In the special cases that iris was not naturally prolapsed from the ab externo incision at the peripheral iridectomy for glaucoma(Barkan, Scheie), the iris could be easily drawn out by applying the iris suction which was designed by author. Kong iris suction is similar to the Bell erisophake, but the cup of the iris suction is transparent so that the prolapsing process through the wound could be seen. The peripheral iridectomy with smallest size of the scleral incision can be performed uing the iris suction without introducing the iris forsceps into chamber.
Iridectomy ; Iris* ; Suction* ; Wounds and Injuries

Author has designed one of the lacrimal vinyl tube which is shaped like the root of the grass (Fig 1) and also an artificial nasolacrimal duct which can be inserted into the man's nasolacimal duct through the nose (Fig 6). It is obtained good result by inserting the root- type vinyl tube the nasolacrimal duct in the cases of the obstruction on the nasolacrimal duct, which is for making permanent lacrimal intubation. Experiment has proved there were no any troubles in the normal nasolacrimal duct by inserting the artificial nasolacrimal duct into the normal man's.
Intubation ; Nasolacrimal Duct* ; Nose ; Poaceae

OBJECTIVE: To evaluate the prevalence and risk factors of clopidogrel resistance, and association between thromboembolic complications and clopidogrel resistance in patient with stent-assisted angioplasty for atherosclerotic cerebrovascular disease. METHODS: Between September 2006 and June 2008, clopidogrel resistance test was performed on 41 patients who underwent stent-assisted angioplasty for atherosclerotic cerebrovascular disease. It was performed before drug administration and about 12 hours after drug administration (loading dose : 300 mg, maintain dose : 75 mg). Two patients were excluded, and 41 patients were included (mean : 67.59+/-7.10 years, age range : 41-79). Among 41 patients, 18 patients had intracranial lesions, and 23 had extracranial lesions. We evaluated the prevalence, risk factors and complications related to clopidogrel resistance. RESULTS: Twenty-one patients (51.2%) showed clopidogrel resistance [intracranial : 10 patients (55.6%), extracranial : 11 patients (47.8%)] and no clopidogrel resistance was seen in 20 patients. Hypercholesterolemia was an indepedent risk factor of clopidogrel resistance. Stent-assisted angioplasty was technically successful in all patients, but acute in-stent thrombosis occurred in 5 patients with intracranial lesions (4 patients with clopidogrel resistance and 1 without clopidogrel resistance). Acute thrombi were completely lysed after intra-arterial infusion of abciximab. CONCLUSION: There was relatively high prevalence of clopidogrel resistance in patients with atherosclerotic cerebrovascular disease. Hypercholesterolemia was an independent predictive factor of clopidogrel resistance. Acute in-stent thrombosis was more frequently seen in the clopidogrel resistant group. Therefore, clopidogrel resistance test should be performed to avoid thromboembolic complications related to stent-assisted angioplasty for atherosclerotic cerebrovascular disease, especially patients with hypercholeterolemia and intracranial lesion.
Angioplasty ; Humans ; Hypercholesterolemia ; Infusions, Intra-Arterial ; Prevalence ; Risk Factors ; Stents ; Thrombosis ; Ticlopidine

The traumatic C1-C2 unifacetal joint dislocation associated with oblique fractures of the C2 body and arch is a rare injury that can be effectively treated with gentle closed reduction under fluoroscopic guidance followed by halo vest immobilization. To our knowledge, however, there are only a few reported cases of this injury. Recognition of associated conditions including vertebral artery compromise, concomitant cervical spine fractures, and life-threatening injuries is paramount to the successful treatment of these patients. A 29-year-old patient, who presented a unifacetal dislocation at C1-C2 with associated oblique fractures of the C2 body and arch, is reported. Closed reduction with Gardner-Wells tong and halo vest application was performed. After 3 months of application of halo vest, the fractures of C2 body and arch had the complete union and the C1-2 dislocation had the good reduction. He had no pain and discomfort in his neck for about 2 years after halo vest removal.
Adult ; Dislocations ; Humans ; Immobilization ; Joints ; Neck ; Spine ; Vertebral Artery

This report describes a 26-year-old man of Takayasu's arteritis complicated with acute myocardial infarction due to the occlusion of proximal left anterior descending artery and renovascular hypertension which was improved spontaneously without obstruction of stenotic renal artery. Coronary artery involvement and myocardial ischemic symptom in Takayasu's arteritis is uncommon and only about 10 case of acute myocardial infarction were reported. But most cases were diagnosed by autopsy after death. In this case, acute myocardial infarction developed during follow up after diagnosis of Takayasu's aortitis and coronary artery involvement was confirmed by coronary angingraphy. Hypertension is found in 40-70% of the cases. In our case hypertension was complicated and thought to be renovascular origin. It was refractory to medication including captopril. During follow up blood pressure was normalized spontaneously after wide fluctuations for 3 times. Now he is normotensive without medication. It is thought to give a new insight to the mechanism and treatment of renovascular hypertension.
Adult ; Aortitis ; Arteries ; Autopsy ; Blood Pressure ; Captopril ; Coronary Vessels ; Diagnosis ; Follow-Up Studies ; Humans ; Hypertension ; Hypertension, Renovascular* ; Myocardial Infarction* ; Renal Artery ; Takayasu Arteritis*

BACKGROUND: Better imaging resolution and less flow masking with TEE than with TTE makes it easier to evaluate the prosthetic valve dysfunction. However, direct comparison between two methods to evaluate prosthetic valve dysfunction remains elucidated. METHODS: Both TTE and TEE were performed in 19 patients with suspected prosthetic valve dysfunction who were admitted to Seoul National University Hospital for evaluating porsthetic valve dysfunction from July, 1992 to May, 1993 and those findings were compared with those of cardiac catheterization and angiography, and surgery 19 cases were included in this study. RESULTS: 11 patients with congestive heart failure underwent TTE, TEE and angiography and each finding was compared to one another. We could see that there is good correlation between transesophageal echocardiographic and angiographic grading in the severity of regurgitation but poor correlation between transthoracic echocardiographic and angiographic finding in that of regurgitation. We also could differentiate between central and eccentric leakage with TEE and in 2 cases TEE enabled us to detect a vegetation on prosthetic valve not detected with TTE and in 1 case the cause of cardiac hemolysis could be known with TEE : eccentric leakage in prosthetic mitral valve. Left atrial thrombi were detected with TEE in two patients with recent cerebral infaction history. CONCLUSION: We conclude that TEE is a good method that enables us to diagnosize the prosthetic valve dysfunction and detect the structural abnormalities surrounding prosthetic valve such as paravalvular leakage, vegetation, cardiac hemolysis and Left atrial thrombi not detected easily by TTE.
Angiography ; Cardiac Catheterization ; Cardiac Catheters ; Echocardiography ; Heart Failure ; Hemolysis ; Humans ; Masks ; Mitral Valve ; Seoul

Aspirin hypersensitivity is a hallmark of aspirin-exacerbated respiratory disease (AERD), a clinical syndrome characterized by the severe inflammation of the respiratory tract after ingestion of cyclooxygenase-1 inhibitors. We investigated the capacity of aspirin to induce interleukin-4 (IL-4) production in inflammatory cells relevant to AERD pathogenesis and examined the associated biochemical and molecular pathways. We also compared IL-4 production in peripheral blood mononuclear cells (PBMCs) from patients with AERD vs aspirin-tolerant asthma (ATA) upon exposure to aspirin. Aspirin induced IL-4 expression and activated the IL-4 promoter in a report assay. The capacity of aspirin to induce IL-4 expression correlated with its activity to activate mitogen-activated protein kinases, to form DNA-protein complexes on P elements in the IL-4 promoter and to synthesize nuclear factor of activated T cells, critical transcription factors for IL-4 transcription. Of clinical importance, aspirin upregulated IL-4 production twice as much in PBMCs from patients with AERD compared with PBMCs from patients with ATA. Our results suggest that IL-4 is an inflammatory component mediating intolerance reactions to aspirin, and thus is crucial for AERD pathogenesis.
Aspirin* ; Asthma ; Cyclooxygenase 1 ; Eating ; Humans ; Hypersensitivity ; Inflammation ; Interleukin-4* ; Mitogen-Activated Protein Kinases ; Negotiating ; Respiratory System ; T-Lymphocytes ; Transcription Factors

BACKGROUND: Confusing data have been presented for the breast cancer cancer patients on correlations between DNA ploidy and the percentage of S-phase cells and other prognostic factors. The aim of this study was to compare DNA ploidy and the S-phase fraction with traditional prognostic factor to evaluate the prognostic significance of DNA ploidy and SPF. METHODS: We performed flow cytometry on archival paraffin blocks of primary breast cancers from 449 patients. The DNA ploidy and the SPF were examined along with tumor size, the status of lymph node metastasis, age, status of hormonal receptor, histologic grade, tumor type to evaluate clinical utility of DNA ploidy and SPF. RESULTS: The results of the DNA ploidy and SPF revealed 166 diploidy (37%), 283 (63%) aneuploidy tumors. The DNA ploidy status correlated significantly with the status of lymph node metastasis and tumor size. No significant correlations were found with age, histologic grade, or ER receptor status. The S-phase fraction correlated significantly with the ER receptot status. No significant correlations were found with age, tumor size, status of lymph node metastasis, histologic grade, tumor type. CONCLUSIONS: An increased incidence of aneuploidy was found in tumors from patients with positive axillary lymph nodes, larger tumor size and increased incidence of higher S-phase fraction was found in tumors from patients with negative ER receptor. To evaluate the clinical utility of these factors, it will be necessory to measure them on a larger number of patients, so that multivariate survival analyses can be performed.
Aneuploidy ; Breast Neoplasms* ; Breast* ; Diploidy ; DNA ; Flow Cytometry ; Humans ; Incidence ; Lymph Nodes ; Neoplasm Metastasis ; Paraffin ; Ploidies

PURPOSE: The purpose of this study is to investigate differentially expressed genes using DNA microarray between advanced gastric cancer (AGC) with aggressive lymph node (LN) metastasis and that with a more advanced tumor stage but without LN metastasis. MATERIALS AND METHODS: Five sample pairs of gastric cancer tissue and normal gastric mucosa were taken from three patients with T3N3 stage (highN) and two with T4N0 stage (lowN). Data from triplicate DNA microarray experiments were analyzed, and candidate genes were identified using a volcano plot that showed > or = 2-fold differential expression and were significant by Welch's t test (p < 0.05) between highN and lowN. Those selected genes were validated independently by reverse-transcriptase-polymerase chain reaction (RT-PCR) using five AGC patients, and tissue-microarray (TMA) comprising 47 AGC patients. RESULTS: CFTR, LAMC2, SERPINE2, F2R, MMP7, FN1, TIMP1, plasminogen activator inhibitor-1 (PAI-1), ITGB8, SDS, and TMPRSS4 were commonly up-regulated over 2-fold in highN. REG3A, CD24, ITLN1, and WBP5 were commonly down-regulated over 2-fold in lowN. Among these genes, overexpression of PAI-1 was validated by RT-PCR, and TMA showed 16.7% (7/42) PAI-1 expression in T3N3, but none (0/5) in T4N0 (p=0.393). CONCLUSION: DNA microarray analysis and validation by RT-PCR and TMA showed that overexpression of PAI-1 is related to aggressive LN metastasis in AGC.
Gastric Mucosa ; Humans ; Lymph Nodes* ; Neoplasm Metastasis* ; Oligonucleotide Array Sequence Analysis ; Plasminogen Activator Inhibitor 1 ; Plasminogen Activators* ; Plasminogen* ; Stomach Neoplasms*

A 45-year-old woman who complained of weight gain and irregular menstruation was diagnosed as having Cushing's syndrome due to a 3 cm sized left adrenal adenoma. She underwent left adrenalectomy, and she also underwent combined anterior pituitary tests before and 9 months after the surgery. The growth hormone and adrenocorticotropic hormone levels failed to respond to hypoglycemia before the surgery, but their responses recovered after the surgery. Cortisol and thyroid stimulating hormone failed to respond to hypoglycemia and thyrotropin releasing hormone (TRH) before the surgery, respectively, but these were improved after the surgery. Luteinizing hormone, follicle stimulating hormone, and prolactin adequately responded to gonadotropin-releasing hormone and TRH, respectively, before and after the surgery. However, the basal levels of these hormones were higher after adrenalectomy, suggesting that hypercortisolemia had a significant influence on all the pituitary hormones.
Adenoma* ; Adrenalectomy ; Adrenocorticotropic Hormone ; Cushing Syndrome* ; Female ; Follicle Stimulating Hormone ; Gonadotropin-Releasing Hormone ; Growth Hormone ; Humans ; Hydrocortisone ; Hypoglycemia ; Hypopituitarism ; Luteinizing Hormone ; Menstruation ; Middle Aged ; Pituitary Hormones ; Prolactin ; Thyrotropin ; Thyrotropin-Releasing Hormone ; Weight Gain