Convergent strabismus fixus is a rare condition in which one or both eyes are anchored in a position of extreme adduction. The involved eye is fixed in this position and cannot be moved, and the forced duction test will confirm the immobility of the eye. This condition generally is thought to be congenital and caused by fibrosis and loss of elasticity of the medial rectus muscle. However Villaseca postulated that fibrosis of the medial rectus muscle is the consequence of contracture following a lateral rectus paralysis rather than a primary anomaly. The authors experienced two cases of monocular convergent strabismus fixus of left eye in a 51 year old female patient and a 63 year old male patient. In the latter case, we performed complete disinsertion of medial rectus muscle combined with recession of conjunctiva and Tenon's capsule and temporary fixation of the globes with traction sutures in a position of abduction on left eye. The result of that surgery, however, was not satisfactory. So we performed 11mm resection of lateral rectus muscle of left eye about 8 weeks after the first surgery and followed up for months in satisfactory result.
Conjunctiva ; Contracture ; Elasticity ; Esotropia* ; Female ; Fibrosis ; Humans ; Male ; Middle Aged ; Paralysis ; Sutures ; Tenon Capsule ; Traction

Microcornea is a condition characterized by a small cornea in an otherwise normal eye and can be defined when corneal diameter is less than 11.00mm. Microcornea may occur as an isolated abnormality or accompany other anterior segment anomalies like aniridia and anterior chamber cleavage abnormalities. Microcornea is part of nanophthalmos, a condition in which a reduction in global dimensions is the only structural abnormality, as well as microphthalmos, a term generally, used to signify a small, abnormal globe. Microcornea is a rare anomaly and its etiology is probably a primary aberration of the growth of the ectoderm of the optic cup. Both autosomal dominant and autosomal recessive patterns of inheritance occur, but it may appear sporadically. Cornea plana is usually seen in association with microcornea wherein the corneal curvature is less than normal. It is often associated with diffuse opacities of the cornea stroma. Cornea plana might be caused by a deep developmental arrest in the fourth month, at which time the cornea begins to increase its curvature relative to the sclera. The authors experienced a case of bilateral microcornea with cornea plana in a family which seemed to transmit as the dominant trait.
Aniridia ; Anterior Chamber ; Cornea* ; Ectoderm ; Humans ; Microphthalmos ; Sclera ; Wills

Microcornea is a condition characterized by a small cornea in an otherwise normal eye and can be defined when corneal diameter is less than 11.00mm. Microcornea may occur as an isolated abnormality or accompany other anterior segment anomalies like aniridia and anterior chamber cleavage abnormalities. Microcornea is part of nanophthalmos, a condition in which a reduction in global dimensions is the only structural abnormality, as well as microphthalmos, a term generally, used to signify a small, abnormal globe. Microcornea is a rare anomaly and its etiology is probably a primary aberration of the growth of the ectoderm of the optic cup. Both autosomal dominant and autosomal recessive patterns of inheritance occur, but it may appear sporadically. Cornea plana is usually seen in association with microcornea wherein the corneal curvature is less than normal. It is often associated with diffuse opacities of the cornea stroma. Cornea plana might be caused by a deep developmental arrest in the fourth month, at which time the cornea begins to increase its curvature relative to the sclera. The authors experienced a case of bilateral microcornea with cornea plana in a family which seemed to transmit as the dominant trait.
Aniridia ; Anterior Chamber ; Cornea* ; Ectoderm ; Humans ; Microphthalmos ; Sclera ; Wills

PURPOSE: As emergency ultrasound (EUS) can improve the management of emergency department patients, education in EUS has become an essential part of emergency medicine resident training. This study examined the efficacy of pediatric EUS education for resident physicians 6 months after training. METHODS: A survey was conducted on emergency medicine resident physicians who participated in the Pediatric Emergency Ultrasound Course in November 2014, which is a training program of pediatric EUS generated by Korean Society of Pediatric Emergency Medicine and Society of Emergency and Critical Care Imaging. The instructor checked the list to evaluate attendee after the course. After the course, resident physicians have been encouraged to use EUS at the patient's bedside, and the same list was checked 6 months after the course. At the same time, a survey of the number of experience of EUS during the 6 months was performed. RESULTS: Ten emergency resident physicians of Seoul National University of Hospital participated in the course and all attendees were re-evaluated 6 months after the course. The mean initial score immediately after the course and that at the 6 months follow-up was 28.6±3.13 and 20.8±3.79, respectively (p < 0.05). No significant relationship was observed between the difference score and the EUS experience number, including the observations of the other physician's EUS (p=0.603) and hands-on by themselves (p=0.771). CONCLUSION: Although a EUS education program could improve the resident physician's ability, the effect decreased with time. Hence, the resident physician's EUS ability cannot be maintained via simple emergency department duty. Therefore, the education program should be repeated regularly.
Critical Care ; Education* ; Emergencies* ; Emergency Medicine* ; Emergency Service, Hospital ; Follow-Up Studies ; Humans ; Seoul ; Ultrasonography*

BACKGROUND: Recently, body composition analyzer has been used widely clinically. Various indirectly measured values of body are calculated without direct measuring. The abdominal circumference that is presented by such instrument may be used for diagnosing abdominal obesity, but the reliable evidence of the accuracy and the validity may be not be enough for application to general population. For this reason, the author investigated the usefulness of automatically produced abdominal circumference for diagnosing abdominal obesity. METHODS: The medical records of 5,555 outpatients who had undergone body composition analysis in a tertiary hospital was collected. The usefulness of the automatically presented abdominal circumference for diagnosing abdominal obesity among general population was investigated. RESULTS: There was a significant positive correlation between abdominal circumference measured by body composition analyzer and measuring tape in the normal, the overweight, and the obese groups of both gender. But, the results were the same only in females in the underweight group. The most significant difference between the two values were 4.8+/-5.0 cm in normal male group and -5.7+/-5.5 cm in female obese group. The difference of the male obese group was lesser than that of the overweight, the normal and the underweight groups. The difference of the male overweight group was lesser than that of the normal group. The difference of the female obese group was lesser than that of the overweight, the normal and the underweight groups. The sensitivity and specificity to detect abdominal obese person among the total subjects was 76.3% and 79.1%, respectively. The specificity was higher in all male and the normal female groups, wheras the sensitivity was higher in the obese and the overweight female groups. CONCLUSION: Physicians should confirm the accuracy of abdominal circumference, especially in normal males and obese female group, although the automatically presented value is convenient and reflects the manually measured one very well which is useful to diagnose abdominal obesity.
Body Composition* ; Body Mass Index* ; Female ; Humans ; Male ; Medical Records ; Obesity, Abdominal ; Outpatients ; Overweight ; Sensitivity and Specificity ; Tertiary Care Centers ; Thinness ; Waist Circumference

In our previous report an anti-HBsAg human monoclonal antibody was generated using antibody phage display library technique. Using pComb3 filamentous phagemid vector, Fab molecule was expressed in fusion form to a phage coat protein in the periplasm of E. coli. A clone of HBsAg binder was selected after panning and designated as B7. In order to select the clones with higher affinity and to examine which chain contributes most to the affinity of B7, the light and heavy chain of B7 was sequentially deleted and replaced with new library. HBsAg-binders were selected and tested by EIA (enzyme immunoassay). It was revealed that the affinity of B7 depends only on the heavy chain of Fd. B7 Fd was constructed without light chain and specificity and affinity was further confirmed by western blot analysis. This human monoclonal Fd antibody was found to react with d antigenic determinant of HBsAg as the original clone did. The nucleotide sequence analysis revealed that VH of B7 could be classified into Kabat's subgroup II and human IgG heavy chain family IV. The CH1 of B7 was IgG1.
Bacteriophages* ; Base Sequence ; Blotting, Western ; Clone Cells ; Hepatitis B Surface Antigens ; Humans ; Immunoglobulin G ; Periplasm ; Sensitivity and Specificity

OBJECTIVES: This study was conducted to review the diffusion process and factors affecting the adoption of the Health Center Information System (HIS). METHODS: Data were collected from POSDATA (private company), MOHW, other Ministries and local governments. To specify the date of adoption, supplementary information was collected from 40 health centers. The following three kinds of factors were analyzed. Internal factors included type, size, and innovativeness of health centers. Community factors were composed of population size, economic status, and level of education. Organizational environmental factors consisted of information score of the municipalities, financial support of the from central government, and the neighborhoodness of innovator health centers. RESULTS: All health centers in the metropolitan cities of Seoul, Gwangju and Jeju adopted the HIS. The laggards were those in the metropolitan cities of Busan (18.8%), Incheon (20.0%) and Daejun (20.0%), and cities with population more than 300, 000 (54.8%) and counties with health center hospitals (47.1%). Financially supported rural health centers adopted the HIS more rapidly than those not supported. The factors identified as being statistically significant (p< 0.05), from a univariate analysis by Kaplan-Meier method, were: (1) internal factors of the type, size and innovativeness of health centers; (2) community factors of population size and economic status; (3) organizational environmental factors of the central government financial support and the neighborhoodness of innovator health centers. A multivariate analysis, using a Cox proportional hazard method, proved the innovativeness of health centers, central government financial support and the neighborhoodness of innovator health centers, were statistically significant (p< 0.05). CONCLUSIONS: The innovativeness of health centers, financial support from central government and the neighborhoodness of innovator health centers, rather than community factors related to regional socioeconomic status, affected the adoption of the HIS in health centers. Further in-depth studies, modifying the MOHW's strategy to propagate the HIS to the laggard health centers, are recommended.
Busan ; Diffusion of Innovation ; Diffusion* ; Education ; Financial Support ; Gwangju ; Incheon ; Information Systems* ; Methods ; Multivariate Analysis ; Population Density ; Residence Characteristics ; Rural Health Services ; Seoul ; Social Class

PURPOSE: Femorofemoral crossover bypass (FCB) is a good procedure for patients with unilateral iliac artery disease. There are many articles about the results of FCB, but most of them were limited to 5 years follow-up. The purpose of our study was to analysis the results of FCB with a 10-year follow-up period. MATERIALS AND METHODS: Between January 1995 and December 2010, 133 patients were operated in Samsung Medical Center (median follow-up: 58.8 months). We retrospectively analysed patient characteristics, the preoperative treatment, the operative procedure, and material used. RESULTS: The indications for FCB were claudication in 110 and critical limb ischemia in 23 patients. Three patients were died due to myocardiac infarction, intracranial hemorrhage, and acute respiratory failure within 30 days after surgery. The one-year primary and secondary patency rates were 89% and 97%, the 5-year primary and secondary patency rates were 70% and 85%, and the 10-year primary and secondary patency rates were 31% and 67%. The 5-year and 10-year limb salvage rates were 97% and 95%, respectively. CONCLUSION: Our long term analysis suggests that FCB might be a valuable alternative treatment modality in patients with unilateral iliac artery disease.
Extremities ; Follow-Up Studies ; Humans ; Iliac Artery ; Infarction ; Intracranial Hemorrhages ; Ischemia ; Limb Salvage ; Respiratory Insufficiency ; Retrospective Studies ; Surgical Procedures, Operative ; Transplants* ; Vascular Patency

This study aimed to evaluate the antimicrobial effects of Acanthopanax sessiliflorum fruit (ASF; Ogaza) extracts on Streptococcus mutans and Streptococcus sobrinus, which are agents that cause dental caries, and on Streptococcus mitis and Streptococcus salivarius, the microbial flora of the oral cavity. The ASF extracts obtained using 70% ethanol were fractionated in the order of ethyl acetate and n-Butanol, concentrated under reduced pressure, and lyophilized to give powdery solvent extracts. The antimicrobial activity of ASF extracts from each solvent was examined using the disk diffusion method. As a result, only those extracts obtained using an ethyl acetate solvent showed antimicrobial activity. These extracts were selected, and the minimum inhibitory concentration was measured by disk diffusion method at various extract concentrations. Results showed a minimum inhibitory concentration of 32 mg/ml. The viable cell count was measured to confirm the minimum bactericidal concentration. Results showed a minimum bactericidal concentration of 64 mg/ml. In the cytotoxicity test using normal human dermal fibroblast cells, the absorbance value of the test group was similar to that of the control group at 0.64, 1.28, and 6.4 mg/ml. The bacteria and their colonies were examined using a scanning electron microscope. Boundaries between the antimicrobial activity region and non-antimicrobial activity region were observed around the paper disk, which was immersed in the extract with 32 mg/ml concentration. Bacterial colonization was not observed in the area with antimicrobial activity. This finding suggests that ASF extracts can inhibit the growth of some microorganisms in the oral cavity, in addition to the effects of these extracts known to date. In particular, ASF extracts may be used as a preparation for preventing dental caries by adding the extract to the toothpaste or oral mouthwash.
1-Butanol ; Bacteria* ; Cell Count ; Colon ; Dental Caries ; Diffusion ; Eleutherococcus* ; Ethanol ; Fibroblasts ; Fruit* ; Humans ; Methods ; Microbial Sensitivity Tests ; Mouth ; Streptococcus ; Streptococcus mitis ; Streptococcus mutans ; Streptococcus sobrinus ; Toothpastes

A lymphatic cyst of the stomach is rare benign tumor which is composed of thin-walled lymphatic space lined by benign-appearing endothelial cells. It rarely manifests clinical symptoms, so it is found incidentally in most cases. Recently, a case of submucosal lymphatic cyst associated with early gastric cancer was experienced. An endoscopy revealed a slightly elevated, edematous lesion adjacent to the malignant ulcer. This case is herein reported with a brief review of related literature.
Endoscopy ; Endothelial Cells ; Lymphocele* ; Stomach ; Stomach Neoplasms* ; Ulcer