PURPOSE: To evaluate the association between age and peripapillary retinal nerve fiber layer (RNFL) thickness measured by Cirrus high-definition (HD) spectral domain optical coherence tomography (OCT) in healthy Korean subjects. METHODS: A total of 302 eyes from 155 healthy Korean subjects (age range, 20 to 79 years) underwent RNFL thickness measurements using the Cirrus HD-OCT. Average, quadrant, and clock-hour RNFL thickness parameters were analyzed in terms of age using linear mixed effect models. RESULTS: Average RNFL demonstrated a slope of -2.1 microm per decade of age (p < 0.001). In quadrant analysis, superior (-3.4 microm/decade, p < 0.001) and inferior (-2.9 microm/decade, p < 0.001) quadrants showed steeper slopes, whereas temporal (-1.1 microm/decade, p < 0.001) and nasal (-1.0 microm/decade, p < 0.001) quadrants revealed shallower slopes. Among the 12 clock-hour sectors, clock hours 6 (-4.5 microm/decade, p < 0.001) and 1 (-4.1 microm/decade, p < 0.001) showed the greatest tendency to decline with age; RNFLs of the 3 (-0.2 microm/decade, p = 0.391) and 4 (-0.6 microm/decade, p = 0.052) o'clock hour sectors did not show significant decay. CONCLUSIONS: RNFL thickness was associated with age, especially in superior and inferior areas. The topographic distribution of correlation between age and RNFL thickness was not uniform.
Adult ; Aged ; *Aging ; *Asian Continental Ancestry Group ; Humans ; Male ; Middle Aged ; *Nerve Fibers ; Reference Values ; Reproducibility of Results ; Retinal Ganglion Cells/*cytology ; Tomography, Optical Coherence/*methods ; Young Adult

PURPOSE: To evaluate the efficacy of a monocular drug trial in eyes with normal-tension glaucoma (NTG). METHODS: This prospective study enrolled 74 patients with NTG. The monocular drug trial was started using latanoprost 0.005% for one week. If the intraocular pressure (IOP) reduction was greater than 15%, the same medication was administered to both eyes for one month. The unadjusted change and adjusted change (the change in the treated eye minus the change in the contralateral eye) in IOP were evaluated, and the predictors of IOP response were analyzed by multivariate linear regression. RESULTS: Among the initial 74 patients, 31 (41.9%) were included; others were excluded because they did not meet the requisite conditions. The most significant predictors of IOP response in the initial eye and subsequent eye were the baseline IOPs in both eyes (beta = 0.907, 0.771, respectively). The adjusted change in IOP of the initial eye had greater association (beta = 0.589) with the IOP after monocular trial in the initial eye than that of unadjusted IOP change (beta = 0.279). The adjusted change in IOP also had greater predictability (beta = 0.348) for IOP after monocular trial in the subsequent eye than that of the unadjusted IOP change (beta = 0.090). CONCLUSIONS: Although the monocular trial in NTG patients had limited efficacy due to its stringent conditions, it was useful for evaluating the IOP response in the initial eye and for predicting the IOP response in the subsequent eye.
Adult ; Aged ; Aged, 80 and over ; Antihypertensive Agents/*therapeutic use ; Female ; Humans ; Intraocular Pressure/drug effects ; Linear Models ; Low Tension Glaucoma/*drug therapy ; Male ; Middle Aged ; Prospective Studies ; Prostaglandins F, Synthetic/*therapeutic use ; Statistics, Nonparametric ; Treatment Outcome

Lidocaline if frequently administered as a component of an anesthetic : for local or regional nerve blocks, to mitigate the autonomic response to laryngoscopy and tracheal intubation, to suppress the cough reflex, and for antiarrythmic therapy. Diazepam dectease the potential central nervous system (CNS) toxicity of local anesthetic agents but -may modify the sitmulant action of lidocaine in addition to their own cardiovascular depressant. The potential cardiovascular toxicity of local anesthetics may be enhanced by the concomitant administration of diazepam. This study was designed to investigate the effects of lidocaine dose and pretreated diazepam to cardiovascular system and plasma concentration of lidocaine. Lidocaine in 100 mcg/kg/min, 200 mcg/kg/min, and 300 mcg/kg/min was given by sequential infusion to dogs anesthetized with halothane-nitrous oxide (Group I). And in group II, after diazepam pretreatment, lidocaine was infused by same way when lidocaine was administered in 100 mcg/kg/min, the low plasma levels (3.97+/-0.22-4.48+/-0.36 mcg/ml) caused a little reduction in cardiovascular hemodynamics. As administered in 200 mcg/kg/min, 300 mcg/kg/min, the higher plasma levels (7.50+/-0.66-11.83+/-0.59 mcg/ml) reduced mean arterial pressure (MAP), cardiac index (CI), stroke index (SI), left ventricular stroke work index (LVSWI), and right ventricular stroke work index (PVSWI) and incresed pulmonary artery wedge pressure (PAWP), central venous pressure (CVP), systemic vascular resistance index (SVRI), but was assciated with little changes of heart rate (HR), mean pulmonary artery pressure (MPAP), and pulmonary vascular resistance index (PVM). When lidocaine with pretreated diazepam was administered in 100 mcg/kg/min, the low plasma level, the lower level than when only lidocaine administered. reduced MAP, but was not changed other cardiovascular hemodynamics. While lidocaine was infused in 200 mcg/kg/min, 300 mcg/kg/min in dogs pretreated diazepam, the higher plasma level (7.64+/-0.79-13.79+/-0.82 mcg/ml) was maintained and was associated with reduced CI, SI, LVSWI and incresed PAWP, CVP, SVRI but was a little changes of HR, MPAP, PVRI. After CaCl2 administeration, CI, SI, SVRI, LVSWI was recovered but PAWP, UP was rather incresed than recovered. The foregoing results demonstrate that pretreated diazepam imposes no additional burden on cardiovascular system when a infusion of large dose of lidocaine is given to dogs anesthetized with halothanenitrous oxide. But caution may be advised if the addition of lidocaine is indicated in subjects who have impared autonomic nervous system and who are in hypercarbic, hypoxic, or acidotic states.
Anesthetics ; Anesthetics, Local ; Animals ; Arterial Pressure ; Autonomic Nervous System ; Cardiovascular System* ; Central Nervous System ; Central Venous Pressure ; Cough ; Diazepam* ; Dogs* ; Heart Rate ; Hemodynamics ; Intubation ; Laryngoscopy ; Lidocaine* ; Nerve Block ; Plasma* ; Pulmonary Artery ; Pulmonary Wedge Pressure ; Reflex ; Stroke ; Vascular Resistance

The purpose of this study was to examine the effect of slow stroke back massage(SSBM) on anxiety and immune response in patients undergoing open heart surgery and to compare the effect of 5-minutes with 10-minutes SSBM. Among the sixty-four patient subjects, twenty-one were one experimental group receiving massage for 10-minutes, twenty for the other experimental group receiving massage for 5-minutes and twenty-three for the control group. Subjects were admitted at Hospitals in Inchon and Puchon for open heart surgery. This study was carried out from October 10, 1997 to May 10, 1998. The levels of anxiety were measured by the Visual Analogue Scale(VAS), Trait anxiety scale, systolic and diastolic blood pressure, pulse rate, blood cortisol and the levels of immune response were measured by the blood T-lymphocyte and Natural killer cell. Study measurements were taken before and after SSBM on the 1st pst operative day. Data were analyzed using x2test, oneway ANOVA, paired t-test, t-test and Pearson product moment correlation. The results were summarized as follows: 1. After SSBM, VAS anxiety level, systolic and diastolic blood pressure and pulse rate of the experimental group were decreased significantly than those measurements before the SSBM. After SSBM, significant difference in the VAS anxiety level, systolic blood pressure and pulse rate between the experimental and control groups were found. 2. After SSBM, the blood cortisol of the experimental and control groups were increased significantly compared with before SSBM. But the significant difference in blood cortisol between the two groups was not found. 3. After SSBM, the blood T-lymphocyte percentages of the experimental and control groups were decease significantly and blood Natural killer cell percentages of the two groups were increased compared with before SSBM. But significant difference in blood T-lymphocyte and Natural killer cell percentages between the two groups was not found. 4. Significant difference in VAS anxiety level, systolic and diastolic blood pressure, pulse rate, blood cortisol, blood T-lymphocyte and Natural killer cell percentages between SSBM for 5 minutes and SSBM for 10 minutes were not found. Based upon the results, this study concludes that the slow stroke back massage for 5 minutes is a useful intervention that decreases anxiety and produces relaxation in patients undergoing open heart surgery.
Anxiety* ; Blood Pressure ; Gyeonggi-do ; Heart Rate ; Heart* ; Humans ; Hydrocortisone ; Incheon ; Killer Cells, Natural ; Massage* ; Relaxation ; Stroke* ; T-Lymphocytes ; Thoracic Surgery*

Inflammatory mediators, such as oxidants, TNF-alpha, and IL-6, play a major role in the systemic response to bum injury It has been known that a continuing inflammatory response cause a sepsis and subsequent multiple organ failure. Recent studies have shown that burn patients receiving recombinant human growth hormone(rhGH) therapy have an improvement of the general condition, but the mechanism by which rhGH exerts its effects has not been clearly understood. The aim of this study was to evaluate the effect of rhGH on the early bum injury. Female Sprague-Dawley rats were divided into four groups : control group, bum group, burn plus rhGH treated group, and rhGH only treated group. Animals were killed at 30min., 3, 6, 24, and 48 hours after treatment. Histology and biochemical changes including malondialdehyde(MDA) content, tissue reduced glutathione(GSH) and catalase activity in the lung and liver, and plasma TNF-alpha and IL-6 levels were examined. Lung histology in the bum plus rhGH treated group showed decreased inflammtory response such as neutrophil and lymphocyte infiltrations, interstitial thickening, and edema compared with the bum group. Liver histology in the bum group revealed mild neutrophil and lymphocyte infiltrations, vacuolization .of hepatocytes, disrupted lobular structures, and dilated sinusoids. But liver histology of the bum plus rhGH was similar to control group. Lung and liver MDA in the burn plus rhGH and rhGH only treated groups were decreased with time compared with the burn group. Lung and liver GSH and catalase activities in the bum plus rhGH and GH only treated groups remained significantly increased compared with the bum group for the 48-hours period. Plasma TNF-alpha levels in the bum group remained elevated for the 48-hours period compared with the bum plus rhGH and rhGH only treated groups. Plasma IL-6 levels in the burn group were significantly increased only at first compared with the bum plus rhGH and rhGH only treated groups. These results suggested that rhGH showed inhibitory effects on the inflammatory cell infiltration and lipid peroxidation in the lung and liver after bum injury. Increased GSH levels and catalase activities seemed to be associated with the antioxidant effect of rhGH. But the inhibitory effect of rhGH on plasma TNF- and R-6 levels was not clearly demonstrated.
Animals ; Antioxidants ; Burns ; Catalase ; Edema ; Female ; Hepatocytes ; Human Growth Hormone* ; Humans* ; Interleukin-6* ; Lipid Peroxidation* ; Liver ; Lung ; Lymphocytes ; Multiple Organ Failure ; Neutrophils ; Oxidants ; Plasma* ; Rats* ; Rats, Sprague-Dawley ; Sepsis ; Tumor Necrosis Factor-alpha*

Traumatic hyphema accounts for about 6.7% of ocular trauma and its visual threatening associated ocular injuries are commotio retinae, retinal detachment, macular hole. cataract and rebleeding. The authors reviewed the medical records of 98 patients (98 eyes) having been admitted to the Joongang Gil Hospital between March 1989 and February 1991 with the diagnosis of nonperforating traumatic hyphema. Prospective study was performed as to the effect of epsilon-aminocaproic acid (EACA) in the clearance time of blood clot in the anterior chamber and the frequency of rebleeding. The avlrage clearance time of blood clot was significantly longer in the EACA treated group (5.8 days) than in the control group (3.5 days)(t-Test P<0.01). The frequency of rebleeding was not statistically significantly different between the EACA treated group (3.9%, 2/52 patients) and the control group (87%, 4/46 patients)(X2-Test P>0.05).
Aminocaproic Acid ; Anterior Chamber ; Cataract ; Diagnosis ; Humans ; Hyphema* ; Medical Records ; Prospective Studies ; Retina ; Retinal Detachment ; Retinal Perforations

A case of metastatic adenoid cystic carcinoma of the lung, originated from the trachea, was diagnosed by fine needle aspiration. Although the cytologic features of adenoid cystic carcinoma have been well described, it is easy to confuse adenoid cystic carcinoma with more common primary small cell neoplasms of the lung, i.e., small cell carcinoma, well differentiated adenocarcinoma, and carcinoid tumor of the lung. The features distinguishing adenoid cystic carcinoma from these neoplasms include 1) tight, globular, honeycomb pattern of cells, 2) acellular basement membrane material in the lumen, and 3) cells lacking true nuclear molding and having bland chromatin pattern. The morphologic feature of metastatic adenoid cystic carcinoma in this case was so distinctive as to permit a definite diagnosis by aspiration cytology.
Adenocarcinoma ; Adenoids* ; Basement Membrane ; Biopsy* ; Biopsy, Fine-Needle* ; Carcinoid Tumor ; Carcinoma, Adenoid Cystic* ; Carcinoma, Small Cell ; Chromatin ; Diagnosis ; Fungi ; Lung* ; Trachea

Purpose: To compare the changes in central anterior chamber depth between supine and sitting positions using an ultrasound biomicroscope among acute angle closure glaucoma, lens-induced angle closure glaucoma, and normal groups. Methods: This study included 18, 13, and 29 individuals with acute angle closure glaucoma, lens-induced angle closure glaucoma, and control, respectively. The central anterior chamber depth, trabecular iris angle, corneal curvature, and axial length were measured in the sitting and supine positions. Results: The central anterior chamber depth in the supine and sitting positions were 1.61 ± 0.47 mm and 1.55 ± 0.46 mm in the acute angle closure glaucoma, which were significantly smaller than those in the normal group (2.48 ± 0.49 mm and 2.47 ± 0.50 mm) (p = 0.01 and p = 0.009, respectively). In lens-induced angle closure glaucoma, the central anterior chamber depth in the supine and sitting positions were 1.65 ± 0.84 mm and 1.52 ± 0.82 mm, respectively, which were significantly smaller than those in the normal group (p < 0.001 for both). The absolute change in central anterior chamber depth with posture alteration was significantly larger in both acute angle closure glaucoma (0.15 ± 0.09 mm) and lens-induced angle closure glaucoma (0.25 ± 0.11 mm) than in the normal control (0.09 ± 0.08 mm) (p = 0.011, p < 0.001, respectively). The largest amount of change was shown in the lens-induced angle closure glaucoma (p = 0.012). The absolute change in anterior chamber angle with posture change wa not significantly different between the groups (p = 0.165). Conclusions Compared to the control group, the central anterior chamber depth was smaller in both glaucoma groups. The absolute change in the anterior chamber depth with posture was significantly larger in the lens-induced angle closure glaucoma than in acute angle closure glaucoma.

Recently it is known that Turner's syndrome is frequently associated with hypothyroidism. We report a case of Turner's syndrome associated with subclinical hypothyroidism. A 23-year-old female was admitted to the hospital with complaints of amenorrhea and short stature. She had a mosaicism of 45, X0/46, Xi(X_q) in the cell, cultured from the peripheral blood. The plasma thyroxine and triiodothyronine were normal and there was no clinical symptom of hypothyroidism. But the thyroid-stimulating hormone(TSH) concentration was unusually higher(184 uU/L). She has been treated with the cyclic therapy of conjugated estrogen and medroxyprogesterone, in addition to the thyroxine replacement therapy. After 2 months, the menstruation was restored and TSH was normalized.
Amenorrhea ; Cells, Cultured ; Estrogens ; Female ; Humans ; Hypothyroidism ; Medroxyprogesterone ; Menstruation ; Mosaicism ; Plasma ; Thyroxine ; Triiodothyronine ; Turner Syndrome ; Young Adult

PURPOSE: Intussusception is one of the most common cause of childhood intestinal obstructions. Early diagnosis is essential to avoid treatment delays, which can increase morbidity and mortality. METHODS: In order to evaluate the factors contributing to air-reduction failure, we reviewed cases of childhood intussusception admitted via the ER and managed by air enema reduction from 1994 to 1998. They were divided into two groups and compared retrospectively by using medical records. Group I was the operation group after air-reduction failure, and group II was the air-reduction group. RESULTS: In 319 cases (279 patients), group I consisted of 112 cases (110 patients), and group II consisted of 207 cases (169 patients). No differences in age, sex, body weight, location of intussusception, laboratory findings (leukocytosis and thrombocytosis), presence of bloody stool, and body temperature were noted between the two groups. Factors significantly contributing to air-reduction failure were duration of symptoms, type of intussusception and a few physical findings (abdominal distension, palpable mass, lethargy, and vomiting). The recurrence rate of group I was significantly lower than that of group II, and most recurrences developed in the first postoperative month. CONCLUSION: Childhood intussusceptions of a non-ileocolic type with longer durations of symptoms and severe clinical findings have a higher chance of air-reduction failure.
Body Temperature ; Body Weight ; Early Diagnosis ; Enema ; Intestinal Obstruction ; Intussusception* ; Lethargy ; Medical Records ; Mortality ; Recurrence ; Retrospective Studies