PURPOSE: To compare the effect of medial rectus recession in consecutive esotropes who had previous monocular medial rectus resection and lateral rectus recession and in non- accommodative esotropes (NAET) with small angle of deviation who had no prior operation. METHODS: We studied the results of unilateral medial rectus recession at postoperative 2 and 6 months in 7 consecutive esotropes and 19 NAET with deviation angle around 20 PD, and analyzed the corrected amount for 1 mm medial rectus recession. We regarded deviated angle of+/-8 PD at orthophoria as successful operation. RESULTS: The abosolute value of remained deviation in consecutive esotropes and NAET were 4.86+/-5.67 PD and 9.05+/-3.95 PD at postoperative 2 months, and 5.42+/-7.89 PD and 8.26+/-4.45 PD at postoperative 6 months, respectively. There were significant differences between at postoperative 2 and 6 months (p<0.05). The success rates in consecutive esotropes and NAET at postoperative 2 months were 86% and 42%, and 71% and 47%, respectively at postoperative 6 months, which were no significant differences (p>0.05). The average amount of corrected deviation for 1 mm recession at postoperative 6 months was 5.84 PD in consecutive esotropes and 2.97 PD in NAET, which were significant differences (p<0.05). CONCLUSION: Unilateral medial rectus recession in consecutive esotropes may be a useful and first choice of operation procedure when considering second operation. The amount of correction for 1 mm medial rectus recession is larger in consecutive esotropes than in NAET, possibly due to previous resection of medial rectus or release of fat adhesion. Therefore the amount of medial rectus recession in consecutive esotropia should be determined after considering the degree of abduction and operative findings.
Esotropia*

PURPOSE: Orbital pseudotumor is a nonspecific benign orbital inflammation without evidence of specific local or systemic cause. Orbital pseudotumor rarely displays predominant tissue eosinophilia without vasculitis. We report this rare case of eosinophilic orbital pseudotumor associated with acute pneumonic infiltrates. METHODS: A 27-year-old man visited our clinic because of painless swelling of the upper and lower lid and proptosis which developed 10 days ago. Subconjunctival mass showed severe eosinophilic infiltration, mild proliferation of capillaries, and non-necrotic vasculitis. We started steroid treatement under the diagnosis of atypical orbital pseudotumor with acute pneumonic infiltrates. RESULTS: At four days after starting steroid treatment, swelling of lids, proptosis and pulmonary infiltration disappeared. At four months there was no evidence of recurrence with the cessation of steroid.
Adult ; Capillaries ; Diagnosis ; Eosinophilia ; Eosinophils ; Exophthalmos ; Humans ; Inflammation ; Orbit* ; Orbital Pseudotumor* ; Pneumonia ; Recurrence ; Vasculitis

Diabetes is a rapidly increasing heath care problem all over the world due to increased prevalence during past decade. Diabetic nephropathy develops in 25-30% of patients with type 1 diabetes and is the leading cause of end stage renal disease. Diabetic nephropathy is characterized by persistent proteinuria, decline in renal function, hypertension and increased cardiovascular morbidity and mortality. Early detection of diabetic nephropathy risk is an important goal because early diagnosis and treatment prevent advanced renal damage and other diabetic complications. Increased urinary albumin excretion rate is widely accepted as the first clinical sign of diabetic nephropathy. However, reduced glomerular filtration or hypertension could be the first manifestation in some diabetic patients. We need improved markers and predictors of diabetic nephropathy risk. We report a case of diabetic nephropathy and decreased glomerular filtration rate (GFR) without microalbuminuria occcured in type 1 diabetic patient.
Diabetes Complications ; Diabetic Nephropathies* ; Early Diagnosis ; Filtration ; Glomerular Filtration Rate ; Humans ; Hypertension ; Kidney Failure, Chronic ; Mortality ; Prevalence ; Proteinuria

The localization and number of oxytocin- and vasopressin-immunoreactive neurons (OXY-IR & VP-IR) and their fibers in the hypothalamic areas (supraoptic nucleus, paraventricular nucleus, lateral hypothalamic area and median eminence) of the hypophysectomized rat were compared with normal rats at 6 months of survival after surgery at the light microscopic level. The number of VP-IR neurons was markedly decreased in the supraoptic nucleus (SON) and paraventricular nucleus (PVN) in the hypophysectomized rats as compared to normal rats. Moreover, The number of VP-IR fibers was decresed in the SON, PVN, lateral hypothalamic area (LHA) and median eminence in the hypophysectomized rats. The number of OXY-IR neurons and thier fibers were also decreased in the SON and PVN in the hypophysectomized rats. The present results demonstrate that hypophysectomy induces a significant decrease in the number of OXY- and VPIR neurons and fibers within hypothalamic areas (SON, PVN, and LHA at 6 months of post-hypophysectomy) are decreased.
Animals ; Hypophysectomy ; Hypothalamic Area, Lateral ; Immunohistochemistry ; Median Eminence ; Neurons* ; Oxytocin* ; Paraventricular Hypothalamic Nucleus ; Rats* ; Supraoptic Nucleus ; Vasopressins

PURPOSE: To determine the intraocular pressure (IOP) lowering effects on the change of anterior chamber depth (ACD), corneal thickness, corneal cell area and density in normal eyes. METHODS: We investigated 58 eyes of 29 volunteers for this study whose refractive error was +/-3 D, IOP was below 21 mmHg, anterior segment and fundus was within normal limit. All of them had normal visual fields. They were randomly classified into two groups. Anterior chamber depth, IOP, central corneal thickness, cell density, cell area, and coefficient of variation of corneal endothelium were measured by single observer in each group. After oral medication of 50% glycerin 1 cc/kg (body weight) in group 1 and Diamox 500 mg and K-contin 600 mg in group 2, IOP, anterior chamber depth, central corneal thickness, cell density, cell area, and coefficient of variation were measured at 1, 2, and 3 hours. RESULTS: In glycerin group after 1 hour, decreased IOP was stastically significant (P<0.05). In Diamox group after 2 hours, decreased IOP was stastically significant (P<0.05). But the change of anterior chamber depth, central corneal thickness, cell density, cell area, and coeff icient of variation was not stastically significant (p>0.05). There was no significant correlation between decreased IOP and the change of anterior chamber depth, central corneal thickness, cell density, cell area, and coefficient of variation. The IOP change was not statistically different between the two groups. CONCLUSIONS: There was no stastically significant correlation between decreased IOP in normal range and the change of ACD, central corneal thickness, cell density, cell area, and coefficient of variation.
Acetazolamide ; Anterior Chamber* ; Cell Count ; Endothelium, Corneal ; Glycerol ; Intraocular Pressure* ; Reference Values ; Refractive Errors ; Visual Fields ; Volunteers

PURPOSE: There was a outbreak of aseptic meningitis in Busan, 2002. We report the clinical features and causative viruses. METHODS: Two hundred seventy six children with aseptic meningitis who were admitted to the Department of Pediatrics, Maryknoll Hospital between January and December, 2002 were included. CSF, stool and throat swab viral cultures were done in 244 of these children. RESULTS: The male to female ratio was 1.4 : 1. Age of patients varied from five months to fourteen years old. Average age was 5.7+/-6.2 years old and mostly between one and four years.(41.3%) Monthly distribution revealed that the number of patients increased from May to July. The main symptoms were fever, headache and vomiting in this order. Respiratory tract infection symptom was associated from June to July and headache and nausea without fever were characteristically observed in children more than 10 years old from November to December. In peripheral blood examination, leukocytosis(WBC>10,000/mm3) showed in 34.8%, ESR was increased in 56.1%, and CRP was positive value in 61%. Therefore differential diagnosis was difficult through peripheral blood examination. CSF findings revealed mean leukocyte count 86.5+/-180.2/mm3, protein 41.7+/-32.9 mg/dL, glucose 56.4+/-9.9 mg/dL. Median hospitalized period was 4.7+/-7.2 days and compared with non-tapping group, hospitalized period was shorter and subsidance of symptoms was faster, therefore antibiotics injection period was shorter in the spinal tapping group. Virus was isolated in 31 cases of 244. The causative agents were echovirus 6, echovirus 9, echovirus 25, coxsakie virus B3, B4. CONCLUSION: There was an epidemics of aseptic meningitis in Busan, 2002; the causative agent was echovirus 6, 9, 25, coxsakie virus B3, B4.
Anti-Bacterial Agents ; Busan* ; Child ; Diagnosis, Differential ; Echovirus 6, Human ; Echovirus 9 ; Enterovirus B, Human ; Female ; Fever ; Glucose ; Headache ; Humans ; Leukocyte Count ; Male ; Meningitis, Aseptic* ; Nausea ; Pediatrics ; Pharynx ; Respiratory Tract Infections ; Spinal Puncture ; Vomiting

D variant of encephalomyocarditis (EMC-D) virus causes diabetes in susceptible mice by direct infection and cytolysis of pancreatic beta cells. cDNA covering the major outer capsid protein (VP1) of EMC-D virus was cloned into Mycobacterium bovis bacillus Calmette-Guerin (BCG). None of the SJL/J male mice, immunized with live recombinant BCG-VP1, became diabetic when challenged with highly diabetogenic EMC-D virus. But the control mice inoculated with normal BCG or rBCG transformed with vector alone developed diabetes in the same challenge. VP1-specific antibodies including neutralizing antibodies were markedly increased as time went on and reached to the maximum titer at week 10 after a single immunization. The plateau of the titer lasted longer than following 4 weeks. Guinea pigs immunized with the live rBCG-VP1 showed strong delayed type hypersensitivity (DTH) to the VP1of EMC-D virus. It means that the live rBCG-VP1 elicit efficient humoral and cell-mediated imrnune responses against EMC-D virus, resulting in prevention of virus-induced diabetes in susceptible mice.
Animals ; Antibodies ; Antibodies, Neutralizing ; Bacillus ; Capsid Proteins ; Clone Cells ; DNA, Complementary ; Guinea Pigs ; Humans ; Hypersensitivity ; Immunization* ; Insulin-Secreting Cells ; Male* ; Mice* ; Mycobacterium bovis*

Improved survival rate of premature infants requiring intensive care lead into an increased risk for nosocomial infections such as disseminated fungal infection. Neonatal candida sepsis has become one of the most important causes of neonatal morbidity and mortality. The most common site of end organ involvement in premature infants with candidemia is the kidney. But no consensus has been reached concerning the treatment of candidemia in the newborn. We recently experienced a case of premature infant who was diagnosed as renal candidiasis with microabscess formation due to Candida Albicans and patient was treated successfully with long term liposomal amphotericin B and fluconazole therapy without surgical drainage.
Amphotericin B ; Candida ; Candida albicans ; Candidemia ; Candidiasis* ; Consensus ; Cross Infection ; Drainage* ; Fluconazole ; Humans ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight* ; Critical Care ; Kidney ; Mortality ; Sepsis ; Survival Rate

BACKGROUND: Although opioids are the most commonly used medications to control postoperative pain in children, the analgesic effects could have a large inter-individual variability according to genotypes. The aim of this study was to investigate the association between single nucleotide polymorphisms and the analgesic effect of morphine for postoperative pain in children. METHODS: A prospective study was conducted in 88 healthy children undergoing tonsillectomy, who received morphine during the operation. The postoperative pain score, frequency of rescue analgesics, and side effects of morphine were assessed in the post-anesthesia care unit. The children were genotyped for OPRM1 A118G, ABCB1 C3435T, and COMT Val158Met. RESULTS: Children with at least one G allele for OPRM1 (AG/GG) had higher postoperative pain scores compared with those with the AA genotype at the time of discharge from the post-anesthesia care unit (P = 0.025). Other recovery profiles were not significantly different between the two groups. There was no significant relationship between genotypes and postoperative pain scores in analysis of ABCB1 and COMT polymorphisms. CONCLUSIONS: Genetic polymorphism at OPRM1 A118G, but not at ABCB1 C3435T and COMT Val158Met, influences the analgesic effect of morphine for immediate acute postoperative pain in children.
Alleles ; Analgesics ; Analgesics, Opioid ; Child* ; Genotype* ; Humans ; Morphine* ; Pain, Postoperative* ; Polymorphism, Genetic ; Polymorphism, Single Nucleotide ; Prospective Studies ; Tonsillectomy

Ongoing advances in the treatment of very-low-birth-weight infants have confronted us with a growing number of infants susceptible to acquired illnesses of the gastrointestinal tract. Although necrotizing enterocolitis has been regarded as the major cause of gastrointestinal perforation in preterm infants, the incidence of spontaneous perforation occurred in an apparently normal bowel is increasing. The risk factors for spontaneous intestinal perforation include prematurity, twin pregnancies, perinatal asphyxia, prior use of umbilical artery catheter, use of indomethacin and/or steroid, and bacterial or fungal sepsis. We report a case of spontaneous ileal perforation occurred in very low birth weight infant who was successfully treated with emergency operation.
Asphyxia ; Catheters ; Emergencies ; Enterocolitis, Necrotizing* ; Gastrointestinal Tract ; Humans ; Incidence ; Indomethacin ; Infant ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight* ; Intestinal Perforation ; Pregnancy, Twin ; Risk Factors ; Sepsis ; Umbilical Arteries