BACKGROUND: Clonidine, an 2-adrenergic agonist, shows the analgesic effect and potentiates the analgesic effect of opioid. However, when it is injected with bolus technique, it reveals the short duration of inadequate analgesia and induces hypotension, bradycardia or sedation. We examined the analgesic and side effects of clonidine administered by continuous epidural infusion over 24 hrs, following epidural morphine injection. METHODS: Sixty parturients, scheduled for elective cesarean section under epidural anesthesia were randomly allocated into three groups. They received an infusion of saline alone (group 1, n= 20), clonidine 20 g/hr (group 2, n= 20), or 40 g/hr (group 3, n= 20) respectively, following epidural morphine 3 mg injection at the end of operation. The total doses and number of request for supplemental analgesic, blood pressure, heart rate, and degree of sedation were measured during 24 hrs. RESULTS: There were significant differences in pain relief between clonidine groups and group 1. The total doses and number of patient's request for supplemental analgesic in clonidine groups, compared to group 1 were significantly decreased (p<0.05), but no significant differences between the two clonidine groups. The diastolic pressure of group 3 was significantly lower than that of group 1 over 24 hrs, and that of group 2 at 18 hr, 24 hr (p<0.05). However, there was no severe hypotension, bradycardia or sedation in the three groups. CONCLUSION: Clonidine administered by continuous epidural infusion over 24 hrs enhances the analgesic effect of epidural morphine, and the infusion of clonidine with 20 g/hr rather than 40 g/hr shows minimal changes of blood pressure. Therefore, administration of epidural clonidine (20 g/hr) following epidural morphine may be considered as a regimen for pain management after cesarean section.
Analgesia* ; Anesthesia, Epidural ; Blood Pressure ; Bradycardia ; Cesarean Section* ; Clonidine* ; Female ; Heart Rate ; Hypotension ; Morphine ; Pain Management ; Pregnancy

PURPOSE: To report the anatomic and visual results of vitrectomy without scleral buckling in rhegmatogenous retinal detachment. METHODS: Primary vitrectomy without scleral buckling for the treatment rhegmatogenous retinal detachment was done in 41 eyes (41 patients) and followed up for a mean period of 21.5 months(range 6~65 months). Indications of primary vitrectomy were uncertain preoperative breaks, the presence of large breaks, the presence of breaks near equator, multiple breaks, proliferative vitreoretinopathy not related to breaks and presence of inferior vitreous hemorrhage. RESULTS: The anatomic success rate after a single operation was 90.2%. Visual acuity was improved or stable in 37 eyes (90.2%). Progression of lens opacity (35.7%) and formation of epiretinal membrane (12.2%) constituted the major complications after primary vitrectomy. CONCLUSIONS: Primary vitrectomy without scleral buckling can be a safe, effective method to repair primary rhegmatogenous retinal detachments in selective cases.
Cataract ; Epiretinal Membrane ; Retinal Detachment* ; Retinaldehyde* ; Scleral Buckling ; Visual Acuity ; Vitrectomy* ; Vitreoretinopathy, Proliferative ; Vitreous Hemorrhage

OBJECTIVE: Abnormal uterine bleeding is one of the most common disorder in gynecologic department. Organic causes of abnormal uterine bleeding are chronic cervicitis, submucosal myoma, endometrial polyp, endometrial malignancy. To find the exact cause of uterine bleeding and rule out the organic uterine disorder in the patients who considered dysfunctional uterine bleeding, hysteroscopic examination and endometrial biopsy were used. METHODS: Study group were 106 patients, who received hysteroscopic endometrial biopsy from 2. 2000 to 8. 2001.with abnormal uterine bleeding, negative in urine pregnancy test, normal in cervix cytology, and without organic lesion causing uterine bleeding in pelvic exam and ultrasonography. Age, parity, hysteroscopic biopsy result were analyzed retrospectively. RESULTS: Mean age of the study group was 43 and mean parity was 2.6. When final hysteroscopic biopsy histology were analysed, proliferative phase was most common (28.3%). Next were secretory phase (17.9%), simple hyperplasia (13.2%), endometrial polyp (10.6%), chronic endocervicitis (4.7%). Submucosal myoma, endometrial cancer, complex hyperplasia were detected in 3.8% each one. Of 106 patients, who considered dysfunctional uterine bleeding, only 63 (59.4%) patients were proved true DUB on hysteroscopic biopsy. Remainder had organic disorder (40.6%). CONCLUSION: When patients visited the hospital with abnormal uterine bleeding, doctors should be suspicious of endometrial organic disease and treat the patients with exact diagnosis. In these patients, hysteroscopic examination and biopsy were very useful and safe method to determine exact diagnosis and treatment plan.
Biopsy ; Cervix Uteri ; Diagnosis ; Endometrial Neoplasms ; Female ; Gynecological Examination ; Humans ; Hyperplasia ; Hysteroscopy ; Metrorrhagia ; Myoma ; Parity ; Polyps ; Pregnancy ; Pregnancy Tests ; Retrospective Studies ; Ultrasonography ; Uterine Cervicitis ; Uterine Hemorrhage

Objective: Although high-density lipoprotein cholesterol (HDL-C) is inversely associated with hematologic malignancies, modification by smoking has not been reported. We investigated how smoking and menopausal status modify these association. Methods: This population-based cohort study enrolled cancer-free individuals who underwent a national cancer screening in 2010 and followed up until December 2017. HDL-C levels were classified into eight groups based on 10 mg/dL intervals: (<30, 30–39, 40–49, 50–59, 60–69, 70–79, 80–89, or ≥90 mg/dL). Results: Among 4,517,892 participants, 5887 had lymphoma, 3348 had leukemia, and 12151 had unspecified hematologic malignancies. The adjusted hazard ratios (aHRs) for the lowest HDL-C levels compared to the 70–79 mg/dL range were 1.83 (1.45–2.31) for lymphoma, 3.14 (2.41–4.08) for leukemia, and 2.34 (2.01–2.72) for unspecified hematologic malignancy.The effects of low HDL-C levels on hematologic malignancies were similar in both men and women. Low HDL-C levels were associated with a higher risk of leukemia regardless of smoking status, but extremely high HDL-C levels were linked to a higher risk of leukemia (aHR, 2.32; 95% confidence interval [95% CI], 1.18–4.55) only in current smokers.The hazardous effect of low HDL-C levels on lymphoma was significant only in never smokers (aHR, 2.01; 95% CI, 1.51–2.68). Hazardous effects of low HDL-C levels on leukemia were observed only in post-menopausal women (aHR, 2.94; 95% CI, 1.69–5.11). Conclusion Low HDL-C levels were associated with a higher risk of leukemia and lymphoma, with discrepancies based on smoking and menopausal status.

Objective: Although high-density lipoprotein cholesterol (HDL-C) is inversely associated with hematologic malignancies, modification by smoking has not been reported. We investigated how smoking and menopausal status modify these association. Methods: This population-based cohort study enrolled cancer-free individuals who underwent a national cancer screening in 2010 and followed up until December 2017. HDL-C levels were classified into eight groups based on 10 mg/dL intervals: (<30, 30–39, 40–49, 50–59, 60–69, 70–79, 80–89, or ≥90 mg/dL). Results: Among 4,517,892 participants, 5887 had lymphoma, 3348 had leukemia, and 12151 had unspecified hematologic malignancies. The adjusted hazard ratios (aHRs) for the lowest HDL-C levels compared to the 70–79 mg/dL range were 1.83 (1.45–2.31) for lymphoma, 3.14 (2.41–4.08) for leukemia, and 2.34 (2.01–2.72) for unspecified hematologic malignancy.The effects of low HDL-C levels on hematologic malignancies were similar in both men and women. Low HDL-C levels were associated with a higher risk of leukemia regardless of smoking status, but extremely high HDL-C levels were linked to a higher risk of leukemia (aHR, 2.32; 95% confidence interval [95% CI], 1.18–4.55) only in current smokers.The hazardous effect of low HDL-C levels on lymphoma was significant only in never smokers (aHR, 2.01; 95% CI, 1.51–2.68). Hazardous effects of low HDL-C levels on leukemia were observed only in post-menopausal women (aHR, 2.94; 95% CI, 1.69–5.11). Conclusion Low HDL-C levels were associated with a higher risk of leukemia and lymphoma, with discrepancies based on smoking and menopausal status.

Objective: Although high-density lipoprotein cholesterol (HDL-C) is inversely associated with hematologic malignancies, modification by smoking has not been reported. We investigated how smoking and menopausal status modify these association. Methods: This population-based cohort study enrolled cancer-free individuals who underwent a national cancer screening in 2010 and followed up until December 2017. HDL-C levels were classified into eight groups based on 10 mg/dL intervals: (<30, 30–39, 40–49, 50–59, 60–69, 70–79, 80–89, or ≥90 mg/dL). Results: Among 4,517,892 participants, 5887 had lymphoma, 3348 had leukemia, and 12151 had unspecified hematologic malignancies. The adjusted hazard ratios (aHRs) for the lowest HDL-C levels compared to the 70–79 mg/dL range were 1.83 (1.45–2.31) for lymphoma, 3.14 (2.41–4.08) for leukemia, and 2.34 (2.01–2.72) for unspecified hematologic malignancy.The effects of low HDL-C levels on hematologic malignancies were similar in both men and women. Low HDL-C levels were associated with a higher risk of leukemia regardless of smoking status, but extremely high HDL-C levels were linked to a higher risk of leukemia (aHR, 2.32; 95% confidence interval [95% CI], 1.18–4.55) only in current smokers.The hazardous effect of low HDL-C levels on lymphoma was significant only in never smokers (aHR, 2.01; 95% CI, 1.51–2.68). Hazardous effects of low HDL-C levels on leukemia were observed only in post-menopausal women (aHR, 2.94; 95% CI, 1.69–5.11). Conclusion Low HDL-C levels were associated with a higher risk of leukemia and lymphoma, with discrepancies based on smoking and menopausal status.

Objective: Although high-density lipoprotein cholesterol (HDL-C) is inversely associated with hematologic malignancies, modification by smoking has not been reported. We investigated how smoking and menopausal status modify these association. Methods: This population-based cohort study enrolled cancer-free individuals who underwent a national cancer screening in 2010 and followed up until December 2017. HDL-C levels were classified into eight groups based on 10 mg/dL intervals: (<30, 30–39, 40–49, 50–59, 60–69, 70–79, 80–89, or ≥90 mg/dL). Results: Among 4,517,892 participants, 5887 had lymphoma, 3348 had leukemia, and 12151 had unspecified hematologic malignancies. The adjusted hazard ratios (aHRs) for the lowest HDL-C levels compared to the 70–79 mg/dL range were 1.83 (1.45–2.31) for lymphoma, 3.14 (2.41–4.08) for leukemia, and 2.34 (2.01–2.72) for unspecified hematologic malignancy.The effects of low HDL-C levels on hematologic malignancies were similar in both men and women. Low HDL-C levels were associated with a higher risk of leukemia regardless of smoking status, but extremely high HDL-C levels were linked to a higher risk of leukemia (aHR, 2.32; 95% confidence interval [95% CI], 1.18–4.55) only in current smokers.The hazardous effect of low HDL-C levels on lymphoma was significant only in never smokers (aHR, 2.01; 95% CI, 1.51–2.68). Hazardous effects of low HDL-C levels on leukemia were observed only in post-menopausal women (aHR, 2.94; 95% CI, 1.69–5.11). Conclusion Low HDL-C levels were associated with a higher risk of leukemia and lymphoma, with discrepancies based on smoking and menopausal status.

Background/Aims: This study aimed to develop a rehabilitation program for musculoskeletal pain experienced by gastrointestinal endoscopists and to investigate its usefulness. Methods: This was a multicenter cohort study. During the first 2 weeks, a questionnaire regarding daily workload and musculoskeletal symptoms was administered. Then, a rehabilitation program including equipment/posture correction and stretching was conducted during the remaining 6 weeks. Follow-up daily workload and musculoskeletal symptom surveys were distributed during the last 2 weeks. The program satisfaction survey was performed at the 6th and 8th weeks. Results: Among 118 participants (69 men), 94% (n=111) complained of musculoskeletal pain at baseline. Various hospital activities at baseline were associated with multisite musculoskeletal pain, whereas only a few workloads were correlated with musculoskeletal pain after the rehabilitation program. Follow-up musculoskeletal pain was negatively correlated with equipment/ posture program performance; arm/elbow pain was negatively correlated with elbow (R=–0.307) and wrist (R=–0.205) posture; leg/foot pain was negatively correlated with monitor position, shoulder, elbow, wrist, leg, and foot posture. Higher performance in the scope position (86.8% in the improvement vs 71.3% in the aggravation group, p=0.054) and table height (94.1% vs 79.1%, p=0.054) were associated with pain improvement. An increased number of colonoscopy procedures (6.27 in the aggravation vs 0.02 in the improvement group, p=0.017) was associated with pain aggravation. Most participants reported being average (32%) or satisfied (67%) with the program at the end of the study. Conclusions Our rehabilitation program is easily applicable, satisfactory, and helpful for improving the musculoskeletal pain experienced by gastrointestinal endoscopists.

PURPOSE: To report the anatomic and visual results of triple surgery in patients with cataract and rhegmatogenous retinal detachment. METHODS: This retrospective study examined 11 cases of phakic detachment. All 11 eyes had both rhegmatogenous retinal detachment and cataract. For these, a triple procedure involving pars plana vitrectomy, cataract surgery and posterior chamber intraocular lens (PCL) insertion was performed. Intraocular lens (IOL) power calculation was performed in the diseased or both eyes. RESULTS: A clear intraoperative view of the fundus was obtained in all cases. The retina was reattached by triple surgery in 9 eyes. In one failed case, there had been extensive detachment with preoperative proliferative vitreoretinopathy grade C type 1. In the other case, retinal detachment recurred due to a new break. The two failed eyes obtained anatomic success by reoperation. Preoperative visual acuity (hand movement/10cm to 0.2) was improved (finger count/20cm to 0.8). There were 2 visual imbalances of -8.0 diopter and -10.0 diopter due to miscalculation of IOL power. CONCLUSIONS: In selective cases, combined triple surgery spares the patient repeat surgery and can offer a more rapid visual rehabilitation by clearly identifying the breaks and avoiding delays in detachment repair. To avoid miscalculation, IOL power must be calculated in both eyes, especially in cases of macular detachment.
Cataract Extraction* ; Cataract* ; Humans ; Lens Implantation, Intraocular* ; Lenses, Intraocular* ; Rehabilitation ; Reoperation ; Retina ; Retinal Detachment* ; Retinaldehyde* ; Retrospective Studies ; Visual Acuity ; Vitrectomy* ; Vitreoretinopathy, Proliferative

PURPOSE: To investigate the accuracy and reproducibility of Optical Low Coherence Reflectometry (OLCR) corneal thickness measurements compared with the Orbscan system and ultrasound pachymeter (IOPac, Mentor). METHODS: Two examiners measured corneal thicknesses of 78 normal eyes and in 36 eyes that had undergone LASIK, and five sequential measurements of corneal thickness with OLCR, Orbscan system, Mentor, and IOPac were performed. Remeasurements of corneal thickness in 24 normal eyes were performed after two days to investigate intra-examiner reproducibility. RESULTS: The average corneal thickness measured in normal subjects was 536.3+/-23.8 micrometer in OLCR, 542.4+/-25.3 micrometer in the Orbscan system, 535.4+/-23.7 micrometer in Mentor, and 534.2+/-24.1 micrometer in IOPac. The average corneal thickness measured in patients who had undergone LASIK was 487.3+/-30.8 micrometer in OLCR, 492.5+/-36.5 micrometer in the Orbscan system, 487.5+/-30.8 micrometer in Mentor, and 485.3+/-30.8 micrometer in IOPac. There was no statistically significant difference between the four pachymeters. The inter-examiner and intra-examiner reproducibilities were shown to be highly reliable. CONCLUSIONS: The OLCR showed similar measurments of corneal thickness with the Orbscan system and ultrasound pachymeter, and showed no difference in reproducibility with different examiners.
Corneal Pachymetry* ; Humans ; Keratomileusis, Laser In Situ ; Mentors ; Ultrasonography*