We examined 60 eyes of 60 patients after excimer photorefractive keratectomy(PRK) for myopia and analyzed the changes of central island on corneal topography for 6 months prospectively. These patients were divided into two groups according to the degree of myopia, group 1(26 eyes, 6 diopters or below by spherical equivalent) and group 2 (34 eyes, over 6 diopters). The occurrence rate of central island was 76.4% collectively, 87.5% in group 1, 67.7% in group 2 at 2 weeks after PRK. It decreased to 30.4%, 43.5%, and 21.1% respectively at 6 months after PRK and was lower in group 2 than group 1. However there was no statistically significant correlation between the reduction of central island size and improvement of corrected visual acuity in both groups. In conclusion, the central island disappeared and decreased the amount for six months follow-up period after PRK and seems to be no effect on the corrected visual acuity.
Corneal Topography ; Follow-Up Studies ; Humans ; Myopia* ; Photorefractive Keratectomy* ; Prospective Studies ; Visual Acuity*

161 patients with tibia fracture were treated by closed intramedullary nailing at the department of Orthopedic Surgery, Eul-Ji General hospital, Dae Jeon, during 5 years from January, 1988 to April, 1993. 134 of these patients were performed with Kiintscher IM nailing and 27 patients with Ender nailing. Rigid IM nailing is the method of choice in tibia shaft fracture with rigid fixation, low complication, wide indication and early weight bearing, but the treatment of segmental fracture of the tibia will have many difficulties because of severe displacement, severe comminution, massive soft tissue damage and lack of blood supply at fracture site. Either antegrade or retrograde Ender nailing was of value for the management of segmental fracture which was too proximally or too dixtally located to insert interlocking screws, open fracture and soft tissue injury around Kiintscher insertion site. The result as fllows; 1. 43 fractures were open and 118 were closed. 69 fractures involved the distal portion, 55 fractures the middle portion, 13 fractures the proximal portion of the tibia and 24 fractures were segmental. 2. Among the 161 eases, 114 cases were male and 47 cases were female, the most common ages were ranged from 21 year to 30 year, involving 44 cases. 3. The most common cause was traffic accident. 4. Average intervals from injury to operation were 6.34 days(closed fracture) and 9.84 days(open fracture). 5. The mean durations of the bone union were 18.90 weeks(closed fracture) and 16.46 weeks(open fracture). 6. Complication included 7 cases delayed union, 3 cases nonunion, 8 cases superficial infection, 4 cases joint stiffness, 3 cases nail migration, 2 cases angular deformity, 2 cases rotational deformity, 1 cases osteomyelitis.
Accidents, Traffic ; Congenital Abnormalities ; Daejeon ; Female ; Fracture Fixation, Intramedullary ; Fractures, Open ; Hospitals, General ; Humans ; Joints ; Male ; Methods ; Orthopedics ; Osteomyelitis ; Soft Tissue Injuries ; Tibia ; Weight-Bearing

The management of ipsilateral fractures of the femoral neck and shaft has proved to be a challenge to the orthopedist. Most major institutions have treatment protocols that emphasize early rigid stabilization of the femoral neck fracture to minimize the incidence of avascular necrosis of the femoral head and the shaft fractures were fixed prior to definitive neck stabilization. Whenever possible, patients should be followed for a minimum of three years to rule out aseptic necrosis of the femoral head. These dual fractures are usually encountered in the young, associated with high-velocity accidents and usually accompanied by multiple system trauma. At the department of orthopedic surgery, Eul Gi General Hospital, from June, 1986 to August, 1993, 21 cases of the concomitant ipsilateral femoral neck and shaft fractures had been treated. The mean follow-up was 2.8 years(ranging from 1.6 to 5.8 years). The diagnosis of femoral neck fracture was delayed in two patients. Seventeen of the 21 cases underwent surgery had a relatively satisfactory functional outcome without complication of femoral head. In two patient, a symptomatic varus nonunion and varus malunion developed. In two cases, osteonecrosis of femoral head developed and one case of these patients was treated with Meyer techniqe of muscle pedicle graft. Our series emphasize that the recommended treatment consists of a closed intramedullary fixation of the femoral shaft fracture followed by ASNI screw fixation of the femoral neck fracture, with good long term functional results and minimum complication. And approaches to the treatment of concomitant femoral neck and femoral shaft fractures should be selected according to the skill and experience of the surgeon and the availability of equipment.
Clinical Protocols ; Diagnosis ; Femoral Neck Fractures ; Femur ; Femur Neck ; Follow-Up Studies ; Head ; Hospitals, General ; Humans ; Incidence ; Neck ; Necrosis ; Orthopedics ; Osteonecrosis ; Transplants

Postoperative pain control is very important not only for the relief of pain. but in the prevention of respiratory acidosis, pulmonary complications, emotional disturbances and sleeping disturbances etc. Jn spite of its significance there are a few studies on postoperative pain control in medical literature. Techniques have been developed for postoperative pain control since the 19 century, for example analgesics, inhalational agents, regional block, hypnosis and accupuncture. However none of these techniques was satisfactory because of various complications. The intermittent intramuscular injection of narcotics (e.g. meperidine) has been used most widely pto the present. There have been many complications, induding addiction, from this method. Our study was done in the recovery room with intramuscular injections of Thalamonal to fully awake patients, with 20 cases each having operation done in the upper abdomen, lower abdomen, and in other sites. We evaluated the results for the requirement of meperidine after the adminstration of Thalamonal. This was compared with the control group. There were 85% of cases that did not require the injection of meperidine. One case was complicated by hypotension, but this patient was improved with routine management for , hypotension. Other complications were not found.
Abdomen ; Acidosis, Respiratory ; Affective Symptoms ; Analgesics ; Humans ; Hypnosis ; Hypotension ; Injections, Intramuscular* ; Meperidine ; Narcotics ; Pain, Postoperative* ; Recovery Room

Sex cord-stromal tumors of the ovary are the third most common types of neoplasms that develop in the ovary and account for about 5-8% of all ovarian malignancies. This group of ovarian neoplasms is derived from the sex cords and the ovarian stroma or mesenchyme. Granulosa-stromal cell tumors include granulosa cell tumor, thecoma and fibroma. The granulosa cell tumor is a low-grade malignancy and accounts for about 2-3% of all ovarian malignancies. Granulosa cell tumors have a prolonged natural history and tendency toward late relapse, reflecting their low grade biology. We present a case of juvenile granulosa cell tumor of the ovary with brief review of literature,
Biology ; Female ; Fibroma ; Granulosa Cell Tumor* ; Granulosa Cells* ; Mesoderm ; Natural History ; Ovarian Neoplasms ; Ovary* ; Recurrence ; Sex Cord-Gonadal Stromal Tumors ; Thecoma

We evaluated postoperative changes of astigmatism and uncorrected visual acuity in 5.5 mm unsutured scleral tunnel incision, phacoemulsification and oval shape intraocular lens(IOL) implantation. Average surgically induced astigmatic changes were 0.09D against the rule(-0.09D) at one week, -0.25D at one month, -0.28D at two months in 55 patients as well as -0.21D at six months(n=25) and -0.38D over one year(n=25). The average uncorrected visual acuities improved from 0.07 preoperatively to 0.67 at one week, 0.75 at one month, 0.75 at two months in 48 patients as well as 0.72 at six months(n=25) and 0.64 over one year(n=25) postoperatively. There were no statistic~lly significant changes from one week over one year in both variables(p>0.05). Our results suggest that change of surgically induced astigmatism is little and stable as a well as rehabilitation of postoperative visual acuity is rapid in cataract operation using the 5.5 mm unsutured scleral tunnel technique.
Astigmatism* ; Cataract ; Humans ; Phacoemulsification ; Rehabilitation ; Visual Acuity*

An imaginative innovation to shorten hospital stays as a means to reduce patient charges, is out-patient surgery. This procedure also minimized the inconvenience and disruption of the family unit, reduced the opportunities for cross-infection, and freed hospital beds for the more seriously ill patients Since the concept of out-patient surgical service was organized, managed, and performed in the Hanyang Medical Center, we had experience of 132 ambulatory anesthetics during the last two years (from Jan. 1974. to Dec. 1975 ). The results are summarized as follower 1. Preanesthetic examination should be routinely checked with Hb., Hct., urinalysis and chest x-ray. 2. Premedication should be administered preanesthetically, atropine sulfate intravenously. 3. ASA class 1 patients should be chosen for short (less than 1 hour) procedures. 4. Anesthesia is induced with Epontol+S.C.C. and maintained with Halothane+N2O+O2. 5. We suggest that ambulatory anesthesia should be more carefully planned, organized, and managed.
Anesthesia* ; Anesthetics ; Atropine ; Humans ; Length of Stay ; Outpatients ; Premedication ; Thorax ; Urinalysis

No abstract available.
Pregnancy*

Intractable pain from advanced carcinoma of the upper abdomen is difficult to manage. On method used to control pain associated with these malignancies is to block off the splanchnic nerve. In 1919 kappis described a technique by which the splanchnic nerve of the upper abdomen could be anesthetized, using a percutaneous injection. This method has been used for the relief of upper abdominal pain due to hepatoma and cancer of the pancreas, stomach, gall bladder, bile duct, and colon. During the period from November 1968 to January 1986, this method was used in 208 cases of malignancy at Severance Hospital and clinically evaluated. Patients were retroactively grouped according to the stage of development of technique used. Twelve patients who received the treatment in the period from November 1968 to March 1977 were designated as group 1, 26 patients from April 1977 to April 1979 as group 2, and 170 from May 1979 to January 1986 as group 3. The results are as follows: 1) The number of patients receiving splanchnic nerve block has been increasing since 1977. 2) A total of 208 patients, including 133 males and 75 females, ranging in age from 18 to 84 and averaging 51. 3) The causes of pain were stomach cancer 90, pancreatic cancer 69, and miscelianeous cancer 49 cases respectively. 4) There were 57.7% who had had surgery, and 3.7% of whom had had chemotherapy before the splanchnic nerve block was done. 5) These blocks were carried out with the patient in the prone position as described by Dr. Moore. Fro group 2 and 3 C-arm image intensifier was used. In group 1, a 22 gauze 10cm long needle was inserted at the lower border of the 12th rib on each side about 7cm from the midline. The average distance from the middle was 6.60+/-0.61cm on the left side and 6.60+/-0.83cm on the right side in group 2, and 5.46+/-0.76 on the left side and 5.49+/-0.69cm on the right side in group 3. The average depth to which the needle was inserted was 8.60+/-0.52cm on the left side and 8.74+/-0.60cm on the right side in group 2, and 8.96+/-0.63cm on the left side and 9.18+/-0.57cm on the right side in group 3. 6) The points of the inserted needles were positioned in the upper quarter anteriorly. 51.8% on the left side and 54.4% on the right side of the L1 vertebra by lateral roentgenogram in group 3. The inserted needle points were located in the upper and anterolateral part, of the L1 vertebra 68.5% on the left side and 60.6% on the right side, on the anteroposterior rentgenogram in group 3. The needle tip was not advanced beyond the anterior margin of the vertebral body. 7) In some case of group 3, contrast media was injected before the block was done. It shows the spread upward along the anterior margin of the vertebral body. 8) The concentration and the average amount of drug used in each group was as follows: In group 1, 39.17+/-6.69ml of 0.5% -1% lidocaine or 0.25% bupivacaine were injected for the test block and one to three days after the test block 40.00+/-4.26ml of 50% alcohol was injected for the semipermanent block. In group 2, 13.75+/-4.48ml of 1% lidocaine were used as the test block and followed by 46.17+/-4.37ml of 50% alcohol was injected as the semipermanent block. In group 3, 15.63+/-1.19ml of 1% lidocaine for test block followed by 15.62+/-1.20ml of pure alcohol and 16.05+/-2.58ml of 50% alcohol for semipermanent block were injected. 9) The result of the test block was satisfactory in all cases. However the semipermanet block was 83.3 percent of the patients in group 1 who received relief from pain for at least 2 weeks after the block, 73.1% in group 2, and 91.8% in group 3. In these unsuccessful cases, 2 cases in group 1 were controlled by narotics but 7 cases in group 2 and 14 cases in group 3 received the same splanchnic nerve block 1 or 2 times again within 2 weeks. But in some cases it was 3 to 5 months before the 2nd block and in 1 cases even 7 years. 10) The most common complications of splanchnic nerve block were hypotensino(25.5%) occasional flushing of the face, nausea, vomiting, and chest discomfort. 11) For the patients in group 3, the supplemental block most commonly used was a continuous epidural block; it was used as a diagnostic block and to afford relief from pain before the splanchnic nervel block was done. 12) The interval between the receiving of the alcohol block and discharge was from 5 to 8 days in 61 cases(31.1%) and from 1 to 2 days in 48 cases(24.5%). From the above results, it can be concluded that the splanchnic nerver block done in the prone position with pure and 50% alcohol immediately after an effective test block with 1% lidocaine under C-arm fluoroscopic control is satisfactory and reliable. How to minimize the repeat block is still a problem to be solved.
Abdomen ; Abdominal Pain ; Bile Ducts ; Bupivacaine ; Carcinoma, Hepatocellular ; Colon ; Contrast Media ; Drug Therapy ; Female ; Flushing ; Humans ; Lidocaine ; Male ; Nausea ; Needles ; Pain, Intractable ; Pancreatic Neoplasms ; Prone Position ; Ribs ; Spine ; Splanchnic Nerves* ; Stomach ; Stomach Neoplasms ; Thorax ; Urinary Bladder ; Vomiting

Since 1957 clinical studies and animal experiments have reported that a solution of hydroxyethyl starch in saline (HES) was effective as a plasma expander. We have studied hydroxyethyl starch as compared to dextran after experimental bleeding. Thirteen dogs averaging 10 kg body weight were utilized in this study. Without premedicants anesthesia was induced with intravenous thiopenthal sodium and subsequently endotracheal intubation was performed. Respiration was controlled with a Harvard Pump, setting the respiratory rate at 15 times a minute and tidal volume at 20 ml/kg. Arterial blood pressure, central venous pressure and EKG lead II were recorded by polygraph. RIHSA was used for the measurement of plasma volume and extracellular volume. Experimental bleeding was equalled 25ml/kg for 15 minutes and the same amount of plasma expander (HES or Dextran) was infused 30 minutes after bleeding. The results were as follows: 1. Blood pressure was markedly decreased after experimental bleeding, but on administration of HES or Dextran it returned to nomal values. In the control group blood pressure persisted at about 90 mmHg. Central venous pressure after the administration of HES or Dextran also recovered to the level before bleeding. Pulse rate was slightly decreased after infusion of plasma expanders. 2. The values of hemoglobin and hematocrit were reduced about 40 percent after infusion of HES or Dextran. 3. Plasma volume was increased about 130 percent and blood volume was increased about 110 percent immediatly after infusion of HES or Dextran. A significant change in ECF could not be observed. 4. A persistent dilutional acidosis after infusion of HES or Dextran was not found. 5. In the HES or Dextran groups osmotic diuresis was observed. In the results of our experimental study no significant differences between HES and Dextran were observed, and it is thought that HES is safe and useful as a plasma expander.
Acidosis ; Anesthesia ; Animal Experimentation ; Animals ; Arterial Pressure ; Blood Pressure ; Blood Volume ; Body Weight ; Central Venous Pressure ; Dextrans ; Diuresis ; Dogs ; Electrocardiography ; Heart Rate ; Hematocrit ; Hemorrhage ; Intubation, Intratracheal ; Plasma Volume ; Plasma* ; Respiration ; Respiratory Rate ; Sodium ; Starch ; Tidal Volume