Among the postoperative complications of ptosis surgery, lagophthalmos and lid lag have been significant and untolerable problems. In this study, progressive change of lagophthalmos and lid lag following external levator resection was examined in 109 eyes of 74 patients from November 1988 through March 1996. Lagophthalmos and lid lag were measured at postoperative 1 month, 3 to 9 months and 12 to 18 months. The relations of lagophthalmos and lid lag according to preoperative MRD, levator function, resection amount of the levator muscle were analyzed. Lagophthalmos measured average 1.11mm and lid lag revealed average 4. 73mm at postoperative 11 to 84 months (mean 22.2 months). At the postoperative 1 year, lagophthalmos and lid lag were significantly decreased and decreasing amount measured 1.17mm and 0.90mm, respectively. Seventy eyes showed lagophthalmos less than 1mm at mean 13 months postoperatively. The postoperative change of lagophthalmos and lid lag had relation to the preoperative levator function.
Humans ; Postoperative Complications

The spinal schwannomas are the most common spinal cord tumors and they make some regressive changes such as necrosis, mucous or cystic degeneration, caseation or calcification occasionally. We experienced a case of intradural ossifying schwannoma in 17 years old male, which occurred in the 2nd 3rd thoracic region. On operative finding, it was a very hard, pinkish gray and bean sized mass, and it firmly adhered to the spinal cord. We found dark bluish necrotic changes at the adhered sites of the spinal cord. On microscopical finding it revealed multiple foci of myxoid degeneration and osseous metaplasia with fibromatosis structure in schwannoma.
Adolescent ; Fibroma ; Humans ; Male ; Metaplasia ; Necrosis ; Neurilemmoma* ; Spinal Cord ; Spinal Cord Neoplasms

Rothia muciliaginosa (R. mucilaginosa) is a facultative, Gram-positive coccus that is considered to be part of the normal flora of the mouth and respiratory tract. There are sporadic reports of the organism causing endocarditis in patients with heart valve abnormalities, as well as meningitis, septicemia, and pneumonia associated with intravenous drug abuse. However, it is an unusual pathogen in cases of peritoneal dialysis (PD)-associated peritonitis. Although R. mucilaginosa is generally susceptible to penicillin, ampicillin, cefotaxime, imipenem, rifampicin, and glycopeptides, there are no guidelines for the treatment of PD-associated peritonitis. Herein, we report a case of PD-associated peritonitis due to R. mucilaginosa that was resolved with intraperitoneal antibiotic treatment.
Ampicillin ; Cefotaxime ; Endocarditis ; Glycopeptides ; Heart Valves ; Humans ; Imipenem ; Meningitis ; Mouth ; Penicillins ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory ; Peritonitis* ; Pneumonia ; Respiratory System ; Rifampin ; Sepsis ; Substance Abuse, Intravenous

Diabetic ketoacidosis (DKA) is a complex medical disorder characterized by abnormalities in electrolyte, acid-base, and volume status. Metabolic acidosis in mild and moderate DKA is corrected with insulin therapy. Bicarbonate therapy may be indicated in cases of severe metabolic acidosis, however the use of bicarbonate in severe DKA is controversial due to a lack of prospective randomized studies. Renal replacement therapy can be used for correction of systemic acidemia. Continuous renal replacement therapy (CRRT) is used in patients who are too hemodynamically unstable to tolerate conventional hemodialysis, but has also been used in treatment of patients with severe DKA. CRRT has never been used previously in DKA patients with refractory metabolic acidosis in Korea. Here, we describe the successful treatment of a DKA patient with refractory metabolic acidosis with CRRT.
Acidosis* ; Diabetic Ketoacidosis* ; Hemodiafiltration* ; Humans ; Insulin ; Korea ; Prospective Studies ; Renal Dialysis ; Renal Replacement Therapy

We have made a clinical analysis of emergency operations which were performed from January to December 1983 at the Chonbuk National University Hospital. The Clinical analysis compared sex and age distribution, physical status, frequency of emergency operation, department, anesthetic method, time, and seasonal distribution. The results were as follows: 1) About forty-eight percent of emergency patients were between 20 to 40. 2) Emergency operative cases were about forty-one percent of all anesthetized patients. 3) About forty-three percent of emergency operations were performed by the Department of General Surgery and the most common surgical operation was appendectomy. 4) Emergency operations in the winter were significantly less common than those of other seasons. 5) About forty percent of emergency operations were performed during daytime office hours.
Age Distribution ; Anesthesia* ; Appendectomy ; Emergencies* ; Humans ; Jeollabuk-do ; Seasons

Methods for the identification and amplification of signals from quantities of intravascularly administered iodinated contrast agent and their combination with image subtraction have evolved into a clinically useful technique called digital subtraction angiography (DAS). The initial motivation for the development of DSA was the desire to replace standard conventional angiographic procedures with simpler, less invasive techniques. We have evaluated IV-DSA and IA-DSA which are made in 150 patients with clinically suspected intracranial diseases from Dec. 1983 to Mar. 1985. Comparison with IA-DSA and conventional angiography indicated that the quality and information of content of the film were equivalent. IV-DSA image quality was inferior to that of conventional angiography. But IV-DSA can be used for intracranial studies to evaluate results of surgery of aneurysm, AVM or tumor and to revaluate vasospasm after subarachnoid hemorrhage before surgery. Also, IV-DSA can be used for neck vessel appearance due to reveal adequate information.
Aneurysm ; Angiography ; Angiography, Digital Subtraction ; Humans ; Motivation ; Neck ; Subarachnoid Hemorrhage

BACKGROUND AND OBJECTIVES: Off-thyroxine serum thyroglobulin (Tg) level is important to predict metastatic disease (MD) in papillary thyroid cancer (PTC); however, it is unclear whether a single off-thyroxine Tg level is sufficient for predicting MD. In this study, we determined whether serial measurement of off-thyroxine serum Tg level can predict metastasis in PTC patients after total thyroidectomy. MATERIALS AND METHODS: We enrolled 140 PTC patients in whom serum thyroid-stimulating hormone (TSH) and Tg levels were measured 7 days before radio-iodine (RAI) treatment (TSHA and TgA) and on the day of RAI treatment (TSHB and TgB) with withholding L-thyroxine for 4 weeks before RAI treatment. The values of TSHinc (TSHB-TSHA) and Tginc (TgB-TgA), Tgratio (TgB/TgA), Tginc/TSHinc and Tgratio/TSHinc were calculated. Tginc/TSHinc and Tgratio/TSHinc were tested if those parameters can predict MD in patients with TSHA>30 microIU/mL and TgA<10 ng/mL. RESULTS: Forty-four patients had MD and 96 had no evidence of MD (non-MD). MD group showed higher levels of TgA, TgB, Tginc, Tginc/TSHinc and Tgratio/TSHinc compared with non-MD group. A significant correlation was found between TSHinc and Tgratio (r=0.669) in MD group. In 43 patients with TSHA>30 microIU/mL and TgA<10 ng/mL (MD, 9; non-MD, 34), both Tginc/TSHinc (100%) and Tgratio/TSHinc (89%) had higher sensitivities for predicting MD than TgB (78%). CONCLUSION: With the increment in serum Tg corrected for the increment in serum TSH, serial measurements of off-thyroxine serum TSH and Tg levels can help predict PTC metastasis.
Factor IX ; Humans ; Neoplasm Metastasis ; Thyroglobulin ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy ; Thyrotropin ; Thyroxine

Background: Suicide among the elderly is a public health concern, as life expectancy is increasing rapidly and suicide rates increase with age. In Korea, self-poisoning is the most common method of attempted suicide. This study aimed to evaluate the characteristics of attempted suicide by self-poisoning among the elderly and to identify risk factors related to the suicide attempts. Methods: A cross-sectional observational study was conducted using the Emergency Department-based Injury In-depth Surveillance database in Korea. We included all adult patients visiting the emergency department (ED) who attempted suicide by poisoning between January 2011 and December 2017 and stratified according to age: the elderly (≥ 65 years old) and the younger group. Characteristics and risk factors for attempted suicide by poisoning among the elderly were evaluated using stepwise regression analysis. Results: Among 25,904 adult patients, 5,164 (19.9%) were classified as elderly. The elderly were more likely to be admitted to hospital and intensive care units, the average ED length of stay was longer, and total mortality was higher than that of the younger group. Male sex, low socioeconomic status, poor physical health, pesticide use, lower alcohol consumption, and fewer prior suicide attempts were found to be risk factors for suicide among the elderly. Conclusion Self-poisoning among the elderly is associated with poorer clinical outcomes than in younger adult patients. Suicide among the elderly is a potentially preventable public health problem, and with proper identification of the associated risk factors, appropriate multidisciplinary intervention strategies can be implemented.

BACKGROUND AND OBJECTIVES: Movement of mitral valve during diastole and blood flow velocity through the valve can be accurately measured using M-mode and pulsed wave Doppler technique, respectively. However, the relationship between mechanical excursion and flow phenomenon at the same cardiac cycle has not been seriously investigated. METHOD: The subjects of this study included twenty cases with normal mitral flow pattern in Doppler echocardiography (Group I, mean age:44+/-20.8years, mean ejection fraction (EF):52+/-20.9%), twenty three cases with relaxation abnormality (Group II, mean age:59+/-11.4years, mean EF:43+/-18.2%) and seventeen cases with restrictive physiology (Group III, mean age: 47+/-15.9years, mean EF: 24+/-11.0%). We measured excursion of mitral leaflets at early (DE) and late (DA) diastole, area of mitral valvular opening using two dimensional calibration on M mode images, and transmitral inflow velocity (E (early ventricular filling)-, A (atrial contraction)-velocity), TVI (time velocity integral) on Doppler echocardiography. RESULTS: DE-excursions (mm) in group I, II, III were 16.8+/-4.7, 14.2+/-3.5, 15.3+/-4.1, DA-excursions (mm) were 9.8+/-3.2, 10.7+/-3.0, 8.3+/-2.7, E-areas (cm2) were 2.8+/-1.3, 2.6+/-0.8, 2.5+/-1.0, A-areas (cm2) were 1.7+/-0.8, 1.7+/-0.7, 2.0+/-0.6, respectively. In E-, A-velocity, deceleration time, E-TVI and A-TVI, there were significant differences among three groups. However, in DE-, DA-excursion, E-, A-area, there were no significant differences among three groups. Between DE excursion and E velocity, DA excursion and A velocity, and total opening area and total TVI in total subjects, significant correlations were absent. CONCLUSION: The mitral excursions and mitral opening areas on M mode images did not show any significant correlations with the mitral inflow velocities and TVI by pulsed Doppler, which suggests that the excursion of mitral leaflets is independent of transmitral inflow.
Blood Flow Velocity ; Calibration ; Deceleration ; Diastole ; Echocardiography* ; Echocardiography, Doppler ; Mitral Valve* ; Physiology ; Relaxation

BACKGROUND: In searching for a differential spinal block between dependent and nondependent sides, we evaluated the influence of the duration of lateral decubitus on the spread of hyperbaric bupivacaine during spinal anesthesia. METHODS: Spinal anesthesia with 1.2 ml of hyperbaric 0.5% bupivacaine (6 mg) was administered with a 25-gauge Whitacre unidirectional needle to 50 ASA 1 patients undergoing unilateral knee arthroscopy. The patients were allocated randomly to three groups according to the duration of lateral decubitus after spinal injection in the lateral position operation side dependent: Group 1, 10 min in lateral decubitus then supine; Group 2, 20 min in lateral decubitus then supine; Group 3, 30 min in lateral decubitus then supine. Sensory and motor block (pinprick/modified Bromage scale) as well as skin temperature were compared between the dependent and nondependent sides. Circulatory variables were recorded for 10 min after being turned supine. RESULTS: The sensory block between dependent and nondependent sides were significantly different in Group 3. In Group 1, the level of maximum sensory block was higher than Group 3 on nondependent side. There was no difference in the number of patients having achieved Grade 3 and 0 motor block among three groups on dependent and nondependent sides. The skin temperature in lateral decubitus was significantly higher on the dependent side than nondependent side in three groups. In Groups 1 and 2, the skin temperatures of nondependent side were increased after turned supine, but that was maintained during supine position in Group 3. The circulatory variables were stable in all 50 patients. CONCLUSIONS: We conclude that when a small dose of 0.5% hyperbaric bupivacaine is injected into patients in the lateral position, complete unilateral spinal anesthesia is achieved when the patients arekeep in a lateral position for more than 30 min after spinal injection.
Anesthesia, Spinal* ; Arthroscopy ; Bupivacaine* ; Humans ; Injections, Spinal ; Knee ; Needles ; Skin Temperature ; Supine Position