PURPOSE: To report clinical features and optical coherence tomographic findings of presumed atypical ocular tuberculosis associated with tuberculosis lymphadenitis and encephalomeningitis. CASE SUMMARY: A 28-year-old female with lymphadenitis in the axillary area presented with a fever and headache of a one week duration. CSF study and MRI findings implied tuberculosis encephalomeningitis, and presumed tuberculosis uveitis manifested with visual disturbance after five days. Ocular symptoms were aggravated and showed anterior iridocyclitis, vitritis, macular edema, and multifocal retinitis with miliary granuloma that was distinct from choroiditis or typical tuberculosis granuloma. After the patient received anti-tuberculosis medication and systemic corticosteroids, significant improvements in visual acuity, ocular findings and OCT results were observed. CONCLUSIONS: Ocular tuberculosis can present with various clinical findings, and caution should be taken so as not to misdiagnose based on these characteristics. In the present case, anti-tuberculosis medication and systemic steroids resulted in the resolution of inflammation. In such cases, monitoring the posterior pole lesion via OCT may be helpful in determining improvement.
Adrenal Cortex Hormones ; Adult ; Choroid ; Choroiditis ; Female ; Fever ; Granuloma ; Headache ; Humans ; Inflammation ; Iridocyclitis ; Lymphadenitis ; Macular Edema ; Meningitis ; Meningoencephalitis ; Retinitis ; Steroids ; Tuberculosis ; Tuberculosis, Miliary ; Tuberculosis, Ocular ; Uveitis ; Visual Acuity

PURPOSE: To describe a case of Wyburn-Mason Syndrome, which is characterized by arteriovenous malformations in the central nervous system and the retina. CASE SUMMARY: A 13-year-old girl who underwent neurosurgical intervention for intraventricular hemorrhage was referred to our ophthalmic clinic because brain angiogram and MRI finding revealed arteriovenous malformations (AVMs) that extended from the orbit and optic chiasm along the optic pathway. Fundus and fluorescein angiography of the left eye showed marked dilation and tortuosity of the retinal vessels. Fluorescein angiographic findings showed rapid filling of all vessels and no dye leakage. CONCLUSIONS: Retinal racemose hemangioma should be considered for Wyburn-Mason syndrome, and the finding of retinal AVMs should warrant cerebral imaging studies including MRI and angiography.
Adolescent ; Angiography ; Arteriovenous Fistula ; Arteriovenous Malformations ; Brain ; Central Nervous System ; Eye ; Fluorescein ; Fluorescein Angiography ; Hemangioma ; Hemorrhage ; Humans ; Neurocutaneous Syndromes ; Optic Chiasm ; Orbit ; Retinal Vessels ; Retinaldehyde

PURPOSE: To compare the corneal power (K) measured by different methods in the patients who underwent photorefractive keratectomy (PRK) or laser in situ keratomilieusis (LASIK) METHODS: Fifty-four patients who had undergone PRK or LASIK from December 1999 to December 2000 and followed for 3 months or longer were selected for this study. The corneal power was measured by five different methods in 35 eyes(18 patients) of PRK group and in 70 eyes (36 patients) of LASIK group: calculation method (C-K), hard contact lens method (H-K), autorefractokeratometer (A-K), manual keratometer (M-K) and topography (T-K). RESULTS: Preoperative mean corneal power was 43.41+/-1.06 D in PRK group and 43.75+/-1.03 D in LASIK group. Postoperative corneal power in PRK group showed following Results: C-K, 40.94+/-1.51 D; H-K, 41.04+/-1.23 D; A-K, 41.18+/-1.29 D; M-K, 41.38+/-1.33 D; T-K, 41.67+/-1.26 D. In LASIK group, the results were: C-K, 38.64+/-2.25 D; H-K, 39.29+/-1.66 D; A-K, 39.53+/-1.61 D; M-K, 39.85+/-1.54 D; T-K, 40.36+/-1.26 D. The corneal power of calculation method was lowest in both groups. Each corneal power was not different statistically from the others in PRK group(p=0.16). However, C-K was significantly lower than A-K (p=0.02), M-K (p=0.00) or T-K (p=0.00) in LASIK group. Also, H-K or AK was lower than T-K statistically in LASIK group (p=0.00, p=0.02). CONCLUSIONS: The corneal power was lowest when measured by calculation method after refractive surgery. In LASIK group, there were statistical differences among the corneal powers by each method.
Humans ; Keratomileusis, Laser In Situ ; Photorefractive Keratectomy ; Refractive Surgical Procedures*

BACKGROUND: Chinese traditional osteopathy is long in history, unique in manipulation and miraculous in therapeutic effect. But people understand it more m perception rather than in theory, more in application rather than in development. There is little research truly on the bioseience.OBJECTIVE: To probe into the macro-idea of Chinese traditional osteopathy, micro-mechanisms on characters and mathematics-physics models, aiming to provide new principles and approaches of treatment for the daily increased bone trauma, fracture and sport injury.SETTING: Physics and machine-electron college of a university, and its affiliated hospital.METHODS: Based on the natural concept of "integration between heaven and human being" and new concept of holistic medicine in Chinese traditional osteopathy, the macro-idea and characters of reduction and union of fracture are generalized from the characters of natural therapy and the biomechanical mechanisms and characters of reduction and union of fracture are summarized from the micro-reaction of bone repair and union so as to discover biomechanical mechanisms and characters of reduction and union of fracture and further to set up biomechanical models and mathematics-physics expressions during the treatment.RESULTS: Chinese traditional osteopathy envelopes macro-idea of "initiative reduction-functional union" in fracture and micro-mechanism on "stress adaptability-functional adaptability" of bone repair and union.CONCLUSION: Chinese traditional osteopathy compiles with the natural,green and non-traumatic therapy in bio-natural law of bone repair and union and supports the theme of "high thought and high skill".

Megacystis Microcolon Intestinal Hypoperistalsis(MMIH) Syndrome is a rare cause of functional neonatal bowel obstruction, characterized by hypoperistalsis, narrow distal ileum and colon, and bladder distension. We report a case of MMIH syndrome and review the literature. The patient was born after 34 weeks of gestation with marked abdominal distension. Her birth weight was 2,830g with 276ml of urine drained by catheter. Prenatal ultrasonic findings were bladder distension, hydronephrosis and possible intraabdominal mass. Supine view of abdomen on third day of life showed dilated loops of proximal small bowel and stomach without colonic gas shadow. Preoperative diagnosis was intestinal obstruction. When the abdomen was opened, the distal ileum was filled with meconium and postoperative diagnosis was meconium plug syndrome. Ganglion cells were present in the ileal biopsy. All postoperative attempts to feed her resulted in bilous vomiting. Voiding cystourethrography done on the 4th day after colon study showed markedly distended bladder, contrast enhanced microcolon and hypoperistalsis. She was dischaged against medical advice by her parents at the age of 23 days and died at home at the age of 33 days.
Abdomen ; Biopsy ; Birth Weight ; Catheters ; Colon ; Diagnosis ; Ganglion Cysts ; Humans ; Hydronephrosis ; Ileum ; Intestinal Obstruction ; Meconium ; Parents ; Pregnancy ; Stomach ; Ultrasonics ; Urinary Bladder ; Vomiting

Microvilli are outer membrane organelles that contain cross-linked filamentous actin.Unlike well-characterized epithelial microvilli, T-cell microvilli are dynamic similar to those of filopodia, which grow and shrink intermittently via the alternate actin-assembly and -disassembly. T-cell microvilli are specialized for sensing Ags on the surface of Ag-presenting cells (APCs). Thus, these finger-shaped microprotrusions contain many signaling-related proteins and can serve as a signaling platforms that induce intracellular signals. However, they are not limited to sensing external information but can provide sites for parts of the cell-body to tear away from the cell. Cells are known to produce many types of extracellular vesicles (EVs), such as exosomes, microvesicles, and membrane particles. T cells also produce EVs, but little is known about under what conditions T cells generate EVs and which types of EVs are released. We discovered that T cells produce few exosomes but release large amounsts of microvilli-derived particles during physical interaction with APCs. Although much is unanswered as to why T cells use the same organelles to sense Ags or to produce EVs, these events can significantly affect T cell fate, including clonal expansion and death. Since TCRs are localized at microvilli tips, this membrane event also raises a new question regarding long-standing paradigm in T cell biology; i.e., surface TCR downmodulation following T cell activation. Since T-cell microvilli particles carry T-cell message to their cognate partner, these particles are termed T-cell immunological synaptosomes (TISs). We discuss the potential physiological role of TISs and their application to immunotherapies.

Group occupational health service programme started in 1990 is one of the measures to cope with limited human and financial resources in occupational health. The programme has expanded rapidly to include 52 institutions, private as well as public, all over the country. In spite of its potential impact on health of employees and practice of occupational health in small and medium sized industries, comprehensive evaluation in terms of quality has not been tried. This study has aims to develop the criteria to assess the quality of newly developed group occupational health service programme, and to investigate the quality of institutions, and finally to develop policies for the quality improvement. 1) Criteria development : By defining occupational health services, in particular for small and medium sized industries, as one of the primary health care, followings are included as core elements of qualitative occupational health programme ; accessibility, continuity, comprehensiveness, technical quality, intersectoral collaboration, emphasis on preventive services, community participation, and adequacy. Again each element is divided into five major components of national health system infrastructure developed by the World Health Organization ; development of health resources, organized arrangement of resources, delivery of health care, economic support, and management. In turn, each component is categorized into three aspects of quality assessment, structure, process and outcome. Expert panel selected several criteria for each category to evaluate the programme. Criteria were modified according to each group of interviewees, to produce two sets of questionnaire, one for chief operating officer and another for nurses in the institutions, and the chief operating officer and workers in the workplace. 2) Subject : Of all 52 institutions, 25 voluntarily participated in the survey. At individual institution, chief operating officer and practicing nurses were interviewed in depth. After intensive education for interviewees, every interview was performed with standardized guideline and questionnaire. The quality of the 'Group occupational health service programme' was found to be lower than expected. Especially In continuity, comprehensiveness, technical quality, community participation and adequacy, lower quality in structural aspect was commonly identified throughout all the institutions. Quality in terms of accessibility and continuity highly varied among institutions. To improve quality of the programme, more comprehensive and systematic programme such as accreditation has to be introduced. In addition, human resources, governmental fund and information systems for individual workers are to be developed. As a long range plan, integration of occupational health services into the national health systems and pooling of financial resources and planned allocation should be considered.
Accreditation ; Consumer Participation ; Cooperative Behavior ; Delivery of Health Care ; Education ; Financial Management ; Health Resources ; Humans ; Information Systems ; Korea* ; Occupational Health Services* ; Occupational Health* ; Primary Health Care ; Quality Improvement ; Questionnaires ; Social Welfare ; World Health Organization

The large part of pathophysiology of cardiac arrhythmias has been clarified but still arrhythmias have bothered anesthesiologists. This study was done in order to investigate the incidence and nature of arrhythmias using Holter monitor for complete study during enflurane anesthesia. The patients were randomly allocated to two groups. Group I received succinylcholine 1.5 mg/kg, and Group II vecuronium 0.1 mg/kg, intravenously for intubation. Continuous electrocardiographic recordings on magnetic tape were made in 34 patients undergoing tympanoplasty during general anesthesia (thiopental(5 mg/kg)-muscle relaxants induction, and N2O(50%)-O2-enflurane(1.2%)-pancuronium maintenance). After completion of the recordings, the tapes were scanned to detect changes in rhythm using the analyzer. Complexes were further studied by readouts on standard ECG paper. The results were as follows: 1) The number of patients(n=14) who exhibited arrhythmias during anesthetic maintenance was significantly greater than that(n=4) during induction. 2) The incidence of occurrence of cardiac arrhythmias was 64.7%. There was no difference between two groups. If sinus tachycardia included, the incidence reached at 94.1%. 3) The frequency of supraventricular arrhythmias was more than two times that of ventricular ones. The arrhythmias occuning at the AV junction were the most common, and VPCs the second most common 4) There was no effect on the frequency in arrhythmia occurrence, of age, gender, preoperative ECG findings, intraoperative serum K(+), and intraoperative PaCO2 The discrepancy in the incidence of arrhythmia occurrence between complete and incomplete studies tells that great caution should be paid perioperatively, especially to the patients who have cardiovascular disorders.
Anesthesia ; Anesthesia, General* ; Arrhythmias, Cardiac* ; Electrocardiography ; Enflurane* ; Humans ; Incidence ; Intubation ; Succinylcholine ; Tachycardia, Sinus ; Tympanoplasty ; Vecuronium Bromide

PURPOSE: The purpose of this study is to evaluate visual acuity and refractive state in preschool children and to find the environmental factors that cause visual acuity and refractive change. METHODS: The initial subjects were 3, 225 preschool children, aged 4 to 6 years old, selected randomly from 15 preschools in Daejeon from August to November, 1997. Among them, 759 (23.5%) children showed 0.6 or less visual acuity or had different visual acuity of more than 2 lines between two eyes. In addition, 537 (70.8%) children who did not showed organic ocular abnormality during the first examination received refraction. Five years later, 120 (22.3%) children were reexamined and enrolled in this study. RESULTS: Uncorrected visual acuity was 0.44 (log MAR -0.36 +/- 0.27) and corrected visual acuity was 0.85 (logMAR -0.07 +/- 0.09) on average in 1997. Generally there was a myopic shift by -1.30 +/- 1.16 diopter (D) for 5 years (p<0.001) and astigmatism was significantly decreased by 0.32 +/- 0.48 D in the hyperopic group (p<0.001). The amount of myopic shift was lower in the children who were wearing eyeglasses than in those who were not in the hyperopic group (p<0.05). Corrected visual acuity was significantly increased by 0.13 (logMAR 0.06 +/- 0.08, p<0.001). The degree of myopic shift was larger in the children whose parents were wearing eyeglasses than in those whose parents were not wearing eyeglasses (p<0.05) but other environmental factors did not influence on visual acuity or refractive change. CONCLUSIONS: Early examination of visual acuity and refractive state, and adequate treatment are important to increase visual function in preschool children.
Astigmatism ; Child ; Child, Preschool* ; Eyeglasses ; Follow-Up Studies* ; Humans ; Hyperopia ; Myopia ; Parents ; Refractive Errors* ; Visual Acuity*

Limitations of polyacrylamide gel or agarose gel electrophoretic methods in genotyping research affect the interpreting of detection results. In order to develop a simple and reliable method for appraising results of ABO genotyping detection, the microfluidic chip analysis system was established by using microfluidic chip to replace the gel electrophoresis and combining with multiplex-PCR-RFLP technique. 150 blood samples were tested by this microfluidic chip analysis system with multiplex-PCR-RFLP technique to evaluate its stability and accuracy. The results showed that all the testing results were consistent with serologic ABO genotyping results and 1 blood sample with decrease of B antigen caused by CML was identified. In conclusion, the established microfluidic chip analysis system is stable and reliable technique. Application of this technique enables the ABO genotyping results to be more objective and accurate.
ABO Blood-Group System ; genetics ; Blood Grouping and Crossmatching ; methods ; DNA Primers ; genetics ; Genotype ; Humans ; Microfluidic Analytical Techniques ; Microfluidics ; Oligonucleotide Array Sequence Analysis