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

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

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: The purpose of this study is to examine the frequency of posterior element injury in patients with traumatic thoraco-lumbar burst fractures and to evaluate the correlation between the MR imaging and CT findings. MATERIALS AND METHODS: The MR images of 38 patients with 39 thoraco-lumbar burst fractures and the results of the CT examinations of 28 patients with 29 fractures were retrospectively analyzed. Both procedures were performed within two weeks of injury. Twenty-one males and 17 females were included ; their average age was 51.3 (range, 11-75) years. MR images were evaluated for injury to the posterior ligamentous complex, comprising the supraspinous ligament(SSL), the interspinous ligament(ISL), the flaval ligament(FL), and the capsule of facets. Analysis of the CT findings focused on the posterior bony elements of the lamina, pedicle, spinous process, and facet joint. RESULTS: MR imaging revealed posterior ligamentous injuries in 18(46.2%) of 39 burst fractures ; there was tearing of the ISL in 15 cases(38.5%), of the SSL in 11(28.2%), of the capsule of facets in 11(28.2%), and of the FL in nine(23.1%). Among the 29 burst fracture cases examined by CT, posterior bony injuries were detected in 13(44.8%). Lamina and facet joint fractures were detected in six cases(20.7%), facet separation or dislocation in six(20.7%), and spinous process and pedicle fracture in one(3.4%). In 29 burst fracture cases, both MRI and CT were performed. Among the 18 cases in which MR imaging revealed posterior ligamentous injuries, CT failed to demonstrate posterior element fractures in seven. On the other hand, among the 13 cases in which CT indicated posterior bony fractures, MR failed to reveal posterior ligamentous injuries in two. CONCLUSION: Posterior element injury is frequently found in patients with traumatic thoraco-lumbar burst fractures demonstrated by MR imaging(46.2%) and CT(44.8%). Both MRI and CT are useful tools for the evaluation of posterior element injury, which determines the degree of instability of traumatic burst fracture.
Dislocations ; Female ; Hand ; Humans ; Ligaments ; Magnetic Resonance Imaging ; Male ; Retrospective Studies ; Zygapophyseal Joint

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*

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

Shone's syndrome is a congenital cardiac malformation that consists of multiple levels of left heart obstruction including supravalvular mitral ring, congenital mitral stenosis(parachute mitral valve), subaortic stenosis, and coarctation of aorta. This syndrome is a very rare congenital anomaly and its prognosis is poor. We experienced 9 patients with Shone's syndrome between 1985 and 1994. There were 8 male and 1 female patients, and mean age was 33.0+/-31.0 months ranged from 2 months to 11 years. The congenital mitral stenosis and coarctation of aorta existed in all patients and the supravalvular mitral ring and subaortic stenosis in 4 patients. Two patients had all four anatomic lesions. 3 patients underwent one stage total correction and the other 6 patients underwent two staged operation that was initial coarctoplasty with thoracotomy and later correction of intracardiac anomalies with median sternotomy. A third operation was performed in 2 patients. These procedures included reoperation for coarctation and replacement of mitral valve for persistent mitral stenosis. There was no operative death at the first operation but two operative deaths at the second operation. The cause of death in two cases was severe heart failure secondary to left ventricular hypoplasia. There was no operative death at the third operation. The seven survivors have been followed from 11 months to 12 years(mean follow-up : 6.7+/-3.6 years). There was no late death and the New York Heart Association activity level was class I for all patients. We conclude that a good long-term outcome can be expected by proper surgical treatment tailored to each individual's anatomy and pathophysiology although the operative mortality and morbidity of Shone's syndrome are high.
Aortic Coarctation ; Cause of Death ; Constriction, Pathologic ; Female ; Follow-Up Studies ; Heart ; Heart Failure ; Humans ; Male ; Mitral Valve ; Mitral Valve Stenosis ; Mortality ; Prognosis ; Reoperation ; Sternotomy ; Survivors ; Thoracotomy

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: Since the 1960 s rabbit antihuman globulin reagent has been used widely. Recently most conjugate of enzyme immunoassay is produced from goat, and precise purification method is developed. Therefore we evaluated the commercial value of the goat antihuman globulin as a blood bank test reagent. METHODS: The human IgG was purified by protein-A gel, and injected into goat. The goat antihuman globulin was coupled by CNBr activated sepharose 4B-gel and purified by 0.2M glycine elution buffer. For verification of this reagent, commercial reagents(Ortho rabbit reagent & DiaMed Gel test) were used. RESULTS: The minimal concentration for detecting antibody of goat reagent was 9 ng/mL. The results of direct antiglobulin tests, with 400 samples collected from donated blood in CPDA-1, were all negative(false positive rate: 0%). With 613 samples collected from inpatients of Severance Hospital, the results were positive in 35 patients(positive rate:5.7%), and those results were in complete agreement with commercial reagent(concordance rate: Goat vs. Ortho :99.8%, Goat vs. DiaMed :98.4%). And with 30 samples of artificially prepared complement-coated RBC, the results were all negative. Indirect antiglobulin test showed higher agglutination score than commercial reagents. CONCLUSIONS: Goat reagent showed high sensitivity and specificity in comparison with rabbit reagent. Because false positive reaction was not observed in negative control samples, the heterophil agglutinin reaction, which was the major problem when the reagent was initially developed, might be excluded. In conclusion, goat reagent seems to be more economical than rabbit reagent because the former can be obtained in a large quantity and of high potency.
Agglutination ; Blood Banks ; Coombs Test ; False Positive Reactions ; Glycine ; Goats* ; Humans ; Immunoenzyme Techniques ; Immunoglobulin G ; Indicators and Reagents ; Inpatients ; Sensitivity and Specificity ; Sepharose