On the proposed fluorescein clearance test by Pflugfelder and Tseng, measurements of volume and concentration of instilled fluorescein, being changed by tear secretion, pumping action, during confined time, are able to discern tear turnover rate(tear clearance). We performed TBUT, Schirmer test and modified FCT to the 60 eyes of healthy person, to the 36 eyes of essential blepharospasm patient, and to the 32 eyes of hemifacial spasm patients. We modified the FCT to economize time. Under the topical anesthesia with 0.5% propacaine, test was performed after instilling a 20 microliter of Flucaine(0.25% fluorescein sodium, and 0.5% propacaine) into the conjunctival sac and standard Schirmer strip was then placed for another 10 minutes. The length of the portion was measured and the concentration of tint fluorescein was graded into 5 degrees(photodocumented classification under the cobalt blue light)(FCT 1). Waiting 10 minutes, a standard Schirmer strip was placed into with nasal stimulation and length and concentration was also measured(FCT 2). The agreement of classification was determined with Kappa values for evaluation for reproducibility and and reliability of FCT. The intra-observer agreement(examination repeated twice) was k=0.84 and the inter-observer agreement(two obsevers' examination) was k=0.77, which revealed a consistent result. Patients with blepharospasm was indicated decreased basal secretion compared with normal control(p<0.001) and also showed delayed tear clearance whith represented significant increased concentration(p<0.001). We concluded that FCT was revealed high reproducibility by intra-observer and inter-observer agreement and test may be useful diagnostic method to evaluate delayed tear clearance.
Anesthesia ; Blepharospasm* ; Classification ; Cobalt ; Fluorescein* ; Hemifacial Spasm ; Humans ; Tears

As a modality of effective treatment for trichiasis, authors performed experimental study of the radio frequency application(Mehl's method) to the cilia of four rabbit eyes with the different application times(10, 30, 60, 180 seconds). For the control, electrolysis to the cilia of the two eyes, and two eyes without any application were observed histopathologically. Regardless of the radio frequency application time, the radio frequency applied eyelids did not reveal any gross changes, and the selective degenerative changes(pyknotic, vacuolar, and karyorrhaxis) were observed microscopically in the hair regeneration part(internal root sheath of hair, hair matrix, and papillae of hair). In the electrolysed eyelids, gross scar and severe necrotic changes were appeared in microscopic findings. As a result of our observation, it is indicated that the application of radio frequency as a treatment for trichiasis, in compare with the electrolysis, revealed less destructive to the adjacent tissue, with more selective changes on the portion for hair regeneration.
Cicatrix ; Cilia* ; Electrolysis ; Eyelids ; Hair ; Regeneration ; Trichiasis

Assuming that botulinum toxin injection can release the involuntary contraction as well as reduce the tear drainage function, mediated by paralysis of orbicularis oculi muscles, then give rise to effect on tear clearance, Authors have examined 18 blepharospasm and 32 hemifacial spasm patients to evaluate the pre- and post- botulinum toxin injectional values of BUT, Schirmer test, and fluolescein clearance test 1, 2, which evaluate possibilities of delayed tear clearanee induced by botulinum toxin injection. Following treatment with botulinum toxin, results of BUT were increased significantly (p<0.0001), values of Schirmer test tended to increase without statistical significance. In fluorescein clearance test 1, length and concentration values were increased significantly(p<0.05), but in fluorescein clearance test 2, only length measurements were increased significantly(p<0.05). And also in blepharospasm cases of BUT values less than 4 second, both Schirmer test and fluorescein clearance test results were increased with statistical significance(p<0.05). We concluded that delayed tear clearance induced by botulinum toxin injection could be effective treatment for facial dystonias, especially combined cases with dry eye.
Blepharospasm* ; Botulinum Toxins* ; Drainage ; Dystonia ; Fluorescein ; Hemifacial Spasm* ; Humans ; Muscles ; Paralysis ; Tears*

The authors have experienced a case of Von Hippel-Lindau disease. A 31 year old man had angioma in the right retina and cystic capillary hemangioblastoma in the left cerebellar hemisphere. The retinal angioma was diagnosed by fundoscopic examination and the hemangioblastoma in the cerebellum was confirmed pathologically. The frequent associated disease, such as pheochromocytoma, polycythemia and intraabdominal tumor, was not noted clinically and radiologically. Total removal of the cerebellar tumor was performed with good result.
Adult ; Capillaries ; Cerebellar Neoplasms ; Cerebellum ; Hemangioblastoma ; Hemangioma ; Humans ; Pheochromocytoma ; Polycythemia ; Retina ; Retinaldehyde ; von Hippel-Lindau Disease*

Stereotaxic biopsy is an useful technique as an alternative to craniotomy for the tissue diagnosis of the intracranial tumors, especially such as deep seated tumor or malignant neoplasm in the dominant hemisphere. Such biopsy was more safe and lesser expensive than any other procedures and had high accuracy. For the purpose of more accuracy, the authors inserted small steel ball marker at the biopsy site and performed repeat C-T brain scanning immediately after the operation. We could confirm the marker in the tumor tissue on the C-T scans. The authors had experienced 4 cases of stereotaxic biopsy as follow; 2 cases of thalamic astrocytomas, 1 case of pineocytoma and 1 case of astrocytoma grade II in the dominant hemisphere. Neither mortality nor morbidity was noted.
Astrocytoma ; Biopsy* ; Brain Neoplasms* ; Brain* ; Craniotomy ; Diagnosis ; Mortality ; Pinealoma ; Steel

BACKGROUND: The number of human immunodeficiency virus (HIV)-infected patients is increasing constantly, and it is well known that there is a significantly high prevalence of osteonecrosis of the femoral head in HIV-infected patients. Therefore, it is important to develop methods that can ensure the safety of both the patients and medical personnel who participate in surgery on HIV-infected patients. Recently, the authors performed 8 procedures on 5 HIV-infected patients. This paper reports our experience. METHODS: This study examined the medical records and radiological studies of 5 HIV-infected patients who had undergone surgery around the hip joint from January, 2005 to September, 2007. During the procedures, their mean age was 38.6 years (range, 23 to 53 years) and all were male. Four of them were under an anti-retroviral therapy program. The reasons for the operations were nonunion of the femoral shaft after trauma in two patients and osteonecrosis of both femoral heads in three. One autologous bone grafting, one screw fixation with autologous bone grafting, five total hip replacement arthroplasties, and one multiple drilling were performed. All procedures were carried out according to the guidelines of HIV infection control made by the Korea Centers for Disease Control and Prevention. The mean follow-up period was 16.6 months (range, 4 to 37 months). RESULTS: The preoperative CD4 count was 130 in one patient, and 200 to 499 in the other 4. The viral loads were 15100 and 420 in two patients, and negative in the other 3. Bony union was achieved in those who had undergone autologous bone grafting. There were significant improvements in both the Harris Hip Score and functional state in those who had total hip replacement arthroplasty. There were no immediate postoperative complications, such as infection. During the follow-up period, one patient died from esophageal variceal bleeding. However, no surgery-related complications were observed in the other 4 patients. CONCLUSIONS: There were no significant complications in HIV-infected patients after the operations around the hip joint when their preoperative immunity was optimal. In addition, the safety of medical personnel can be assured when the operation is performed in line with the guidelines of HIV infection control.
Adult ; *Arthroplasty, Replacement, Hip/adverse effects ; Bone Transplantation ; CD4 Lymphocyte Count ; Femoral Fractures/complications/*surgery ; Femur Head Necrosis/complications/*surgery ; Fractures, Ununited/complications/*surgery ; HIV Infections/*complications/immunology/transmission/virology ; Humans ; Infectious Disease Transmission, Patient-to-Professional/prevention & control ; Male ; Middle Aged ; Postoperative Complications ; Viral Load ; Young Adult

Allergy to latex gloves has been described as an unusual complication during labor. However, IgE mediated hypersensitivity reaction to natural rubber have recently been identified as an international health problem. In this first case report in Korea, latex anaphylaxis during labor is described in an operating room nurse who has been continuously exposed to latex gloves. Because of the increasing frequency of latex allergy, obstetrician should take care and give more attention to the clinical history, as well as be aware of this possibility especially in high risk groups.
Anaphylaxis* ; Hypersensitivity ; Hypersensitivity, Immediate ; Korea ; Latex Hypersensitivity ; Latex* ; Operating Rooms ; Rubber ; World Health

OBJECTIVE: To assess the pregnancy outcomes complicated by maternal heart diseases. METHODS: From 1994 to 2001, medical records of pregnant women who had reached at least 20 weeks of gestation with maternal heart diseases were reviewed. RESULTS: 224 deliveries of 195 women were enrolled in this study. In 117 (52.2%) cases the heart diseases were of rheumatic origin, in 96 (42.9%) cases congenital, and the remaining 11 (4.9%) cases were miscellaneous group that included arrhythmia, cardiomyopathy, and mitral valve prolapse. There were 2 (0.9%) cases of maternal death related to pregnancy. Majority (91.9%) were in New York Heart Association functional classes I, II before, during, and after delivery. Mean gestational age at birth and birth weight were 37.9 weeks and 2883 gm. Perinatal mortality rate was 17.9/1000 and the rate of congenital malformation was 2.7%. Recurrence risk of neonatal congenital heart disease was 2.1%. CONCLUSION: Most complications were developed in the pregnancies complicated by maternal heart diseases with New York Heart Association functional classes III, IV. Functional status of the pregnant women is the important risk factor in maternal and fetal outcomes.
Arrhythmias, Cardiac ; Birth Weight ; Cardiomyopathies ; Female ; Gestational Age ; Heart Defects, Congenital ; Heart Diseases* ; Heart* ; Humans ; Maternal Death ; Medical Records ; Mitral Valve Prolapse ; Parturition ; Perinatal Mortality ; Pregnancy Outcome ; Pregnancy* ; Pregnant Women ; Recurrence ; Risk Factors

OBJECTIVE: To examine if amniotic fluid (AF) monocyte chemotactic protein-1 (MCP-1) concentrations are useful in the identification of intrauterine infection and pregnancy outcomes in preterm labor with intact membranes. METHODS: The study population consists of 65 patients who received amniocentesis for preterm labor with intact membranes. Amniotic fluid was cultured for aerobic and anaerobic bacteria, as well as mycoplasmas. MCP-1 was determined by a sensitive and specific immunoassay. Fisher's exact test, Mann-Whitney U test, receiver operating characteristic curve, survival techniques, logistic regression, and Spearman correlation were used for statistical analysis. RESULTS: (1) Patients with a positive amniotic fluid culture had a significantly higher median AF MCP-1 concentration than those with negative results (median, 9.0 ng/mL; range, 0.45-40.5 ng/mL; vs median, 0.82 ng/mL; range, 0.06-30.1 ng/mL; P<.01). (2) Patients with AF MCP-1 concentration of >1.9 ng/mL had a significantly shorter median interval to delivery, the higher rate of histologic chorioamnionitis, preterm delivery within 2 and 5 days, and the occurrence of congenital proven or suspected sepsis than did those with AF MCP-1 concentration of <1.9 ng/mL after adjustment for gestational age (P<.05). (3) There was strong correlation between AF MCP-1 concentrations and AF interleukin-6 concentrations (r=.881, P<.001). CONCLUSION: AF MCP-1 determinations are useful in the identification of intrauterine infection, preterm delivery, and neonatal infectious complication in preterm labor with intact membranes.
Amniocentesis ; Amniotic Fluid* ; Bacteria, Anaerobic ; Chemokine CCL2* ; Chorioamnionitis ; Female ; Gestational Age ; Humans ; Immunoassay ; Interleukin-6 ; Logistic Models ; Membranes ; Monocytes* ; Mycoplasma ; Obstetric Labor, Premature* ; Pregnancy ; Pregnancy Outcome ; ROC Curve ; Sepsis

Idiopathic pulmonary fibrosis (IPF) is a lethal parenchymal lung disease characterized by myofibroblast proliferation. Alveolar epithelial cells (AECs) are thought to produce myofibroblasts through the epithelial to mesenchymal transition (EMT). Receptor for advanced glycation end products (RAGE) is a member of the immunoglobulin superfamily of cell surface receptors whose activation is associated with renal fibrosis during diabetes and liver fibrosis. RAGE is expressed at low basal levels in most adult tissues except the lung. In this study, we evaluated the interaction of ligand advanced glycation end products (AGE) with RAGE during the epithelial to myofibroblast transition in rat AECs. Our results indicate that AGE inhibited the TGF-beta-dependent alveolar EMT by increasing Smad7 expression, and that the effect was abolished by RAGE siRNA treatment. Thus, the induction of Smad7 by the AGE-RAGE interaction limits the development of pulmonary fibrosis by inhibiting TGF-beta-dependent signaling in AECs.
Animals ; Epithelial Cells/cytology ; Epithelial-Mesenchymal Transition/*drug effects ; Glycosylation End Products, Advanced/genetics/*metabolism ; Idiopathic Pulmonary Fibrosis/metabolism ; Pulmonary Alveoli/cytology ; RNA, Small Interfering/genetics ; Rats ; Receptors, Immunologic/genetics/*metabolism ; Smad7 Protein/genetics/*metabolism ; Transforming Growth Factor beta/genetics/metabolism