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*

No abstract available.
Frontal Sinus*

The disorders of cardiac and pulmonary function as complications of scoliosis, have been described by numerous investigators since Hippocrates. The abnormalities of respiratory and cardiovascular function in scoliosis include reduced lung volume and compliance of the total respiratory system, arterial hypoxemia, which may be associated with hypercapnia, impaired chemical regulation of ventilation and increased pulmonary vascular resistance. We recently had experienced of two cases of severe scoliosis of Cesarean section (onse was a severe kyphoscoliotic patient) in Eul Zi Hospital, and was anesthetized with halothane or ethrane. The following conclusions were observed: 1) Arterial blood gas must be checked serially. 2) Anesthesiologists must know the degree of abnormality of the spine and the cardiopulmonary dysfunction. 3) During anesthesia, intermittent positive pressure breatheing(IPPB) or positive end expiratory pressure(PEEP) is needed for good oxygenation. 4) Intubation tube length and tube location are very important. 5) For treatment of postoperative complications, digitalization, bronchodilators, and mechanical ventilation may be needed.
Anesthesia ; Anoxia ; Bronchodilator Agents ; Cesarean Section* ; Compliance ; Enflurane ; Female ; Halothane ; Humans ; Hypercapnia ; Intubation ; Lung ; Oxygen ; Postoperative Complications ; Pregnancy ; Research Personnel ; Respiration, Artificial ; Respiratory System ; Scoliosis ; Spine ; Vascular Resistance ; Ventilation

A total of 573 patients hospitalized in National Seoul Mental Hospital and 76 of healthy persons as control were examined by indirect latex agglutination test in order to evaluate Toxoplasma antibody titers in mental patients. Throughout this survey, 1:32 or more titers of diluted sera were regarded as positive. The 573 samples of test sera showed negative in 386 cases (67.4 percent), 1:2 in 93 cases (16.2 percent), 1:4 in 57 cases (9.9 percent), 1:8 in 14 cases (2.4 percent), 1:16 in 12 cases (2.1 percent), 1:32 in 5 cases (0.9 percent), 1:64 in 1 case (0.2 percent), 1:128 in 3 cases (0.5 percent) and 1:256 in 2 cases (0.3 percent) respectively. Among total 573 mental patients, 11 cases (19 percent) showed positive, and they were 9 cases (1.8 percent) of schizophrenia and 2 cases (7.4 percent) of manic depression. One case (1.3 percent) out of 76 control sera showed positive result.
parasitology-protozoa ; Toxoplasma gondii ; immunology ; indirect latex agglutination test ; schizophrenia ; manic depression

A clinical observation was made randomely selected 30 of 78 cases of balanced anesthesia consist of Demerol, Valium and N2O-O2, inhalation, performed from January to March 1980 at Eul-Ji General Hospital, Seoul, Korea. After pre-oxygenation, all cases received 5 mg of d-Tubocurarine, 5 mg/Kg of thiopental sodium, orotracheal intubation was facilitated with l.5 mg/kg of succinylcboline chloride intravenously and N2O-O2, (2:1 L/min) inhalation was carried out with semiclosed circle absorber system and 1 mg/kg of Demerol and 0. 2 mg/kg of Valium were intermittently injected intravenously. 0.04 mg/kg of pancuronium bromide, 0.4 mg/kg of succinylcholine chloride intravenously or 0.1% succinylcholine chloride by way of dripping was given and maintained controlled respiration. The following results were observed; 1) Systolic blood pressure was decreased 6. 5% at 5 minutes following anesthesia initiated, and maintained initial pressure at 30 minutes, at the end of anesthesia, and in recovery room. 2) Diastolic blood pressure was increased 4. 5% at 5 minutes, 7. 9% at 30 minutes following anesthesia initiated, however maintained the pressure at the end of anesthesia and in recovery room. 3) Pulse rates were maintained 5 minutes. 3.7% increased 30 minutes following anesthesia was initiated, maintained same rates at the end of anesthesia and in the recovery room. 4) 26% of anesthetized patients required narcotics for pain up to 4 hours of staying recovery room. 5) Jerking movement and psychosis were not observed following anesthesia. 6) Respiratory assistance and antidotes were not needed for all patients.
Anesthesia ; Antidotes ; Balanced Anesthesia* ; Blood Pressure ; Diazepam* ; Heart Rate ; Hospitals, General ; Humans ; Inhalation ; Intubation ; Korea ; Meperidine* ; Narcotics ; Pancuronium ; Psychotic Disorders ; Recovery Room ; Respiration ; Seoul ; Succinylcholine ; Thiopental ; Tubocurarine

PURPOSE: The present study investigated the therapeutic effects of periocular triamcinolone acetonide injections to treat inflammatory signs in patients with severe acute thyroid-associated ophthalmopathy. METHODS: Twenty-two patients with symptoms of severe acute thyroid ophthalmopathy were enrolled in the present study. The patients received four doses of 20 mg of triamcinolone acetonide via periocular injection into the inferotemporal orbital quadrant every 2 weeks. The changes in visual acuity, intraocular pressure, eye ball motility, exophthalmos, thickness of extraocular muscles, clinical activity score and NOSPECS score were measured. RESULTS: Eighteen of 22 patients (81.8%) showed improvement in soft tissue swelling, ten patients (45.5%) showed improvement in conjunctival hyperemia and one patient showed improvement of ocular motility. Clinical activity score and NOSPECS score had significant improvements. No patient had changes in visual acuity, intraocular pressure, diplopia, proptosis or thickness of extraocular muscles. An ocular adverse effect was found in one patient, who had subcutaneous fat atrophy at the injection site. CONCLUSIONS: In patients with severe acute thyroid ophthalmopathy, periocular triamcinolone acetonide injection can be effective to improve acute inflammatory symptoms, without significant adverse effects.
Atrophy ; Diplopia ; Exophthalmos ; Eye ; Graves Ophthalmopathy ; Humans ; Hyperemia ; Injections, Intraocular ; Intraocular Pressure ; Muscles ; Orbit ; Subcutaneous Fat ; Thyroid Gland ; Triamcinolone ; Triamcinolone Acetonide ; Visual Acuity

BACKGROUND: A laparoscopic cholecystectomy has many clinical advantages and is now recognize as the choice for treatment for gallstones. However a laparoscopic cholecystectomy is often not feasible or is converted to the conventional open method in patients with acute cholecystitis because of surrounding adhesion, tissue edema, and high postoperative complications. Lately, good clinical results have been reported by many authors for a percutaneous cholecystostomy followed by a laparoscopic cholecystectomy in the management of acute cholecystitis. METHODS: Between January 1996 and March 1997, 56 acute cholecystitis patients were surgically treated in our institution. Thirteen patients underwent percutaneous drainage followed by a laparoscopic cholecystectomy (Group I). Also a laparoscopic cholecystectomy without a prior percutaneous cholecystostomy was attempted in 43 patients (Group II). RESULTS: There were no differences in the age and the sex distributions, the chief complaints on admission, and the severity of inflammation between the two groups. The only significant difference was the wall thickness of the gallbladder on postoperative pathologic examinations, 4.7 mm for Group I and 6.2 mm Group II (p=0.038). For the patients in Group I, percutaneous drainage of the gallbladder continued for 5.4 days on average, and the cholecystectomy was usually performed about 15 days later. A laparoscopic cholecystectomy was possible in 10 patients (76%) in Group I, but had to be converted to the open method in 3 patients. In Group II, only 17 patients (39.5%) out of 43 underwent a successful laparoscopic cholecystectomy. In other words, the open conversion rate was 24% in Group I and 60.5% in Group II. The wall thicknesses of the gallbladder excised laparoscopically were 3.98 mm and those of the conventionally removed gallbladder were 6.96 mm on average. This difference in the wall thickness was statistically significant (p=0.013) and was the only factor related with the open conversion rate. CONCLUSIONS: We think that a laparoscopic cholecystectomy performed several days after percutaneous drainage of the gallbladder to eliminate acute inflammation may be recommended for management of acute cholecystitis patients with severe clinical symptoms and ultrasonographic findings of marked gallbladder dilatation or pericholecystic fluid collection.
Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Cholecystitis, Acute ; Cholecystostomy* ; Dilatation ; Drainage ; Edema ; Gallbladder ; Gallstones ; Humans ; Inflammation ; Postoperative Complications ; Sex Distribution ; Tissue Adhesions

BACKGROUND: The reduction in hematocrit (Hct) by hemodilution tends to cause an increase in cardiac output and a proportional decrease in arterial oxygen content. Additionally the reduction of systemic oxygen delivery (DO2) leads to significant differences in regional blood flow. It is therefore important to characterize the effects of hemodilution on regional oxygen metabolism in individual organs. This study was undertaken to evaluate and compare the effects of acute normovolemic anemia induced by hemodilution. METHODS: Six dogs were anesthetized and mechanically ventilated. Catheters were inserted in the right femoral and pulmonary arteries for blood sampling, and a gastric tonometer catheter was inserted into the gastric lumen. Baseline measurements of systemic hemodynamics, arterial ketone body ratio (AKBR), gastric intramucosal pH (pHi) and arterial lactate were recorded. Hemodilution was then begun by 6% pentastarch and was made in four levels of hematocrit values of 20%, 15%, 10% and 6%. RESULTS: Mean arterial pressures of Hct 10% and 6% was decresaed (P < 0.05) and Hct 15% and 10% increases in cardiac output and pulmonary capillary wedge pressure (PCWP) were observed. Central venous pressure and mean pulmonary arterial pressure were incresed (P < 0.05) at Hct 15%, 10% and 6%. DO2 progressively decreased (P < 0.05). AKBR and pHi began to decreased at Hct 15%. Arterial lactate decrease at Hct 15% and was above 7.4 mmol/L at Hct 6%. CONCLUSIONS: By the measurements of AKBR and pHi, the disturbance of splanchnic oxygenation can be detected early compared to those of O2 in terms of oxygen metabolism and the critical point of DO2 during acute normovolemic anemia induced by hemodilution.
Anemia* ; Animals ; Arterial Pressure ; Cardiac Output ; Catheters ; Central Venous Pressure ; Dogs* ; Hematocrit ; Hemodilution* ; Hemodynamics ; Hydrogen-Ion Concentration* ; Hydroxyethyl Starch Derivatives ; Lactic Acid* ; Metabolism ; Oxygen Consumption* ; Oxygen* ; Pulmonary Artery ; Pulmonary Wedge Pressure ; Regional Blood Flow

Nonparasitic true splenic cyst is a rare disease and the epidermoid cyst accounts for the majority of the cases. And the epidermoid cyst producing CA19-9 is extremely rare. We present a case of true splenic cyst with high cystic fluid CA19-9 level. A 26-year-old woman complained left upper quadrant abdominal pain. Abdominal ultrasonography and CT depicted a 17 x 13 cm sized cystic lesion in the left upper abdomen. The aspirated cystic fluid showed high concentration of CA19-9, but serum CA19-9 level was normal. Spleen with huge unilocular cyst was removed surgically. The cyst was lined with single layered cuboidal epithelial cells and negative for immunohistochemical staining with anti-CA19-9 antibody.
Abdomen ; Abdominal Pain ; Adult ; Epidermal Cyst ; Epithelial Cells ; Female ; Humans ; Rare Diseases ; Spleen* ; Splenic Diseases ; Ultrasonography

A case of chronic epidural hematoma in the left frontal region is presented. The patient presented with a unique neurologic sign, exophthalmos, which was not a result of the injury but of in-growth of granulation tissue of the hematoma capsule into the orbit through the orbital roof defect. The time interval between head injury and the operation was about 25 years. Our case represent the second most longest time interval among the reviewed literatures.
Craniocerebral Trauma ; Exophthalmos* ; Granulation Tissue ; Hematoma* ; Humans ; Neurologic Manifestations ; Orbit