No abstract available.
Head* ; Pancreas*

The abnormalities in Hypothalamic-pituitary-adrenal(HPA) axis are associated with many psychiatric symptoms including depression. We present a report of a 71 year old man who was admitted to the psychiatric department presenting symptoms of headache, avolition, loss of energy, psychomotor retardation, poor appetite, insomnia, anxiety resulting from adrenal insufficiency and hypopituitarism. Hypothyroidism and electrolyte disturbance were managed and headache, insomnia, anxiety, GI symptoms were improved. But he remained in anergic state. After discharge, he was readmitted to infection department with high fever and drowsy mentality. Adrenal insufficiency was recognized and he was treated with corticosteroid replacement therapy. Finally his diagnosis was made as panhypopituitarism and overall symptoms were resolved. In this case, we showed how the atypical symptoms resulting from hypopituitarism develop and progress. Hypothyroidism, adrenal insufficiency, and growth hormone deficiency resulting secondarily from panhypopituitarism were associated with various nonspecific symptoms such as loss of energy, fatigue, insomnia, weight loss, decreased appetite etc. In clinical situation, differential diagnosis with depression is needed when clinicians were met a patient with these nonspecific symptoms. It is important that laboratory tests and differential diagnosis with endocrine diseases should be conducted, especially in geriatric patients with nonspecific symptoms like anergia, fatigue, poor appetite and so on.
Adrenal Insufficiency ; Anxiety ; Appetite ; Axis ; Depression ; Diagnosis, Differential ; Endocrine System Diseases ; Fatigue ; Fever ; Growth Hormone ; Headache ; Humans ; Hypopituitarism ; Hypothyroidism ; Sleep Initiation and Maintenance Disorders ; Weight Loss

OBJECTIVES: Delirium is a disorder defined as a sudden disturbance in thinking, speaking, acting and sleep pattern due to altered level of consciousness and cognitive function. The objective of this study is to analyze characteristics and therapeutic methods of the delirious patients during the recent 5 years, and provide basic data for further studies and investigation regarding delirium in the occurrence and treatment. METHODS: We retrospectively reviewed medical records of 475 patients who were consulted for delirium in Kyunghee University Medical Center from January 2007 to December 2011. RESULTS: During the 5 years, among the 475 patients who were diagnosed as delirium, men were more common(61.7%). The most commonly consulted reason and cause were sleep disturbance(80.8%) and post-operational delirium(30.9%), respectively. The medication prescription percentage was 76.6% and was significantly increased year after year. Ratio of using antipsychotics were 76.4% among prescribed medication and the most frequently prescribed antipsychotic drug was quetiapine(46.8%). Other specialists commonly misdiagnosed delirium when the patient was previously diagnosed as dementia(6.8%). CONCLUSIONS: In our study, post-operational delirium was the most commonly referred reason and the percentage of medication prescription tended to increase. Patients with history of dementia were more easily misdiagnosed as diseases other than delirium. Our study suggests that we should evaluate symptoms, causes, reasons of consultation, management tendency of delirium. We should also closely observe changes in sleep patterns and establish the prevention strategies for post-operational delirium and therapeutic bases for pharmacotherapy.
Academic Medical Centers ; Antipsychotic Agents ; Consciousness Disorders ; Delirium ; Dementia ; Humans ; Male ; Medical Records ; Prescriptions ; Retrospective Studies ; Specialization ; Thinking

Emphysematous cholecystitis is an uncommon condition which may mimic acute cholecystitis. But it differs from acute cholecystitis in its relatively greater frequency in men and diabetics and has graver prognosis. The condition is diagnosed by demonstration of air in lumen,wall of gallbladder and/or pericholecystic space using a variety of radiographic techniques: simple abdominal radiography, ultrasonography and CT scanning. One illustrative case is presented herein and the pertinent literature is reviewed.
Cholecystitis, Acute ; Emphysematous Cholecystitis* ; Gallbladder ; Humans ; Male ; Prognosis ; Radiography, Abdominal ; Tomography, X-Ray Computed ; Ultrasonography

PURPOSE: To obtain magnetization transfer ratio(MTR) of the annulus fibrosus and nucleus pulposus and to assess the feasibility of utilizing the changes of these MTRs as an early indicator of disk degeneration. MATERIALS AND METHODS: MR images of lumbar spine with magnetization transfer(MT) technique in 42 patients were obtained. spin echo techniques (600/14) with same TR/TE with 1KHz off-resonance saturation were employed in 1.0T MR system. MTRs were calculated in two regions, anterior annulus fibrosus and nucleus pulposus, and the results were compared between the normal and degenerative disks, from grade I to IV, on T2-weighted images. RESULTS: MTRs of the nucleus pulposus were 17.6% in the normal disks, and 26.7%, 28.4%, 29.1%, 29.7% in degenerative disks, from grade I to IV, respectively, with a significant difference(P<0.05). On the other hand, MTRs in the annulus fibrosus were 30.2% in the normal disks and 31.5%, 33.2%, 32.1% and 35.6% in degenerative disks, from grade I to IV, respectively, without significant difference. CONCLUSION: Since MTRs are significantly higher in degenerative nucleus pulposus than those of the normal disks, increased MTRs in the nucleus pulposus can be used as an early sign of the degeneration of the nucleus pulposus.
Hand ; Humans ; Intervertebral Disc Degeneration* ; Magnetic Resonance Imaging* ; Spine

PURPOSE: The authors sought to determine the neuroprotective effect of melatonin in a model of ischemic injury in rabbit retina. METHODS: Ischemia was induced by high intraocualr pressure. A dose of 100 microgram of melatonin or dimethyl sulfoxide(DMSO) alone was injected intravitreally just after the induction of ischemia. After 7 and 14 days, the neuroprotective effect of melatonin on ischemic retina was examined with light microscope and transmission electron microscope. RESULTS: The authors found reduction of cytoplasm of retinal ganglion cell(RGC), vacuole formation, chromatin condensation and rupture of nuclear membrane in ischemia-injured eyes treated with DMSO alone. But in melatonin treated eyes, we found that RGC layer's thickness and number of RGC reduced and destruction of cytoplasmic organells and nuclear damage were minimal. The partial recovery of wave is noted in melatonin-treated eyes after ischemia induction. CONCLUSIONS: The melatonin(100 microgram) protected the rabbit retina from high intraocular pressure-induced ischemic injury when administered intravitreally. Melatonin may be useful to decrease neuronal damage in the retina as a result of ischemic injury. But further investigations are neccesary to decide effective concentration, route and time of administration.
Chromatin ; Cytoplasm ; Dimethyl Sulfoxide ; Ganglion Cysts ; Ischemia* ; Melatonin* ; Neurons ; Neuroprotective Agents* ; Nuclear Envelope ; Retina ; Retinaldehyde* ; Rupture ; Vacuoles

Recently short term chemotherapy has become popular for the treatment of genitourinary tuberculosis. But it is questionable weather short term chemotherapy can cure all cases of genitourinary tuberculosis regardless of their severity ;and the role of nephrectomy in patients with renal tuberculosis is still controversial. Herein we analyzed 52 patients with confirmed urinary tuberculosis who were treated with triple drugs, including isoniazid, rifampicin and ethambutol, for 6 to 9 months. The patients ranged from 13 to 71 years of age, and the male to female ratio was 2.4: 1. Follow up period ranged from 6 to 65 months with a mean period of 19.7 months. The patients were classified according to the severity of renal tuberculosis on pyelography into Group I ( minimal, 8 patients), II (moderate, 9 patients) and III (severe, 35 patients), and treatment result were analyzed in each group. Of 52 patients, 19 were treated by chemotherapy only and 33 (63.5%) reconstructive surgery. Success rates of short term chemotherapy in terms of cure of tuberculosis and preservation of functional renal tissue were :overall 75%, 100% in Group I , 77% in Group II and 68.6% in Group III. Two of 9 patients in Group II and 10 of 17 in Group III who were treated with chemotherapy only, deteriorated with loss of the kidney. Poor vascular pyonephrotic kidney and progressive ureteral stricture were suggested as the main cause of failure. Ureteroneocystostomy and double J enting were helpful not only in the preservation of the kidney but also in the rapid cure of a renal tuberculosis. 24 patients who were treated with 6 to 9 months chemotherapy after removal of their nonfunctioning kidney were relapse-free on follow up. In conclusion, 6 to 9 months chemotherapy is adequate minimal urinary tuberculosis. For the treatment of moderate to advanced urinary tuberculosis, a longer period of chemotherapy may be adequate, and meticulous follow up with IVP and aggressive management of ureteral stricture is essential. A far advanced, nonfunctioning, unilateral tuberculosis kidney is better to be removed early, followed by 6 to 9 months' chemotherapy.
Constriction, Pathologic ; Drug Therapy* ; Ethambutol ; Female ; Follow-Up Studies ; Humans ; Isoniazid ; Kidney ; Male ; Nephrectomy ; Rifampin ; Tuberculosis* ; Tuberculosis, Renal ; Ureter ; Urography ; Weather

A case of Korean hemorrhagic fevery confirmed by fluorescent antibody technique in a 8years old boy was reported with a brief review of references.
Fluorescent Antibody Technique* ; Hemorrhagic Fever with Renal Syndrome* ; Humans ; Male

PURPOSE: Magnetization transfer imaging(MTI) is a new imaging contrast technique. Our MT pulse sequence is designed as fixed time interval between echo and MT pulse. This study was peformed to evaluate the influence of variations in TR/TE on MTR in T1 weighted image of normal brain tissue on this kind of MT pulse sequence. MATERIALS AND METHODS: Seven healthy volunteers in twenties of age as the objectives, MRI was taken under various TR/TE(TR/TE ;700/14, 650/14, 750/14, 700/20 and 1500/20 msec). MTR was calculated from signal intensities measured at the same point in both pre and post MT images and statisticslly analyzed. The MR imager used in this study was 1.0T Magnetom 42SP(Siemens, Erlangen, Germany) and the parameters of additional MT pulse sequence were offset 1000Hz and bandwidth 250Hz, and posteriorly located to echo with 7.7 msec fixed interval. Offset of this MT pulse was variable. RESULT: In white matter of brain tissue from a normal person, MTR was 34-39%(average 37%) for TR and TE of 700/14 in T1WI and 33-36%(average 35%) for TR/TE of 650/14, and 34-38%(average 35%) for TR/TE of 750/14 which showed no statistical difference. However, in case of 1500/20 of TR/TE, MTR was 26-28%(average 26%) which is statistically significant. With TR/TE of 700/14 as the standrd value, the MTR of gray and white matter were 37% and 29% respectively, showing a definite difference of statistical means. Signal from CSF in ventricles is rarely influenced by MT pulse. CONCLUSION: Conclusively, a subtle variation in TR/TE in T1WI has little influence on MTR but wide range of variation in TR/TE as in proton density image induces significant difference in MTR on this kind of MT pulse sequence. Therefore, the exchangeable usage of MTR data would be possible in narrow range of TR/TE change but difficult in wide range of variation.
Brain* ; Healthy Volunteers ; Humans ; Magnetic Resonance Imaging ; Protons ; Reference Values*

No abstract available.
Meconium* ; Retrospective Studies*