BACKGROUND: Paramedian approach is more useful than midline approach when degenerative changes are encountered in the interspinous structure and when ideal positioning of the patient can not be achieved. The purpose of this study was to determine the guideline of depth from skin to subarachnoid space by midline or paramedian approach in Korean adult. METHODS: The distance from skin to subarachnoid space was measured in 47 patients recieving spinal anesthesia by midline approach and 30 patients by paramedian approach at L3-4 level. RESULTS: The mean depth to subarachnoid space was 5.44+/-0.47 cm in midline approach. In paramedian approach by 18.0degrees of caudal and 18.5degrees of lateral angle, mean depth was 6.24+/-0.60 cm. There were significant correlation between depth and weight, and depth and ponderal index. In ages over 50 years old, difficult cases were significantly more in midline approach than in paramedian approach. CONCLUSIONS: Measurement of factors as weight or ponderal index can be used to predict the depth. Paramedian approach is more useful than midline approach in ages over 50 years old.
Adult* ; Anesthesia, Spinal* ; Humans ; Middle Aged ; Needles* ; Punctures* ; Skin ; Subarachnoid Space

No abstract available.
Adenocarcinoma, Mucinous* ; Child* ; Colon* ; Humans ; Mucins*

During the reproductive period, human endometrium undergoes a pattern of cyclic change. Human endometrium undergoes a complex pattern of proliferation, secretory activity, and menstruation over an approximately 28 days period. Proliferative activity is highest during late proliferative phase under influence of estrogen, and minimal activity in the late secretory and menstrual phase. To study a possible change of telomerase activity during menstrual cycle, telomerase activities in normal and hormone treated endometrium were tested using telomerase repeat amplification protocol(TRAP) assay. Telomerase activities were detected in 9 of 10 proliferative endometrium(90%), and maximal activity was shown in late proliferative phase. Only 3 of 10 secretory endometrium(30%) revealed weak activity. However telomerase activity was not detected in menstrual phase endometrium(N 2) and senile endometrium(N=3). Four of tamoxifen treated endometrium(N 4) and 1 of provera treated endometrium(N 3) Levels of telomerase activity of treated endometrium(N 4) and late proliferative endometrium(N 6) were as high as them of detected in endometrial cancer and hyperplasia. Above findings reveal that telomerase activity of endometrium is changed according to menstrual cycle, And the level of telomerase activity is related to proliferative activity of endometrium that is dependent on the status of female sex steroid hormone and tamoxifen treatment.
Endometrial Neoplasms* ; Endometrium* ; Estrogens ; Female ; Humans ; Hyperplasia ; Medroxyprogesterone Acetate ; Menstrual Cycle ; Menstruation ; Reproduction ; Tamoxifen ; Telomerase*

Hemangioblastomas comprise 1 to 2% of all intracranial neoplasm, and 8 to 12% of tumors within the posterior fossa. They are composed of admixtures of three different cell types; endothelial cells, pericytes and stromal cells. Although most hemangioblastomas arise sporadically, they are associated with von Hippel-Lindau disease in about 20% cases. We have experienced a case of multiple hemangioblastomas occuiing in the cerebellum, medulla oblongata and cervical spinal cord simultaneously in a 55-year-old male. He had complained of headache, dizziness, generalized weakness and gait disturbance for 2 weeks. The patient had neither specific family history nor increased hematocrit. MRI showed a nonenhancing cystic lesion with an enhancing mural nodule in the right cerebellar hemisphere and two separate enhancing nodules in the medulla oblongata and dorsal cervical spinal cord at the 5-6th. Grossly, the excised mass of the cerebellum, 2.5 x 2 x 1.8cm, was solid to partly cystic, and that of spinal cord, lcm in diameter, was mostly solid. Microscopically, the tumor was composed of thin-walled blood vessels in variable size and interspersed stromal cells. The stromal cells revealed dimorphic cytoplasm that were either homogeneous and eosinophilic, or clear and vacuolated. Immunohistochemically, the endothelial cells reacted positively for glial fibrfllaty acidic protein(GFAP) and vimentin. The stromal cells reacted diffusely positively for vimentin, focally positively for GFAP and S-100 protein near the periphery of the tumor, focally positivel for neuro specipic enolase(NSE), and negatively for lysozyme, desmin and chromogranin. Ultrastructurally, the stromal cells contained numerous microfilaments and lipid droplets.

Hemangioblastomas comprise 1 to 2% of all intracranial neoplasm, and 8 to 12% of tumors within the posterior fossa. They are composed of admixtures of three different cell types; endothelial cells, pericytes and stromal cells. Although most hemangioblastomas arise sporadically, they are associated with von Hippel-Lindau disease in about 20% cases. We have experienced a case of multiple hemangioblastomas occuiing in the cerebellum, medulla oblongata and cervical spinal cord simultaneously in a 55-year-old male. He had complained of headache, dizziness, generalized weakness and gait disturbance for 2 weeks. The patient had neither specific family history nor increased hematocrit. MRI showed a nonenhancing cystic lesion with an enhancing mural nodule in the right cerebellar hemisphere and two separate enhancing nodules in the medulla oblongata and dorsal cervical spinal cord at the 5-6th. Grossly, the excised mass of the cerebellum, 2.5 x 2 x 1.8cm, was solid to partly cystic, and that of spinal cord, lcm in diameter, was mostly solid. Microscopically, the tumor was composed of thin-walled blood vessels in variable size and interspersed stromal cells. The stromal cells revealed dimorphic cytoplasm that were either homogeneous and eosinophilic, or clear and vacuolated. Immunohistochemically, the endothelial cells reacted positively for glial fibrfllaty acidic protein(GFAP) and vimentin. The stromal cells reacted diffusely positively for vimentin, focally positively for GFAP and S-100 protein near the periphery of the tumor, focally positivel for neuro specipic enolase(NSE), and negatively for lysozyme, desmin and chromogranin. Ultrastructurally, the stromal cells contained numerous microfilaments and lipid droplets.

PURPOSE: Duane's retraction syndrome is a congenital eye movement disorder caused by innervational disturbance. It is rare that Duane's retraction syndrome is associated with Goldenhar's syndrome which shows systemic congenital malformations. We report a case of bilateral Duane's retraction syndrome associated with Goldenhar's syndrome, which was treated with strabismus surgery and excision of epibulbar lipodermoid. METHODS: A 14-month-old boy with exotropia showed severe limitation of adduction, mild limitation of abduction, globe retraction and palpabral fissure narrowing on attempted adduction in both eyes. He also had a diffuse small epibulabar mass under the lateral conjunctiva in the left eye. The angle of exodeviation was 45PD on alternate prism cover and uncover test. He had had cleft lip, multiple skin tags on the face and preauricular appendages since birth and undergone an operation for these abnormalities at age of 4 months. Bilateral 7.5mm recession of the lateral recti and excisional biopsy of epibulbar mass of the left eye were performed. RESULTS: A case of Duane's retraction syndrome associated with Goldenhar's syndrome was found. The patient obtained orthophoria in his primary gaze after bilateral recession of lateral recti. The epibulbar mass was consistent with lipodermoid on pathologic examination.
Biopsy ; Cleft Lip ; Conjunctiva ; Duane Retraction Syndrome* ; Exotropia ; Humans ; Infant ; Male ; Ocular Motility Disorders ; Parturition ; Skin ; Strabismus

PURPOSE: We performed this study to evaluate the occurrence of consecutive esotropia after early surgery in the patients with intermittent exotropia less than 4 years of age. METHODS: We analyzed the surgical results of 37 patients who underwent surgery before 4 years of age retrospectively. They were followed up at least more than 1 year after surgery. The orthophoria was defined as an exophoria of 0 to 12PD or an esophoria of 0 to 5PD after surgery. The consecutive esotropia was defined as an esodeviation lasting more than 3 months that needed surgical correction due to sensorial deterioration. RESULTS: Preoperative angle of exodeviation at distance ranged from 20PD to 60PD (mean 35.1 +/- 9.2PD). Twenty-seven of 37 patients (75.7%) showed orthophoria after surgery in 1 year follow-up and 20 of 31 patients (64.5%) in 2 years follow-up. Five patients (13.5%) showed recurrence and 4 patients (10.8%) consecutive esotropia. Immediate postoperative overcorrection was 14.1 +/- 8.7PD(0-30) in patients who were orthophoric after postoperative follow-up more than 2 years. The rate of consecutive esotropia was high in patients with an exo-angle of 30PD or more and a large amount of recession of lateral recti more than 7mm. CONCLUSIONS: This study revealed that consecutive esotropia after early surgery for intermittent exotropia less than 4 years of age was noted to the 10.8%.
Esotropia ; Exotropia* ; Follow-Up Studies ; Humans ; Recurrence ; Retrospective Studies

The purpose of this study was to develop and test the validity of standardized Korean nomenclature of the Home Health Care Classification(HHCC), developed by Saba at the University of Georgetown. The four phases of the study were : (1) Two professors and 15 graduate students, who were taking a nursing intervention course, translated the HHCC into Korean. (2)12 nurses with various clinical backgrounds reviewed each nomenclature taking into consideration of the definition and activities, and the Delphi method was used to determine the best appropriate nomenclature for each term; (3)20 academic and clinical experts in nursing were given a questionnaire to rate the validity of each Korean nomenclature using a 5 point Likert scale ranging from very inappropriate to very appropriate; (4) Five members of the Korean Nurses Association Research Committee reviewed the survey results and determined the most appropriate Korean nomenclature for each term of the HHCC. Most of the nomenclatures had a score of more than 4.0, but several terms had a score lower than 4.0. They are Ambulation therapy(3.1.1), Anticipatory grieving(3.11), Sexual patterns alteration(3.17), Nursing care coordination(3. 22), Physical therapist service(3.22), Regular diet(3.33), and Instrumental activities of daily living(3.44). These research results will be included in the nursing vocabulary dictionary to be published by the Korean Nurses Association.
Classification* ; Delivery of Health Care* ; Humans ; Nursing ; Nursing Care ; Physical Therapists ; Vocabulary ; Walking ; Surveys and Questionnaires

No abstract available.
Lissencephaly* ; Walker-Warburg Syndrome

The effects of C-phycocyanin (C-pc), a phycobiliprotein, on the expression of pro-fibrotic mediators in hyper-tropic scarring such as connective tissue growth factor (CTGF) and α-smooth muscle actins (α-SMA) were investigated in relation to trans-differentiation of fibroblast to myo-fibroblast, an icon of scar formation. C-pc was isolated from Spirulina Platensis extract using sonication method and C-pc concentration was determined by Bennet and Bogorad equation. α-SMA and CTGF levels in wounded primary human dermal fibroblasts were determined by western blot analysis and immuno-fluorescence confocal microscope was employed. Fibroblast contractility was examined by three-dimensional collagen lattice contraction assay. There was an elevation of α-SMA (121%) and CTGF (143%) levels in wound cells as compared with non-wound cells. The does-response profiles of down regulation demonstrated that the maximum inhibitions of α-SMA by 63% (p<0.05) and CTGF by 50% (p<0.1) were achieved by C-pc (6 nM) treated cells. In confocal assay, non-wound fibroblasts exhibited basal level of α-SMA staining, while wounded cells without C-pc treatment showed strong up-regulation of α-SMA by 147% (p<0.05). C-pc (6 nM) inhibited α-SMA expression by 70% (p<0.05) and reduced collagen contraction by 29% (p<0.05). C-pc seemed to lessen the over expression of CTGF, α-SMA, subsequently alleviating the fibrotic contracture. This study suggests the potential application of C-pc to regulation of the expression of pro-fibrotic mediators in scarring process and its potential usage as an efficient means for anti-fibrosis therapy.
Actins* ; Blotting, Western ; Cicatrix ; Collagen ; Connective Tissue Growth Factor* ; Connective Tissue* ; Contracture ; Down-Regulation ; Fibroblasts ; Humans ; Methods ; Myofibroblasts ; Phycocyanin* ; Sonication ; Spirulina ; Up-Regulation ; Wound Healing ; Wounds and Injuries