PURPOSE: To present the results of patients undergoing surgical treatment and determine clinical guidelines for the face turn, and up and down shoot in Duane retraction syndrome (DRS). METHODS: Thirty-four patients with DRS were treated with single horizontal rectus muscle recession, lateral rectus (LR) recession with Y-splitting, or LR recession with Y-splitting combined with medial rectus (MR) recession. The different treatment approaches were based on the angle of deviation in the primary position, versions, and ductions. In all patients, ocular alignment, face turn and up and down shoot were assessed preoperatively and postoperatively. RESULTS: The average standard deviation reduced from 18.5 +/- 6.5 prism diopters (PD) to 4.6 +/- 5.8 PD in horizontal rectus muscle recession and 14.4 +/- 5.5 PD to 1.6 +/- 2.8 PD in LR recession with Y-splitting. LR recession with Y-splitting combined with MR recession was effective in reducing globe retraction. Postoperative 4-mm LR recession with Y-splitting did not change ocular alignment; 7-mm LR recession with Y-splitting showed an average correction of 12.8 PD. Postoperatively, all patients presented a reduction in face turn; however, there was no statistically significant difference between the 2 procedures (Mann-Whitney U test, p = 0.620). CONCLUSIONS: Decisions regarding surgical approaches in DRS should be based on the amount of deviation in primary eye position, the expression of up and down shoot, and the degree of face turn. Surgeons planning Y-splitting of LR with MR recession must consider modifying the MR recession amount due to the smaller LR recession effect of Y-splitting compared with conventional LR recession.
Duane Retraction Syndrome ; Eye ; Humans ; Muscles

No abstract available.
Humans ; Microsporum* ; Siblings* ; Tinea Capitis* ; Tinea*

the ineidence of abdominal subcutaneous endometriosis is quite rare we have experienced one case of subcutaneous endometriosis. The typical clinical bistory and local findings of endometriasis enabk us to make the conect diagnosis. the treatment of choice is complete surgical excision of endometrial tissue and post operative medical therapy. This case was reported with a brief review of the comcemed literatures.
Diagnosis ; Endometriosis* ; Female ; Subcutaneous Tissue*

We present a patient with spinal epidural arteriovenous fistula presented with subdural hematoma and progressive myelopathy. Transarterial embolization using NBCA results in complete obliteration of fistula without complication. The pathophysiology, angioarchitexture of the lesion and strategy for its cure would be discussed.
Arteriovenous Fistula* ; Fistula ; Hematoma, Subdural* ; Humans ; Spinal Cord Diseases ; Spine

PURPOSE: The purpose of this study was to analyze the clinical and radiological results of distal chevron osteotomy in patients aged 50 and older with moderate-to-severe hallux valgus. MATERIALS AND METHODS: The authors reviewed the medical records and radiographs of 19 patients (26 feet). Average age at time of surgery was 58 years and the mean follow-up period was 3 years and 1 month. For radiological evaluation, we analyzed changes in hallux valgus angles and 1st-2nd intermetatarsal angles after index operations. Clinical results were assessed with respect to pain, activities of daily living, and shoe-wear. RESULTS: Hallux valgus angles and 1st-2nd intermetatarsal angles improved, but considerable correction loss occurred with time. This correction loss was found to be significantly correlated with preoperative subluxation of the 1st metatarsophalangeal joint and the 1st-2nd intermetatarsal angle. Clinically, remarkable improvements were achieved in terms of pain and level of activity, but most patients (except 4) still wore comfortable shoes rather than hard shoes at latest follow-ups. CONCLUSION: Distal chevron osteotomy is beneficial for patients aged 50 and older with moderate-to- severe hallux valgus deformity, but correction loss may occur in patients with marked subluxation of the 1st metatarsophalangeal joint or a severe 1st-2nd intermetatarsal angle.
Activities of Daily Living ; Aged ; Congenital Abnormalities ; Follow-Up Studies ; Hallux ; Hallux Valgus ; Humans ; Medical Records ; Metatarsophalangeal Joint ; Osteotomy ; Shoes

PURPOSE: We reviewed the results of ankle arthritis with advanced deformity treated with open arthrodesis. MATERIALS AND METHODS: Seventeen patients who had painful ankle arthritis with advanced deformity underwent open arthrodesis using chevron osteotomy or transfibular approach and were followed for an average of 4.2 years (range, 1.5 to 9.7 years). The average age was 51.4 years and the most common cause was traumatic arthritis (13 patients). Postoperative outcome was evaluated using Mazur's grading system for ankle function. we also checked time to union, patient satisfaction, complications, position of arthrodesis and degenerative changes of adjacent joints. RESULTS: Clinical score was improved to 76.4 points from 46.7 points. Average time to union was 4.3 months and the rate of satisfaction was 88%. Complications included 1 nonunion, 2 malunion, 1 superficial infection and 1 combined delayed union and malunion. There were 14 cases within 5 degrees valgus in frontal plane and 13 cases within neutral to 5 degrees dorsiflexion in sagittal plane. 3 cases in chevron osteotomy revealed valgus and plantarflexed position over 5 degrees. Degenerative changes of adjacent joints was seen in 2 patients. CONCLUSION: Open arthrodesis for ankle arthritis with advanced deformity shows favorable clinical outcome. Transfibular approach shows more consistent results than chevron soteotomy for desired position of arthrodesis.
Ankle* ; Arthritis* ; Arthrodesis* ; Congenital Abnormalities* ; Humans ; Joints ; Osteotomy ; Patient Satisfaction

PURPOSE: We reviewed the results of ankle arthritis with advanced deformity treated with open arthrodesis. MATERIALS AND METHODS: Seventeen patients who had painful ankle arthritis with advanced deformity underwent open arthrodesis using chevron osteotomy or transfibular approach and were followed for an average of 4.2 years (range, 1.5 to 9.7 years). The average age was 51.4 years and the most common cause was traumatic arthritis (13 patients). Postoperative outcome was evaluated using Mazur's grading system for ankle function. we also checked time to union, patient satisfaction, complications, position of arthrodesis and degenerative changes of adjacent joints. RESULTS: Clinical score was improved to 76.4 points from 46.7 points. Average time to union was 4.3 months and the rate of satisfaction was 88%. Complications included 1 nonunion, 2 malunion, 1 superficial infection and 1 combined delayed union and malunion. There were 14 cases within 5 degrees valgus in frontal plane and 13 cases within neutral to 5 degrees dorsiflexion in sagittal plane. 3 cases in chevron osteotomy revealed valgus and plantarflexed position over 5 degrees. Degenerative changes of adjacent joints was seen in 2 patients. CONCLUSION: Open arthrodesis for ankle arthritis with advanced deformity shows favorable clinical outcome. Transfibular approach shows more consistent results than chevron soteotomy for desired position of arthrodesis.
Ankle* ; Arthritis* ; Arthrodesis* ; Congenital Abnormalities* ; Humans ; Joints ; Osteotomy ; Patient Satisfaction

OBJECTIVE: To evaluate the effect of orally administered dienogest (DNG) for dysmenorrhea and pelvic pain associated with endometriosis. METHODS: For this study we recruited 89 patients with dysmenorrhea and pelvic pain associated with endometriosis diagnosed by laparoscopy. All patients complained of persistent dysmenorrhea and pelvic pain despite surgical treatment 6 months previously. After 6 months of DNG treatment, we used a 0 to 3 point verbal rating scale to measure the severity of disability in daily life due to dysmenorrhea and pelvic pain, and the use of analgesics. Weight gain, serum lipid and liver enzyme tests were performed before treatment and after 6 months of DNG treatment. RESULTS: Total dysmenorrhea scores assessed by the verbal rating scale significantly decreased by the end of treatment (P<0.001). The mean (±standard deviation) pain score for dysmenorrhea before and after treatment were 1.42±1.1 and 0.1±0.3, respectively. The mean non-menstrual pelvic pain scores before and after treatment were 0.52±0.6 and 0.18±0.3, respectively, showing a significant difference (P<0.001). The use of analgesics significantly decreased by the end of the treatment (P<0.001). The associated adverse effects were weight gains (in 56 of 89 patients, 63%) and uterine bleeding (in 28 of 89 patients, 31.5%). The weight gain (before treatment, 57.9±9.7; after treatment, 61.1±12.6) was statistically significant (P<0.040). CONCLUSION: This study demonstrated that orally administered DNG could be used to effectively treat dysmenorrhea and pelvic pain associated with endometriosis although the side effects of weight gain and uterine bleeding should be considered.
Analgesics ; Dysmenorrhea* ; Endometriosis* ; Female ; Humans ; Laparoscopy ; Liver ; Pelvic Pain* ; Uterine Hemorrhage ; Weight Gain

BACKGROUND: Ceramides are the main lipid component of the stratum corneum and are a structurally heterogeneous and complex group of sphingolipids of which sphingoid bases are the basic structural constituents. Altered levels of sphingoid bases have been reported in skin conditions that involve dryness and barrier disruption, including atopic dermatitis. OBJECTIVE: The purpose of this study was to investigate the altered levels of sphingoid bases in psoriatic epidermis and their relationship with the clinical severity of the psoriasis. METHODS: Samples from the lesional and non-lesional epidermis were obtained from eight psoriasis patients. Levels of sphingosine and sphinganine were analyzed by high-performance liquid chromatography. The expression of ceramide synthase and ceramidase proteins, which are related to sphingosine and sphinganine metabolism, were measured using Western blot analysis. RESULTS: Levels of sphingosine and sphinganine in the lesional epidermis were significantly higher than those in the non-lesional epidermis. Although there was no altered ceramide synthase and ceramidase, there was a highly significant positive correlation between the % change of ceramidase, the degradative enzyme of ceramide into sphingosine, and the Psoriasis Area Severity Index (PASI) score. CONCLUSION: The levels of sphingosine and sphinganine were significantly increased in psoriatic epidermis and the % change of ceramidase was positively correlated with the clinical severity of psoriasis.
Blotting, Western ; Ceramidases ; Ceramides ; Chromatography, Liquid ; Epidermis ; Humans ; Oxidoreductases ; Proteins ; Psoriasis ; Skin ; Sphingolipids ; Sphingosine

BACKGROUND: Ceramides are the main lipid component of the stratum corneum and are a structurally heterogeneous and complex group of sphingolipids of which sphingoid bases are the basic structural constituents. Altered levels of sphingoid bases have been reported in skin conditions that involve dryness and barrier disruption, including atopic dermatitis. OBJECTIVE: The purpose of this study was to investigate the altered levels of sphingoid bases in psoriatic epidermis and their relationship with the clinical severity of the psoriasis. METHODS: Samples from the lesional and non-lesional epidermis were obtained from eight psoriasis patients. Levels of sphingosine and sphinganine were analyzed by high-performance liquid chromatography. The expression of ceramide synthase and ceramidase proteins, which are related to sphingosine and sphinganine metabolism, were measured using Western blot analysis. RESULTS: Levels of sphingosine and sphinganine in the lesional epidermis were significantly higher than those in the non-lesional epidermis. Although there was no altered ceramide synthase and ceramidase, there was a highly significant positive correlation between the % change of ceramidase, the degradative enzyme of ceramide into sphingosine, and the Psoriasis Area Severity Index (PASI) score. CONCLUSION: The levels of sphingosine and sphinganine were significantly increased in psoriatic epidermis and the % change of ceramidase was positively correlated with the clinical severity of psoriasis.
Blotting, Western ; Ceramidases ; Ceramides ; Chromatography, Liquid ; Epidermis ; Humans ; Oxidoreductases ; Proteins ; Psoriasis ; Skin ; Sphingolipids ; Sphingosine