Changes in contrast sensitivity have been demonstrated in patients with normal Snellen acuity. In an attempt to elucidate more sensitively the visual dysfunction before developement of either overt retinopathy or a reduction in Snellen acuity in patients with retinal disorders, contrast sensitivity test was performed in diabetic patients with normal Snellen acuity and control subjects matched for age and sex. The results were as follows. 1) Throughout all spatial frequencies(1.5 - 3.0 - 6.0 - 12.0 - 18.0 cpd), contrast sensitivity was significantly lower(P-value<0.01) in the diabetic eyes with retinopathy(30.7 - 49.3 - 52.5 - 16.1 - 7.8) than in the normal controls(42.5 - 84.3 - 103.0 - 60.5 - 25.1) or the diabetic eyes without retinopathy(43.1 - 92.2 - 95.8 - 43.4 - 16.4 ). 2) In high spatial frequencies(12.0 - 18.0 cpd) contrast sensitivity in the diabetic eyes without retinopathy group(43.4 - 16.4) was significantly decreased(P-value<0.01) in comparison with the normal controls(60.5 - 25.1). So, contrast sensitivity test is more sensitive test for central visual function than Snellen acuity.
Contrast Sensitivity* ; Diabetic Retinopathy* ; Humans ; Retinaldehyde

The increased survival of patients with breast cancer has given rise to other problems associated with the complications of chemotherapy. One major complication is premature ovarian failure, an especially harmful outcome for women of reproductive age. This study was performed to evaluate the efficacy of GnRH agonist (GnRHa) treatment on protecting ovarian function in young breast cancer patients (30.59+/-5.1 yr) receiving chemotherapy after surgery. Twenty-two women were enrolled and given subcutaneous injections of leuprolide acetate (3.75 mg) every 4 weeks during chemotherapy. Follow-up laboratory tests (luteinizing hormone [LH], follicle stimulating hormone [FSH], and estradiol) were performed 1, 3, and 6 months after chemotherapy. Menstruation patterns and clinical symptoms were followed up for a mean duration of 35.6+/-1.7 months. FSH and LH levels were normal in all patients 6 months after completing chemotherapy (8.0+/-5.3, 4.4+/-2.7 mIU/mL, respectively). During follow-up, none of the patients complained of menopausal symptoms and 81.8% experienced recovery of menstruation. This report is the first trial of GnRHa as a treatment modality to protect ovarian function during adjuvant chemotherapy in young Korean breast cancer patients.
Adult ; Antineoplastic Agents/adverse effects/therapeutic use ; Antineoplastic Agents, Hormonal/therapeutic use ; Breast Neoplasms/diagnosis/*drug therapy/surgery ; Combined Modality Therapy ; Cyclophosphamide/adverse effects/therapeutic use ; Doxorubicin/adverse effects/therapeutic use ; Female ; Follicle Stimulating Hormone/analysis ; Gonadotropin-Releasing Hormone/*agonists ; Humans ; Leuprolide/administration & dosage ; Luteinizing Hormone/analysis ; Menstruation ; Ovarian Function Tests ; Primary Ovarian Insufficiency/etiology/*prevention & control ; Republic of Korea ; Tamoxifen/therapeutic use ; Time Factors

OBJECTIVES: We evaluated the effects of adding intravenous pamidronate to ongoing menopausal hormone therapy (MHT) on bone mineral density (BMD) in postmenopausal Korean women with low BMD.METHODS: This retrospective cohort study included 74 postmenopausal women who received MHT for at least 1 year and had a BMD T-score of less than −2.0. Maintaining the same MHT regimen, these women were divided into two groups: oral placebo group (n = 44) and a pamidronate group of patients with gastrointestinal discomfort (n = 30) who received 15–30 mg pamidronate intravenously every 3–12 months. BMD was reviewed at 12-month follow-up. Bone resorption markers in both groups, urinary deoxypyridinoline levels in the placebo group, and serum N-telopeptide of type I collagen in the pamidronate group were assessed at 6 and 12 months.RESULTS: At baseline, the body mass index (BMI), duration of previous MHT, and femur neck (FN) BMD differed between the groups. Within-group analysis revealed that BMD of the lumbar spine (LS) and total hip (TH) significantly increased in the placebo group, whereas those of the LS, FN, and TH increased in the pamidronate group. The increase in BMD of LS was significantly greater in the pamidronate group, after adjusting for BMI and duration of previous MHT (mean change: 3.7% vs. 6.2%; P < 0.001). There were no changes in bone resorption markers in either group.CONCLUSIONS: Adding intravenous pamidronate to ongoing MHT for 12 months might increase LS BMD in postmenopausal Korean women with low BMD.
Body Mass Index ; Bone Density ; Bone Resorption ; Cohort Studies ; Collagen Type I ; Female ; Femur Neck ; Follow-Up Studies ; Hip ; Hormone Replacement Therapy ; Humans ; Osteoporosis ; Postmenopause ; Retrospective Studies ; Spine

PURPOSE: We surveyed parental knowlege about febrile convulsion in order to reduce unnecessary use of diagnostic method and management, and to use as an educational guideline. METHODS: The survey composed of four items : etiology, diagnosis and treatment, prognosis, and method management at home. The rate of correct answers on the total questionnaire, and each questionnaires was compared to the febrile convulsion group (FCG) and control group (CG), to a group that had one episode of febrile convulsion and two and more episodes. The questionnaire about method management was compared to FCG and CG. RESULTS: Comparisons done on the general profiles between FCG and CG showed no singnificant difference statistically. The rate of correct answers on the total questionnaire is 30.6% in FCG and 21.2% in CG. The rate of correct answers on the total questionnaire is 29.0% in the group that had one episode of febrile convulsion, and 33.0% in two and more episodes. Comparing the method management between FCG and CG, cold massage and acupuncture were higher in FCG, statistically. CONCLUSION: The rate of correct answers showed no significant difference between FCG and CG, and was very low in both groups. There is also no difference in the rate of correct answers. Parental knowledge about proper management before they go to the hospital is insufficient. Therefore, we need to establish an educational program on febrile convulsion in order to reduce the use of unnecessary diagnostic method and inappropriate management.
Acupuncture ; Diagnosis ; Humans ; Massage ; Parents* ; Prognosis ; Surveys and Questionnaires ; Seizures, Febrile*

Crohn's disease was originally described as a small bowel disorder and has been known to involve the large bowel in approximately 40% of all cases with or without concomitant ileal component. We describe two cases of Crohn's diseas of small intestine and colon with a summary of differential diagnosis with ulcerative colitis. Both cases were originally diagnosed and treated as ileal tuberculosis. Grossly, there were skip lesions in both cases with prominent pseudopolyps and ulcerations in colon. Also noted were typical serpentine lesions in ileum as well as in colon. Microscopically, transmural inflammation was confirmed and one case showed scattered noncaseating granulomas in the wall. Submucosal edema and fibrosis with thickening of the wall was not prominent in colon. Polymerase chain reaction performed on paraffin block for the demonstration of Mycobacterium tuberculosis in one case showed negative reaction.
Colitis, Ulcerative ; Colon* ; Crohn Disease* ; Diagnosis, Differential ; Edema ; Fibrosis ; Granuloma ; Ileum ; Inflammation ; Intestine, Small* ; Mycobacterium tuberculosis ; Paraffin ; Polymerase Chain Reaction ; Tuberculosis ; Ulcer

PURPOSE: To find the applicability of adjuvant radiotherapy for extrahepatic bile duct cancer (EBDC), we analyzed the pattern of failure and evaluate prognostic factors of locoregional failure after curative resection without adjuvant treatment. MATERIALS AND METHODS: In 97 patients with resected EBDC, the location of tumor was classified as proximal (n = 26) and distal (n = 71), using the junction of the cystic duct and common hepatic duct as the dividing point. Locoregional failure sites were categorized as follows: the hepatoduodenal ligament and tumor bed, the celiac artery and superior mesenteric artery, and other sites. RESULTS: The median follow-up time was 29 months for surviving patients. Three-year locoregional progression-free survival, progression-free survival, and overall survival rates were 50%, 42%, and 52%, respectively. Regarding initial failures, 79% and 81% were locoregional failures in proximal and distal EBDC patients, respectively. The most common site was the hepatoduodenal ligament and tumor bed. In the multivariate analysis, perineural invasion was associated with poor locoregional progression-free survival (p = 0.023) and progression-free survival (p = 0.012); and elevated postoperative CA19-9 (> or =37 U/mL) did with poor locoregional progression-free survival (p = 0.002), progression-free survival (p < 0.001) and overall survival (p < 0.001). CONCLUSION: Both proximal and distal EBDC showed remarkable proportion of locoregional failure. Perineural invasion and elevated postoperative CA19-9 were risk factors of locoregional failure. In these patients with high risk of locoregional failure, adjuvant radiotherapy could be considered to improve locoregional control.
Bile Duct Neoplasms ; Bile Ducts, Extrahepatic* ; Celiac Artery ; Cystic Duct ; Disease-Free Survival ; Follow-Up Studies ; Hepatic Duct, Common ; Humans ; Ligaments ; Mesenteric Artery, Superior ; Multivariate Analysis ; Prognosis ; Radiotherapy, Adjuvant* ; Recurrence ; Risk Factors ; Survival Analysis ; Survival Rate

OBJECTIVE: Obsessive-compulsive disorder (OCD) is a clinically heterogeneous disorder with a bimodal pattern in age onset and treatment outcomes. This study attempted to ascertain the importance of the age factor for a better phenotypic precision. Therefore, the authors compared adult OCD patients with an early symptom onset to adult OCD patients with a later symptom onset. METHODS: One hundred sixty five patients with OCD were evaluated with semistructured interviews;79 with symptom onset before the age of 17 (early onset group) and 86 with symptom onset after the age of 17 (late onset group). The two groups were analyzed in terms of Y-BOCS (Yale-Brown Obsessive Compulsive Scale) scores and demographic data including clinical variables. RESULTS: Early onset group has more comorbidity of tic disorder and lesser of depression and anxiety disorder than late onset group. Early onset group showed more family history of tic disorder than late onset group. The treatment response to SSRI is relatively declined after 18 months of initiation in early onset group. CONCLUSION: The results indicate that age at onset may be an important factor in subtyping OCD. Early onset group may have more biological and familial tendency that might be differentiate the two groups.
Adult ; Age Factors ; Age of Onset ; Anxiety Disorders ; Comorbidity ; Depression ; Humans ; Obsessive-Compulsive Disorder* ; Tic Disorders

The neurotoxic effects of inorganic lead, a common environmental toxic substance, include peripheral neuropathy in adults and encephalopathy in children. Behavioral changes including hyperactivity, short attention span, easy distractibility and impulsiveness have also been noted in patients with chronic lead exposure in childhood. The level of norepinephrine in brain may relate to hyperactivity and chronic lead exposure. The purpose of this study was to determine the effect of inorganic lead (PbCl(2)) administration in neonatal rats using immunocytochemical and electron microscopical analysis of norepinephrinergic neurons of the locus ceruleus. Lead chloride were dissolved in distilled water at the concentration of 0.05%, 0.1% and 0.2% and the solution was administered orally via drinking water. After 4, 8 or 12 weeks of continuous administration, all rats were sacrificed and the brain was processed and immunostained with antibody against tyrosine hydroxylase, a rate limiting enzyme of norepinephrine synthesis antibody. The number of tyrosine hydroxylase immunostained cell bodies in locus ceruleus was estimated. Densitometric analysis of tyrosine hydroxylase immunoreactive profiles in electron microscopic photographs were done by using image analyzer. The number of tyrosine hydroxylase immunoreactive neurons in the locus ceruleus had increased statistically after lead administration. Density of tyrosine hydroxylase immunoreactive profiles in the electron microscopy had also increased. Degenerative changes, such as intra-axonal vacuolar space formation, were found within tyrosine hydroxylase immunoreactive axons. Somewhat widened intercellular spaces and retracted processes were also found in the region of the locus ceruleus. Increased tyrosine hydroxylase immunoreactivity may correlate with hyperreactivity of lead intoxicated children. Degenerative changes may be responsible for the short attention span, easy distractibility and impulsiveness observed in case of mild lead poisoning.
Adult ; Animals ; Axons ; Brain ; Child ; Drinking Water ; Extracellular Space ; Humans ; Immunohistochemistry ; Lead Poisoning ; Locus Coeruleus* ; Microscopy, Electron ; Neurons* ; Norepinephrine ; Peripheral Nervous System Diseases ; Rats* ; Tyrosine 3-Monooxygenase ; Water

Objective: To compare the lumen parameters measured by the location-adaptive threshold method (LATM), in which the inter- and intra-scan attenuation variabilities of coronary computed tomographic angiography (CCTA) were corrected, and the scan-adaptive threshold method (SATM), in which only the inter-scan variability was corrected, with the reference standard measurement by intravascular ultrasonography (IVUS). Materials and Methods: The Hounsfield unit (HU) values of whole voxels and the centerline in each of the cross-sections of the 22 target coronary artery segments were obtained from 15 patients between March 2009 and June 2010, in addition to the corresponding voxel size. Lumen volume was calculated mathematically as the voxel volume multiplied by the number of voxels with HU within a given range, defined as the lumen for each method, and compared with the IVUS-derived reference standard. Subgroup analysis of the lumen area was performed to investigate the effect of lumen size on the studied methods.Bland-Altman plots were used to evaluate the agreement between the measurements. Results: Lumen volumes measured by SATM was significantly smaller than that measured by IVUS (mean difference, 14.6 ㎣ ; 95% confidence interval [CI], 4.9–24.3 ㎣ ); the lumen volumes measured by LATM and IVUS were not significantly different (mean difference, -0.7 ㎣ ; 95% CI, -9.1–7.7 ㎣ ). The lumen area measured by SATM was significantly smaller than that measured by LATM in the smaller lumen area group (mean of difference, 1.07 ㎟ ; 95% CI, 0.89–1.25 ㎟ ) but not in the larger lumen area group (mean of difference, -0.07 ㎟ ; 95% CI, -0.22–0.08 ㎟ ). In the smaller lumen group, the mean difference was lower in the Bland-Altman plot of IVUS and LATM (0.46 ㎟ ; 95% CI, 0.27–0.65 ㎟ ) than in that of IVUS and SATM (1.53 ㎟ ; 95% CI, 1.27–1.79㎟ ). Conclusion SATM underestimated the lumen parameters for computed lumen segmentation in CCTA, and this may be overcome by using LATM.

Objective: To compare the lumen parameters measured by the location-adaptive threshold method (LATM), in which the inter- and intra-scan attenuation variabilities of coronary computed tomographic angiography (CCTA) were corrected, and the scan-adaptive threshold method (SATM), in which only the inter-scan variability was corrected, with the reference standard measurement by intravascular ultrasonography (IVUS). Materials and Methods: The Hounsfield unit (HU) values of whole voxels and the centerline in each of the cross-sections of the 22 target coronary artery segments were obtained from 15 patients between March 2009 and June 2010, in addition to the corresponding voxel size. Lumen volume was calculated mathematically as the voxel volume multiplied by the number of voxels with HU within a given range, defined as the lumen for each method, and compared with the IVUS-derived reference standard. Subgroup analysis of the lumen area was performed to investigate the effect of lumen size on the studied methods.Bland-Altman plots were used to evaluate the agreement between the measurements. Results: Lumen volumes measured by SATM was significantly smaller than that measured by IVUS (mean difference, 14.6 ㎣ ; 95% confidence interval [CI], 4.9–24.3 ㎣ ); the lumen volumes measured by LATM and IVUS were not significantly different (mean difference, -0.7 ㎣ ; 95% CI, -9.1–7.7 ㎣ ). The lumen area measured by SATM was significantly smaller than that measured by LATM in the smaller lumen area group (mean of difference, 1.07 ㎟ ; 95% CI, 0.89–1.25 ㎟ ) but not in the larger lumen area group (mean of difference, -0.07 ㎟ ; 95% CI, -0.22–0.08 ㎟ ). In the smaller lumen group, the mean difference was lower in the Bland-Altman plot of IVUS and LATM (0.46 ㎟ ; 95% CI, 0.27–0.65 ㎟ ) than in that of IVUS and SATM (1.53 ㎟ ; 95% CI, 1.27–1.79㎟ ). Conclusion SATM underestimated the lumen parameters for computed lumen segmentation in CCTA, and this may be overcome by using LATM.