Myopic discs(range: -0.5D) which were taken a confocal scanning laser ophthalmoscope(HRT, Heidelberg Engineering) were analyzed to determine the relationship between optic disc parameters and myopic refractive errors. Regression analysis and coefficient variation were used for a statistic tool. The disc area was not correlated with the myopic refractive error(p=0.21) and showed 16.0% of coefficient of variation. Cup area, cup disc area ratio, rim area, cup volume, rim volume, mean cup depth, maximum cup depth and cup shape measure showed statistically significant correlation with myopic refractive error, respectively(p<0.05). Among these parameters, rim area varied least(within all myopic eyes) with 16.5% of coefficient of variation. As the rim area is the most stable optic disc parameter interindividually in myopic population, it seem to be valuable for follow-up evaluation when a glaucomatous damage is suspected in myopic eyes by calculating its expected normal value with a regression equation.
Myopia* ; Reference Values ; Refractive Errors*

Myopic discs(range: -0.5D) which were taken a confocal scanning laser ophthalmoscope(HRT, Heidelberg Engineering) were analyzed to determine the relationship between optic disc parameters and myopic refractive errors. Regression analysis and coefficient variation were used for a statistic tool. The disc area was not correlated with the myopic refractive error(p=0.21) and showed 16.0% of coefficient of variation. Cup area, cup disc area ratio, rim area, cup volume, rim volume, mean cup depth, maximum cup depth and cup shape measure showed statistically significant correlation with myopic refractive error, respectively(p<0.05). Among these parameters, rim area varied least(within all myopic eyes) with 16.5% of coefficient of variation. As the rim area is the most stable optic disc parameter interindividually in myopic population, it seem to be valuable for follow-up evaluation when a glaucomatous damage is suspected in myopic eyes by calculating its expected normal value with a regression equation.
Myopia* ; Reference Values ; Refractive Errors*

The current model of compact bone is that of a system of Haversian (longitudinal) canals connected by Volkmann's (transverse) canals. Models based on either histology or microcomputed tomography do not accurately represent the morphologic detail and microstructure of this system, especially that of the canal networks and their spatial relationships. The aim of the present study was to demonstrate the morphologic pattern and network of the Haversian system and to compare endosteal and periosteal sides in rats using three-dimensional (3D) reconstruction. Ten Sprague-Dawley rats aged 8-10 weeks were used. The femurs were harvested from each rat and fixed, decalcified with 10% EDTA-2Na, serially sectioned at a thickness of 5 microm, and then stained with hematoxylin and eosin. The serial sections were reconstructed three-dimensionally using Reconstruct software. The Haversian canals in the endosteal region were found to be large, highly interconnected, irregular, and close to neighboring canals. In contrast, the canals in the periosteal region were straight and small. This combined application of 3D reconstruction and histology examinations to the Haversian system has confirmed its microstructure, showing a branched network pattern on the endosteal side but not on the periosteal side.
Animals ; Eosine Yellowish-(YS) ; Femur ; Haversian System* ; Hematoxylin ; Rats* ; Rats, Sprague-Dawley ; X-Ray Microtomography

PURPOSE: We evaluated the influence of time-related input, throughput, and output factors on ambulance diversions in an urban emergency department (ED). METHODS: Data was prospectively collected in an urban ED for one year. We measured daily input factors (daily number of visit, etc), throughput factors (ED length of stay), and output factors (occupancy rate of adult ward, etc). The duty emergency physician had the authority to declare an ambulance diversion. There was no written protocol for ambulance diversion, and each diversion lasted 4 hours if not extended. We estimated the effect of the potential factors of the same day and the previous day on ambulance diversion with a multivariates logistic regression analysis excluding variables with collinearity RESULTS: The total annual number of visits was 40,863. The number of patients delivered by ambulance was 4,059 (9.9%). Ambulance diversion occurred 29 times during 365 twenty-four hour observation intervals (7.9%). The multivariates logistic regression analyses revealed three significant independent factors of ambulance diversion: the ward occupancy rate of the previous day (odds ratio [OR], 1.278; 95% confidence interval [CI], 1.039-1.573), the elderly proportion for the day (OR, 1.106; 95% CI, 1.005-1.217), the total number of visits of the day (OR, 1.079; 95% CI, 1.039-1.120). CONCLUSION: Daily number of visits, proportion of elderly, and ward occupancy rate of the previous day were found to be factors related with ambulance diversion, with the hospital occupancy rate of the previous day showing the highest OR.
Adult ; Aged ; Ambulances ; Crowding ; Emergencies ; Emergency Service, Hospital ; Humans ; Logistic Models ; Prospective Studies ; Time Factors

Etomidate and midazolam are the most popular drugs among the induction agents for emergent endotracheal intubation. The purpose of this study was to compare the incidence of adrenal insufficiency and mortality between the septic shock patients who received etomidate (ETM group) and those who received midazolam (MDZ group). Between November 2004 and September 2006, 65 patients were analyzed in this study. The hospital mortality rate was 36% in the ETM group (n=25) and 50% in the MDZ group (n=40), which was not statistically significant (p=0.269). The incidence of relative adrenal insufficiency was significantly higher in the ETM group than in the MDZ group (84% and 48%, respectively; p=0.003). On multivariate analysis, the use of etomidate was the only significant factor affecting the incidence of relative adrenal insufficiency (odds radio, 5.59; 95% confidence interval, 1.61- 19.4). In conclusion, we think that physicians who treat patients with septic shock should be aware that etomidate can cause adrenal insufficiency, and should start corticosteroids if etomidate is administered.
Adrenal Cortex Hormones/therapeutic use ; Adrenal Insufficiency/chemically induced/complications ; Aged ; Anesthetics, Intravenous/*adverse effects ; Etomidate/*adverse effects ; Female ; Humans ; *Intubation, Intratracheal ; Male ; Midazolam/*adverse effects ; Middle Aged ; Retrospective Studies ; Shock, Septic/complications/drug therapy/*mortality

Seven patients having midline granuloma received local irradiation from March 1983 to June 1986. Clinically, all of the 7 patients had pansinusitis with necrotic destruction of the involved sites and one case revealed colonic lesion. Each of the patients received a tumor dose of 4,000 ~ 5,000 cGy/5~6wks to the upper aerodingestive tract using a 6-MV linear accelerator. Complete and partial remission occurred in 3 patients each, and in one case, the disease progressed despite of the irradiation.
Colon ; Granuloma* ; Humans ; Particle Accelerators

OBJECTIVES: To compare the diagnostic and prognostic performance of amniotic fluid white blood cell(AF WBC) count and amniotic fluid culture for the prenatal diagnosis of intrauterine infection and the prediction of neonatal outcomes in patients with preterm labor and intact membranes. Methods: Amniocentesis was performed in 75 patients with preterm labor and intact membranes, who delivered preterm neonates within 72 hours after amniocentesis. AF WBC was determined and amniotic fluid was cultured for aerobic and anaerobic bacteria as well as mycoplasma. The relations among placental histologic findings, perinatal outcome, AF WBC count, and AF culture were examined. Student t test, Mann Whitney U test, lamda2 test, Fisher's exact test, modified t test, and logistic regression analysis were used for statistical analysis. RESULTS: Microbial invasion of the amniotic fluid was more frequent in the patients with histologic chorioamnionitis than patients without histologic chorioamnionitis (28.9% vs 5.4%, p<0.05), and patients with histologic chorioamnionitis had significantly higher amniotic fluid white blood cell counts than those patients without such lesion (median 99, range 0-3024 cells/mm3 vs median 1, range 0-180 cells/mm3, p<0.01). Amniotic fluid white blood cell count (> or = 50cell/mm3) had a sensitivity of 55.3%(21/38) and a specificity of 94.6%(35/37) for the diagnosis of histologic chorioamnionitis and a sensitivity of 47.5%(19/40) and specificity of 90.9%(30/33) for the prediction of significant neonatal morbidity (defined as neonatal sepsis, respiratory distress syndrome, pneumonia, intraventricular hemorrhage, bronchopulmonary dysplasia, or necrotizing enterocolitis). These sensitivities were significantly higher than those of amniotic fluid culture (for histologic chorioamnionitis, 55.3% vs 28.9% ; for significant neonatal morbidity, 47.5% vs 25.0%, p<0.01 for each). CONCLUSION: Amniotic fluid WBC count is a more sensitive test for the prenatal diagnosis of intrauterine infection and for the prediction of significant neonatal morbidity than amniotic fluid culture in the patients with preterm labor and intact membranes.
Amniocentesis ; Amniotic Fluid* ; Bacteria, Anaerobic ; Bronchopulmonary Dysplasia ; Chorioamnionitis ; Diagnosis ; Female ; Hemorrhage ; Humans ; Infant, Newborn ; Leukocyte Count* ; Leukocytes* ; Logistic Models ; Membranes* ; Mycoplasma ; Obstetric Labor, Premature* ; Pneumonia ; Pregnancy ; Prenatal Diagnosis* ; Sensitivity and Specificity ; Sepsis

BACKGROUND: The authors sought to determine whether a shallow needle approach to the axillary artery would improve complete sensory blocks of median, radial, and ulnar nerves as compared with a perpendicular approach when transarterial axillary block is performed using a scalp vein needle (23G, 3/4'). METHODS: Fifty-four patients were allocated equally to a perpendicular group (the PA group) or a shallow approach group (SA group). Sensory and motor scores were evaluated and compared in the two groups at 5-minute intervals for 20 minutes after block. The main outcome variables were rates of blockage of median, radial, and ulnar nerves. RESULTS: Excellent block rates (defined as completion of surgery using brachial plexus block alone) were obtained in both groups (SA group 77.8% vs. PA group 70.3%, P = 0.755). However, the rate of blockage of all three nerves was significantly higher in the SA group (74% vs. 40.7%, P = 0.013). Furthermore, the rate of complete sensory block of the radial nerve at 20 minutes was significantly greater in the SA group (85.2% vs. 59.3%, P = 0.033). CONCLUSIONS: A shallow needle approach to the axillary artery resulted in a significantly higher median, radial, and ulnar nerve block rate at 20 minutes after LA injection than a perpendicular approach.
Axillary Artery* ; Brachial Plexus Block* ; Brachial Plexus* ; Humans ; Needles* ; Radial Nerve ; Scalp ; Ulnar Nerve ; Veins

BACKGROUND: The authors sought to determine whether a shallow needle approach to the axillary artery would improve complete sensory blocks of median, radial, and ulnar nerves as compared with a perpendicular approach when transarterial axillary block is performed using a scalp vein needle (23G, 3/4'). METHODS: Fifty-four patients were allocated equally to a perpendicular group (the PA group) or a shallow approach group (SA group). Sensory and motor scores were evaluated and compared in the two groups at 5-minute intervals for 20 minutes after block. The main outcome variables were rates of blockage of median, radial, and ulnar nerves. RESULTS: Excellent block rates (defined as completion of surgery using brachial plexus block alone) were obtained in both groups (SA group 77.8% vs. PA group 70.3%, P = 0.755). However, the rate of blockage of all three nerves was significantly higher in the SA group (74% vs. 40.7%, P = 0.013). Furthermore, the rate of complete sensory block of the radial nerve at 20 minutes was significantly greater in the SA group (85.2% vs. 59.3%, P = 0.033). CONCLUSIONS: A shallow needle approach to the axillary artery resulted in a significantly higher median, radial, and ulnar nerve block rate at 20 minutes after LA injection than a perpendicular approach.
Axillary Artery* ; Brachial Plexus Block* ; Brachial Plexus* ; Humans ; Needles* ; Radial Nerve ; Scalp ; Ulnar Nerve ; Veins

PURPOSE: Deep vein thrombosis (DVT) is a serious disease which causes life-threatening pulmonary embolism and chronic venous insufficiency. In order to prevent pulmonary embolism, inferior vena cava (IVC) filter placement is commonly performed nowadays. We carried out this study to analyze the patterns of the indications for IVC filter placement, the complications associated with procedure, and the follow-up results. METHOD: We treated 42 patients with acute DVT between September 2001 and November 2002 at Gil Medical Center. Our subjects included 10 patients who underwent IVC filter placement during the same period. Duplex sonography and CT venography were performed in all cases. The filter was placed by one interventional radiologist just after checking the nonselective venography. The patients were followed monthly with a physical examination. Plain abdominal film was checked every 3 months, and CT venography every 6 months. RESULT: The mean age was 55.6 years (range 35~72) and the male-to-female ratio was 1:4. The associated diseases were advanced cancer in 3 cases, intracranial hemorrhage in 2 and spinal cord injury and ankylosis of the hip joint in 1. There were 8 cases of hypercoagulable states; 7 of protein S deficiency, 3 of protein C deficiency and 1 of antithrombin III deficiency. Indications for filter insertion were a contraindication to anticoagulation in 5 cases, recurrent pulmonary embolism in 2, floating IVC thrombosis in 2, complication of anticoagulation in 1, prophylactic use before catheter-directed thrombolysis in 1, and quadriplegia in 1. Four Greenfield filters and six TrapEase filters were used. Filters were deployed at infrarenal IVC in 8 cases and suprarenal IVC in 2 cases. There were no major complications related to the procedure. Late complications were not detected during the 7-month follow-up (range 2~16 months). CONCLUSION: We performed 10 IVC filter placements for therapeutic purpose without any serious complications. A wider range of indications, including prophylactic use, might be considered in the future practice for DVT.
Ankylosis ; Antithrombin III Deficiency ; Follow-Up Studies ; Hip Joint ; Humans ; Intracranial Hemorrhages ; Phlebography ; Physical Examination ; Protein C Deficiency ; Protein S Deficiency ; Pulmonary Embolism ; Quadriplegia ; Spinal Cord Injuries ; Thrombosis ; Vena Cava Filters* ; Vena Cava, Inferior* ; Venous Insufficiency ; Venous Thrombosis*