To investigate retinal hemodynamics in diabetic retinopathy, the perifoveral capillary leukocyte velocity for retinal microcirculation was measured in eyes of 16 control. 12 non-proliferative diabetic retinopathy(NPDR) and 10 proliferative diabetic retinopathy(PDR) on the video fluorescein angiogram using a scanning laser ophthalmoscope(SLO 101, Rod-enstock, Munich, Germany) in 20 degrees retinal field. And the times of arm to retinal circulation, arterio-venous circulation and venous lamina flow for retinal macrocirculation were also measured in eyes of 18 control, 16 NPDR and 10 PDR in 40 degrees retinal field. There was not any statistically significant difference between control eyes(140.62 +/- 34.11 pixels/see, 1.21 +/- 0.29 mm/sec) and NPDR eyes(133.98 +/- 31.85 pixels/sec, 1.15 +/- 0.27 mm/sec) in mean perifoveal capillary leukocyte velocity(p=0.60). But it was significantly decreased in PDR eyes(108.80 +/- 26.19 pixels/see, 0.94 +/- 0.23 mm/sec) compared with control(p=0.01) and NPDR eyes(p=0.05). The were not any significant differences in the times of arm to retinal and arterio-venous circulation respectively(p>0.05) among the eyes of control(12.09 +/- 1.41 sec, 2.41 +/- 0.86 sec), NPDR(12.66 +/- 1.42 see, 2.32 +/- 0.96 sec) and PDR(12.90 +/- 1.51 see, 2.54 +/- 0.94 sec). But the venous lamina flow time was significantly decreased in eyes of NPDR(6.91 +/- 2.32 see, p=0.02) and PDR(7.03 +/- 1.89 sec, p=0.01) compared with that of control(5.46 +/- 1.18 see). These results indicate that a significant retinal microcirculatory deficit exists in the eyes of PDR, and venous lamina flow time may be a good index of retinal macrocirculatory deficit in diabetic retinopathy.
Arm ; Capillaries ; Diabetic Retinopathy ; Fluorescein ; Hemodynamics* ; Leukocytes ; Microcirculation ; Ophthalmoscopes* ; Retinaldehyde*

Most local anesthetics intravenously administered inhibit neuromuscular transmission or enhance the neuromuscular block of both nondepolarizing and depolarizing musde relaxants. Local anesthetics used to treat cardiac arrhythmias intraoperatively or postoperatively may, therefore, greatly augment a residual neuromuscular block. To obtain adequate balanced anesthesia and postoperative analgesia, general anesthesia with epidural anesthesia is frequently selected. In the present study we investigated the effects of lidocaine HC1 administered into epidural space on the neuromuscular blocking action of vecuronium. Eighty adult gynecological patients of ASA class I or II were studied. Patients were divided into four groups as follows ; Group I (n=20); vecuronium 0.1 mg/kg iv administered only Group II(n=20); vecuronium 0.1 mg/kg iv and lidocaine 6 mg/kg administered into epidural space Group III(n=20); vecuronium 0.1 mg/kg iv and lidocaine 8 mg/kg administered into epidural space Group IV(n=20); vecuronium 0.1 mg/kg iv and lidocaine 10 mg/kg administered into epidural space Patients of experimental groups II, III and IV were anesthetized by epidural block with 2 % lidocaine followed by general anesthesia 15 minutes later. Before induction with fentanyl(3 ug/kg), droperidol(0.04 mg/kg), thiopental sodium (5 mg/kg) and vecuronium(0.1 mg/kg) iv, neuromuscular monitoring was set by using ABM(Anesthesia and Brain activity Monitor, Datex Co, Finland) which stimulating ulnar nerve at the wrist with supramaximal stimuli at a frequency of 2 Hz and 20 seconds interval. The electromyographic response of hypothenar muscles was recorded. Following stabilization of the control twitch height, vecuronium(0.1 mg/kg) was intravenously injected, and tracheal intubation was performed when the first twitch height of the train of four twitch response(T1) was 5 % of the controL Anesthesia was maintained with O2 (2 L/min) and N2O (4 L/min). The time of onset of action (time from vecuronium iv to 0 % of T1), time of maximal twitch depression (time from loss of T1 to reappearance of T1), Recovery index (time from recovery of 25 % of T1 to 75 % of T1) and T4 ratios (ratio of the height of the fourth twitch to T1) at 25 %, 50 % and 75% of T1 were measured and compared among the groups. The results were as follows ; 1. The time of onset of action was 3.99+/-0.92 minutes in the control group and 2.94+/-0.89 minutes in the lidocaine 10 mg/kg administered group(P<0.05). 2. The time of maximal twitch depression was 19.055.46 minutes in the control group and 24.02+/-6.94, 25.33+/-5.84, 27.07+/-5.26 minutes in the lidocaine 6 mg/kg, 8 mg/kg, 10 mg/kg administered groups(P<0.05). 3. Recovery index was 14.76+/-5.40 minutes in the control group and 20.39+/-4.56, 22.36+/-7.98 minutes in the lidocaine 8 mg/kg, 10 mg/kg administered groups(P<0.05). 4. The lidocaine administered into epidural space has little effect on the recovery of T4 compared with that of T1(P>0.05). These results suggest that the effect of lidocaine HC1 administered into epidural space on the neuromuscular blocking action of vecuronium showed prolonged depression and recovery time, and reduced time of the onset of action with dose larger than lidocaine 8 mg/kg.
Adult ; Analgesia ; Anesthesia ; Anesthesia, Epidural ; Anesthesia, General ; Anesthetics, Local ; Arrhythmias, Cardiac ; Balanced Anesthesia ; Brain ; Depression ; Epidural Space* ; Humans ; Intubation ; Lidocaine* ; Muscles ; Neuromuscular Blockade* ; Neuromuscular Monitoring ; Thiopental ; Ulnar Nerve ; Vecuronium Bromide* ; Wrist

We conducted this cohort analytic study to determine whether women with unexplained elevations of maternal serum hCG at 15-18 weeks' gestation are at increased risk for pregnancy complications and adverse perinatal outcomes. The inclusion criteria were a singleton gestation, a confirmed gestational age, and an hCG level greater than 2.0 multiples of the median (MoM). The exclusion criteria were fetal anomalies, an abnormal karyotype, molar pregnancy, and an MSAFP level greater than 2.5 multiples of the median (MoM). A group of randomly selected women with hCG levels under 2.0 MoM served as controls. Patients with elevated levels of hCG had a significantly higher risk for PIH (17.9% versus 4.5%; P <.05) and preterm delivery (17.9% versus 3.5%; P<, 05) than control. But no significant differences were observed in the incidence of intrauterine growth restriction and low birth weight and in the newborn weight. We suggested that pregnancies with unexplained elevated hCG levels should be regarded as high-risk pregnancies. And these patients require careful monitoring with adequate obstetric management.
Abnormal Karyotype ; Chorionic Gonadotropin* ; Cohort Studies ; Female ; Gestational Age ; Humans* ; Hydatidiform Mole ; Incidence ; Infant, Low Birth Weight ; Infant, Newborn ; Pregnancy ; Pregnancy Complications ; Pregnancy Outcome* ; Pregnancy* ; Pregnancy, High-Risk

No abstract available.
Heart Diseases* ; Heart*

No abstract available.
Cerebral Hemorrhage* ; Mucormycosis*

To verify the accuracy and reproducibility of corneal thickness measurements obtained with Orbscan (Orbtek, Inc., Salt Lake City, USA), the measurements were compared with those taken with an ultrasound pachymeter (Omega Compuscan, Storz). Central corneal thickness was measured by each method in 100 eyes of 50healthy subjects. The averages by the two methods were compared. One examiner took the measurements twice by each method in 20 eyes of 10 subjects, and intraexaminer reproducibility was evaluated. Two examiners measured the thickness in 20 eyes of 10 subjects and interexaminer reproducibility was assessed. The average corneal thickness was 550.27+/-3.56 micrometer in the Orbscan measurements and 526.62+/-3.70 micrometer in the ultrasound pachymetry: There was a statistically significant difference between the two methods. Significant difference was noticed but this showed a constant corresponding correlation with the Orbscan showing a 4.4%lower average. The intraexaminer and interexaminer reproducibility showed high reliability(Guttman split-half point<0.99). The Orbscan pachymetry is a highly reliable method and may be widely used in clinical practice.
Corneal Pachymetry* ; Lakes ; Ultrasonics* ; Ultrasonography

PURPOSE:The purpose of this study was to assess the growth status and to evaluate the factors affecting the development of metabolic syndrome in children born with small for gestational age (SGA) at term gestation. METHODS:We retrospectively reviewed medical records of 73 (36 boys, 37 girls) children born with SGA at term gestation who were visited for short stature and metabolic problems at Seoul National University Children' Hospital between 1994 and 2003. We assessed several clinical parameters as follows:birth weight, height standard deviation score (SDS), weight SDS, weight for height, bone age (BA), chronologic age (CA), predicted adult height (PAH) and midparental height (MPH). We evaluated the factors affecting height SDS according to pubertal status. We also evaluated the factors affecting development of type 2 diabetes mellitus, dyslipidemia or obesity. RESULTS:Pubertal children had greater height SDS, weight SDS and difference between BA and CA than prepubertal children, respectively (P<0.05). Height SDS positively correlated with difference between BA and CA (r=0.43, P<0.01), but BA advancement (BA>CA) was not observed in prepubertal children. BA advancement was observed in all pubertal children except one. The children who had greater weight SDS than height SDS had significantly lower height SDS and delayed BA, respectively (P<0.05). The children who had metabolic problems had higher weight SDS (P<0.05). CONCLUSION: This study suggests that rapid skeletal maturation may develope during transition from prepuberty to puberty and catch-up growth may contribute to the development of metabolic syndrome in children born with SGA, but further study will be required.
Adolescent ; Adult ; Child* ; Diabetes Mellitus, Type 2 ; Dyslipidemias ; Gestational Age* ; Humans ; Medical Records ; Obesity ; Pregnancy* ; Puberty ; Retrospective Studies ; Seoul

Clinical study has been carried out on the 80 consecutive cases of traumatic hyphema who had been admitted to Won-Kwang University Hospital for the 3 year period between March of 1985 and February of 1988. Based on these 80 patients, a clinical analysis was conducted as to the degree of bleeding, the time of arrival to hospital after injury, the frequency of rebleeding and the final visual acuity. The followings were the results. 1. Male patients were 67(83.8%) of 80 and the younger age group occupied more than half of all cases; 23(28.8%) in teenagers, 21(26.3%) in third decade. 2. There were varieties of trauma for hyphema such as stone blow(cases, 16.3%), fist(8 cases, 10.0%) and glass pieces(8 cases, 10.0%). 3. Grade I hyphema(bleeding less than one third of anterior chamber) was 45 cases(56.3%) of all. The associated ocular injuries were eyelids laceration (20 cases, 25.0%), angle recession(cases, 15.0%), corneal damage and iris sphinctor rupture(11 cases, 13.8%) and vitreous hemorrhage(10 cases, 12.5%). 4. Of 10 cases of rebleeding encountered in non-perforating group, nine was in Grade II hyphema(bleeding 1/3 and 1/2 of anterior chamber) and the bleeding was noted four to six days after initial trauma. 5. The final visual acuity of above 0.5 increased from 2.3% to 65.1% in Grade I hyphema, from 9.1% to 54.5% in Grade II huphema and from 0 to 36.4% in Grade III hyphema(bleeding more than one half of anterior chamber). 6. The major causes of impaired visual acuity were disorders of vitreous and retina(11 cases, 40.8%) and cataract(5 cases, 18.5%).
Adolescent ; Eyelids ; Glass ; Hemorrhage ; Humans ; Hyphema* ; Iris ; Lacerations ; Male ; Visual Acuity

Pigmented lesions of palmar and plantar skin may cause diagnostic problems, because some features of benign lesions in these sites may raise the suspicion of melanoma if considered alone. Transepidermal elimlnation is a mechanism by which a substance is eliminated through the epidermis, and it is apt to be confused with a feature of melanoma that tumor cells are located at all layers of the epidermis. We report a case of transepidermal elimination of nevus cells in acral letiginous nevus which needs a differential dignosis of melanoma.
Epidermis ; Melanoma ; Nevus* ; Skin

The metal ceramic crown is currently the most popular complete veneer restoration in dentistry, but in many cases, the metal cervical collar at the facial margin is unesthetic and unacceptable. Facial porcelain margin has been used in place of it. But this dose not solve the problems, such as dark gingival discoloration and cervical opaque reflection of porcelain veneer. Recently, metal copings which were designed to terminate its labio-cervical end on the axial walls coronal to the shoulder have been clinically used to solve the esthetic problem of metal ceramic crown. But in this design, porcelain veneer of labio-cervical area which is not supported by metal may not be able to resist the stress during cementation and mastication. The purpose of this study was to evaluate fracture strength and fractured appearance of crowns according to different coping designs. A resin maxillary left central incisor analogue was prepared for a metal ceramic crown, and metal dies were made with duplication mold. Metal copings were made and assigned to one of four groups based on facial framework designs: group 1, coping with 0.5mm metal collar; group 2, metal extended to the shoulder; group 3, metal extended to 1 mm coronal to the shoulder; group 4, metal extended to 2mm coronal to the shoulder. Copings and crowns were adjusted to be same size and thickness, and cemented to metal dies with zinc phosphate cement by finger pressure. Fracture strength was measured with Instron Universal Testing Machine. Metaldies were anchored in Three-way-vice at 3mm below finish line and at 130degree inclined to the lone axis of the crown. Load was directed lingually at 2mm below midincisal edge. Load value at initial crack and at catastrophic fracture was recorded. The results obtained were as follows: 1. Fracture strength values at initial crack were higher in groups 1, 2 than in groups 3, 4 but this difference was not statistically significant(P<0.05). 2. Conventional metal collared crown had greater catastrophic fracture strength than any other collarless crowns. 3. The greater the labial metal coping reduction, the lower the catastrophic fracture strength of crowns but when more than 1mm of labial metal reduction was done, the difference in strengths was not statistically significant(p<0.05). 4. The strongest collarless coping design was group 2.
Axis, Cervical Vertebra ; Cementation ; Ceramics* ; Crowns* ; Dental Porcelain ; Dentistry ; Fingers ; Fungi ; Incisor ; Mastication ; Shoulder ; Zinc Phosphate Cement