No abstract available.
Rubinstein-Taybi Syndrome*

The operative treatment of orbital blowout fracture involves restoration of intra-orbital soft tissue and bony structural integrity. In extensive blowout fracture, postoperative edema and subsequent increase of intraoribital pressure may sometimes lead to displace the implant. To prevent postperative displacement of the implant, we tried reinforcing the implant using a buttress consisting of micro-titanium mesh and titanium mesh in 13 cases of extensive orbital blowout fracture, including medical wall fracture (6), inferior wall fracture (5) and inferomedial wall fracture (2). A small thin titanium buttress was inserted beneath the implant at the point where intraorbital pressure was involved maximally. It was usually placed superoinferiorly in a medial wall fracture wall fracture, mediplaterally along th posterior ridge of bony defect in an inferior wall fracture, and anteroposteriorly in an inferomedial wall fracture. No evidence of implant displacement after operation was noted in any cases and this was confirmed by postoperative computed tomographic scan. Also, any complication by a titanium buttress did not occur. Orbital implant reinforcement using a titanium buttress may be an available technique for preventing implant displacement in reconstruction of extensive orbital blowout frature.
Edema ; Orbit* ; Orbital Implants ; Titanium*

The results of 17 fractures of tibial shaft treated with Rush nails under the image intensifier and early weight bearing are reported. Thirteen of these fractures were closed. All fractures were united between 12 and 21 weeks clinically, 17 and 26 weeks radiologically after operation. All cases were healed without significant complications, such as fracture disease. The advantages of this method were as follows; 1) normal knee motion and early weight bearingare possible during healing. 2) There is a relatively rapid restoration of bone continuity. This method of treatment for tibial shaft fractures were indicated as follows; 1. Mid-shaft fracture. 2. Segmental fracture of shaft. 3. Expectation of compression force at fracture surface by weight bearing. 4. Open fracture of shaft.
Fractures, Open ; Knee ; Methods ; Tibia ; Weight-Bearing

Gastric lavage is one of gastrointestinal decontamination methods which have been controversial in the clinical toxicology field for a long time. Expert groups of American and European clinical toxicologists have published the position papers regarding gastric lavage three times since 1997. They recommended that gastric lavage should not be used as a routine procedure in the management of acute intoxication, because they thought that there is no certain evidence of improving clinical outcome by its use. However, the studies they reviewed were not well-controlled randomized trials, which cannot be conducted in the clinical toxicology field due to variability of patients and ethical problems. Therefore, the results from these studies should be interpreted with caution. They also insisted that gastric lavage can be undertaken within 60 minutes of ingestion. The limitation of one hour after ingestion is too arbitrary and may cause a lot of misunderstanding. Formation of pharmacobezoar or gastric hypomotility after ingestion may significantly delay the gastric emptying time so that gastric lavage can be useful even after several hours or more in case of highly toxic substances or severe intoxication. Furthermore, as there are a number of serious intoxication by toxic pesticides with large amount in suicidal attempts in Korea, it seems that gastric lavage may be used more frequently in Korea than in Western countries. When deciding whether or not to use gastric lavage, all the indications, contraindications, and possible adverse effects should be taken into account on the basis of risk-benefit analysis. If the procedure is decided to be done, it should only be performed by well-trained experts.
Decontamination ; Eating ; Gastric Emptying ; Gastric Lavage ; Humans ; Korea ; Pesticides ; Toxicology

Purpose: To investigate changes in corneal endothelial cell (CEC) by cumulative dissipated energy (CDE) during phacoemulsification. Methods: Based on the degree of nucleus sclerosis (NS), changes in CECs were compared preoperatively and at 1 and 3 months postoperatively in 67 eyes that underwent phacoemulsification. Results: The mean CDE used during surgery was 4.30 ± 2.31. A comparison of the surgical measurements before and 1 month after surgery revealed significant differences in the cell density (CD) and coefficient of variation (CV) (p < 0.001, 0.011, respectively). The CD showed significant differences among NS grades 2–6 (p < 0.001). The CDE increased significantly with higher NS grades (r = 0.809, p < 0.001). Within the same NS grade, there was a positive correlation between higher CDE and greater CEC loss (r = 0.559, p = 0.001). CD changes were significantly associated with increasing CDE (r = 0.612, p < 0.001). The CD loss also increased significantly from NS2 to NS6 (p < 0.001). At 3 months postoperatively, surgical measurements revealed a significant decrease in CD with increasing NS grade (p = 0.010). Conclusions CDE increased with higher NS grades and there was a positive correlation between CDE and CEC loss. Therefore, surgeons should plan surgical techniques preoperatively to minimize CDE as NS increases. Additionally, it is important to assess CEC damage postoperatively based on surgical measurements in patients with high intraoperative CDE.

Purpose: To investigate changes in corneal endothelial cell (CEC) by cumulative dissipated energy (CDE) during phacoemulsification. Methods: Based on the degree of nucleus sclerosis (NS), changes in CECs were compared preoperatively and at 1 and 3 months postoperatively in 67 eyes that underwent phacoemulsification. Results: The mean CDE used during surgery was 4.30 ± 2.31. A comparison of the surgical measurements before and 1 month after surgery revealed significant differences in the cell density (CD) and coefficient of variation (CV) (p < 0.001, 0.011, respectively). The CD showed significant differences among NS grades 2–6 (p < 0.001). The CDE increased significantly with higher NS grades (r = 0.809, p < 0.001). Within the same NS grade, there was a positive correlation between higher CDE and greater CEC loss (r = 0.559, p = 0.001). CD changes were significantly associated with increasing CDE (r = 0.612, p < 0.001). The CD loss also increased significantly from NS2 to NS6 (p < 0.001). At 3 months postoperatively, surgical measurements revealed a significant decrease in CD with increasing NS grade (p = 0.010). Conclusions CDE increased with higher NS grades and there was a positive correlation between CDE and CEC loss. Therefore, surgeons should plan surgical techniques preoperatively to minimize CDE as NS increases. Additionally, it is important to assess CEC damage postoperatively based on surgical measurements in patients with high intraoperative CDE.

Purpose: To investigate changes in corneal endothelial cell (CEC) by cumulative dissipated energy (CDE) during phacoemulsification. Methods: Based on the degree of nucleus sclerosis (NS), changes in CECs were compared preoperatively and at 1 and 3 months postoperatively in 67 eyes that underwent phacoemulsification. Results: The mean CDE used during surgery was 4.30 ± 2.31. A comparison of the surgical measurements before and 1 month after surgery revealed significant differences in the cell density (CD) and coefficient of variation (CV) (p < 0.001, 0.011, respectively). The CD showed significant differences among NS grades 2–6 (p < 0.001). The CDE increased significantly with higher NS grades (r = 0.809, p < 0.001). Within the same NS grade, there was a positive correlation between higher CDE and greater CEC loss (r = 0.559, p = 0.001). CD changes were significantly associated with increasing CDE (r = 0.612, p < 0.001). The CD loss also increased significantly from NS2 to NS6 (p < 0.001). At 3 months postoperatively, surgical measurements revealed a significant decrease in CD with increasing NS grade (p = 0.010). Conclusions CDE increased with higher NS grades and there was a positive correlation between CDE and CEC loss. Therefore, surgeons should plan surgical techniques preoperatively to minimize CDE as NS increases. Additionally, it is important to assess CEC damage postoperatively based on surgical measurements in patients with high intraoperative CDE.

The authors conducted a clinical observation of 55 cases of solitary pulmonary nodules at Yeungnam University Hospital from June 1986 to October 1990, and the following results were obtained: 1. The age distribution was ranged from 18 to 77 years, and the male-to female ratio was 1.8:1. 2. Among 55 cases of nodules, 28 cases were benign and 27 cases were malignant nodules, and of malignant nodules, the primary lung cancer was 23 cases and of benign nodules, 18 cases were tuberculoma. 3. 23 cases (41.8%) was asymptomatic and the other 32 cases were symptomatic; chest pain 12 cases, hemoptysis; 8 cases, cough; 8 cases and dyspnea; 4 cases. 4. The non-smoker-to-smoker ratio was 1:1.04, but among 23 smoker over 20 pack years, 14 cases were malignant nodules. 5. According to nodular size, there is no striking differences between benign and malignant nodules except 3-4 cm sized nodules. 6. The lobar distribution of nodules, 35 cases were in the right lung (upper lobe; 14 cases, middle lobe; 11 cases, and lower lobe; 10 cases) and 23 cases were in the left lung (upper lobe; 9 cases, lower lobe; 11 cases), and the malignant nodules were most commonly observed in the right upper lung.
Age Distribution ; Chest Pain ; Cough ; Dyspnea ; Female ; Hemoptysis ; Humans ; Lung ; Lung Neoplasms ; Solitary Pulmonary Nodule* ; Strikes, Employee ; Tuberculoma

PURPOSE: To evaluate the classification of punctal stenosis based on the shape of the external punctum, clinical characteristics and histopathologic features. METHODS: Patients who experienced tearing and were diagnosed with punctal stenosis were evaluated in this study. Punctal stenosis was classified according to the shape of the lower external punctum, which included membranous type, slit type, horseshoe type, and pinpoint type. Tear meniscus height, 2% fluorescein dye disappearance test and lacrimal pathway irrigation were measured or performed. For treatment, a punctal snip operation and silicone tube placement were performed, and the peripunctal histopathological findings were evaluated. RESULTS: Punctal stenosis was classified into four types: membranous type (17 eyes, 21.5%), slit type (11 eyes, 13.9%), horseshoe type (25 eyes, 31.6%), and pinpoint type (26 eyes, 32.9%). The tear meniscus was significantly higher, and the 2% fluorescein dye disappeared significantly more slowly in the punctal stenosis group. However, correlation of the tear meniscus height and 2% fluorescein dye disappearance test with the punctum shape was not statistically significant. A history of previous chemotherapy was significantly associated with the occurrence of punctal stenosis, especially the membranous type (p < 0.05). Histopathologic evaluation of the punctum showed differences between the punctum types. Pinpoint puncta exhibited a high density of muscle fibers, while they were faintly visible in the membranous type. CONCLUSIONS: Acquired punctal stenosis has various shapes, and the major types of stenotic puncta exhibited unique histopathologic features. Punctal stenosis and its pathophysiology may be related to multiple factors, such as age and systemic 5-fluorouracil chemotherapy history.
Classification* ; Constriction, Pathologic* ; Drug Therapy ; Fluorescein ; Fluorouracil ; Humans ; Lacrimal Apparatus ; Lacrimal Apparatus Diseases* ; Silicon ; Silicones ; Tears

PURPOSE: Glyphosate is widely used and its toxic exposures are not rare. Occasionally, glyphosate intoxication can lead to death. The aim of this study is to analyze clinical findings and fatality in glyphosate intoxication. METHODS: Clinical data on acute glyphosate intoxication were prospectively collected at 28 hospitals nationwide between August 2005 and July 2006. The patients' clinical symptoms and characteristics of fatalities were investigated and statistical analysis was performed. RESULTS: Among 105 patients who were finally included, gastrointestinal symptoms(59%) were the most common. A significant difference in the amount ingested was observed between patients with higher systolic blood pressure and those with systolic blood pressure less than or equal to 80 mmHg (p<0.001). The more the patients ingested, the more aggravated their mental status became (p=0.004). Seven patients(6.7%) died, and all of them had ingested greater than or equal to 200 ml. Patients who died had ingested greater amounts than the survivors (p<0.001), and their mental status was worse (p<0.001), and systolic blood pressure was lower (p<0.001). According to the result of logistic regression analysis, relative risk was 24.1-fold higher in the 'poor' mental status group compared with 'good'. CONCLUSION: Patients who ingested large amounts of glyphosate showed poor mental status and lower blood pressure. Statistical difference in amount ingested, mental status, and systolic blood pressure was observed between survivors and patients who died. Ingested amounts and mental status were the most important factor of the prognosis of glyphosate intoxication.
Blood Pressure ; Herbicides ; Humans ; Logistic Models ; Poisoning ; Prognosis ; Prospective Studies ; Survivors