To evaluate surgically induced astigmatism in cataract surgery, we studied retrospectively a series of 30 eyes with 6.5mm sutureless frown incision(Group 1) and 30 eyes with linear scleral tunnel incision and 3 interrupt sutures using 100 nylon(Group 2). In all cases phacoemulsifications were performed and posterior chamber lenses were implanted. Group 1 showed the against-the-rule astigmatism at postoperative 2 week, and then the change of the astigmatism was minimal and still against-the-rule by postoperative 6 week and 3 month. In contrast, Group 2 showed with-therule astigmatism at postoperative 2 week and then showed the against-the-rule by postoperative 6 week and 3 month. There was no significant difference in the proportion of corrected visual acuity of 0.5 or better between two groups at postoperative 3 month, while uncorrected visual acuity of 0.5 or better was 93.3% in group 2, and 30.0% in group 1 at postoperative 3 month. In this study, it was found that the pattern of surgically induced astigmatism and uncorrected visual outcome in cataract surgery were different according to incision and suture techniques.
Astigmatism ; Cataract ; Nylons* ; Phacoemulsification ; Retrospective Studies ; Suture Techniques ; Sutures* ; Visual Acuity

We compared the diagnostic accuracy of the simple x-ray with that of the computed tomography, and analyzed the surgical results according to the timing of operation in 52 patients with suspected orbital blowout fractures who complained diplopia after midfacial trauma. Of all the cases, 40 orbital fractures were confirmed with CT and forced duction test and the remaining 12 patients were thought to have transient functional impairment because the clinical signs were resolved with time. CT detected all the 40 actual fractures, so the dignostic accuracy(100%) was higher than that of the simple x-ray(75%) which detected 30 fractures of the 40 actual fractures(p=0.001). We operated 19 patients who have persistent diplopia, enophthalmos of more than 2 mm, and large fracture defect, and there was significant improvement of symptoms and signs in patients on whom operations were performed within 2 weeks after trauma rather than after 2 weeks.
Diagnosis* ; Diplopia ; Enophthalmos ; Humans ; Orbit* ; Orbital Fractures

To evaluate the efficacy of the intracanalicular silicone plug in dry eye, we performed lower horizontal canalicular occlusion with the Herrick lacrimal plug Twenty-eight of the 34 eyes(81 %) were able to discontinue or reduce to occasional use of the instillation of artificial tears and the remaining unsatisfactory 6 eyes were investigated by radiologic study for silicone plug. In 2 eyes, the plugs were invisible in radiologic study and the canaliculi were occluded repeatedly. In one of the four eyes with their plugs in place, upper canaliculus was occluded additionally. By thorough evaluation of the status of the plug by radiologic study and secondary attempt. 31 of the 34 eyes(91%) were able to discontinue or reduce to occasional use of the instillation of artificial tears. The intracanalicular plug has no protruded portion out of the puntum, so complications such as reflex tearing, conjunctival irritation, and loss of plug through the punctum, were not occurred. Waters' view with soft tissue density was effective in demonstration of silicone intracanalicular plug.
Dry Eye Syndromes* ; Ophthalmic Solutions ; Reflex ; Silicones* ; Tears

BACKGROUND: This study was performed to investigate the relationship between the extent of hippocampal resection and the postsurgical memory outcome in temporal lobe epilepsy (TLE). METHODS: In 36 patients with TLE, the longitudinal distances of pre-surgical hippocampus and post-surgical hippocampal remnant were measured on 3 mm thick coronal MRI images perpendicular to the long axis of hippocampus. Memory tests were performed before and 1 year after the surgery. The relationships of the extent of hippocampal resection (EHR) and the asymmetry index of Wada retention memory scores (WAI) with postsurgical memory outcomes were tested. RESULTS: The ratios of post-surgical/pre-surgical scores in immediate and delayed verbal memory and immediate, delayed and recognition visual memory were not significantly correlated with the EHR. Only verbal recognition memory was positively correlated with the EHR. In TLE of the dominant hemisphere, the ratios of post-surgical/pre-surgical scores of verbal and visual memories were not significantly correlated with the EHR, but the WAIs were significantly correlated with the delayed visual memory changes (p<0.05). In TLE of the non-dominant hemisphere, the ratios of post-surgical/pre-surgical scores of delayed verbal and immediate visual memory (in percentiles) were positively correlated with the EHR (p<0.05). However, a linear regression analysis showed that none of postsurgical memory subtypes were significantly correlated with the EHR. CONCLUSIONS: This study suggests that the extent of hippocampal resection itself does not have a significant relationship with the outcome of postsurgical memory in patients with mesial TLE.
Axis, Cervical Vertebra ; Epilepsy, Temporal Lobe* ; Hippocampus ; Humans ; Linear Models ; Magnetic Resonance Imaging ; Memory* ; Temporal Lobe*

Tracheal bronchus is an uncommon anomaly in which an ectopic bronchus originates directly from the supracarinal trachea. It is usually an asymptomatic anatomical variant incidentally found on computed tomography or bronchoscopy. However, it can present with symptoms, such as chronic cough, wheezing, atelectasis, and recurrent pneumonia. We report a case of tracheal bronchus diagnosed in the neonatal period, in which the term baby presented with respiratory distress and persistent pulmonary hypertension of the newborn after birth, but no other congenital anomaly was found on further evaluation.
Bronchi* ; Bronchoscopy ; Cough ; Female ; Humans ; Hypertension, Pulmonary* ; Infant ; Infant, Newborn* ; Parturition ; Persistent Fetal Circulation Syndrome ; Pneumonia ; Pulmonary Atelectasis ; Respiratory Sounds ; Trachea

Pulmonary mucormycosis is an uncommon, serious opportunistic infection caused by fungi belonging to the order Mucorales and it occurs exclusively in debilitated or immuno-compromised hosts. It is known that the fungi can invade the blood vessels and cause serious ischemic necrosis and bleeding5. We experienced a fatal case of pulmonary mucormycosis in a diabetic 75-year-old man who developed a progressive necrotizing lesion despite administering proper and prompt medical and surgical treatment. We report here on this case along with a review of the relevant medical literature.
Aged ; Blood Vessels ; Diabetes Mellitus ; Fungi ; Humans ; Mucorales ; Mucormycosis ; Necrosis ; Opportunistic Infections

BACKGROUND: Osteopontin (Opn) is recognized as an important adhesive bone matrix protein and a key cytokine involved in immune cell recruitment and tissue repair and remolding. However, serum levels of osteopontin have not been evaluated in patients with chronic obstructive pulmonary disease (COPD). Thus, the aim of this study was to evaluate and compare the serum levels of osteopontin in patients experiencing COPD exacerbations and in patients with stable COPD. METHODS: Serum samples were obtained from 22 healthy control subjects, 18 stable COPD patients, and 15 COPD with exacerbation patients. Serum concentrations of osteopontin were measured by the ELISA method. RESULTS: Serum levels of osteopontin were higher in patients with acute exacerbation than with stable COPD and in healthy control subjects (62.4+/-51.9 ng/mL, 36.9+/-11.1 ng/mL, 30+/-11 ng/mL, test for trend p=0.003). In the patients with COPD exacerbation, the osteopontin levels when the patient was discharged from the hospital tended to decrease compared to those at admission (45+/-52.1 ng/mL, 62.4+/-51.9 ng/mL, p=0.160). Osteopontin levels significantly increased according to patient factors, including never-smoker, ex-smoker and current smoker (23+/-5.7 ng/mL, 35.5+/-17.6 ng/mL, 58.6+/-47.8 ng/mL, test for trend p=0.006). Also, osteopontin levels showed a significantly negative correlation with forced expiratory volume in one second (FEV1%) predicted in healthy controls and stable COPD patients (r=-0.389; p=0.013). C-reactive protein (CRP) was positively correlated with osteopontin levels in patients with COPD exacerbation (r=0.775; p=0.002). CONCLUSION: The serum levels of osteopontin increased in patients with COPD exacerbation and tended to decrease after clinical improvement. These results suggest the possible role of osteopontin as a biomarker of acute exacerbation of COPD.
Adhesives ; Biomarkers ; Bone Matrix ; C-Reactive Protein ; Disease Progression ; Enzyme-Linked Immunosorbent Assay ; Forced Expiratory Volume ; Humans ; Osteopontin ; Pulmonary Disease, Chronic Obstructive

PURPOSE: Both atopy and bronchial hyperresponsiveness (BHR) are characteristic features of asthma. Several BHR studies comparing groups of atopic and nonatopic asthmatics have reported conflicting results. The aim of this study was to compare BHR to indirect stimuli, such as mannitol or exercise, between atopic and nonatopic asthmatics in children. METHODS: We performed a retrospective analysis of data from 110 children with asthma, aged 6–18 years using skin prick tests, and serum total and specific IgE levels. Atopy degree was measured using the sum of graded wheal size or the sum of the allergen-specific IgE. Bronchial provocation tests (BPTs) using methacholine were performed on all subjects. BPTs using indirect simuli, including exercise and mannitol, were also performed. RESULTS: Asthma cases were classified as atopic asthma (n=83) or nonatopic asthma (n=27) from skin prick or allergen-specific IgE test results. There was no significant difference in the prevalence of BHR to mannitol or exercise between atopic and nonatopic asthmatics. Atopic asthma had a significantly lower postexercise maximum decrease in % forced expiratory volume in 1 second (FEV1) (geometric mean [95% confidence interval]: 31.9 [22.9–40.9] vs. 14.0 [9.4–18.6], P=0.015) and a methacholine PC20 (provocative concentration of methacholine inducing a 20% fall in FEV1) than nonatopic asthmatics (geometric mean [95% confidence interval]: 1.24 [0.60–1.87] ng/mL vs. 4.97 [3.47–6.47]) ng/mL, P=0.001), whereas mannitol PD15 (cumulative provocative dose causing a 15% fall in FEV1) was not significantly different between the 2 groups. CONCLUSION: There was no significant difference in the prevalence of BHR to mannitol or exercise between atopic and nonatopic asthmatics in children.
Asthma ; Bronchial Provocation Tests ; Child* ; Forced Expiratory Volume ; Humans ; Immunoglobulin E ; Mannitol ; Methacholine Chloride ; Prevalence ; Retrospective Studies ; Skin

BACKGROUND: This study is to evaluate the effect of systemic corticosteroid on the clinical outcomes and the occurrence of complications in mechanical ventilated patients with severe community-acquired pneumonia (CAP). METHODS: We retrospectively assessed the clinical outcomes and complications in patients with severe CAP admitted to ICU between March 1, 2003 and July 28, 2009. Outcomes were measured by hospital mortality after ICU admission, duration of mechanical ventilation (MV), ICU, and hospital stay. Complications such as ventilator associated pneumonia (VAP), catheter related-blood stream infection (CR-BSI), and upper gastrointestinal (UGI) bleeding during ICU stay were assessed. RESULTS: Of the 93 patients, 36 patients received corticosteroids over 7 days while 57 patients did not receive corticosteroids. Age, underlying disease, APACHE II, PSI score, and use of vasopressor were not different between two groups. In-hospital mortality was 30.5% in the steroid group and 36.8% in the non-steroid group (p>0.05). The major complications such as VAP, CR-BSI and UGI bleeding was significantly higher in the steroid group than in the non-steroid group (19.4% vs. 7%, p<0.05). The use of steroids and the duration of ICU stay were significantly associated with the development of major complications during ones ICU stay (p<0.05). CONCLUSION: Systemic corticosteroid in patients with severe CAP requiring mechanical ventilation may have no beneficial effect on clinical outcomes like duration of ICU stay and in-hospital mortality but may contribute to the development of ICU acquired complications.
Adrenal Cortex Hormones ; APACHE ; Catheters ; Hemorrhage ; Hospital Mortality ; Humans ; Length of Stay ; Pneumonia ; Pneumonia, Ventilator-Associated ; Respiration, Artificial ; Retrospective Studies ; Rivers ; Steroids

BACKGROUND: Although fever is one of the most common and challenging problem in intensive care medicine(ICU), it is difficult to distinguish between infectious and non-infectious causes. Procalcitonin(PCT) has recently been reported to be an indicator of various infectious diseases. This study examined whether or not measuring the serum PCT level in patients with fever in the ICU can help distinguish fevers with infectious causes from those with non-infectious causes. METHODS: ICU patients with fever at 38degrees C or over from March to August 2005 were prospectively enrolled. The cause of the fever was identified by the culture results and clinical course. The leukocytes, CRP, PCT, IL-6, and TNF-alpha in the fever patients with infectious and non-infectious causes were compared, and the PCT level in the patients with fever in the ICU were compared with those without fever. RESULTS: 1) 42 patients were enrolled and 46 cases of fever were analyzed. 26 cases were considered to be infectious, while 13 cases were considered to be non-infectious. 7 cases were found to have no clear causes. 2) There were no significant differences in the degree of fever, leukocytes count, CRP, IL-6, and TNF-alpha levels in the patiemts with infectious and non-infectious causes. 3) The serum PCT level was higher in those with infectious causes than in those with non-infectious causes (15.1+/-32.57ng/mL vs 2 .68+/-3.63ng/mL) but there was no statistical significance (p=0.06). 4) The serum PCT level of the ICU patients with fever was significantly higher than in those without fever (10.94+/- 27.15ng/mL vs 0.45+/-0.49ng/mL) (p=0.02). CONCLUSION: The serum PCT cannot be used to distinguish the fever in ICU patients with infectious causes from that with non-infectious causes.
Communicable Diseases ; Fever* ; Humans ; Critical Care ; Interleukin-6 ; Leukocytes ; Prospective Studies ; Tumor Necrosis Factor-alpha