The human oral mucosa has noncornified lining epithelium, cornified masticatory epithelium, and complex epithelium. The epithelium of human tongue shows diverse morphological variations from one site to another, and conflicting reports exist in the literature concerning the type of lingual epithelium. Cytokeratin[CK] have been shown to characterize different type of epithelia. In the present study to clarify intermediate filament patterns of tongue mucosa and lingual gland in human fetus from second trimester of pregnancy and adult, cytokeratin expression was investigated immunohistochemically using antibodies for cytokeratins in the dorsal surface of tongue, taste bud, and lingual gland, and comparison with the expression between fetus and adult was made. The epithelium of the fetal lingual papillae consisted of 4 to 6 layered stratified cells, and that of the inferior surface of tongue consisted of 6-8 layered stratified cells in PAS-hematoxylin stain. The lingual gland was well differentiated and the alveolus was strongly positive to PAS reaction. The dorsal surface of the adult tongue was composed of lingual papillae. The papillae was covered by keratinized stratified squamous epithelium and interpapillary area by nokeratinized epithelium in hematoxylin-eosin stain. The taste bud was present in the fungiform papilla. The lingual gland appeared among the muscle layers near the inferior surtace and was composed of mucous and serous cells. By immunohistochemical stain, the epithelium of the lingual papillae exhibited various staining-intensities for cytokeratin antibodies, and showed same staining patterns bosh epithelium in tip of papilla and interpapillary area in fetus. However, the dorsal epithelium of the adult tongue showed different staining patterns between tip of the papilla and interpapillary area. In fetal lingual papilla CK7 and CK8 were expressed in superficial cells, AE8 in intermediate and superficial cells, CKl4 in basal cells. MNFI116 and AE3 showed a strong reaction in basal and suprabasal cells. The epithelium of the inferior lingual surface reacted positively with AE8 and CK14, MNF116, and AE3. CK7 and CK8, however, were not reacted. In adult lingual papilla CK10 was expressed in superficial cells of the tip of the papilla, AE8 in suprabasal cells of interpapillary epithelium, CKl4 in basal cells of papillary and interpapillary epithelium, CKl9 in superficial cells of interpapillary epithelium, MNFI116 and AE3 in suprabasal cells of papillary and interpapillary epithelium. However, CK7, CK8, CK18, and 5D3 were not expressed in the epithelium of the dorsal tongue. The cells of taste bud in fetus showed positive reactions for CK7, CK8, MNF116, and AE3, but negative reactions with CK10 and AE8. The cells of taste bud in adult were stained with CK7, CK8, CK18, and MNF116, but not stained with CK10 and AE8. In lingual gland of fetus, CK7, CK8, CKl8, 5D3, MNF116, and AE3 were expressed in alveolar cells. Only CK10 gave a negative staining in ductal cells. The mucous cells of the adult lingual gland were reacted with CK7, CK10, CK18, CK19, and MNF116, and the serous cell with CK7, CK19, and MNF116. The ductal cells of the adult lingual gland were stained with CK7, AE8, CK18, CKl9, 5D3, MNF116, and AE3. CK14 was expressed in the cells of intralubular ductule, not in the ductal cells. By electron microscopy, the epithelia of both dorsal and inferior lingual surfaces in fetus consisted of nonkeratinized stratified squamous epithelium. A cell with clear cytoplasm and some dense granules was noted among the basal cells. These results indicate that the epithelium of fetal lingual papillae is non-keratinized type and the epithelium of the papillary tip is keratinized type and interpapillary epithelium is nonkeratinized type in adult, and suggest that the superficial cell containing cytokeratins 7 and 8 in dorsal lingual epithelium of fetus has a similar role to the periderm of fatal skin.
Adult ; Antibodies ; Cytoplasm ; Epithelium* ; Female ; Fetus* ; Humans* ; Immunohistochemistry ; Intermediate Filaments ; Keratins ; Microscopy, Electron ; Mouth Mucosa ; Mucous Membrane ; Negative Staining ; Periodic Acid-Schiff Reaction ; Pregnancy ; Pregnancy Trimester, Second ; Skin ; Taste Buds ; Tongue

OBJECTIVE: This study was conducted to evaluate the incidence, the optimal timing of screening examinations for retinopathy of prematurity(ROP) and to analyze perinatal risk factors associated with cryotherapy or lasertherapy(CT/LT) in ROP. METHODS: Medical records of 130 very low birth weight(VLBW) infants who admitted to the NICU of Wonkwang University Hospital from July 1997 to June 2002 were reviewed retrospectively. We evaluated the incidence and severity of ROP by gestational age(GA) and birth weight(BW). And the comparisons of perinatal risk factors between ROP with and without CT/LT have been made. RESULTS: Incidence of ROP was 36.9% and mean GA and BW were 29.1+/-1.99 weeks, 1,153+/-209 gm in VLBW infants respectively. ROP Stage II or greater was 15.4% of VLBW infants, 41.7% of ROP infants, and 27.1% of ROP infants were treated with CT/LT. All infants with BW <750gm or GA <26 weeks were developed ROP with stage II or greater and treated with CT/LT. First detection of ROP was performed at chronologic age(CA) 3 weeks, postconceptional age(PCA) 30 weeks, and first identification of threshold ROP needed with CT/LT were at CA 5 weeks and PCA 33 weeks. The perinatal risk factors with CT/LT for ROP were significant in GA, BW, Apgar score at 1 and 5 minutes and number of blood transfusion. The mean time of spontaneous regression is 13.4+/-8.8 weeks in the mild ROP infants without CT/LT. CONCLUSION: The incidence of ROP is 36.9% and the optimal timing of screening for ROP should be selected by earlier time in 2 guidelines of at 5 weeks of CA and 33 weeks of PCA in VLBW infants. And the related risk factors with CT/LT for threshold ROP were GA, BW and Apgar score at 1 and 5 minutes and number of blood transfusions.
Apgar Score ; Blood Transfusion ; Cryotherapy ; Humans ; Incidence* ; Infant* ; Infant, Very Low Birth Weight* ; Mass Screening* ; Medical Records ; Parturition ; Passive Cutaneous Anaphylaxis ; Retinopathy of Prematurity* ; Retrospective Studies ; Risk Factors*

BACKGROUND: Geriatric patients undergoing hip arthroplasty are generally considered to be at high risk for anesthesia and surgery. Thus, the evaluation of safe anesthetic methods for hip arthroplasty in geriatric patients is important and necessary. METHODS: 228 geriatrics, either sex, older than 65 years, who were performed hip arthroplasty from Mar. 1985 to Jun. 1995, were investigated for anesthetic techniques, postoperative complications and the other problems, retrospectively. According to the kinds of anesthetic techniques, the items including primary indication for operation, name of operation, blood loss, perioperative complications, time from the end of operation to the first analgesic requirement and frequency of analgesic requirements for postoperative 72 hours were analyzed. RESULTS: The mean age of the patients with caudal anesthesia was significantly higher than that with general inhalation anesthesia. The blood loss in patients with epidural anesthesia was significantly more than that in hypobaric spinal anesthesia. The most frequent perioperative complications were cardiovascular problems including hypotension, hypertension, arrythmias, and myocardial infarction. The numbers of analgesic requirement within the postoperative 72 hours was the lowest in epidural anesthesia. There was one postoperative fatal case, whose the cause of death was found to pulmonary thromboembolism by autopsy. CONCLUSIONS: This study suggested that there were many risks for anesthesia and operation in geriatric patients with hip arthroplasty, and the cardiovascular complications were the most frequent. Thus, for hip arthroplasty in geriatrics, the choice of optimal anesthetic techniques depending on the patients physical status and physicians skill should be emphasized with the proper perioperative anesthetic management.
Analgesia ; Anesthesia* ; Anesthesia, Caudal ; Anesthesia, Epidural ; Anesthesia, Inhalation ; Anesthesia, Spinal ; Arrhythmias, Cardiac ; Arthroplasty* ; Autopsy ; Cause of Death ; Geriatrics* ; Hip* ; Humans ; Hypertension ; Hypotension ; Myocardial Infarction ; Orthopedics ; Postoperative Complications ; Pulmonary Embolism ; Retrospective Studies*

BACKGROUND: The actions of mivacurium (MVC), a new benzylisoquinolinium nondepolarizing neuromuscular blockade, may be potentiated if preceded by succinylcholine (SCh). Additionally, the interaction between inhalational anesthetics and MVC has not yet been established in the cat. The effect of enflurane or isoflurane on the neuromuscular blocking action of MVC by preadministrated succinylcholine was evaluated. METHOD: Twelve cats, either sex, were assigned into two groups, based on the preadministration of succinylcholine (SCh) what about the sciatic nerve-anterior tibialis preparation, cumulative dose-response study and the estimation of recovery profiles from the twitch depression of about 95 % under pentobarbital, isoflurane or enflurane anesthesia was done. The ED50, ED95 and the recovery profiles were compared. RESULTS: The ED50 and ED95 under isoflurane (24.5 & 37.3) and enflurane (20.6 & 32.1) were significantly lower than those under pentobarbital anesthesia(28.4 & 42.9 ug/kg, respectively) without preadministrated SCh. The effective doses of MVC with preadministrated SCh had the same manner. The recovery profiles under enflurane anesthesia were significantly slower than those under pentobarbital anesthesia. The higher the recovered twitch height under enflurane anesthesia, the slower the recovery speed. CONCLUSION: The potency of MVC and recovery profiles under inhalation anesthetics are greater than those under pentobarbital. However, preadministrated SCh causes no significant difference in its potency or recovery.
Anesthesia ; Anesthetics ; Anesthetics, Inhalation ; Animals ; Cats* ; Depression ; Enflurane* ; Isoflurane* ; Neuromuscular Blockade* ; Pentobarbital ; Pharmacology ; Succinylcholine*

Purpose: To report two cases of massive subretinal fluid accumulation at laser irradiated sites after photodynamic therapy in patients with age-related macular degeneration (ARMD).Case summary: (Case 1) A patient with bilateral polypoidal choroidal vasculopathy, who was treated with half-dose verteporfin photodynamic therapy (PDT), developed decreased visual acuity. On fundus examination, massive subretinal fluid accumulation was observed in the laser irradiated sites of both eyes. The subretinal fluid was reabsorbed without further treatment, and the patient's visual acuity has recovered. (Case 2) A patient with ARMD, accompanied by a choroidal neovascular membrane and accumulation of subretinal fluid in the right eye, developed decreased visual acuity on the treated eye a day after receiving half-dose PDT treatment. On fundus examination, the subretinal fluid in the right eye had increased more than 5-fold compared to pre-treatment levels. After one week, the amount of subretinal fluid decreased and the patient's visual acuity improved. However, since retinal exudate still remained, intravitreal bevacizumab treatment was administered. Thereafter, the patient’s fundus findings were unremarkable. Conclusions In the case of photodynamic therapy for ARMD, a large amount of subretinal fluid may occur as a rare complication. The subretinal fluid was naturally absorbed, but close observation is needed with the possibility of developing subretinal fluid in the event of decreased vision after photodynamic therapy.

PURPOSE: Blind individuals who have photoreceptor loss are known to perceive phosphenes with electrical stimulation of their remaining retinal ganglion cells. We proposed that implantable lateral geniculate body (LGB) stimulus electrode arrays could be used to generate phosphene vision. We attempted to refine the basic reference of the electrical evoked potentials (EEPs) elicited by microelectrical stimulations of the optic nerve, optic tract and LGB of a domestic pig, and then compared it to visual evoked potentials (VEPs) elicited by short-flash stimuli. METHODS: For visual function measurement, VEPs in response to short-flash stimuli on the left eye of the domestic pig were assessed over the visual cortex at position Oz with the reference electrode at Fz. After anesthesia, linearly configured platinum wire electrodes were inserted into the optic nerve, optic track and LGB. To determine the optimal stimulus current, EEPs were recorded repeatedly with controlling the pulse and power. The threshold of current and charge density to elicit EEPs at 0.3 ms pulse duration was about ±10 microA. RESULTS: Our experimental results showed that visual cortex activity can be effectively evoked by stimulation of the optic nerve, optic tract and LGB using penetrating electrodes. The latency of P1 was more shortened as the electrical stimulation was closer to LGB. The EEPs of two-channel in the visual cortex demonstrated a similar pattern with stimulation of different spots of the stimulating electrodes. We found that the LGB-stimulated EEP pattern was very similar to the simultaneously generated VEP on the control side, although implicit time deferred. CONCLUSIONS: EEPs and VEPs derived from visual-system stimulation were compared. The LGB-stimulated EEP wave demonstrated a similar pattern to the VEP waveform except implicit time, indicating prosthetic-based electrical stimulation of the LGB could be utilized for the blind to perceive vision of phosphenes.
Animals ; Electric Stimulation ; Electrodes, Implanted ; Evoked Potentials, Visual/*physiology ; Geniculate Bodies/*physiology ; Male ; Optic Nerve/physiology ; Optic Tract/physiology ; Photic Stimulation ; Sus scrofa ; Visual Cortex/*physiology

Gleno-humeral joint is a ball and socket joint. It has the greatest range of movement among all the joints of the body. The greatest range of movement is inevitably accompanied by a considerable loss in stability. Thirty-three persons underwent Double contrast CT arthrography of the shoulder for the evaluation of suspected shoulder derangement. We performed 62 shoulder arthrography(33 abnormal shoulders and 29 normal shoulders) and reviewed their findings retrospectively. They had recurrent shoulder dislocation(30 shoulders) or nonspecific shoulder pain(3 shoulders). Injury of the glenoid labrum was seen in 28 shoulders at double contrast CT arthrography. Among 28 cases of the labral injury, detachment was seen in 15 cases, labral tear in 5 cases, and labral erosion in 8 cases. Double contrast CT arthrography also showed Hill-Sachs in 20 shoulders. The numbers of type 1, type 2, and type 3 capsulolabral attachment in 33 shoulder instability cases were 10, 16, and 7, respectivity, while, 16, 12, and, 1 in 29 normal controls. Type 2 and 3 are more common in shoulder instability group than normal control group. Operation was done in 18 shoulders. Comparing with operation findings, the sensitivity of double contrast CT arthrography in the detection of Hill-Sachs defect was 100% with the specificity of 71% and the accuracy of 89%. The sensitivity, and accuracy of double contrast CT arthrography in the detection of labral injury were 94%, 100%, and 95, respectively. Double contrast CT arthrography is a minimally invasive and highly accurate technique for in the evaluation of glenohumeral instability.
Arthrography ; Humans ; Joints ; Retrospective Studies ; Sensitivity and Specificity ; Shoulder* ; Tears

BACKGROUND: Patients are most likely to develop severe arterial desaturation during the early postoperative period. Respiratory complications in postanesthesia care unit (PACU) increase the risk of major adverse cardiac outcomes, unanticipated ICU admission or delay in PACU discharges. The increased use of inhalation agents with low blood : gas partition coefficient, intermediate-acting muscle relaxants and continuous pulse oximeter monitoring over the past 10 years may have altered the incidence of immediate postoperative hypoxemia. This study was undertaken to determine the overall incidence of immediate postoperative hypoxemia in PACU. METHODS: Hypoxemia was defined as a pulse oxygen saturation (SpO2) of less than 90% lasting for at least 20 sec. The occurrence of hypoxemia was documented and notified to the anesthesiologist by PACU nurses. The anesthesiologist recorded contributory factors and the management modalities used in patients with hypoxemia. RESULTS: The incidence of hypoxia was 3.5 per 1,000 patients after general anesthesia. Most hypoxemic events (88%) occurred during the first 5 minutes after arrival in PACU. Upper airway obstruction was the major contributory factor for hypoxemia (75.5%) and most of these patients recovered simply after a jaw thrust or the insertion of an oral or nasal airway. CONCLUSIONS: Postoperative hypoxemia does not occur often in PACU, but when it does, it is associated with major morbidity and increased medical costs. Therefore, oxygen supply is recommended in patients with risk factors of hypoxemia during transfer from operating rooms to PACU. Close monitoring of hypoxemia in PACU is needed in all patients after general anesthesia.
Airway Obstruction ; Anesthesia, General ; Anoxia ; Humans ; Incidence* ; Inhalation ; Jaw ; Operating Rooms ; Oximetry* ; Oxygen ; Postoperative Period ; Risk Factors

BACKGROUND: Although the first coronary Wallstent implantation ushered in a new era in interventional cordiology with the purpose of circumventing the two major limitations of coronary balloon angioplasty, early acute occlusion and late restenosis, the previous investigators have reported a high rate of subacute occlusion after Wallstent implantation. However, recent studies have reported a low incidence rate of subacute closure and restenosis using the newly modified coronary Less Shortening in aortocoronary vein grafts. The present study reports the immediate results of the Less Shortening Wallstent Implantation for 21 diffuse native coronary lesions in 20 patients. METHODS: Twenty patients were enrolled at the Yonsei Univ. Cardiovasular Center of medical College, Yonsei University in Seoul, Korea from March 1996 through May 1996. The specific angiographic criteria for enrollment included at least 75% diameter stenosis, according to the estimate of two investigatior ; a lesion that was 20mm or more in lenght and a vessel diameter of at least 2.5mm. Bail-out procedure was performed in the case of abrupt closure or threatened closure, defined as a dissection and over 50% residual stenosis of the artery. RESULTS: The coronary Less Shortening Wallstents were successfully implanted in the 21 diffuse coronary lesions(more than 20mm in length) of the 20 patients(pts), including 7 pts of acute myocardial infarction, 11 pts of unstable angina, and 2 pts of stable angina. Angiographic results after Less Shortening Wallstent were 3.0+/-0.3mm in minimal luminal diameter(MLD), 6.7+/-10.8% diameter stenosis(DS) comparing with pre-stent implantation MLD and DS, respectively, 0.3+/-0.4mm and 89.9+/-8.4%. During the in-hospital phase, no major cardiac event occurred except 2 cases of transmural myocardial infarction, including one of stent thrombosis and one of side branch occlusion, despite of inclusion of 7 cases of threatened occlusion in the long lesion. The peristent spasms were observed in 11 among 21 lesions, although long term significance of peristent spasm is not defined. The relative risk for peristent spasm were 10 times higher when larger stents(expanded stent diameter/reference artery diameter>1.7) were implanted. There was no peristent spasm when stents of which expanded stent diameter 1.4 times smaller than reference artery size ware used. CONCLUSION: The results of this introductory study suggest that new Less Shortening Wallstent may reduce the requirement of multiple stent in the long lesion and a lower rate of thrombotic occusion in comparison to its prototype. Further large scale long term follow-up study is needed to evaluate the role of new Less Shortening Wallstent.
Angina, Stable ; Angina, Unstable ; Angioplasty, Balloon, Coronary ; Arteries ; Constriction, Pathologic ; Coronary Artery Disease ; Coronary Disease* ; Follow-Up Studies ; Humans ; Incidence ; Korea ; Myocardial Infarction ; Phenobarbital ; Research Personnel ; Seoul ; Spasm ; Stents ; Thrombosis ; Transplants ; Veins

Plasma inorganic fluoride concentrations were measured in adult patients without hepatic or renal disease following sevoflurane-N2O anesthesia (n = 7) or enflurane-N2O anesthesia (n = 6). The anesthetic dosage of sevoflurane and enflurane was 6.48 +/- 2.15 %-hours and 6.57 +/- 2.50 %-hours, respectively. The mean peak plasma inorganic fluoride concentration in the sevoflurane group was 19.5 +/- 13.4 mumol/L 1 hour after anesthesia, which decreased to preanesthetic levels 24 hours after anesthesia. In the enflurane group the values were 13.2 +/- 5.8 mumol/L at the end of anesthesia and decreased, but remained, still twice as high as the preanesthetic level 24 hours after anesthesia. The relationship of plasma inorganic fluoride concentration and anesthetic dosage was more pronounced in the sevoflurane group (r = 0.68, slope = 4.2) than in the enflurane group (r = 0.39, slope = 1.2). In conclusion, sevoflurane-N2O anesthesia results in similar subnephrotoxic levels of plasma inorganic fluoride as enflurane-N2O anesthesia, and although the fluoride concentration had a better correlation to anesthetic dosage in the sevoflurane group than in the enflurane group, its excretion was faster in the sevoflurane group than in the enflurane group.
Adolescent ; Adult ; *Anesthesia, General ; *Anesthetics ; Comparative Study ; *Enflurane ; *Ethers ; Female ; Fluorides/*blood ; Human ; Male ; Middle Age ; *Nitrous Oxide