The effect of 0.25% and 0.5% Timolol on intraocular pressure and concentration in aqueous humor was studied after topical instillation in the white rabbit. The intraocular pressure was measured with pneuma tonometer and the Timolol concentration in aqueous humor was measured with High Preformance Liquid Chromatograph after fine needle aspiration of aqueous humor at various time intervals. The results were as follows; 1. The percentage reduction of intraocular pressure increased with time and reached a peak after 3 hours. 2. The concentration of Timolol in aqueous humor increased with time and reached a peak after 3 hours. 3. There was close correlation between intraocular pressure and Timolol concentration in aqueous humor.
Aqueous Humor* ; Biopsy, Fine-Needle ; Intraocular Pressure* ; Timolol*

No abstract available.
Chancre ; Lip

Primary malignant melanornn of the vagina is rare, with only about 130 reported cases worldwide. They presumably arise from melanocytes that are present in the vagina in 3% of normal wornen. Vaginal melanoma accounts for less than 1% of melanomas and less than 3% of primary malignant tumors of the vagina. Most of patients complain vaginal bleeding, vaginal discharge, foreign body sensation in order. The best treatment of vaginal melanoma rernains eni.gmatic, Many authors indicate that radical surgery may be the pcferred approach and the number of reported cases treated with radical surgery is increasing. But other author comment that no significant change in survival is apparent with radical surgery. Overall prognosis is poor as most patients have deeply penetrating lesions at the time of diagnosis. Recently, not only the effort to increase the survival rate but the quality of life including sexual function after treatment is becoming an important issue about treatment ot cancer patients. We experienced a case of primary malignant melanoma of the vagina treated with radical surgery and restored the sexual function by vulvovaginal reconstruction using gracilis myocutaneous flap. So we report this case with brief literature review.
Diagnosis ; Foreign Bodies ; Humans ; Melanocytes ; Melanoma* ; Myocutaneous Flap ; Prognosis ; Quality of Life ; Sensation ; Survival Rate ; Uterine Hemorrhage ; Vagina* ; Vaginal Discharge

Lumboperitoneal(LP) shunt has the advantage of complete extracranial surgical management, minimizing intracranial complication. The clinical usefulness of LP shunt in selecting patients with communicating hydrocephalus after aneurysmal subarachnoid hemorrhage(SAH) was compared with that of ventriculoperitoneal(VP) shunt. Chronic hydrocephalus was defined as clinically and radiographically demonstrated hydrocephalus that lasted 2 weeks or longer after the original hemorrhage and required shunting. Thirty four patients(9.6%) underwent shunt placement (LP shunt: 22, VP shunt: 12). There was no statistically significant difference in age, Hunt-Hess grade, Fisher grade, hypertension, vasospasm, shunt interval, Evan's index, intracranial pressure, and periventricular lucency between patients with a LP shunt and those with a VP shunt. An clinical improvement of 9 cases(40.9%) in patients with a LP shunt and 11 cases(91.6%) in a VP shunt were seen(p<0.005). Our findings suggest that VP shunt would be the better choice of treatment compared to LP shunts in treating chronic hydrocephalus after aneurysmal SAH.
Aneurysm ; Hemorrhage ; Humans ; Hydrocephalus* ; Hypertension ; Intracranial Aneurysm* ; Intracranial Pressure ; Subarachnoid Hemorrhage ; Ventriculoperitoneal Shunt*

According to the widely accepted concept that contraction of arterial smooth muscle is dependent on the Ca2+/calmodulin and protein kinase C(PKC) systems, it has been recently proposed that activation of these two systems in vascular smooth muscle cells has a bearing on the pathogenesis of cerebral vasospasm. However, most of the reported PKC inhibitors display a poor selectivity. In a rabbit "vasospasm" model, we tested the effect of a new PKC inhibitor(Bisindolylmaleimides; BIS) which has been known for a relatively high degree of selectivity, and also investigated the possible role of a inhibitor of Ca2+/calmodulin-dependent protein kinase(CAM kinase II inhibitor; KN-62). Finally, the vasodilating action of BIS was compared to KN-62. The basilar artery was visualized using transclival exposure, and its diameter monitored using videomicroscopy. Rabbit basilar artery was constricted in vivo by topical application of phorbol dibutyrate. Application of phorbol dibutyrate elicited an acute constriction, reducing arterial diameter to 46.5% of baseline diameter. Treatment with BIS (5micrometer) attenuated phorbol dibutyrate-induced vasoconstriction to 96.2% of baseline. Subsequently, application of oxyhemoglobin(oxy-Hb; 10 -4M) reduced vascular diameter to 68.5% of baseline. This vasospastic response was reversed by 91.4% or 81.3% using BIS(5micrometer) or KN-62(5micrometer), respectively. Combined applications of BIS and KN-62 to investigate the enhancing effect produced basilar arterial constriction of 94.9% of baseline. These findings demonstrate that BIS is a potent PKC inhibitor, and PKC system, rather than Ca2+/calmodulin system, appears to play a major role in the occurrence of cerebral vasospasm. Additionally, we suggest that combination of PKC with CAM kinase II inhibitor may be more useful therapeutic agents for treating cerebral vasospasm.
Basilar Artery* ; Calcium-Calmodulin-Dependent Protein Kinase Type 2 ; Constriction* ; Microscopy, Video ; Muscle, Smooth ; Muscle, Smooth, Vascular ; Phosphotransferases ; Protein Kinase C* ; Protein Kinases* ; Vasoconstriction ; Vasospasm, Intracranial

Antibiotic stewardship is a key strategy for limiting antibiotic resistance. Over the last decade the South Korean government has implemented a series of healthcare policies directed to this end, consisting of legislative separation of drug prescribing and dispensing, antibiotic utilization reviews, healthcare quality assessment, and public reporting. As a result, the proportion of antibiotic prescriptions for acute upper respiratory tract infections in primary healthcare facilities decreased from 72.9% in 2002 to 42.7% in 2013. However, no significant decrease in antibiotic resistance occurred over the same period in clinically important bacteria such as Streptococcus pneumoniae. These government-driven policies played a pivotal role in improving antibiotic use for outpatients and surgical patients in South Korea. However, to achieve long-lasting successful outcomes, coordinated efforts and communications among the stakeholders, including physicians and medical societies, are needed.
Bacteria ; Delivery of Health Care ; Drug Prescriptions ; Drug Resistance, Microbial ; Drug Utilization Review ; Health Policy ; Humans ; Inappropriate Prescribing ; Korea* ; Outpatients ; Prescriptions ; Primary Health Care ; Quality Assurance, Health Care ; Respiratory Tract Infections ; Societies, Medical ; Streptococcus pneumoniae ; Utilization Review

Hantaviruses cause two forms of human disease: hemorrhagic fever with renal syndrome (HFRS) and hantavirus pulmonary syndrome. Hantavirus infection can occur in pregnant women and it can have an influence on the maternal and fetal outcomes, although this is a rare finding even in endemic areas. We describe here a recent case of HFRS complicating pregnancy.
Pregnancy Complications, Infectious/*diagnosis ; Pregnancy ; Humans ; Hemorrhagic Fever with Renal Syndrome/*diagnosis ; Female ; Adult

BACKGROUND: Aminoglycosides are useful for the treatment of aerobic gram-negative infections, and this is despite the narrow therapeutic index and the potential nephrotoxicity and ototoxicity. Once daily dosing of aminoglycosides has recently been suggested as an alternative method to multiple daily dosing. We compared the two dosing regimens of aminoglycosides for the development of nephrotoxicity. METHODS: This study was conducted as part of an ongoing quality improvement program. For the administration of aminoglycosides in adult patients with suspected or documented gram-negative infection, multiple daily dosing was used until April 2005 and thereafter once daily dosing was recommended. RESULTS: A total of 85 patients who received aminoglycoside for more than 3 days from March to August 2005 were available for analysis (40 in the once daily dosing group and 45 in the multiple daily dosing group). The mean duration of administration was 7.7 (range: 3-19) days in the once daily dosing group and 8.0 (range: 3-31) days in the multiple daily dosing group (p=0.83). Aminoglycoside-associated nephrotoxicity was observed in a patient in the once daily dosing group (2.5% vs 0%, respectively, p=0.48). CONCLUSIONS: No significant difference in the development of nephrotoxicity was found between the two dosing regimens for aminoglycosides, but this finding had low statistical power. This may be due to underdosing of aminoglycosides in the multiple daily dosing group.
Acute Kidney Injury ; Adult ; Aminoglycosides* ; Drug Administration Schedule ; Humans ; Quality Improvement

Purpose: To understand the process of hemodynamic change and compensatory hypertrophy of the contralateral kidney in an acute ureteral obstruction (UO), the inducible nitric oxide synthase (iNOS), vascular endothelial growth factor (VEGF) and hypoxia-inducible factor-1alpha (HIF-1alpha) expressions in the contralateral kidney were evaluated during the acute stage of unilateral UO in the rat. Materials and Methods: Specimens (kidneys) were aseptically removed from 35 Sprague-Dawley rats (8 weeks old, weight 250-300gm) of the control (0 hours), sham (6, 12 and 24 hours) and experimental groups (UO 6, 12 and 24 hours). The iNOS, VEGF and HIF-1alpha expressions in the contralateral kidney (total renal tissue, medulla and cortex) were evaluated by immunohistochemical staining. The HIF-1alpha expression was also evaluated by a Western blot assay. Results: Contrary to the control and sham groups, the iNOS, VEGF and HIF-1alpha expressions in the contralateral kidney from the immunohistochemical staining increased with time of obstruction, especially in the medulla. The HIF-1alpha expression in the contralateral kidney by the Western blot assay was increased in all the renal tissue, medulla and cortex compared to those in the control and sham groups. Conclusions: In the contralateral kidneys of rats with UO increased expressions of iNOS, VEGF and HIF-1alpha may facilitate trophic changes and a compensatory increase in the blood flow.
Animals ; Blotting, Western ; Hemodynamics ; Hypertrophy ; Kidney* ; Models, Animal* ; Nitric Oxide Synthase Type II ; Rats* ; Rats, Sprague-Dawley ; Ureter* ; Ureteral Obstruction* ; Vascular Endothelial Growth Factor A*

Acute panautonomic neuropathy characterized by selective involvement of sympathetic and parasympathetic nerves with complete or relative sparing of somatic motor and sensory functions was first described by Young et al in 1969. We experienced acute pandysautonomia with peripheral neuropathy. The serial electrophysiologic studies revealed progressive periphear axonal polyneuropathy. Autonomic function test suggested dysautonomia of selective postganglionic lesion in 1 case and pandysautonomia in 3 cases. Our four cases wree Acute panautonomic neuropathies which simultaneously developed sensorimotor polyneuropathy. All Laps were normal except elevated CSF protein without pleocytosis. Recovery was poor in general, but 34-years-old female patient was markedly improved after plasmapheresis. Therefore we recommend immunologic treatment such as plasmapheresis or pulse therapy in early stage of progressive pandysautonomia.
Axons ; Female ; Humans ; Leukocytosis ; Peripheral Nervous System Diseases ; Plasmapheresis ; Polyneuropathies ; Primary Dysautonomias ; Sensation