Grave's disease is an autoimmune disorder and affects thyroid gland and orbit. Ocular manifestations of this disease, referred to as Grave's ophthalmopathy are caused by deposition of antithyroglobulin immune complexes into extraocular muscles and orbital fats. Consequent increase in volume of orbital contents results in exopthalmos. Severe exopthalmos results in several significant visual consequences as follows: exposure keratitis, diplopia and optic neuropathy. Orbital decompression for Grave's ophthalmopathy has traditionally been performed through either an external or a transantral approach. The advent of intranasal endoscopes allowed for the development of a transnasal approach for medial and inferior orbital wall decompression. Recently, the authors experienced a case of Grave's ophthalmopathy complicated with exposure keratitis and performed endoscopic transnasal orbital decompression, so report this case with a review of literature.
Antigen-Antibody Complex ; Decompression* ; Diplopia ; Endoscopes ; Fats ; Keratitis ; Muscles ; Optic Nerve Diseases ; Orbit* ; Thyroid Gland

Intentional delay of aftercoming siblings in multiple gestation is an infrequent occurrence in obstetrics. After delivery of an immature twin, conventional treatment calls for induction and delivery of the aftercoming sibling. However, several case reports have documented the feasibility of an expectant management. And also, as in our case, an aggressive treatment consisting of cerclage, tocolysis, and broad-spectrum antibiotics has been shown to prolong pregnancy. We experienced an unavoidable delivery of a nonviable first twin after premature rupture of membranes at 16 weeks' of gestation. The placenta was left undisturbed. Twin B was confirmed to be alive within the intact second sac. Tocolysis was started and cervical cerclage was done directly after delivery of twin A. Pregnancy was successfully prolonged, which enabled the second fetus to remain in utero and grow for another 145 days. To our knowledge, this was the longest interval between deliveries in a twin pregnancy reported in the literature. A healthy 3,050 gm male was delivered by cesarean section at 37 weeks' of gestation. Below we present this case in detail and discussed with respect to the aggressive approach undertaken to prolong gestation.
Anti-Bacterial Agents ; Cerclage, Cervical ; Cesarean Section ; Female ; Fetus ; Humans ; Male ; Membranes ; Obstetrics ; Placenta ; Pregnancy* ; Pregnancy, Twin ; Rupture ; Siblings ; Tocolysis ; Twins*

PURPOSE: It is not clear that the development of glomerular injury and aggravation by tumor necrosis factor alpha (TNF-alpha) is related to intrarenal or serum concentration of TNF-alpha. So, we studied the relationship between the concentration of TNF-alpha and aggravation of glomerular damage in the Henoch-Schonlein nephritis(HSN) and idiopathic nephrotic syndrome(INS). METHODS: We collected the sera and urines of 21 patients with Henoch-Schonlein purpura(HSP) and 22 patients with INS visited Chungbuk National University hospital from March 1998 to March 2001. The concentration of TNF-alpha in the sera and urines were measured by sandwich ELISA. RESULTS: Serum TNF-alpha levels in the HSP patients with renal involvement were significantly higher than those without renal involvement(P=0.009). But urine TNF-alpha levels have no correlation with renal involvement(P=0.088). In the HSN patients, proteinuria have a significant correlation with serum TNF-alpha levels(P=0.004) but less correlation with urine TNF-alpha levels(P=0.053). Otherwise, proteinuria have no correlation with serum TNF-alpha levels(P=0.763) but have a significant correlation with urine TNF-alpha levels(P=0.007) in INS. CONCLUSION: These result suggest that the serum concentration of TNF-alpha would be important to glomerular involvement in HSP. And, it is interesting that proteinuria shows a significant relation with serum TNF-alpha levels in the HSN, but with urine TNF-alpha levels in the INS. This means the major production of TNF-alpha may be originated by extrarenal inflammation in the HSN and by intrarenal tubulo-interstitial damage due to proteinuria in the INS.
Chungcheongbuk-do ; Enzyme-Linked Immunosorbent Assay ; Humans ; Inflammation ; Nephritis* ; Nephrotic Syndrome* ; Proteinuria* ; Tumor Necrosis Factor-alpha*

PURPOSE: Anatomic configuration of the ankle joint is useful information during various ankle procedures. This study was prospectively designed to investigate the sagittal inclination pattern of the ankle joint. MATERIALS AND METHODS: Lateral standing ankle radiographs from one-hundred people (age: 17~68, M:F=45:55) and magnetic resonance (MR) sagittal ankle images from twenty-four people (age: 16~65, M:F=14:10) were studied. Post-traumatic, arthritic, or grossly deformed ankles at any reason were excluded. The posterior inclination angle (PIA) of the distal tibia was measured and compared between the lateral and the medial segment. RESULTS: On plain radiographic data, the average PIA of the distal tibia was 6.14 degrees +/-3.56 degrees (range 0 degree to 14 degrees) in the lateral segment and 13.16 degrees +/- 3.05 degrees (range 6 degrees to 22 degrees) in the medial segment. On MR imaging data, the average PIA of the distal tibia was 5.08 degrees +/- 4.26 degrees (range 1 degree to 10 degrees) in the lateral segment and 10.16 degrees +/- 4.87 degrees(range 5 degrees to 17 degrees) in the medial segment. The PIA between two segments was significantly different. CONCLUSION: The sagittal configuration of the medial area ankle joint and the lateral area ankle joint has difference in the degree of posterior inclination and shape of curvature.
Ankle Joint* ; Ankle* ; Magnetic Resonance Imaging ; Prospective Studies ; Tibia

Neurofibromatosis is a syndrome of multiple neurofibromas, abnormal skin pigmentation and certain bony abnormalities. Sometimes the growth of plexiform neurofibromatosis on the face or trunk is centripetal and usually involves the mediastinum and skull base. However, it is very rare that neurofibromatosis involves the trigeminal ganglion. Its encroachment around the foramina of the skull base may induce facial palsy or conductive hearing loss. The guiding principle in the treatment of generalized neurofibromatosis is a radical excision with preservation of vital structures and an immediate reconstruction of the bony skeleton and soft tissue defect. The authors experienced 4 cases of neurofibromatosis involving the trigeminal ganglion. All had trigeminal symptoms for 3 to 4 years. These were severe headache and intractable trigeminal neuralgia. Tumors in all 4 cases were spread in the centripetal type from extracranial neurofibromatosis. The facial nerve was affected in 4 cases. Malignat Schwannoma occurred in 1 case. Accurate diagnosis and assessments were necessary with CT, MRI art oomputer-aided simulation design. Intraoperative bleeding was minimal with hypotensive anesthesia. Surgical approach to the middle cranial fossa involved temporary removal of the zygomatic arch and TMJ disarticulation with downward traction of the mandible. Satisfactory results have been obtained far 3 to 7 years(mean 5 years) follow-up.
Anesthesia ; Cranial Fossa, Middle ; Diagnosis ; Disarticulation ; Facial Nerve ; Facial Paralysis ; Follow-Up Studies ; Headache ; Hearing Loss, Conductive ; Hemorrhage ; Magnetic Resonance Imaging ; Mandible ; Mediastinum ; Neurilemmoma ; Neurofibromatoses* ; Neurofibromatosis 1 ; Skeleton ; Skin Pigmentation ; Skull Base ; Temporomandibular Joint ; Traction ; Trigeminal Ganglion* ; Trigeminal Neuralgia ; Zygoma

OBJECTIVES: This study was designed to assess the epidemiology of DSM-IV posttraumatic stress disorder(PTSD), including information on lifetime and current prevalence, the kinds of traumas most often associated with PTSD, and sociodemographic correlates. METHOD: For this survey, an urban area with total population of 611,921 persons was chosen. Modified version of traumatic event checklist and Clinician Administered PTSD Scale were administrated to a representative sample of 850 persons aged 15 to 65 years above through home visiting. RESULTS: The lifetime and current prevalence of PTSD in survey area was 4.71% and 2.12%. the lifetime and current prevalence in male and female were of no significant statistical differences(p>.05). And the lifetime prevalence by age, and education were of no significant statistical differences. Only the lifetime prevalence by marital status was of significant statistical differences(p<0.001). The lifetime prevalence to any traumatic exposure was 78.79%. Sudden unexpected death of a close person was the most prevalent traumatic event(51.06%). Among the traumas, natural disaster, fire and explosion, motor vehicle accident, serious accident at work or home, physical assault, assault with a weapon, combat, life-threatening illness, and serious injury to death you caused to someone else were more commonly associated with male sex, and sexual assault was more commonly associated with female sex. The traumas commonly associated with PTSD were natural disaster, fire and explosion, motor vehicle accident, serious accident at work or home, physical assault, sexual assault, combat, and life-threatening illness. CONCLUSION: The lifetime and current prevalence in survey area were lower than those of previous studies. This study found differences between men and women on the type of trauma experienced, and the type of trauma associated with PTSD. Future epidemiological studies to assess PTSD from all lifetime traumas rather than from only a small number of retrospectively reported ones will be required, and larger sample size covering the country will be required for better estimation.
Checklist ; Diagnostic and Statistical Manual of Mental Disorders ; Disasters ; Education ; Epidemiologic Studies* ; Epidemiology ; Explosions ; Female ; Fires ; House Calls ; Humans ; Male ; Marital Status ; Motor Vehicles ; Prevalence ; Retrospective Studies ; Sample Size ; Stress Disorders, Post-Traumatic* ; Weapons

PURPOSE: To investigate the perception and barriers of Kangaroo-Mother Care (KMC) among nurses in Neonatal Intensive Care Units (NICU). METHODS: Participants were 131 nurses working in NICU who completed self-report questionnaires which included information regarding perception, barriers, and practice of KMC. Collected data were analyzed using SPSS 18.0 program for descriptive statistics, t-test, ANOVA, and Pearson correlation coefficients. RESULTS: Of the participants, 33.6% reported the practice of KMC in their NICU, with 75.6% wanting to receive training in KMC and 31.3% having received KMC education. Most of the participants agreed that KMC enhances attachment, parental confidence, and effective breast feeding but they reported a negative perception in providing KMC for premature infants weighing less than 1000 grams or intubated premature infants. Major barriers to practicing KMC were safety of infants, possible work overload for nurses, as well as absence of consistent guidelines. Barriers to KMC among nurses who received the KMC training were lower than nurses who did not receive the KMC training (t=-2.11, p=.037). CONCLUSION: Education program and standardized clinical practice protocol should be developed to foster the positive perception and to reduce nurse barriers to KMC.
Breast Feeding ; Education ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Intensive Care Units ; Intensive Care Units, Neonatal ; Intensive Care, Neonatal* ; Kangaroo-Mother Care Method* ; Parents

PURPOSE: To determine changes in the signal intensity of intracerebral hemorrhagic lesions according to the time interval, between the onset of symptoms and MR imaging in the T1-weighted (T1W1), T2-weighted (T2W1) and diffusion-weighted modes. MATERIALS AND METHODS: Thirty-four patients with hemorrhagic stroke who underwent DWI and conventional MRI were involved in this study. Hemorrhagic phase was determined according to the time interval between the onset of symptoms and MR scanning, and was as follows: acute (3 days or less): eight patients); early subacute (7 days or less): ten patients; late subacute (4 weeks or less): seven patients; early chronic (3 months or less) : four patients); and late chronic (more than 3 months): five patients. Using a 1.5T MR imager and the single-shot echo-planar imaging technique, T1-weighted, fast spin-echo T2-weighted, and diffusion-weighted were obtained. In all cases qualitative signal intensity (SI) at the center of a lesion was recorded, and the ratio between this and normal brain parenchyma was calculated. RESULTS: SI at the center of a lesion was found to be iso or high/high/high (T1WI/T2WI/DWI) in five of eight acute-phase cases (interval of 24 hours or less) and low/low/low in the remaining three (interval of 72 hours or less). Other signal intensities were as follows: early subacute phase: high/low/low (all ten cases); late subacute phase: high/high/high (all seven cases); early chronic phase: high/high/high (all four cases); late chronic phase: low/high/low (all five cases). Mean SIRs were as follows: in the five acute-phase cases in which SI was iso or high: 1.42+/-0.78 / 2.58+/-0.84 / 1.35+/-0.08 (T1WI / T2WI / DWI); in the remaining three acute-phase cases: 0.94 +/-0.18 / 0.63+/-0.16 / 0.27+/-0.10; in the early subacute phase, 1.35+/-0.01 / 0.97+/-0.21 / 0.86+/-0.22 in early subacute phase, 1.58+/-0.04 / 1.54+/-0.09 / 1.44+/-0.14; in the early chronic phase: 1.26+/-0.11 / 1.06+/-0.14 / 0.97+/-0.12; and in the late chronic phase: 0.65+/-2.23 / 1.51+/-0.12 / 0.23+/-0.18. CONCLUSION: The DWI findings of intracerebral hemorrhage reflect the findings of T2WI. When interpreting the DWI findings in patients with intracerebral hemorrhage, an understanding of the temporal evolution of this is very helpful.
Brain ; Cerebral Hemorrhage ; Diffusion* ; Echo-Planar Imaging ; Humans ; Intracranial Hemorrhages* ; Magnetic Resonance Imaging ; Stroke

Mucormycosis is an uncommon opportunistic fungal infection mostly affecting immunocompromised patients and gastrointestinal mucormycosis is a rare and life-threatening. We describe a 31-year-old man with a history of idiopathic cyclic neutropenia who developed perforations of the stomach and intestine and intra-abdominal bleeding due to disseminated gastrointestinal mucormycosis after the initial operation.
Adult ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Immunocompromised Host ; Intestines ; Mucormycosis* ; Neutropenia ; Stomach