PURPOSE: Malignant glaucoma is a rare complication of anterior segment surgery. The authors present a case of a malignant glaucoma-like phenomenon during cataract surgery in a primary open-angle glaucoma (POAG) patient. CASE SUMMARY: A 74-year-old man with POAG underwent a cataract surgery in his left eye. After phacoemulsificiation, sodium hyaluronate was used to form the capsular bag for intraocular lens implantation. Following this procedure, the capsular bag space and anterior chamber became shallow. Intraocular pressure (IOP) elevated, and the shallowing of the anterior chamber and capsular bag space continued to a dangerous level. The surgical procedure was stopped and postponed for two days. After two days, IOL was successfully implanted in the posterior bag. CONCLUSIONS: Although the preoperative ophthalmologic examination failed to reveal a zonular problem, there was a possibility for a small area of zonular defect. A malignant glaucoma-like phenomenon was suspected to have occurred due to leakage of sodium hyaluronate or balanced salt solution into the vitreous through a small area of zonular dialysis. If a similar condition, occurs delayed surgery for IOL implantation would be more effective than vitrectomy or laser treatment.
Aged ; Anterior Chamber ; Cataract ; Dialysis ; Eye ; Glaucoma ; Glaucoma, Open-Angle ; Humans ; Hyaluronic Acid ; Intraocular Pressure ; Lens Implantation, Intraocular ; Vitrectomy

In order to investigate the factors influencing QOL and life satisfaction of the physically disabled, the author interviewed, by using structuralized questionnaire, 440 individuals among the physically disabled who were participated in Health Examination from April to July, 1997. The questionnaire consisted of the general characteristics(sex, age, marital status, family number, etc), the Reintegration to Normal Living Index(RNLI) to assess QOL, and the single item of five-likert scale to evaluate life satisfaction. The means of RNLI were 16.2+/-4.8 in total score, 12.2+/-3.4 in daily functioning and 4.0+/-2.1 in perception of self. The respondents were less reintegrated toward social activities and relationships than impairments or disabilities. While the satisfied group was 47.3%, the dissatisfied group was 52.7%. As the results of multiple regression and logistic regression analysis, the significant predictors of QOL were age, education, job, grade of disability and subjective health status. The life satisfaction were related to economic status, job and subjective health status. To improve QOL and life satisfaction of the physically disabled, it is important that we improve their basic socioeconomic status by getting a job through rehabilitation education and induce them to have positive self-assessment by extending the opportunity of social participation.
Daegu* ; Surveys and Questionnaires ; Disabled Persons* ; Education ; Humans ; Logistic Models ; Marital Status ; Surveys and Questionnaires ; Rehabilitation ; Self-Assessment ; Social Class ; Social Participation

PURPOSE: We report a case of tectonic lamellar corneal patch graft using acellular corneal tissue (Halo Sterile Cornea; Lions VisionGift, Portland, OR, USA) for treating a large corneal ulcer perforation CASE SUMMARY: A 72-year-old male previously treated for corneal ulcer was referred after presenting with decreased vision and abrupt tears in the right eye. His best-corrected visual acuity was 0.025 (20/800) and slit-lamp examination showed collapsed anterior chamber and 2 x 2 mm corneal perforation with protruded iris at the peripheral cornea. Infiltration in superficial stroma was observed near the perforation. Despite conjunctival flap, the cornea showed leakage due to perforation. To preserve ocular integrity, the patient underwent tectonic lamellar corneal patch graft using acellular corneal tissue. After surgery, the corneal patch graft was well attached. Re-epithelialization occurred after 3 days. There was no recurrence of perforation or corneal graft melting. Visual acuity improved to 0.32 (20/63) after 6 months. CONCLUSIONS: Tectonic lamellar corneal patch graft using acellular corneal tissue can be a useful treatment option in large corneal ulcer perforation located at the periphery.
Aged ; Anterior Chamber ; Cornea* ; Corneal Perforation ; Corneal Ulcer* ; Freezing ; Humans ; Iris ; Lions ; Male ; Re-Epithelialization ; Recurrence ; Tears ; Transplants* ; Visual Acuity

PURPOSE: We evaluated the effectiveness and complications of transurethral resection of the prostate plus incision of the bladder neck and prostate(TUR-P+I) and transurethral resection of the prostate(TUR-P). MATERIALS AND METHODS: We reviewed 101 patients with benign prostatic hyperplasia(BPH) who were randomized to TUR-P+I(N=78; Group I) or TUR-P(N=23; Group II) from December 2000 to March 2002. After TUR of the adenoma, the trigone, bladder neck, and surgical capsule of the prostate were incised with a pointed coagulating electrode at the 5- and 7-o'clock positions from the distal edge of the ureteral orifice to the verumontanum. Patients were evaluated at 1 month, 3 months, and 6 months after operation in terms of the change in International Prostatic Symptom Score(IPSS), peak urinary flow rate, and complications. RESULTS: The mean prostatic weight of Groups I and II was 40.5+/-15.5 g and 36.7+/-10.6 g, respectively. The operative time and resected prostatic weight of Group I were 59.0+/-23.8 min and 16.2+/-11.4 g and those of Group II were 64.1+/-27.5 min and 11.5+/-5.8 g. The postoperative complication rates were similar in the two groups. The preoperative IPSS symptom score and peak urinary flow rate were 22.4+/-6.4 and 9.8+/-5.4 mL/sec, respectively, in Group I and 23.7+/-7.6 and 9.3+/-4.4 mL/sec in Group II. The 1-, 3-, and 6-month IPSS were 13.2+/-6.0, 10.1+/-5.1, and 9.2+/-4.8 in Group I and 13.2+/-5.0, 10.1+/-4.2, and 9.2+/-4.4 in Group II. The peak urinary flow rates at those times were 15.6+/-4.9, 15.8+/-5.6, and 15.9+/-5.1 mL/sec in Group I and 14.6+/-4.2, 14.6+/-3.9, and 14.3+/-4.5 mL/sec in Group II. CONCLUSIONS: The TUR-P+I could be a safe, effective surgical method for BPH. However, longer follow-up and more patients are required to establish the value of this technique.
Adenoma ; Electrodes ; Follow-Up Studies ; Humans ; Neck* ; Operative Time ; Postoperative Complications ; Prostate* ; Prostatic Hyperplasia* ; Transurethral Resection of Prostate* ; Ureter ; Urinary Bladder*

No abstract available.
Humans

BACKGROUND: The plasma effect-site equilibrium rate constant (k(e0)) of propofol has been reported in various pharmacodynamic studies; however, it is not desirable to apply k(e0) for the link with pharmacokinetic models that were separately investigated. Thus, we titrated k(e0) for the pharmacokinetic model, which is known as the multiple covariates adjusted model of propofol. METHODS: Ninety female patients scheduled for gynecologic surgery were randomly assigned to three groups targeting different plasma concentrations of 5.4, 8.1, and 10.8 microgram/ml. Target-controlled infusions (TCI) were provided by a computer-assisted continuous infusion system. Time to loss of responsiveness (LOR) was measured by a blind investigator; effect-site concentrations (C(e)) for LOR were then calculated with simulation of TCI using different k(e0)s. We determined the k(e0) minimizing total discrepancy (TD) between the inputted and calculated k(e0) from the t(1/2)k(e0)s for a given probability of LOR of the C(e), and also obtained the k(e0) for the minimal TD between the median Ce, which were compared to the known k(e0). RESULTS: k(e0)s from these two methods were 0.3692 and 0.3788/min. C(e)s for LOR with these k(e0)s were significantly different from those with Schnider's k(e0). CONCLUSIONS: We proposed a method for titration of the k(e0) of propofol. The k(e0)s of propofol was lower than Schnider's k(e0). An adequate k(e0) for the specific pharmacokinetic model and a certain population would be useful for prediction of an accurate C(e), and could be used for calculation of accurate dosing during targeting of the effect site.
Aluminum Hydroxide ; Anesthesia ; Carbonates ; Female ; Gynecologic Surgical Procedures ; Humans ; Plasma ; Propofol

A man's self-esteem can be influenced by his external genitalia. If a man perceives his penis as inadequate size, whether real or imagined, such feelings invade his sexual activities. Most patients seek increased thickness and length to improve appearance during intercourse. Many men want to enlarge their penes despite of normal function or above average size. Dermal fat graft is extracted from a patient and penile augmentation with it is highly satisfactory since the amount of dermal fat graft absorption to the body itself is pretty low and rare cases of complication, and its natural appearance of penis without physical comfort. The most common complications after dermal grafting are penile skin edema and erythema. Sebaceous glands usually disappear within 2 weeks and hair follicles generally within 2 months. We report our experience with the evaluation and management of patient who present with uncommon penile cutaneous fistula after penile augmentation with dermal fat grafting.
Absorption ; Cutaneous Fistula* ; Edema ; Erythema ; Genitalia ; Hair Follicle ; Humans ; Male ; Penis ; Sebaceous Glands ; Sexual Behavior ; Skin ; Transplants

PURPOSE: This study was conducted to determine whether a learning curve is necessary to obtain a successful total mesorectal excision (TME) for mid or low rectal cancer. METHODS: We retrospectively reviewed the records of 80 patients that underwent a total mesorectal excision for mid or low rectal cancer between 1994 and 1998 and between 1999 and 2002. We compared the results between the two period groups. Endpoints were postoperative urological functions and the local recurrence rate. RESULTS: There was no significant difference for age, gender, tumor differentiation and stage between patients in the two groups. Local recurrence (LR) developed in 23% of patients in the early group and 7.5% of patients in the late group. The cumulative LR risk at 60 months was 27.5% for the early period group and 9.9% for the late period group (P=0.082) and the difference between the two groups was significant for TNM III stage (29.8% vs. 9.8%, P=0.049). Postoperative urological complications were not significantly different between the two groups (P=0.75). CONCLUSION: Based on these results, TME seemed to require a learning curve. In clinical trials for rectal cancer surgery, the learning curve for qualified surgery from the standpoint of oncological outcome should be considered to minimize bias due to surgeon-associated factors. A more broad application of the TME concept to a larger number of patients with mid or low rectal cancer is warranted.
Bias (Epidemiology) ; Humans ; Learning ; Learning Curve ; Rectal Neoplasms ; Recurrence ; Retrospective Studies

BACKGROUND: This study evaluates the effectiveness of the target-controlled infusion (TCI) of remifentanil through stepwise increases in the effect-site concentration (Ceff) in preventing coughs. METHODS: In a preliminary study, we randomly selected 140 patients to receive remifentanil through two-step increases in Ceff (1.0 ng/ml to 4.0 ng/ml: Group R1-4; 2.0 ng/ml to 4.0 ng/ml: Group R2-4). Based on the results of the preliminary study, we employed another sample of 140 patients and implemented a three-step increase in TCI (1.0 ng/ml to 2.0 ng/ml to 4.0 ng/ml: Group R1-2-4). We then compared this treatment with direct targeting based on 4.0 ng/ml TCI (Group R4). We recorded the episodes of coughs, rating them as mild (1-2), moderate (3-4), or severe (5 or more). RESULTS: In Group R1-4, one patient (1.5%) coughed during the first step, and five (7.3%) coughed during the second step. In Group R2-4, nine (13.2%) coughed during the first step, but none coughed during the next step. Only one patient had a mild cough during the three-step increase in TCI, that is, patients in Group R1-2-4 were significantly less likely to cough than those in Group R4 (P < 0.001). CONCLUSIONS: Stepwise increases in the TCI of remifentanil reduced the incidence of remifentanil-induced coughing, and the three-step increase in TCI nearly eliminated remifentanil-induced coughing.
Cough ; Humans ; Incidence ; Opioid-Related Disorders ; Piperidines ; Resin Cements

BACKGROUND: For the long-term management of chronic dermatitis such as atopic dermatitis or xerotic eczema, it is important for a clinician to choose a medication that has the least side effects. OBJECTIVE: We planned to evaluate the anti-inflammatory effect of a moisturizer containing green-tea extracts compared with 1% hydrocortisone lotion. METHODS: The anti-inflammatory effects of 1% hydrocortisone lotion and a moisturizer containing green-tea extracts were evaluated in the inflammation of skin induced by ultraviolet B(UVB) irradiation and sodium lauryl sulfate(SLS) irritation. Twice a day application of topical agents for reducing artificially induced local inflammation was done. Mexameter and chromameter were used for the evaluation of erythema. RESULTS: UVB induced erythema continued to increase regardless of applying topical agents. In contrast, SLS-induced erythema slowly decreased with time duration. Furthermore, increasing pattern of erythema was irregular after UVB irradiation. These results suggest that SLS-induced erythema was more reliable for evaluation of anti-inflammatory effects of topical agent. In addition, we found that a moisturizer containing green tea extracts showed nearly the same effect as or even more effective than 1% hydrocortisone lotion. CONCLUSION: A moisturizer containing green tea extracts would be effective for improving dry skin and also for the treatment of atopic dermatitis or xerotic eczema.
Dermatitis ; Dermatitis, Atopic ; Eczema ; Erythema ; Hydrocortisone ; Inflammation ; Skin ; Sodium ; Tea