No abstract available.
Humans ; Infant, Newborn* ; Rhabdomyoma*

PURPOSE: To report the clinical features and surgical results for lower lid entropion with kinked tarsus compared with entropion with weakened capsulopalpebral fascia. METHODS: From March 2008 to December 2009, 20 patients (24 eyes) with lower lid entropion were examined. The patients were divided into the aggravated entropion with kinked tarsus group or the weakened capsulopalpebral fascia group based on the height of tarsus, the shapes of the lower lid and tarsus, and conjunctiva changes. For treatment of entropion in the kinked tarsus group, full thickness tarsotomy with rotatory suture (tarsal fracture operation) was performed, and in the weakened CPF group, a CPF tight procedure was performed. The results of the operations were retrospectively evaluated. RESULTS: The mean age of the patients with entropion in the kinked tarsus group (15 cases) was 66.7 +/- 11.4 years, and the mean age of the patients with entropion in the weakened CPF group (9 cases) was 67.2 +/- 6.2 years. The height of the lower lid tarsus of each group was 3.80 +/- 0.39 mm and 5.20 +/- 0.30 mm, respectively. Except for one case of recurrence after tarsal fracture operation in the kinked tarsus group and reoperation with CPF tightening, there were no significant complications or recurrence in either group. CONCLUSIONS: Entropion with kinked tarsus was more common than entropion with weakened CPF in the present study. In addition, surgical treatment based on the shape and cause of entropion showed good results.
Animals ; Ankle ; Conjunctiva ; Entropion ; Eyelids ; Fascia ; Humans ; Recurrence ; Reoperation ; Retrospective Studies ; Sutures

STUDY DESIGN: Retrospective study. OBJECTIVES: To analyze the outcomes of conservative management in elderly patients over 65 years of age who were diagnosed with pyogenic spondylitis. SUMMARY OF LITERATURE REVIEW: The surgical treatment of pyogenic spondylitis can lead to complications in elderly patients in a poor general condition or with underlying diseases. MATERIALS AND METHODS: We performed a retrospective review of 32 patients who were diagnosed with pyogenic spondylitis and had a minimum of 12 months of follow-up. Age, sex, comorbidities, clinical symptoms, and the involved segments were analyzed retrospectively. The diagnosis was assessed using clinical, laboratory, and radiologic findings. Antibiotic therapy was either specific (if positive culture results were found) or broad-spectrum cephalosporin (when the pathogenic agent was not isolated). Outcomes were assessed using residual pain and neurologic deficits. RESULTS: The mean onset time was 23.5 days (range, 3-90 days). The mean period of intravenous antibiotic therapy was 36.3 days (range, 10-90 days). All cases underwent conservative management, and 4 patients with progressive neurologic deficits due to epidural abscess underwent posterior laminectomy and abscess drainage. In all cases, the infection was successfully treated, although 12 cases reported residual lower back pain and 2 continued to exhibit minor neurologic deficits. CONCLUSIONS: In elderly patients with pyogenic spondylitis, satisfactory results were obtained with conservative management using antibiotics and orthosis after an early diagnosis, unless progressive neurologic symptom instability or spine deformities were noted.
Abscess ; Aged* ; Anti-Bacterial Agents ; Comorbidity ; Congenital Abnormalities ; Diagnosis ; Drainage ; Early Diagnosis ; Epidural Abscess ; Follow-Up Studies ; Humans ; Laminectomy ; Low Back Pain ; Neurologic Manifestations ; Orthotic Devices ; Retrospective Studies ; Spine ; Spondylitis*

PURPOSE: To report a case of white-centered retinal hemorrhage in infective endocarditis. CASE SUMMARY: A 45-year-old patient complained of acute visual loss. The patient had a history of epidural anesthesia for the relief of back pain. On the day of admission the patient showed no light perception and had a white-centered retinal hemorrhage and cotton wool spot in the left eye upon fundus examination. Other ocular manifestations were not specific and there were no specific findings on a brain MRI and visual evoked potential. The patient was diagnosed with pyogenic spondylitis and was treated by abscess drainage and systemic antibiotics therapy. The patient's near vision improved up to 0.4/0.5. He was diagnosed with infective endocarditis based on the echocardiogram with epidural and subarachnoid hemorrhage. CONCLUSIONS: Roth spot can occur in many diseases such as diabetes, leukemia, anemia, and trauma, but most commonly in sepsis due to infective endocarditis. Therefore, medical evaluation and an echocardiogram for patients with white-centered retinal hemorrhage should be considered.
Abscess ; Anemia ; Anesthesia, Epidural ; Anti-Bacterial Agents ; Back Pain ; Brain ; Drainage ; Endocarditis* ; Evoked Potentials, Visual ; Humans ; Leukemia ; Magnetic Resonance Imaging ; Middle Aged ; Retinal Hemorrhage* ; Retinaldehyde* ; Sepsis ; Spondylitis ; Subarachnoid Hemorrhage ; Wool

PURPOSE: To evaluate injury patterns of facet joints and associated soft tissue injuries in patients withacute traumatic cervical facet joint injuries. MATERIALS AND METHODS: From among patients with cervical spinetrauma, 27 with facet joint injuries, as seen on CT and MRI, were chosen for this study. CT scans were analyzedwith regard to the location of facet joint injury, the presence or absence of facet dislocation or fracture, andother associated fractures. MR images were analyzed with regard to ligament injury, intervertebral disc injury,intervertebral disc herniation, and spinal cord injury. RESULTS: The most common location of facet joint injurywas C6-7 level(n=10), followed by C5-6(n=8). Among these 27 patients with facet joint injuries, 12(44%) hadbilateral injuries and 15(56%) unilateral injuries. Facet fractures were present in 17 cases(63%) and the fractureof inferior facet was more frequent than superi-or. Patterns of fracture were vertical, transverse, or comminuted,but vertical fracture was the most common. Various degrees of dislocation were observed in patients with facetfractures. Fractures other than facet includ-ed pillar(n=11), lamina(n=6), transverse process(n=14), body(n=13),and spinous process(n=3). On MR im-ages, anterior longitudinal ligament injury was found in 8 patients(30%),posterior longitudinal ligament injury in 4(15%), and interspinous ligament injury in 20(74%). Twelvepatients(44%) had spinal cord injuries includ-ing edema(n=8) and hemorrhage(n=4). Among patients with discabnormalities, 11(41%) had intervertebral disc injuries, and traumatic disc herniations were found in nine. CONCLUSION: Traumatic cervical facet joint injuries were manifested as various patterns and frequentlyassoci-ated with other fractures or soft tissue injuries. Analysis of CT and MR findings of these injury patternshelped formulate a therapeutic plan and determine of prognosis.
Dislocations ; Humans ; Intervertebral Disc ; Ligaments ; Longitudinal Ligaments ; Magnetic Resonance Imaging* ; Prognosis ; Soft Tissue Injuries ; Spinal Cord Injuries ; Spine* ; Tomography, X-Ray Computed ; Zygapophyseal Joint*

We report a case of cervicomedullary compression by an anomalous vertebral artery treated using microsurgical decompression with intraoperative monitoring. A 68-year-old woman presented with posterior neck pain and gait disturbance. MRI revealed multiple abnormalities, including an anomalous vertebral artery that compressed the spinal cord at the cervicomedullary junction. Suboccipital craniectomy with C1 laminectomy was performed. The spinal cord was found to be compressed by the vertebral arteries, which were retracted dorsolaterally. At that time, the somatosensory evoked potential (SSEP) changed. After release of the vertebral artery, the SSEP signal normalized instantly. The vertebral artery was then lifted gently and anchored to the dura. There was no other procedural complication. The patient's symptoms improved. This case demonstrates that intraoperative monitoring may be useful for preventing procedural complications during spinal cord microsurgical decompression.
Abnormalities, Multiple ; Aged ; Decompression* ; Evoked Potentials, Somatosensory ; Female ; Gait ; Humans ; Laminectomy ; Magnetic Resonance Imaging ; Microvascular Decompression Surgery ; Monitoring, Intraoperative* ; Neck Pain ; Spinal Cord ; Vertebral Artery*

BACKGROUND: Hypothermia following the induction of anesthesia is caused by core to peripheral redistribution of body heat. It has been reported that propofol causes more severe hypothermia than sevoflurane by inhibiting thermoregulatory vasoconstriction during surgical procedures. Therefore, we evaluated the induction and maintenance of anesthesia with intravenous propofol to determine if it causes more core hypothermia than inhaled sevoflurane. METHODS: Forty-five patients who underwent hysterectomy were divided into two groups randomly, a propofol-remifentanil (PR) anesthesia group and a sevoflurane-remifentanil (SR) anesthesia group. Each group was subjected to anesthetic induction with either 1.5 mg/kg propofol or inhalation of 5% sevoflurane, respectively. Anesthesia in the former group was maintained with propofol while it was maintained with sevoflurane in the latter group. Specifically, 6-10 mg/kg/hr propofol, 3 L/min medical air, 2 L/min O2, and 0.25 mg/kg/hr remifentanil were used in the PR group for maintenance, while 1.5 vol% sevoflurane, 3 L/min medical air, 2 L/min O2 and 0.25 mg/kg/hr remifentanil were used for maintenance in the SR group. We measured the core temperature 8 times, prior to induction and 10, 20, 30, 45, 60, 75 and 90 minutes after induction. RESULTS: Core temperatures decreased in both the PR and SR group during surgical operation, but there was no significant difference between the two groups. CONCLUSIONS: Anesthesia induced and maintained by propofol did not cause a greater degree of hypothermia than sevoflurane.
Anesthesia ; Hot Temperature ; Humans ; Hypothermia ; Hysterectomy ; Inhalation ; Methyl Ethers ; Piperidines ; Propofol ; Vasoconstriction

PURPOSE: To evaluate the efficacy of anterior-side rectangular 4-snip punctoplasty, a modification of posterior ampullectomy that is currently used in patients with punctal stenosis. METHODS: We performed a retrospective chart review of patients with punctal stenosis who underwent anterior-side rectangular 4-snip punctoplasty at our hospital. Fluorescein dye disappearance test (FDT) and questionnaire on tearing symptoms and tear meniscus height (TMH) based on spectral-domain optical coherence tomography (SD-OCT) were evaluated in preoperative and postoperative follow-up examinations of the patients. Anatomical success was defined as punctum without re-stenosis at last visit; functional success was defined as FDT grade of 0 or 1, or tearing symptom score of 2 or less. RESULTS: A total of 44 anterior-side 4-snip punctoplasty procedures were performed in 27 patients. The average age of all subjects was 56.0 +/- 11.0 years (range, 39 to 82 years). The mean follow-up period was 9.4 months (range, 6 to 20 months). FDT, tearing symptom score (p < 0.01, Wilcoxon signed-rank test), and TMH (p < 0.01, paired t-test) were significantly decreased after surgery. Anatomical success was 40/44 cases (90.9%) and functional success was 38/44 cases (86.4%). There were no complications such as skin defect or cosmetic problems. CONCLUSIONS: Anterior-side rectangular 4-snip punctoplasty is an effective surgical procedure for patients with punctal stenosis, maintaining functions of the lacrimal drainage system without re-stenosis of punctum.
Constriction, Pathologic* ; Drainage ; Fluorescein ; Follow-Up Studies ; Humans ; Surveys and Questionnaires ; Retrospective Studies ; Skin ; Tomography, Optical Coherence

A hepatic angiosarcoma is a rare primary malignant neoplasm, which accounts for only 2% of all primary hepatic tumors. The prognosis of a hepatic angiosarcoma is very poor, and most patients die within a year of the initial diagnosis. We report a case of a hepatic angiosarcoma in a 57-year-old man. Although a dynamic CT had suggested a carvenous hemangioma 12 months earlier, the tumor size increased and spontaneously ruptured, so surgical resection was mandatory. A pathological examination, including immunohistochemical studies, showed positive staining for CD34 and Factor VIII, which confirmed the diagnosis of an angiosarcoma. Although dynamic CT is an excellent modality for the diagnosis of a cavernous hemangioma of the liver, hepatic angiosarcomas should be ruled out in selected cases, because they may present with very similar CT findings to benign hemangioma.
Diagnosis ; Factor VIII ; Hemangioma ; Hemangioma, Cavernous* ; Hemangiosarcoma* ; Humans ; Liver ; Middle Aged ; Prognosis ; Rupture, Spontaneous

PURPOSE: To determine the correlation of the clinical characteristics and histopathologic findings of lacrimal sac after external dacyrocystorhinostomy (DCR). METHODS: From March 2008 to June 2009, 49 lacrimal sac tissues of 47 patients were obtained after external DCR and divided according to fibrosis and inflammatory findings. The correlation of preoperative duration of symptoms with NLD obstruction, symptoms of recurrence and outcomes of the operation to the histopathologic findings were retrospectively evaluated. RESULTS: The mean age of the patients was 58.83 +/- 11.49 years and the mean duration of preoperative symptoms was 65.2 +/- 69.05 months. Forty-three cases (88%) maintained good openings and 30 cases (61%) had no recurring symptoms over 6 months after the operation. Among the significant symptoms, severe subepithelial inflammations were observed more frequently at shorter duration. However, the fibrosis showed a positive relation with the preoperative duration of symptoms (Spearman correlation test, p<0.05). Most failures were found in the severe inflammation and fibrosis groups and were recovered with anti-inflammatory treatment. CONCLUSIONS: Inflammation and fibrosis of the lacrimal sac could be an important prognostic and predictive factor of outcomes of DCR.
Dacryocystorhinostomy ; Fibrosis ; Humans ; Inflammation ; Recurrence ; Retrospective Studies