PURPOSE: To report a case of proptosis occurring during a Valsalva maneuver in a neurofibromatosis patient with an arachnoid cyst. CASE SUMMARY: A 42-year-old man diagnosed with type I neurofibromatosis visited our hospital with a 20-year history of enophthalmos in the left eye. The patient also complained of exophthalmos during the abdominal straining. On exophthalmometry, a 4 mm enophthalmos was found. The patient also presented with a limited motion to the superior and lateral direction. There was an ocular pulsation corresponding to the heart rate. During the Valsalva maneuver, a marked exophthalmos of the left eye occurred. The patient had light brown spots on the skin of the face and body trunk. Following an orbital computed tomography (CT), defects of the left sphenoid bone were present. Posteriorly, an arachnoid cyst was found; however, there was a lack of varix. The archnoid cyst was also observed to expand into the orbit during the Valsalva maneuver and forward the globe. CONCLUSIONS: To date, cases of proptosis occurring during a Valsalva maneuver by causes other than orbital varix are rare. Herein, the authors report a case with a review of literature.
Adult ; Arachnoid ; Enophthalmos ; Exophthalmos ; Eye ; Heart Rate ; Humans ; Light ; Neurofibromatoses ; Orbit ; Skin ; Sphenoid Bone ; Sprains and Strains ; Valsalva Maneuver ; Varicose Veins

The purpose of this study was to provide fundamental data to propose further directions of education on rehabilitation nursing by investigating the adequacy of the educational contents of rehabilitation nursing. This study was a descriptive survey study. The data collected at 25 universities and 24 junior colleges through questionnaires to answer the research questions from August 10 to September 30, 2000. The questionnaire was consisted of 24 items. The contents of rehabilitation nursing education were developed by consulting with the rehabilitation nursing professionals. The results are as follows Rehabilitation nursing was taught as an independent class in 15 universities and 9 junior colleges. Most professors majoring in adult nursing(66.8%) were in charge of teaching the courses. For the adequacy of the teaching contents of rehabilitation nursing, conceptual bases for rehabilitation was the highest score(4.0), and interdisciplinary rehabilitation team, activities of daily living, clients of rehabilitation, nursing process in rehabilitation nursing, functional evaluation, movement and mobility, physical therapy, occupational therapy, sensation and perception, communication/language, eating and swallowing, bladder elimination, community based rehabilitation nursing, sleep, rest &, fatigue, bowel elimination., historical perspectives of rehabilitation nursing, sexuality, pulmonary rehabilitation, pain, cardiac rehabilitation, skin integrity, family care was ordered.
Activities of Daily Living ; Adult ; Deglutition ; Eating ; Education ; Fatigue ; Humans ; Nursing Process ; Occupational Therapy ; Surveys and Questionnaires ; Rehabilitation Nursing* ; Rehabilitation* ; Sensation ; Sexuality ; Skin ; Urinary Bladder

Lymphocytic infundibuloneurohypphysitis(LINH) is a newly classified disorder and proposed as a common cause of idiopathic central diabetes insipidus. It is characterized by thickening of the infundibulum and/or pituitary stalk and absence of high signal in the neurohypophysis in sellar MRI and the microscopic findings of diffuse lymphocytic infiltration within the neurohypophysis. A 12year-old boy presented polyuria and headache. The result of water deprivation test was compatible with central diabetes insipidus. Brain MRI showed thickening of the pituitary stalk and loss of high signal in the neurohypophysis. Craniotomy and excisional bi6opsy was done under the impression of pituitary tumor. Microscopically, neurohypophysis showed dense lymphocytic infiltration and no malignant cells. Six months after the operation, the previously thickened pituitary stalk and neurohypophysis appeared normal in follow-up MRI.
Brain ; Craniotomy ; Diabetes Insipidus, Neurogenic ; Follow-Up Studies ; Headache ; Humans ; Magnetic Resonance Imaging ; Male ; Pituitary Gland ; Pituitary Gland, Posterior ; Pituitary Neoplasms ; Polyuria ; Water Deprivation

PURPOSE: To investigate the natural course of iatrogenic Horner's syndrome induced by procedures in the neck and upper thoracic areas. METHODS: Four patients who developed ptosis after undergoing procedures near the neck and upper thoracic areas were diagnosed with iatrogenic Horner's syndrome. We evaluated the clinical courses of the patients retrospectively. We also performed a systematic Medline search through Pubmed to find patients with iatrogenic Horner's syndrome. We summarized onset times and natural courses of reported cases. RESULTS: In two cases, ptosis improved completely within 2 and 4 months. In the other two cases, ptosis persisted through the last follow-up. As a result of our Medline search, we identified 51 cases in 47 journals. In 31 patients (62%), symptoms improved from 17 minutes to 3 months after surgery. However, in 20 patients (38%), symptoms persisted for up to 20 months. CONCLUSIONS: Although the mechanism underlying iatrogenic Horner's syndrome induced by procedures in the neck and upper thoracic area is not clearly understood, the syndrome may occur when the sympathetic nerve pathway is damaged directly or indirectly. Surgical correction should be postponed because this rare complication may resolve spontaneously within 4 months. The surgeon should explain the possibility of Horner's syndrome to patients after neck and upper thoracic surgery.
Catheterization ; Follow-Up Studies ; Horner Syndrome ; Humans ; Neck ; Retrospective Studies ; Stellate Ganglion ; Thoracic Surgery

PURPOSE: To report late complications of hydrogel buckles (MIRAgel explant, MIRA, Waltham, U.S.A.) from use in scleral buckling surgery for retinal detachment. METHODS: The clinical records of 10 patients who underwent MIRAgel removal between January 1993 and March 2005 were reviewed. Preoperative computerized tomography (CT) scans were examined in three patients with suspected orbital mass. The unused and removed MIRAgel were examined by scanning electron microscopy (SEM). RESULTS: The average interval to MIRAgel removal was 9.4 years. Patients presented with complaints of restricted gaze (6 cases), exposed buckle (6 cases), palpebral mass (5 cases), and periorbital swelling (3 cases). Initially, 4 patients were misdiagnosed with orbital tumor or cellulitis. MIRAgel were removed by transconjunctival or skin incision, (totally in 7 eyes and partially in 3 eyes). CT scans showed circumferential soft tissue mass surrounding the globe with a peripherally-enhancing rim. SEM showed that unused samples had a smooth surface and uniformly sized micropores. The surfaces of the removed MIRAgel were uneven, with micropores that were distorted in shape and irregular in size. CONCLUSIONS: Because late complications with MIRAgel have various clinical aspects, complete history taking and ophthalmic examination are essential in making an accurate diagnosis and choosing proper treatment. Patients with MIRAgel should be followed up periodically, and its timely removal should be considered.
Cellulitis ; Diagnosis ; Humans ; Hydrogel* ; Microscopy, Electron, Scanning ; Orbit ; Retinal Detachment ; Scleral Buckling* ; Skin ; Tomography, X-Ray Computed

PURPOSE: To report late complications of hydrogel buckles (MIRAgel explant, MIRA, Waltham, U.S.A.) from use in scleral buckling surgery for retinal detachment. METHODS: The clinical records of 10 patients who underwent MIRAgel removal between January 1993 and March 2005 were reviewed. Preoperative computerized tomography (CT) scans were examined in three patients with suspected orbital mass. The unused and removed MIRAgel were examined by scanning electron microscopy (SEM). RESULTS: The average interval to MIRAgel removal was 9.4 years. Patients presented with complaints of restricted gaze (6 cases), exposed buckle (6 cases), palpebral mass (5 cases), and periorbital swelling (3 cases). Initially, 4 patients were misdiagnosed with orbital tumor or cellulitis. MIRAgel were removed by transconjunctival or skin incision, (totally in 7 eyes and partially in 3 eyes). CT scans showed circumferential soft tissue mass surrounding the globe with a peripherally-enhancing rim. SEM showed that unused samples had a smooth surface and uniformly sized micropores. The surfaces of the removed MIRAgel were uneven, with micropores that were distorted in shape and irregular in size. CONCLUSIONS: Because late complications with MIRAgel have various clinical aspects, complete history taking and ophthalmic examination are essential in making an accurate diagnosis and choosing proper treatment. Patients with MIRAgel should be followed up periodically, and its timely removal should be considered.
Cellulitis ; Diagnosis ; Humans ; Hydrogel* ; Microscopy, Electron, Scanning ; Orbit ; Retinal Detachment ; Scleral Buckling* ; Skin ; Tomography, X-Ray Computed

OBJECTIVE: Hematologic abnormalities in toxemia mothers and their babies have been documented. The purpose of this study was to explore the hematologic findings in mothers with toxemia and postnatal hematologic findings in their babies. The relationship of hematologic findings between toxemia mothers before delivery and their babies immediately after birth was also examined. METHODS: Forty-six pairs of singleton toxemia mothers and their babies born by C-section with 28 to 35 weeks of gestation from Jan. 1995 to Dec. 1999 were enrolled. Fifty pairs of singleton normotensive mothers and their babies with the same gestational period and delivery method were matched for control group. Blood samples of mothers were performed before delivery, and those of their babies, were done immediately after birth, day 3 and 7 of life. Hemoglobin(Hb) concentration, total white blood cell(WBC) count, absolute neutrophil count(ANC), and platelet count were examined. RESULTS: Toxemia mothers have significantly lower platelet count compared with controls(191,000+/-83,200/mm3 vs. 252,000+/-92,700/mm3, p<0.05). There were no difference between both groups in Hb, WBC and ANC. On the first day of life, Hb was significantly higher(16.97+/-2.36g/dL vs 14.32+/-1.5g/dL, p<0.05), but WBC, ANC and platelet count were significantly lower in babies born to toxemia mothers than those of control group(p<0.05 for all). In babies born to toxemia mothers, Hb was significantly decreased until the seventh day of life(16.97g/dL, 15.48g/dL, 14.61g/dL, p<0.05), however, WBC and platelet count were significantly decreased until the third day of life and then incresed until the seventh day of life(11,832/mm3, 8,334/mm3, 10,104/mm3 for WBC, p<0.05, and 152,220/mm3, 144,720/mm3, 214,090/mm3 for platelet, p<0.05, respectively). CONCLUSION: Hemoglobin concentration was significantly higher, whereas WBC, ANC and platelet were significantly lower in babies of toxemia mothers than those of control group. In babies born to toxemia mothers, Hb was significantly decreased until the seventh day of life, however, WBC and platelet count were significantly decresed until the third day and then increased until the seventh day of life. There was no relationship between hematologic findings of toxemia mothers and their babies.
Blood Platelets ; Humans ; Mothers* ; Neutrophils ; Parturition ; Platelet Count ; Pregnancy ; Toxemia*

STATEMENT OF PROBLEM: High stress concentration on the crestal cortical bone has been regraded as a major etiologic factor jeopardizing long term stability of endosseous implants. PURPOSE: To investigate if the design characteristics of crestal module, i.e. internal type, external type, and submerged type, affect stress distribution on the crestal cortical bone. MATERIAL AND METHODS: A cylindrical shaped implant, 4.3 mm in diameter and 10 mm in length, with 3 different crestal modules, i.e. internal type, external type, and submerged type, were analysed. An axisymmetric scheme was used for finite elment formulation. A vertical load of 50 N and an oblique load of 50 N acting at 45degrees with the implant's long axis was applied. The peak crestal bone stress acting at the intersection of implant and crestal bone was compared. RESULTS: Under vertical load, the crestal bone stress was high in the order of internal, external, and submerged types. Under the oblique loading condition, it was in the order of internal, submerged, and external types. CONCLUSION: Crestal module design was found to affect the level of the crestal bone stresses although the actual amount was not significant.
Axis, Cervical Vertebra ; Dental Implants ; Finite Element Analysis

The author list should be corrected as follows. Jin-Hyun Cho, Kwang-Heon Jo, Kyu-Bok Lee, Cheong-Hee Lee.

PURPOSE: The purpose of this study was to investigate the influence of mobilization on bone-implant interface prior to osseointegration of fixtures. MATERIALS AND METHODS: The experimental implants (3.75 mm in diameter, 4.0 mm in length) were made of commercially pure (Grade IV) titanium, and were treated with RBM (MegaGen(R): Ca-P). The 80 implants (two in each tibia) were inserted into the monocortical tibias of 20 rabbits which each weighed more than 3.5 kg (Female, New Zealand White). According to the removal torque interval, the groups were divided into 10 groups, Group I (6 wks), Group II (4 days + 6 wks), Group III (4 days + 1 wk + 6 wks), Group IV (1 wk + 6 wks), Group V (1 wk + 1 wk + 6 wks), Group VI (2 wks + 6 wks), Group VII (2 wks+ 1 wk + 6 wk), Group VIII (3 wks + 6 wks), Group IX (3 wks + 1 wk + 6 wks) and Group X (10 wks). The control groups were Group I and X, the removal torque was measured at 6 wks and 10 wks with a digital torque gauge (Mark-10, USA). In the experimental groups, the removal torque was given once or twice before the final removal torque and the value was measured each time. After which, the implants were put back where they had been except the control groups. All the experimental groups were given a final healing time (6 wks) before the final removal torque test, in which values were compared with the control groups and the 1st and/or 2nd removal torque values in each experimental group. RESULTS: In the final removal torque tests, the removal torque value of Group X (10 wks) was higher than that of Group I (6 wks) in the control groups but not statistically different. There were no significant differences between the experimental groups and control groups (P>.05). In the first removal torque comparison, the experimental groups (4 days or 1 wk) values were significantly lower than the other experimental groups (2 wks or 3 wks). In the comparison of each experimental group according to healing time, the final removal torque value was significantly higher than the 1st torque test value. CONCLUSION: Once or twice mobilization of fixture prior to osseointegration did not deter the final bone to implant osseointegration, if sufficient healing time was given.
Implants, Experimental ; New Zealand ; Osseointegration ; Rabbits ; Tibia ; Titanium ; Torque