In order to investigate the cumulative incidence and risk factors for diabetic retinopathy among non-insulin dependent diabetes mellitus, 116 patients which given diagnosis of diabetes at age 30 years or older who had been followed-up for more than 10 years and were initially free from retinopathy were analysed retrospectively. Several risk factors for retinopathy were analysed at the initial examinations: sex, age at the onset, age at the initial examination, duration, fasting plasma glucose(FPG), two-hour postpradial plasma glucose(pp2), blood pressure, hypertension status, therapeutic regimen, total cholesterol, HDL-cholesterol, triglyceride, body mass index. After a mean follow-up time of 11.7 years. The cumulative incidence was 31.0%. By univariate analysis. Significant risk factors of retinopathy were age at the onset, age at the initial examination. FPG, PP2, therapeutic regimen. However, By using multivariate analysis. Independent risk factors were not found.
Blood Pressure ; Body Mass Index ; Cholesterol ; Diabetes Mellitus ; Diabetic Retinopathy* ; Diagnosis ; Fasting ; Follow-Up Studies ; Humans ; Hypertension ; Incidence* ; Multivariate Analysis ; Plasma ; Retrospective Studies ; Risk Factors* ; Triglycerides

In order to evaluate the ocular autonomic dysfunction in diabetics, pupil cycle time(PCT) was assessed in 201diabetics and 33controls. PCT was significantly different between the diabetics and controls and prolonged in diabetics in regard to the severity of retinopathy(p<0.05). PCT was significantly prolonged in diabetics in regard to the diabetic peripheral neuropathy and nephropathy(p<0.05). PCT was significantly different among the diabetic groups in regard to the duration of diabetes(p<0.05). Sustainde PCT was unmeasurable in 56.7% of diabetics and in 72.3% of proliferative diabetic retinopathy compared with 28.8% of controls(p<0.05). Ocular autonomic dysfunction in diabetics correlated closely with the severity of the diabetic retinopathy, diabetic petiphetal neuropathy and nephropathy, diabetic duration.
Diabetic Nephropathies ; Diabetic Retinopathy ; Peripheral Nervous System Diseases ; Pupil*

No abstract available.
Ixodes* ; Tick Bites* ; Ticks*

PURPOSE: The aim of this study is to investigate the reproducibility of the quantitative assessment of segmental wall motion and systolic thickening provided by an automatic quantitation algorithm. MATERIALS AND METHODS: Tc-99m-MIBI gated myocardial SPECT with dipyridamole stress was performed in 31 patients with known or suspected coronary artery disease (4 with single, 6 with two, 11 with triple vessel disease; ejection fraction 51+/-14%) twice consecutively in the same position. Myocardium was divided into 20 segments. Segmental wall motion and systolic thickening were calculated and expressed in mm and % increase respectively, using AutoQUANTTM software. The reproducibility of this quantitative measurement of wall motion and thickening was tested. RESULTS: Correlations between repeated measurements on consecutive gated SPECT were excellent for wall motion (r=0.95) and systolic thickening (r=0.88). On Bland-Altman analysis, two standard deviation was 2 mm for repeated measurement of segmental wall motion, and 20% for that of systolic thickening. The weighted kappa values of repeated measurements were 0.807 for wall motion and 0.708 for systolic thickening. Sex, perfusion, or segmental location had no influence on reproducibility. CONCLUSION: Segmental wall motion and systolic thickening quantified using AutoQUANTTM software on gated myocardial SPECT offers good reproducibility and is significantly different when the change is more than 2 mm for wall motion and more than 20% for systolic thickening.
Coronary Artery Disease ; Dipyridamole ; Humans ; Myocardium ; Perfusion ; Tomography, Emission-Computed, Single-Photon*

Although dysphagia in patients with acute leukemia is usually related to reflux esophagitis, infectious esophagitis, chemotherapy1) and leukemic infiltration2), acute esophageal stricture resulting from chemotherapy in the patient with leukemia is very rare. A 40-year-old man with acute myelogenous leukemia was admitted for operation of esophageal stricture which was developed within 1 month of chemotherapy. An esophagectomy and esophagogastrostomy with pyloroplasty was carried out. Histology showed mucosal infiltration of mononuclear cells and transmural fibrosis involving submucosa and the muscle layer.
Adult ; Deglutition Disorders ; Drug Therapy ; Esophageal Stenosis* ; Esophagectomy ; Esophagitis ; Esophagitis, Peptic ; Fibrosis ; Humans ; Induction Chemotherapy* ; Leukemia ; Leukemia, Myeloid, Acute

PURPOSE: To evaluate the diagnostic accuracy of MR imaging in posterior cruciate ligament(PCL) injuries, to describe the variety of these injuries and to assess the type and frequency of associated knee injuries. MATERIALS AND METHODS: We retrospetively analysed 75 cases with knee injuries. In all cases, the prescence of a PCL tear was determined by arthroscopy or surgery and the type of tear and patterns of associated knee injuries were described. RESULTS: Twenty-eight PCL tears were identified with arthroscopy or surgery. Figures for the sensitivity, specificity, and accuracy of MR diagnosis for the PCL injury were 86%, 94% and 91% respectively. Twenty-one cases(75%) had complete PCL tears and seven (25%) had partial tears. The commonest tear site was midsubstance(18 cases, 64.3%). Twenty-seven cases(96%) had associated knee injuries ; the remaining patient(4%) had isolated PCL injuries. There were 19 cases(68%) of ligamentous injuries, ten (36%) of meniscal tear, ten (36%)of bony injuries, and 20 (71%) of joint effusions. Of the ligamentous injuries, those involving the medialcollateral ligament were most often seen(10 cases, 36%). CONCLUSIONS: MR imaging is an accurate method for the detection and evaluation of PCL injury and associated knee abnormalities.
Arthroscopy ; Diagnosis ; Joints ; Knee ; Knee Injuries ; Ligaments ; Magnetic Resonance Imaging* ; Posterior Cruciate Ligament* ; Sensitivity and Specificity

BACKGROUND: Minimally invasive technique for various cardiac surgeries has become widely accepted since it has been proven to have distinct advantages for the patients. We describe here the results of our experiences of minimal incision in cardiac surgery. MATERIAL AND METHOD: From February 1997 to November 1998, we successfully performed 31 cases of minimally invasive cardiac surgery. Male and female ratio was 17:14, and the patients age ranged from 1 to 75 years. A left parasternal incision was used in 9 patients with single vessel coronary heart disease. A direct coronary bypass grafting was done under the condition of the beating heart without cardiopulmonary bypass support(MIDCAB). Among these, one was a case of a reoperation 1 week after the first operation due to a kinked mammary artery graft. A right parasternal incision was used in one case of a redo mitral valve replacement. Mini-sternotomy was used in the remaining 21 patients. The procedures were mitral valve replacement and tricuspid annuloplasty in 6 patients, mitral valve replacement 5, double valve replacement 2, aortic valve replacement 1, removal of left atrial myxoma 1, closure of atrial septal defect 2, repair of ventricular septal defect 2, and primary closure of r ght ventricular stab wound 1. The initial 5 cases underwent a T-shaped mini-sternotomy, however, we adopted an arrow-shaped ministernotomy in the remaining cases because it provided better exposure of the aortic root and stability of the sternum after a sternal wiring. RESULT: The operation time, the cardiopulmonary bypass time, the aorta cross-clamping time, the mechanical ventilation time, the amount of chest tube drainage until POD#1, the chest tube indwelling time, and the duration of intensive care unit staying were in an acceptable range. There were two surgical mortalities. One was due to a rupture of the aorta cannulation site after double valve replacement on POD#1 in the mini-sternotomy case, and the other was due to a sudden ventricular arrhythmia after MIDCAB on POD#2 in the parasternal incision case. Postoperative complications were observed in 2 cases in which a cerebral embolism developed on POD#2 after a mini-sternotomy in mitral valve replacement and wound hematoma developed after a right parasternal incision in a single coronary bypass grafting. Neither mortality nor complication was directly related to the incision technique itself. CONCLUSION: Minimally invasive surgery using parasternal or mini-sternotomy incision can be used in cardiac surgeries since it is as safe as the standard full sternotomy incisions.
Aorta ; Aortic Valve ; Arrhythmias, Cardiac ; Cardiopulmonary Bypass ; Catheterization ; Chest Tubes ; Coronary Disease ; Drainage ; Female ; Heart ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Hematoma ; Humans ; Intensive Care Units ; Intracranial Embolism ; Male ; Mammary Arteries ; Mitral Valve ; Mortality ; Myxoma ; Postoperative Complications ; Reoperation ; Respiration, Artificial ; Rupture ; Sternotomy ; Sternum ; Surgical Procedures, Minimally Invasive ; Thoracic Surgery* ; Transplants ; Wounds and Injuries ; Wounds, Stab

No abstract available.
Female ; Humans ; Pregnancy Trimester, First* ; Pregnancy*

During a eight-month period from june 1993, cataract surgery using a scleral pocket of 7 mm in length was performed on 30 eyes of 26 patients. In order to evaluate the effect of chamber entry length and closure technique on astigmatic changes and visual recovary, three different surgical procedures were carried out and compared retrospectively. The visual acuity, refraction and keratometry were assessed at every week. The H group(15 eyes) had a single horizontal suture after phacoemulsification followed by implantation of a one piece of PMMA lens through 7 mm chamber entry. The F group(6 eyes) had a single horizontal suture followed by implantation of a foldable lens through 4 mm chamber entry. The R group(9 eyes) had a single radial suture followed by implantation of one piece of PMMA lens through 7 mm chamber entry. Overall uncorrected visual acuity of 20/40 or better was 67% at 1 week, 93% at 8 weeks postoperatively and there was no statistically significant difference among the three groups(p>0.05). The overall change of mean refractive astigmatism from 1 to 8 weeks postoperatively was 0.69D and there was no statistically significant difference among the three groups(p>0.05). The overall change of mean keratometric astigmatism method from 1 to 8 weeks postoperatively was 0.12D and there was no statistically significant difference among the three groups(p>0.05). Early clinical observations indicate that cataract surgery using a scleral pocket of 7 mm in length shows early visual recovery and minimizes surgically induced astigmatism without serious complications.
Astigmatism ; Cataract* ; Humans ; Phacoemulsification ; Polymethyl Methacrylate ; Retrospective Studies ; Sutures ; Visual Acuity

PURPOSE: To determine the rates at which normal ovaries in women of reproductive age were observed at MRI, as well as differences in the size of a normal ovary and follicles, and the number of follicles, according to age. MATERIALS AND METHODS: The MRI findings in 46 patients with normal ovaries were retrospectively analysed and proven grossly at surgery and/or pathologically. The detection rate and size of the ovaries, and the number of follicles and size of the largest were determined, and differences were analyzed according to age: under 30, 30-39, and 40 years or over. RESULTS: Among 46 patients, bilateral ovaries were detected in 39 and unilateral ovary in seven. The overall detection rate was 92.4% (85/92), varying according to age. It was 100% (18/18) in those aged under 30, 95% (38/40) in the 30-40 age group, and 85.3% (29/34) among those aged 40 or over. Ovary size ranged between 15 and 50 (average, 24.3) mm and was most commonly 20-30 mm, regardless of age (60%). The average size was 28.8 mm under 30 years of age, 25.3 mm between 30 and 39, and 20.3 mm at age 40 or over (p<0.01). The number of follicles was recorded as 2, 3, 4, or 5 or more, with 10.6%, 23.5%, 18.8% and 47.1% of patients, respectively, assigned to these categories. Among those aged 30-39, ovaries containing five or more follicles were most common, with 83.3% of those under 30 and 47.4% of those aged 30-39 falling into this category. Among patients aged 40 or over, only 24.1% of ovaries contained five or more follicles; most (37.9%) contained three (p<0.05). The size of the largest follicle ranged from 2 to 30 mm and, regardless of age, 5-10-mm follicles were most common (43.5%). There were no significant differences according to age. CONCLUSION: MRI is a useful tool for detecting normal ovaries in women of reproductive age. We found that most normal ovaries were 20-30 mm in size and contained five follicles or more, the largest follicle being 5-10 mm. The size of an ovary and the number of follicles decreased significantly with age.
Female ; Humans ; Magnetic Resonance Imaging* ; Ovary* ; Retrospective Studies