PURPOSE: To assess the accuracy of estimating postoperative deviation in large-angle exotropia over 40 prism diopters (PD). METHODS: A retrospective analysis was performed on 61 exotropia patients with over 40 PD exotropia who had undergone 2-muscle surgery by two surgeons and with at least 6 months follow-up. The accuracy was assessed by analyzing the discrepancy between preoperatively predicted residual deviation and deviation at postoperative 6weeks. Successful surgery was defined as deviation within +/- 10 PD at the last postoperative visit. RESULTS: More accurate residual deviation was predicted in exotropia with prism diopters between 40 and 59 (97.8%) than in exotropia with 60 PD or more (62.5%). And there was no significant difference between two surgeons. Surgical success rates at six months and one year after surgery were 96.8%, 94.7% in exotropia with 40 to 49 PD, 71.4%, 60.0%, 50 to 59 PD, 50.0%, 45.5%, 60 PD or more, respectively. There were four patients of whom the postoperative deviation angle exceeded more than 10 PD of the estimated deviation. CONCLUSIONS: The accuracy of estimating residual deviation prior to surgery was higher and more successful surgery was achieved in exotropia ranging in 40 to 59 PD than in exotropia with 60 PD or more. Therefore, 2- muscle surgery will be suitable for large-angle exotropia with less than 60 PD.
Exotropia ; Follow-Up Studies ; Humans ; Muscles ; Retrospective Studies

OBJECTIVES: The purpose of this study was to observe the changes of lipid levels during 4 years of hormone replacement therapy (HRT) in postmenopausal women. We also tried to determine whether lipid changes were different according to the treatment regimen and baseline lipid values. METHODS: A total of 108 postmenopausal women were treated with cyclic combined HRT (n=60), continuous combined HRT (n=19), and conjugate estrogen (n=29) alone. Serum total cholesterol, HDL-cholesterol, LDL-cholesterol and triglyceride were measured before and after HRT every year. RESULTS: After 4 years of HRT, HDL-cholesterol level raised significantly (10.1%, p=0.001), but total cholesterol and LDL-cholesterol levels were not changed (1,1%, -0.1%). Triglyceride level significantly raised at first year (22.2%, p=0.001) and maintained over three year, but the level became similar to the baseline value at fourth year. The changing patterns of HDL-cholesterol, LDL-cholesterol and triglyceride were not different among cyclic HRT, continuous HRT and estrogen alone treatment group but total cholesterol levels at fourth year were significantly different according to the treatment regimen (-12.7% in continuous HRT, -0.3% in estrogen alone, and 7.3% in cyclic HRT, p=0.02). HRT had more favorable effect in women with baseline hypercholesterolemia compared to women with baseline normocholesterolemia since the reducing effects on total-cholesterol and LDL-cholesterol and the raising effect on HDL-cholesterol were greater. CONCLUSION: Postmenopausal HRT had a more beneficial effect on lipid profile in women with Hypercholesterolemia. This finding may suggest that those women could be the best candidates for HRT.
Cholesterol ; Estrogens ; Female ; Follow-Up Studies* ; Hormone Replacement Therapy* ; Humans ; Hypercholesterolemia ; Triglycerides

Natriuretic peptides comprise a family of three structurally related peptides; atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), and C-type natriuretic peptide (CNP). The present study was performed to investigate the effect of ANP on the proliferation and activity of ROS17/2.8 and HOS cells which are well-characterized osteoblastic cell lines. ANP dose-dependently decreased the number of ROS17/2.8 and HOS cells after 48-hour treatment. ANP generally increased the alkaline phosphatase activity of ROS17/2.8 and HOS cells after 48 hr treatment, regardless of the fact that basal activity of alkaline phosphatase was much lower in HOS cells compared to that of ROS17/1.8 cells. ANP increased the NBT reduction by ROS17/2.8 and HOS cells. ANP showed the variable but no significant effect on the nitric oxide production by ROS17/2.8 and HOS cells. ROS17/2.8 and HOS cells produced and secreted gelatinase into culture medium, and this enzyme was thought to be the gelatinase A type with the molecular weight determination. The gelatinase activity produced by ROS17/2.8 cells was increased by the treatment of ANP. However, the enzyme activity was not affected by ANP treatment in the HOS cell culture. In summary, ANP decreased the proliferation and increased the alkaline phosphatase activity and NBT reduction of osteoblasts. These results indicate that ANP is one of the important regulators of bone metabolism.
Alkaline Phosphatase ; Atrial Natriuretic Factor ; Cell Culture Techniques ; Cell Line ; Gelatinases ; Humans ; Matrix Metalloproteinase 2 ; Metabolism ; Molecular Weight ; Natriuretic Peptide, Brain ; Natriuretic Peptide, C-Type ; Natriuretic Peptides ; Nitric Oxide ; Osteoblasts* ; Peptides

Adenomas of the major duodenal papilla are rare but clinically important since they are a premalignant condition. Endoscopic mucosal resection has emerged as the first line therary for ampullary adenoma. However, various complications such as pancreatitis, bleeding or duodenal perforation have been reported after endoscopic mucosal resection. To our knowledge, cholangitis has not been reported as a complication of the procedure in the literature. We report a case of papillary stenosis and cholangitis caused by endoscopic mucosal resection of ampullary adenoma. We performed the endoscopic biliary spincterotomy followed by biliary stenting and cholangitis was successfully controlled.
Adenoma* ; Ampulla of Vater ; Cholangitis* ; Constriction, Pathologic* ; Hemorrhage ; Pancreatitis ; Stents

Adenomas of the major duodenal papilla are rare but clinically important since they are a premalignant condition. Endoscopic mucosal resection has emerged as the first line therary for ampullary adenoma. However, various complications such as pancreatitis, bleeding or duodenal perforation have been reported after endoscopic mucosal resection. To our knowledge, cholangitis has not been reported as a complication of the procedure in the literature. We report a case of papillary stenosis and cholangitis caused by endoscopic mucosal resection of ampullary adenoma. We performed the endoscopic biliary spincterotomy followed by biliary stenting and cholangitis was successfully controlled.
Adenoma* ; Ampulla of Vater ; Cholangitis* ; Constriction, Pathologic* ; Hemorrhage ; Pancreatitis ; Stents

BACKGROUND/AIMS: Dieulafoy lesions are an important cause of upper gastrointestinal bleeding. The purpose of this study was to assess the efficacy of endoscopic treatment for these lesions and to identify the possible predictive factors for rebleeding associated with clinical and endoscopic characteristics. METHODS: Records from 44 patients admitted with Dieulafoy bleeding between January 2006 and December 2007 were reviewed. We retrospectively analyzed the clinical and endoscopic findings and then correlated the rebleeding risk factors with Dieulafoy lesions. RESULTS: Primary hemostasis was achieved by endoscopic treatment in 39 patients (88.6%). There were no significant differences between the rebleeding and non-rebleeding groups with respect to age, gender, initial hemoglobin levels, presence of shock, concurrent disease, location of bleeding, or initial hemostatic treatment methods. However, the use of non-steroidal anti-inflammatory drugs or anticoagulants (p=0.02) and active stages in the Forrest classification (p<0.01) were risk factors for rebleeding after endoscopic therapy. CONCLUSIONS: Endoscopic therapy is effective and safe for treating Dieulafoy lesions, and it has both short- and long-term benefits. Early identification of risk factors such as the use of non-steroidal anti-inflammatory drugs or anticoagulants and the Forrest classification of bleeding predict the outcome of Dieulafoy lesions.
Adult ; Aged ; Arteriovenous Malformations/complications/*therapy ; Female ; Gastrointestinal Hemorrhage/etiology/*therapy ; Hemostasis, Endoscopic/*methods ; Humans ; Male ; Middle Aged ; Recurrence ; Risk Factors