Laser in situ keratomileusis[LASIK] is a refractive surgical procedure that is effective in treating myopia and astigmatism. The incidence of corneal infection after LASIK is approximately 0.02% according to international experience. We experience the case of a 20-year old man who developed endophthalmitis; corneal edema, epithelial defect, hypopyon was found 2 days after LASIK. He was immediately given intravenous and subconjuntival injection[tobramycin and ceftazidime] and topical fortified eyedrop[tobramycin and ceftazidime]. The microbiologic study revealed Serratia marcescens as the causative organism. Three days after therapy was instituted, the hypopyon resolved. After 4 months of LASIK, visual acuity was 1.0 and maintained recently. We report a case of endophthalmitis after LASIK by Serratia marcescens which detected early and treated by antibiotics. In addition, close postoperative surveillance and education for hygiene was required on early postoperative period.
Anti-Bacterial Agents ; Astigmatism ; Corneal Edema ; Education ; Endophthalmitis* ; Humans ; Hygiene ; Incidence ; Keratomileusis, Laser In Situ ; Myopia ; Postoperative Period ; Refractive Surgical Procedures ; Serratia marcescens ; Visual Acuity ; Young Adult

The mentalis muscle is a paired muscle originating from the alveolar bone of the mandible. This muscle is the main target muscle for botulinum neurotoxin (BoNT) injection therapy, which aims to treat cobblestone chin caused by mentalis hyperactivity. However, a lack of knowledge on the anatomy of the mentalis muscle and the properties of BoNT can lead to side effects, such as mouth closure insufficiency and smile asymmetry due to ptosis of the lower lip after BoNT injection procedures. Therefore, we have reviewed the anatomical properties associated with BoNT injection into the mentalis muscle.An up-to-date understanding of the localization of the BoNT injection point according to mandibular anatomy leads to better injection localization into the mentalis muscle. Optimal injection sites have been provided for the mentalis muscle and a proper injection technique has been described. We have suggested optimal injection sites based on the external anatomical landmarks of the mandible. The aim of these guidelines is to maximize the effects of BoNT therapy by minimizing the deleterious effects, which can be very useful in clinical settings.

Purpose: A laparoscopic radical nephrectomy is known to cause less morbidity than a traditional open radical nephrectomy. In our institution, the laparoscopic approach, with intact specimen removal, has become the standard technique for radical nephrectomies. Herein, we report the results and oncological outcome of the experience of a single center. Materials and Methods: We reviewed 68 transperitoneal laparoscopic radical nephrectomies, performed for suspected renal cell carcinoma between December 1999 and June 2006. All data were collected from the patient's medical records. Results: The mean tumor size, surgical time and estimated blood loss were 4.82cm (1.7-14), 228.5 min (120-480) and 409.1cc (32-1,312), respectively. Conversion to open surgery was required in one case due to Endo-GIA malfunction, and conversion to hand-assisted surgery was performed in one case. The histological findings were pT1, pT2 and pT3 in 40 (59.7%), 9 (13.4%) and 18 patients (26.9%), respectively. In one case, the histology confirmed a non-malignant disease. The follow-up period was from 3 to 80 months (median 18). Distant metastasis was observed in 2 cases, but there was no local recurrence or port metastasis. Conclusions: A laparoscopic radical nephrectomy is a safe and feasible treatment for localized renal cell carcinomas. Longer follow-up and large scale studies are necessary to evaluate the long-term survival and disease- free rates, and confirm the effectiveness of performing a radical laparoscopic nephrectomy.
Carcinoma, Renal Cell ; Conversion to Open Surgery ; Follow-Up Studies ; Humans ; Laparoscopy ; Medical Records ; Neoplasm Metastasis ; Nephrectomy* ; Operative Time ; Recurrence

The depressor anguli oris (DAO) muscle is a thin, superficial muscle located below the corner of the mouth. It is the target for botulinum neurotoxin (BoNT) injection therapy, aimed at treating drooping mouth corners. Hyperactivity of the DAO muscle can lead to a sad, tired, or angry appearance in some patients. However, it is difficult to inject BoNT into the DAO muscle because its medial border overlaps with the depressor labii inferioris and its lateral border is adjacent to the risorius, zygomaticus major, and platysma muscles. Moreover, a lack of knowledge of the anatomy of the DAO muscle and the properties of BoNT can lead to side effects, such as asymmetrical smiles. Anatomical-based injection sites were provided for the DAO muscle, and the proper injection technique was reviewed. We proposed optimal injection sites based on the external anatomical landmarks of the face. The aim of these guidelines is to standardize the procedure and maximize the effects of BoNT injections while minimizing adverse events, all by reducing the dose unit and injection points.

One hundred sixty three patients were hysteroscoped for various reasons at our department over 10 year period. Ninety eight patients out of 163 who were diagnosed and treated for their intrauterine adhesions(IUAs) by hysteroscopy were analysed retrospectively. Patients were classified as having mild, moderate or severe stage of IUAs according to American Fertility Society classification. Twenty nine patients(29.6%) had mild IUAs, 43 patients (43.9%) had moderate IUAs, and 26 patients(26.5%) were classified as having severe stage IUAs. The predisposing causal factors of IUAs were abortion, full-term delivery, H. mole, pelvic tuberculosis and myomectomy in order of frequency but in eight cases no cause was identified. After hysteroscopic surgery, although high rate(83.9%) of restoration of normal menstruation was attained but term pregnancy rate was only 53.3% and rather high rate (32%) of preterm or abortion were identified and those pregnancy outcomes were correlated with the stage of IUAs. Complications of surgery consisted of uterine or bladder perforation, pulmonary edema and hemorrhage.
Classification ; Female ; Fertility ; Hemorrhage ; Humans ; Hysteroscopy ; Menstruation ; Pregnancy ; Pregnancy Outcome ; Pregnancy Rate ; Pulmonary Edema ; Retrospective Studies ; Tuberculosis ; Urinary Bladder

PURPOSE: To study the change in corneal sensitivity, tear film stability, tear clearance and blink rate after LASIK. METHODS: The authors have performed LASIK to correct the visual acuity in myopia of 3 males and 18 females(42 eyes). The corneal sensitivity(Cochet-Bonnet esthesiometer), tear film break-up time, fluorescein clearance and blink rate were measured prior to operation, 2 weeks, 1 and 3 months after LASIK. RESULTS: There was decrease in corneal sensitivity after LASIK, which did not recover to the pre-operative level by 3 months after LASIK. To restore corneal sensitivity, more time was needed for regrowth and maturation of the nerve fiber. The decrease in BUT scores 1 and 3 months after LASIK was statistically significant. The decrease in blink rate after LASIK was also statistically significant. The increase in FCT concentration grade was not statistically significant. There was a trend toward a reduction in blink rate in the group with more correction. CONCLUSIONS: Symptoms suggestive of relative tear deficiency such as foreign-body sensation, visual fluctuation and absence of reflex tear have described after LASIK. Change in corneal sensitivity, tear film stability and blink rate were associated with such dry eye symptoms.
Fluorescein* ; Humans ; Keratomileusis, Laser In Situ* ; Male ; Myopia ; Nerve Fibers ; Reflex ; Sensation ; Tears* ; Visual Acuity

PURPOSE: To investigate the patterns of corneal topography after LASIK METHODS: The author have performed LASIK to correct the myopia of 21 male and 34 female patients. The corneal topography was performed at preoperative state and 2 days, 1, 3, 6, 12months after operation. RESULTS: Differential maps were classified using a standard eight-category classification scheme which were divided into a combined regular group(toric-with-axis, toric-against-axis, homogeneous, focal topographic variant) and a combined irregular group(semicircular, irregularly irregular, central island, keyhole). At 2 days, the distribution of corneal topographic patterns was 61.8% in a combined regular group and 38.2% in a combined irregular group. Of all patterns, the homogeneous pattern was predominant. The best corrected visual acuity was better in a combined regular group than in a combined irregular group which was statistically significant. After postoperative 1 month, most irregular patterns had a change in topography, generally to an optically smoother pattern. CONCLUSIONS: Corneal topography has been established as an invaluable tool for refractive surgery and this analysis allows the recognition of normal and abnormal patterns of ablation following excimer laser surgery.
Classification ; Corneal Topography* ; Female ; Humans ; Keratomileusis, Laser In Situ ; Lasers, Excimer ; Male ; Myopia ; Refractive Surgical Procedures ; Visual Acuity

OBJECTIVES: Protein-calorie malnutrition has been shown to be prevalent among patients on chronic dialysis, And assessment of nutritional status of continuous ambulatory peritoneal dialysis(CAPD) patients has assumed greater importance because of the association of protein-calorie malnutrition with increasing morbidity and mortality. So we observed the incidence and clinical effect of protein-calorie malnutrition, and we compared the indices of nutrition with dialysis adequacy utilizing urea kinetic modeling and cretinine clearance in CAPD patients. METHODS: We performed a cross-sectional study in which eight parameters, based on anthropometry, blood chemistry and subjective symptoms, were scored according to the degree of abnormalities in 82CAPD patients. A malnutrition index was derived from these scores. We also performed comparative analysis to identify significant correlations of the indices of urea kinetic modeling and creatinine clearance with the other parameters of nutritional status. RESULTS: The malnutrition index classified 47(57%) patients as normal, 30(37%) intermediately malnourished, and 5(6%) as severely malnourished. Malnutrition index showed a significant correlation with the body mass index(BMI), triceps skinfold thickness(TSF), mid-arm circumference(MAC), mid-arm muscle area (MAMA), duration of CAPD, subjective symptoms, serum albumin, transferrin, cholesterol, and triglyceride. The malnutrition index also showed a significant correlation with residual renal function(RRF), and standardized creatinine clearance(SCCr). The TWR-Kt/V(total Kt/Vurea per week with consideration of residual renal urea clearance) was significantly lower in the severely malnourished group than in the normal group. Serum alkaline phosphatase and BUN levels were higher in the severely malnourished group than in the normal and inter-mediate groups. CONCLUSION: In assessing the nutrition status of CAPD patients, body weight, TSF, MAC, MAMA, subjective symptoms, serum albumin, transferrin, cholesterol, triglyceride, urea nitrogen, and alkaline phosphatase were considered useful parameters. There was a trend of increased BUN and decreased TWR-Kt/V in severely malnourished patients, and the value of SCCr was significantly lower in malnourished patients. However, no meaningful relationships between TW-Kt/V and malnutrition index or between NPCR(normalized protein catabolic rate) and malnutrition index were found m this cross-sectional study. As the number of patients with longer duration of CAPD or negligible RRF has increased in the malnourished patients, regular monitoring of these parameters, especially TWR-Kt/V and SCCr, may be helpful to assess dialysis adequacy to keep good nutritional status of each CAPD patient.
Alkaline Phosphatase ; Anthropometry ; Body Weight ; Chemistry ; Cholesterol ; Creatinine* ; Cross-Sectional Studies ; Dialysis ; Humans ; Incidence ; Malnutrition ; Mortality ; Nitrogen ; Nutritional Status ; Peritoneal Dialysis, Continuous Ambulatory* ; Protein-Energy Malnutrition ; Serum Albumin ; Transferrin ; Triglycerides ; Urea*

Polypeptide growth factors belong to a class of potent biologic mediators which regulate cell differentiation, proliferation, migration and metabolism. IGF-I is polypeptides secreted by skeletal cells and is considered as regulators of bone formation. The purpose of this study is to evaluate the effects of IGF-I on bone nodule formation and alkaline phosphatase activity of MC3T3-E1 cells. MC3T3-E1 cells were seeded at 1x10(4) cells/well, 1x10(5) cells/well in alpha-modified Eagle medium containing 10% fetal bovine serum, 10 mM beta-glycerophosphate and 50microgram/ml of ascorbic acid. Before 48 hours of indicated time, medium were changed with serum free medium. After 24 hours, 0.1, 1, 10 ng/ml IGF-I were added to the cells and cultured for 3, 7, 14, 21, 28 days. And histochemical analysis was done and ALP activity was measured and was expressed as nmol/min/mg of protein. The bone nodule formation in MC3T3-E1 cells of IGF-I was seen at 21, 28 days, but there were no difference between control group and experimental groups. The ALP activity decreased when it is compare to control 2 group except for 1 ng/ml, 10 ng/ml IGF-I of 21-day-groups and 1 ng/ml IGF-I of 28-day-groups. Dose response effects of IGF-I of ALP activity in MC3T3-E1 cells were seen the highest ALP activity at 1ng/ml until 21days and the highest ALP activity at 10 ng/ml of 28 daygroups. The peak times were seen at 7-day group, 14-day group on control group and experimental group respectively, and 1 ng/ml group was the highest ALP activity. From the above results, IGF-I was not seen notable effect on bone nodule formation and decreased ALP activity of MC3T3-E1 cells but the use of IGF-I to mediate biological stimulation of MC3T3-E1 cells shows promise for future therapeutic application.
Alkaline Phosphatase ; Ascorbic Acid ; Cell Differentiation ; Eagles ; Insulin-Like Growth Factor I* ; Intercellular Signaling Peptides and Proteins ; Metabolism ; Osteogenesis ; Peptides

Encephalitis is known as a rare complication of varicella zoster virus (VZV) reactivation. It is usually regarded as a complication of a cutaneous infection in patients with impaired cellular immunity. The reported incidence of herpetic motor involvement range between 0.5 and 31%, but is possibly more frequent as the weakness is readily obscured by pain. A 53-years-old woman, who presented with severe shoulder pain, fever, headache and seizure, which developed the day after skin eruptions, also developed motor paresis 7 days after the seizure. Her cerebrospinal fluid (CSF) was VZV-Polymerase chain reaction (PCR) negative, but VZV specific IgG antibody positive, and her brain MRI was found to be normal. With the early diagnosis and proper treatment, such as intravenous administration of acyclovir, stellate ganglion block and Yamamoto New Scalp Stimulation (YNSS), the patient completely recovered, without psychoneurological sequelae. Herein, we present this case, with a discussion of the relevant literature on the incidence, pathophysiology, diagnosis and management of central nervous system VZV involvement.
Acyclovir ; Administration, Intravenous ; Brain ; Central Nervous System ; Cerebrospinal Fluid ; Diagnosis ; Early Diagnosis ; Encephalitis* ; Female ; Fever ; Headache ; Herpes Zoster* ; Herpesvirus 3, Human ; Humans ; Immunity, Cellular ; Immunoglobulin G ; Incidence ; Magnetic Resonance Imaging ; Paresis* ; Scalp ; Seizures ; Shoulder Pain ; Skin ; Stellate Ganglion