OBJECTIVE: Postoperative hydrocephalus is a common complication following craniectomy in patients with traumatic brain injury, and affects patients’ long-term outcomes. This study aimed to verify the risk factors associated with the development of hydrocephalus after craniectomy in patients with acute traumatic subdural hemorrhage (tSDH). METHODS: Patients with acute traumatic SDH who had received a craniectomy between December 2005 and January 2016 were retrospectively assessed by reviewing the coexistence of other types of hemorrahges, measurable variables on computed tomography (CT) scans, and the development of hydrocephalus during the follow-up period. RESULTS: Data from a total of 63 patients who underwent unilateral craniectomy were analyzed. Postoperative hydrocephalus was identified in 34 patients (54%) via brain CT scans. Preoperative intraventricular hemorrhage (IVH) was associated with the development of hydrocephalus. Furthermore, the thickness of SDH (p=0.006) and the extent of midline shift before craniectomy (p=0.001) were significantly larger in patients with postoperative hydrocephalus. Indeed, multivariate analyses showed that the thickness of SDH (p=0.019), the extent of midline shift (p<0.001) and the coexistence of IVH (p=0.012) were significant risk factors for the development of postoperative hydrocephalus. However, the distance from the midline to the craniectomy margin was not an associated risk factor for postoperative hydrocephalus. CONCLUSION: In patients with acute traumatic SDH with coexisting IVH, a large amount of SDH, and a larger midline shift, close follow-up is necessary for the early prediction of postoperative hydrocephalus. Furthermore, craniectomy margin need not be limited in acute traumatic SDH patients for the reason of postoperative hydrocephalus.
Brain ; Brain Injuries ; Follow-Up Studies ; Hematoma ; Hematoma, Subdural* ; Hemorrhage ; Humans ; Hydrocephalus* ; Multivariate Analysis ; Retrospective Studies ; Risk Factors ; Tomography, X-Ray Computed

Pituicytoma is a rare solid benign tumor of the sellar and/or suprasellar region originating from the pituicytes of the neurohypophysis or infundibulum, which is not differentiated from a pituitary adenoma that is diagnosed mostly in the sellar and/or suprasellar region. In addition, cystic tumors are very rare and have not been reported due to their solid and hypervascular natures. A 33-year-old man presented with a chronic headache which exacerbated recently. MRI was performed and revealed a cystic tumor in the sellar and suprasellar regions with a small parenchymal island in the cyst compressing the optic chiasm. The endoscopic endonasal transsphenoidal approach was used to remove the tumor. Immunohistochemical staining was positive for thyroid transcription factor 1, S-100 protein, and glial fibrillary acidic protein. The pituicytoma was diagnosed based on histologic findings. The authors review herein the literature on clinical presentation, diagnosis, surgical management, and outcome.

BACKGROUND: Rapid adrenocorticotropin (ACTH) stimulation test using 250ug of ACTH (1-24) has been used as a standard test in the initial assessment of adrenal function. However, it has recently been suggested that a rnaximal cortisol response can be achieved with a much lower ACTH dose, and reducing the dose might further enhance the sensitivity of the test in the detection of mild adrenal insufficiency. This study was performed to evaluate the role of low-dose (lug) ACTH stimulation test in the assessment of adrenal function and the diagnosis of subtle adrenal insufficiency. METHODS: Twenty-two subjects with suspected adrenal insufficiency due to long-term corticosteroid use were included in this study. The correlations between clinical features and the serum cortisol responses to low dose (lug) and high dose (250 ug) ACTH stimulation were evaluated. RESULTS: In high dose test, 10 (67%) out of 15 subjects with clinical features of adrenal insufficiency showed decreased serum cortisol response (peak cortisol level <18 ug/dL), but 5 (33%) subjects showed normal response (peak cortisol level > 18ug/dL). On the other hand, 14 (93%) subjects with clinical features of adrenal insufficiency showed decreased serum cortisol response in low dose test, while only one showed normal response. In 7 subjects without clinical features of adrenal insufficiency, 5 subject (71%) showed normal response, and 2 subjects (29%) showed decreased response in both low and high dose tests. CONCLUSION: These results suggest that the 1-ug low dose ACTH stimulation test might be more sensitive than conventional 250-ug test in the detection of mild adrenal insufficiency. Further studies are needed to determine the optimal dose of ACTH and the criteria for normal response to ACTH stimulation.
Adrenal Insufficiency* ; Adrenocorticotropic Hormone* ; Cosyntropin ; Diagnosis* ; Hand ; Hydrocortisone

PURPOSE: The purpose of this study is to evaluate the clinical and radiologic results of using Acutrak screws for treating ankle medial malleolar fracture. MATERIALS AND METHODS: We reviewed 38 cases of ankle medial malleolar fracture treated with Acutrak screws from February 2005 to May 2008. RESULTS: In clinical result, there were 30 exellent cases, 7 good cases, 1 fair case. In radiologic result, there is no case with reduction loss. Average union time is 10.5 weeks. CONCLUSION: We conclude that Acutrak screw fixation is a useful method for ankle medial malleolar fracture, there are many advantages in accurate anatomical reduction, small incision, short operative time.
Animals ; Ankle ; Operative Time

BACKGROUND: Clinical concern and incidence of mycotic keratitis in ophthalmic practice has been increasing. OBJECTIVE: The purpose of this study was to investigate clinical and mycological feature of mycotic keratitis. METHODS: We evaluated the clinical and mycological aspect of mycotic keratitis in 14 patients from October 1993 to March 1997 in Dongguk Unversity Hospital. RESULTS AND CONCLUSION: Mycotic keratitis showed high incidence in fifth (42.9%), sixth (35.7%), and fourth decade (14.3%). The ratio of male to female patient was 1:3.6. The seasonal prevalence was highest in autumn. A scratch or abrasion from vegetation was the most common type of the eye trauma in mycotic keratitis. The positive rate of KOH examination and culture was 92.9%, respectively. The common causative organisms of mycotic keratitis were Fusarium sp. (38.5%) and Alternaria sp. (38.5%), followed by Curvularia sp. (7.7%), Aspergillus flavus (7.7%) and Acremonium sp. (7.7%).
Acremonium ; Alternaria ; Aspergillus flavus ; Female ; Fusarium ; Humans ; Incidence ; Keratitis* ; Male ; Prevalence ; Seasons

Skeletal muscles are known to have tolerance to ischemia, but a prolonged ischemia can cause damage to muscular tissues. The ischemia-reperfusion injury results from the oxygen free radicals released by leucocytes and formed by the reaction of hypoxanthine and xanthine oxidase. Superoxide dismutase (SOD), one of major antioxidant enzymes ocurring in the various tissues of the body metabolizes or scarvanges the oxygen free radicals. Although many studies reported difference in tolerance to ischemia and reperfusion between white and red muscles, some other investigators failed in finding such difference. The present study was performed to examine effects of graded periods of ischemia and reperfusion on the cellular ultrastructure and activity of SOD in white and red muscles. The Sprague-Dawley rats (200~250 g) were used as experimental animals. Under pentobarbital (50 mg/kg IP) anesthesia, incision was made on lower abdomen and left common iliac artery was occluded by means of a vascular clamp for 2, 4 and 6 hour (hrs). Thereafter, the superficial portion of mid-belly of anterior tibial muscle and soleus muscles were excised at 0, 24 and 72 hrs after onset of reperfusion. The specimens were sectioned into slices, 2 mm in length, 1 mm in width and thickness. Some specimens were prepared for electron microscopic observation and others for determination of SOD activity by using antihuman Cu, Zn- and Mn-SOD antibodies. The results obtained were as follows. 1. In anterior tibial muscle, areas with loose electron-density and dilated cristae were observed in the mitochondria immediately after 2 hrs of ischemia, while widened intermyofibrillar spaces and dilated cisternae of sarcoplasmic reticulum were seen after 2 hrs and 24 hrs reperfusion. When subjected to 2 hrs ischemia and 72 hrs reperfusion, no significant change was found in the cellular ultrastructure. 2. In soleus muscle, electron density was loose in the matrix of mitochondria immediately after 2 hrs of ischemia, while cisternae of sarcoplasmic reticulum were dilalated after 2 hrs of ischemia and 24 hrs reperfusion. Following 2 hrs of ischemia and 72 hrs reperfusion, the electron microscopic findings were similar to those of normal rats. 3. The changes in cellular ultrastructure were more prominent in both the 4 hrs and 6 hrs ischemia groups, in which degree of ultrastructural changes were proportional to duration of reperfusion. 4. In anterior tibial muscle, trace or weak immunoreactivities of Cu, Zn- and Mn-SOD were seen, whereas trace immunoreactivity of Cu, Zn-SOD and trace or weak immunoreactivity of Mn-SOD were observed in soleus muscle. 5. The immunoreactivities of Cu, Zn- and Mn-SOD were not altered in 2 hrs ischemic and 72 hrs reperfused group, while they were increased slightly in 2 hrs ischemic and 24 hrs reperfused group. 6. In both muscles, the activity of SOD increased following 4 hrs or 6 hrs ischemia and 24 hrs or 72 hrs reperfusion. The changes in immunoreactivity of Mn-SOD were not different between two muscles, whereas immunoreactivity of Cu, Zn-SOD were higher in anterior tibial muscle. Consequently, it is suggested that significant ischemia reperfusion injuries are produced after 4~6 hrs ishemia followed by 24 hrs or 72 hrs reperfusion, that anterior tibial muscle is more susceptible to ischemic reperfusion injury and that the ischemic-reperfusion injury is closely related with activity of SOD.
Abdomen ; Anesthesia ; Animals ; Antibodies ; Free Radicals ; Humans ; Hypoxanthine ; Iliac Artery ; Ischemia* ; Mitochondria ; Muscle, Skeletal ; Muscles* ; Oxygen ; Pentobarbital ; Rats* ; Rats, Sprague-Dawley ; Reperfusion Injury ; Reperfusion* ; Research Personnel ; Sarcoplasmic Reticulum ; Superoxide Dismutase ; Xanthine Oxidase

PURPOSE: Base on the concept of the Mac stitch, we designed the modified Mac-suture bridge technique to improve the outcome of arthroscopic repair of rotator cuff tear with poor tissue quality. Moreover, we evaluated both the radiological and clinical outcomes of the surgery to assess the effectiveness of the newly designed technique. MATERIALS AND METHODS: From January 2010 to December 2014, a total of 52 patients (25 males, 27 females) with rotator cuff tear, with poor tissue quality according to both radiological and intraoperative findings, who underwent arthroscopic rotator cuff repair using the modified Mac-suture bridge technique and followed-up for at least 1 year were included in this study. The mean patient age at the time of surgery was 60 years. The average follow-up period was 20 months. We evaluated the clinical outcomes by checking the range of motion and compared the following, both preoperatively and postoperatively: American Shoulder and Elbow Surgeon (ASES) score, University of California, Los Angeles (UCLA) score, Constant shoulder score (CSS), visual analogue scale (VAS). In addition, we analyzed 42 series of postoperative magnetic resonance imaging by using the Sugaya's classification for the evaluation of the repair integrity. RESULTS: All clinical scores showed significant improvement (ASES score improved from 56.75 to 83.44, UCLA score from 20.52 to 29.23, CSS from 64.04 to 80.90, and VAS from 6.17 to 1.62; p<0.001). The range of motion was also improved; forward flexion improved from 108° to 158°, abduction from 109° to 160°, external rotation from 27° to 50°, and internal rotation from 31° to 57° (p<0.001). Satisfactory radiologic results were noted on postoperative magnetic resonance imaging, consisting of 15 cases (35.7%) type I, 22 cases (52.4%) type II, 3 cases (7.1%) type III, 2 cases (4.8%) type IV, and no type V, according to the Sugaya's method. CONCLUSION: The modified Mac-suture bridge technique provided satisfactory results both radiologically and clinically for the treatment of rotator cuff tear with poor tendon tissue quality. It could possibly be a good alternative to previous techniques of arthroscopic repair.
California ; Classification ; Elbow ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Male ; Methods ; Range of Motion, Articular ; Rotator Cuff* ; Shoulder ; Sutures* ; Tears* ; Tendons

This study was intended to explore the effects of endothelium-independent, direct smooth muscle relaxants(papaverine, verapamil) and endothelium-dependent vasodilators(acetylcholine, bradykinin, adenosine) on the isolated cavernosal smooth muscle strips taken from diabetic men with impotence. When smooth muscle contraction was evoked with norepinephrine for the study of relaxation to these vasodilators, the tension induced was similar in diabetic and non-diabetic men with importance. Papaverine showed the strongest relaxation response followed by verapamil, acetylcholine, bradykinin and adenosine both in non-diabetic and in diabetic men. Relaxation of the cavernosal tissues to endothelium-independent vasodilators was similar in non-diabetic and diabetic men. However, the relaxation response of the tissues to endothelium-dependent vasodilators was significantly reduced in the diabetic group compared with that in the non-diabetic group (p<0.05). In conclusion, the impairment of endothelium-mediated relaxation of cavernosal smooth muscle seems to play a more important role in the pathogenesis of diabetogenic impotence rather than the problem of smooth muscle itself. This finding forms a rational basis for the use of intracavernosal injections of vasodilators to induce endothelium-independent relaxation of the cavernosal smooth muscle in the patients with diabetogenic impotence.
Adult ; Comparative Study ; Diabetes Mellitus/*physiopathology ; Endothelium, Vascular/*physiology ; Human ; Impotence/*physiopathology ; In Vitro ; Male ; Middle Age ; Muscle Relaxation/drug effects ; Muscle, Smooth/*drug effects/physiology ; Penis/*physiopathology ; Vasodilator Agents/*pharmacology

BACKGROUND: Diabetic nephropathy is the most frequent complication in patients with diabetes mellitus (DM). In clinical practice, the glomerular filtration rate (GFR) is often estimated from serum creatinine. Recently, serum cystatin C has been suggested being a better parameter for diagnosis of impaired renal function. We evaluated serum cystatin C as a potential new marker of GFR in diabetes patients. METHODS: Serum cystatin C and serum creatinine (sCr) were measured in 73 DM patients to evaluate their usefulness in diabetic patients. DM patients were divided into three groups (whole DM patients, albuminuric patients, and DM patients with sCr<1 mg/dL). Serum cystatin C and sCr were compared with creatinine clearance (CCr). RESULTS: The overall correlation coefficient for the reciprocal of serum cystatin C was superior to that of the reciprocal of serum creatinine in all three patient groups. With CCr cut-off values of 60 mL/min and 80 mL/min, receiver operating characteristic (ROC) plotting demonstrated that serum cystatin C had a higher sensitivity and specificity for detecting decreased GFR than did serum creatinine in all three patient groups. CONCLUSIONS: These findings suggest that serum cystatin C is superior to serum creatinine as a marker of GFR measured by correction or mean ROC-plot AUC in diabetic patients; therefore, serum cystatin C could be used for the early detection of the impairment of renal function.
Area Under Curve ; Creatinine ; Cystatin C* ; Diabetes Mellitus ; Diabetic Nephropathies ; Diagnosis ; Glomerular Filtration Rate ; Humans ; ROC Curve ; Sensitivity and Specificity

PURPOSE: The structural performance of a fixation system was investigated in the case of screw insertion into the pedicular canal with or without its threads fastened in the cortex and in the broken pedicle. MATERIALS AND METHODS: The symmetric geometric model was used for the pull-out test, and the simplified 3-dimensional model at 3 level, namely, the 3rd, 4th and 5th lumbar vertebrae, was used for the axial compressive loading test. RESULTS: According to the result of the axial-loading test, bending moments and Von-Mises stresses were increased at the junction between the head and the 2nd and 3rd pitches of the lumbar pedicle screw and at the center of 4th lumbar vertebral body, in the models of intact, posterior elements removed and unstable fractured spines. As the results of flexibility, there is no difference in intra-cortical insertion compared to intra-medullary pedicle insertion in the intact spine model. However, flexibility of the laminectomy model was 8% better that of the intra-cortical insertion, and the unstable fracture model 2% better. CONCLUSION: There is no difference in the flexibility of intra-cortical and intra-medullary pedicle screw insertion. The stability of the posterior structure is more important than anterior pedicle screw fixation.
Head ; Laminectomy ; Lumbar Vertebrae ; Pliability ; Spine