We tried to correlate brain CT findings with clinical state at admission and outcome at discharge in 42 selected cases from 94 adult patients under the diagnosis of tuberculous meningitis at Seoul National University Hospital during last four years from 1981. Their clinical state at admission and outcome at discharge were classified into three groups by severity of symptoms, respectively. The final outcome of them were well correlated with their clinical states at admission. Observed abnormal brain CT findings in this series were hydrocephalus (74%), dirthy cisternal enhancement (52%), infraction (38%), periventricular low density (36%), and tuberculoma (19%). The poorer the clinical state at admission and outcome at discharge, the more frequent the abnormal brain CT findings, especially of periventricular low density and infraction. But periventricular low density without infarction seemed to affect more deleterious effect on clinical state at admission than on final outcome.
Adult ; Brain* ; Diagnosis ; Humans ; Hydrocephalus ; Infarction ; Seoul ; Tuberculoma ; Tuberculosis, Meningeal*

Cutaneous metastatic tumors on the scalp from the rectum are very A 66-year-old male presented a nodule and papule an his scalp three months after surgical removal of a rectal adenocarcinorna. Biopsy specien from the scalp showed adenocarcinoma which is similar to the primary rectal carcinoma.
Adenocarcinoma* ; Aged ; Biopsy ; Humans ; Male ; Rectum* ; Scalp*

No abstract available.
Arthritis, Rheumatoid* ; Limbic Encephalitis*

BACKGROUND: Pediatric hand burns are a difficult problem because they lead to serious hand deformities with functional impairment due to rapid growth during childhood. Therefore, adequate management is required beginning in the acute stage. Our study aims to establish surgical guidelines for a primary full-thickness skin graft (FTSG) in pediatric hand burns, based on long-term observation periods and existing studies. METHODS: From January 2000 to May 2011, 210 patients underwent primary FTSG. We retrospectively studied the clinical course and treatment outcomes based on the patients' medical records. The patients' demographics, age, sex, injury site of the fingers, presence of web space involvement, the incidence of postoperative late deformities, and the duration of revision were critically analyzed. RESULTS: The mean age of the patients was 24.4 months (range, 8 to 94 months), consisting of 141 males and 69 females. The overall observation period was 6.9 years (range, 1 to 11 years) on average. At the time of the burn, 56 cases were to a single finger, 73 to two fingers, 45 to three fingers, and 22 to more than three. Among these cases, 70 were burns that included a web space (33.3%). During the observation, 25 cases underwent corrective operations with an average period of 40.6 months. CONCLUSIONS: In the volar area, primary full-thickness skin grafting can be a good indication for an isolated injured finger, excluding the web spaces, and injuries of less than three fingers including the web spaces. Also, in the dorsal area, full-thickness skin grafting can be a good indication. However, if the donor site is insufficient and the wound is large, split-thickness skin grafting can be considered.
Burns ; Child, Preschool ; Congenital Abnormalities ; Demography ; Female ; Fingers ; Hand ; Hand Deformities ; Humans ; Incidence ; Male ; Medical Records ; Retrospective Studies ; Skin ; Skin Transplantation ; Tissue Donors ; Transplants

A ganglioneuroma is a rare benign tumor that originates in the neural crest, and is found along the path of the sympathetic chain, from the base of the skull to the pelvic cavity. It is characterized histologically by the composition of mature ganglion cells and nerve fibers. Due to the slow growth of the tumor, it may be incidentally found or detected by the pressure effects on adjacent structures. Herein, a case of a ganglioneuroma arising from the retroperitoneal sympathetic chain is reported in a 45-year-old female patient with a review of the literature.
Female ; Ganglion Cysts ; Ganglioneuroma* ; Humans ; Middle Aged ; Nerve Fibers ; Neural Crest ; Retroperitoneal Space ; Skull

BACKGROUND: Previous studies have suggested that recombinant human thyroid stimulating hormone (rhTSH) stimulation is an acceptable alternative to thyroid hormone withdrawal (THW) when radioiodine remnant ablation is planned for thyroid cancer treatment, based on superior short-term quality of life with non-inferior remnant ablation efficacy. This study evaluated the cost-effectiveness of radioiodine remnant ablation using rhTSH, compared with the traditional preparation method which renders patients hypothyroid by THW, in Korean perspective. METHODS: This economic evaluation considered the costs and benefits to the Korean public healthcare system. Clinical experts were surveyed regarding the current practice of radioiodine ablation in Korea and their responses helped inform assumptions used in a cost effectiveness model. Markov modelling with 17 weekly cycles was used to assess the incremental costs per quality-adjusted life year (QALY) associated with rhTSH. Clinical inputs were based on a multi-center, randomized controlled trial comparing remnant ablation success after rhTSH preparation with THW. The additional costs associated with rhTSH were considered relative to the clinical benefits and cost offsets. RESULTS: The additional benefits of rhTSH (0.036 QALY) are achieved with an additional cost of Korean won 961,105, equating to cost per QALY of 26,697,361. Sensitivity analyses had only a modest impact upon cost-effectiveness, with one-way sensitivity results of approximately 33,000,000/QALY. CONCLUSION: The use of rhTSH is a cost-effective alternative to endogenous hypothyroid stimulation prior to radioiodine ablation for patients who have undergone thyroidectomy in Korea.
Cost-Benefit Analysis ; Delivery of Health Care ; Humans* ; Korea ; Quality of Life ; Quality-Adjusted Life Years ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy ; Thyrotropin Alfa ; Thyrotropin*

OBJECTIVE: There are two established surgical treatment options for carotid artery stenosis. Carotid endarterectomy (CEA) has been accepted as a gold standard for surgical treatment while carotid artery stenting (CAS) has recently become an alternative option. Each treatment option has advantages and disadvantages for the treatment outcomes. We propose a protocol for selection of a proper surgical treatment option for carotid artery stenosis. MATERIALS AND METHODS: A total of 192 published articles on management of carotid artery stenosis were reviewed. Preoperatively considerable factors which had been repeatedly noted in those articles for the risk/benefits of CEA or CAS were selected. According to those factors, a protocol with four categories was established. RESULTS: CEA or CAS is indicated when the patient has a symptomatic stenosis > or = 50%, or when the patient has an asymptomatic stenosis > or = 80%. Each treatment option has absolute indications and favorable indications. Each absolute indication is scored with three points, and each favorable indication, one point. Based on the highest scores, a proper treatment option (CEA or CAS) is selected. CONCLUSION: We have been treating patients according to this protocol and evaluating the outcomes of our protocol-based decision because this protocol might be helpful in assessment of risk/benefit for selection of a proper surgical treatment option in patients with carotid artery stenosis.
Carotid Arteries ; Carotid Stenosis* ; Constriction, Pathologic ; Endarterectomy, Carotid ; Humans ; Stents

PURPOSE: To investigate the efficacy of an amniotic membrane contact lens on corneal epithelial wound healing. METHODS: We made a model with a corneal epithelial wound by applying 6 mm round filter paper soaked with 1 N NaOHonto the central cornea in 24 eyes of 12 rabbits. The rabbits were divided into three groups: AMCL (amniotic membrane contact lens), T-AMT (temporary amniotic membrane transplantation) and the control group. We evaluated corneal wound healing every postoperative day using a digital photo slitlamp and fluorescein dye. The corneas were harvested for histopathologic studies after seven days and analyzed with hematoxylin-eosin (H & E) stain and TUNEL staining. RESULTS: The average wound healing time was similar between the amniotic membrane contact lens and the temporary amniotic membrane transplantation group. The number of the infiltrated PMNs (polymorphonuclear cells) was 8.8+/-2.58, 8.6+/-2.19 and 48.6+/-7.12 in the AMCL, T-AMT and control groups, respectively. Apoptotic keratocytes were 3.8+/-1.1, 3.6+/-1.09 and 23.2+/-5.06 in the AMCL, T-AMT and control groups, respectively. In the AMCL and T-AMT groups, the number of infiltrated PMNs and apoptotic keratocytes were significantly less than those the control group (p<0.05). There were not significant differences in the number of PMNs and apoptotic cells in the AMCL and the T-AMT groups. CONCLUSIONS: Amniotic membrane contact lenses have the benefits of being an easily applied method and having a wound healing ability comparable to that possible with conventional suture methods.
Amnion ; Contact Lenses ; Cornea ; Eye ; Fluorescein ; In Situ Nick-End Labeling ; Membranes ; Rabbits ; Sutures ; Transplants ; Wound Healing

A case is reported of neurilemmoma of the right masseteric nerve in the masseter muscle. We experienced a 34-years-old male patient who had neurilemmoma in the masseter muscle caused by chronic irritation. Special stain using S-100 immunoperoxidase was useful in establishing the diagnosis in this case. The most important aspect of this case is the anatomical site of the neurilemmoma; this tumor was originated from the masseteric nerve and is the first case reported in the masseter muscle. The patient underwent surgical excision of the tumor and no recurrence occured.
Diagnosis ; Humans ; Male ; Masseter Muscle* ; Neurilemmoma* ; Recurrence

Pheochromocytoma is derived from the chromaffin cells and patients with pheochromocytoma present with several signs and symptoms by producing, storing and secreting catecholamine. Spontaneous rupture or necrosis of pheochromocytoma is extremely rare, but it can be lethal because of the dramatic change in the circulation such as an acute abdominal emergency or shock. Spontaneous remission of the clinical symptoms due to necrosis of the pheochromocytoma is rare. We describe such a case that presented with cardiogenic shock due to extensive necrosis of the pheochromocytoma and this was followed by spontaneous remission of the clinical symptoms without removal of the pheochromocytoma.
Chromaffin Cells ; Emergencies ; Humans ; Necrosis ; Pheochromocytoma ; Remission, Spontaneous ; Rupture, Spontaneous ; Shock ; Shock, Cardiogenic