BACKGROUND: Recently, measurement of heart rate variability and the nonlinear complexity of heart rate dynamics have been used as indicators of cardiovascular health. Hypertensive patients showed alternation of cardiovascular homeostasis. We designed this study to evaluate the effect of anesthesia in hypertensive patients with approximate entropy (ApEn), representing the nonlinear complexity. METHODS: With informed consent, none premedicated normotensive (n=18) and hypertensive patients (n=18) were included in this study. ECG data were collected from 10 minutes before induction to 15 minutes after induction. Collected ECG data were stored into computer binary files. We calculated ApEn from the collected ECG data. RESULTS: Before induction, ApEn of hypertensive patients was significantly lower than that of normotensive patients (p<0.05). During induction and maintenance of anesthesia, there was no difference of ApEn between the two groups. ApEn of normotensive patients during induction and maintenance of anesthesia was significantly lower than that of pre-induction (p<0.05). ApEn during maintenance of anesthesia was lower than that of induction of anesthesia (p<0.05). ApEn of hypertensive group during maintenace of anesthesia was significantly lower than that of pre-induction of anesthesia (p<0.05). CONCLUSIONS: As the ApEn of hypertensive patients is lower than that of normotensive patients during pre-inducton period, the heart rate dynamics of hypertensive patients is more regular normotensive patients. The anesthesia is deepened, the heart rate dynamics of the both group is more regular. During the maintenance of anesthesia, the regularity of the heart rate dynamics that not different in both group from the results.
Anesthesia* ; Electrocardiography ; Entropy* ; Heart Rate ; Homeostasis ; Humans ; Hypertension* ; Informed Consent

PURPOSE: To evaluate the postoperative corneal topographic changes after 23-gauge transconjunctival vitrectomy. METHODS: Twenty eyes of 20 consecutive patients who required vitrectomy were included in the present study. The 23-gauge transconjunctival vitrectomy was performed by a single surgeon from September 2007 through November 2007. Videokeratography system (TMS-4, Tomey Co., Japan) was obtained preoperatively and at 1 day, 2 weeks, and 1 month postoperatively. The date changes of Fourier indices including spherical power, regular astigmatism, asymmetry, and higher-order irregularity were analyzed at the central 3- and 6-mm zone of the cornea. RESULTS: Twenty eyes, including eyes with proliferative diabetic retinopathy (n = 9), vitreous hemorrhage and opacity (n = 7), and epiretinal membrane (n = 4), underwent the operation. None of the Fourier indices significantly changed throughout the observation period (p < 0.05, Wilcoxon-signed-ranks test). CONCLUSIONS: A 23-gauge transconjunctival vitrectomy does not induce significant changes in corneal topography even in the central 6-mm zone, as well as the 3-mm zone of the cornea.
Astigmatism ; Cornea ; Corneal Topography ; Diabetic Retinopathy ; Epiretinal Membrane ; Eye ; Humans ; Vitrectomy ; Vitreous Hemorrhage

PURPOSE: To evaluate the postoperative corneal topographic changes after 23-gauge transconjunctival vitrectomy. METHODS: Twenty eyes of 20 consecutive patients who required vitrectomy were included in the present study. The 23-gauge transconjunctival vitrectomy was performed by a single surgeon from September 2007 through November 2007. Videokeratography system (TMS-4, Tomey Co., Japan) was obtained preoperatively and at 1 day, 2 weeks, and 1 month postoperatively. The date changes of Fourier indices including spherical power, regular astigmatism, asymmetry, and higher-order irregularity were analyzed at the central 3- and 6-mm zone of the cornea. RESULTS: Twenty eyes, including eyes with proliferative diabetic retinopathy (n = 9), vitreous hemorrhage and opacity (n = 7), and epiretinal membrane (n = 4), underwent the operation. None of the Fourier indices significantly changed throughout the observation period (p < 0.05, Wilcoxon-signed-ranks test). CONCLUSIONS: A 23-gauge transconjunctival vitrectomy does not induce significant changes in corneal topography even in the central 6-mm zone, as well as the 3-mm zone of the cornea.
Astigmatism ; Cornea ; Corneal Topography ; Diabetic Retinopathy ; Epiretinal Membrane ; Eye ; Humans ; Vitrectomy ; Vitreous Hemorrhage

PURPOSE: To describe femtosecond laser-assisted corneal biopsy and its use in assessing the causative organism in a case of fungal keratitis that occurred 8 months after penetrating keratoplasty. CASE SUMMARY: A 27-year-old man who had undergone penetrating keratoplasty 8 months prior showed atypical diffuse corneal haze and erosion. Diagnostic corneal biopsy using a femtosecond laser was performed because of repeated negative test results for an infectious organism and a lack of improvement, despite steroid and empirical antibiotic therapy. A corneal flap 200 micrometer in depth and 3 mm in diameter was obtained. The biopsy showed pseudohyphae, which led to a diagnosis of Candidal keratitis. No complications occurred during the procedure. CONCLUSIONS: Femtosecond laser-assisted corneal biopsy enabled identification of the infectious pathogen. This technique is easy, safe, and rapid, and it yields a biopsy specimen with a uniform depth and precise size. Femtosecond laser-assisted corneal biopsy can be used as an accurate diagnostic method in uncertain cases of corneal ulcers.
Adult ; Biopsy ; Humans ; Keratitis ; Keratoplasty, Penetrating

PURPOSE: To investigate the clinical features and compliance of cosmetic contact lens (CL)-related complications compared with soft CL-related complications. METHODS: We performed a retrospective chart review of 97 patients (194 eyes) regarded as having CL-related complications at the outpatient clinic. The portion of complications, gender, age, and chief complaints at the initial visit were analyzed, as was compliance to cosmetic and soft CL-related guidelines for use. RESULTS: A total of 97 patients (49 patients with cosmetic CL-related complications and 43 patients with soft CL-related complications) were evaluated. The mean age of the subjects using cosmetic CL was 19.8 years (14-31 years), and all the patients were female. The chief complaints at the initial visit included ocular pain, injection, blurred vision, dryness, itching and foreign body sensation. The main complications included corneal erosion, sterile corneal infiltrate, allergic disease, neovascularization, corneal ulcer and dry eye syndrome. No statistical difference was found regarding chief complaints or complications. The proportion of patients lost to follow-up was 47% in cosmetic CL-related and 20% in soft CL-related complications, a significant difference (p = 0.015). CONCLUSIONS: Because young females are the most common CL patients and do not always fully comply with the guidelines for use, ophthalmologists need to warn these patients about the risk of serious complications.
Ambulatory Care Facilities ; Compliance* ; Contact Lenses, Hydrophilic ; Corneal Neovascularization ; Dry Eye Syndromes ; Female ; Foreign Bodies ; Humans ; Lost to Follow-Up ; Pruritus ; Retrospective Studies ; Sensation ; Ulcer

BACKGROUND: Clinical isolates of AmpC beta-lactamase- producing Enterobacteriaceae were evaluated to determine the prevalence of CTX-M extended-spectrum beta-lactamases (ESBLs) and their genetic environments. METHODS: A total of 250 non-duplicate isolates of Eneterobacter aerogenes, E. cloacae, Citrobacter freundii, Serratia marcescens and Morganella morganii were collected at a Korean hospital. ESBL production was determined by double disk synergy test. For ESBL producers, bla genes were sequenced and blaCTX-M environment was characterized by PCR mapping and sequencing. RESULTS: Among the 250 isolates 29 (11.6%) produced ESBL, and 14 of the 29 isolates produced CTX-M ESBLs, including CTX-M-9 by 8 isolates, CTX-M-3 by 4 isolates, CTX-M-12 by 1 isolate, and CTX-M-14 by 1 isolate. ISEcp1 was present upstream of blaCTX-M-3, 12, and 14. Three of the four CTX- M-3 producers had the same genetic environment (pemK-ISEcp1-blaCTX-M-3-orf477-mucA). An IS903-like element was found downstream of blaCTX-M-14. ISCR1 was identified upstream of blaCTX-M-9 and ISCR1 and blaCTX-M-9 were located on sul1-type class 1 integron. The variable region between the 5'-CS and the first 3'-CS contained dfrA16 and aadA2. Its structure was similar to that of In60, but our isolates did not have IS3000 or second 3'-CS. CONCLUSION: CXT-M type ESBL was prevalent in AmpC beta-lactamase-producing Enterobacteriaceae, particularly E. cloacae. blaCTX-M genes were associated with ISEcp1 or ISCR1. This is the first report on the genetic environment of blaCTX-M in Korean isolates.
beta-Lactamases ; Citrobacter freundii ; Cloaca ; Enterobacteriaceae ; Integrons ; Korea ; Morganella morganii ; Polymerase Chain Reaction ; Prevalence ; Serratia marcescens

PURPOSE: Flexible intramedullary nailing is a advanced method for treating forearm fractures with fewer complications. But sometimes these nails should not be used due to the narrower internal diameter of the forearm bones. We studied the inner diameter of the radius and ulna of children along with their age in relation to the width of the nail. MATERIALS AND METHODS: We reviewed the forearm AP radiographs of all the patients who visited our institute during a specific period, in which their age was between 6 and 19. We measured the inner diameters of the radius and ulna at their narrowest location, and we analyzed the diameter in relation to the patients' age groups, and we compared this data with the width for the nail. RESULTS: A total of 208 patients was included in this study. The inner diameter grew with their increasing age, and the younger the patients, the higher was the rate of inappropriate use of the nail. On linear regression analysis, the age plus or minus 1 SD for usage of the ready-made nail was 12.6 years-old for the male radius. CONCLUSION: The nail was sometimes too thick for the diameter of the forearm bones of Korean children. It is correct for the surgeon to select whatever material to fix the fracture, but appropriate thickness of the nail should be selected thoughtfully in preoperative planning.
Child ; Forearm ; Fracture Fixation, Intramedullary ; Humans ; Linear Models ; Male ; Nails ; Radius ; Ulna

BACKGROUND: Although secondary cervicothoracic scoliosis frequently occurs in patients with congenital muscular torticollis (CMT), the relationship between scoliosis and CMT has not been evaluated. This study aims to evaluate the effects of surgical release of sternocleidomastoid (SCM) muscle on secondary cervicothoracic scoliosis in patients with CMT and determine factors affecting the improvement of scoliosis after surgical release of SCM muscle. METHODS: Eighty-seven of the 106 patients, confirmed as having secondary cervicothoracic scoliosis with CMT with a minimum 1-year follow-up, were included in this study. Preoperative and last follow-up radiologic outcomes were assessed for the cervicomandibular angle (CMA), Cobb angle of the cervicothoracic scoliosis, and direction of convexity in the scoliosis curve. Patients were divided into two groups to assess the improvement of Cobb angle according to residual growth potential; age ≤ 15 years and > 15 years. The improvement of Cobb angle after surgical release was compared in the two groups. Correlation analysis and multivariable regression analysis were performed to determine the factors affecting the improvement of scoliosis. RESULTS: All the radiologic parameters, such as the Cobb angle and CMA, improved significantly after surgical release (p < 0.001). The improvement of Cobb angle was significantly higher in age ≤ 15 years than in age > 15 years (p < 0.001). The improvement of Cobb angle was significantly correlated with age (r = −0.474, p < 0.001) and the preoperative Cobb angle (r = 0.221, p = 0.036). In multivariable regression analysis, age and preoperative Cobb angle were shown to be predisposing factors affecting the improvement of scoliosis. CONCLUSIONS: The results showed that SCM release can be a beneficial treatment for secondary cervicothoracic scoliosis. The improvement of scoliosis was greater when the SCM release was performed before the patient reached the end of growth.
Causality ; Follow-Up Studies ; Humans ; Scoliosis ; Torticollis

Purpose: We investigated the effects of upper eyelid surgery on corneal higher-order aberrations and astigmatism. Methods: We enrolled 38 patients (66 eyes) who underwent blepharoplasty and 48 (81 eyes) who underwent levator resection. The marginal reflex distance1 (MRD1), corneal astigmatism, and corneal higher-order aberrations were measured preoperatively, and at 6 months postoperatively, and the two groups were compared. Results: Corneal astigmatism decreased significantly in the ptosis repair group (p < 0.001) but there was no significant change in the axis of astigmatism. Preoperative third-order and coma-like aberrations were significantly more common in the ptosis repair group than in the other group (p = 0.027 and p = 0.044, respectively); both decreased significantly after the operation (p = 0.030 and p = 0.006, respectively). The decrease in MRD1 and changes in the two aberrations showed a significantly stronger negative correlation in the ptosis repair group than in the other group (b = -0.186; p < 0.001 and b = -0.159; p < 0.001, respectively). Conclusions For patients with both cataract and ptosis, it is best to perform levator resection surgery before cataract surgery, because corneal higher-order aberrations and astigmatism are improved by levator resection. In turn, this reduces postoperative refractive error and improve vision quality.

PURPOSE: To evaluate the changes in higher-order aberrations (HOAs) after implantation of an ICL (implantable contact lens). METHODS: Twenty-six eyes that had undergone ICL implantation between February 2008 and October 2009 were included. Ocular higher-order aberrations of all the eyes were measured using the Hartmann-Shack aberrometer (KR9000PW). Examinations were performed preoperatively, as well as one week, one month, and three months after ICL implantation. Changes in ocular total higher-order aberrations, total spherical aberration, coma aberration, trefoil aberration, and S3 and S4 calculated in the central 4-mm zone and expressed as root mean square (RMS) values were analyzed. RESULTS: The mean patient age was 25.4 years, and the mean preoperative spherical equivalent was -6.40 diopters(D). The mean postoperative spherical equivalents were 0.00 +/- 0.13D, 0.03 +/- 0.21D, -0.013 +/- 0.12D at one week, one month,and three months, respectively. There were no statistically significant differences in ocular higher-order aberration RMS,including spherical, coma, or trefoil aberration, at one week, one month, or three months postoperative or between preoperative and postoperative measurements. CONCLUSIONS: There is no significant change of ocular higher order aberration in the central 4-mm zone after ICL implantation.
Coma ; Eye ; Humans ; Lenses, Intraocular ; Lotus