Canalith repositioning maneuver is effective to treat benign paroxysmal positional vertigo(BPPV). This case showed complicated form of the BPPV such as changes of canalolithiasis to cupulolithiasis, involvement of one canal to two canals and from unilateral to bilateral involvement during the reposition maneuver. This patient was diagnosed as left lateral canalolithiasis at first. After left barbecue maneuver, the type was changed to the right posterior cupulolithiasis. Semont maneuver was performed and then the type of BPPV was changed to combined type with right posterior canalolithiasis and left lateral canalolithiasis. We performed left barbecue maneuver and right Epley maneuver. Then the type of BPPV was changed to left lateral cupulolithiasis. After Brandt-Daroff maneuver and left barbecue maneuver, nystagmus and dizziness disappeared finally.
Dizziness ; Humans

PURPOSE: To experimentally investigate the effect for muscle weakness after superior rectus Z-myotomy and histological changes. METHODS: Superior rectus muscle fibers of rabbits (16 rabbits, 32 eyes) were cut transversely with scissors across 75% of the muscle in two different positions on opposite sides. In group 1 (16 eyes), myotomies were performed at 2 and 7 mm from the muscle insertion (5 mm gap) and in group 2, performed at 2 and 5 mm (3 mm gap). The change of mark, eyeball position, and muscle tension after myotomy and 4 weeks postoperatively was evaluated, the location of the mark was examined, and muscle tissue biopsy was performed. RESULTS: After Z-myotomy, the marks of the two groups moved significantly posteriorly from insertion within groups (p<0.05), with no significant differences between groups (p=0.469). Eyeball positions of the two groups moved significantly inferiorly (p<0.05); the amount of position change of group 1 was greater than group 2 (p<0.05). When the globe was pulled in opposite directions for muscle action, the degree of change decreased with significant difference within groups (p<0.05), but there were no significant differences between groups (p=0.32). CONCLUSIONS: Z-myotomy of the superior rectus muscle affected the recession of eyeball position and weakened the muscle action. Muscle weakening affected by the different gaps between myotomies did not show consistent results.
Biopsy ; Muscle Tonus ; Muscle Weakness ; Muscles ; Rabbits

PURPOSE: To compare surgically-induced corneal astigmatism after 3.0 mm-sized incision and 3.2~3.4 mm-sized extended incision in cataract surgery. METHODS: This study included 205 eyes of 202 patients having phacoemulsification with temporal clear corneal incision. The eyes were classified into 4 groups according to IOL type and incision size: Group A, silicone IOL was inserted using the injector through 3.0 mm sized incision; Group B, silicone IOL was inserted using the injector through 3.2 mm sized incision; Group C, acrylic IOL was inserted using the forceps through 3.4 mm sized incision; and Group D, acrylic IOL was inserted using the injector through 3.2 mm sized incision. The uncorrected visual acuity, autorefractometry, and keratometry were taken preoperatively and at 1 week and 2 months postoperatively. RESULTS: Preoperatively, there was no significant difference between the 4 groups in preoperative astigmatism. On the seven operative day, there was significant difference between the 4 groups with one-way ANOVA test (P=.044), and between A and C, and between A and D with post-hoc tests (P<.05). There was no significant difference between the 4 groups at 2 months postoperatively (P=.945). On the seven operative day, there were significant differences between the 4 groups in surgically-induced corneal astigmatism with one-way ANOVA test (P=.009), and between A and C, and between A and D with post-hoc tests (P<.05). There was no significant difference between the 4 groups at 2 months postoperatively (P=.985). CONCLUSIONS: The 3.0 mm-sized clear corneal incision without extension induced early stabilization of surgically-induced corneal astigmatism and rapid visual rehabilitation.
Astigmatism* ; Cataract* ; Humans ; Phacoemulsification ; Rehabilitation ; Silicones ; Surgical Instruments ; Visual Acuity

OBJECTIVE: Using immersive virtual environment technique, we aimed to preliminarily examine whether nicotine affects the interpersonal distance, as the size of personal space, in schizophrenic patients, which have extraordinarily high smoking rate. METHOD: Ten male schizophrenic patients who were at least moderate current smokers smoked a high (0.9 mg nicotine as an active drug) or low (0.1 mg nicotine as a placebo) nicotine-yielding cigarette after overnight-abstinence in randomized, double blind, cross-over design. Following the smoking session, subjects performed the 'self-introduction task' in virtual environment by introducing themselves consecutively to six different avatars, which varied in gender and facial/verbal expressions (neutral, angry, and happy). In the tasks, subjects were asked to step forward to each avatar until they felt most comfortable to greet the avatar first. The distance was measured by the head-tracking device, which was transmitting real-time data to the computer. Affective valence and arousal to each avatar were also rated by subjects following the tasks. RESULTS: The overall interpersonal distance of the drug group was significantly greater than that of placebo group (Z = -2.93, p = 0.022). The distances with emotionally neutral avatars (male/female) of the six were significantly different between the two groups (Z = -2.19, p = 0.028 ; Z = -2.09, p = 0.037). Within-group analysis revealed a significant difference among the distances with the six avatars in the placebo group (x2 = 17.03, df = 5, p = 0.004), but there was no significant within-group difference in the drug group (x2 = 6.11, df = 5, p = 0.295). CONCLUSION: These preliminary findings suggest that nicotine may increase the size of personal space of schizophrenic patients probably by enhancing the social stimuli perception through affecting the patients' cognitive function.
Female ; Male ; Humans

PURPOSE: To investigate the clinical features of monocular amblyopia which failed to respond to occlusion therapy. METHODS: We retrospectively reviewed the records of 57 children who failed to respond to occlusion therapy. Treatment failure was defined in two ways: visual improvement failure indicating less than two lines of visual acuity improvement, and functional failure indicating a final visual acuity in the amblyopic eye worse than 20/40 after more than 3 months of occlusion therapy. We investigated the clinical features of the patients and also classified and analyzed the factors related to prognosis into fixed factors and adjustable factors according to the adjustability during treatment. RESULTS: The visual acuity of the amblyopic and sound eyes was and average of 0.20+/-0.12 (0.02~0.5) and 0.80+/-0.18 (0.5~1.0), respectively. Forty-one patients (71.9%) had strabismus and esotropia was most frequent (65.9%). According to the age distribution, the 5~6-year-old group was most frequent (21 patients, 36.8%). Four adjustable factors, the interval from diagnosis to treatment, good compliance, full term occlusion, and sufficient occlusion, were insufficiently applied to the visual improvement failure group and the functional failure group as 60% and 53.1%, respectively. CONCLUSIONS: Clinical features of monocular amblyopia which failed to respond to occlusion therapy were moderate amblyopia with strabismus and relatively younger children. There was room for improvement to additional treatment of 50~60%.
Child ; Male ; Female ; Humans

This study reports the protective of systemic nicardipine and intracisternal nicardipine administration in the three-hemorrhage canine model of chronic cerebral vasospasm. Twenty-one dogs were assigned to one of three groups : control, intravenous nicardipine, and intracisternal nicardipine. All animals received a total of 12ml of fresh unheparinized autologous blood via three cisternal injection. Selective vertebral angiograms were obtained before intravenous nicardipine for 7 days continuously, the other seven were treated by intracisternal nicardipine for 7 days, and the remaining were not treated. Animals were sacrificed at day 9. Comparisons were based on the percentage of reduction in basilar artery diameter(% RBAD). The ultrastructural changes were studied by transmission electron microscopy(TEM). There was a mean reduction(+/- standard deviation) of 54+/-6% in control dogs, 35+/-4% in dogs with intravenous nicardipine, 32+/-6% in dogs with intracisternal dicardipine(difference significant, t-test, P<0.05). The preventive effects of intracisternal nicardipine was superior to those of intravenous nicardipine. There was a strong trend toward reduction of medial necrosis in the basilar artery in dogs with intravenous and intracisternal group compared to control dogs. All basilar arteries showed structural changes with celectron microscopic examination ; these included medial necrosis, lysosome, initial changes, endothelial cell vacuoles, and adventitial erythrocytes, leukocytes. Intimal proliferation was unusual in all three groups, but reduction of intimal proliferation was found in dogs with treatment, and it was believed that vasospasm in this stage is due to long-standing smooth muscle contraction and not to arterial wall thickening. There was significant reduction of blood clot in intracisternal nicardipine group, which may be due to inhibitory action on platelet aggregation of nicardipine. These investigations support the hypothesis that the presence of clotted blood around the intracranial arteries is the cause of vasospasm.
Animals ; Arteries ; Basilar Artery ; Dogs ; Endothelial Cells ; Erythrocytes ; Leukocytes ; Lysosomes ; Muscle, Smooth ; Necrosis ; Nicardipine* ; Platelet Aggregation ; Vacuoles ; Vasospasm, Intracranial*

PURPOSE: To evaluate the effect of Nd:YAG laser posterior capsulotomy on refraction, anterior chamber depth (ACD), and intraocular pressure (IOP). METHODS: For forty-eight eyes of 38 patients who received Nd:YAG laser therapy, we measured visual acuity, refraction, ACD, and IOP before the capsulotomy and at 1 day, 7 days, 30 days, 90 days after. RESULTS: There were no significant difference in ACD or IOP after YAG laser capsulotomy (P>.05). But we found significant decrease in astigmatism 1day after laser treatment, especially In the large axial length group (> or =24 mm)(P<.05). This early change in astigmatism was recovered to similar to what it was before laser treatment. CONCLUSIONS: YAG laser treatment after treatment of cataract is a stable method without clinically significant effect on refraction, ACD, or IOP, except for transient astigmatic change.
Anterior Chamber ; Astigmatism ; Cataract ; Humans ; Intraocular Pressure ; Laser Therapy ; Lasers, Solid-State ; Posterior Capsulotomy* ; Visual Acuity

We studied the relationship between eye position in the awakened state and in the surgical plane of anesthesia in orthophoric and horizontal strabismus patients. We classified 105 orthophoric and horizontal strabismus patients into 5 groups, measured the eye position at the primary position by photographic measurement of the corneal reflex positions and undertook a quantitative study of eye position. Under general anesthesia, the mean divergence was 39.7 +/- 8 PD for the esotropia group, 36.6 +/- 11.7 PD for exophoria, 27.4 +/- 8.1 PD for orthophoria, and 11.1 +/- 10.2 PD for exotropia I (< or=30 PD). Therefore, the esotropia group had the largest amount of divergence among the groups, but the eye position of the exotropia II (> 30 PD) group was rather convergent at 11.0 +/- 6.5 PD. According to the eye position of the fixating and nonfixating eyes in the esotropia group, both eyes converged with an angle deviation of 14.4 +/- 4.8 PD divergent and 14.1 +/- 4.8 PD divergent, respectively (P=.71). In the exotropia groups (I, II), the fixating eye diverged but the nonfixating eye rather converged. Therefore, the angle deviation was 19.0 +/- 2.1 PD divergent for the fixating eye and 18.2 +/- 6.4 PD divergent for the nonfixating eye (P=.68). In conclusion, under general anesthesia, eye positions in the awakened state and in the surgical plane of anesthesia were convergent or divergent, and showed a tendency to converge into the position of 25-35 PD divergent. Therefore, we could not distinguish fixating eye from nonfixating eye under general anesthesia.
Adolescent ; Adult ; *Anesthesia, General ; Child ; Child, Preschool ; Esotropia/*physiopathology ; Exotropia/*physiopathology ; Eye Movements/*physiology ; Humans ; Photography ; Vision, Binocular/physiology