Intermittent exotropia at times is completely controlled by the convergence mechanisms and at other times escapes this control and becomes a manifest exotropia. The treatment of choice is surgical and the treatment is directed at normalization of binocular functions, and recurrence and overcorrection are frequently seen after surgery. Therefore it is important to decide the time and the type of surgery. The author experienced 66 cases of intermittent exotropia in which surgery was done. Surgery was indicated in the cases with deviation of 20 PD or more, deviation of less than 20 PD with asthenopia, exotropia occurred during more than 40% of waking hours, and deterioration of stereoacuity even at early age. Bilateral recession was initial procedure regardless type of intermittent exotropia. In the case with amblyopia, however, R and R was done on the amblyopic eye and in convergence insufficiency type bimedial resection. Lateral Incomitancy was present in 37.9%. The basic type which was shown in 68.2% was the most frequent one. The amount of esodeviation was 15 to 10 PD in 43.9% and 11 to 15 PD in 21.2% on the first postoperative day. The phoria within 10 PD was shown in 95.4% 6 weeks after surgery, in 98.5% 3 months after surgery, and in 93.9% 6 months after surgery. Six months after surgery, 4 cases revealed exodeviation above 16 PD and no case esodeviation. Stereopsis was tested in 54 cases who understood the test before operation and 43 cases(79.6%) showed stereopsis. Nine out of 11 cases who had no stereopsis showed stereopsis after operation. In this study, success rate of first surgery was as high as 93.9% in 6 months follow-up and stereopsis was restored in considerable number of cases in intermittent exotropia compared to other types of strabismus and binocular function could also be restored and improved after surgery.
Amblyopia ; Asthenopia ; Depth Perception ; Esotropia ; Exotropia* ; Follow-Up Studies ; Ocular Motility Disorders ; Recurrence ; Strabismus ; Telescopes ; United Nations

No abstract available.
Radiation, Ionizing

The recent prevalence of syphilis has known to be increased progressively throughout the world, since middle of 1950. In Korea, current trend of increased syphilic infection has became a major public health problem. The authors selected sero-positive patients, among the outpaients of department of dermatology, urology, OB & GY, and physical examination, and performed statistical analysis of this sero-positive patients. Results are as following; 1) Of the 2,007 patients taken physical examination, 30 patient(1.49%) were reactive to VDRL. 2) 0.71% of the total out patients of the dermatologic dcpartment were sero-positive. Annual ratio of the syphilitic patient were increased progressively. 3) Ratio of the syphilitic patients to the total outpatients of OB & GY department was 0.55% and somewhat increased since 1976. 4) In the age distribution, the third decade shared 51.8% of the total sero-positive patients 5) In the sexual ratio. male:female=l: l. 62 in the total sero-positive patients. (male:female=l: 1.06 in the dermatologic department.) 6) In the stage distribution, latent syphilis patients were 59.14% of the total syphilitic patients.
Age Distribution ; Dermatology ; Female ; Humans ; Korea ; Outpatients ; Physical Examination ; Prevalence ; Public Health ; Syphilis ; Syphilis, Latent ; Urology

Anisometropia is caused by axial ametropia and refractive ametropia. Almost all anisometropia in children are known to be caused by axial ametropia. Axial ametropic anisometropia is corrected by the spectacles by Knapp's rule. We experienced 41 patients with anisometropia, in whom the relationship between the difference in axial length in each eye(x) and the difference in refractive error in each eye(y) was linear, y = -0.00758+2.18554x. According to this approximate regression formula, 27 patients(66%) showed axial ametropic anisometropia and 14 patients(34%) showed refractive ametropic anisometropia. Twenty three(85%) out of 27 patients had had amalyopia. Ten patients(83%) at the age of 9 or less improved their visual acuity after amblyopia treatment, but only 4 patients(36%) older than 9 showed mild improvement. In authors' experience, axial ametropic anisometropia can be corrected by spectacles with full amount of refractive error and by proper amblyopia treatment. It is important to diagnose and treat the axial ametropic anisometropia in early childhood, however even in the patients older than 9 years old the visual prognosis is not so hopeless if treated with fully corrected spectacles and proper amblyopia treatment.
Amblyopia ; Anisometropia ; Child ; Eyeglasses ; Humans ; Prognosis ; Refractive Errors ; Visual Acuity

Cytogenetic dosimetry is useful for evaluating the absorbed dose of ionizing radiation based on analysis of radiation-induced chromosomal aberrations. We created two types of in vitro dose-response calibration curves for dicentric chromosomes (DC) and translocations (TR) induced by X-ray irradiation, using an electron linear accelerator, which is the most frequently used medical device in radiotherapy. We irradiated samples from four healthy Korean individuals and compared the resultant curves between individuals. Aberration yields were studied in a total of 31,800 and 31,725 metaphases for DC and TR, respectively, obtained from 11 X-ray irradiation dose-points (0, 0.05, 0.1, 0.25, 0.5, 0.75, 1, 2, 3, 4, and 5 Gy). The dose-response relationship followed a linear-quadratic equation, Y=C+αD+βD², with the coefficients C=0.0011 for DC and 0.0015 for TR, α=0.0119 for DC and 0.0048 for TR, and β=0.0617 for DC and 0.0237 for TR. Correlation coefficients between irradiation doses and chromosomal aberrations were 0.971 for DC and 0.6 for TR, indicating a very strong and a moderate correlation, respectively. This is the first study implementing cytogenetic dosimetry following exposure to ionizing X-radiation.
Calibration ; Chromosome Aberrations ; Cytogenetics ; In Vitro Techniques* ; Particle Accelerators ; Radiation, Ionizing ; Radiotherapy

BACKGROUND: Tuberculosis is still one of the major public health problems in Korea. The patient's compliance with anti-tuberculosis therapy is the most important matter in managing tuberculosis. Research, particularly on this issue, is needed. Therefore, we analyzed the factors associated with compliance of pulmonary tuberculosis patients using the Health Belief Model. METHODS: One hundred and 47 patients who visited the outpatient Department of Family Medicine in Asan Medical Center from January 1995 to December 1998, and who were diagnosed as having pulmonary tuberculosis and treated with anti-tuberculosis drugs were chosen through chart reviews. Questions were given by telephone with questionnaire based on Health Belief Model. RESULTS: One hundred and two patients out of the total 147 participated in the study. The group was divided into two: 79 patients as a compliance group, and 23 as a non-compliance group. Recognition of their diagnosis, recognition of the duration of taking anti-tuberculosis drugs, disturbance of daily living with taking the drugs, efficacy expectations were statistically significant factors between the two groups. CONCLUSIONS: Higher the knowledge about their diagnosis as having tuberculosis, higher their knowledge about the durations of having to take the anti-tuberculosis drugs, less disturbance they had experieced on their daily living, and higher their expectation for the efficacies of taking the drugs resulted in higher compliance with anti-tuberculosis medication.
Chungcheongnam-do ; Compliance* ; Diagnosis ; Humans ; Korea ; Outpatients ; Public Health ; Telephone ; Tuberculosis ; Tuberculosis, Pulmonary* ; Surveys and Questionnaires

Nonocclusive mesenteric ischemia (NOMI) is known to occupy about 25+ACU- to 60+ACU- of intestinal infarction. NOMI has been reported to be responsible for 9+ACU- of the deaths in the dialysis population and the postulated causes of NOMI include intradialytic hypotension, atherosclerosis and medications, such as diuretics, digitalis and vasopressors. Clinical manifestations, such as fever, diarrhea and leukocytosis, are nonspecific, which makes early diagnosis of NOMI very difficult. Case: A 66-year-old woman on maintenance hemodialysis for 5 years was admitted with syncope, abdominal pain and chilly sensation. Since 7 days prior to admission, blood pressure on the supine position during hemodialysis had frequently fallen to 80/50 mmHg. Four days later, she complained of progressive abdominal pain. Rebound tenderness and leukocytosis (WBC 13900/mm3) with left shift were noted. Stool examination was positive for occult blood. Abdominal CT scan showed a distended gall bladder with sludge. Under the impression of acalculous cholecystitis, she was operated on. Surgical and pathologic findings of colon colon were compatible with NOMI. Because of recurrent intradialytic hypotension, we started midodrine 2.5 mg just before hemodialysis and increased the dose up to 7.5 mg. After midodrine therapy, blood pressure during dialysis became stable and the symptoms associated with hypotension did not recur. CONCLUSION: As NOMI may occur within several hours or days after an intradialytic hypotensive episode, abdominal pain should be carefully observed and NOMI should be considered as a differential diagnosis. In addition, we suggest that midodrine be considered to prevent intradialytic hypotensive episodes.
Aged ; Case Report ; Colectomy ; Colon/surgery ; Colon/blood supply ; Female ; Human ; Ischemia/therapy ; Ischemia/pathology ; Ischemia/etiology+ACo- ; Kidney Failure, Chronic/therapy ; Mesentery/blood supply+ACo- ; Midodrine/administration +ACY- dosage ; Renal Dialysis/methods ; Renal Dialysis/adverse effects+ACo- ; Treatment Outcome ; Vasoconstrictor Agents/administration +ACY- dosage

BACKGROUND: The prevalence of dementia is estimated to be as high as 5 10% over 65 years of age in Korea. It is important to evaluate of dementia for the elderly, because of the chronicity and progressiveness of the disease. However, cognitive impairment often goes unrecognized by physician because the many previous tools to evaluate cognitive function in the clinical setting are complex, time consuming and sometimes questionable correlation with real world functioning. The purpose of this study is to assess the usefulness of The Time and Change test as screening test for dementia ,on the basis of the correlation between this measure(T&C) and MMSE K. METHODS: The subject for this study consisted of 64 elderly who visited to the outpatient department of family medicine of the Ehwa Mok dong hospital or Elderly Welfare Center in Seoul. They received the T&C test and MMSE K examination. Sensitivity, specificity, negative predictive value, and Pearson' Correlation coefficient were calculated using standard formulas. RESULTS: The T&C had a sensitivity of 50%, a specificity of 88 %, a positive predictive value of 69%, a negative predictive value of 77 %, respectably. when timed cutpoints were added, The T&C test had a sensitivity of 95%, specificity of 83 %, a positive predictive value of 75%, a negative predictive value of 97 %. respectibaly. CONCLUSION: The Time and Change(T&C) tests can be an effective, simple and performance based tool to recognize dementia. Further validation with a representative elderly sample is needed to establish screening value in primary care or community populations.
Aged* ; Dementia ; Humans ; Korea ; Mass Screening* ; Outpatients ; Prevalence ; Primary Health Care ; Sensitivity and Specificity ; Seoul

PURPOSE: We investigated the prognostic impact of discordance between the receptor status of primary breast cancers and corresponding metastases. METHODS: A total 144 patients with breast cancer and distant metastasis were investigated. The estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) status of primary tumor and corresponding metastases were assessed. Tumor phenotype according to receptor status was classified as triple-negative phenotype (TNP) or non-TNP. Concordance and discordance was determined by whether there was a change in receptor status or phenotype between primary and metastatic lesions. RESULTS: The rates of discordance between primary breast cancer and metastatic lesions were 18.1%, 25.0%, and 10.3% for ER, PR, and HER2, respectively. The rates of concordant non-TNP, concordant TNP and discordant TNP were 65.9%, 20.9%, and 13.2%, respectively. Patients with concordant ER/PR-negative status had worse postrecurrence survival (PRS) than patients with concordant ER/PR-positive and discordant ER/PR status (p=0.001 and p=0.021, respectively). Patients who converted from HER2-positive to negative after distant metastasis had worst PRS (p=0.040). Multivariate analysis showed that concordant TNP was statistically significant factor for worse PRS (p<0.001). CONCLUSION: Discordance in receptor status and tumor phenotype between primary breast cancer and corresponding metastatic lesions was observed. Patients with concordant TNP had worse long-term outcomes than patients with concordant non-TNP and discordant TNP between primary and metastatic breast cancer. Identifying the receptor status of metastatic lesions may lead to improvements in patient management and survival.
Breast Neoplasms ; Breast* ; Estrogens ; Humans ; Multivariate Analysis ; Neoplasm Metastasis* ; Phenotype* ; Prognosis* ; Receptor, Epidermal Growth Factor ; Receptors, Progesterone

PURPOSE: The progressivity of central precocious puberty (CPP) seems to depend on the age at presentation. We evaluated the clinical courses of CPP girls according to their age at initiation of treatment. METHODS: One hundred thirty five girls with CPP diagnosed between Jan. 2003 and Dec. 2009 and regularly followed for more than one year were included. They were treated with gonadotropin-releasing hormone agonists (GnRHa) every four weeks. Subjects were divided into two groups based on whether they were treated before (Group I, N=20) or after seven years of age (Group II, N=115). We compared the anthropometric parameters, the predicted adult height (PAH), predicted treatment periods, and the laboratory findings of the two groups every six months. RESULTS: Out of 135 CPP patients, 123 were idiopathic and twelve had neurogenic problems. At the baseline, patients' average bone age (BA) was significantly older than chronologic age (CA) and PAH was significantly shorter than target height (TH). BA and CA were significantly older in group II, but the BA/CA ratio was significantly greater in group I. The average treatment period required to overcome the CA-BA difference was 4.64 yr (group I vs II; 7.98 yr vs 4.24 yr, P < 0.01), and the period needed to overcome PAH-TH difference was 2.49 yr (group I vs II; 4.37 yr vs 2.32 yr, P < 0.01). CONCLUSION: Among the girls with CPP, the younger age group had more advanced BA than CA, and needed significantly longer treatment periods to overcome the BA-CA gap and PAH-TH gaps.
Adult ; Gonadotropin-Releasing Hormone ; Humans ; Piperazines ; Puberty, Precocious