To evaluate the consistency of the thickness and size of the corneal flap made by the Innovatome automatic microkeratome and to determine the cor-relation between preoperative variables and corneal flap dimensions, we per-formed the prospective study comprised 102 consecutive eyes of 51 patients having laser in-situ keratomileusis (LASIK)with the Innovatome microker-atome.Central corneal thickness, corneal curvature, and refractive error were measured preoperatively.All flaps were created using No.170 blades. The mean corneal flap thickness was 139.70 +/-2 2.5 6 micrometer, and the range was 93.0 ~193.7 micrometer.There was no relationship between the corneal flap thickness and the preoperative corneal curvature or spherical equivalent, but the corneal flap thickness increased with the preoperative central corneal thickness. The mean corneal flap size (vertical diameter)was 9.17 +/- 0.25 mm (range :8.5 0 ~9.7 5 mm).There was no relationship between the corneal flap diameter and the preoperative central corneal thickness or spherical equivalent, but the corneal flap size increased with the preoperative corneal curvature.
Humans ; Keratomileusis, Laser In Situ* ; Prospective Studies ; Refractive Errors

The purpose of this study is to evaluate the changes of central corneal thickness and axial length after laser-assisted in situ keratomileusis (LASIK) surgery for myopia. 101 eyes of 53 patients who underwent laser in-situ keratomileusis (LASIK) were included in this study.Routine examinations were done in all cases. Central corneal thickness, axial length, keratometry, and refractive error were measured preoperatively and on the 6 month post-operatively. Mean preoperative spherical equivalent was -5.52 D (SD, 1.98 D).Preoperative and postoperative mean central corneal thickness was 530.64 micrometer (SD, 27.62 micrometer)and 468.84 micrometer (SD, 33.32 micrometer).Preoperative and postoperative keratometry was 43.69 D (SD, 1.90 D)and 39.12 D (SD, 1.98 D).Preoperative and postoperative average axial length was 25.56 mm (SD, 1.05 mm)and 25.51 mm (SD, 1.08 mm).When postoperative measurements were compared with preoperative measurements, there was a significant decrease in central corneal thickness (t=25.68, p=0.000)and keratometry (t=23.61, p=0.000), but there was no significant difference in axial length (t=1.82, p=0.072). Refractive changes related to axial length measurements changes on the 6 month after LASIK are not important compared with the total refractive corrections of LASIK.
Follow-Up Studies* ; Humans ; Keratomileusis, Laser In Situ* ; Myopia* ; Refractive Errors

Seven patients with aortic valve vegetation were examined by M-mode and two dimensional echocardiography. Underlying cardiac abnormalities were found in 6 patients, four had rheumatic heart disease, one had congenital bicuspid aortic valve, one had coexistence of asymmetrical septal hypertrophy and aortic regurgitation. Aortic regurgitation were found in all patients. One of seven patients had cerebral embolization and all patients had overt congestive heart failure. Of 5 patients medically treated, three became moribund, one died and one improved clinically. One patient underwent cardiac surgery, the aortic cusps were congenital bicuspid with vegetation, aortic valve replacement was successful. Echocardiogram of 7 patients with aortic valve vegetation showed characteristic shaggy, irregular mass of echoes produced by vegetation in the aortic valve during systole and diastole. Two of seven patients had abnormal mass of echoes in the left ventricular outflow tract. During systole, two had vegetation on the right coronary cusp and one had vegetation on the noncoronary cusp by M-mode echocardiography. In other patients we could not localize invoving aortic cusps by M-mode echocardiogram. All patients had left ventricular volume overload. For of seven patients had fluttering of anterior mitral valve. Two had fluttering of interventricular seputm. Five had premature mitral valve closure before QRS complex.
Aortic Valve Insufficiency ; Aortic Valve* ; Bicuspid ; Diastole ; Echocardiography* ; Heart Failure ; Humans ; Hypertrophy ; Mitral Valve ; Rheumatic Heart Disease ; Systole ; Thoracic Surgery

PURPOSE: To investigate the relationship of refraction, geometry of the posterior corneal surface and the residual corneal thickness after excimer laser photorefractive keratectomy. METHODS: Thirty eyes of 15 patients were treated with Star S2 Smooth Scan (VISX, U.S.A.) and followed up for 3 months. The refractive, anteroposterior changes in the posterior corneal surface and residual corneal thickness were measured using slit-scanning topography, Orbscan IIR (Orbtek, Bausch & Lomb) at 1 week preoperatively, and 1 and 3 months postoperatively. RESULTS: Mean forward shift of the posterior cornea surface was 8.83+/-1.34 micrometer, 11.53+/-4.23 micrometer and 14.70+/-3.50 micrometer at 1 week, 1 month, and 3 months respectively. Mean spherical equivalence of posterior cornea was = -7.01+/-0.31 D preoperatively; it changed to -7.17+/-0.47 D, -7.22+/-0.21 D and -7.17+/-0.6 D at 1 week, 1 month and 3 months. The degree of forward shift of posterior corneal surface is correlated with the posterior corneal refractive changes (r=-0.808, P< 0.01). The forward shift of the posterior corneal surface is correlated with the residual corneal thickness (r=-0.483, P< 0.01). CONCLUSIONS: Photorefractive keratectomy significantly influenced the forward shift of the cornea, which is correlated with the residual corneal thickness.
Cornea ; Humans ; Lasers, Excimer ; Photorefractive Keratectomy*

PURPOSE: To assess the the accuracy and variability in pachymetry measurements obtained by Orbscan and ultrasonic pachymeter in laser in situ keratomileusis (LASIK). METHODS: Thirty two eyes of 16 patients before LASIK were measured by ultrasonic pachymeter and Orbscan. Thirty eyes of 16 patients that had LASIK were measured by ultrasonic pachymeter and Orbscan postoperatively. The theoretical residual corneal thickness was compared to measurements by both instruments in eyes that had LASIK procedures. RESULTS: The ultrasound pachymeter measurements (543.8+/-24.2 micrometer) were thicker than the Orbscan pachymetry measurements, (541.2+/-24.9 micrometer) by mean of 2.7+/-7.4 micrometer (SD), preoperatively. But this is not statistically significant (p>0.05). Postoperatively, the ultrsound measurements were consistent with theoretical residual corneal thickness, 461.8+/-37.4 micrometer versus 467.9+/-30.71 micrometer (p=0.064), while Orbscan measurements were statistically less than the theoretical residual corneal thickness, 433.2+/-48.75 micrometer versus 464.32+/-33.4 micrometer (p<0.001). CONCLUSIONS: In LASIK eyes, the ultrasonic pachymetry was a more accurate measurement of corneal pachymetry than Orbscan topography system.
Corneal Pachymetry ; Humans ; Keratomileusis, Laser In Situ* ; Ultrasonics* ; Ultrasonography

The authors have reviewed 11 cases of prosthetic replacement for severe proximal humeral fractures which were treated from March 1989 to December 1993, paying particular attention to the range of motion attained after surgery and the factors which influence the limitation of shoulder motion. The results of this study were as follows: l. Among the 11 cases, 10 cases showed sttisfactory pain relief. 2. Active motion of the shoulder averaged 91° of forward flexion, 72.8° of abduction and 35° of external rotation. 3. The humeral offset averaged 30.9mm in normal shoulder and 18.9mm in affected shoulder. 4. In 6 cases which the humeral offset measured over 20mm, active motion averaged 104° of forward flexion and 83° of abduction and 5 cases showed satisfactory results. 5. In 5 cases which the humeral offset measured under 20mm, active motion averaged 104° of forward flexion and 83 of abduction and 5 cases showed unsatisfactory results. 6. Prosthetic replacements were performed within 1 week after injury in 7 cases and among these 5 cases showed satisfactory results. The range of motion after prosthetic replacement for severe proximal humeral fracture was disappointing. We concluded that limited range of motion is mainly due to reduced humeral offset and restoration of humeral offset by appropriate reattachment of greater tuberosity will allow better clinical result.
Range of Motion, Articular ; Shoulder ; Shoulder Fractures

The computer-aided design/computer-aided manufacturing (CAD/CAM) system was introduced to shorten the production time of all-ceramic restorations and the number of patient visits. Among these types of ceramic for dental CAD/CAM, they have been processed into inlay, onlay, and crown shapes using leucite-reinforced glass-ceramics to improve strength. The purpose of this study was to observe the mechanical properties and microstructure of leucite-reinforced glass-ceramics for dental CAD/CAM. Two types of leucite-reinforced glass-ceramic blocks (IPS Empress CAD, Rosetta BM) were prepared with diameter of 13 mm and thickness of 1 mm. Biaxial flexural testing was conducted using a piston-on-three-ball method at a crosshead speed of 0.5 mm/min. Weibull statistics were used for the analysis of biaxial flexural strength. Fracture toughness was obtained using an indentation fracture method. Specimens were observed by field emission scanning electron microscopy to examine the microstructure of the leucite crystalline phase after acid etching with 0.5% hydrofluoric acid aqueous solution for 1 minute. The results of strength testing showed that IPS Empress CAD had a mean value of 158.1±8.6 MPa and Rosetta BM of 172.3±8.3 MPa. The fracture toughness results showed that IPS Empress CAD had a mean value of 1.28±0.19 MPa·m(1/2) and Rosetta BM of 1.38±0.12 MPa·m(1/2). The Rosetta BM sample exhibited higher strength and fracture toughness. Moreover, the crystalline phase size and ratio were increased in the Rosetta BM sample. The above results are expected to elucidate the basic mechanical properties and crystal structure characteristics of IPS Empress CAD and Rosetta BM. Additionally, they will help develop leucite-reinforced glass-ceramic materials for CAD/CAM.
Ceramics ; Crowns ; Crystallins ; Humans ; Hydrofluoric Acid ; Inlays ; Methods ; Microscopy, Electron, Scanning

A brain lesion located at the lateral side of the sella turcica can produce a junctional scotoma by compressing the ipsilateral optic nerve and the contralateral inferonasal nerve fiber. This study reports a female patient with a junctional scotoma caused by a cerebral aneurysm. At the initial visit, she complained of visual disturbance in both eyes and the right optic disc was atrophied. The visual field showed right blindness and left superotemporal quadrantopsia. A brain CT indicated an approximately 3 cm sized brain mass located superolateral to the sella turcica. The brain MRI showed the lesion to be more like an aneurysm than a pituitary adenoma. Therefore, 4 vessels angiography was done, and this lesion was confirmed to be a sellar variant of an aneurysm located at the right carotid siphon. Like a tumor of the optic chiasm, a cerebral aneurysm can cause visual disturbance and visual field defects. Therefore, an early differential diagnosis is important because the prognosis and treatment of an aneurysm differ.
Aged ; Cerebral Angiography ; Female ; Human ; Intracranial Aneurysm/*complications/radiography ; Magnetic Resonance Imaging ; Optic Nerve Diseases/diagnosis/*etiology ; Scotoma/diagnosis/*etiology ; Tomography, X-Ray Computed ; Visual Fields

ICD (implantable cardioverter-defibrillator) has been recently accepted as the most effective treatment for patients with medically refractory or life threatening ventricular tachycardia or ventricular fibrillation. Determination of the DFT (defibrillation threshold) is important in the implantation of ICD. DFT is the lowest shock energy that successfully terminates ventricular fibrillation. Preoperative amiodarone use, increased body size, and left ventricular dilatation are associated with high DFT. Recently, we experienced a 66 year-old male patient presenting with syncope due to idiopathic ventricular fibrillation in whom DFT was high and unstable, probably due to preoperative use of amiodarone.
Aged ; Amiodarone ; Body Size ; Dilatation ; Humans ; Male ; Shock ; Syncope ; Tachycardia, Ventricular ; Ventricular Fibrillation*

Intramural pregnancy is one of the rarest form of ectopic pregnancy that only 20 cases have been reported in the world so far. Pathologically, the location of the gestational sac is completely isolated from the uterine cavity and entirely surrounded by myometrium without any contact of endometrium. Many reports noted that there would be possible relationship between the intramural pregnancy and prior uterine traumatic factor- curettage, cesarean section, myomectomy, salpingectomy, and manual removal of the placenta and so on. We have recently experienced a case of intramural pregnancy following curettage, managed completely by the laparoscopic excision and additive single dose intramuscular MTX treatment. So, we report this case with a brief review of the literature.
Animals ; Cesarean Section ; Curettage ; Endometrium ; Female ; Gestational Sac ; Mice ; Myometrium ; Placenta ; Pregnancy* ; Pregnancy, Ectopic ; Salpingectomy