Restriction of eye movement after surgery is an unusual but troublesome complication. A patient presented with a limitation of abduction after a 5 mm resection of medial rectus muscle and an 8 mm recession of lateral rectus muscle. Since the forced duction test was positive, restrictive factors were suggested to be implicated. A reparative operation was performed at the postoperative 9 month, and the forced duction test was negative after releasing the resected medial rectus muscle. The patient showed an improved abduction after recessing the resected muscle. Even after an uneventful surgery, resection of an extraocular muscle may cause restriction of ocular rotation caused by muscle scarring to the sclera or by an increased tightness of the muscle.
Adolescent ; Case Report ; Exotropia/*surgery ; *Eye Movements ; Human ; Male ; Ocular Motility Disorders/*etiology/*physiopathology ; Oculomotor Muscles/*physiopathology/*surgery ; Ophthalmologic Surgical Procedures/*adverse effects ; Postoperative Period

PURPOSE: To assess long-term anatomic and visual outcomes and associated complications of lens-sparing vitrectomy (LSV) for treatment of tractional retinal detachments (TRDs) associated with stages 4B and 5 retinopathy of prematurity (ROP). METHODS: We performed a retrospective review of medical records and data analyses of consecutive patients who presented with stages 4B and 5 ROP and underwent LSV from 1999 to 2007. Retinal reattachment status, visual acuity and postoperative complications were evaluated. RESULTS: Twenty-one eyes of 20 patients, including 13 eyes with stage 4B ROP and 8 eyes with stage 5 ROP, were examined. The mean follow-up period was 5.6 years. In 9 (43%) out of 21 eyes, retinas were eventually reattached. The anatomic success rates were 62% in stage 4B and 13% in stage 5 ROP. In eyes with reattached retinas, visual acuity better than form vision was shown in 7 eyes (78%), whereas no light perception was present in 10 eyes (83%) among eyes with TRD on final examination. Postoperative intraocular hemorrhage occurred in nine eyes (43%). Long-term complications of cataract, corneal opacity, glaucoma and strabismus developed in 4 (19%), 6 (29%), 7 (33%) and 8 (38%) eyes, respectively, and were more common in eyes with TRD. CONCLUSIONS: After following-up for a mean of 5.6 years, the anatomical success rate of LSV was encouraging for the correction of TRD associated with stage 4B ROP but not for stage 5 ROP. Retinal reattachment is important for obtaining better visual outcomes and preventing the development of late complications.
Female ; Follow-Up Studies ; Humans ; Infant, Newborn ; *Infant, Very Low Birth Weight ; Lens, Crystalline/*surgery ; Male ; Retinopathy of Prematurity/diagnosis/physiopathology/*surgery ; Retrospective Studies ; Severity of Illness Index ; Time Factors ; Treatment Outcome ; Visual Acuity ; Vitrectomy/*methods

PURPOSE: To assess long-term anatomic and visual outcomes and associated complications of lens-sparing vitrectomy (LSV) for treatment of tractional retinal detachments (TRDs) associated with stages 4B and 5 retinopathy of prematurity (ROP). METHODS: We performed a retrospective review of medical records and data analyses of consecutive patients who presented with stages 4B and 5 ROP and underwent LSV from 1999 to 2007. Retinal reattachment status, visual acuity and postoperative complications were evaluated. RESULTS: Twenty-one eyes of 20 patients, including 13 eyes with stage 4B ROP and 8 eyes with stage 5 ROP, were examined. The mean follow-up period was 5.6 years. In 9 (43%) out of 21 eyes, retinas were eventually reattached. The anatomic success rates were 62% in stage 4B and 13% in stage 5 ROP. In eyes with reattached retinas, visual acuity better than form vision was shown in 7 eyes (78%), whereas no light perception was present in 10 eyes (83%) among eyes with TRD on final examination. Postoperative intraocular hemorrhage occurred in nine eyes (43%). Long-term complications of cataract, corneal opacity, glaucoma and strabismus developed in 4 (19%), 6 (29%), 7 (33%) and 8 (38%) eyes, respectively, and were more common in eyes with TRD. CONCLUSIONS: After following-up for a mean of 5.6 years, the anatomical success rate of LSV was encouraging for the correction of TRD associated with stage 4B ROP but not for stage 5 ROP. Retinal reattachment is important for obtaining better visual outcomes and preventing the development of late complications.
Female ; Follow-Up Studies ; Humans ; Infant, Newborn ; *Infant, Very Low Birth Weight ; Lens, Crystalline/*surgery ; Male ; Retinopathy of Prematurity/diagnosis/physiopathology/*surgery ; Retrospective Studies ; Severity of Illness Index ; Time Factors ; Treatment Outcome ; Visual Acuity ; Vitrectomy/*methods

PURPOSE: To assess the long-term anatomic and visual outcomes and associated complications of lens-sparing vitrectomy (LSV) in infants with progressive posterior-type tractional retinal detachment (TRD) associated with stage 4A retinopathy of prematurity (ROP). METHODS: In a retrospective case series, the medical records of consecutive patients who presented with progressive posterior-type stage 4A ROP and underwent LSV between 1999 and 2007 were reviewed. Retinal attachment status, visual acuity, and development of postoperative complications were assessed. RESULTS: Eleven eyes of 9 patients were included. The mean follow-up period was 4.6 years. In 8 eyes (73%), plus disease was present at the time of LSV. In 3 eyes (27%), 2 (66%) without plus disease and 1 (13%) with plus disease, the retina remained reattached in the end, while 8 eyes (73%) had TRD on final examination. Two eyes with reattached retinas showed favorable visual acuity. In those eyes with detached retinas, 5 (68%) showed no light perception. When surgery for ROP was unsuccessful, development of cataract, corneal opacity, or glaucoma was common. CONCLUSIONS: The long-term anatomic success rate of LSV for progressive posterior-type stage 4A ROP was low, especially in the presence of plus disease at the time of LSV. Anatomical reattachment is very important for preventing complications and gaining better visual outcomes.
Disease Progression ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Postoperative Complications/epidemiology ; Retinal Detachment/epidemiology ; Retinopathy of Prematurity/*surgery ; Retrospective Studies ; Treatment Outcome ; Visual Acuity ; Vitrectomy/*methods

PURPOSE: Approximately 29% of patients visiting the emergency department are children and teens. Training emergency medicine (EM) residents for treatment of pediatric emergency patients is essential. We conducted a survey of the status of pediatric emergency medicine (PEM) education and made recommendations with regard to the direction of educational programs for PEM using the Delphi method. METHODS: We conducted a survey of 93 emergency medicine training hospitals and conducted the Delphi study with the first and second round. Variables of educational status included general information on the hospital, educational contents, and method for PEM. The Delphi method was used to obtain the consensus of experts with regard to which objectives, essential procedures, and necessary components for PEM training should be included. RESULTS: The rate of response for PEM educational status was 60(62.4%). The type of pediatric department rotation was essential 40.5%, optional 21.4%, and no rotation 38.1%. Capability of EM residents was 33.3% in PEM objectives and 45% in PEM procedures. Each rate of response for the Delphi study was 65% in the first round and 56.9% in the second round. We obtained the consensus of experts, with 52 of 59 objectives and 18 of 20 procedures. The appropriate period for pediatric emergency rotation was three months and the appropriate staff members for pediatric emergency education were the pediatric emergency physician, pediatric physician, and emergency physician, in order. CONCLUSION: Pediatric emergency training was not appropriate for an EM residency program. Experts agreed with 52 objectives and 18 procedures for PEM training of EM residents. We recommended a training period of three months and the appropriate staff member for PEM was the pediatric emergency physician.
Adolescent ; Child ; Consensus ; Curriculum ; Delphi Technique ; Educational Status ; Emergencies ; Emergency Medicine ; Humans ; Internship and Residency ; Pediatrics

No abstract available.
Dexmedetomidine* ; Propofol*

No abstract available.
Dexmedetomidine* ; Propofol*

PURPOSE: To evaluate the usefulness of internal fixation with plate in treating infected nonunion of long bone. MATERIALS AND METHODS: From March 1993 to February 2004, ten patients who underwent internal fixation with plate and cancellous bone graft on account of infected nonunion of long bone were retrospectively examined. The medical treatment were composed of thorough and adequate debridement of necrotic tissue, irrigation and plate fixation. Two patients were operated on with bridging plate method. Autologous cancellous bone graft was performed in 6 patients. In 2 cases, it was performed 4 weeks after internal fixation. RESULTS: In 9 patients, radiographic union appeared on the average of 6.8months and infections were cured before union occurred. CONCLUSION: Internal fixation with plate is a useful method for the solid fixation in the treatment of infected nonunion. The general concern was that the inserted hardware worsened the infection, which was overcomed with the operative techniques as bridging plate, debridement and cancellous bone graft.
Debridement ; Humans ; Retrospective Studies ; Transplants

BACKGROUND: Phadiatop test has been introduced as a single test for screening the atopics who were sensitized to common inhalant allergens. MATERIAL AND METHOD: We compared the clinical efficiency of Phadiatop test and total IgE level for defining presence of atopy in 136 asthmatic subjects. The presence of atopy was defined by skin prick test done with 10 common inhalant allergens. More than 2+ skin reactivity was defined as having atopy. Phadiatop test and total IgE level in serum were measured using Pharmacia CAP systems. RESULT: 109 out of 136 subjects had more than 2+ skin reactivity to at least one allergen and another 27 subjects had 1+ or negative skin reactivity to allergens. The performance characteristics of Phadiatop test for screening atopy was superior than total IgE level, with sensitivity(91.7% vs. 82.6%), positive predictive value(94.3% vs. 86.5%) and concordance rate(89.0 % vs. 75.7% ). Specificity and negative predictive value of the Phadistop test were acceptable and higher than that of total IgE level. CONCLUSION: These results suggested that Ph adiatop may be simple and useful for screening atopic status in Korean asthmatic subjects.
Allergens ; Hydrogen-Ion Concentration ; Immunoglobulin E ; Mass Screening* ; Sensitivity and Specificity ; Skin

PURPOSE: To describe the clinical course of congenital aniridia and to evaluate prognostic factors for visual outcome after long-term follow-up. METHODS: The medical records of 120 eyes from 60 patients with congenital aniridia were retrospectively reviewed. The prevalence and clinical course of ophthalmic characteristics, systemic disease, refractive errors, and visual acuity were assessed. Prognostic factors for final visual outcomes were analyzed. RESULTS: Aniridic keratopathy developed in 82 (69%) of 119 eyes. Macular hypoplasia was observed in 70 eyes of 35 patients (91%). Cataract was observed in 63 of 120 eyes (53%). Nystagmus was present in 41 patients (68% of 60 patients) at the initial visit but decreased in five patients (8% of 60 patients). Ocular hypertension was detected in 19 eyes (20% of 93 eyes), six (32% of 19 eyes) of which developed secondarily after cataract surgery. The mean changes in spherical equivalent and astigmatism during the follow-up period were -1.10 and 1.53 diopter, respectively. The mean final visual acuity was 1.028 logarithm of minimal angle of resolution. Nystagmus and ocular hypertension were identified as prognostic factors for poor visual outcome. CONCLUSIONS: Identification of nystagmus and ocular hypertension was important to predict final visual outcome. Based on the high rate of secondary ocular hypertension after cataract surgery, careful management is needed.
Adolescent ; Adult ; Aniridia/*diagnosis/physiopathology ; Cataract/diagnosis ; Child ; Child, Preschool ; Corneal Diseases/diagnosis ; Eye Abnormalities/diagnosis ; Eye Diseases/*diagnosis/physiopathology ; Follow-Up Studies ; Humans ; Infant ; Infant, Newborn ; Nystagmus, Pathologic/diagnosis ; Ocular Hypertension/diagnosis ; Prognosis ; Retina/abnormalities ; Retrospective Studies ; Visual Acuity/*physiology ; Young Adult