We compared the result of 6 patients[group A]treated with high dose steroid only with the result of 14 patients[group B]treated with optic canal decompression after at least 24 hours of high dose steroid therapy without improvement. 4 of 6 patients[66%]in group A and 7 of 14 patients[50%]in group B improved in visual acuity.But 1 of 6 patients[17%] in group A and 6 of 14 patients[43%]in group B had marked improvement in visual function[above 0.02].Of 5 patients with optic canal fracture in orbit CT in group B, all had improved visual function and 4 had marked improvement in visual function. If CT demonstrates bony fragments impinging on intracanalicular optic nerve, or if vision deteriorates or fails to improve during the first 24 hours of high dose steroid and initial visual acuity is no light perception, optic canal decompression is considered effective and valid treatment modality in TON.
Decompression* ; Humans ; Optic Nerve ; Optic Nerve Injuries* ; Orbit ; Visual Acuity

To evaluate the meaning of anti-HCV detection in patients treated with IVIG, serum levels of aspartate aminotranstferase(AST), alanine aminotransterase(ALT), HCV Ab titer were measured after treatment with IVIG in 36 patients diagnised of Kawasaki disease or neonatal sepsis. Also polymerase chain reaction (PCR) for the detection of HCV was done in 8 patients with persistent HCV Ab positivity at 3 months after IVIG treatment. The results were as follows 1) HCV Ab was positive in all 36 patients at 1 week after IVIG treatment, but in only 8 cases it was positive at 3 months after IVIG treatment. 2) AST, ALT were elevated in 9 cases at 1 week after IVIG treatment, but they were normalized in all cases at 3 months after IVIG treatment. 3) PCR for the detection of HCV was done in 8 patients with persistent HCV Ab positivity at 3 months after IVIG treatment, but HCV was not isolated in any cases. These results suggested that detection of anti-HCV was merely transitory phenominon of HCV Ab transmission, did not show any evidence of HCV infection due to HCV transmission.
Alanine ; Aspartic Acid ; Hepacivirus* ; Hepatitis C* ; Hepatitis* ; Humans ; Immunoglobulins* ; Immunoglobulins, Intravenous ; Mucocutaneous Lymph Node Syndrome ; Polymerase Chain Reaction ; Sepsis

The intramedullary glioma of spinal cord has occupied 22.5% of intraspinal neoplasm, and is the most common among the intramedullary spinal cord tumor, and the first successful operative removal was performed in 1907 by Elsberg. The intramedullary astrocytoma has frequent incidence in the thoracic and cervical region of the spinal cord, which has more frequent grade I astrocytoma. We experienced a case of intramedullary grade II astrocytoma of the thoracolumbar region which has associated a paraplegia as neurological deficit. A 26 year old Korean female has admitted to our clinic because of paraplegia with incontinence for 2 years. On admission, the neurological examination revealed a paraparesis below T12 level with urinary and fecal incontinence and then local tenderness from T10 to L1 level. The simple X-ray film of the thracolumbar spine has showed erosion of both pedicle, widening of interpeduncular distance and scalloping change of posterior vertebral margin from T12 to L1, which were similar to the picture of intramedullary spinal cord tumor. We performed a myelography by pantopaque through the lumbar and cisternal puncture for accurate site of lesion, and found a complete block at L1 level and T10 level on myelogram. Then the immediate total laminectomy from T8 to L1 was applied. The operative finding was a intramedullary mass with cystic fluid, which has compressed the spinal cord. After aspiration of cystic fluid, we removed the tumor mass incompletely because of intermingling with spinal cord but the decompression was enough. The neurological defict was improved gradually for post-operative 4 weeks, thereafter improvement was stopped and remained the paraparesis. The post-operative pathological diagnosis was grade II astrocytoma, which composed of anaplastic cell and radiotherapy has followed.
Adult ; Astrocytoma* ; Decompression ; Diagnosis ; Fecal Incontinence ; Female ; Glioma ; Humans ; Incidence ; Iophendylate ; Laminectomy ; Myelography ; Neurologic Examination ; Paraparesis ; Paraplegia ; Pectinidae ; Punctures ; Radiotherapy ; Spinal Cord Neoplasms ; Spinal Cord* ; Spine ; X-Ray Film

Storch is credited as being the first to describe in 1899 what we call "ependymoma" today. And ependymomas were first set apart as a single group by Bailey in 1924. The literature up to the present contains numerous reports of tumors classified as "ependymoma". From 1 to 6 percent of all intracranial tumors are ependymomas. As the above, the tumors are very rare. The incidence is higher in those with large proportion of young patients and average age is approximately 20 years. About 40 percent of intracranial ependymomas are supratentorial and the remainders are infratentorial. We experienced a case of 4th ventricular ependymoma with subarachnoid hemorrhage. A 23 year old female was admitted to the hospital because of severe headache and frequent vomiting, who had been intermittently suffered from the headache for 8 months prior to admission. On admission, the neurologic examinations revealed irritable mentality, vomiting and papilledema, and xanthochromic CSF was identified on lumbar puncture. X-ray films of skull series showed evidence of increased ICP. A mass lesion was suspected in the posterior fossa on vertebral angiogram and brain C-T films revealed a mass lesion in the midline of the posterior fossa, slightly enhanced on contrast study and associated with hydrocephalus. Following Torkildsen's shunting procedure suboccipital craniectomy was performed, and we removed the tumor mass incompletely within the 4th ventricle. The pathologically microscopic finding was papillary ependymoma, grade II. Total neuraxis irradiation was applied for 6 weeks. The post-operative course was satisfactory.
Brain ; Ependymoma* ; Female ; Headache ; Humans ; Hydrocephalus ; Incidence ; Neurologic Examination ; Papilledema ; Skull ; Spinal Puncture ; Subarachnoid Hemorrhage ; Vomiting ; X-Ray Film ; Young Adult

We experienced a case of an extradural cyst of lumbar spine associated with a freshly ruptured intervertebral disc on L3-4 intervertebral space. A 22-years old Korean female was admitted to hospital because of low back pain radiating to the both legs for about 7 weeks, after mild trauma in the running bus. The low back pain and bilateral sciatic pain had aggravated by coughing and sneezing, similar to the protruded intervertebral disc. Neurological examination revealed the signs similar to those of the protruded intervertebral disc. Simple X-ray films of lumbar spine revealed scoliosis, stretching of lumbar lordotic curve. Myelography showed a complete block from lower one third of L3 vertebral body to upper one fourth of L4 vertebral body by spinal puncture of L2-3 and L5-S1 interspace, respectively. We performed a total laminectomy of L3-4 for the above lesion. The operative finding showed an extradural cyst adhesive with L3 nerve root sheath and freshly ruptured intervertebral disc on L3-4 interspace. The extradural cyst was 2.0x1.5x0.5cm in size and its surface was not smooth but coarse. The contents of cyst was yellowish brown fluid(xanthochromic). We removed the extradural cyst completely and the ruptured(tiny tagged) contents of nucleus pulposus. The post-operative course was satisfactory, dramatically. The microscopic findings of the extradural cyst showed a simple cyst including a profuse pigments of hemosiderin, highly suggested one formed from and epidural hematoma by trauma.
Adhesives ; Cough ; Female ; Hematoma ; Hemosiderin ; Humans ; Intervertebral Disc ; Laminectomy ; Leg ; Low Back Pain ; Myelography ; Neurologic Examination ; Running ; Scoliosis ; Sneezing ; Spinal Puncture ; Spine ; X-Ray Film ; Young Adult

Neuromuscular complications after hematopoietic stem cell transplantation are rarely reported. We report one male patient with ophthalmoplegia, flaccid paralysis, and hyporeflexia after peripheral blood stem cell transplantation (PBSCT). A cerebrospinal fluid study showed albuminocytologic dissociation, and nerve conduction studies revealed demyelinating polyneuropathies. Intravenous immunoglobulin was tried following a diagnosis of Guillain-Barre syndrome (GBS). After 11 months he was able to walk alone with a walker. This is probably the first report of GBS related to PBSCT in Korea.
Dissociative Disorders ; Guillain-Barre Syndrome ; Hematopoietic Stem Cell Transplantation ; Humans ; Immunoglobulins ; Korea ; Male ; Neural Conduction ; Ophthalmoplegia ; Paralysis ; Peripheral Blood Stem Cell Transplantation ; Polyneuropathies ; Reflex, Abnormal ; Walkers

PURPOSE: To investigate the usefulness of evaluating liver cirrhosis through the measurement of liver volume. MATERIALS AND METHODS: In a control group(20 normal subjects) and 20 cirrhotic patients, variations in liver volume before and after a meal were obtained. A case-control study was conducted between the two groups. RESULTS: In the control group, the range of increased liver volume after the meal was 67-186ml. Mean increased liver volume was 119.3ml, the range of percentage increase was 6-12% and the mean percentage increase was 9.89%. In cirrhotic patients, the range of increased liver volume after the meal was 1-20ml. Mean increased liver volume was 6.9ml, the range of percentage increase was 0-1.9% and the mean percentage increase was 0.65%. Compared with the control group, cirrhotic patients showed a much smaller increase in liver volume (p<0.01). CONCLUSION: Difference in variation of liver volume between a control group and cirrhotic patients before and after a meal can be used for the evaluation of liver cirrhosis.
Case-Control Studies ; Humans ; Liver Cirrhosis* ; Liver* ; Meals ; Tomography, Spiral Computed*

PURPOSE: The purpose of the present study was to investigate the prophylactic effects of a fixed combination of dorsolamide/timolol on intraocular pressure (IOP) elevation before intravitreal anti-VEGF injection. METHODS: A prospective, randomized clinical trial was conducted on 91 eyes of 91 patients undergoing intravitreal anti-VEGF injection. The eyes were randomly divided into 2 groups, the eyes which had used the fixed prophylactic dorsolamide/timolol combination (group 1, 58 eyes) and the eyes which had not used the combination (group 2, 15 eyes). The IOP was measured one hour and 5 minutes prior to the procedure, 5 minutes interval up to 30 minutes after the procedure and one hour, 1 day, 7 days, and one month after the procedure. The IOP changes were analyzed. RESULTS: The mean 5 minutes and 30 minutes postoperative IOPs were 14.12 +/- 4.18 mm Hg and 10.87 +/- 1.58 mm Hg in group 1 and 28.21 +/- 3.16 mm Hg and 17.48 +/- 2.34 mm Hg in group 2, respectively. After IVBI, the mean 5 min postoperative IOP was 12.17 +/- 1.13 mm Hg in group 1 and 27.12 +/- 3.35 mm Hg in group 2. After IVRI, the mean 5 minutes postoperative IOP was 15.98 +/- 4.14 mm Hg in group 1 and 25.19 +/- 1.04 mm Hg in group 2. CONCLUSIONS: Prophylactic use of a fixed dorsolamide/timolol combination before intravitreal anti-VEGF injection is an easy and safe method of preventing IOP elevation immediately after intravitreal injection of bevacizumab or ranibizumab.
Antibodies, Monoclonal, Humanized ; Eye ; Humans ; Intraocular Pressure ; Intravitreal Injections ; Prospective Studies ; Timolol ; Bevacizumab ; Ranibizumab

OBJECTIVE: Although the association between low vitamin D levels and depressive symptoms has been widely reported, studies investigating the relationship between hypovitaminosis D and depressive symptomatology are scarce. METHODS: We retrospectively studied the relationship between vitamin D status and depressive symptoms in 196 patients hospitalized for a major depressive episode. RESULTS: The baseline 17-item Hamilton Depression Rating Scale total and depression factor (item 1, 2, 3, 7) scores were significantly higher in the vitamin-D-insufficiency/deficiency group than in the vitamin-D-sufficiency group. CONCLUSION: It is important to consider measuring the vitamin D levels of patients with severe and core depressive symptoms and providing vitamin D supplementation when necessary.
Anhedonia ; Depression ; Humans ; Inpatients ; Retrospective Studies ; Vitamin D ; Vitamins

Objective: The relationship among physical functional decline, low-grade inflammation, and depression remains unclear. The aim of this study was to examine the association between hand grip strength (HGS) and high-sensitivity C-reactive protein (hs-CRP) in a large sample with depression. Methods: This study used data obtained from a representative Korean sample of 9,402 people who participated in the seventh Korean National Health and Nutrition Examination Survey. Physical function was assessed using a digital grip strength dynamometer. Depression was identified using a cutoff of 5 on the Patient Health Questionnaire-9 (PHQ-9), and high hs-CPR level was defined as ≥ 3.0 mg/L. Results: In older adults (≥ 60 years) with depression, 43.8% of those with high hs-CRP levels had low HGS, compared to 21.8% of those with hs-CRP levels ＜ 3.0 mg/L (p = 0.002). Multivariate analysis revealed that, after adjustments for potentially confounding factors, high hs-CRP was independently associated with lower HGS (B = −2.25; 95% confidence interval = −4.49 to −0.02) in older adults with depression, but not in younger or middle-aged adults with depression. Conclusion These findings suggest a significant correlation between physical functional decline and low-grade inflammation in older adults with depression.