PURPOSE: To report clinical features of visually disabled people by newly revised legal blindness criteria. METHODS: A prospective evaluation of all blind registrations was conducted at Dongguk University Hospital from January 2000 to December 2000. Detailed ophthalmologic evaluations were performed and the review of the diagnosis was done in order to find out the cause of the visual disability. RESULTS: There were 273 patients (343 eyes) for newly registered blindness. Of these, 190 (69.6%, 190/273) were men and mean age was 53.8+/-15.48. The sixth degree visual disability was most common (74.0%, 202/273) according to the newly revised legal blindness criteria, and most common cause of blindness was trauma (38.2%, 131/343). Government office advised 122 patients (44.7%, 122/273) to register legal blindness . CONCLUSION: Further nationwide epidemiological survey for legal visual disability is required by standardized classification and criteria.
Blindness ; Classification ; Diagnosis ; Humans ; Male ; Prospective Studies

OBJECTIVES: Neurobiological models for obsessive-compulsive disorder(OCD) have consistently implicated prefrontal-striatal circuits in the pathophysiology of this disorder. But, prior studies have inconsistently found alteration in caudate and frontal lobe volumes in patients with OCD. This study was undertaken in the hope that semi-automated linear transformation methods would elucidate the morphometric differences of various parts of brain between OCD and normal control group. METHODS: Thirteen patients meeting the DSM-IV criteria for OCD, and 9 psychiatrically normal comparison subjects participated in the study. 3-D brain MRIs using Spoiled gradient-recalled (SPGR) sequence were acquired for each subjects. After spatially normalized according to Talairach and Tournoux's coordinates, the gray and white matters were segmented by semiautomated methods using fuzzy algorithm. Each lobal volumes was measured according to Talairach and Tournoux's coordinates, and the region of interests of caudate nuclei was manually traced. The frontal lobe was divided into 3 subregions; dorsolateral prefrontal cortex, orbital frontal cortex, mesial frontal cortex accoring to the coordinates and Broadman's cytoarchitectonics. RESULTS: Only the volume of left and right frontal gray matter showed a significant difference between OCD and normal subjects. In OCD, the frontal gray matter volume was increased in tendency. There's no difference in laterality and no coorelation with clinical severities. CONCLUSION: Findings of increased frontal gray matter volumes in patients implicate a structural abnormality of these brain regions in the pathophysiology of OCD. The increased frontal gray matter volumes reflect a epiphenomena due to increased cerebral blood flows and metabolic rates before the structural changes may occur.
Brain* ; Caudate Nucleus ; Diagnostic and Statistical Manual of Mental Disorders ; Frontal Lobe ; Hope ; Humans ; Magnetic Resonance Imaging* ; Obsessive-Compulsive Disorder* ; Orbit ; Prefrontal Cortex

Ulcer in buttock is mainly a pressure sore, which is frequently occurred at the sacral region in Korea and its surgical treatment is chiefly the operation using gluteus maximus myocutaneons flaps. For the treatment of ulcerated lesion in gluteal area, various methods using gluteus maximus muscle have been developed. We reviewed and analyzed the 100 cases using gluteus maximus myocutaneous flaps in our department since 1980. The results were summarized as follows ; 1) The ratio between male and female was 3:1. 2) The prevalent age groups were between third and fifth decades. 3) The main cause was the trauma. 4) The wound culture showed the pattern of mixed infections in most cases, consisting of Staphylociccus, Pseudomonas, Enterococcus, Streptococcus, and others. 5) The postoperative complications were noted in about thirty percent of the cases. The complications were flap tip necrosis, wound infection, wound disruption, and others. 6) For the treatment of small ulcers, a pure skin flap or myoplasty may be used, but for the treatment of large one, a kind of myocutaneous flap should be selected. 7) Gluteus maximus myocutaneous flaps can be used as variable methods, but of which the island flap is ideal in deep and large ulcerated lesion.
Buttocks ; Coinfection ; Enterococcus ; Female ; Humans ; Korea ; Male ; Myocutaneous Flap* ; Necrosis ; Postoperative Complications ; Pressure Ulcer ; Pseudomonas ; Sacrococcygeal Region ; Skin ; Streptococcus ; Ulcer ; Wound Infection ; Wounds and Injuries

The enzyme linked immunosorbent assay (ELISA)-inhibition test using a Clonorchis sinensis species-specific mouse monoclonal antibody(MAb), CsHyb 0605-23, showed increased specificity over the conventional ELISA used for serodiagnosis of clonorchiasis. To characterize the corresponding antigen further, the MAb was tested against polysaccharide, protein and glycolipid fractions obtained from a crude extract of C. sinensis adult worms, using chloroform, methanol and phenol extractions. Only the polysaccharide fraction was recognized by the MAb among those fractions. Mild oxidation of the antigen with sodium periodate showed decreased reactivity against the MAb. We concluded that the antigen and antigenic determinants recognized by the MAb are carbohydrates.
parasitology-helminth-trematoda ; Clonorchis sinensis ; Monoclonal antibody ; antigen ; immunology ; carbohydrate ; polysaccharide ; enzyme-linked immunosorbent assay ; diagnosis

Objectives: Suicide is the major public mental health concerns all over the world. The comparison of suicide attempters and suicide completers could be the fundamental evidence for the suicide prevention. The aim of this study is to explore the differences between suicide attempters and suicide completers in terms of the stressors, suicide methods, and psychiatric diagnosis. Methods: Two types of secondary data were collected for the analyses. Data of the suicide attempters (n = 680) were gathered by intensive reviewing the medical records of Samsung Medical Center, Seoul, Republic of Korea. Data of suicide completers (n = 11,722) were collected by the psychological autopsy data which were gathered by Korean Foundation for Suicide Prevention. Suicidal methods, psychiatric disorders and stressors before suicidal attempt were compared between suicide attempter and completers. Results: Suicide completers were older and male predominant compared to suicidal attempt. Hanging or gas intoxication were more commonly used in the suicide completion, while wrist cutting or drug intoxication were more common in suicide attempters. All types of stressors were found to be high in suicide completers than suicide attempters. However, the proportion of economic and physical stress were greater in suicide completers, while the proportion of family stress were greater in suicide attempters. According to the recorded diagnoses, the rates of depressive disorders, sleep-wake disorders, substance-related disorders were higher in suicide completers, while the rates of anxiety disorders and trauma- and stressor-related disorders, bipolar and related disorders and somatic symptom disorders were higher in suicide attempters. However, after controlling the gender and age, there were no significant differences in diagnosis between suicide attempters and suicide completers. Conclusion These findings implicate that suicide attempters and completers differed in suicide methods and type of stress. The results suggests that economic stressors, physical illness might raise the risk of suicide completion.

BACKGROUND: Because laparoscopic surgery has many advantages compared with conventional methods, it has recently been applied to not only intraabdominal or intrathoracic surgery but also thyroidectomy. It is possible that arterial blood gases and hemodynamic variables can be changed by patient position and insufflation of pressurized CO2 into extraperitoneal or intraperitoneal space, so we examined the changes in arterial blood gases, end tidal CO2 (P(ET)CO2) and hemodynamic variables during an endoscopic thyroidectomy with extraperitoneal CO2 insufflation, laparoscopic cholecystectomy and gynecologic laparoscopic surgery with intraperitoneal CO2 insufflation under N2O, enflurane inhalational general anesthesia. METHODS: Forty ASA class I or II patients were included in this study, endoscopic thyroidectomy group (n = 10), laparoscopic cholecystectomy group (n = 18), gynecologic laparoscopic surgery group (n = 12). All patients were underwent controlled mechanical ventilation (tidal volume: 10 ml/kg, respiratory rate: 12/min) and the ventilator mode was fixed in this volume and rate until the end of the operation. The position of patients during the endoscopic thyroidectomy and laparoscopic cholecystectomy were under 5 degree reverse Trendelenburg position, whereas the gynecologic laparoscopic surgery was under a 10 degree head-down lithotomy position. Variables were measured before CO2 insufflation (10 minute after induction), 10, 20 and 30 minutes after CO2 insufflation and 40 minutes after CO2 deflation. RESULTS: PaCO2 and P(ET)CO2 were significantly increased during CO2 insufflation compared with preinsufflation values in all groups, but the magnitude of increases of PaCO2 and PETCO2 was not significantly different among the three groups. The mean magnitude of increases of PaCO2 at 10 minutes after CO2 insufflation were as follows: gynecologic laparoscopic surgery (6.21 +/- 2.0 mmHg), endoscopic thyroidectomy (5.07 +/ 2.3 mmHg), and laparoscopic cholecystectomy (5.01 +/- 2.2 mmHg). CONCLUSIONS: We concluded that PaCO2 and P(ET)CO2 were significantly increased during CO2 insufflation compared with the preinsufflation values in all groups, but the magnitude of increases of PaCO2 and P(ET)CO2 was not significantly influenced by CO2 insufflation site and patient position.
Anesthesia, General ; Carbon Dioxide ; Cholecystectomy, Laparoscopic* ; Enflurane ; Gases* ; Head-Down Tilt ; Hemodynamics ; Humans ; Insufflation ; Laparoscopy* ; Respiration, Artificial ; Respiratory Rate ; Thyroidectomy* ; Ventilators, Mechanical

Background/Aims: There is increasing evidence that supplementation with pre- and probiotics appears to have positive effects on irritable bowel syndrome (IBS). The aim of this study was to determine the effects of a new synbiotic formulation on gastrointestinal symptoms in elderly patients with IBS. Methods: Sixty-seven IBS patients aged ≥60 years were randomly assigned to either a placebogroup (n=34) or a synbiotic group (n=33). During a 4-week intervention, subjects used a placebo or a synbiotic containing Lactobacillus paracasei DKGF1 and extracts of Opuntia humifusa once a day. Patients were evaluated with the subject global assessment, visual analog scale, and Bristol stool chart. The primary outcome was the overall responder rate and the secondary outcome was the responder rates for abdominal symptom reduction at week 4. Results: Overall, responder rates were significantly higher in the synbiotic group (51.5%) than in the placebo group (23.5%) (p=0.017). Abdominal pain (58.8% vs 81.8%) and psychological wellbeing (26.4% vs 60.6%) were noticeably improved in the synbiotic group (p=0.038 and p=0.004, respectively). However, there were no significant differences in gas and bloating symptoms (p=0.88 and p=0.88, respectively). In patients with constipation-dominant and diarrhea-dominant IBS (n=16), the synbiotic significantly improved abdominal pain and defecation symptoms (responder rates for the placebo vs the synbiotic: 22.2% vs 85.7%, p=0.04). There were no adverse events in either group. Conclusions The results indicate that this new synbiotic supplement can potentially relieve abdominal symptoms in elderly IBS patients.

BACKGROUND: Laryngeal allotransplantation (LA) is a technique involving transplantation of a deceased donor's larynx into a recipient, and it may be substituted for conventional laryngeal reconstruction. There are widely different views on LA, as the recipient is administered continuous, potentially life-threatening, immunosuppressive therapy for a functional or aesthetic result, which is not directly related to life extension. The purpose of this study was to analyze the difference in risk acceptance and expectations of LA between four population groups. METHODS: A survey was performed to examine patients' risk acceptance and expectations of LA. The survey included 287 subjects in total (general public, n=100; kidney transplant recipients, n=53; post-laryngectomy patients, n=34; doctors, n=100), using a Korean translated version of the louisville instrument for transplantation (LIFT) questionnaire. RESULTS: All four groups responded differently at various levels of their perception in risk acceptance and expectations. The kidney transplant recipients reported the highest risk acceptance and expectations, and the doctor group the lowest. CONCLUSIONS: This study examined the disparate perception between specific population groups of the risks and benefits of using LA for the promotion of the quality of life. By addressing the information gaps about LA in the different populations that have been highlighted from this survey, we suggest that LA can become a more viable alternative to classical surgery with resultant improved quality of life for patients.
Data Collection ; Humans ; Kidney ; Larynx ; Life Expectancy ; Patient Acceptance of Health Care ; Population Groups ; Quality of Life ; Reconstructive Surgical Procedures ; Risk Assessment ; Transplantation ; Surveys and Questionnaires

We experienced a case of middle cerebral artery-distal internal carotid artery bypass surgery for treating a ruptured cerebral aneurysm in a 50-year-old female who also had a descending aortic dissection and a past history of receiving a Bentall operation for an ascending aortic dissection 7 years previously. The patient successfully underwent surgery and we report on this experience along with a brief review of the relevant literature.
Anesthesia ; Anesthesia, General ; Carotid Artery, Internal ; Female ; Humans ; Intracranial Aneurysm ; Middle Aged

BACKGROUND: When applying pulsed radiofrequency on dorsal root ganglia for treating chronic lower back pain, maximum efficiency can be expected when a needle is placed 1-2 cm peripheral to the dorsal root ganglion. The object of this study is to analyze images taken after adding contrast to transforaminal epidural injection, categorize root ganglia according to anatomical position, and provide a reference for efficient needle positioning in applying pulsed radiofrequency on dorsal root ganglia. METHODS: From January 2008 to January 2009, 457 patients who visited our hospital for root pain or radiculopathy were treated with transforaminal epidural injection on the nerve roots based on the dermatome of the painful area. Anteroposterior views were taken after injection of contrast. A virtual line was made by connecting the internal and external parts of the spinal pedicle from the contrast images. Then the dorsal root ganglia were categorized as intraspinal (IS), intraforaminal (IF), or extraforaminal (EF). RESULTS: In the fourth lumbar spine, dorsal root ganglia positions were 48% IF, 41% IS, and 6% EF. In the fifth lumbar spine, dorsal root ganglia positions were 75% IF, 10% IS, and 6% EF. In the first sacral spine, dorsal root ganglia locations were 8% IF and 83% IS. CONCLUSIONS: Positional categorization of dorsal root ganglia according to contrast images was proven to be good anatomical references for effective radiofrequency or blocking of dorsal root ganglia.
Catheter Ablation ; Ganglia ; Ganglia, Spinal ; Humans ; Injections, Epidural ; Low Back Pain ; Lumbosacral Region ; Needles ; Radiculopathy ; Spinal Nerve Roots ; Spine