OBJECTIVE: This study was to investigate the clinical efficiency of clomiphene citrate/GnRH antagonist protocol comparing with the clomiphene citrate only protocol in infertile women with normal ovulatory cycles. METHOD: Among 116 patients, 43 were received assisted reproductive technologies using natural ovulatory cycle, 38 and 35 were received clomiphene citrate only protocol and clomiphene citrate/GnRH antagonist combined protocol, respectively, and the clinical results were compared and analyzed. RESULTS: In each group, basal levels of LH, FSH, E2 and FSH, E2 on hCG day injected were not different, but LH level and endometrial thickness on hCG injected day were decreased significantly and the pregnancy rate was increased significantly in clomiphene citrate/GnRH antagonist group. CONCLUSION: The pregnancy rate was increased significantly in clomiphene citrate/GnRH antagonist group compared with natural ovulatory cycle and clomiphene citrate only group.
Clomiphene* ; Female ; Humans ; Pregnancy Rate ; Reproductive Techniques, Assisted

PURPOSE: To evaluate abnormal neurosonographic (NSG) findings of thalami and basal ganglia in full term babies with hypoxic-ischemic encephalopathy and to correlate the findings with follow-up studies and prognosis. METHODS: We evaluated 13 full term babies with abnormal NSG findings of thalarni and basal ganglia. NSG was performed within 7 days after clinical abnormalities. Follow-up NSG was done in 11 cases; CT scan in 4 and MRI in 7. We classified NSG findings as diffuse, unilateral, and focal types according to increased echogenicity and evaluated prognosis based on follow-up studies and neurological sequelae. RESULTS: Nine cases of diffuse type had diffuse echogenic changes of bilateral thalami and basal ganglia, slit-like lateral ventricles suggesting cerebral edema, and increased parenchymal echogenicity. In diffuse type, follow-up studies showed more prominent echogencities and ventricular dilatations and cerebromalacia. One case of unilateral type caused by thromboembolism had unilateral echogenicity of right thalamus and basal ganglia with increased echogenicity of the ipsilateral cerebral hemisphere and compression of the lateral ventricle, suggesting cerebral infarction. Follow-up study showed unilateral cystic cerebromalacia. Three cases of focal type had a localized echogenic area in thalamus with lacunar infarction, which decreased in size during follow-up. Among nine cases of diffuse type, one died within 2 days, two were discharged against medical advice, and six had severe neurologic sequelae. One case of unilateral type had a moderate degree of neurologic sequelae. All 3 cases of focal type had normal development. CONCLUSION: Pattems of abnormal echogenicity in thalami and basal ganglia in fullterm infants with hypoxic-ischemic encephalopathy are correlated with the outcome and may be helpful for treatment planning.
Basal Ganglia* ; Brain ; Brain Edema ; Brain Ischemia* ; Cerebral Infarction ; Cerebrum ; Dilatation ; Encephalomalacia ; Follow-Up Studies ; Humans ; Hypoxia-Ischemia, Brain ; Infant* ; Lateral Ventricles ; Magnetic Resonance Imaging ; Prognosis* ; Stroke, Lacunar ; Thalamus* ; Thromboembolism ; Tomography, X-Ray Computed

BACKGROUND: The survival in patients with hepatocellular carcinoma (HCC) has recently been improved by the advancement in the early detection of HCC. Among the various treatment modalities, the surgical resection has been considered as the most effective for small HCC, and the clinical course of patients with small HCC who underwent curative resection is known to be dependent on the etiology of HCC. Since the differences in the etiology of HCC depend on the different geographical area, it is necessary to verify the clinical outcomes and their affecting factors in patients with small HCC after curative resection in Korea, one of the hepatitis- B-virus(HBU)-endemic areas. METHODS: A total of 89 patients with small HCC (or=50 years old), Child's classification and vascular invasion were factors affecting the rate of recurrence. CONCLUSION: These results verify that the clinical outcomes of patients with small HCC after curative resection in Korea are similar to those of patients with different etiology of HCC in other geographic areas. To improve the prognosis of patients with small HCC after curative resection, strict preoperative evaluation of the presence of vascular invasion and postoperative preservation of liver function are necessary as well as the close postoperative follow-up for the early detection of recurrence.
Carcinoma, Hepatocellular* ; Classification ; Follow-Up Studies ; Hepatitis B Surface Antigens ; Humans ; Korea ; Liver ; Liver Cirrhosis ; Mortality ; Prognosis ; Recurrence ; Retrospective Studies ; Seoul ; Survival Rate

This study was conducted to evaluate the effect of VDT work on eyes and vision among workers in a TV manufacturing plant. The study subjects consisted of 264 screen workers and 74 non-screen workers who were less than 40 years old male and had no history of opthalmic diseases such as corneal opacities, trauma, keratitis, etc and whose visual acuity on pre-employment health examination by Han's test chart was 1.0 or above. The screen workers were divided into two groups by actual time for screen work in a day; Group 1, 60 workers, lesser than 4 hours a day and group 11, 204 workers, more than 4 hours a day. From July to October 1992 a questionnaire was administered to all the study subjects for the general charateristics and subjective eye symptoms after which the opthalmologic tests such as visual acuity, spherical equivalent, lacrimal function, ocular pressure, slit lamp test, fundoscopy were conducted by one opthalmologist. The proportion of workers whose present visual acuity was decreased more than 0. 15 in comparison with that on the pre-employment health examination by Han's test chart was 20.6% in Group Ii, 15.0% in Group I and 14.9% in non-screen workers. However, the differences in proportion were not statistically significant. The proportion of workers with decreased visual acuity was not associated with the age, working duration, use of magnifying glass and type of shift work (independent variables) in all of the three groups. However, screen workers working under poor illumination had a higher proportion of persons with decreased visual acuity than those working under adequate illumination (P<0.05). The proportion of workers whose near vision was decreased was 27.5% in Group II, 18.3% in Group I, and 28.4% in non-screen workers and these differences in proportion were not statistically significant. Changes of near vision were not associated with 4 independent variables in all of the three groups. Six out of sever-subjective eye symptoms except tearing were more common in Group I than in non-screen workers and more common in Group II than in Group I (P<0.01). Mean of the total scores for seven subjective symptoms of each worker (2 points for always, 1 point for sometimes, 0 point for never) was not significantly different between workers with decreased visual acuity and workers with no vision change. However, mean of the total scores for Group II was higher than those for the Group I and non-screen workers (P < 0. 01). Total eye symptom scores were significantly correlated with the grade of screen work, use of magnifying glass, and type of shift work. There was no independent variable which was correlated with the difference in visual acuity between the pre-employment health examination and the present state, the difference between far and near visions, lacrimal function, ocular pressure, and spherical equivalent. Multiple linear regression analysis for the subjective eye symptom scores revealed a positive linear relationship with actual time for screen work and shift work(P<0.01). In this study it was not observed that the VDT work decreased visual acuity but it induces subjective eye symptoms such as eye fatigue, blurred vision, ocular discomfort, etc. Maintenance of adequate illumination in the, work place and control of excessive VDT work are recommended to prevent such eye symptoms.
Adult ; Asthenopia ; Corneal Opacity ; Glass ; Humans ; Keratitis ; Lighting ; Linear Models ; Male ; Plants* ; Surveys and Questionnaires ; Tears ; Vision, Ocular ; Visual Acuity ; Workplace

It is known that in animals with increased intracranial pressure the cerebral perfusion is curtailed, but whether it is caused by deranged responsiveness of the cerebral vessel is not known. Thus, it was attempted in this study to find out the changes of cerebrovascular response to Kallikrein in the rabbits with increased ICP(20mmHg) under urethane-anesthesia. 1) intracarotid arterial kallikrein elicited increases in cerebral blood flow and decreases in blood pressure and arterial resistance. 2) Cerebral blood flow was significantly decreased in rabbits with increased ICP in comparison with the control rabbits. 3) Intraarterial kallikrein caused dose-depent increases of cerebral blood flow in both groups, but responses were significantly reduced in ICP-elevated group. 4) Kallikrein produced dose-dependent hypotensive effect in both groups with no significant difference between both groups. 5) Cerebrovascular resistance was greater in rabbits with elevated ICP(20 mmHg), but kallikrein induced decreases of cerebrovascular resistance in both groups to the same degree, 6) Above results suggested that increased ICP reduces the cerebral blood flow by increasing cerebrovascular resistance, but it does not modify the reponsiveness of cerebral vessel to kallikrein.
Animals ; Blood Pressure ; Intracranial Pressure ; Kallikreins* ; Perfusion ; Rabbits*

PURPOSE: To evalvate the usefulness of single-voxel localized proton MR spectroscopy(MRS) in monitoring changes in cerebral metabolites in cases of acute cerebral infarction. MATERIALS AND METHODS: In 15 cats with common carotid artery occlusion and 21 patients with acute cerebral infarction T2-weighted (T2WI), diffusion-weighted (DWI), and MR spectroscopic images were obtained at various times after stroke onset. RESULTS: In the cat model, Lac and alpha-Glx levels increased as early as 30minutes after vascular occlusion and continued to increase for a further 2 hours. The remaini ng metabolites, NAA, Cho, mI, and alpha, alpha-Glx, showed no significant change. During clinical study, increases in Lac and alpha,alpha-Glx, and decreases in NAA were detected three hours after stroke onset. These metabolites continued to change until 72 hours had elapsed. The remaining metabolites, Cho, mI, and alpha-Glx tended to be constant. CONCLUSION: MRS is capable of measuring and monitoring the metabolites involved in acute cerebral infarction. MRS may play an important role in the investigation of pathophysiology as well as in the early diagnosis of acute cerebral infarction.
Animals ; Carotid Artery, Common ; Cats ; Cerebral Infarction* ; Early Diagnosis ; Humans ; Magnetic Resonance Spectroscopy* ; Protons* ; Stroke

BACKGROUND: Because of many physical, psychological, and social stresses, adolescence is a vulnerable period to psychiatric disorders. But in Korea, there is actually not enough time for primary care physicians to screen such patients during ordinary medical interviews. Therefore this research was done to develop and validate a brief screening questionnaire for the detection of adolescent patients with psychiatric problems. METHODS: Three family physicians in charge of their own adolescent clinics developed a five-item questionnaire for screening adolescents with psychiatric problems by reviewing related literature with consultation by a psychiatrist. After performing a pretest and gathering second opinions from other psychiatrists and nurse-teachers, final questionnaire was redeveloped. Verification of its reliability by using test-retest method and internal consistency by calculating Cronbach's alpha coefficient was done. Also inspection of its validity by comparing the scores of psychiatric patient group to normal group was done. And finally the discrimination point was obtained. RESULTS: For reliability Kappa value of new questionnaires ranged from 0.33 to 0.63. One item was dropped because of its negative influence to the internal consistency and the discrimination power. With the four final items, we estimated the validity for distinguishing psychiatric patients from the normal group by calculating the sensitivity and specificity of each cutting point of scores. For the each cutting point 1, 2, and 3, sensitivity was 85%, 75%, 40%, respectively, and specificity was 27%, 62%, 84%, respectively. We considered score 1 as the best cutting point because the purpose of the questionnaire was screening rather than diagnosis. CONCLUSION: A brief four-item screening questionnaire(SAPPO. Screening method of Adolescent Psychiatric Problems in Outpatient clinic) was developed and its reliability and validity was estimated.
Adolescent* ; Diagnosis ; Discrimination (Psychology) ; Humans ; Korea ; Mass Screening* ; Outpatients ; Physicians, Family ; Physicians, Primary Care ; Primary Health Care* ; Psychiatry ; Referral and Consultation ; Reproducibility of Results ; Sensitivity and Specificity ; Surveys and Questionnaires

To evaluate the refractive error and glasses wering state, we performed screening eye examination on elementary school children living in rural area. Among 1254 shcool children(male : 542, female : 712), 352(28.1%) children were emmetropia and 902(71.9%) children ametropia. Three hundred ninety two(72.3%) of 542 male students and 510(71.6%) of 712 female students were not emmetropia. There was no statistical significance in sexual difference of refractive errors. As refractive errors, 38.3%(481) were myopia, 27.8%(348) hyperopia, and 5.8%(73( mixed astigmatism respectively. In diopteric distribution of refractive errors, refractive error under +/-2.0D was 72.0%(650/902). Among children with refractive errors, 333(36.9%) children did not require glasses, but rest of childfen needed glasses. Three hundred nine(34.3%) children did not wear glasses inspite of refractive errors, 33(3.7%) children were wearing incorrect glasses and 2 children were wearing glasses unnecessarily. In children, early eye examination is essential for their eye health. Therefore attention to early eye examination and correct glasses wearing seem to be very important especially for child living in rural area.
Astigmatism ; Child* ; Emmetropia ; Eyeglasses ; Female ; Glass ; Humans ; Hyperopia ; Male ; Mass Screening ; Myopia ; Refractive Errors

The infradiaphragmatic type of Total Anomalous Pulmonary Venous Return(TAPVR) is a rare congenital cardiacanomaly which usually results in death during the period of early infancy. A two month-old baby boy with cyanosisand respiratory distress was suspected of having a TAPVR clinically and the two-dimensional echocardiographicfindings were compatible with the infradiaphragmetic type of TAPVR. The subsequent cardiac catheterization andcineangiogram revealed the common pulmonary vein connected with portal vein and inferior vena cava in theinfradiaphragmetic area with obvious obstruction. The surgery and the autopsy confiremd the preopeative diagnosis.Among infants presenting pulmonary venous congestion in the newborn period. TAPVR below the diaphragm shold be oneof the important diagnostic cosiderations.
Autopsy ; Cardiac Catheterization ; Cardiac Catheters ; Diaphragm ; Humans ; Hyperemia ; Infant ; Infant, Newborn ; Male ; Portal Vein ; Pulmonary Veins ; Scimitar Syndrome ; Vena Cava, Inferior

Adrenal insufficiency during the treatment of pulmonary tuberculosis is a troublesome condition and can at times be lifethreatening if untreated. Rifampin is one of the most widely prescribed anti-tuberculosis agents. Furthermore, rifampin has been known to be capable of affecting the metabolism of various medications, including glucocorticoids. In this paper, a case of recurrent adrenal insufficiency induced by rifampin during the treatment of pulmonary tuberculosis is reported. The patient was a 63-year-old man who was diagnosed with Addison's disease 17 years earlier and had been undergoing glucocorticoid replacement therapy. Five months before, the patient manifested pulmonary tuberculosis and was immediately given anti-tuberculosis medication that included rifampin. After one week of medication, general weakness and hyponatremia occurred. Despite the increased dose of the glucocorticoid medication, the adrenal insufficiency recurred many times. Since the substitution of levofloxacin for rifampin, the episodes of adrenal insufficiency have not recurred so far.
Addison Disease ; Adrenal Insufficiency ; Glucocorticoids ; Humans ; Hyponatremia ; Middle Aged ; Ofloxacin ; Rifampin ; Tuberculosis, Pulmonary