The preoperative diagnosis of the masked bilateral superior oblique palsy (SOP) is very diffcult, so the clinical manifestation is very important. We studied to determine diagonostic criteria of the masked bilateral SOP. Among 24 patients. who were diagnosed as unilateral SOP preoperatively, 5 patients developed postoperative masked bilateral SOP. 2 patients had been diagnosed masked bilateral SOP preoperatively. We compared 17 cases of unilateral SOP with seven cases of masked bilateral SOP about V-shift, head tilt test and the degree of excyclotorsion. The mean V-shift of the masked SOP patients was 5.3PD and that of the unilateral SOP patients was 1.5PD(p=0.09). The mean excyclotosion difference between the primary position and downgaze was 9.7 degree in masked cases and 2.6 degree in unilateral ones respectively (p=0.35). The mean difference of hyperdeviation the right versus the left tilted head position was 22PD in masked cases and 18.1PD in unilateral ones (p=0.35). The cases of excyclotorsion difference over 5 degrees between primary and downgaze were five(71%) in masked cases but none in unilateral cases(p=0.0001). So above finding may be strongly suggested as diagnosing the masked bilteral SOP.
Diagnosis* ; Head ; Humans ; Masks* ; Paralysis*

BACKGROUND: There has been a lot of changes in prehospital medical environment with development of EMSS(emergency medical service systems). Especially in out-of-hospital cardiac arrest, the patients could survive when they are moved to the hospitals earlier. The purpose of this research is to know the status of EMSS in Korea by analyzing CPR(cardiopulmonary resuscitation) outcomes of out-of-hospital cardiac arrest patients at 3 hospital in the western area of Seoul and Incheon. METHODS: From July 1997 to June 1998, we collected data about out-of-hospital cardiac arrest victims at Ewha Womens University Mokdong Hospital, Catholic University Medical College St. Mary Hospital, and Kachon University Chung Ang Gil Hospital. We used same record form based on the 'Utstein Style'. RESULTS: CPR were performed in 265 out-of-hospital cardiac arrest patients at 3 hospitals. One hundred twelve(42.3%) patients recovered the spontaneous circulation at least once and eight(3.0%) patients discharged alive. One hundred ninety four(73.2%) patients died of medical causes, one hundred two(38.5%) cardiogenic and ninety two(34.7%) non-cardiogenic, and seventy(26.4%) patients died of traumatic causes. Initial EKG showed VT/VF(ventricular tachycardia/ventricular fibrillation) in thirty one(11.7%) patients, asystole in one hundred fifty one(57.0%) patients and other rhythms in eighty three(31.3%) patients. Among one hundred two cardiogenic cardiac arrest patients, two(2.0%) patients was discharged alive. CONCLUSION: Overall survival rate of out-of-hospital cardiac angst patients was 3% which was poorer than that of the western country. The proportion of the cardiogenic cause was 3% which was only hart of the western country. VT/VF is relatively not common as a initial EKG rhythm. These differences might be due to difference in the prevalence pattern of out-of-hospital cardiac arrest as well as prematurity of the EMSS.
Cardiopulmonary Resuscitation ; Electrocardiography ; Female ; Heart Arrest ; Humans ; Incheon ; Korea ; Out-of-Hospital Cardiac Arrest* ; Prevalence ; Seoul ; Survival Rate

BACKGROUND: Urography(IVU) is considered the best first investigation in patient with suspected urinary calculi, but recently ultrasonography(USG), combined with a plain film of the abdomen, has been suggested as an alternative. METHODS: We undertaken study to see if this approch can be used in emergency patients and outpatients by radiologists with different amounts of ultrasound experence. Some 192 patients with suspected urinary colic presenting to Koo Hospital Emergency Department and Youngnam Universith Hospital outward Department(IM, URO, FM) over 12-month period were studied. They had a plain abdominal film(KUB) and USG examination of the kidney, ureter, bladder following hydration and subsequently underwent IVU. Of these, 22 patients passed a stone before their IVU. The data analysis was performed on the remaining 170 patients. Urography was used as the gold standard. RESULTS: Some 170 patients subsequently underwent IVU at a mean interval of 1.8 days after the ultrasound examination. In 91 of 170 patients the IVU was positive. In 97 of 170 patients the combination of JUB plus USG was positive, leaving three false negative KUB plus USG. Thus the sensitivity of KUB plus USG was 97%, specificity was 89%, positive predictive value was 91%, and negative predictive value was 96%. CONCLUSIONS: Our findings in this study suggest that in the hydrated patient the combination of KUB plus US is a very sensitive and relative specific screening test. Because of the high negative predictive value of KUB plus US, urography is not likely to be helpful when KUB plus US are negative. Urography is indicated only if KUB plus US findings are equivocal or if intervention is necessa.ry.
Abdomen ; Colic ; Emergencies ; Emergency Service, Hospital ; Humans ; Kidney ; Mass Screening ; Outpatients ; Sensitivity and Specificity ; Statistics as Topic ; Ultrasonography* ; Ureter ; Urinary Bladder ; Urinary Calculi* ; Urography*

We studied the success rate of bilateral 7mm medical rectus recession for 24 patients with large angle congenital esotropia through long-term follow-up. The success rate was 100%(24/24) at immediate postoperative period, 83.3%(20/24) at postoperative 6 months, 79.1%(19/24) at postoperative 1 year, 64.1%(9/14) at postoperative 18 months and 54.5% (6/11) at postoperative 2 years. Residual esotropia rate was 0%(0/24) at immediate postoperative period, 16.6%(4/24) at postoperative 6 months, 16..6%(4/24) at postoperative 1 year, 14.2%(2/14) at postoperative 18 months and 18.1%(2/11) at postoperative 2 years. Consecutive exotropia rate was 0%(0/24) at immediate postoperative period, 0%(0/24) at postoperative 6 months, 4.1 %(1/24) at postoperative 1 year, 21.4%(3/14) at postoperative 18 months and 27.2%(3/11) at postoperative 2 years. Residual esotropia may develop before 6 months and consecutive exotropia after 1 year postoperatively.
Esotropia* ; Exotropia ; Follow-Up Studies ; Humans ; Muscles* ; Postoperative Period

In third nerve palsy, the functions in the four of the six extraocular muscles are compromised and its treatment is the most difficult problem in the paralytic strabismus. In surgical method, large recession and resection of horizontal rectus muscles, lateral rectus muscle transposition to medial rectus muscle and superior oblique muscle transposition are used for strabismus surgery on oculomotor nerve palsied eye. We compared the results of two methods of surgical correction. In three eyes, lateral muscle transpositions to medial rectus muscle were performed. On the last follow up examination (men; 6.7 months), two eyes resulted in severe hypertropia and unacceptable ocular alignment and no improvement of limited adduction. In six eyes of whom superior oblique muscle transpositions were performed, all resulted in acceptable ocular alignment, no hypertropia, and the limitations of adduction were improved markedly. Therefore, in the treatment of third nerve palsy, sperior oblique muscle transposition is more effective than lareral rectus muscle transposition to medial rectus muscle.
Exotropia* ; Follow-Up Studies ; Muscles ; Oculomotor Nerve Diseases* ; Oculomotor Nerve* ; Strabismus

We have experienced a case of occult hepatocellular carcinoma metastasized to the heart in a 41 year old female. The hepatocellular carcinoma invaded the hepatic vein, grew in a snakelike fashion up the inferior vena cava and reached the right atrium. Ultrastural examination in this case confirmed the hepatocellular origin of the tumor.
Female ; Humans ; Carcinoma, Hepatocellular

No abstract available.
Endocrine Cells* ; Immunohistochemistry* ; Sciuridae*

The distributions and morphological characteristics of neurons displaying immunoreactivity to the catecholamine synthetic enzymes, tyrosine hydroxylase[TH], dopamine-beta-hydroxylase[DBH], and phenyletha-nolamine-N-methyltransferase[PNMT] were examined in the adjacent sections of the diencephalon of the striped field mouse [Apodemus agrarius coreae].Only TH-, and no DBH- or PNMT-immunoreactive neurons were found in the diencephalon. In the preoptic area, TH-immunoreactive neurons were found in the anterior preoptic nucleus of Loo[APN], periventricular preoptic nucleus, medial preoptic nucleus, lateral preoptic nucleus and suprachiasmatic nucleus. In the hypothalamus, TH-immunoreactive neurons were found in theparaventricular hypothalamic nucleus, periventricular gray, retrochiasmatic area,anterior hypothalamic nucleus of anterior hypothalamic area and retrochiasmatic region of the hypothalamus. In the rostral tuberal region of the hypothalamus, TH-immunoreactive neurons were found in the paraventricular nucleus, periventricular gray and arcuate nucleus. In the midtuberal region of the hypothalamus, TH-immunoreactive neurons were found in the paraventricular nucleus, dorsomedial hypothalamic nucleus, zona incerta and arcuate nucleus. In the caudal tuberal region of the hypothalamus, dorsal hypothalamic nucleus, posterior hypothalamic complex and arcuate nucleus.
Animals ; Anterior Hypothalamic Nucleus ; Arcuate Nucleus ; Diencephalon* ; Dopaminergic Neurons* ; Dorsomedial Hypothalamic Nucleus ; Hypothalamus ; Immunohistochemistry ; Mice ; Neurons ; Paraventricular Hypothalamic Nucleus ; Preoptic Area ; Subthalamus ; Suprachiasmatic Nucleus ; Tyrosine

No abstract available.
Immunohistochemistry* ; Sciuridae*

OBJECTIVE:To evaluate the biodurability of the covering material in retrievable metallic stents covered with polycarbonate polyurethane. MATERIALS AND METHODS: Using a peristaltic pump at a constant rate of 1ml/min, bile was recirculated from a reservoir through a long tube containing four stents. Each of these was removed from the system every two weeks and a radial tensile strength test and scanning electron microscopy (SEM) were performed. Each stent, removed at 2, 4, 6 and 8 weeks, was compared with a control stent not exposed to bile juice. RESULTS: Gross examination showed that stents were intact at 2 weeks, but at 4, 6 and 8 weeks cracks were observed. The size of these increased gradually in accordance with the duration of exposure, and at 8 weeks several large holes in the polyurethane membrane were evident. With regard to radial tensile strength, extension and peak load at break were 84.47% and 10.030 N/mm, 54.90% and 6.769 N/mm, 16.55% and 2.452 N/mm, 11.21% and 1.373 N/mm at 0, 2, 4 and 6 weeks, respectively. Scanning electron microscopy at 2 weeks revealed intermittent pitting and cracking, and examination at 4, 6 and 8 weeks showed that the size of these defects was gradually increasing. CONCLUSION: When the polyurethane membrane was exposed to bile, biodegradation was first observed at week two and increased gradually according to the duration of exposure.
Bile Acids and Salts/physiology ; Biodegradation ; Hydrogen-Ion Concentration ; Microscopy, Electron, Scanning/*instrumentation ; Phantoms, Imaging ; *Polyurethanes ; *Stents ; Support, Non-U.S. Gov't ; Tensile Strength ; Time Factors