Complications after a median sternotomy incision, which is used currently in most open heart surgery, are serious, although it is infrequent. Reconstruction of the sternal defect resulting from dehiscence of median sternotomy is still big challenge to the most plastic surgeons. Since vascularized greater omentum was transposed to eliminate mediastinal wound problems, many vascularized regional muscle flaps became mainstay in reconstruction of median sternotomy wound. We treated 13 patients with median sternotomy dehiscence between October of 1993 and March of 1998. In two patients, the wound problems were so confined to superficial tissue that debrided and closed primarily. Eleven patients with deep wound infection were managed with vigorous debridement of all necrotic tissues and resultant defects were covered with regional muscle flaps: rectus myocutaneous flap(3) and bilateral pectoralis advancement flap(8). We used the pectoralis major advancement flaps without counter incision at humeral insertion site and the dissections were limited only medial to the anterior axillary line to preserve the axillary fold. In five patients with larger defects, we elevated muscle and cutaneous flaps separately to make these flaps more mobile. Large portion of two rectus abdominis flaps could not survive, whereas pectoralis advancement flaps had mo special wound problems. Only one patient developed fistula due to remained wire, regardless to flap surgery.
Debridement ; Fistula ; Humans ; Omentum ; Rectus Abdominis ; Sternotomy* ; Thoracic Surgery ; Wound Infection ; Wounds and Injuries

Ten pigmented raqbits were dark adapted for 30 minutes previously and then exposed to room illumination of 200 lux for 10 seconds. In mesopic adaptation, the oscillatory potentials(OPs) were recorded. The coefficient of variation in the peak latency, time interval, summed amplitude, and amplitude of each individual OP wavelet were obtained. The peak latency showed the smallest coefficient of variation. The summed amplitude of the OPa and the time interval showed smaller coefficient of variation than amplitude of each individual OP component. Therefore the peak latency, summed amplitude, and time interval may be reliable factors to evaluate the OPs. The increase of the light stimulus did not affect the amplitude of O3. However, O1 and O2 tended to increase in amplitude and O4 to decrease as the intensity of light stimulus increased. These facts may suggest that each individual component of OP has different orign. As the intensity of light stimulus increased, the summed amplitude of OPs was increased and peak latency of O1, O2, O3, and O4 were decreased. Time intervals showed no significant changes.
Lighting ; Rabbits*

In determining the effects of strabismus surgery, it is very important to know where the reattachment site of an extraocular muscle following recession procedure is located. Undercorrections or overcorrections after muscle surgery have been thought to be due to a postoperative positional changes of reattachment site along the surface of the globe. The author performed this experimental study to evaluate the amounts of changes of reattachment site after recession procedure in rabbit with 4 different methods of scleral fixation;direct suture with 6-0 vicryl, hang-back suture, application with Tisseel and Histoacryl. Superior rectus recession was performed in all 40 rabbit eyes, 10 eyes in each group. The distance from limbus to proximal end of recessed superior rectus muscle was measured on day 1, 2, 3, 5 and 7 postoperatively. Further measurements were followed at 2, 3, 4 and 8 weeks after recession procedure. The muscles were found an average of 0.4mm posterior to the intended position in direct suture group and 0.5 mmin hang-back suture group at one week postoperatively. But in the other two groups in which tissue adhesive agents, Tisseel and Histoacryl were used, the amount of displacement of the reattachment site were minimal of within 0.1 mm. From this experimental study, it is suggested that the positional changes of the reattachment site after recession procedure may influence the surgical corrective effects for strabismus.
Enbucrilate ; Fibrin Tissue Adhesive ; Muscles ; Polyglactin 910 ; Strabismus ; Sutures ; Tissue Adhesives

Injuries to the ligament, bone and other supporting structures of the knee joint have a tendency to increase becsuse of the increasing traffics, popularity of sports and industrial accidents. It is well known that the knee joint is burdened on motion and weight bearing and structurally it is more frequently injuried than other joints. When there is injury to the knee, it is frequently combined with injury to ligaments and other supporting structures rather than pure tibial condyle fracture. There remains a residual instability of the knee joint because of neglecting of the injured ligaments if treatment is concerned only with tibial condyle fracture. To obtain complete recovery from the injury, early diagnosis, prompt treatment and well planned exercise are important. Thirty patients with ligaments injury and tibial condyle fracture who were treated at the Depsrtment of Orthopaedic Surgery of Wallace Memorial Baptist Hospital from 1983 to 1987 have been reviewed. Through combined operative and conservative treatment, excellant and good results were obtained in 93% of the cases.
Accidents, Occupational ; Clinical Study ; Early Diagnosis ; Humans ; Joints ; Knee Joint ; Knee ; Ligaments ; Protestantism ; Sports ; Weight-Bearing

PURPOSE: To report a case of bilateral retinal detachment in a 15-year-old child with Tourette syndrome. CASE SUMMARY: A 15-year-old child treated for Tourette syndrome for 4 years presented with decreased visual acuity of several days in duration. The fundus of the right eye was not observed due to lens opacity and posterior synechiae. The B-scan of the right eye showed funnel-shaped densely reflective echoes connected to the optic disc, suggesting a total retinal detachment. Fundus examination of the left eye revealed an inverted retinal flap, which covered the posterior pole. During vitrectomy of the left eye, a ciliary body detachment anterior to a giant retinal tear extending 360 degrees was observed. In addition, an inverted flap covering 2 superior retinal quadrants was observed. A perfluorocarbon liquid was injected to unfold the tear's inverted flap, and silicone oil tamponade was performed. CONCLUSIONS: Self-induced and repeated periocular trauma induced by motor tics of Tourette syndrome can result in bilateral retinal detachment. Regular ophthalmic examinations are helpful for early detection of ocular complications including periocular trauma induced by motor tics of Tourette syndrome.
Adolescent ; Cataract ; Child ; Ciliary Body ; Eye ; Humans ; Retinal Detachment ; Retinal Perforations ; Retinaldehyde ; Silicone Oils ; Tics ; Tourette Syndrome ; Visual Acuity ; Vitrectomy

PURPOSE: To retrospectively evaluate the clinical effect of intravitreal (IVT) and posterior subtenon (PSTT) triamcinolone acetonide (TA) injection in diabetic macular edema. METHODS: Fifty eyes of 43 patients with diabetic macular edema (DME) were included. Twenty-two eyes in the IVT group received 4 mg/0.1 ml intravitreal TA injections and 26 eyes in the PSTT group received 40 mg/1.0 ml subtenon TA injections. LogMAR visual acuity and intraocular pressure (IOP) were measured and, using OCT, central macular thickness (CMT) and total macular volume (TMV) were also measured before and 1, 3, and 6 months postoperatively. RESULTS: Both groups showed significant decreases in the mean CMT and TMV. The mean CMT in the IVT group was significantly thinner than that of the PSTT group 1 month postoperatively. The percentage reduction in CMT and TMV were also greater in the IVT group than the PSTT group 1 month postoperatively. Both groups showed significant improvements in mean visual acuity, with no significant difference between the two groups. However, at 1-month postoperative improvement in visual acuity was significantly greater in the IVT group than the PSTT group. The mean IOP in the IVT group was also greater than that in the PSTT 1 month postoperatively. CONCLUSIONS: Both injections caused a significant increase in visual acuity and a decrease in CMT and TMV. The effect was more pronounced in the IVT group. However, the PSTT injection also appeared to be a safe and effective technique for the treatment of DME.
Eye ; Humans ; Intraocular Pressure ; Intravitreal Injections ; Macular Edema ; Retrospective Studies ; Triamcinolone ; Triamcinolone Acetonide ; Visual Acuity

No abstract available.
Diagnosis, Differential ; Fluorescein Angiography ; Fundus Oculi ; Hamartoma/*congenital/diagnosis ; Humans ; Male ; Retinal Diseases/*congenital/diagnosis ; Retinal Pigment Epithelium/*pathology ; Retinal Telangiectasis/*diagnosis ; Tomography, Optical Coherence ; Young Adult

The effects of pressure induced ischemia on the retina were studied by means of Electroretinogram(ERG) and Electron microscopy. Acute ischemias were induced in the cat's eyes by raising the intraocular pressure over the systolic pressure for 90 minutes in group one and 3 hours in group two. ERGs and OPs(Oscillatory potentials) were recorded 1 hour. 1 day, 3 days, 7 days and 14 days after prsssure-induced ischemia, respectively. The eyes were enucleated 1 hour, 1 day, 3 days, 7 days and 14 days after ischemia for evaulation of structural damage of the retina. The amplitudes of a-, b-waves and the summed amplitudes of OPs(SOP) were decreased to 57.4%, 51.9% and 45.2% of control values at one day after ischemia and then recovered to 80%, 68.8% and 59% at 14 days after ischemia in group one. In group two, the amplitudes of a-, b-waves and the summed amplitudes of OPs appeared to flat at 1 hours after ischemia and then recovered to 50%, 50% and 30.7% of control values at 14 days after ischemia. In group one, electron microscopic study revealed generalized retinal damages including retinal edema and the pyknosis of the nucleus. And these changes seemed to be recovered gradually until two weeks after damages. In group two, the retina received more severe ischemic damages than group one, such as destruction of photoreceptors, necrosis of photoreceptor, bipolar cells and ganglion cells on one day after ischemia. After 2 weeks, the loss of photoreceptors and the pigment epithelial migration into the inner retinal layer were noted. In conclusion, the ERG study revealed that the OPs was the most vulnerable components to the ischemia and the histopathological study showed that the photore ceptors received more severe damage from the retinal ischemia than the other components.
Animals ; Blood Pressure ; Cats* ; Ganglion Cysts ; Intraocular Pressure ; Ischemia* ; Microscopy, Electron ; Necrosis ; Papilledema ; Retina ; Retinaldehyde

We report an unusual case of unilateral frosted branch angiitis associated with Behcet's disease, including a review of previously reported cases. A 39-year-old male with history of recurrent oral and genital ulcers presented with visual loss in his left eye. Fundus findings demonstrated occlusive retinal vasculitis resembling acute frosted branch angiitis. Laboratory examinations including viral markers revealed no abnormal findings except positive HLA-B51. The patient was treated with systemic steroid and cyclosporine. Six months after presentation, new oral ulcers and pseudofolliculitis appeared, and he was diagnosed with Behcet's disease following rheumatology consultation. During follow-up, there was no change in visual acuity of hand movement, and disc neovascularization developed even after complete panretinal photocoagulation. Ocular manifestations of Behcet's disease can present as unilateral frosted branch angiitis, and may consecutively involve in both eyes. Early immunosuppressive treatment is recommended.
Adult ; Behcet Syndrome/*complications/diagnosis ; Diagnosis, Differential ; Fluorescein Angiography ; Fundus Oculi ; Humans ; Magnetic Resonance Imaging ; Male ; Retinal Artery/*pathology ; Retinal Vasculitis/diagnosis/*etiology

PURPOSE: To determine the clinical features and surgical outcomes of retinal detachment associated with atopic dermatitis METHODS: Thirteen eyes of ten patients with atopic dermatitis and rhegmatogenous retinal detachment were surgically treated and followed up for 3 months or longer. Fundus examination on retinal breaks and detachment and follow-up on anatomic reattachment were examined. RESULTS: The retinal breaks were often multiple (62%) and mostly located near the ora serrata (77%). Irregularly shaped breaks (35%) and ora dialysis (27%) were found in many cases. Ciliary epithelial detachment was found in 3 eyes. Retinal detachments were localized in 11 eyes (85%) and shallow in 7 eyes (54%). The result of the initial surgery (reattachment rate, 69%) was unfavorable because of new break formation, but the result of second operation (reattachment rate, 100%) was successful. CONCLUSIONS: The shape of retinal tears associated with atopic dermatitis was irregualr and ora dialysis was commonly found. Therefore, retinal detachment associated with atopic dermatitis seems to be related to ocular trauma.
Dermatitis, Atopic* ; Dialysis ; Follow-Up Studies ; Humans ; Retinal Detachment* ; Retinal Perforations ; Retinaldehyde*