We performed this study to evaluate the quantitative three-dimensional measurements of neurosensory retinal detachment in central serous chorioretinopathy and the correlation among the type of leakage points on fluorescein angiography, initial visual acuity, the area and height of neurosensory retinal detachment. Types of leakage point were classified into ink-blot type (A) and smokestack type (B). Horizontal and vertical diameters, area, and maximal height of retinal detachment were measured by HRT (Heidelberg Retina Tomograph). Mean horizontal diameter was 3.69+/-1.00mm(range, 1.87~5.30mm), mean vertical diameter was 3.52+/-0.87mm(range, 1.77~4.88mm), mean area was 10.89+/-5.11 mm2(range, 4.29~21.50 mm2), and mean maximal height was 0.24+/-0.07mm(range, 0.10~0.36mm). Initial visual acuity of smokestack type was 0.39+/-0.25, and that of ink-blot type was 0.66+/-0.29. Initial visual acuity of smokestack type was statistically lower than that of ink-blot type. Area and maximal height or retinal elevation were 9.45+/-4.87 mm2, 0.23+/-0.08mm in type A and 13.41+/-4.77 mm2, 0.26+/-0.07mm in type B. The difference in area and maximal height of retinal elevation between type A and type B was not statistically significant. In smokestack type, initial visual acuity was significantly lowered as the area or the maximal height of retinal elevation increased, but the correlation was not statistically significant. In ink-blot type, no correlation was found between initial visual acuity and area or maximal height of retinal elevation.
Central Serous Chorioretinopathy ; Fluorescein Angiography ; Retina ; Retinal Detachment* ; Retinaldehyde* ; Visual Acuity

To investigate the relationship between psychological behavior and the development of central serous chorioretinopathy, we performed a study on stress and personality characteristics on 39 central serous chorioretinopathy patients and 38 healthy subjects as a control group. We used Life Change Inventory(MMPI) for personality characteristics. As a result, the mean stress scale in the patients group was significantly higher than in the normal control group(p<0.05) and the mean T-xcore of three neurotic scales such as hypochondriasis, depression and hysteria in the patients group were significantly higher than in the normal control group(p=0.029, 0.004, 0.012).
Central Serous Chorioretinopathy* ; Climacteric ; Depression ; Humans ; Hypochondriasis ; Hysteria ; MMPI ; Weights and Measures

A case of Porokeratosis (Mibelli) involved to the nail plate in 25 years old male was described, This is rare and the first case of Porokeratosis (mibelli) variety reported in Korea. The clinical and histopathological study revealed characteristic features of this disease. Author reviewed reports of the literature.
Adult ; Humans ; Korea ; Male ; Porokeratosis

Intravenous patient-controlled analgesia(PCA) is gaining wide spread popularity in management of post-operative pain maintaining an effective blood concentrations of analgesics. We studied 48 patients, ASA class I or II, undergoing obstetric or gynecologic surgery under general anesthesia. We examined postoperative pain control level, patients satisfaction and side effects associated with the use of morphine and Baxter infusor. Each patient received 0.1 mg/kg as a loading dose and 0.0125 mg/kg/hr of morphine as maintenance dose. A unit was fitted with patient control module which had a flow rate of 0.5ml/hr and lockout interval was 15 minutes. Results were as follow. Pain scores were 1.88+/-0.81(first day), 1.31+/-0.71(second day). Visual analogue scales were 4.40+/-2.06(first day), 3.40+/-1.71(second day). 41 out of 48 patients in total were satisfied but nausea, dizziness or pruritus was noted. We recommend the use of PCA with morphine after surgery to improve post-operative pain because it provides adequate pain relief and a few side effects with high patients satisfaction.
Analgesia, Patient-Controlled* ; Analgesics ; Anesthesia, General ; Dizziness ; Female ; Gynecologic Surgical Procedures* ; Humans ; Infusion Pumps ; Morphine* ; Nausea ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Pruritus ; Weights and Measures

Case Report The silicone oil is widely used as an intraocular tamponade after vitrectomy but its complications were frequently found in postoperative period. The cataract was one of the most common complications in the eyes filled with silicone oil. The cataract in the eyes filled with silicone oil can be removed with either the intracapsular or the extracapsular-extraction technique. But these surgical techniques have two major problems: posterior capsular fibrosis and intraoperative loss of silicone oil. We report two cases of complicated cataract in the eyes filled with silicone oil which those were successfully performed by lens aspiration or extracapsular cataract extraction with large posterior continuous circular capsulorhexis and basal iridectomy without any loss of silicone oil under the continuous positive pressure achieved with an anterior chamber maintainer such as healon and balaneed salt solution.
Anterior Chamber ; Capsulorhexis ; Cataract Extraction* ; Cataract* ; Catheters* ; Fibrosis ; Hyaluronic Acid ; Iridectomy ; Postoperative Period ; Silicone Oils* ; Vitrectomy

BACKGROUND/AIMS: Acute calculous suppurative cholangitis(ACSC) is the most severe complication of bile duct stone(s) and carries 100% mortality if left untreated, and emergent decompression is a life-saving procedure. Endoscopic therapy such as endoscopic sphincterotomy(EST) or endoscopic nasobiliary drainage(ENBD) are well-mtablished treatment of choice instead of emergent surgieal or percutaneous drainages which have a high mortality or morbity, respectively. However, EST and subsequent stone removal is operator-dependent, time consuming, associated with complication rate of 6~12%, and may be inadequeate in many critically ill patients. Recently, endoscopic retrograde biliary drainage(ERBD) is suggested to be as effective in temporary biliary drainage for retained common duct stone and acute cholangitis as ENBD is, and preferred to ENBD in some reports, because ENBD can be pulled out occasionally by confused patient, more time consuming, unpleasant, a hindrance for the patient, and does not seem to be any more effective than ERBD. So, we performed this study to evaluate the role of ERBD in patient with ACSC. METHODS: In Gil Hospital from March 1995 to April 1997, 35 patients were diagnosed as ACSC among the 289 patients with common bile duct stone(s). Of those with ACSC, "the emergent group" were 19 patients with common bile duct stone(s) in which polyethylene biliary stent was placed with the proximal end above the stone and the distal end in the duodenum within 1 days after admission, and "the delayed group" were 9 patients with common bile duct(CBD) stone(s) in which biliary stenting was delayed for 1 days or longer after admission. In both groups, diagnosis rate according to the endoscopic retrograde cholangiopancreatography(ERCP) timing, clinical manifestations at admission, clinical and laboratory effectiveness of ERBD, and mortalities were analyzed and compared by the unpaired t-test. RESULTS: 1. The mean ages and male to female ratio in the emergent group were 65.1, 11:8, respectively and 61.4, 5:4 in the delayed group. On admission, hypotension and confused mentality were more frequent in the emergent group than in the delayed group, but there were no difference in the frequency of medical disease, cholecystectomy history between the two groups. 2. In laboratory findings, anemia, leukocytosis, and thrombocytopenia were more severe in the emergent group than in the delayed group, but there were no difference in the liver function test between the two groups. 3. The diagnosis rate of ACSC according to the ERCP timing was 90.9% by the emergent ERCP, whereas 1.9% by delayed ERCP, and among the 33 procedures of emergent ERCPs, 5 ERCPs were performed without aid of fluoroscopy. 4. In endoscopic findings of papilla, the incidence of gross pus, impacted stone, choledochoduodenal fistula, and papillary hyperemia was 100%, 53.6%, 46.4%, and 21.4%, respectively. In ERCP findings, single CBD stone was most common(53.6%), followed by multiple CBD stone(46.4%), IHD stone(s)(21.4%), and GB stone(14.2%). There were no differences in endoscopic and ERCP findings between the two groups. 5. After ERBD, abdominal pain and fever, and the level of total bilirubin and GOT were subsided or normalized more rapidly in the emergent group than in the delayed group, but there were no differences in the duration of hypotension and the level of GPT, ALP, and creatinine between the two groups. 6. The success rate of ERBD were 100% in the emergent group and 77.8% in the delayed group, so overal l success rate was 92.3%. After ERBD, the effectiveness determined by clinical and laboratory findings were 94.7% in the emergent group and 100% in the delayed group, so overall effectiveness was 96.2%. 7. Definite treatment consisted of endoscopic management in 23 patients(82.1%), elective operation for gallbladder or IHD stone(s) in 3(10.7%) after endoscopic removal of CBD stone(s), permanent biliary stenting due to the patient's refusal of further endoscopic or surgical management after recovery from sepsis in 3 patients(10.7%), and urgent operation in 1 patient(3.6%) in the emergent group. One patient in the delayed group died of sepsis in spite of successful biliary drainage, so overall mortality rate was 3.6%. CONCLUSIONS: ERBD is an effective alternative method of decompressing the bile duct in patient with ACSC due to CBD stone(s), and high index of suspicion of the diagnosis is necessary because failure of diagnosis can result in delaye ddrainage and may be associated corresponding increase in mortality.
Abdominal Pain ; Anemia ; Bile ; Bile Ducts ; Bilirubin ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis* ; Cholecystectomy ; Common Bile Duct ; Creatinine ; Critical Illness ; Decompression ; Diagnosis ; Disulfiram ; Drainage* ; Duodenum ; Female ; Fever ; Fistula ; Fluoroscopy ; Gallbladder ; Humans ; Hyperemia ; Hypotension ; Incidence ; Leukocytosis ; Liver Function Tests ; Male ; Mortality ; Polyethylene ; Sepsis ; Stents* ; Suppuration ; Thrombocytopenia

Nevus anemicus is a congenital anomaly characterized by pale macules of varying size and shape, and it is due to the increased sensitivity of blood vessels to catecholamines. However, the clinical features of nevus anemicus are not yet fully established. A clinical observation was made analyzing 26 cases of nevus anemicus over a 10-year period. Histopathological investigation in 6 cases, stain with Fontana-Masson in 4 cases, irradiation of ultraviolet B in 5 cases, digital infrared thermal imaging in 5 cases and color analysis using true-color imaging in 12 cases were also performed. The results were as follows: 1. The ratio of men to women was 1.2:1. The lesions were mostly(80%) present before the age of 18, but only 15% of the patients' lesions were present at birth. 2. The lesions were most frequently found on the face(33.3%) and neck(33.3%), followed by the chest(14.8%), lower extremities(7.4%) and back(7.4%). 3. Most patients(92.3%) had a single lesion. The extent of the lesions did not exceed 10% of the body surface area and the lesions did not show any progression or resolution. 4. The stainability of Fontana-Masson in nevus anemicus lesions showed no significant change compared with perilesional normal skin. 5. Irradiation of ultraviolet B ray(minimal erythemal dose to 80mJ/cm2) did not induce erythema on nevus anemicus lesions. 6. There was no significant temperature difference between nevus anemicus lesions and perilesional normal skin. 7. There was no significant correlation between chrominance and age. In conclusion, nevus anemicus in Korea shows the same incidence in both sexes, it usually arises at birth or childhood, but it may also develop later in life. Most patients show focal lesions that do not progress or resolve.
Blood Vessels ; Body Surface Area ; Catecholamines ; Erythema ; Female ; Humans ; Incidence ; Korea ; Male ; Nevus* ; Parturition ; Skin

Continuous epidural analgesia with morphine via portable infusor(Baxter Infusor, BI) is a good technique for the management of intractable cancer pain. The method of subcutaneous tunnelling with portable infusor has been widely used for the cancer pain management. We examined the doses of morphine, duration of subcutaneous tunnelling, side effects, age distribution and causes of pain. The mean initial dose of morphine was 6.09 and the last 24.02 mg. Mean duration of subcutaneous tunnelling was 53.71 days and voiding difficulty, pruritus, respiratory depression were observed. Most of the patients were at the ages of 6th decade and the most common cause of pain was stomach cancer. It is suggested that the management of intractable cancer pain with epidural morphine through subcutaneous tunnelling via portable infusor is satisfactory and reliable.
Age Distribution ; Analgesia, Epidural ; Humans ; Infusion Pumps* ; Morphine ; Pain Management ; Pruritus ; Respiratory Insufficiency ; Stomach Neoplasms

BACKGROUND/AIMS: Endoscopic sphincterotomy (EST) has become a well-established therapeutic modality for common bile duct stone (s). EST and subsequent stone extraction, including mechanical lithotripsy, can clear bile duct in 85% to 95% of patients. Other therapeutic modalities which have been developed to enhance bile duct clearance including extracorporeal shock-wave lithotripsy, electrohydraulic or laser lithotripsy, and chemical dissolution are high cost, not yet widely available especially in community hospital, yet to be perfected, or still under clinical evaluation. The use of biliary stenting has been proposed as an alternative therapy for patients at high risk for surgery. We carried out this prospective, controlled study to evaluate the long-term effect of biliary stenting for endoscopically unextractable common bile duct stone (s). METHODS: Of the 233 patients with common bile duct stone (s) admitted at Gil Hospital from Jan. 1995 to Dec. 1996, the stent group were 14 patients with retained comrnon bile duct stone (s) in which 7Fr polyethylene biliary stent was placed with the proximal end above the stone and the distal end in the duodenum. The control group were 6 patients with common bile duct stone (s) not treated, because of patients refusal of surgical or endoscopic management. Follow-up was achieved by direct interview and telephone, and consisted of prospective analysis of all complications that occured during long-term follow-up period. Complication rates in the both groups were compared using chi-square test and cumulative complication-free rates were calculated by Kaplan-Meier analysis.
Bile Ducts ; Common Bile Duct* ; Disulfiram ; Duodenum ; Follow-Up Studies ; Hospitals, Community ; Humans ; Kaplan-Meier Estimate ; Lithotripsy ; Lithotripsy, Laser ; Polyethylene ; Prospective Studies ; Sphincterotomy, Endoscopic ; Stents* ; Telephone

The efficacy of the fine needle aspiration biopsy and cytological examination (FNABC) under ultrasonographic (US) guides for the diagnosis of cervical tuberculous lymphadenitis was assessed. In one hundred and one patients with a neck mass or masses, tuberculous lymphadenitis has been proved by FNABC. US disclosed the physical characteristics of the masses: All the cases that involved two or more lymph nodes were multiple lesions. Eighty lesions (79.1%) were multiregional, and in 19 cases (18.8%), bilateral neck was involved. The posterior triangle of the neck was the most prevalent site (N = 69, 68.3%). Ninety two cases (90.9%) were hypoechoic lesions and 9 (9.1%) showed mixed echo patterns. There was no hyperechoic lesion (p< 0.001). The sensitivity of FNABC was 77.2% and the specificity was 99.0%. The diagnostic accuracy was 85.0%. There was no complication during the procedure. FNABC for the diagnosis of cervical tuberculous lymphadenitis is a safe, convenient procedure and has a relatively high specificity. The limitation of FNABC, the low sensitivity, seemed to be compensated by US examinations.
Biopsy, Needle/*methods ; Human ; Neck ; Tuberculosis, Lymph Node/*pathology/*ultrasonography