Paroxysmal nocturnal hemoglobinuria(PNH) is a rare, acquired disease involving multiple hematopoietic lines. Characteristics of PNH are intrinsic hemolytic anemia, iron deficiency anemia and venous thrombosis. report a case of PNH with characterostoc MR and CT findings. The signal intensity of renal cortex was lower than that of medulla on both T1- and T2- weighted MR imaging. On T2 weighted MR images, the liver showed very low signal intensity but the signal intensity of the spleen was normal. On precontrast CT the attenuation of renal cortex was higher than that of renal medulla and the attenuation of liver was higher than that of the spleen. These findings of MR imaging and CT were the result from the deposition of hemosiderin in the cells of proximal convoluted tubules and transfusional hemosiderosis of liver.
Anemia, Hemolytic ; Anemia, Iron-Deficiency ; Hemoglobinuria, Paroxysmal* ; Hemosiderin ; Hemosiderosis ; Liver ; Magnetic Resonance Imaging ; Spleen ; Venous Thrombosis

No abstract available.
Breast Neoplasms* ; Breast* ; Lymph Nodes* ; Neoplasm Metastasis*

PURPOSE: We experienced a case of ocular motility disturbance with esotropia and hypotropia, following implantation of Molteno to the superotemporal quadrant. METHODS: The patient recovered to orthophoria after removal of implant and fibrotic scar tissue with recession and resection. RESULTS: Multiple complications have been reported in association with Molteno implantation, including hypotony, cataract, choroidal hemorrhage, retinal detachment, endophthalmitis, hyphema, phthisis. However ocular motility disturbances have been documented in only a few cases and never in Korea to our knowledge. Therefore, we report this case with the review of related literatures.
Cataract ; Choroid Hemorrhage ; Cicatrix ; Endophthalmitis ; Esotropia ; Humans ; Hyphema ; Korea ; Retinal Detachment ; Strabismus*

We examined the variations in the limbus-insertion distance, the width and the insertion shape of 260 horizontal recti muscles in 137 strabismic patients, and evaluated the relationship between insertion shape and postoperative results. The average limbus-insertion distance of medial rectus muscle was 4.72 +/- 0.49mm and that of lateral rectus muscle was 6.29 +/- 0.58mm. The width of medial rectus and lateral rectus mascle was 9.84 +/- 0.83mm and 9.57 +/- 0.84mm. The insertion shapes of horizontal rectus muscle were divided into 5 groups, straight, oblique type I and II, concave and convex patterns. According to insertion shape, insertion shape of the medial rectus muscle had no statistic difference in esotropia and exotropia(P=0.179), but in case of the lateral rectus muscle, it was staistically significant in both exotropia and esotropia(P=0.036). When the deviation angle was larger than 40 delta, the length of limbus width was statistically significant in lateral rectus muscle(P=0.018). The insertion shape divided into straight and non-straight pattern was statistically insignificant on postoperative success rate.
Esotropia ; Exotropia ; Humans ; Muscles

The purpose of this study is to develop social medicine curriculum model and to propose its management device. The study developed the curriculum model and its management plan as follows; First, the social medicine curriculum can be implemented starting from the first semester of first year through the first semester of fourth year, and is splitted up into two semesters for each year of medical school. Second, a semester consists of sixteen weeks, giving two hours course per week. Third, the sixteen weeks curriculum should be composed of sub courses which lasts at least four weeks each. Forth, the elective course of social medicine is of four blocks in total, and runs from second semester of the second year through first semester of the fourth year. This means the elective courses in the first semester are opened to third and fourth year students. And the elective courses in the second semester are opened to second and third year medical students. Fifth, the minimum number of elective courses should be more than four courses per semester. Sixth, the credits for core and elective social medicine courses are one point each for any lectures or laboratories carried out in the following way; one hour course provided for sixteen weeks or two hours course provided for eight weeks. The social medicine education stands firm as one of the core subjects in twenty-first century medical education. Thus, the effectiveness and systematic development of the program as well as running it will be the most important criterion for determining the competency of a medical school.
Curriculum* ; Education ; Education, Medical ; Humans ; Lectures ; Running ; Schools, Medical ; Social Medicine* ; Students, Medical

From December 1987 to September 1988, clinical evaluation were performed at the Yeungnam University Hospital on 138 patients with exudative pleural effusion comparing with biochemical, bacteriologic, cytologic and pathologic studies. The results were as follows 1. Among these 138 cases, Incidence of tuberculosis was 57.3%, neoplasm 26.8%. High tendency in malignant pleural effusion occurred in elder age. 2. In tuberculosis pleural effusion, the rate of positive smear and culture for acid-fast bacilli in the pleural fluid was 3.7% and positive biopsy for granuloma 75%. 3. In malignant pleural effusion, the rate of positive cytology for cancer cell in the fluid was 42% and positive biopsy 60%. 4. Analysis in tuberculosis and malignancy showed the tendency of high pH, WBC, protein and of low glucose, but there were clinically not significant in differentiating malignant pleural effusion from tuberculous pleural effusion. 5. Among 23 cases in which the pleural tissue findings were chronic nonspecific reaction pathologically, tuberculosis (52.2%), malignancy (26%), and idiopathic (21.8%) eventually in follow up studies.
Biopsy ; Follow-Up Studies ; Glucose ; Granuloma ; Humans ; Hydrogen-Ion Concentration ; Incidence ; Pleural Effusion* ; Pleural Effusion, Malignant ; Tuberculosis

Spontaneous gastric perforation is an important but rare cause of gastrointestinal perforation in neonates. Just over 200 cases have been reported in the literatures. In spite of recent surgical advances in its managements, mortality rate has been reported as high as 25~50%. Because of physiologic differences, immature immune mechanisms, variations in gastrointestinal flora and poor localization of perforation, a neonate with gastric perforation is at high risk. The pathogenesis is greatly debated. Five patients with spontaneous neonatal gastric perforation who were operated upon at the Department of Pediatric Surgery, Seoul National University Hospital from 1980 to 1993 were reviewed. Four patients were male and one female. The first indication of perforation was 1 day to 6 days of life. All of 5 perforations were located along the greater curvature of the stomach. The size of perforation ranged from 2 cm to 10 cm. Debridement and primary closure were performed in all patients. The operative mortality was 40%(2 of 5). The cause of perforation was not identified in all cases. Prematurity and necrotizing enterocolitis, synchronous or metachrotlous, were thought to be crucial prognostic factors. Earlier recognition and surgical intervention are necessary to reduce morbidity and mortality.
Debridement ; Enterocolitis, Necrotizing ; Female ; Gastrointestinal Microbiome ; Humans ; Infant, Newborn ; Male ; Mortality ; Seoul ; Stomach

No abstract available.
Leukemia, Myelogenous, Chronic, BCR-ABL Positive*

A morphological study on the ultrastructures of the alimentary tract and the excretory system of Clonorchis sinensis was conducted. The liver flukes were collected from rabbit liver six months after the experimental infection The worms were washed with 0.85 percent saline solution and immediately moved to cold 2.5 percent glutaraldehyde in 0.1 M phosphate buffer pH 7.4. The materials were dissected and fixed for two hours. The blocks were post-fixed in 1 percent osmium tetroxide. The blocks were embedded in Epon 812. Ultra thin sections were cut with Sovall MT-2 ultramicrotome and stained with uranyl acetate and lead citrate. Sections were then observed with Hitachi HS-7S electron microscope. The following results were obtained in a series of observations. The walls of oral cavity and esophagus comprised tegumental syncytium, basement membrane, loose connective tissue, muscular layer and parenchymal cells. The apical surface and the base of the syncytium were covered with a protoplasmic membrane for each forming numerous invaginations. Granular endoplasmic reticulum was developed in the epithelium of the oesophagus. The gastrodermis of Clonorchis sinensis comprised two types of cells in general. The first cell type was numerous one forming a single continuous layer of epithelial cells. Each of the cells had outfolded cytoplasm into the caecal lumen and lamellae along the cell surface. Among the above epithelial cells, no considerable differences in structure reflecting their functional states were identified. The second cell type was less differentiated in nature and lay within the gastrodermis above the basement membrane but not in contact with the caecal lumen, being overlapped by neighboring gastrodermal cells of the type described above. At this portion the gastrodermis seemed to be a pseudostratified epithelium. There were well-developed lamellae along the surface of epithelia of all canals or duct concerning evacuation. The excretory pore was 7.5 micrometer in diameter and dorso-terminally opended. The epithelium of the excretory pore, a syncytial layer, contained many microtubules unlike the other part of tegumental layer of this worm. The epithelium thickness of the excretory pore was very irregular(1.3-5.5 micrometer).
parasitology-helminth-trematoda ; Clonorchis sinensis ; electron microscopy ; alimentary tract ; liver ; rabbit

BACKGROUND: Ropivacaine and levobupivacaine, both single S-enantiomers, show less toxicity on the central nervous and cardiovascular system than racemic bupivacaine. Earlier studies have shown that levobupivacaine and bupivacaine are almost equipotent while ropivaciane was 60% less potent than bupivacaine. The aim of this prospective, double blinded study was to compare the clinical efficacy and safety of epidural anesthesia produced by 0.5% levobupivacaine and 0.5% ropivacaine for a cesarean section. METHODS: Sixty-two parturients undergoing an elective cesarean section were randomized to receive either epidural levobupivacaine 0.5% 20 ml (n = 31) or epidural ropivacaine 0.5% 20 ml (n = 31). Surgery was commenced when the sensory block had reached the dermatome level, T6. The onset, duration, quality of the sensory and motor block and abdominal muscle relaxation were evaluated. The blood pressure and heart rate of the mother and neonatal outcome, as assessed by the Apgar score and umbilical pH, were also recorded. RESULTS: There was no difference in the onset time, the segmental spread of sensory block and analgesic supplement between the two groups. However, levobupivacaine produced a longer duration of sensory block than ropivacaine (levobupivacaine 224.1 +/- 66.6 min, ropivacaine 176.5 +/- 32.8 min, P < 0.05). The onset time (except Bromage scale 2), intensity and duration of the motor block and muscle relaxation were similar in both groups. There was no difference in the maternal and neonatal outcomes between the two groups. CONCLUSIONS: 0.5% levobupivacaine and 0.5% ropivacaine produced equivalent efficacy and safety in epidural anesthesia for a cesarean section, but levobupivacaine resulted in a longer duration of sensory block.
Abdominal Muscles ; Anesthesia, Epidural* ; Apgar Score ; Blood Pressure ; Bupivacaine ; Cardiovascular System ; Cesarean Section* ; Female ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Mothers ; Muscle Relaxation ; Pregnancy ; Prospective Studies ; Relaxation