We evaluated retrospectively the clinical records of 46 cases of Duanes retraction syndrome. The purpose of this study is to demonstrate a clinical characteristics of this syndrome and improvement of abnormal head posture and degree of deviation in 14 cases undergoing operation. Unilateral manifestation was in 42 cases and 4 cases were involved bilaterally. Left eye was involved predominantly in 29 cases (63.0%). The frequencies analyzed according to Hubers classification were that Type I was 64.3%, Type II 7.1%, and Type III 28.6% in unilateral cases. Of unilateral cases, compensatory face turn was exhibited in 65.2% of Type I, 100% of Type II, and 60.0% of Type III. In primary position, 44.4% of Type I had esodeviation, and 100% of Type II ad 83.3% of type III had exodeviation. The major concerns of most patients or their parents were the correction of strabismus and gaze limitation, but they hardly recognized abnormal head posture. The correction of abnormal head posture and strabismus was achieved in 78.6% postoperatively.
Classification ; Duane Retraction Syndrome* ; Esotropia ; Exotropia ; Head ; Humans ; Parents ; Posture* ; Retrospective Studies ; Strabismus

PURPOSE: We expected the motion fraction could be checked, with simple radiographic examination, according to the guide-line of fluoroscopic technique, and recovery of the function also could be correlated with the improvement of the motion fraction. MATERIALS AND METHODS: We measured the motion fraction of the glenohumeral and scapulothoracic movement using fluoroscope in 30-degree intervals of arm elevation in the scapular plane. The ratio of glenohumeral to scapulothoracic movement (thetaGH/thetaST) was 1.6 for the full range of motion in scapular plane. During arm elevation, scapular tilting from the coronal plane was decreased from 42 degrees to 20 degrees tilting as well as internal rotation (scapular extension). We also measured the motion fraction (thetaGH/thetaST) and functional recovery of the shoulder in 11 patients after operative treatment of the shoulder instability in 15 patients from December 1996 to August 1997. RESULTS: We could find out a significant correlation between the recovery of motion fraction and shoulder function. These results would be applied in planing rehabilitation program after treatment of the shoulder instability. CONCLUSIONS: The measuring technique of glenohumeral to scapulothoracic movement (thetaGH/thetaST) with fluoroscopy could be applied to the simple radiographic measurement at the out-patient clinic in order to identify the pathology and recovery of shoulder motion after treatment
Arm ; Fluoroscopy ; Humans ; Outpatients ; Pathology ; Range of Motion, Articular ; Rehabilitation ; Shoulder*

More women have died from cardiovascular disease since middle 1980's than men due to the women's older age and multiple comorbid conditions. Additionally, women with acute coronary syndrome have worse outcomes, including sudden cardiac death and death before arriving to the hospital, due to the women's atypical symptoms and the delayed diagnosis and treatment. There are many reports on the gender-specific differences in the pathophysiology of ischemic heart disease. In addition to the previous reports, the WISE study was started for improving both our understanding and the clinical outcomes of ischemic heart disease of women. These studies have suggested the structural and functional differences in the female vasculature, new paradigms for the diagnosis and treatment of the ischemic heart disease of women, the various roles of estrogen and the new therapeutic targets for preventing ischemic heart disease (IHD) or improving cardiovascular outcomes. On-going and future studies should focus on further understanding of the pathophysiology, the clinical usefulness of the new diagnostic markers that may related to the IHD of women, and the development of non-invasive, easily reproducible diagnostic tools for early detection of IHD and for predicting the adverse outcomes.
Acute Coronary Syndrome ; Cardiovascular Diseases* ; Death, Sudden, Cardiac ; Delayed Diagnosis ; Diagnosis ; Estrogens ; Female ; Humans ; Male ; Myocardial Ischemia

To evaluate the utility, safety, and reliability of diode laser endophotocoagulation in proliferative diabetic retinopathy, seventy-two consecutive eyes treated with diode endophotocoagulation were studied. A retrospective control group of 62 consecutive eyes undergoing vitrectoiny with argon laser endophotocoagulation was also studied. Minimal period of follow-up was 3 months. Final visual acuity was improved in 44 eyes (61.1%), and was 5/200 or better in 45 eyes (62.5%) with diode endophotocoagulation. In comparison, final visual acuity was irnproved in 40 eyes (64.5%), and was 5/200 orbetter in 37 eyes (61.6%) for argon endophotocoagulation. A rupture of Bruch`s rneinbrane was developed in 2 eyes with diode laser treatment, and a retinal hemorrhage was developed in one eye with argon laser treatment. No statistically significant difference was found between the two groups regarding the rate of visual iniprovement and final visual results. This study supports the conclusion that the diode laser is as effective for the endophotocoagulation in proliferative diabetic retinopathy as argon laser treatment.
Argon ; Diabetic Retinopathy ; Follow-Up Studies ; Lasers, Semiconductor* ; Retinal Hemorrhage ; Retrospective Studies ; Rupture ; Visual Acuity

Pseudomembranous colitis (PMC) is a nosocomial and opportunistic infection caused by Clostridium difficile. PMC is related to the use of antibiotics leading to intestinal dysbiosis and an overgrowth of C. difficile. Metronidazole or vancomycin is considered to be the standard therapy for the management of PMC. However, PMC has a 15%-30% recurrence rate and can be refractory to standard treatments, resulting in morbidity and mortality. Here we describe a patient who experienced refractory PMC who was treated with fecal microbiota transplantation. A 69-year-old woman was admitted to the hospital with consistent abdominal pain and diarrhea, which had been present for 5 months. She was diagnosed with PMC by colonoscopy and tested positive for C. difficile toxin. Even though she took metronidazole for 10 days, followed by vancomycin for 4 weeks, her symptoms did not improve. Because of her recurrent and refractory symptoms, we decided to perform fecal microbiota transplantation. Fifty grams of fresh feces from a donor were obtained on the day of the procedure, mixed with 500 mL of normal saline, and then filtered. The filtered solution was administered to the patient's colon using a colonoscope. After the procedure, her symptoms rapidly improved and a follow-up colonoscopy showed that the PMC had resolved without recurrence.
Abdominal Pain ; Aged ; Anti-Bacterial Agents ; Clostridium difficile ; Colon ; Colonoscopes ; Colonoscopy ; Diarrhea ; Dysbiosis ; Enterocolitis, Pseudomembranous* ; Feces ; Female ; Follow-Up Studies ; Humans ; Metronidazole ; Microbiota ; Mortality ; Opportunistic Infections ; Recurrence ; Tissue Donors ; Vancomycin

BACKGROUND: This study was designed to examine whether iNOS pathway is pathologically altered in experimental diabetic nephropathy and whether therapy with ACE inhibitor (imidapril: I) or angiotensin II type 1 receptor (AT1) blocker (L-158, 809: L) ameliorates these changes. METHODS: Male SD rats were injected with diluent (control: C) or streptozotocin. Diabetic (D) rats were then randomized to receive vehicle, I (2 mg/ kg/d) or L (1 mg/kg/d) by gavage. At the end of the 12-week treatment, rats underwent either a 4 hour placebo or an intraperitoneal LPS (2 mg/kg) challenge. Inducible NOS mRNA and protein were measured by RT-PCR and Western blot in isolated glomeruli. RESULTS: Systolic blood pressure and urinary protein excretion increased significantly in D rats compared with C. The basal expression of iNOS mRNA was increased in D rats compared with that of C, whereas there was no significant difference in the level of protein. Upon LPS stimulation, the iNOS mRNA and protein expression was significantly elevated in D rats. In D rats, this up-regulation of LPS-stimulated iNOS expression was equally ameliorated by both I and L in mRNA and protein levels. CONCLUSION: LPS-stimulated glomerular iNOS expression was enhanced in diabetic nephropathy, and the activation of angiotensin II may play a role in this enhancement.
Angiotensin II* ; Angiotensins* ; Animals ; Blood Pressure ; Blotting, Western ; Diabetic Nephropathies ; Humans ; Male ; Nitric Oxide Synthase Type II* ; Rats* ; Receptor, Angiotensin, Type 1 ; RNA, Messenger ; Streptozocin ; Up-Regulation

BACKGROUND AND OBJECTIVES: It is not well understood whether the left ventricular geometry is associated with such diastolic parameters as the left atrial volume and the left ventricular filling pressure, as assessed by the Doppler indices. Accordingly, this study aimed to evaluate the influence of the left ventricular geometry on the left atrial volume and the left ventricular filling pressure, as assessed by the Doppler indices. SUBJECTS AND METHODS: 181 patients (mean age: 63+/-9 years old, 62 males) with hypertension were included for echocardiographic analysis. The hypertensive patients were classified into four groups according to the left ventricular mass index and the relative wall thickness: normal geometry, concentric remodeling, eccentric hypertrophy and concentric hypertrophy. We excluded all the individuals with established cardiovascular disease, atrial fibrillation, significant aortic and/or mitral valve disease, or an ejection fraction <50%. RESULTS: By definition, the left ventricular mass was increased in the patients with eccentric and concentric hypertrophy. Both the left ventricular end-systolic diameter and the left ventricular end-diastolic diameter were reduced in the concentric remodeling group, whereas the left ventricular end-systolic diameter and the left ventricular end-diastolic diameter were increased in the eccentric and concentric hypertrophy groups. Compared with the patients with normal geometry, the patients with eccentric and concentric hypertrophy demonstrated a significant higher value for the left atrial volume index. The ratio of the transmitral inflow velocity to the mitral annular velocity (E/E') showed a stepwise increase from the patients with normal geometry to the patients with concentric remodeling, and then to the patients with eccentric and concentric hypertrophy. CONCLUSION: This study demonstrates that in a patient population with hypertension and who are without systolic dysfunction, the left atrial volume index and the E/E' demonstrated a progressive worsening of the left ventricular diastolic function from patients with normal geometry to the patients with concentric remodeling, and then to the patients with eccentric and concentric hypertrophy.
Atrial Fibrillation ; Cardiovascular Diseases ; Echocardiography ; Echocardiography, Doppler ; Heart Atria ; Humans ; Hypertension ; Hypertrophy ; Mitral Valve ; Ventricular Remodeling

BACKGROUND AND OBJECTIVES: Dysfunction of arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs) contributes significantly to morbidity and hospitalization in the dialysis population. We evaluated the primary patency of AVFs following percutaneous transluminal angioplasty (PTA) in haemodialysis patients. SUBJECTS AND METHODS: We performed 231 interventions in 118 patients with a mean age of 62.1+/-12.9 years. We performed 122 interventions in 53 AVG patients (44.9%), and 109 interventions in 65 AVF patients (55.1%). If there was thrombosis of the vascular access, urokinase was administered and/or thrombus aspiration was performed. The stent was inserted when balloon dilatation did not expand sufficiently or elastic recoil occurred. RESULTS: For the 118 patients, the median patency time was 10.45+/-10.29 months at 92 months of follow-up. The primary patencies for stenotic AVFs at 6, 12, 24, 36, 48, and 60 months were 63.4%, 41.4%, 17.0%, 9.7%, 7.3%, and 2.4%, respectively. The primary patencies for AVGs at 6, 12, 24, and 36 months were 36.9%, 19.5%, 10.8%, 2.1%, respectively, and were obtained by means of the Kaplan-Meier analysis (log rank=6.42, p<0.05). The median patency time was 11.0 months and 4.45 months in the non-thrombus and thrombus groups, respectively. The complication rate was 1.73% (4/231); two cases of pseudoaneurysms and two cases of extravasation were detected. All therapy failures (5/231) occurred in thrombotic lesions of AVGs and were treated surgically. CONCLUSION: PTA is an efficacious method for the correction of stenosis of AVFs for hemodialysis, thus prolonging the patency of the fistulas.
Aneurysm, False ; Angioplasty ; Arteriovenous Fistula ; Constriction, Pathologic ; Dialysis ; Dilatation ; Fistula ; Follow-Up Studies ; Hospitalization ; Humans ; Kaplan-Meier Estimate ; Renal Dialysis ; Stents ; Thrombosis ; Transplants ; Urokinase-Type Plasminogen Activator

Eisenmenger's syndrome is defined as a high pulmonary vascular resistance associated with pulmonary hypertension or high pulmonary pressure close to systemic values with a reverse or bidirectional shunt at aortopulmonary, interventricular or interatrial levels. We report the case of a 42-year-old woman with an emergency operation for ovarian bleeding with Eisenmenger's syndrome secondary to large VSD. She had abdominal pain and vaginal spotting which developed one month earlier. In a preoperative abdominal ultrasonography, there was a fluid collection on the Cul-de-sac. There was no significant cardiorespiratory symptom except peripheral cyanosis. Anesthesia was performed with fentanyl, midazolam and vecuronium in standard monitorings including pulmonary artery pressure monitoring. Bolus and continuous infusions of amrinone were given to decrease right to left shunt. After the administration of amrinone, PaO2, PaO2/FiO2, P(A-a)O2 and P(a/A)O2 were improved and pulmonary arterial pressure was preferentially decreased compared with systemic arterial pressure. There was no significant problem throughout the operation, a right ovarian wedge resection. She was transferred to the intensive care unit in an intubated state postoperatively and discharged one week later without any complications.
Abdominal Pain ; Adult ; Amrinone ; Anesthesia ; Arterial Pressure ; Cyanosis ; Eisenmenger Complex* ; Emergencies ; Female ; Fentanyl ; Hemorrhage* ; Humans ; Hypertension, Pulmonary ; Intensive Care Units ; Metrorrhagia ; Midazolam ; Pulmonary Artery ; Ultrasonography ; Vascular Resistance ; Vecuronium Bromide

BACKGROUND: Anemia is associated with worse long term outcomes in heart failure. However, there is little evidence on the effect of low hemoglobin level to the left ventricular (LV) structure and diastolic function in hypertensive patients. This study assessed the relationship of hemoglobin level to LV filling pressure in elderly hypertensive patients. METHODS: From January 2005 to January 2009, 200 newly diagnosed hypertensive patients over 50 years old (mean age 60 +/- 6 years, 116 women) were analyzed. The clinical parameters and comprehensive echocardiographic data were obtained. The patients with and without anemia were compared. RESULTS: There were significant differences between the anemic and non-anemic groups in the LV mass index (115.27 +/- 34.95 vs. 103.75 +/- 28.21 g/m2), left atrial (LA) volume index (29.31 +/- 10.74 vs. 24.99 +/- 7.43 mL/m2), and E/E' (11.92 +/- 4.34 vs. 9.37 +/- 2.51). Chronic renal failure was more prevalent in anemic group. On multivariate logistic analysis, anemia was significantly correlated with high LV filling pressure, reflected by E/E', even after controlling for LV mass index and LA volume index. Furthermore, E/E' was significantly correlated with the hemoglobin level (R2 = 0.093, p < 0.001). CONCLUSION: In newly-diagnosed hypertensive patients over 50 years old, the presence of anemia was significantly associated with elevated LV filling pressure and LV structural changes. And the hemoglobin level was negatively correlated with noninvasively estimated LV filling pressure.
Aged ; Anemia ; Heart Failure ; Hemoglobins ; Humans ; Hypertension ; Kidney Failure, Chronic