We compared the pain produced during different phases of phacoemulsification cataract surgery using a scleral pocket incision under pinpoint anesthesia with that under intracameral anesthesia. This prospective study comprised each 100 cataract patients who had no complications influencing the degree of pain during surgery. Patients were asked about pain immediately after each phase and pain occurring during each phase was measured using 4 step verbal scale(from 0 to 4). In both anesthesia,conjunctival reposition was the most painful.Pinpoint injection was statistically significantly more painful than induction of intracameral anesthesia.The pain score during conjunctival reposition and at 1hr after surgery were significantly higher under intracameral anesthesia than under pinpoint, but during most of phases under both anesthesia,the pain score was relatively low. Intracameral anesthesia is easy,safety and dose not require additional ocular damage during induction of anesthesia,so if combined with topical anesthesia,it is very effective during cataract surgery using scleral pocket incision.
Anesthesia* ; Cataract* ; Humans ; Phacoemulsification ; Prospective Studies

No abstract available.
Arthritis, Rheumatoid* ; Humans ; Neuroma*

Clear cell sarcoma is a rare malignant rumor of the kidney which occurs in children and is differentiated from Wilms' tumor by its different clinicopathologic features and natural history. Previous studies indicate that this tumor may be of mesenchymal cell origin; however, this has not been proven conclusively. Further accumulation and study need to be conducted in order to clarify the histogenesis of this tumor. We report two cases of clear cell sarcoma of the kidney which occurred in a 2 and a half-year old and a 2-year old boy. This report places special emphasis on the clinicopathologic characteristics of these two cases including electron microscopic and immunohistochemical findings. Attempts were also made to differentiate the clinicopathologic aspects of clear cell sarcoma from Wilms' tumor and speculate on the histogenesis of this rumor.
Child ; Male ; Female ; Humans

BACKGROUND: This study aimed to assess the status of infection control during influenza A pandemic (H1N1) 2009. METHODS: A questionnaire survey was conducted in November 2009 at the 100 hospitals designated by the Korea Centers for Disease Control and Prevention (KCDC) as influenza A pandemic (H1N1) 2009-treatment institutions. RESULTS: In 32.3% of the hospitals, the ventilation system of the influenza A pandemic (H1N1) 2009 isolation ward was separated from the hospital's ventilation system. With regard to wearing personal protective equipment while caring for patients with H1N1 infection, during usual patient contact, masks were always worn by all medical staff at all the hospitals; however, medical staff at 38.7% and 51.6% of the hospitals did not wear gloves and gowns, respectively. During aerosol-generating procedures, some medical staff wore surgical masks, whereas medical staff at 10% and 23.3% of the hospitals did not wear gowns and protective goggles, respectively. In all, 64.5% of the hospitals responded that the contents of the guidelines established by the KCDC were insufficient for reference purposes in actual practice. CONCLUSION: Some of influenza A pandemic (H1N1) 2009-treatment institutions are believed to be inadequate in facilities, infection control during patient treatment, and administrative measures among their efforts to prevent transmission in hospital. In preparation against the outbreak of similar diseases in the future, the government needs to establish guidelines highly applicable by medical staff, to secure exclusive spaces and personnel for treating infectious disease patients, and to develop personal protective gear support and management systems.
Centers for Disease Control and Prevention (U.S.) ; Communicable Diseases ; Delivery of Health Care ; Eye Protective Devices ; Humans ; Infection Control ; Influenza, Human ; Korea ; Masks ; Medical Staff ; Pandemics ; Ventilation ; Surveys and Questionnaires

It is difficult to diagnose thyroid storm in an emergency room, especially in cases when there is no past history of thyroid disease or specific symptoms such as thyroid hypertrophy and exophthalmia. Nevertheless, thyroid storm is a medical emergency threatening the patient's life, and immediate diagnosis and intensive treatment are critical to the patient's well-belling. We experienced a case of thyroid storm with comparatively rare symptoms in an emergency department. A 29-yearold male was taken to the emergency room with diarrhea, vomiting and fever. Initially, the patient's symptoms were attributed to acute gastroenteritis. As time passed, consciousness decreased and tachycardia appeared, and we ultimately suspected thyroid storm because of the atypical symptoms and were able to cure the patient with early treatment.
Consciousness ; Diabetes Mellitus ; Diarrhea ; Emergencies ; Fever ; Gastroenteritis ; Humans ; Hypertrophy ; Male ; Tachycardia ; Thyroid Crisis ; Thyroid Diseases ; Thyroid Gland ; Vomiting

Objective: In September 2018, the traffic law revision has enforced all passengers in cars to wear seatbelts. Our study aims to investigate the effects of this law revision on fellow passengers involved in car accidents by considering their seatbelt-wearing rate and severity score. Methods: This study is a retrospective observational study. Data were collected from the Emergency Department-based Injury in-depth Surveillance (for the years 2017 and 2019), Korea Disease Control and Prevention Agency. Candidates were patients who visited emergency rooms (ERs) of 23 hospitals from January to December in the years 2017 and 2019. Patients under the age of 15 years or without Excess Mortality Ratio-adjusted Injury Severity Score (EMR-ISS) data or having accidents on highways were excluded. Results: The total number of patients who visited ERs during the study periods was 91,506 and 14,806 in 2017 and 2019, respectively, and were included in our study. There were more fellow female passengers than male passengers during both the study periods: 5,559 in 2017 (67.9%) and 4,341 in 2019 (66.8%). Compared to 52.2% in 2017, the rate of wearing seatbelts increased to 54.5% in 2019. However, after adjusting for age, sex, use of ambulance, injury time, alcohol use, type of road, and counterpart, multivariate logistic regression revealed that compared to the 2017 group, the odds ratio of severe injuries in the 2019 group was 1.10 (95% confidence interval, 0.98-1.24). Conclusion Increased rate of wearing seatbelts after imposing the traffic law revision was not satisfactory. Therefore, it is necessary to tighten regulations on fellow passengers without seat belts and improve awareness through public relations.

Epidural emphysema and pneumoscrotum with subcutaneous emphysema are rare in a child past the neonatal period. Their most common causes are bronchial asthma and respiratory infection. Here, we report an 18-month-old boy who was presented with severe air leak, consisting of epidural emphysema, pneumoscrotum, subcutaneous emphysema, and pneumomediastinum, complicated by a bronchial foreign body. The air leak was resolved dramatically after removing the foreign body.
Asthma ; Child ; Emphysema* ; Epidural Space ; Foreign Bodies* ; Humans ; Infant ; Male ; Mediastinal Emphysema ; Subcutaneous Emphysema

No abstract available.
Adult* ; Humans ; Lip* ; Rhabdomyosarcoma, Alveolar*

PURPOSE: To investigate the effects of nitric oxide (NO) on the permeability of cultured human trabecular meshwork cell (HTMC) monolayer. METHODS: HTMCs were cultured until confluency in the Transwell inner chamber and then exposed to 0, 10 or 100 microm S-nitroso-N-acetyl-DL-penicillamine (SNAP) and 0.5 mm L-NG-Nitroarginine methyl ester (L-NAME) for 24 hours. Permeabilities of carboxyfluorescein through the HTMC monolayer were measured using a spectrofluorometer after 2 hours in the outer chamber. Cellular viabilities and production of NO were assessed using 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) and Griess assay, respectively. RESULTS: The cellular survival was not affected by 10 or 100 microm SNAP (p > 0.05) but NO production increased in a dose-dependent manner (p < 0.05). SNAP significantly increased the permeability of carboxyfluorescein through the HTMC monolayer in a dose-dependent manner compared with non-exposed control (p < 0.05). The endothelial NO synthase inhibitor L-NAME abolished SNAP-induced increase of the carboxyfluorescein permeability (p > 0.05). CONCLUSIONS: NO increased the permeability of carboxyfluorescein through the HTMC monolayer in a dose-dependent manner. Thus, NO could increase trabecular outflow by increasing the permeability of trabecular cell layer in addition to trabeular messwork (TM) relaxation.
Humans ; NG-Nitroarginine Methyl Ester ; Nitric Oxide Synthase ; Nitric Oxide* ; Permeability* ; Relaxation ; Trabecular Meshwork*

Use of laparoscopic appendectomy (LA) for perforated appendicitis (PA) in children remains controversial because of the development of postoperative intra-abdominal abscess formation. We developed the irrigation method for the prevention of abscess formation after LA performed for PA in children with severe panperitonitis. We called it 'the shaking irrigation'. The object of this study was to analyze the efficacy of this irrigation method. All cases of PA with severe panperitonitis in children that underwent LA with massive shaking irrigation and drainage between June 2003 and December 2007 were studied retrospectively. We included only PA with panperitonitis and large amounts of purulent ascites throughout the abdomen as well as an inflamed small bowel with ileus. Thirty-four children were involved in this study. The mean patient age was eight years. The mean amount of irrigation fluid was 8.2L (range: 4-15L). The mean operative time was 89.5 min. The mean length of the hospital stay was 5.1 days. There were no postoperative intra-abdominal abscesses. There was no conversion to open surgery. In conclusion, Use of LA in PA with severe panperitonitis in children is safe and effective. Massive shaking irrigation and abdominal drainage appears to prevent intra-abdominal abscesses after LA for PA with panperitonitis.
Abdomen ; Abdominal Abscess ; Abscess ; Appendectomy ; Appendicitis ; Ascites ; Child ; Conversion to Open Surgery ; Drainage ; Humans ; Ileus ; Length of Stay ; Operative Time ; Retrospective Studies