We evaluated an effect of the distance between the incision line and corneal limbus on surgically induced astigmatism in sutureless cataract surgery with scleral tunnel incision. We made a 6mm scleral tunnel incision 1.0mm from the limbus (Group 1, 24 eyes) and 2.5mm from the limbus (Group 2, 30 eyes) and implanted polymethylmethacrylate (PMMA) intraocular lenses with a round optic of 6mm following phacoemulsification. We employed the Jaffe method and Cravy method of vector analysis to evaluate the change of Surgically induced astigmatism. The mean surgically induced astigmatism using Jaffe method was 1.24 D and 0.98 D one day after surgery in Group 1 and 2, respectively. The difference between them was statistically significant(p<0.01) and became insignificant(p>0.05) after postoperative one week. In the superior incision cases, the difference using Cravy method was not statistically significant for whole followup period. In the temporal incision cases, the surgically induced astigmatism was 0.39 D and 0.02 D one day after surgery in Group 1 and 2, respectively. The difference was statistically significant(p<0.05) and became statistically insignificant(p>0.05) after postoperative one week. In this study it was found that a distance of incision line from corneal limbus longer than 1 mm was not an important factor in influencing the surgically induced astigmatism one week after sutureless cataract surgery using a watertight scleral tunnel incision.
Astigmatism ; Cataract* ; Follow-Up Studies ; Lenses, Intraocular ; Limbus Corneae ; Phacoemulsification ; Polymethyl Methacrylate

Myocarditis is defined as the myocardial inflammation caused by various infectious agents (such as virus, rickettsia , bacteria, protozoa, fungus and parasites). The clinical manifestations of myocarditis ranges from the asymptomatic state due to focal inflammation to fulminant fatal congestive heart failure secondary to diffuse myocardial involvement. Clinically, in some cases, it may simulate an acute myocardial infarction. We experienced a case of acute fulminant myocarditis that presented as acute myocardial infarction initially, and then progressed into and recovered from congestive heart failure and multiorgan failure.
Asymptomatic Diseases ; Bacteria ; Estrogens, Conjugated (USP)* ; Fungi ; Heart Failure* ; Inflammation ; Myocardial Infarction ; Myocarditis* ; Rickettsia

BACKGROUND:We performed this study to determine the influence of the administration of pneumoperitoneum on the blood flow of the thoracoabdominal aorta during laparoscopic cholecystectomy (LC). METHODS: Ten patients for LC were enrolled in this study. Anesthesia was performed with propofol, fentanyl and rocuronium. Pneumoperitoneum was made by CO2 gas intraperitoneal instillation at an intraperitoneal pressure of 10-12 mmHg. Peak velocity of blood flow in the systolic phase (PV), mean acceleration of blood flow from the start of systole (MA) and systolic flow time corrected for heart rate (FTc), measured by esophageal doppler monitoring (EDM), and heart rate (HR) and mean brachial BP (MBP) were measured 1, 5 and 10 min after the institution of pneumoperitoneum, (T1, T5 and T10) and compared with those before the institution of pnuemoperotoneum (T0). LC was started after recording all measurements and a position change to the reverse-Trendelenberg position. RESULTS: PV, MA, FTc and HR showed no significant change throughout this study, but MBP at T5 and T10 (110.1 +/- 18.5 mmHg and 107.8 +/- 10.4 mmHg) were significantly higher than at T0 (84.9 +/- 12.9 mmHg) (P = 0.002 and 0.005 respectively). CONCLUSIONS: The administration of pneumoperitoneum neither changed nor interferenced with abdominal aortic blood flow.
Acceleration ; Anesthesia ; Aorta ; Cholecystectomy, Laparoscopic* ; Fentanyl ; Heart Rate ; Humans ; Pneumoperitoneum* ; Propofol ; Systole

BACKGROUND: The incidence of reported nontyphoidal Salmonellosis has increased during last decade in Korea. Salmonella typhimurium and Salmonella enteritidis are two major serotypes in nontyhoidal Salmonella. To determine the nature of potential outbreak S. typhimurium infection in a community, we retrospectively evaluated clinical and epidemiologic features of S. typhimurium infections and performed pulsed-field gel electrophoresis(PFGE) to investigate a genetic relatedness of S. typhimurium isolated in Guro Hospital. METHODS: From May 1998 to April 1999, a total of 20 S. typhimurium strains were isolated from 18 patients. PFGE patterns were analyzed for 20 S. typhimurium strains Clinical and epidemiological features were evaluated from their medical records. RESULTS: Seventy two percent(13/18) were acute gastroenteritis, and 11 %(2/18) were enteric fever and 16 %(3/18) were intussusception. Seventy eight percent(14 of 18) of patients were six years old or less than. There were two major type(A, B) on PFGE analysis. Eight of 20 strains showed identical PFGE type(A1). Eleven strains were subtypes of A1. One strain showed different type(B). Similarity coefficients between A1 and its subtypes were all over 0.765 and they showed close genetic distance on dendrogrm. Antibiogram of Al eight strains were various. CONCLUSIONS: High genetic relationship among 20 S. typhimurium strains for a year in Guro area indicates that they were possibly originated from one clone and that there might be a common source of infection. More efforts should be directed toward the epidemiological investigation of the cases to detect outbreaks and prevent further spread of the infection.
Clone Cells ; Disease Outbreaks ; Gastroenteritis ; Humans ; Incidence ; Intussusception ; Korea ; Medical Records ; Microbial Sensitivity Tests ; Molecular Epidemiology* ; Retrospective Studies ; Salmonella enteritidis ; Salmonella Infections ; Salmonella typhimurium* ; Salmonella* ; Tertiary Care Centers* ; Typhoid Fever

Postoperative hyphema following cataract extraction surgery is not usually a serious complication and clears quickly in the most cases. Sutureless cataract surgery was reported to have less incidence of postoperative hyphema than conventional cataract surgery. We analyzed the incidence of postoperative hyphema in each group according to the depth and the length of scleral pocket incision in 500 eyes with the sutureless cataract surgery via superior incision during two years. One day after surgery, 90 cases(18.0%) had hyphema and most of them(74.4%) showed grade 1 severity. The incidence of hyphema was 23.0% in the deep incision group and only 11.9% in the superficial incision group(p<0.01). The percentage of grade 1 hyphema was 66.6% in the deep group and 92.6% in the superficial group, then severity was greatly reduced in the superficial incision group(p<0.01). The incidence of hyphema in the group of 7.0 mm in length was highest among the 6.0, 6.5, 7.0 mm groups(p<0.01), and the shorter the incision length, the milder the serverity of hyphema(p<0.01). The incidence of hyphuma was the lowest(6.2%) in the group of 6.0 mm in length and superficial incision, and it was the highest(28.5%) in the 7.0 mm in length and deep incisional group(p<0.01).
Cataract Extraction ; Cataract* ; Hyphema* ; Incidence*

IgA nephropathy is the most common form of glomerulonephritis characterized by deposit of IgA on mesangium. We experienced an elderly patient who was admitted for generalized edema, and diagnosed IgA nephropathy and early gastric cancer concomittantly. It has been reported that the incidence of nephrotic syndrome combined with malignancy increases with aging. Moreover, close relationship between IgA nephropathy and malignancy has been reported especially in the elderly patient. So, active investigations for possible malignancy are required in case of elderly patient with IgA nephropathy. In this case, we found improved proteinuria and hematuria of the patient after tumor resection during following up. This case suggest causal association between early gastric cancer and IgA nephropathy clinically.
Aged* ; Aging ; Delirium ; Depression ; Edema ; Glomerulonephritis ; Glomerulonephritis, IGA* ; Hematuria ; Humans ; Immunoglobulin A* ; Incidence ; Nephrotic Syndrome ; Proteinuria ; Stomach Neoplasms*

BACKGROUNDS: As Korea has advanced into the aging society, Acute Coronary Syndrome is increased in number, especially elderly age group. The symptoms of acutecoronary syndrome in eldery were presented in atypical feature frequently. We studied the relation of the first symptom and diagnosis of acutecoronary syndrome and distribution of risk factor and coronary angiographic finding in elderly patient of korea society. METHODS: The subjects who were under went coronary angiography between 2002.5 and 2003.8 were dividedunder 65 years old group and over 65 years old group. And each group described diagnosis, risk factor, first symptom and coronary angiographic finding retrospectively. RESULTS: The diagnosis of unstable angina are more higher(46.5% vs. 26.1%, p<0.01) in the over 65 years old group and the first significant symptom of typical chest pain was more higher(57.4% vs. 47.6%, p<0.01) in the under 65 years old group and dyspnea was more higher(22.8% vs. 9.2%, p<0.01) in the over 65 years old group. The number of abnormal vessel were more higher(66.3% vs. 46.9%, p<0.01) in the over 65 years old group. CONCLUSION: Over 65 years old group compared with younger age group were prewented more frequently angina equivalent symptom than typical chest pain. And at the diagnosis of Acute Coronary Syndrome, over 65 years old group showed more severe coronary angiographic finding. Consequently, early stage of diagnostic approach and treatment need scrupulous attention in the elderly patients.
Acute Coronary Syndrome* ; Aged* ; Aging ; Angina, Unstable ; Chest Pain ; Coronary Angiography ; Diagnosis* ; Dyspnea ; Humans ; Korea* ; Retrospective Studies ; Risk Factors

BACKGROUND: Metabolic syndrome, a concurrence of disturbed glucose and insulin metabolism, over- weight and abdominal fat distribution, dyslipidemia and hypertension, is associated with subsequent de- velopment of type 2 diabetes mellitus and cardiovascular disease, especially coronary heart disease. The aim of the study is to assess the relationship between metabolic syndrome and coronary heart disease in elderly greater than 65 years old. METHODS: Eighty two elderly patients greater than 65 years old who underwent coronary angiography were divided into two groups with metabolic syndrome or without metabolic syndrome, and assessed the association with coronary angiographic finding. The metabolic syndrome factors and cardiovascular risk factors of JNC 7 were investigated to assess the relationship with coronary heart disease in elderly. Coronary heart disease was defined as 50% or greater diameter in stenosis of coronary artery in coronary angiography. RESULTS: In elderly patients with metabolic syndrome, coronary angiographically abnormal findings(p<0.05) and multi vessel disease findings(p<0.05) were presented significantly higher than non metabolic syndrome patients. In elderly patients with 3 and more cardiovascular risk factors of JNC 7, coronary angiographically abnormal findings(p<0.05) and multi vessel disease findings(p=0.059) were presented more than the other patients. Diabetes mellitus was related significantly with coronary heart disease(p value 0.044). CONCLUSION: In elderly patients, metabolic syndrome was significantly related with coronary heart disease and diabetes mellitus had strong relationship with coronary heart disease. Metabolic syndrome and cardiovascular risk factors of JNC 7 should be further evaluated to assess the relationship with coronary heart disease in the future.
Abdominal Fat ; Aged* ; Cardiovascular Diseases ; Constriction, Pathologic ; Coronary Angiography ; Coronary Disease* ; Coronary Vessels ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Dyslipidemias ; Glucose ; Heart ; Humans ; Hypertension ; Insulin ; Metabolism ; Risk Factors

Recently, laparoscopic techniques are being increasingly used for retroperitoneal surgery. These procedures are considered relatively safe and non-invasive, however, there exists a small but important risk of developing complications related to insufflation with carbon dioxide (CO2). A 51-year-old female patient was admitted for retroperitoneal laparoscopic nephrectomy under general anesthesia. About 60 minutes after carbon dioxide pneumoperitoneum, the patient's oxygen saturation decreased. A chest x-ray was taken in the operating room, which showed pneumothorax in the right lung. We concluded that anesthesiologists should be aware of the occurrence of pneumothorax during the retroperitoneal laparoscopic procedure careful monitoring and appropriate management are needed.
Anesthesia, General ; Carbon Dioxide ; Female ; Humans ; Insufflation ; Laparoscopy ; Lung ; Middle Aged ; Nephrectomy* ; Operating Rooms ; Oxygen ; Pneumoperitoneum ; Pneumothorax* ; Thorax

Peptic ulcer bleeding is a frequent cause of upper G-I bleeding. Endoscopic injection therapy with hypertonic saline-epinephrine (HS-E) is a cost-effective and widely used therapy for hemostasis; however, 1~3% of patients experience bleeding or perforation. A 70 year-old male patient was admitted with melena and hematemesis. An endoscopy on admission showed the presence of a 1 cm- sized well-demarcated ulcer with pulsatile bleeding at the lesser curvature of the distal antrum. Approximately 28 mL of HS-E solution was injected around the exposed vessel. Follow-up endoscopy performed 7 days later showed the presence of a 2 cm-sized newly developed mucosa necrosis at the lesser curvature of the pyloric channel, which was caused by ischemic necrosis of the gastric mucosa after HS-E injection. Endoscopic injection therapy with HS-E solution is a relatively safe technique, but mucosa necrosis can occur with the use of a dose of HS-E that is considered safe. We report a case of gastric mucosa necrosis following endoscopic HS-E injection therapy of a bleeding peptic ulcer.
Endoscopy ; Follow-Up Studies ; Gastric Mucosa ; Glycosaminoglycans ; Hematemesis ; Hemorrhage ; Humans ; Male ; Melena ; Mucous Membrane ; Necrosis ; Peptic Ulcer ; Stomach ; Ulcer