PURPOSE: The present study examined how intraocular pressure is affected by changes in sleeping posture (22-2400 hours) from the sitting position to the supine, prone, and lateral positions in normal subjects. METHODS: Ophthalmological examination was performed on 140 eyes of 70 healthy adult men, and changes in the intraocular pressure were measured according to posture during sleep. The subject was initially relaxed and the base intraocular pressure was measured in the sitting position. In order to reduce the influence of intraocular pressure among the positions, namely, the supine, the prone, and the lateral recumbent positions, the subject was seated for ten minutes before assuming each position. Intraocular pressure was measured twice at 0 and 10 minutes in each position, and the mean of the two values was used for comparison. RESULTS: Compared to the intraocular pressure in the sitting position, intraocular pressure increased significantly in the supine, prone, and lateral positions (p< 0.05). Compared to the base intraocular pressure, the intraocular pressure measured in the prone position showed the largest difference, increasing 6.34 mm Hg in the right eye and 6.43 mm Hg in the left eye. The intraocular pressure measured in the lateral position was 3.62 mm Hg higher in the right eye and 3.63 mm Hg higher in the left eye, and that in the supine position was 2.42 mm Hg and 2.28 mm Hg higher in the right and left eyes, respectively. CONCLUSIONS: The change in posture during sleeping from the sitting position to the supine, prone, and lateral positions caused increases in intraocular pressure in normal subjects. The results show that the change in sleeping posture induced by sleeping habits may raise intraocular pressure.
Adult ; Eye ; Glaucoma ; Humans ; Intraocular Pressure ; Male ; Posture ; Prone Position ; Supine Position

No abstract available.
Ultrasonography, Prenatal*

Healing is an intricate, interdependent process that involves complex interactions between cells, the microcellular environment, biochemical mediators and extracellular matrix molecules. The goals of wound healing are to minimize bloods loss, to replace any defect with new tissue, and to restore an intact epithelial barrier as rapidly as possible. The rate of wound healing is limited by the available vascular supply and the rate of formation of new capillaries and matrix molecules, which are heavily influenced by locally-acting growth factors that affect proliferation, angiogenesis, chemotaxis, gene expression, proteinases, and protein production. We present a new method for wound control and treatment, the V.A.C (vacuum-assisted closure) technique. It places open-cell foam dressing into the wound cavity and applies subatmospheric pressure. The application of subatmospheric pressure accelerates the rate of wound healing by the foollowing two mechanisms: 1. Removal of excessive interstitial fluids, which decrease localized edema, reduce concentration of inhibitory factors, and increase local blood flow. 2. Transmission of mechanical forces to surrounding tissues with resultant deformation of the extracellular matrix and cells, which then increase protein and matrix synthesis as well as cell proliferation. We applied it to 17 patients: 1 Livedo vasculitis, 1 burned by flame 3 pressure sores, 1 extravasation injury, 1 wound infection, 2 wound disruption, and 8 diabetes mellitus feet. In the end, most of the remaining wounds were treated with a simple split-thickness skin graft and the results were encouraging. We concluded that the V.A.C technique may be an effective substitute to help promote wound healing. It could be especially helpful in chronic complicated wounds in aging or debilitated patients who can not tolerate aggressive surgical procedures.
Aging ; Bandages ; Burns ; Capillaries ; Cell Proliferation ; Chemotaxis ; Diabetes Mellitus ; Edema ; Extracellular Fluid ; Extracellular Matrix ; Foot ; Gene Expression ; Humans ; Intercellular Signaling Peptides and Proteins ; Peptide Hydrolases ; Pressure Ulcer ; Skin ; Transplants ; Vasculitis ; Wound Healing* ; Wound Infection ; Wounds and Injuries*

BACKGROUND: Several antibiotics can be used to treat ventilator-associated pneumonia caused by carbapenem-resistant A. baumannii (CRAB-VAP) including high-dose sulbactam. However, the effectiveness of high-dose sulbactam therapy is not well known. We report our experience with high-dose sulbactam for treatment of CRAB-VAP. METHODS: Medical records of patients with CRAB-VAP who were given high-dose sulbactam between May 2013 and June 2015 were reviewed. RESULTS: Fifty-eight patients with CRAB-VAP were treated with high-dose sulbactam. The mean age was 72.0 ± 15.2 years, and the acute physiology and chronic health evaluation II (APACHE II) score was 15.1 ± 5.10 at the time of CRAB-VAP diagnosis. Early clinical improvement was observed in 65.5% of patients, and 30-day mortality was 29.3%. Early clinical failure (odds ratio [OR]: 8.720, confidence interval [CI]: 1.346-56.484; p = 0.023) and APACHE II score ≥ 14 at CRAB-VAP diagnosis (OR: 10.934, CI: 1.047-114.148; p = 0.046) were associated with 30-day mortality. CONCLUSIONS: High-dose sulbactam therapy may be effective for the treatment of CRAB-VAP. However, early clinical failure was observed in 35% of patients and was associated with poor outcome.
Acinetobacter baumannii* ; Acinetobacter* ; Anti-Bacterial Agents ; APACHE ; Diagnosis ; Humans ; Medical Records ; Mortality ; Pneumonia, Ventilator-Associated* ; Sulbactam*

No abstract available.

PURPOSE: To investigte the extrusion rate of punctal plugs and to evaluate their long-term effectiveness related to punctal occlusion. METHODS: The subjects were 120 eyes of 60 patients with tear-deficient dry eye who underwent punctal occlusion using a silicone punctal plug from May 2003 to Jun 2004. They were followed up for 382.3+/-164.3 days. We studied the extrusion rate and the period of extrusion for each plug and examined the differences between the objective and subjective indicators of dry eye syndrome before and after plug insertion and between extruded and non-extruded punctal plugs. RESULTS: In this study, 25.8% of all plugs were extruded during the follow-up period. The majority of plugs (41.9%) were extruded within 100 days after plug insertion. As objective indicators, results of Schirmer test and BUT were significantly increased after plug insertion. As subjective indicators, the patients' clinical symptoms significantly improved. Patient use of artificial tear drops significantly decreased and was discontinued by 70.8% after plug insertion. There were however no significant differences between the extrusion group and the non-extrusion group in each case. CONCLUSIONS: Punctal plug occlusion therapy for tear-deficient dry eye is effective, but the extrusion rate is relatively high. Regardless of punctal plug extrusion, patients experienced a symptomatic improvement. Serious consideration of this fact may greatly aid in making therapeutic adaptations and maintaining a good relationship.
Dry Eye Syndromes* ; Follow-Up Studies ; Humans ; Silicones ; Tears

PURPOSE: To report a primary surgical repair of a severe corneal laceration, a lens prolapse and a traumatic aniridia by blunt trauma in Terrien's marginal degeneration. METHODS: A 46-year-old female visited our hospital for corneal laceration due to a blunt trauma of the right eye. A primary corneal suture was done and 8 days later, amniotic membrane transplantation was performed. RESULTS: The perforated eyeball regained its integrity with a stabilized cornea. Also, the anterior chamber was reformed and visual acuity improved. CONCLUSIONS: In the first case of Terrien's marginal degeneration in the right eye, which had a 360-degree iridodialysis(aniridia) with aphakia due to blunt traumatic separation of the iris root from the ciliary body. We achived a good operative result with primary corneal suture and amniotic membrane transplantation.
Amnion ; Aniridia ; Anterior Chamber ; Aphakia ; Ciliary Body ; Cornea ; Female ; Humans ; Iris ; Lacerations ; Middle Aged ; Prolapse ; Rupture* ; Sutures ; Visual Acuity

PURPOSE: To report the results of performing an Ahmed glaucoma valve implantation without removing the anterior chamber lens to treat secondary glaucoma. CASE SUMMARY: A 72-year-old male visited the hospital for imminent visual field loss in the left eye. At the time of the visit, he had a mild headache, and the intraocular pressure of the left eye was 38 mm Hg. The left eye had received anterior chamber lens insertion with iridectomy and the posterior capsule was ruptured. The vitreous protruded at the two o'clock site and adhered to the backside of the anterior chamber lens tilting it toward the temporal cornea. At the time of the visit, the maximum corrected vision of the left eye was 0.32. The patient was diagnosed with secondary glaucoma caused by the anterior chamber lens. Because the patient did not want to have the anterior chamber lens removed and the supporting area of the anterior chamber lens blocked the trabeculectomy and peripheral iridectomy sites, the authors performed an Ahmed glaucoma valve implantation instead. The outcome of Ahmed glaucoma valve implantation was evaluated through a preoperative and postoperative vision test and periodical corneal endothelial cell analysis. During the six months of postoperative follow-up, the vision was improved, intraocular pressure was stabilized, and corneal endothelial cells were maintained. CONCLUSIONS: When a patient requires glaucoma surgery for secondary glaucoma caused by an anterior chamber lens, an Ahmed implantation without lens removal may be an option which may carefully be considered. However, because of the possibility of subsequent complications, a longer follow-up period is necessary.
Aged ; Anterior Chamber ; Cornea ; Endothelial Cells ; Eye ; Follow-Up Studies ; Glaucoma ; Headache ; Humans ; Intraocular Pressure ; Iridectomy ; Male ; Trabeculectomy ; Vision Tests ; Vision, Ocular ; Visual Fields

STUDY DESIGN: Clinical and radiographic results of spine fracutre treated with pedicle screws and hooks were reviewed. OBJECTIVES: Evaluate the efficacy of tile pedicle screw and hook for thoracolumar bursting fracture. SUMMARY OF LITERATURE REVIEW: Despite of the mechanical advantage of the pedicle screw, the metal failure in short segment fusion has been reported. A biomechanical study showed additional laminar hook increased rotational strength. MATERIALS AND METHODS: Between 1994 and 1996, seventeen patients who had a Denis type B bursting fracture of the thoracolumbar spine were treated by posterior instrumentation with pedicle screws and laminar hooks and auterior interbody fusion after partial corpectomy. They have been followed for an average of 13.4 months. RESULTS: At last follow-up, radiographs showed successful fusion of the injured spinal segment in all patient. The subsidence of grafts which were used In anterior interbody fusion was an average of 0.76mm. There was a loss of 2.6 degrees on average in the correction of the kyphosis. No patients had screw breakage or loosening. CONCLUSIONS: We concluded that posterior fixation with screws and hooks, anterior decompression by partial corpectomy, and strut-grafting in patient who had a Denis type B bursting frafture of the thoracolumbar spine yielded good radiographic and functional results.
Decompression ; Follow-Up Studies ; Humans ; Kyphosis ; Spine* ; Transplants

No abstract available.
Carcinoma, Hepatocellular* ; Diagnosis*