Reconstruction of the anophthalmic contracted socket was performed in 28 eyes (34 cases) from October 1981 to February 1985. The follow-up period after surgery ranged from 6 months to 12 months. The age range of the patients was from 5 years to 60 years, and there were 25 males and 3 females. Degree of the contraction and method of the operation were as follows: 1. Mildly contracted socket. Among 12 eyes, 7 eyes were operated with acrylic conformer(AC) after buccal mucous membrane graft(BMMG) and 5 eyes with dental conformer(DC) after buccal mucous membrane graft. 2. Moderately contracted socket. Among 9 eyes, 6 eyes were operated with AC after BMMG and 3 eyes with DC after BMMG. 3. Severely contracted socket. Among 7 eyes, 5 eyes were operated with AC after BMMG and 2 eyes with DC after BMMG. The results were as follows: 1. Etiology of the contracted socket was inflammation(12 eyes: 43%), trauma(7 eyes: 25%), burn(5 eyes: 18%) and irradiation(4 eyes: 14%). 2. In reconstruction of the contracted socket, buccal mucosa was a good substitute for conjunctiva. 3. Better result was obtained in the cases with lesser contraction preoperatively, and in the cases of reconstruction after preoperative repair of lid defect. 4. The optimal interval for further surgery was at least about 6 months due to resolution of the fibroblastic activity. 5. Postoperative complications were noted in 8 cases(24%), which were recontraction in 4 cases(12%), shrinkage of the graft in 2 cases(6%), necrosis of the graft in 1 case(3%), and infection in 1 case(3%). 6. Most patients now wear artificial eyes with or without lightly tinted glasses, giving them good appearance, even though their sight was gone.
Conjunctiva ; Eye, Artificial ; Eyeglasses ; Female ; Fibroblasts ; Follow-Up Studies ; Glass ; Humans ; Male ; Mouth Mucosa ; Mucous Membrane ; Necrosis ; Postoperative Complications ; Transplants

A case of macular subretinal neovascular membrane was treated by red-light krypton photocoagulation. We used continuous red-light krypton laser(647.1nm) because this light is not absorbed by the hemoglobin in the retinal hemorrhage or by the macular luteal pigment(Xanthophyll). 3 weeks after treatment there was no specific change in the treated area. 6 weeks later, we found that the treated area showed some regression of subretinal neovascular membrane. After 3 monthes, the destruction of the subretinal neovascular membrane was complete, and the visual acuity was improved.
Krypton* ; Light Coagulation ; Membranes ; Retinal Hemorrhage ; Visual Acuity

A 61-year-old korean male had noticed a growth on his left eye for the last 3 monthes. This had begun at the nasal limbus of his cornea and had spread over the surface of the cornea. The patient had undergone surgery for the removal of a "tumor on his stomach", about 3 years before, but, no further information concerning this was obtainable. The elevated mass was removed easily by simple excision, and the diagnosis was confirmed histopathologically as "conjunctival carcinoma in situ".
Carcinoma in Situ* ; Cornea ; Diagnosis ; Humans ; Male ; Middle Aged

A man with bilateral primitive persistent trigeminal artery combined with cerebral rete mirabile is reported. Direct both common carotid artery angiogram is described with a brief discussion of the embryogenesis of carotid-basilar anastomosis and cerebral rete mirabile. Associated findings of previously reported cases of persistent trigeminal artery and cerebral rete mirabile are briefly reviewed. Persistent of the bilateral trigeminal artery associated with hemorrhage from cerebral rete mirabile seems worthy of notation. The angiographic findings were as follows; 1) The characteristic angiographic findings are bilateral occlusion at the cavernous portion of internal carotid artery. 2) Retrograde filling of middle cerebral artery from the collateral anastomotic channel was showed. 3) Anterior and posterior cerebral arteries are filled from leptomeningeal anastomotic channel and cerebral rete anastomosis. Authors suggested that the persistent trigeminal artery is congenital origin and cerebral rete mirabile may suspect to the secondary change.
Arteries* ; Carotid Artery, Common ; Carotid Artery, Internal ; Embryonic Development ; Female ; Hemorrhage ; Middle Cerebral Artery ; Posterior Cerebral Artery ; Pregnancy

Pericardial defect is a rare congenital cardiac disorder. Most patients were asymptomatic but some patients with partial pericardial defect occasionally complain acute symptoms such as angina, syncope, rarely sudden cardiac death. So, differential diagnosis with other ischemic or structural heart disease is crucial in the management of such patients. But there is no consistently successful diagnostic method. In the past, artificial diagnostic pneumothorax was used to document the absence of pericardium. However, it is not easily accepted due to excess morbidity and failure rate. Recently, echocardiography and more often, computed tomography, magnetic resonance imaging are used to confirm the diagnosis. We experienced a 52 years old male patient with atypical chest pain, who was diagnosed as complete left pericardial defect with computed tomography.
Chest Pain ; Death, Sudden, Cardiac ; Diagnosis ; Diagnosis, Differential ; Echocardiography ; Heart Diseases ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Pericardium ; Pneumothorax ; Syncope

Aseptic subcutaneous abscesses are characterized by deep, round lesions histologically consisting of neutrophils, without evidence of microorganisms on culture. Although these are sometimes reported in healthy individuals, most are reported in patients with inflammatory bowel disease, including Crohn's disease and ulcerative colitis. A 79-year-old man without underlying disease presented with multiple skin-colored nodules and masses on his face and extremities 4 years ago. All of the microbiology studies for bacteria and fungi were negative and he did not respond to antibiotics. However, the lesions improved markedly after systemic prednisolone treatment. We diagnosed his lesions as aseptic subcutaneous abscesses. Further studies to evaluate inflammatory bowel disease were negative. Here, we report a case of multiple aseptic subcutaneous abscesses without an underlying disease.
Abscess* ; Aged ; Anti-Bacterial Agents ; Bacteria ; Colitis, Ulcerative ; Crohn Disease ; Extremities ; Fungi ; Humans ; Inflammatory Bowel Diseases ; Neutrophils ; Prednisolone

Primary duodenal tuberculosis, duodenal Crohn's disease, duodenal lymphoma, duodenal cancer is extremely rare event. Vague upper abdominal pain, weight loss(10 Kg) had been present for several months in a 52-yeer-old woman. Endoscopy revealed an irregular ulcer in the second part of the duodenum. CT of the abdomen revealed pooly defined hypodense and centrally low density masses along the hepatoduodenal ligament, with poor separation from the head of pancreas. Hypotonic duodenogram showed spiculation and smooth indentation of mucosal fold at medical aspect of sup. portion m descending duodenum. ERCP showed medially displaced distal CBD and main pancreaticduct. At first, lymphoma, cancer, Crohn's disease, duodenal tuberculosis were considered in the differential diagnosis. Endoscopic biopsy sepecimen of duodenal lesion showed atypical lymphocytes. We excluded the diagnosis of the duodenal cancer. We started anti-tubercular drugs because in our country tuberculosis is endemic. After 4 weeks anti-tuberculosis therapy, follow up endoscopy and biopsy specimens showed healing stage of duodenal ulcer and chronic granulomatous inflammation with multinucleated giant cell. Thus we concluded that when duodenal lesion which could not confirmed histopathologically it was wise to start antitubercular therapy than to perform exploraparotomic dianostic procedures.
Abdomen ; Abdominal Pain ; Biopsy ; Cholangiopancreatography, Endoscopic Retrograde ; Crohn Disease ; Diagnosis ; Diagnosis, Differential ; Duodenal Neoplasms ; Duodenal Ulcer ; Duodenum ; Endoscopy ; Female ; Follow-Up Studies ; Giant Cells ; Head ; Humans ; Inflammation ; Ligaments ; Lymphocytes ; Lymphoma* ; Pancreas ; Tuberculosis* ; Ulcer

BACKGROUND: Thiopental and propofol are commonly used intravenous induction agents and entropy is a new method of assessing depth of anesthesia. In this study we evaluated the entropy responses to endotracheal intubation during anesthetic induction with thiopental or propofol. METHODS: Forty ASA class I and II adult female patients undergoing elective surgeries were enrolled into this randomized, prospective study. At 1 minute after fentanyl 2 microgram/kg, thiopental 5 mg/kg (group T) or propofol 2 mg/kg (group P) was administered for induction. And endotracheal intubation was performed following succiny choline 1 mg/kg. From pre-induction till post-intubation 10 minutes, the entropy and hemodynamic variables were measured and compared. RESULTS: The entropy following intubation increased significantly in both groups. But entropy changes in group T were greater than those in group P remained below 65. CONCLUSIONS: Our results using the entropy to monitor anesthetic depth during induction and intubation, suggest that thiopental 5 mg/kg is more likely to be associated with lighter planes of anesthesia and consequent risk of arousal reaction following endotracheal intubation than propofol 2 mg/kg.
Adult ; Anesthesia ; Arousal ; Choline ; Entropy* ; Female ; Fentanyl ; Hemodynamics ; Humans ; Intubation ; Intubation, Intratracheal* ; Propofol* ; Prospective Studies ; Succinylcholine* ; Thiopental*

BACKGROUND: The use of tourniquet is associated with severe hemodynamic changes, particularly in elderly patients. This study examined the effects of continuously infused remifentanil or nicardipine with esmolol on the attenuation of the hemodynamic changes with enflurane inhalation during total knee arthroplasty in elderly patients. METHODS: Thirty elderly female patients undergoing total knee arthroplasty were enrolled into this randomized, prospective study. Remifentanil (group R) or nicardipine with esmolol (group EN) was infused using a titration method to maintain a mean arterial pressure (MAP) of 90 mmHg to 70 mmHg during tourniquet inflation. In addition, the inhalation of enflurane was adjusted to guarantee a hypnotic state based on entropy. The hemodynamic variables, inhaled concentration of enflurane, recovery time, and postoperative pain characteristics were measured and compared. RESULTS: Following tourniquet inflation, the MAP was increased and maintained in the target since 20 min after that in both group. Following tourniquet deflation the MAP was decreased significantly in both groups and more patients in group R required a vasopressor. Group R inhaled a lower enflurane concentration and showed more rapid recovery than group EN. There were no significant differences in the level of postoperative pain between the two groups. CONCLUSIONS: These results suggest that remifentanil is more likely to be associated with hypotension after tourniquet deflation and require more attention than nicardipine with esmolol.
Aged* ; Arterial Pressure ; Arthroplasty* ; Enflurane ; Entropy ; Female ; Hemodynamics* ; Humans ; Hypotension ; Inflation, Economic ; Inhalation ; Knee* ; Nicardipine* ; Pain, Postoperative ; Prospective Studies ; Tourniquets