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

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

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

We report three cases of neuroendocrine tumors of the lung characterized by large pleomorphic cell with frequent mitosis, which show neuroendocrine differentiation by both light microscopy or electron microscopy and iminunohistochemistry. These tumors have been categorized as large cell neuroendocrine carcinoma by Travis et al.(1991) in contrast with non-small cell lung cancer with neuroendocrine differentiation. In the latter, neuroendocrine differentiation is not evident by light microscopy and must be demonstrated by imunohistochemstry or by electron microscopy. The prognosis of large cell neuroendocrine carcinoma, together with non-small cell lung cancer with neuroendocrine differentiation, appears to be worse than cancer without neuroendocrine differentiation and intermediate between atypical carcinoid and small cell lung cancer. Larger numbers of patients will be needed to demonstrate significant differences in survival.
Lung Neoplasms

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*

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

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: The purpose of this study was to examine the nurses' knowledge and attitude to pain management in children and explore the status of pain management in clinical practice. METHOD: The subjects were 131 nurses enrolled in 3 university affiliated hospitals. Questionnaire method was utilized for data collection. Data was analyzed by SPSS statistical program. RESULT: The result was as follows: 1. The overall mean score of the pain knowledge was 16.88 (58.2%). The percentages of correct response in test subsections were pain assessment 45.5, choice of medication and drug action 48.7, and pain statement 79.6 respectively. 2. 70.3% of the nurses agreed or strongly agreed that the procedural pain should always be eliminated. And, 44.3% of the nurses agreed or strongly agreed that post-operative treatment of pain in children should always aim at eliminating the pain completely. 3. There was a significant relationship between pain attitude and knowledge related facts about pain(r=.217, p < .01). 4. When asked to identify the point of self-reported pain on a 0-10 scale at which the nurse would give medication, point 7 was mostly identified (29%). 5. Only 19.8% of the nurses utilized pain rating scale to assess children's pain. 6. The nonpharmacologic interventions nurses used most were position change, emotional support, and massage. 7. 68.7% of the nurses indicated that they learned about pain management from their current working environment. Also, Mostly helpful resource identified in increasing their pain management knowledge and skills was the continuing education program. CONCLUSION: The findings showed that there was a need to develop educational program for adequate pain management for children. Further research study is recommended to examine the effectiveness of the intervention methods for children's pain.
Child* ; Data Collection ; Education, Continuing ; Humans ; Massage ; Pain Management* ; Pain Measurement ; Child Health ; Surveys and Questionnaires