BACKGROUND: Morphine has been commonly used for postoperative pain control. We measured plasma concentrations of morphine and compared the efficacy and safety of continuous epidural analgesia (CEA) using morphine-bupivacaine with intravenous patient controlled analgesia (IV-PCA) with morphine for 48 hrs after the end of the operation. METHODS: Nineteen patients undergoing Mile's operation were assigned to receive a morphine loading dose of 5 mg followed by IV-PCA with 0.1% morphine (IV-PCA group, n = 9) or a morphine loading dose of 2 mg and 0.125% bupivacaine 10 ml, followed by CEA with 0.004% morphine and 0.075% bupivacaine at a rate of 5 ml/hr (CEA group, n = 10). The plasma concentrations of morphine were measured and visual analog scales (VAS) for pain were recorded at 1, 6, 12, 24, and 48 hr postoperatively and the effects on respiration and any other side effects were noted. RESULTS: The mean maximal and minimal levels of plasma morphine were 40.2 +/- 21.2 ng/ml and 23.4 +/- 9.7 ng/ml for the IV-PCA group and 11.8 +/- 3.5 ng/ml and 8.2 +/- 1.9 ng/ml for the CEA group, respectively. Resting and dynamic pain scores were significantly lower in the CEA group than in the IV-PCA group. There were no significant differences for the effects on respiration and for any side effects between the two groups. CONCLUSIONS: We evaluated plasma concentrations of morphine with CEA using morphine-bupivacaine and IV-PCA using morphine for the postoperative pain control. The CEA group had better postoperative analgesia than that of the IV-PCA group and the incidence of side effects were not significantly different between the two groups.
Analgesia ; Analgesia, Epidural ; Analgesia, Patient-Controlled ; Bupivacaine ; Humans ; Incidence ; Morphine ; Pain, Postoperative ; Plasma ; Respiration ; Weights and Measures

This study was undertaken to evaluate the outcome of combined phacoemulsification, intraocular lens implanation, and trabeculectomy with Mitomycin C. We reviewed 39 eyes in 36 consecutive cases who had been undergone triple procedure for coexisting cataract and glaucoma from January 1993 to October 1995 at Chonnam university hospital. The mean follow-up period was 8. 8 months. Preoperatively, most patients had a visual acuity of worse than 0.4, but the visual acuity improved postoperatively in 20 eyes (51.0%) achieving the visual acuity better than 0.5 at 6 months after the surgery. The mean preoperative intraocular pressure was 31.1 +/- 12.9mmHg, and the mean postoperative IOP was 16.5 +/- 5.4mmHg at 6 months follow-up. The mean number of antiglaucoma medication was 1.87 preoperatively, and 0.28 postoperatively. The postoperative complications were posterior capsular opacity (7 eyes), hyphema (2 eyes), shallow anterior chamber (3 eyes), transient hypotony without macular edema (2 eyes). There was no statistically significant difference in intraocular pressure control at different concentration of Mitomycin C (0.2 and 0.4mg/ml). We conclude that the use of Mitomycin C in combined procedure provides good short-term(6 months) results regarding intraocular pressure control and visual recovery.
Anterior Chamber ; Cataract ; Follow-Up Studies ; Glaucoma ; Humans ; Hyphema ; Intraocular Pressure ; Jeollanam-do ; Lenses, Intraocular* ; Macular Edema ; Mitomycin* ; Phacoemulsification* ; Postoperative Complications ; Trabeculectomy ; Visual Acuity

No abstract available.
Humans

In order to see whether the binocular patching with cycloplegia improves the prognosis in the treatmet of traumatic hyphema, we studied prospectively 77 patients with nonperforating traumatic hyphema who were admitted and treated at the Chonnam University Hospital between January 1994 and July 1995. We analyzed the clearance time of blood clot in the anterior chamber, the incidence of rebleeding and the final visual acuity. The patients were divided into four groups : group I, of 17 patients treated by monocular patching ; group II, of 19 patients treated by monocular patching with cycloplegia ; group III, of 20 patients treated by absolute bed rest with binocular patching ; group IV, of 21 patients treated by absolute bed rest with binocular patching and cycloplegia. The average clearance time of blood clot was 7.4 days in group I, 7.4 days in group II, 6.9 days in group III and 7.5 days in group IV. The incidence of rebleeding was 5.8% (n=1) in group I, 10.5% (n=2) in group II, 0% (n=0) in group III, 14.3% (n=3) in group IV. The final visual acuity of 0.6 or better was achieved in 10 patients (58.8%) of group I, 13 patients (68.4%) of group II, 13 patients (65.0%) of group III, 14 patients (66.7%) of group IV. In the treatment of traumatic hyphema, binocular and monocular groups as well as cycloplegic and non-cycloplegic groups showed no significant difference from each other in the clearance time of blood clot, incidence of rebleeding and the final visual acuity.
Anterior Chamber ; Bed Rest ; Humans ; Hyphema* ; Incidence ; Jeollanam-do ; Prognosis ; Prospective Studies ; Telescopes ; Visual Acuity

Hydroxyapatite has been reported as an excellent orbital implant for good prosthetic motility without implant migration or protrusion. We performed hydroxyapatite orbital implantation in 102 patients between January 1992 and December 1995 ; 52 cases (50.8%) of evisceration, 43 cases (42.2%) of enucleation and 7 cases (7.0%) of secondary implantation for the better prosthetic motility. We performed 99mTc-MDP bone scan in 77 patients between 4 and 16 months (mean: 7.6 months) postoperatively. The 69 patients (89.6%) revealed radiotracer uptake over grade II. The 75 patients of 81 patients excellent cosmesis with satisfactory prosthetic motility. Conjunctival wound dehiscence were observed in 51 patients (50.0%) ; in 30 cases of evisceration, in 19 cases of enucleation, and in 2 cases of secondary implant. And hydroxyapatite implant exposure were developed in 17 patient (16.7%) ; in 14 cases of eviseration (82.4%) and 3 case of enucleation (17.6%). And 8 patients of exposed hydroxyapatite were healed spontaneously and another 4 patients are under observation to expect the wound dehiscence to heal spontaneously. Exposed hydroxyapatite implants with more than 5mm in diameter were managed with dermis graft in two cases, scleral patch graft in two cases and oral mucosal graft in one case. Hydroxyapatite orbital implant needed higher cost and longer duration until the full treatment, but it gave an excellent cosmetic reconstruction without any extrusion or unacceptable infection.
Dermis ; Durapatite* ; Humans ; Orbit* ; Orbital Implants* ; Technetium Tc 99m Medronate ; Transplants ; Wounds and Injuries

The branchiogenic anomalies are common congenital cervical anomalies. They usually arise from an incomplete obliteration of the branchial apparatus during fetal development. These anomalies may be confused with and mistaken for other potentially more serious lesions, such as cystic hygromas, teratomas, and lymphomas. The anomalies are typically discovered in the pediatric and adolescent population and develop unilaterally. Bilateral manifestations are very rare and have a familial tendency. In addition, anomalies such as intrauterine and postnasal growth retardation, premature aging and unusual faces may be related with bilateral occurrence. This is the first report in the Korean language literature of bilateral branchial fistulas.
Adolescent ; Aging, Premature ; Branchial Region* ; Fetal Development ; Fistula* ; Humans ; Lymphangioma, Cystic ; Lymphoma ; Teratoma

Because of the excellent cosmetic and functional reconstruction compared with other integrated implant, hydroxyaptite is commonly used in recently. This excellent cosmetic effect is acquired by successful integration between hydroxyapatite and normal orbital tissue by fibrovascular tissue. We performed simultanously magnetic resonance imaging and bone scan to two patients undergoing hydroxyapatite orbital implantation after evisceration and evaluating fibrovascular ingrowth into the implant between MRI and bone scan and observed ingrowing pattern of fibrovascular tissue into the hydroxyapatite after evisceration especially. MRI studies are somewhat more valuable imaging than bone scan. Vascularization into the implant were started from inserted portion of extraocular muscle and posterior aspect of implant and slowly progressed to the center of hydroxyapatite sphere. There was no relation between inserted duration and fibrovascular ingrowth due to individual variation. And constrast enhanced MRI appears to be the best imaging method for evaluating the hydroxyapatite orbital implant and its fibrovascular ingrowth. In spite of low specificity compared with MRI, bone scan is also valuable method for the evaluating vascularization of the hydroxyapatite because of low cost and easy follow-up.
Durapatite* ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging* ; Orbit* ; Orbital Implants* ; Sensitivity and Specificity ; Tomography, Emission-Computed, Single-Photon*

Choridal osteomas are benign, ossified peripapillary lesions occurring predominantly in healthy young women, They appear as yellow-white to yellow-red lesions with well-defined geographics borders. On radiologic examination, bony lesion is shown. We report herein a case of choroidal osteoma located at the posterior pole of the left eye in a 27-years-old woman the chief complaint of decreased visual acuity.
Choroid* ; Female ; Humans ; Osteoma* ; Visual Acuity

No abstract available.
Calcium* ; Fetal Blood* ; Phosphorus*

Preretinal hemorrhage, which is located between the retina and vitreous face and is commonly developed on the macula, causes impaired central vision and if it persists, it may cause complications, such as epimacular membrane. A 49-year-old male who had dry type of age-related macular degeneration in both eyes and had an oval shaped premacular hemorrhage of unknown etiology in his left eye. We applied Q-switched Nd:YAG laser on membrane anterior to preretinal hemorrhage and ruptured it. Preretinal hemorrage was drained to inferior vitreous cavity and his central vision was rapidly improved.
Hemorrhage* ; Humans ; Macular Degeneration ; Male ; Membranes ; Middle Aged ; Punctures* ; Retina