PURPOSE: Direct injection of doxorubicin into the eyelids results in permanent loss of muscle fiber and it is considered an attractive nonsurgical method in essential blepharospasm therapy. However, necrosis of skin overlying orbicularis oculi muscle is the most serious side effect of this therapy. The purpose of this study is to determine the effect of doxorubicin delivered by osmotic pump which release doxorubicin slowly, and to evaluate the degree of overlying skin injury following chemical myectomy. METHODS: Thirty three rabbits were assigned to three groups according to the doxorubicin concentration. The first group received direct injections of 0.5 mg doxorubicin diluted in 0.1 ml of saline in the right lower eyelid. and osmotic pump was inserted into the left lower eyelid which contained 0.5 mg doxorubicin in 0.1 ml of saline. The second group received 1 mg doxorubicin and the third group received 2 mg doxorubicin. Eight weeks after injection, the eyelids were assessed for the degree of muscle fiber loss microscopically. For the evaluation of functional change of muscle, an EMG study was carried out. RESULTS: Skin necrosis developed in all rabbits except for one which received injection of 0.5 mg doxorubicin. Skin necrosis appeared earlier in the direct injection group. The duration of skin necrosis was shortened at lower concentrations(0.5 mg, 1.0 mg) with a pump delivery(P<0.05). But there was no statistical differences in the 2.0 mg concentration. The size of necrosis was much smaller in rabbits using pump delivery than those of direct injection group in high doxorubicn concentrations(1.0 mg, 2.0 mg)(P<0.05). The total size of muscle fiber was decreased after a doxorubicin injection. There was no statistical difference between the direct injection group and the pump group(P<0.05). The similar effect on the muscle was noted regardless of the slow release of the doxorubicin into the muscle. Light microscopic study demonstrated destructive change of muscle and it was replaced by connective tissues. Electron microscopic study showed destruction of micro-architecture of muscle fibers. Functionally, in EMG study, there was no motor activity in the injection area. But some motor unit potentials appeared in the periphery of skin necrosis site. CONCLUSIONS: These results suggest that the osmotic pump may be used as an effective adjuvant in preventing skin necrosis in blepharospasm treatment.
Blepharospasm ; Connective Tissue ; Doxorubicin* ; Eyelids* ; Motor Activity ; Necrosis* ; Rabbits ; Skin*

No abstract available.
Alopecia Areata ; Alopecia ; Humans ; Prognosis

We report 10 cases of the patients with telecanthus undergone modified transnasal wiring procedure between May, 1986 and December, 1990. The procedure of this operation is characterized as follow: Each wire is traversed through 2 holes in nasal bone to the medial canthal ligament. After piercing through the ligament, the wire is returned to the opposite medial canthal ligament over the nasal bone. Ultimately 2 ends of each wire are tied together on one side without silicone sheath. We believe that this modified procedure is more effective and simple for the correction of telecanthus with less recurrence rates than conventional method.
Humans ; Ligaments ; Nasal Bone ; Recurrence ; Silicones

Squamous cell papilloma is one of epitheial tumors. Squamous cell papilloma of the lacrimal sac is so rare that the indrvidual clinician rarely acquires substantial experience in their management. The patients with benign squamous cell papilloma present with epiphora, palpable mass and bloody discharge that can be mistaken clinically as evidence of chronic dacryocystitis. The choice of treatment is simple excision and recurrence rate is approximately 20-30%. Most of the papilloma does not reveal any malignant change. We experienced a 40-year-old woman who had a soft, irregular surfaced palpable mass and unilateral epiphora for one year in the lower lid and inner canthus of the left eye. We treated with dacryocystectomy including tumor mass. The histopathologic evaluation revealed the tumor to be a benign squamous cell papilloma. The general conditions of the patient and operation sites are good so, we present our case with a brief review of the literature.
Adult ; Dacryocystitis ; Female ; Humans ; Lacrimal Apparatus Diseases ; Papilloma* ; Recurrence

It has been known that right ACA occlusions can cause callosal disconnection syndrome. A 61-year old right-handed man was admitted because of a left ACA occlusion. MRI showed infarction of the medial frontal cortex and the anterior two-thirds of the corpus callosum. He presented with weakness and gait initiation failure in the right leg with grasp reflex, suspicious alien hand sign, and tactile anomia in the right hand. He was diagnosed with transcortical motor aphasia. He was unable to successfully complete written tasks in response to dictations and writing down spontaneous answers. He wrote down incorrect words and demonstrated paragraphism with his left hand. He could copy simple items but not written words and complex items with his left hand. Finally, he had difficulties in writing answers in response to complex verbal and written commands with his left hand, but preserved the ability to simple verbal commands, somato-sensory, and visually guided tasks. We attribute these results to the anterior callosal disconnection of the right sensorimotor cortex from the left language area.
Anomia ; Anterior Cerebral Artery ; Aphasia, Broca ; Corpus Callosum ; Emigrants and Immigrants ; Gait ; Hand ; Hand Strength ; Humans ; Infarction ; Leg ; Magnetic Resonance Imaging ; Middle Aged ; Reflex ; Writing

No abstract available.
Adult* ; Humans

No abstract available.
Adult* ; Humans

Experiences of 26 cases of electrical bone stimulation on normal adult rabbits was documented in this paper. The cathodic electrode was introduced longitudinally into the medullary cavity of the proximal tibia and the anodic electrode was introduced transversely in the distal femur of the same side. The contralateral tibia was used as the control, of which the Teflon coated Kirschner wire was introduced longitudinally into the medullary cavity. 10uA of direct current was passed continuously through the fixed wires between the proximal tibia and distal femur. At the second, fourth and sixth week, random bone scan with 99m-Tc was performed and the animals were sacrificed. The specimen X-rays of the tibia and femur were taken and the specimens were prepared for the microscopic study. The followings are obtained from this experimental study. 1. The rate of new bone formation is 69.2% in the stimulated group and 7.7% in the control group. There were also fibrosis and cartilage formation as well as the new bone formation. The fibrosis and cartrilage formation are observed only in the electrically stimulated side and their occurances are 69.2% and 11.1% respectively. So The new bone formation and fibrosis are definitely increased in the bones of the cathodic electrical stimulation than those of the control side. 2. The intramembraneous ossification is the predominent feature of this electrically stimulated new bone formation. 3. Bone and soft tissue necrosis was the main microscopic feature in the anode side. 4. Since new bone, fibrous tissue and sometimes new cartilage were observed in this study, it seems that the cathodic electrical stimulation is not specific for the new bone formation, but induce crude tissues such as bone, cartilage, fibrous tissue or vessels. Furthermore, it can be postulated that the 10uA electrical stimulation is only one of the best electrical environment for the formation of the crude tissues, especially for bone and fibrous tissue.
Adult ; Animals ; Cartilage ; Electric Stimulation ; Electrodes ; Femur ; Fibrosis ; Humans ; Necrosis ; Osteogenesis ; Polytetrafluoroethylene ; Rabbits ; Tibia

PURPOSE: This study was to examine the relationships between knowledge with same sub-areas of education needs and adherence to self-management guidelines, and to investigate the factors that influence adherence. METHOD: One hundred eleven patients with terminal stage of kidney failure were conveniently selected from a university hospital in Incheon. RESULTS: The level of knowledge was high, with a mean score of 15.25. The level of adherence to self-management guidelines was low, with a mean score of 64.53. The patients' education needs were high. The significant influencing factors on adherence were gender, educational level, and two sub-areas of knowledge, 'exercise and daily life' and 'follow-up care and treatment'. CONCLUSION: Relationships between knowledge, education needs, and adherence should be further examined before developing and implementing intervention programs for adherence to treatment guideline in hemodialysis patients.
Humans ; Renal Dialysis ; Renal Insufficiency ; Self Care

PURPOSE: Keratomileusis was performed in rabbits to investigate the effects of corneal epithelium on the corneal stromal keratocyte apoptosis and the effect of human IL-1alpha and TNFalpha on apoptotic genes in human corneal stromal cells was evaluated. METHODS: Fifty six New Zealand white rabbits underwent corneal flap procedure and corneal epithelium was inserted between the corneal flap and underlying stroma. Keratocyte apoptosis was detected with the TUNEL assay. Gene array technique was used to evaluate changes in apoptosis gene in human stromal fibroblasts in response to human recombinant IL-1alpha and TNFalpha in vitro. RESULTS: Keratocyte apoptosis was significantly greater in group for flap with insertion of peripheral epithelium at 4 hours after surgery(p=0.0249). IL-1alpha or TNFalpha regulated the expression of several genes (insulin like growth factor, stress activated protein kinase, GTP binding protein, IGFBP4) up and down in human stromal fibroblasts in culture. CONCLUSIONS: We think that the differences in the stromal cell apoptosis after keratomileusis were due to stromal cell response to various factors of inserted corneal epithelium. We found various new apoptosis gene expression in cultured human keratocytes mediated by IL-1alpha and TNFalpha that were secreted in corneal epithelium. These genes likely trigger the apoptosis of keratocyte following epithelial insertion associated with corneal surgery.
Apoptosis* ; Epithelium ; Epithelium, Corneal* ; Fibroblasts ; Gene Expression ; GTP-Binding Proteins ; Humans ; In Situ Nick-End Labeling ; Keratomileusis, Laser In Situ ; Protein Kinases ; Rabbits ; Stromal Cells ; Tumor Necrosis Factor-alpha