PURPOSE: To compare the influences on the cornea between the WhiteStar mode and the continuous mode in the Sovereign(R) phacoemulsification unit after cataract surgery using temporal clear corneal incisions. METHODS: This study comprised 46 eyes of 23 patients who had cataracts in both eyes with similar grades of nucleosclerosis. The WhiteStar mode was used in one eye, and the continuous mode was used in the other eye. Pachymetry at the corneal center and 2 mm from the temporal limbus was performed. Topography and specular microscopy were performed, and surgically induced astigmatism was calculated using the Holladay-Cravy-Koch formula by simulated keratometric readings of Humphrey topography. Effective phaco time and average phaco power were recorded. RESULTS: Changes of corneal thickness at the center of the eye and at the incision site were significantly lower in the WhiteStar mode than in the continuous mode at 1 month postoperatively. However, there was no significant difference in corneal thickness at either site and in other parameters measured at 2 months postoperatively. The effective phaco time in the WhiteStar mode was significantly lower than in the continuous mode for cataracts with a high grade of nucleosclerosis. CONCLUSIONS: The early postoperative corneal edema in the WhiteStar mode was less than in the continuous mode. However, there was no remarkable difference in corneal endothelial damage. The effectiveness of phacoemulsification in the WhiteStar mode was superior to that in the continuous mode, especially for dense cataracts.
Astigmatism ; Cataract ; Cornea* ; Corneal Edema ; Endothelium, Corneal ; Humans ; Microscopy ; Phacoemulsification ; Reading

PURPOSE: To evaluate the efficacy of two excimer laser systems with eye-tracker in the term of decentration amount. METHODS: We performed LASIK with LaserScan LSX(TM) (group 1, 39 eyes) and Allegretto Wave(TM) (group 2, 94 eyes), both of which were equipped with eye-tracker. The amount of decentration was measured on a difference map that was obtained from preoperative and postoperative corneal topography, and was compared between the two groups. RESULTS: The amount of decentration was significantly higher in group 1 (0.39 +/- 0.22 mm) than in group 2 (0.29 +/- 0.18 mm) (p=0.018). When these groups were subdivided by preoperative spherical equivalent, in case of under -6.0 D, the amount of decentration between the two groups (0.31 +/- 0.16 mm in group 1, 0.28 +/- 0.15 mm in group 2, p=0.380), whereas in case of over -6.0 D, the amount of decentration was significantly higher in group 1 (0.48 +/- 0.26 mm) than in group 2 (0.30 +/- 0.21 mm) (p=0.020). CONCLUSIONS: Allegretto Wave(TM) showed better centration ability than LaserScan LSX(TM) and this superiority was more profound in highly myopic eyes.
Corneal Topography ; Keratomileusis, Laser In Situ* ; Lasers, Excimer

Background: Chronic stress at work is known to be associated with the risk of developing metabolic syndrome. Recent studies have evaluated stressand its association with metabolic syndrome in specific occupational groups. In the present study, we examined the relationship between stress andthe risk of developing metabolic syndrome in each occupational group. Methods: The present study examined 7,460 Korean workers, aged 20–65 years, whose data were collected from the Korea National Health andNutrition Examination Survey conducted between 2014 and 2016. The information on usual stress awareness was self-reported, and thebiochemical profile of the blood was conducted. The chi-square test and multiple logistic regression analysis were used to investigate therelationship between stress and metabolic syndrome in each occupational group. Results: The metabolic syndrome was prevalent in 26.3% of the study subjects. In the function-related job groups, the individuals with high stress levelsshowed a significantly higher risk of developing metabolic syndrome (odds ratio, 1.625; 95% confidence interval, 1.042–2.534) than those with lowstress levels. An increasing trend was observed, which suggested the increased risk of developing metabolic syndrome across increasing stress levelsin a stratified analysis in many occupational groups, specifically in function-related, viz., manager and expert, office worker, service worker, andsimple laborer (P for trend <0.001) groups. Conclusion The stress levels were significantly correlated with the risk of developing metabolic syndrome in function-related job groups. A differencebetween dose-response association of stress levels and metabolic syndrome existed in each occupational group.

BACKGROUND: The aim of this study was to investigate the predictive value of snoring frequency in the diagnosis and severity of obstructive sleep apnea. METHODS: Patients who underwent polysomnography with one or more of the following characteristics were included: 1) sleepiness, non-restorative sleep, fatigue, or insomnia symptoms; 2) arousal due to cessation of breathing or the occurrence of gasping or choking when waking up; and 3) habitual snoring, breathing interruptions, or both, noted by a bed partner or other observer. We analyzed the differences in clinical and polysomnographic variables between patients with and without obstructive sleep apnea and investigated the associations of those variables with obstructive sleep apnea severity. RESULTS: One hundred ninety-three patients met the inclusion criteria, and 145 of the 193 patients were diagnosed with obstructive sleep apnea. Multiple logistic regression analysis showed that large neck circumference (p = 0.0054) and high snoring index (p = 0.0119) were independent predictors for obstructive sleep apnea. Moreover, between the obstructive sleep apnea severity groups, there was a strong tendency of difference in body mass index (p = 0.0441) and neck circumference (p = 0.0846). However, there was no significant difference in snoring frequency according to obstructive sleep apnea severity (p = 0.4914). CONCLUSIONS: We confirmed that snoring frequency is a predictor of obstructive sleep apnea. In addition, we showed for the first time that snoring frequency is not associated with obstructive sleep apnea severity, thus it is not a valuable marker for predicting obstructive sleep apnea severity.
Airway Obstruction ; Arousal ; Body Mass Index ; Diagnosis ; Fatigue ; Humans ; Logistic Models ; Neck ; Polysomnography ; Respiration ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive* ; Sleep Initiation and Maintenance Disorders ; Snoring*

Granular cell basal cell carcinoma is a rare histopathologic variant of basal cell carcinoma in which some or all of the neoplastic cells show cytologic features of granular cells. These distinctive cells contain abundant eosinophilic cytoplasm housing numerous fine and coarse refractile granules. The 62-year-old man presented with a 5-year history of asymptomatic, solitary 1 cm-diameter, hemispherical, brown to black, smooth-surfaced, hard nodule on the left chest. The histopathological features showed a tumor with the general configuration of a solid basal cell carcinoma, in which there were masses of granular cells with eosinophilic and granular cytoplasm. The tumor was positive for cytokeratin and negative for lysozyme and PAS. Surgical excision was performed.
Carcinoma, Basal Cell* ; Cytoplasm ; Eosinophils ; Housing ; Humans ; Keratins ; Middle Aged ; Muramidase ; Thorax

OBJECTIVES: Documented risk factors for obstructive sleep apnea include advanced age, male gender, hypertension, large neck circumference, and obesity; but some controversy remains regarding the risk factors, especially in Asians. In this study, we evaluated the risk factors for obstructive sleep apnea in snoring patients, and also analyzed the risk factors that could predict the severity of obstructive sleep apnea. METHODS: The inclusion criteria were patients 1) who visited our hospital with a chief complaint of snoring as witnessed by a sleep partner and 2) who underwent overnight polysomnography. The primary endpoint was the presence of obstructive sleep apnea as a dependent variable. RESULTS: One hundred forty-seven patients met the inclusion criteria. Of the 147 patients, 109 patients were diagnosed with obstructive sleep apnea. Multivariate analysis showed that old age and large neck circumference were significant independent variables for predicting the presence of obstructive sleep apnea, whereas hypertension and large neck circumference were independent variables for predicting the severity of obstructive sleep apnea. CONCLUSIONS: We demonstrated that neck circumference can be used to predict the presence as well as the severity of obstructive sleep apnea in snoring Asian patients.
Asian Continental Ancestry Group ; Humans ; Hypertension ; Male ; Multivariate Analysis ; Neck* ; Obesity ; Polysomnography ; Risk Factors ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive* ; Snoring*

A 77-year-old man developed acute vertigo and unsteady gait. Neurological examination revealed spontaneous left-beating nystagmus in the primary position. He fell to the left when walking without support. Magnetic resonance imaging showed an acute infarction involving the right parieto-temporal lobe. Although the vertigo and unsteady gait are most often associated with vestibular disorders involving the infratentorial structures, those may occur in cerebral infarction of the parieto-temporal lobe.
Aged ; Cerebral Infarction ; Gait Disorders, Neurologic* ; Humans ; Infarction* ; Magnetic Resonance Imaging ; Neurologic Examination ; Stroke ; Vertigo* ; Walking

Coronavirus disease 2019 (COVID-19) has spread widely across the world since January 2020.There are many challenges when caring for patients with COVID-19, one of which is infection prevention and control. In particular, in cases where surgery must absolutely be performed, special infection control may be required in order to perform surgery without spreading infection within the hospital. We aim to present potentially useful recommendations for nondeferrable surgery for COVID-19 patients based on in vivo and in vitro research and clinical experiences from many countries.

OBJECTIVES: Vacuum-assisted breast biopsy (VABB) is a widely used technique for the diagnosis of breast lesions. It is carried out with local anesthesia, but procedural pain and stress are still problematic. Dexmedetomidine is a α-2 receptor agonist that can sedate without significant respiratory depression. The study aimed to report the effectiveness of sedation with monitored anesthesia care (MAC) using dexmedetomidine in VABB. METHODS: This was a retrospective chart review of patients who received VABB under MAC with dexmedetomidine. Forty-seven patients during the period of February 2015 to July 2016 were included. We collected data on patient characteristics, infusion drug and dose, induction to incision time, anesthetic, operation, and recovery time and other complications and vital signs. RESULTS: The mean operating time was 50.1 ± 24.9 minutes, and the anesthetic time was 71.2 ± 28.3 minutes. The mean time from induction to incision was 17.0 ± 5.2 minutes, and the recovery time was 20.1 ± 10.3 minutes. None of the patients needed an advanced airway management. Further, none of them showed hemodynamic instability. CONCLUSIONS: VABB was successfully performed with MAC using dexmedetomidine, and there was no respiratory depression or hemodynamic instability.
Airway Management ; Anesthesia ; Anesthesia, Local ; Biopsy ; Breast ; Dexmedetomidine ; Diagnosis ; Hemodynamics ; Humans ; Respiratory Insufficiency ; Retrospective Studies ; Vital Signs

PURPOSE: The purpose of this study was to compare the clinical outcomes of arthroscopic anatomical double bundle (DB) anterior cruciate ligament (ACL) reconstruction with either selective anteromedial (AM) or posterolateral (PL) bundle reconstruction while preserving a relatively healthy ACL bundle. MATERIALS AND METHODS: The authors evaluated 98 patients with a mean follow-up of 30.8±4.0 months who had undergone DB or selective bundle ACL reconstructions. Of these, 34 cases underwent DB ACL reconstruction (group A), 34 underwent selective AM bundle reconstruction (group B), and 30 underwent selective PL bundle reconstructions (group C). These groups were compared with respect to Lysholm and International Knee Documentation Committee (IKDC) score, side-to-side differences of anterior laxity measured by KT-2000 arthrometer at 30 lbs, and stress radiography and Lachman and pivot shift test results. Pre- and post-operative data were objectively evaluated using a statistical approach. RESULTS: The preoperative anterior instability measured by manual stress radiography at 90° of knee flexion in group A was significantly greater than that in groups B and C (all p<0.001). At last follow-up, mean side-to-side instrumented laxities measured by the KT-2000 and manual stress radiography were significantly improved from preoperative data in all groups (all p<0.001). There were no significant differences between the three groups in anterior instability measured by KT-2000 arthrometer, pivot shift, or functional scores. CONCLUSION: Selective bundle reconstruction in partial ACL tears offers comparable clinical results to DB reconstruction in complete ACL tears.
Adolescent ; Adult ; Anterior Cruciate Ligament/*surgery ; Anterior Cruciate Ligament Reconstruction/*methods ; Arthroscopy ; Female ; Humans ; Male ; Middle Aged ; Organ Sparing Treatments/*methods ; Treatment Outcome ; Young Adult