No abstract available.
Axilla* ; Paget Disease, Extramammary*

PURPOSE: To report a case of failed sealing of full-thickness macular hole associated with an entrapped microbubble in the hole after vitrectomy, peeling of the internal limiting membrane and C3F8 (14%) gas injection. CASE SUMMARY: A 69-year-old female visited our clinic for decreased visual acuity in her right eye. The best corrected visual acuity (BCVA) was 20/200 in the right eye. The fundoscopy and spectral domain optical coherence tomography (SD-OCT) showed a full-thickness macular hole. She had a history of spine surgery and, thus was unable to maintain a prone position after surgery. The patient underwent pars plana vitrectomy, peeling of the internal limiting membrane and C3F8 (14%) gas injection in a sitting position postoperatively. Three weeks postoperatively, fundoscopy showed an entrapped microbubble within the macular hole, which was not sealed as observed on SD-OCT. We thought the entrapped microbubble within the macular hole prevented closure of the hole and removed it during the repeated surgery. At 2 weeks after the microbubble removal, fundoscopy and SD-OCT in the right eye showed the closure of the macular hole and the BCVA was improved to 20/40. CONCLUSIONS: We experienced a failed sealing of full-thickness macular hole due to an entrapped microbubble within the hole after macular hole surgery and observed the closure of the macular hole after removal of the microbubble. Based on our results, early microbubble removal operation should be considered in the treatment of an entrapped microbubble within the hole.
Aged ; Female ; Humans ; Membranes ; Microbubbles* ; Prone Position ; Retinal Perforations* ; Spine ; Tomography, Optical Coherence ; Visual Acuity ; Vitrectomy

No abstract available.
Keratosis, Seborrheic* ; Poroma* ; Scalp*

Monitoring fetal movement serves as an indirect rneasure of fetal well-being, especially for central nervous system integrity and function. Methods to monitor fetal movement vary from the simple approach of having the mother chart perceived movement to highly specialized methods. However there were no reliable objective monitoring methods in Korea. For development of objective method for evaluating fetal movement, during pregnancy, one-hundred and two pregnant patients were entered to this study. All patients were divided into following 3 groups and each type of monitoring methods were applied. Group 1(N=20): Type I using portable FHR Doppler unit(IFD-100 model, Intermed, Korea). Group 2(N=20): Type II using FHR Microphone(Prenatal Listening Kit, Model FS002, Unisar Inc., US). Group 3(N=62): Type III using conventional ultrasound transducer(Corometric 115 Model, US). In this study, accurate counting of the fetal movementutus were best performed using Type III, because of monitoring fetal movements has its greatest efficiency when using conventional ultrasound transducer of fetal monitor. It was also attractive to doctors and nurses as a convenient methods because it needed only single transducer when compared to Type I and II. Although monitoring fetal body movement permits a general assessment of well-being, no perfect technique is still reliable. Futher techniques would be developed using the results of this study for improvement of several factors such as accuracy and objectiveness
Central Nervous System ; Fetal Monitoring ; Fetal Movement* ; Humans ; Korea ; Mothers ; Pregnancy* ; Transducers ; Ultrasonography

BACKGROUND: Ski injuries depend on many factors which involve the skier's skill, the skiing environment, and skier's equipment. The purpose of this study was to determine the factors associated with fractures by skiing accident. SUBJECT: We evaluated 566 patients with ski injuries who visited to the emergency post located in the YongPyong Ski Resorts from Nov. 1996 to Feb. 1997. Among the patients,379 patients had no fracture(group I) and 187 patients had fracture(group II). RESULT: There was no differences in mean age and sex ratio between two groups. Fractures of the lower extremities were more common than the upper extremities. Slipping was the most common injury mechanism. arming-up was done in 40% of group I and in 17% of group II. The fracture injuries were more common in the skier with intermediate(45%) skill than the beginner(29%) and the ones with advanced skill(12%). The slope with intermediate difficulty was the most frequent site of fracture accidents. The fracture group tended to choose the slope beyond their skiing ability. CONCLUSION: Our results suggest that fracture during skiing can be prevented if skiers do warming-up prior to skiing and choose slope appropriate to their skiing skill.
Emergencies ; Health Resorts ; Humans ; Lower Extremity ; Sex Ratio ; Skiing ; Upper Extremity

PURPOSE: Acute abdominal pain can be the result of many different pathophysiological processes. Among the many possible causes, acute mesenteric ischemia is a life threatening condition if the diagnosis is delayed. Generally, the mortality rate for other disease has gradually decreased; however, the mortality rate for acute mesenteric ischemia has not changed significantly and it continues to be 75% to 80% for acute mesenteric arterial embolism or thrombosis and 44% for acute mesenteric venous thrombosis. The aim of this study was to conduct an analysis of the clinical characteristics and mortality of the patients with acute mesenteric ischemia according to the etiology. METHOD: From 1989 to 2004, 43 patients were treated for acute mesenteric ischemia. Their mean age was 59 years, ranging from 24 to 81, and the male to female gender ratio was 24:19. We retrospectively analyzed their initial symptoms, the age and gender distribution, the treatment modalities and the mortality rates. RESULT: The causes of acute mesenteric ischemia were arterial embolism in 27 cases, arterial thrombosis including arterial dissection in 7 cases and venous thrombosis in 9 cases. Almost all of the patients complained of acute abdominal pain and abdominal tenderness. The overall mortality rate was 30.2% and the rates were 37.0% for mesenteric artery embolism, 42.9% for mesenteric artery thrombosis and 0% for mesenteric venous thrombosis. CONCLUSION: In this study, the causes of acute mesenteric ischemia were mesenteric artery embolism and thrombosis, including dissection and mesenteric venous thrombosis. The factors influencing the mortality were the cause of the acute mesenteric ischemia, the extent of involvement of the mesenteric vessels and the extent of bowel necrosis. Thus the most important things for the treatment of acute mesenteric ischemia are early diagnosis and proper treatment.
Abdominal Pain ; Diagnosis ; Early Diagnosis ; Embolism ; Embolism and Thrombosis ; Female ; Humans ; Ischemia* ; Male ; Mesenteric Arteries ; Mortality ; Necrosis ; Retrospective Studies ; Thrombosis ; Venous Thrombosis

Dulaglutide, a weekly injectable glucagon-like peptide-1 receptor agonist, has demonstrated effectiveness when combined with basal insulin. We examined whether the efficacy of dulaglutide is comparable to that of prandial insulin in kidney transplant (KT) recipients with type 2 diabetes mellitus (T2DM) undergoing multiple daily insulin injection (MDI) therapy. Thirty-seven patients, who switched from MDI therapy to basal insulin and dulaglutide, were retrospectively analyzed. Changes in glycosylated hemoglobin (HbA1c) and fasting plasma glucose (FPG) levels, body weight, and basal insulin dose were evaluated over 6 months. Dulaglutide was comparable to three injections of prandial insulin in terms of glycemic control (HbA1c 7.1% vs. 7.0%; 95% confidence interval [CI], –0.53 to 0.28; P=0.53). The basal insulin and dulaglutide combination resulted in a reduction in FPG levels by 9.7 mg/dL (95% CI, 2.09 to 41.54; P=0.03), in body weight by 4.9 kg (95% CI, 2.87 to 6.98; P<0.001), and in basal insulin dose by 9.52 IU (95% CI, 5.80 to 3.23; P<0.001). Once-weekly dulaglutide may be an effective alternative for thrice-daily prandial insulin in KT recipients with T2DM currently receiving MDI therapy.

OBJECTIVE: To investigate the additive effect of sono-guided subacromial bursa injection of hyaluronate with steroid in patients with peri-articular shoulder disorders. METHOD: This prospective randomized controlled trial involved 26 patients who had shoulder pain. Group A, consisting of 13 patients, was treated with a sono-guided subacromial bursa injection containing a mixture of 0.5% lidocaine (5 ml) and triamcinolone 40 mg (1 ml), followed by injection with sodium hyaluronate (2 ml) once a week for 3 weeks. The other 13 patients (Group B) were treated with a sono-guided subacromial bursa injection containing a mixture of 0.5% lidocaine (5 ml) and triamcinolone 40 mg (1 ml) once a week for 3 weeks. The effects were assessed using a visual analogue scale (VAS) of shoulder pain, active range of motion (AROM), shoulder function assessment scale (SFA), shoulder disability questionnaire (SDQ) at study entry and every week from first injection until 4 weeks after the 1st injection (= 2 weeks after 3rd injection). RESULTS: (1) Demographic features and all parameters measured before injection did not show a significant difference between the 2 groups. (2) Statistically significant improvements were shown in VAS, SFA, SDQ during the 1st, 2nd, and 4th week after the first injection in both groups (p<0.05). (3) SFA showed significant improvement at 1 week after injection only in group A (p<0.05). (4) AROM of internal rotation showed significant improvement at week 4 after the 1st injection only in group A (p<0.05). CONCLUSION: Subacromial bursa injection of hyaluronate with steroid in patients with peri-articular shoulder disorders has additive effects on functional improvement of the affected shoulder, including the AROM of internal rotation.
Humans ; Hyaluronic Acid ; Lidocaine ; Prospective Studies ; Range of Motion, Articular ; Shoulder ; Shoulder Pain ; Triamcinolone ; Surveys and Questionnaires

OBJECTIVE: To investigate the effect of botulinum toxin type A (BTXA) on drooling and the morphologic change of the salivary gland in patients with cerebral palsy. METHOD: Eight cerebral palsy patients suffering from severe drooling participated in this study. BTXA was injected into both submandibular and parotid glands under intravenous sedation and with ultrasound guidance (1 unit/gland/kg: maximum 100 units) in an outpatient or inpatient procedure. The severity of drooling was measured before injection and 3 weeks after injection using the Teacher Drooling Scale, the Drooling Score-severity, frequency and the Visual Analog Scale. To investigate the morphologic change of the salivary glands, the size of salivary glands were measured before injection and 3 weeks after injection using computed tomography of the neck. The measurement values were analyzed by Wilcoxon signed rank test. RESULTS: Statistically significant improvements were shown in all three parameters for assessing the severity of drooling after BTXA injections (p<0.05). Size of the salivary glands were significantly decreased at 3 weeks after BTXA injection (p<0.05). CONCLUSION: Salivary gland injection with BTXA could be a useful treatment method to reduce drooling in patients with cerebral palsy and decreased size of salivary glands may partially explain the mechanism.
Botulinum Toxins ; Botulinum Toxins, Type A ; Cerebral Palsy ; Humans ; Inpatients ; Neck ; Outpatients ; Parotid Gland ; Salivary Glands ; Sialorrhea ; Stress, Psychological

Hematocrit is an important determinant of oxygen delivery. Of particular interest, its target level is very wide for different kinds of shock: from 30% for hemorrhagic or septic shock to 56% for secondary polycythemia. This range is not only wide but also deviated to the higher level from the optimal value of 40%. In this letter, the authors determine the mathematical basis of the wide and deviated range of hematocrit starting from the Hagen-Poisseuille equation.
Hematocrit ; Hemoglobins ; Oxygen ; Polycythemia ; Shock ; Shock, Septic