter misplacement based on catheter detection in the right atrial cavity. The secondary endpoint was optimizing catheter placement and examining catheter-associated complications. Results: Of the 110 patients identified, 10 were excluded because of poor echogenicity and vein access failure. The remaining 100 patients underwent PICC placement with TTE. The catheter was visualized in the right atrial cavity in 90 patients. CXR exams revealed catheter misplacement in seven cases. Eight patients with catheter misplacement underwent the same procedure in the other arm. In two patients, PICC placement failed due to anatomical reasons. Catheter misplacement was detected using TTE with sensitivity, specificity, positive predictive value, and negative predictive value of 97% confidence interval (CI; 91.31%–99.36%), 90% CI (55.50%–99.75%), 99%, and 75%, respectively. Conclusions: TTE is a reliable tool for detecting catheter misplacement and optimizing catheter tip positioning during PICC placement.