The purpose of this paper was to report a successful treatment of transluminal Nd:YAG laser embolysis (NYE) for branch retinal artery occlusion (BRAO) with visible emboli. Two patients with acute, severe vision loss secondary to a branch retinal artery occlusion with visible emboli in one eye underwent NYE. A complete ocular examination was performed which included biomicroscopy of the posterior pole of the retina, intraocular pressure measurement, fundus color photographs, and fluorescein angiography (FA). After the NYE, the two patients showed dramatic improvements in best-corrected visual acuity, as well as, immediate and dramatic restorations in flow past the obstructed arteriole in FA. NYE is a treatment modality to be considered in patients with BRAO who present acutely with severe vision loss and a visible embolus.
Aged ; Aged, 80 and over ; Female ; Fluorescein Angiography ; Follow-Up Studies ; Fundus Oculi ; Humans ; Laser Coagulation/*methods ; Lasers, Solid-State/*therapeutic use ; Microscopy, Acoustic ; Retinal Artery Occlusion/diagnosis/*surgery ; Thrombectomy/*methods ; Visual Acuity

OBJECTIVE: Our purpose was to determine normal amniotic fluid alpha-fetoprotein level in midtrimester Korean pregnant women whose neonatal outcomes were normal. METHODS: Amniotic fluid alpha-fetoprotein(AFAFP) levels were measured by specific radioimmunoassay (RIA) in midtrimester pregnant women for various indications of amniocentesis from May 1992 to July 1999 at Seoul National University Hospital. Normal ranges were obtained from 640 singleton pregnancies in which neonatal outcomes were normal. RESULTS: Median values of AFAFP in Korean pregnant women were 13,250ng/mL, 12,900ng/mL, 11,150ng/mL, 9,430ng/mL, 8,019ng/mL, 6,800ng/mL, 5,850ng/mL, 5,750ng/mL, 5,210ng/mL, 3,420ng/mL at 15 week, 16 week, 17 week, 18 week, 19 week, 20 week, 21 week, 22 week, 23 week, 24 week, respectively. CONCLUSION: This determination of the median values and the normal range of AFAFP level by each gestational week in uncomplicated Korean women could be used reference values for prenatal diagnosis of various disorders like open neural tube defect.
alpha-Fetoproteins* ; Amniocentesis ; Amniotic Fluid* ; Female ; Humans ; Neural Tube Defects ; Pregnancy ; Pregnancy Trimester, Second* ; Pregnant Women* ; Prenatal Diagnosis ; Radioimmunoassay ; Reference Values* ; Seoul

No abstract available.
Humans ; Pregnancy* ; Prognosis* ; Takayasu Arteritis*

An association between choledochal cyst and carcinoma is well established. Here, we report an extremely rare case of undifferentiated carcinoma exhibiting extensive sarcomatous features arising in a choledochal cyst. The patient in our case had a radiologically confirmed choledochal cyst and anomalous pancreaticobiliary ductal union, and mild wall thickening in the cyst was observed on endoscopic retrograde cholangiopancreatography. The patient underwent common bile duct excision and cholecystectomy. In the choledochal cyst, a nodule measuring 1.5x1 cm was detected. The lesion was composed of atypical, spindle-shaped and large, round pleomorphic tumor cells simulating sarcoma. Neither glandular nor squamous differentiation was observed. These cells were immunoreactive for both vimentin and cytokeratin by immunohistochemistry. These histologic and immunohistochemical findings were consistent with undifferentiated carcinoma, spindle and giant cell type, according to the WHO classification.
Carcinoma* ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy ; Choledochal Cyst* ; Classification ; Common Bile Duct ; Giant Cells ; Humans ; Immunohistochemistry ; Keratins ; Sarcoma ; Vimentin

PURPOSE: The mechanism of scar formation is not fully understood. Fibroblast is an important cell in wound healing process. We experienced a patient who was taking progesterone orally. Upper blepharoplasty was performed on her but, wound healing was delayed. We hypothesized that progesterone was the cause of delayed wound healing and fibroblast proliferation inhibition. We investigated the effect of progesterone in vitro on human dermal fibroblasts to study the effects on fibroblast proliferation. METHODS: Human dermal fibroblasts from four persons were cultured initially. Progesterone is mixed to them at various concentrations, and fibroblast cell count was measured by MTT assay method at 570nm. We confirmed that progesterone has some inhibitory effect on fibroblast proliferation and maximal inhibitory concentration of progesterone was determined. Then fibroblasts from a total of nineteen persons were cultured and the effects of progesterone were studied. RESULTS: The initial study showed the maximal inhibitory concentration of progesterone to be 50 microgram/ml. The main study showed that progesterone had 70.9% inhibitory effect on human dermal fibroblast in vitro. CONCLUSION: Progesterone has inhibitory effect on cultured human dermal fibroblast proliferation in vitro.
Blepharoplasty ; Cell Count ; Cicatrix ; Fibroblasts* ; Humans* ; Progesterone* ; Wound Healing

PURPOSE: The aim of this study was to determine whether crossed cerebellar hyperperfusion (CCH) was helpful in discriminating mesial from lateral temporal lobe epilepsy (TLE) and what other factors were related in the development of CCH on ictal brain SPECT. MATERALS AND METHODS: We conducted retrospective analysis in 59 patients with TLE (M:41, F:18; 27.4+/-7.8 years old; mesial TLE: 51, lateral TLE: 8), which was confirmed by invasive EEG and surgical outcome (Engel class I , II). All the patients underwent ictal Tc-99m HMPAO brain SPECT and their injection time from ictal EEG onset on video EEG monitoring ranged from 11 sec to 75 sec (32.6+/-19.5 sec) in 39 patients. Multiple factors including age, TLE subtype (mesial TLE or lateral TLE), propagation pattern (hyperperfusion localized to temporal lobes, spread to adjacent lobes or contralateral hemisphere) and injection time were evaluated for their relationship with CCH using multiple logistic regression analysis RESULTS: CCH was observed in 18 among 59 patients. CCH developed in 29% (15/51) of mesial TLE patients and 38% (3/8) of lateral TLE patients. CCH was associated with propagation pattern; no CCH (0/13) in patients with hyperperfusion localized to temporal lobe, 30% (7/23) in patients with propagation to adjacent lobes, 48% (11/23) to contralateral hemisphere. Multiple logistic regression analysis revealed that propagation pattern (p=0.01) and age (p=0.02) were related to the development of CCH. CONCLUSION: Crossed cerebellar hyperperfusio ictal brain SPECT did not help differentiate mesial from lateral temporal lobe epilepsy. Crossed cerebellar hyperperfusion was associated with propagation pattern of temporal lobe epilepsy and age.
Brain* ; Electroencephalography ; Epilepsy ; Epilepsy, Temporal Lobe* ; Humans ; Logistic Models ; Retrospective Studies ; Technetium Tc 99m Exametazime* ; Temporal Lobe* ; Tomography, Emission-Computed, Single-Photon*

OBJECTIVE: We undertook this study to find out general characteristics of hypertensive disorder in pregnancy and to clarify whether polymorphic marker of promoter region of angiotensinogen G(-6)A polymorphism is associated with the development of hypertensive disorder in pregnancy. METHODS: From August 1998 to March 2002, we recruited 230 pregnant women complicated by hypertension in pregnancy. Retrospective chart review was done. They were assigned to each group according to a new classification. Hypertensive groups were divided into two groups: high blood pressure group (High) was defined as having diastolic blood pressure (DBP) higher than 110 mmHg and low blood pressure group (Low) as having DBP lower than 110 mmHg. Maternal blood was collected and DNA was extracted from 161 normotensive and 200 hypertensive Korean pregnant women. Genomic DNA was prepared and the relevant genomic region was amplified using polymerase chain reaction (PCR). PCR products were digested with the restriction enzyme, Mva I, size fractionated on 3% agarose gels containing ethidium bromide. RESULTS: Family history of hypertension was more common in women with chronic hypertension or superimposed preeclampsia than in women with transient hypertension or preeclampsia (p<0.05). No significant difference in genotype distribution was found between diagnostic groups and control. However, among hypertensive disorder in pregnancy, high blood pressure group had AA genotype more frequently than low blood pressure group (p<0.05). CONCLUSION: Family history is more common in women with underlying hypertension. Angiotensinogen AA genotype may be associated with high blood pressure level in hypertensive disorder in pregnancy.
Angiotensinogen* ; Blood Pressure ; Classification ; DNA ; Ethidium ; Female ; Gels ; Genotype ; Humans* ; Hypertension ; Hypotension ; Polymerase Chain Reaction ; Pre-Eclampsia ; Pregnancy* ; Pregnant Women ; Promoter Regions, Genetic ; Retrospective Studies ; Sepharose

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

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

This study was performed to assess the usefulness of magnetoencephalography (MEG) as a presurgical evaluation modality in Korean pediatric patients with lesional localization-related epilepsy. The medical records and MEG findings of 13 pediatric patients (6 boys and 7 girls) with localization-related epilepsy, who underwent epilepsy surgery at Seoul National University Children's Hospital, were retrospectively reviewed. The hemispheric concordance rate was 100% (13/13 patients). The lobar or regional concordance rate was 77% (10/13 patients). In most cases, the MEG spike sources were clustered in the proximity of the lesion, either at one side of the margin (nine patients) or around the lesion (one patient); clustered spike sources were distant from the lesion in one patient. Among the patients with clustered spike sources near the lesion, further extensions (three patients) and distal scatters (three patients) were also observed. MEG spike sources were well lateralized and localized even in two patients without focal epileptiform discharges in the interictal scalp electroencephalography. Ten patients (77%) achieved Engel class I postsurgical seizure outcome. It is suggested that MEG is a safe and useful presurgical evaluation modality in pediatric patients with lesion localization-related epilepsy.
Adolescent ; Brain/radionuclide imaging ; Brain Diseases/pathology ; Child ; Child, Preschool ; Epilepsies, Partial/pathology/*surgery ; Female ; Ganglioglioma/pathology ; Humans ; Infant ; Magnetic Resonance Imaging ; *Magnetoencephalography ; Male ; Malformations of Cortical Development/pathology ; Neoplasms, Neuroepithelial/pathology ; Positron-Emission Tomography ; Retrospective Studies ; Seizures/diagnosis