PURPOSE: To evaluate the clinical features of high myopic eyes with cataracts implanted with negative power intraocular lenses (IOLs) at the time of cataract surgery. METHODS: A retrospective chart review was conducted of 18 eyes of 14 patients who underwent cataract surgery with negative power IOLs and 10 eyes in 9 patients with low power IOLs. We investigated axial length, IOL power, preoperative and postoperative best-corrected visual acuity (BCVA) and preoperative and postoperative spherical equivalent (SE) refractive errors. RESULTS: Mean BCVA showed significant improvement in both groups. We measured postoperative SE refraction and the difference between the mean intended and the mean achieved SE refractive errors in the negative power group (17 eyes) was +1.59 ± 1.34 D and +0.31 ± 0.50 D in the low power group. CONCLUSIONS: BCVA was significantly improved in the majority of eyes, although they had myopic macular degeneration or posterior staphyloma. However, the mean achieved postoperative SE refraction was more hyperopic than the predicted postoperative SE error. Additionally, hyperopic refractive error was greater in the negative power group than the low power group. Therefore, we recommend that postoperative hyperopic refractive error should be considered when performing cataract surgery in high myopic patients.
Cataract Extraction* ; Cataract* ; Humans ; Lens Implantation, Intraocular* ; Lenses, Intraocular* ; Macular Degeneration ; Myopia* ; Refractive Errors ; Retrospective Studies ; Visual Acuity

PURPOSE: To analyze and compare ultrasound pachymetry (USP) with a more recently adopted device, the intra ocular lens (IOL) master 700, which are both used to measure central corneal thickness. METHODS: The central corneal thickness was measured in 24 eyes of 12 glaucoma patients and in 83 eyes of 42 normal patients. First, the IOL master 700 was used to measure the central corneal thickness, followed by measurements taken using USP later. The results were analyzed using a paired t-test. We analyzed the agreement and the correlations between the two test devices by using Bland-Altman plots and the Pearson correlation test. To evaluate the reproducibility, measurements with the IOL master 700 were taken twice for a few normal patients within a small time interval. RESULTS: Via the IOL master 700, the thickness of the central cornea showed a high reproducibility and repeatability, demonstrating 2.7 ± 1.7 µm for the test-retest variability, 6.78% for the coefficient of variation, and 0.997 for the intraclass correlation value. The mean measurements using USP and the IOL master 700 are 554.4 ± 37.4 µm and 551.1 ± 37.1 µm, respectively, showing that the IOL master 700 measured significantly smaller values than USP with a p-value < 0.001. The deviations between the two methods are scattered throughout the 95% confidence interval. According to the Pearson correlation test, the measured values of the two test devices were found to have a highly positive correlation (r = 0.977, p < 0.0001). CONCLUSIONS: This study demonstrated that the central corneal thickness (CCT) measured via the IOL master was significantly thinner than that of USP, and the two test devices had a high correlation and good agreement. The CCT value measured via the IOL master 700 also exhibited high reproducibility.
Cornea ; Glaucoma ; Humans ; Tomography, Optical Coherence* ; Ultrasonography*

PURPOSE: Conventional radiation therapy portal images gives low contrast images. The purpose of this study was to enhance image contrast of a linacgram by developing a low-cost image processing method. MATERIALS AND METHODS: Chest linacgram was obtained by irradiating humanoid phantom and scanned using Diagnostic-Pro scanner for image processing. Several types of scan method were used in scanning. These include optical density scan, histogram equalized scan, linear histogram based scan, linear histogram independent scan, linear optical density scan, logarithmic scan, and power square root scan. The histogram distribution of the scanned images were plotted and the ranges of the gray scale were compared among various scan types. The scanned images were then transformed to the gray window by pallette fitting method and the contrast of the reprocessed portal images were evaluated for image improvement. Portal images of patients were also taken at various anatomic sites and the images were processed by Gray Scale Expansion (GSE) method. The patient images were analyzed to examine the feasibility of using the GSE technique in clinic. RESULTS: The histogram distribution showed that minimum and maximum gray scale ranges of 3192 and 21940 were obtained when the image was scanned using logarithmic method and square root method, respectively. Out of 256 gray scale, only 7 to 30% of the steps were used. After expanding the gray scale to full range, contrast of the portal images were improved. Experiment performed with patient image showed that improved identification of organs were achieved by GSE in portal images of knee joint, head and neck, lung, and pelvis. CONCLUSION: Phantom study demonstrated that the GSE technique improved image contrast of a linacgram. This indicates that the decrease in image quality resulting from the dual exposure, could be improved by expanding the gray scale. As a result, the improved technique will make it possible to compare the digitally reconstructed radiographs (DRR) and simulation image for evaluating the patient positioning error.
Head ; Humans ; Knee Joint ; Lung ; Neck ; Patient Positioning ; Pelvis ; Thorax

PURPOSE: In the present study, a case of double fovea artifact on spectral-domain optical coherence tomography (SD-OCT) was reported. CASE SUMMARY: A nine-year-old male presented with blurred vision of both eyes. His best corrected visual acuity (BCVA) was 20/20 in both eyes, and complete ophthalmologic evaluation including fundus examination and fundus photography revealed no abnormality in both eyes. He underwent SD-OCT imaging with the Cirrus HD-OCT. The Macular Cube 512 × 128 protocol of his right eye revealed an unusual pseudo-duplication of the fovea in the vertical meridian. The same protocol in his left eye also rendered a pseudo-duplication of two foveas in the vertical and horizontal meridians on the retinal thickness map. Re-examination with the same OCT system and protocol was performed two weeks later after the patient received counseling on fixation during the examination, and it revealed normal contour of the fovea in both eyes. CONCLUSIONS: Double fovea artifact seen in SD-OCT is a rare artifact that can possibly lead to misdiagnosis and inappropriate clinical treatment. Since the artifact was resolved with better fixation of the patient, repeating the scan with better patient compliance is necessary when such an artifact is encountered.
Artifacts* ; Counseling ; Diagnostic Errors ; Humans ; Male ; Meridians ; Patient Compliance ; Photography ; Retinaldehyde ; Tomography, Optical Coherence* ; Visual Acuity

PURPOSE: To compare the clinical effectiveness of 1% Prednisolone acetate ophthalmic solution and 0.1% Bromfenac sodium hydrate ophthalmic solution on prevention of cystoid macular edema after cataract surgery. METHODS: A retrospective chart review of 349 patients who received phacoemulsification with intraocular lens implantation in Severance Hospital from July 2013 to January 2016 was performed. In these patients, 192 eyes received 1% Prednisolone acetate ophthalmic solution, and 157 eyes were treated with topical 0.1% Bromfenac sodium hydrate ophthalmic solution. The incidence and severity of cystoid macular edema (CME) were evaluated by retinal foveal thickness on optical coherence tomography for patients who showed best corrected visual acuity (BCVA) less than 0.5 (log MAR ≥ 0.3). RESULTS: There was no significant difference between the two groups in age (p = 0.708), sex (p = 0.977), or the side of operated eye (p = 0.443). The two groups showed BCVA 0.04 ± 0.09 (Steroid group) and 0.03 ± 0.07 (nonsteroidal anti-inflammatory drug [NSAID] group) at 1 month after the surgery and the difference was not significant (p = 0.947). One eye in the topical steroid group had cystoid macular edema, and 3 eyes in the steroid group showed elevated intraocular pressure (IOP) over 30 mm Hg. There were no IOP elevations or macular edema in the NSAID group. CONCLUSIONS: The results showed that 0.1% Bromfenac sodium hydrate ophthalmic solution had a similar effect to 1% Prednisolone acetate ophthalmic solution on preventing CME after cataract surgery. This indicates that topical NSAID can be considered along with topical steroids in order to prevent CME after cataract surgery.
Cataract* ; Humans ; Incidence ; Intraocular Pressure ; Lens Implantation, Intraocular ; Macular Edema* ; Phacoemulsification ; Prednisolone* ; Retinaldehyde ; Retrospective Studies ; Sodium ; Steroids ; Tomography, Optical Coherence ; Treatment Outcome ; Visual Acuity

Pacemaker malfunctions are secondary to alterations of the preset pacing rate, irregular pacing failure of sensing, failure of cardiac capture or depolarization, and various combinations of these events. A 76 years old male patients was admitted due to pacemaker malfunction. 2 years ago, he was diagnosed as complete atrioventricular block. And then bipolar permanent pacemaker was implanted. Since then syncopal attack developed repetitivly. 12 lead ECG and 24 hour holter moniter monitoring, revealed pacing and sensing failure, thus we converted bipolar system into unipolar system. since then syncopal attack did not developed again.
Atrioventricular Block* ; Electrocardiography ; Humans ; Male

Heterotopic brain tissue is a developmental anomaly of neurogenic origin with no malignant potential, and is usually present around the nose of children and infants. So it has been called nasal glioma. But, even more rarely, heterotopic glial tissue may be found in various sites other than nasal cavity, such as the ethmoidal sinus, palate, tonsillar area, pharynx, ear, subcutaneous tissue, lung, and female genital tract. We experienced a more unusual case of a polypoid heterotopic brain tissue in the soft palate in a 3-year-old boy. The mass was microscopically reminiscent of "gliosis" of the central nervous system and interestingly contained choroid plexus focally. The glial nature of the lesion was confirmed by glial fibrillary acidic protein immunostain.
Brain* ; Central Nervous System ; Child ; Child, Preschool ; Choroid Plexus ; Ear ; Female ; Glial Fibrillary Acidic Protein ; Glioma ; Humans ; Infant ; Lung ; Male ; Nasal Cavity ; Nose ; Palate ; Palate, Soft* ; Pharynx ; Subcutaneous Tissue

The frictional force has been considered as an harmful factor in an active unit where tooth movement occurs, but as an advantageous factor in anchor unit that resist tooth movement. That is, efficient tooth movement is planned by using ligation methods that have low levels of bracket-wire frictional force and the anchorage control can be achieved by using ligation methods that have high levels of bracket-wire frictional force that result in binding of the bracket accompanied by little or no tooth movement. The purpose of this study was to evaluate the frictional force generated between bracket and wire in accordance with the methods of ligation, the material of ligation and the passage of time under artificial saliva. Tested were 0.017X0.022 inch stainless steel wires in standard edgewise twin brackets for upper central incisors in a 0.018-inch slot The wires were ligated into the brackets with elastomeric modules and stainless steel ligatures. Whole tie, half tie, twisting tie and double overlay tie were done with elastomeric modules. With 0.009-inch stainless steel ligature whole tie and half tie were done by needle holder and whole tie by ligature tying plier. With 0.012-inch stainless steel ligature whole ties were done by needle holder. Whole tie groups of elastomeric module were kept in artificial saliva bath at 37degress C for 28 days. The frictional force was recorded by means of an Instron universial testing instrument (4202 INSTRON, Instron Co., U.S.A.) at initial, 7, 14, 21, and 28 days. The results for ligated samples in a simulated oral environment revealed the following: In elastomeric module whole tie, 28 days group was significantly greater mean static frictional force than any other group but there were no significant differences among any other group (p>0.05). Elastomeric module twisting ties were significantly greater mean static frictional forces than any other ligation method but there were no significant differences between twisting tie and double overlay tie (p>0.05). Twisting tie, double overlay tie, whole tie, half tie showed differences in decreasing order. Stainless steel half tie produced lower mean static frictional forcee than whole tie, ligation by ligature tying plier produced greater mean static frictional force than by needle holder and ligation with 0.012-inch stainless steel ligature produced greater mean static frictional force than with 0.009-inch stainless steel ligature (p<0.05). There were no significant differences between the mean static frictional forces of elastomeric whole tie and stainless steel whole tie (p>0.05).
Baths ; Elastomers ; Friction* ; Humans ; Incisor ; Ligation* ; Needles ; Orthodontic Brackets* ; Saliva, Artificial ; Stainless Steel ; Tooth Movement

PURPOSE: Fundamental nursing is a major course in which student nurses learn core and basic theories and nursing skills needed to solve patients' nursing problems before students starts clinical practicum. METHODS: The 10 textbooks under review were selected as the most recent textbooks since 2013. As the first in a series of textbook review studies, we reviewed textbooks and procedure books on vital signs, body temperature regulation, and oxygenation, with a focus on differences in numbers, range, etc. RESULTS: The most significant difference in vital signs assessment was the normal range for body temperature, which could be different according to age group, measurement sites and measuring devices. For topics on body temperature regulation, there were variations in describing stages of fever, definition, and patterns across 10 textbooks. For the topic on the oxygenation, the normal oxygen saturation level, FiO2 and L/min compatibility across various oxygen supply devices, and unit compatibility of French vs milimeter for the selection of size of the suction catheter were not clear. CONCLUSION Textbooks can be more effective nursing education guidelines when they provide standardized information as to figures and terms for nursing skills.

Merkel cell carcinoma (MCC) is an uncommon but potentially aggressive neuroendocrine carcinoma of the skin. It typically develops on sun-exposed areas of the head and neck, particularly the eyelid, periorbital region, and extremities. We report a case of unusually located MCC, presenting as a conjunctival mass, which has only been reported once in the English literature. An 83-year-old male presented with a 0.8 x 0.7 cm sized mass protruding from the lower fornix of the right conjunctiva. The mass was excised. The tumor was located in the submucosa without connection to the overlying mucosa. Light microscopic findings showed a carcinoma with undifferentiated small round cells and the presence of cytokeratin (CK AE1/3, CK7) and neuroendocrine markers. We established a diagnosis of MCC. As reported in the literature, the majority of MCCs are positive for CK20 but negative for CK7. But, this case showed an uncommon cytokeratin immunohistochemical profile of positive for CK7 and negative for CK20, suggesting a new immunophenotypic MCC variant.
Aged, 80 and over ; Carcinoma, Merkel Cell ; Carcinoma, Neuroendocrine ; Conjunctiva ; Extremities ; Eyelids ; Head ; Humans ; Keratins ; Light ; Male ; Mucous Membrane ; Neck ; Neuroendocrine Tumors ; Skin