Head tilt test is useful in diagnosing cyclovertical muscle palsy, especially superior oblique palsy, In this study, we observed efficacy and pattern of head tilt test in 12 patients of unilateral superior oblique palsy(7 congenital, 4 traumatic and 1 vascular) who had abnormal head tilt to nonparetic side. The results of head tilt test were compared to preoperative status in 8 patient, 3 month after surgery. All patients in this study showed positive response of head tilt test. Among them, 9 patients showed definite elevation of paretic eye. However, 2 patients mainly showed definite depression of nonparetic eyes that were amblyopic. The last patient did not show definite vertical deviation in either eye but complained of increasing diplopia. After surgery, abnormal head tilt and positive head tilt response disappeared in 7 patients. In conclusion, preoperative head tilt test is one of the valuable methods in diagnosisng unilateral superior oblique palsy especially in young patients and in those who developed spread of comitance. In addition, the positive head tilt test does no always mean the elevation of paretic eye.
Depression ; Diplopia ; Head* ; Humans ; Paralysis*

BACKGROUND: Controversy exists as to whether or not inhalation anesthetics and intravenous anesthetics impair arterial oxygenation (PaO2) during one lung ventilation (OLV). Accordingly, we examined the effect of enflurane and propofol on PaO2 and pulmonary vascular resistance (PVR) during OLV. METHODS: Forty patients, who had prolonged periods of OLV anesthesia with minimal trauma to the nonventilated lung were studied in a cross over design. Patients were randomized to four groups; Group 1 received 1 MAC of enflurane and oxygen from induction until the first 20 min after complete lung collapse, then were switched to propofol 100 g/kg/min (P100). In group 2, the order of the anesthetics was reversed. Group 3, Group 4 received the same order of the anesthetics as Group 1, Group 2, respectively but received propofol 200 g/kg/min (P200). RESULTS: During OLV, the PaO2 values were lower than those with two lung ventilation (TLV), there were no significant differences among each groups and between propofol and enflurane in PaO2, but in the selected patients (n=10, PaO2<120 mmHg during OLV), PaO2 in propofol group was higher than that of enflurane group (p<0.05). Conversion from TLV to OLV caused a significant increase in PVR, but there were no difference in PVR between propofol and enflurane group. CONCLUSIONS: These results suggest that the usual clinical dose of propofol affords no advantage over 1 MAC of enflurane anesthesia except low PaO2 patients during OLV. Propofol might be of value in risk patients of hypoxemia during thoracic surgery when OLV is planned.
Anesthesia ; Anesthetics ; Anesthetics, Inhalation ; Anesthetics, Intravenous ; Anoxia ; Cross-Over Studies ; Enflurane* ; Humans ; Lung ; One-Lung Ventilation* ; Oxygen* ; Propofol* ; Pulmonary Atelectasis ; Thoracic Surgery ; Vascular Resistance ; Ventilation

An adenoid cystic carcinoma of the lacrimal gland is the most common epithelial neoplasms in lacrimal gland. But it is rare in clinical practice and is poor prognosis below 50% at 2 year survival rate with various clinical management. We experienced a case of a 62-year-old woman who had complained just proptosis and no other tumor symtoms. Being different from the other adenoid cystic carcinoma of the lacrimal gland, MRI revealed mass of the right superiotemporal lacrimal gland which was well demarcated and displaced in nasal area to the optic nerve and no metastasis to adjacent nerves and bones. We performed the lateral orbitotomy followed by macroscopical complete resection of tumors. The histopathologic findings revealed the adenoid cystic carcinoma of the lacrimal gland and were showed variable. So we would report our case with a brief review of the literature.
Adenoids* ; Carcinoma, Adenoid Cystic* ; Exophthalmos ; Female ; Humans ; Lacrimal Apparatus* ; Magnetic Resonance Imaging ; Middle Aged ; Neoplasm Metastasis ; Neoplasms, Glandular and Epithelial ; Optic Nerve ; Prognosis ; Survival Rate

Recently there has been decreasing trend of high tibial osteotomy in management of the gonarthrotic patients partly due to recurrence of the symptom and, more importantly, due to the relative success of the total knee joint replacement procedure. But there is still room for the high tibial osteotomy, although it may be 'outdated' procedure, in that younger active patients do well postopera- tively for an enough period of time and that even the older have some gain of pain-relief in early postoperative period. The purpose of this study is to detect the affecting factors of the result of the operation. We reviewed 25 valgus high tibial osteotomies in 23 patients who had medial gonarthrosis and could be followed-up more than 1 year among 32 cases between August 1989 and January 1994. The mean length of follow-up was 30 months(ranged twelve to fifty four months). The results were compared according to modified grading of the HSS score. All cases showed the increase of the score from preop. average 65.2 points to postop. 87.8 points, mainly by the decrease of pain and the increase of functional activity. The severity of degenerative change on the radiographs and the degree of varus seemed to be related with the early clinical results of the operation, but the age was not a major affecting factor. These results could be debatable due to some differences from the others', and long term follow-up would be needed.
Follow-Up Studies ; Humans ; Knee Joint ; Knee ; Osteoarthritis ; Osteotomy ; Postoperative Period ; Recurrence

OBJECTIVE: This study is to explore the effects on specific bindings between [ 3H]RX821002, alpha-2 adrenergic receptor antagonist and alpha-2 adrenergic receptor in rat brain by G-protein modulation. METHODS: The radioligand binding receptor study was conducted with [ 3H]RX821002, a new alpha-2 adrenergic receptor antagonist, in the presence or absence of Gpp(NH)p and pertussis toxin. RESULTS: The alpha-2 adrenergic receptors were saturated with [ 3H]RX821002 in the fashion of the single binding site. The dissociation constant (Kd) was 0.70+/-0.30 nM, and maximum binding (Bmax) was 599.9+/-283.4 fmol/mg protein. The saturation study showed that the maximum binding (B max ; 668.0+/-50.1 fmol/mg protein) was increased and the dissociation constant (Kd ; 0.61+/-0.14 nM) was decreased significantly in the presence of Gpp (NH)p compared to those (B max ; 559.8+/-81.9 fmol/mg protein, Kd ; 0.87+/-0.14 nM) in the absence of Gpp (NH)p (by paired t-test ; B max, p=0.023, Kd, p=0.005). In the presence of pertussis toxin, the maximum binding (B max ; 617.0+/-58.5 fmol/mg protein) was increased significantly (by paired t-test ; B max, p=0.001) but the issociation constant (Kd ; 0.92+/-0.24 nM) was not decreased compared to those (B max ; 554.1+/-66.1 fmol/mg protein, Kd ; 0.89+/-0.24 nM) in the absence of pertussis toxin. CONCLUSION: These results confirm that the binding profiles between [ 3H]RX821002 and alpha-2 adrenergic receptors be modified by G-protein modulation. This suggests that the drug effects on receptors be influenced by various conditions such as G-protein modulation.
Animals ; Binding Sites ; Brain* ; GTP-Binding Proteins* ; Guanylyl Imidodiphosphate ; Pertussis Toxin ; Rats* ; Receptors, Adrenergic, alpha-2

Although prenatal and neonatal intensive care in recent years improved survival of infants, the risk of cerebral palsy (CP) in infants with perinatal asphyxia persisted. Screening criteria for risk factors of cerebral palsy and delayed development (DD) in term infants with perinatal asphyxia are required so that early diagnosis and rehabilitation and physical therapy could decrease the neurologic complications and maximize quality of life. To identify the risk factors of CP and DD in infants with perinatal asphyxia, we undertook a case-control study of 25 infants with perinatal asphyxia (5 min Apgar score below 6). At one year follow-up, 12 infants developed CP and DD and 13 control infants showed normal development. Risk factors associated with an increased risk of CP and DD were the number of abortion (p=0. 031), history of neonatal seizure (p=0.021), hypoxic ischemic encephalopathy (p=0.046), and poor response to resuscitation immediately after birth (p=0.017). In term infants with perinatal asphyxia, the risk factors of CP and DD were increased number of abortion, history of neonatal seizure, and hypoxic ischemic encephalopathy and poor response to resuscutation. Thus infants with these risk factors should be carefully followed up after hospital discharge and further extensive and prospective study in term infants with perinatal asphyxia could elucidate possible mechanisms related to cerebral palsy and delayed development.
Apgar Score ; Asphyxia* ; Case-Control Studies ; Cerebral Palsy* ; Early Diagnosis ; Follow-Up Studies ; Humans ; Hypoxia-Ischemia, Brain ; Infant* ; Infant, Newborn ; Intensive Care, Neonatal ; Mass Screening ; Parturition ; Quality of Life ; Rehabilitation ; Resuscitation ; Risk Factors* ; Seizures

BACKGROUND: More attention is given to oxidative hypothesis which causes atherosclerosis to be recognized as inflammatory response. The relationship between serum ferritin which catalyzes lipid peroxidation and high sensitivity C-reactive protein which reflects vascular inflammation was investigated among adults in a health promotion center. METHODS: The study group consisted of 297 men and women (men 86, women 211) who visited the health promotion center of a hospital in Seoul to have a health checkup from October 1, 2004 to April 1, 2005. These subjects answered the questionnares and were measured in the following; blood tests, brachial-ankle pulse wave velocity and several anthropometric measurements. Statistical analysis was performed on 111 subjects after exclusion of those subjects who were taking antihypertensive agents or antidiabetic agents, and who had acute inflammatory diseases, acute liver diseases, anemia, and who had a WBC > or =11,000x10(3)/mm3 or a serum ferritin > or =200 ug/L or a ABI (Ankle Brachial Index) <0.9. RESULTS: The average serum ferritin concentration of men against women was 132.57+/-43.12 ng/ml to 78.23+/-38.10 ng/ml which means that men have about 1.7 times as high concentration than women (P<0.001). Serum ferritin was significantly correlated with high sensitivity C-reactive protein (r=0.332). Even in multiple stepwise regression analysis, there was a independent relationship between serum ferritin and high sensitivity C-reactive protein (beta=0.138, P=0.010). When we analyzed with distinction of sex, this relationship in women was constant (beta=0.131, P=0.031), but serum ferritin in men just showed the trend of correlation with BMI (beta=9.510, P=0.059). CONCLUSION: There is a significant relationship between the increase of serum ferritin and high sensitivity C-reactive protein in healthy women; furthermore, studies in men need to be confirmed.
Acute Disease ; Adult ; Anemia ; Antihypertensive Agents ; Atherosclerosis ; C-Reactive Protein ; Female ; Ferritins ; Health Promotion ; Hematologic Tests ; Humans ; Hypoglycemic Agents ; Inflammation ; Lipid Peroxidation ; Liver Diseases ; Male ; Oxidative Stress ; Pulse Wave Analysis

PURPOSE:To investigate the significance of umbilical artery acidosis and compare perinatal outcomes according to the types of acidosis for a tertiary hospital population delivered at term. METHODS:We reviewed maternal and neonatal medical records of all term liveborn infants with an umbilical artery pH<7.25 who were delivered at our university-based center for three years. Two hundred seventy two study population were grouped into respiratory (N=137), metabolic (N=103), and mixed (N=32) acidosis. Pregnancy complications and perinatal outcomes were analyzed using student T test and chi square test. RESULTS:The mean umbilical artery pH values of respiratory, metabolic, and mixed acidosis were 7.20+/-.05, 7.16+/-.90, and 7.07+/-.10, respectively. Neonates with pathologic fetal acidemia were more frequent in mixed acidosis and less frequent in respiratory acidosis (P<0.001). However, there were no significant differences in 1min and 5min Apgar scores. The cases with multiple nuchal cords were significantly common in mixed acidosis (P=0.021) and oligohydroamnios was higher in the metabolic acidosis (P=0.037). While the high base deficit (> or =20 mEq/L) and high pCO2 (> or =20 mmHg) were significantly associated with low pH value, the perinatal outcomes were not significantly different according to the level of base deficit or pCO2. CONCLUSION:The mixed acidemia was more associated with pathologic fetal acidemia than pure respiratory or metabolic acidosis. The ability to predict not only metabolic but also respiratory component of fetal acidemia may help in safe management of delivery leading to reduce the fetal acidemia.
Acidosis ; Acidosis, Respiratory ; Humans ; Hydrogen-Ion Concentration ; Infant ; Infant, Newborn ; Medical Records ; Nuchal Cord ; Pregnancy Complications ; Tertiary Care Centers ; Umbilical Arteries

For definitive antenatal diagnosis of fetal aneuploidy, invasive tests such as chorionic villous sampling, amniocentesis and cordocentesis are required for chromosome analysis. However, to reduce the risk of miscarriage associated with procedural complications, it is important to detect pregnant women with high risk of fetal aneuploidy. Recently, there have been advances in maternal serum and sonographic markers for screening of chromosomal defects in the first and second trimester. The serum screening methods include first trimester screening with nuchal translucency and second trimester multi marker screening. Particularly, combining first and second trimester results can increase the detection rate of Down syndrome with lower false-positive rates. In addition to biochemical markers, second trimester sonogram to detect major and minor sonographic markers for chromosomal defects is important to identify the high risk pregnancy. To detect the fetal aneuploidy with high specificity and sensitivity, we need to interpret the maternal age, the results of first and second trimester serum markers and genetic sonographic findings all together.
Abortion, Spontaneous ; Amniocentesis ; Aneuploidy ; Biomarkers ; Chorion ; Cordocentesis ; Down Syndrome ; Female ; Humans ; Mass Screening ; Maternal Age ; Nuchal Translucency Measurement ; Pregnancy ; Pregnancy Trimester, First ; Pregnancy Trimester, Second ; Pregnancy, High-Risk ; Pregnant Women ; Prenatal Diagnosis ; Sensitivity and Specificity

OBJECTIVE: Although anterior cervical discectomy and fusion (ACDF) is the standard treatment for degenerative cervical disc disease, concerns regarding adjacent level degeneration and loss of motion have suggested that arthroplasty may be a better alternative. We have compared clinical and radiological results in patients with cervical disc herniations treated with arthroplasty and ACDF. METHODS: We evaluated 53 patients treated for cervical disc herniations with radiculopathy, 21 of whom underwent arthroplasty and 32 of whom underwent ACDF. Clinical results included the Visual Analogue Scale (VAS) score for upper extremity radiculopathy, neck disability index (NDI), duration of hospital stay and convalescence time. All patients were assessed radiologically by measuring cervical lordosis, segmental lordosis and segmental range-of-movement (ROM) of operated and adjacent disc levels. RESULTS: Mean hospital stay (5.62 vs. 6.26 days, p<0.05) and interval between surgery and return to work (1.10 vs. 2.92 weeks, p<0.05) were significantly shorter in the arthroplasty than in the fusion group. Mean NDI and extremity VAS score improved after 12 months in both groups. Although it was not significant, segmental ROM of adjacent levels was higher in the fusion group than in the arthroplasty group. And, segmental motion of operated levels in arthroplasty group maintained more than preoperative value at last follow up. CONCLUSION: Although clinical results were similar in the two groups, postoperative recovery was significantly shorter in the arthroplasty group. Although it was not significant, ROM of adjacent segments was less in the arthroplasty group. Motion of operated levels in arthroplasty group was preserved at last follow up.
Animals ; Arthroplasty ; Convalescence ; Diskectomy ; Extremities ; Follow-Up Studies ; Humans ; Length of Stay ; Lordosis ; Neck ; Radiculopathy ; Return to Work ; Upper Extremity