A 31-years-old female presented with left eyelid, canalicular, and conjunctival lacerations after struck by a glass bottle.She had left hypertropia and limitation of depression.Primary repairs of left eyelid, canalicular, and conjunctival laceration were performed that day.After two weeks, the explorative operation was done because of the inability of depression of left eye. We identified the transection of inferior rectus muscle, and repaired it.Three months after second operation, there were 12 prism diopters of left hyper-tropia, 12 prism diopters of left exotropia in the primary position, and 20 prism diopters of left hypertropia in left down gaze.Double Maddox rod testing revealed 6degrees of left incyclotropia, and she presented head tilt to the left. Four months after second operation, 5 mm recession of left superior rectus muscle was done.Postoperatively, she had nearly orthotropia in primary position, but 10 prism diopters in left downgaze.She had only 2 degrees of left incyclotropia, and showed the improvement of ocular torticollis.
Depression ; Exotropia ; Eyelids ; Female ; Glass ; Head ; Humans ; Lacerations ; Ocular Motility Disorders* ; Strabismus

OBJECTIVE: Unfolding is a rendering method to visualize organs at a glance by virtually incising them. Although conventional methods exploit gray-scale volume datasets such as CT or MR images, we use the Visible Korean Human dataset preserving actual color. This can be helpful for the study of anatomical knowledge. Segmented images of Visible Korean Human dataset store the boundary of organs. Since medical experts manually perform the segmentation from anatomical color images, it is very time-consuming. In general, therefore, some images selectively sampled with interval from entire color images are segmented. When we generate a segment volume dataset with the selected images, final results are deteriorated due to lack of segmentation information for missed images. In this paper, we solve this problem by generating intermediate images without performing a manual segmentation. METHODS: Firstly, after comparing differences of organ's contours in between two consecutive segmented images, we represent the differences as a user-defined value in the intermediate images. This procedure is repeated for all pairs of manually segmented images to reconstruct entire volume data consist of manually segmented images and their intermediate images. In rendering stage, we perform the radial volume ray casting along with the central path of target organ. If a ray reaches to a region having the user-defined values, we advance over the region without compositions to the boundary of that region. Then the color composition is begun by performing backtracking, since the advanced region is regarded to the thickness of it. RESULTS: As a result, we can produce high quality unfolding images for the stomach, colon, bronchus, and artery of the Visible Korea Human dataset. CONCLUSION: Since our approach can be applied to virtual dissection including actual human colors, it is helpful for the endoscopy and anatomy studies.
Arteries ; Bronchi ; Colon ; Endoscopy ; Humans ; Korea ; Stomach

No abstract available.

This report concerns a child who developed left ; Iung collapse during induction of anesthesia for suture ligation of patent ductus arteriosus. Acute massive collapse of a lobe, a whole lung or even both lungs in the space of a few minutes without apparent cause is said to be a rare elinical entity. Clinically this condition is manifested by difficulty in breathing or in inflation of the lung. On auscultation, there may be rhonchi or no sound of any air entry into the lung. If unrelieved, this condition will progress, with hypoxia and cardiac arrest. " We observed that the affected lung expanded during inflation with very high pressure ventilation, and then the collapsed lung was smoothly inflated after suture ligation of patent ductua arteriosus without any specific management. It appears that the development of lung collapse is not through the wrong choice of agents or technics of anesthesia, but from failure to appreciate the hemodynamics of ductus arteriosus or unknown factors. We could not find a definite mechanism of lung collapse, but there are contributing factors including compression of a main brobchus, bronchial secretion, decrease of surfactant and others. The operation was successful and she recovered satisfactorily.
Anesthesia* ; Anoxia ; Auscultation ; Child ; Ductus Arteriosus ; Ductus Arteriosus, Patent ; Heart Arrest ; Hemodynamics ; Humans ; Inflation, Economic ; Ligation ; Lung ; Pulmonary Atelectasis ; Respiration ; Respiratory Sounds ; Sutures ; Ventilation

Medullary pyramid is the one place where corticospinal fibers are isolated as the pyramidal tract, and the result of such lesions has been a flaccid hemiplegia. Medial medullary syndrome may occur bilaterally, resulting in flaccid quadriplegia with facial sparing, bilateral lower motor neuron signs of the tongue, and complete loss of position and vibratory sensation affecting all for extremities. Occasionally, only the pyramid is damaged, resulting in a pure motor quadriplegia without other medullary signs. We report a 78-year-old man who suddenly developed flaccid quadriplegia without any other medullary signs. Brain MRI showed bilateral medial medullary infarctions that was probably due to anterior spinal artery occlusion.
Aged ; Arteries ; Brain ; Extremities ; Hemiplegia ; Humans ; Infarction ; Magnetic Resonance Imaging ; Motor Neurons ; Pyramidal Tracts ; Quadriplegia* ; Sensation ; Tongue

The authors experienced one case of Gronblad-Strandberg syndrome with subretinal neovascularization which showed characteristic signs of pseudoxanthoma elasticum(PXE) and angioid streak. PXE is an uncommon hereditary disorder which involves the elastic tissue of the dermis and may also involve the eye and the cardiovascular system. Angioid streaks are red or dark-brown jagged irregular lines extending in spoke like fashion toward periphery from an area of peripapillary atrophy. We report a case of Gronblad-Strandberg syndrome with subretinal neovasculari zation in a 49 year old korean female.
Angioid Streaks ; Atrophy ; Cardiovascular System ; Dermis ; Elastic Tissue ; Female ; Humans ; Middle Aged ; Pseudoxanthoma Elasticum*

In order to know about the utilization of health subcenter in a Korean rural community, a study was carried out through analyzing the records on the outpatients in Su-Dong Health Subcenter during 5 years from 1978 to 1982, and the following results were obtained. 1. The annual utilization rate of health subcenter of Su-Dong Myun showed decreasing tendency such as 946.6 in 1978, 886.4 in 1979, 736.5 in 1980, 708.3 in 1981 and 609.1 in 1982 per 1,000 people. 2. In terms of annual utilization rate of health subcenter by sex, utilization rate of female was higher than that of male such as in 1978 (male 908.6, female 986.3), 1979 (male 819.2, female 956.7) and 1981 (male 686.0, female 731.5) except 1980 (male 790.0, female 683.3) and 1982 (male 632.7, female 585.0). 3. Every year the 5 major diseases of the new patients cared in health subcenter were the same as follows; Diseases of the Respiratory System, Diseases of the Digestive System, Diseases of the Skin and Subcutaneous Tissue, Accident Poisoning and Violence, and Diseases of the Nervous System and Sensory Organ. 4. In terms of annual utilization rate of health subcenter by age, utilization rate of 0~4 year group was highest every year such as 3,666.0 in 1978, 3,232.5 in 1979, 2,819.0 in 1980, 2,361.4 in 1981 and 2408.7 in 1982 per 1,000 people. 5. The average visiting times per case to health subcenter were not much different every year such as 1.75 times in 1978, 1.79 times in 1979, 1.69 times in 1980, 1.79 times in 1981, and 1.80 times in 1982. 6. The monthly utilization rates per 1,000 people of health subcenter had two peaks in February(40.9 in 1980 and 86.4 in 1981) and July(84.6 in 1980 and 721. 1981) except 1982. 7. The distribution of new patients by the source of medical fee payment was follows; community health organization member 86.9%, medicaid program 6.5%, and medical insurance 6.6% in 1980 and community health organization member 76.8%, medicaid program 11.4%, and medical insurance 11.8%, in 1981 and community health organization member 78.2%, medicaid program 14.8% and medical insurance 13.2% in 1982.
Digestive System ; Fees, Medical ; Female ; Humans ; Insurance ; Male ; Medicaid ; Nervous System ; Outpatients ; Poisoning ; Respiratory System ; Rural Population ; Skin ; Subcutaneous Tissue ; Violence

PURPOSE: This study is aimed to investigate perceptions of caregivers and medical staff toward do not resuscitate (DNR) and advance directives (AD). METHODS: Participants were 141 caregivers and 272 medical staff members from five general hospitals. A questionnaire used for the study consisted of 20 items: 14 about DNR perceptions, three about AD, one each for age, gender and employment. RESULTS: Both medical staff and caregivers strongly recognized the need for DNR and AD, and the level of recognition was higher with medical staff than caregivers (DNR chi2=44.56, P=0.001; AD chi2=16.23, P=0.001). The main reason for the recognition was to alleviate sufferings of patients in the terminal phase. In most cases, DNR and AD were filled out when patients with terminal conditions were admitted, and patients made the decisions by consulting with their guardians. Medical staff better recognized the need and for growing demand for guidelines for the DNR and AD decision making process than caregivers (chi2=7.41, P=0.0025). CONCLUSION: This study showed that patients highly rely on their caregivers when making decisions for DNR and AD. Thus, it is important that patients and caregivers are provided with objective information about the decisions. Since participants' strong support for DNR and AD was mainly aimed at alleviating patients' suffering, further study is needed in the association with hospice care. Medical staff also needs to understand the different views held by caregivers and fully consider the disparity when informing patients/caregivers to make the DNR and AD decisions.
Advance Directive Adherence ; Advance Directives ; Caregivers* ; Decision Making ; Employment ; Hospice Care ; Hospitals, General ; Humans ; Medical Staff* ; Personnel, Hospital ; Resuscitation Orders ; Surveys and Questionnaires

We reviewed eight solitary fibrous tumors occurring at sites other than pleura (three orbit, two retroperitoneum, one each hard palate, thyroid, and tongue) which shared the histologic and immunohistochemical features of solitary fibrous tumors of pleura. Six patients were women, and two were men, aged from 26 to 74 years. The tumors ranging from 1.5 to 19 cm in diameter presented as well-circumscribed, unencapsulated, soft to rubbery tissue masses. Histologically they were characterized by a proliferation of spindle or ovoid cells intervened by a dense bundles of collagen. A variety of growth patterns was identified but the so-called patternless pattern was the predominant one. One tumor exhibited highly cellular sarcomatous areas with extensive necrosis, which was diagnosed as malignant solitary fibrous tumor. Immunohistochemical studies showed that all of the tumors were strongly positive for both CD34 and vimentin, but negative for cytokeratin, S-100 protein, EMA, and desmin. One case examined ultrastructurally showed features of fibroblast. All but one showed no evidence of recurrence or metastasis over follow-up period of 14 to 32 months. We conclude that extrapleural solitary fibrous tumors represent a distinct mesenchymal tumor with variable histologic features and should be differentiated from other spindle cell mesenchymal tumors.
Collagen ; Desmin ; Female ; Fibroblasts ; Follow-Up Studies ; Humans ; Keratins ; Male ; Necrosis ; Neoplasm Metastasis ; Orbit ; Palate, Hard ; Pleura ; Recurrence ; S100 Proteins ; Solitary Fibrous Tumors* ; Thyroid Gland ; Vimentin

Retinal hamartomas are the most common ocular abnormalities in up to 50% of patients with tuberous sclerosis. Other ocular lesions are retinal pigment epitheliallesions and salmon-colored nodules in the eyelid and conjunctiva. We have experienced two cases of tuberous sclerosis. The first patient was a 13 year-old female with type 1 and type 2 of retinal hamartomas and retinal pigment epithelial lesion. The second patient was a 19-year-old male with type 1 and type 3 of retinal hamartomas and intracranial calcifications.
Adolescent ; Conjunctiva ; Eyelids ; Female ; Hamartoma ; Humans ; Male ; Retinaldehyde ; Tuberous Sclerosis* ; Young Adult