No abstract available.

Patients with a poor or total absence of levator function require correction of their ptosis by a sling procedure. The aim of the procedure is to utilize the action of the frontalis muscle to mechanically raise a droopy eyelid Frontalis suspension procedure using a temporalis fascia or Tutoplast Dura was performed on 36 ptotic eyelids of 23 patients(age range 2-37 years) with a poor or absent levator function. The author used a surgical technique based on a modified Fox`s method. Satisfactory results were achieved in 42 lids according to the criteria of Jordan after an average follow-up of 23 months. No serious complication was seen immediately postoperative and during the follow-up period. Temporalis fascia and Tutoplast Dura appear to be effective and safe alternative sling materials for frontalis suspension surgery.
Blepharoptosis* ; Eyelids ; Fascia ; Follow-Up Studies ; Humans ; Jordan

No abstract available.
Tibia*

No abstract available.
Diagnosis* ; Molecular Biology* ; Prognosis* ; Stomach Neoplasms*

No abstract available.
Diagnosis* ; Molecular Biology* ; Prognosis* ; Stomach Neoplasms*

Spontaneous subarachnoid hemorrhage(SAH) is a cause of high mortality and morbidity in the emergency department. Rebleeding has been well investigated, and it is now recognized that early operation can prevent rebleeding. However, ultra-early rebleeding, which may occur prior to early operation(within 24 hours after admission), worsens the clinical outcome of patients with SAH. To determine the risk factors of ultra-early rebleeding in patients with spontaneous SAH before early operation, we analyzed the cases of 383 patients admitted within 24 hours after their last attack of SAH between 1994 to 1996. In this analysis, diagnosis of rebleeding before admission was defined only if the patients experienced a definite clinical deterioration once more after an attack suggesting SAH. After admission patients who observed a sudden neurological deterioration were subject to repeat CT scanning and rebleeding was diagnosed only when new hemorrhage was observed on the CT scan in comparison with the previous scan. 45 cases(11.7%) of 383 patients had ultra-early rebleeding. The incidence of ultra-early rebleeding significantly increased in the patients who admitted hospital within 2 hours after attack. The incidence of ultra-early rebleeding also increased in the old-age group(70 years or more), patients with high systolic blood pressure, those who underwent angiography within 6 hours of the last SAH, and patients who had poor neurological condition.
Angiography ; Blood Pressure ; Diagnosis ; Emergency Service, Hospital ; Hemorrhage* ; Humans ; Incidence ; Mortality ; Risk Factors* ; Tomography, X-Ray Computed

BACKGROUND: Headache is a common symptom. It has not proved useful methods that the physician evaluated the alert patient who had headache. It needs the presence of predictors of intracranial pathology(ICP) which serves as influential factors in the indication of evaluation and hospitalization of patients. METHOD: So, in order to identify such factors, patient records were retrospectively analysed. 168 patients with the chief complaint of headache presented to the Emergency Department of Chonnam University Hospital during the period from January 1, 1995 to December 31, 1997. All were in an alert mental state and had no evidence of trauma and intoxication. RESULTS: 14 cases(8.3% revealed ICP. 41 cases(24.4% revealed systemic disease. The remainder of cases were divided among unclassified headaches(61 cases, 36.3%, tension headaches(30 cases, 17.9%, and migraine(22 cases, 13.1%. Comparison of ICP-positive and ICP-positive cases revealed that ICP-Positive Patients could be categorized by the following findings: (1) Presence of the focal sign through neurological examination, (2) age greater than 55 years, (3) presence of associated symptoms, (4) acute headache. These four manifestations were proven to be statistically significant as predictors of ICP. CONCLUSION: Although the positive predictive value of the above criteria is not perfect for the prediction of ICP, they are worthy of clinical consideration in alert patients presenting with headache.
Emergencies* ; Emergency Service, Hospital* ; Headache* ; Hospitalization* ; Humans ; Jeollanam-do ; Neurologic Examination ; Retrospective Studies

BACKGROUND: Although diagnostic peritoneal lavage (DPL) is a well-established, reliably objective method of diagnosis of intraperitoneal injury, it is too sensitive to be used as a absolute indicator for emergency laparotomy. Recently, Otomo et al, have devised a new DPL criteria specifically designed and modified the classics criteria to aid in diagnosis of intestinal injury. So the author studied the difference of diagnostic sensitivity, specificity, and accuracy between the new and classic criteria for intestinal injury. METHODS: The author reviewed retrospectively one hundred fifteen patients underwent DPL from January 1993 to August 1999. The author adopted the classic criteria positive for intestinal injury when the lavage fluid was white blood cell(WBC) > or = 500/mm3 and newly developed supplementary criteria positive when RBC > or = 100,000/mm3, the positive-negative borderline was adjusted to WBC > or = RBC/150, and when RBC <100,000/mm3, to WBC > or = 500/mm3. And analyzed the difference of sensitivity, specificity, and accuracy each other. RESULTS: Among 115 patients, the sensitivity, specificity, and accuracy for intestinal injury were 96.4%, 87.4%, and 89.6% for the new criteria, and 100%, 42.5%, and 56.5% for the classic criteria. After exclusion of 10 patients in whom-DPL was performed within 3 hours or after 18 hours from the time of injury, the sensitivity, specificity and accuracy for intestinal injury were 96.4%, 97.4%, and 97.1% for the new criteria, and 100%, 46.8%, and 61% for the classic criteria. When analyzed the time interval from injury to DPL in the new criteria, 105 patients that DPL was performed between 3 to 18 hours had 2 false-positive, while 115 patients regardless of DPL time 11 false-positive. CONCLUSIONS : The author concluded that the new criteria of DPL effluent performed between 3 to 18 hours from abdominal blunt trauma would be more specific and accurate indicator of intestinal perforation than the classic criteria. And this new criteria will be used as a reliable indicator for emergency laparotomy for that patients.
Diagnosis ; Emergencies ; Humans ; Intestinal Perforation ; Laparotomy ; Peritoneal Lavage* ; Retrospective Studies ; Sensitivity and Specificity ; Therapeutic Irrigation

A standardized approch to serious head injury employing immediate CT scanning and aggressive medical and surgical therapy has improved outcomes in cases of intracranial lesions. Unfortunately, there is less agreement on how patients with mild head injury should be handled when first seen in an emergency department setting. The ideal policy in mild head injury would be diagnosis or rule-out intracranial lesions as quickly as possible. We reviewed the records of 126 mild head injury patients admitted during 6-month period to the Chonnam University Hospital to identify a group of mild head injury patients having lesions on brain CT scanning and to investigate the risk factors affecting abnormal lesions on brain CT scanning. All patients had alert mental status without neurological deficit and signs of skull fracture. Routine brain CT scans were obtained on all patients. Fifteen patients(12%) had 17 lesions on brain CT scans. Three patients needed surgery for their intracranial lesions. The initial Glasgow Coma Scale(GCS) was 15 in 107 patients and 14 in 19 patients. The incidence of abnormal brain CT lesions for each GCS was 9% in 15 and 26% in 14. The common symptoms of patients who had abnormal brain CT lesions was headache in 7(47%) cases, loss of consciousness in 7(47%) cases, amnesia in 4(27%) cases, dizziness in 4(27%) cases, vomiting in 3(20%) cases, and lethargy in 3(20%) cases. These data suggest that early brain CT scanning is necessary in alert patients who have GCS in 14, headache loss of consciousness, amnesia, dizziness, vomiting, or lethargy following mild head injury.
Amnesia ; Brain* ; Coma ; Craniocerebral Trauma* ; Diagnosis ; Dizziness ; Emergency Service, Hospital ; Head* ; Headache ; Humans ; Incidence ; Jeollanam-do ; Lethargy ; Risk Factors ; Skull Fractures ; Tomography, X-Ray Computed* ; Unconsciousness ; Vomiting

PURPOSE: Since the discovery of estrogen receptor-beta(ER-beta, five C-terminal variants of ER-beta were identified. We designed this study to investigate the pattern and clinical implications of ER-betaand its splicing variants expression in normal and malignant mammary tissues. METHODS: Using reverse transcription polymerase chain reaction (RT-PCR), we examined the expression levels of ER-alpha and ER-betaand its five splicing variants (beta1, beta2, beta3, beta4, beta5) in 50 paired normal and cancer tissues. We measured the densities of RT-PCR products using Tina version 2.10 (Raytest, Germany). Firstly, the incidence and intensity of ER-alpha and ER-beta and its five splicing variants were compared. Then the expression of ER-betamRNA splicing variants was also analyzed with regard to the ER-alphaprotein expression measured by immuno-histochemical staining and the menopausal status of the patients. Chi-square test and paired samples t-test were used for statistical analysis. Differences were considered to be significant with a p-value of less than 0.05. RESULTS: The expression of ER-betamRNA variants in normal breast and cancer tissues were as follows: ER-beta2 (100%/100%), ER-beta4 (76%/74%), ER-beta5 (32%/58%), and ER-beta1 (14%/16%). ER-beta3 was not detected at all. In terms of intensity, we observed a significant decrease of ER-beta2 (P<0.001) and an increase of ER-beta5 (P=0.004) in the mRNA expression levels among breast cancers compared to the corresponding normal breast tissues. Compared to the corresponding normal tissues, a significant decrease of ER-beta2 in cancer tissues was observed in patients with ER-alpha-positive (P<0.001), with age over 50 (P=0.01), and under 50 (P=0.04) as well, but not in patients with ER-alpha-negative (P=0.48). ER-beta4 also significantly decreased in patients with ER-alpha-positive (P=0.004) and with age over 50 (P=0.07). ER-beta5 showed a significant increment only in patient aged over 50 (P=0.04). CONCLUSION: ER-alpha mRNA expression significantly increases but ER-beta mRNA expression decreases in the cancer tissues compared to the corresponding normal tissues. Among ER-beta variant forms, ER-beta2 is predominant in both normal and malignant mammary tissues and ER-beta4, ER-beta5, and ER-beta1 in descending order but ER-beta3 does not express in mammary tissues. The decrease of ER-beta2 and ER-beta4 expression is prominent in cancer tissue especially in ER-alpha-positive cancers, which suggests that ER-beta2 and ER-beta4 may possess a regulatory function in mammary carcinogenesis. Further investigations to verify the roles of ER-beta variants are mandatory.
Breast ; Breast Neoplasms ; Carcinogenesis ; Estrogens* ; Humans ; Incidence ; Polymerase Chain Reaction ; Receptors, Estrogen ; Reverse Transcription ; RNA, Messenger