PURPOSE: To analyze pre- and post-operative factors associated with favorable long-term sensory outcome after surgical correction for infantile esotropia. METHODS: This study retrospectively examined 40 patients with infantile esotropia who underwent surgery from January 2000 to December 2010. Clinical characteristics analyzed included age at onset, age at surgery, mean preoperative deviation, amblyopia on initial visit, other associated strabismus (Inferior oblique overaction (IOOA), dissociated vertical deviation (DVD), latent nystagmus), initial and subsequent postoperative motor alignment at 1-week and 2-year follow-up, recurrence rate, and stereopsis. Long-term sensory outcome was categorized as favorable (< or =400 arcsec) or unfavorable (>400 arcsec). RESULTS: The mean follow-up period was 92.53 +/- 46.46 months. There were 19 patients (47.5%) in the favorable group and 21 (52.5%) in the unfavorable group. There were no statistically significant differences between the groups with respect to age at onset or surgery, presence of amblyopia, and prevalence of IOOA and DVD, latent nystagmus, or initial postoperative alignment at 1-week. There was a tendency towards worse binocularity with larger preoperative angles of esodeviation, but it was not significant. Binocularity was significantly higher among those who had surgery at age < or =24 months than at age >24 months. Orthotropic alignment within +/-10 PD at 2-year follow-up was 68.4% in the favorable group and 38.1% in the unfavorable group. Reoperation was performed on 8 patients (38.1%) in the unfavorable group and no patients (0.0%) in the favorable group. CONCLUSIONS: Surgical correction of infantile esotropia within the first 2 years of life and maintenance of orthotropic alignment within +/-10 PD without additional surgery with a minimum follow-up of 2 years may be associated with favorable long-term sensory outcome in infantile esotropia.
Amblyopia ; Depth Perception ; Esotropia* ; Follow-Up Studies ; Humans ; Prevalence ; Recurrence ; Reoperation ; Retrospective Studies ; Strabismus ; Telescopes

No abstract available.
Female ; Humans ; Hysterosalpingography* ; Laparoscopy*

Intravenous patient-controlled analgesia(PCA) is gaining wide spread popularity in management of post-operative pain maintaining an effective blood concentrations of analgesics. We studied 48 patients, ASA class I or II, undergoing obstetric or gynecologic surgery under general anesthesia. We examined postoperative pain control level, patients satisfaction and side effects associated with the use of morphine and Baxter infusor. Each patient received 0.1 mg/kg as a loading dose and 0.0125 mg/kg/hr of morphine as maintenance dose. A unit was fitted with patient control module which had a flow rate of 0.5ml/hr and lockout interval was 15 minutes. Results were as follow. Pain scores were 1.88+/-0.81(first day), 1.31+/-0.71(second day). Visual analogue scales were 4.40+/-2.06(first day), 3.40+/-1.71(second day). 41 out of 48 patients in total were satisfied but nausea, dizziness or pruritus was noted. We recommend the use of PCA with morphine after surgery to improve post-operative pain because it provides adequate pain relief and a few side effects with high patients satisfaction.
Analgesia, Patient-Controlled* ; Analgesics ; Anesthesia, General ; Dizziness ; Female ; Gynecologic Surgical Procedures* ; Humans ; Infusion Pumps ; Morphine* ; Nausea ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Pruritus ; Weights and Measures

Continuous epidural analgesia with morphine via portable infusor(Baxter Infusor, BI) is a good technique for the management of intractable cancer pain. The method of subcutaneous tunnelling with portable infusor has been widely used for the cancer pain management. We examined the doses of morphine, duration of subcutaneous tunnelling, side effects, age distribution and causes of pain. The mean initial dose of morphine was 6.09 and the last 24.02 mg. Mean duration of subcutaneous tunnelling was 53.71 days and voiding difficulty, pruritus, respiratory depression were observed. Most of the patients were at the ages of 6th decade and the most common cause of pain was stomach cancer. It is suggested that the management of intractable cancer pain with epidural morphine through subcutaneous tunnelling via portable infusor is satisfactory and reliable.
Age Distribution ; Analgesia, Epidural ; Humans ; Infusion Pumps* ; Morphine ; Pain Management ; Pruritus ; Respiratory Insufficiency ; Stomach Neoplasms

PURPOSE: We describe a very rare the leiomyosarcoma that developed in the conjunctiva. METHODS: A 59-year-old man was treated at another hospital two months before presenting to our institution. He had not gotten any better and so was admitted to our hospital. He had normal visual acuity and intraocular pressure. However, we found a geographic, highly vascularized mass involving the corneal limbus in the medial bulbar conjunctiva, from which a pterygium had been removed a year previously. An excision of the mass was carried out to detect a suspected conjunctival intraepithelial neoplasm. RESULTS: Tissue obtained from operation had cells with thin nuclei, spindle cells with pleomorphic cigar-shaped nuclei and eosinophilic cytoplasm, atypical cells, and from four to five mitotic figures under ten high power field. In immunohistochemical staining, Vimentin, Smooth muscle actin (SMA), Desmin, CD68 stained positively and cytokeratin, Cam5.2, S-100, HMB-45, CD 34 stained negatively. We found no clues of other origins from the general physical examination. Considering these factors, we conclude that this was a Stage I, G2T1aN0M0 leiomyosarcoma with moderate differentiation. CONCLUSIONS: Analysis by immunohistochemical staining is necessary to detect leiomyosarcoma in the conjunctiva, as it is very rare and hard to diagnose by the histologic method alone. We report a leiomyosarcoma of the conjunctiva after pterygium excision, and suggest that it be considered a differential diagnosis of conjunctival masses, even though it is very rare.
Actins ; Adult ; Carcinoma in Situ ; Conjunctiva* ; Cytoplasm ; Desmin ; Diagnosis, Differential ; Eosinophils ; Humans ; Intraocular Pressure ; Keratins ; Leiomyosarcoma* ; Limbus Corneae ; Middle Aged ; Muscle, Smooth ; Physical Examination ; Pterygium ; Vimentin ; Visual Acuity

To elucidate the role of CNS GABA ergic system in the regulation of cardiovascular function, the effects of intracerebroventricular(icv) bicuculline(BIC), a selective GABAA antagonist, on blood pressure and heart rate were investigated in urethane anesthetized rabbits. 1) Icv BIC produced dose-dependent pressor and bradycardiac effect, while intravenous(iv) BIC had no effect on blood pressure and heart rate. 2) The pressor effect of BIC(10(g) was significantly attenuated by pretreatments with icv ketamine(5 mg) or icv diazepam(0.1 mg, 1 mg). Bilateral vagotomy and pretreatment with icv mecamylamine(0.2 mg), iv chlorisondamine(1 mg/kg), in phentolamine(1 mg/kg) did not affect the pressor action. 3) The bradycardiac effect of BIC(10(g) was abolished or reversed to slight tachycardia by bilateral vagotomy and pretreatment with icv ketamine(2.5 mg, 5 mg), icv diazepam(0.1 mg, 1 mg) and iv chlorisondamine(1 mg/kg). Neither icv mecamylamine(0.2 mg) nor iv phentolamine(1 mg/kg) affected the bradycardia. These results suggest that blockade of GABAA receptor produce pressor action which is associated with central excitatory amino acid system and produce reflex bradycardia induced by the pressor effect, and that sympathetic nervous system might not be involved in the pressor effect.
Bicuculline* ; Blood Pressure* ; Bradycardia ; Excitatory Amino Acids ; gamma-Aminobutyric Acid ; Heart Rate* ; Heart* ; Rabbits* ; Reflex ; Sympathetic Nervous System ; Tachycardia ; Urethane ; Vagotomy

PURPOSE: BioSorbFX(R)(BIONX Implant Inc.) and Macropore(R)(Medtronics Inc.) are mesh-type resorbable copolymer plate. This report presents a new model necessary for orbital wall reconstruction, accoding to the operative outcomes of orbital fracture with its use. METHODS: A follow-up on 11 patients was performed to ascertain the operative effects of the mesh-type resorbable material for 6 months. RESULTS: The patients were 7 males and 4 females. The patients' average age was 29.7 years and the mean follow-up period was 8.1 months. The most common site of fracture was inferior wall. In these cases, simultaneous fracture of the medial wall and floor was frequently observed. One case showed limitation of ocular movement, diplopias and enophthalmos simultaneously; 3 cases, enophthalmos and diplopia; 5 cases showed limitation of ocular movement and diplopia; and 2 cases, considerable possibility or the presence of enophthalmos due to extended fracture size. The cases improved remarkably after being operated and none were observed to have worsened. Moreover, serious complications, such as visual loss, the infection of implants, dislocation, exposure, etc., were not observed. CONCLUSIONS: Altogether, it is considered that the mesh-type resorbable copolymer plate may be safely used in orbital wall reconstruction without conspicuous complication.
Diplopia ; Dislocations ; Enophthalmos ; Female ; Follow-Up Studies ; Humans ; Male ; Orbit* ; Orbital Fractures

PURPOSE: To identify predictive factors for recovery time in patients with orbital fracture with diplopia through analysis of preoperative and postoperative computed tomography (CT) images and postoperative recovery time. METHODS: We retrospectively analyzed CT findings-preoperative: fracture size, type of fracture, fracture site, extraocular muscle (EOM) swelling, EOM and soft tissue injury, and the amount of soft tissue herniation; post-operative: degree of enophthalmos, and diplopia recovery period in 379 patients who underwent surgical treatment for orbital fracture between March 2006 and December 2015. RESULTS: The average postoperative follow-up period was 556.2 ± 59.5 days, and the mean duration of recovery was 23.9 ± 42.5 (range, 3–186) days. The recovery time of diplopia was significantly increased with the following preoperative CT findings: fracture size (small and medium < large) (p = 0.049), type of fracture (linear < hinge < comminuted, trap-door) (p < 0.01), fracture site (inferior < medial and both) (p < 0.01), EOM and soft tissue injury (prolapse and torsion, muscle entrapment, kinked muscle) (p < 0.01), and the amount of soft tissue herniation (small and medium < large) (p < 0.001). The mechanism of injury, sex, age, and the degree of enophthalmos were not related to the length of the diplopia recovery period. CONCLUSIONS: The length of diplopia recovery could be predicted by CT findings.
Diplopia ; Enophthalmos ; Follow-Up Studies ; Humans ; Orbit ; Orbital Fractures ; Retrospective Studies ; Soft Tissue Injuries

Hepatie hilar ductal carcinoma is relatively rare, but the prognosis is known to be poor because an early diagnosis is difficult. Because the majority of patients are already infiltrated into adjacent organ by itself at the diagnosis, the rate of resectability is low. The best method of treatment is curative resection, and the range of tumor invasion is very important. The preoperative diagnosis is difficult because the cholangiography may be normal in cases of superficial invasion. Multifocal lesions within the biliary tract may be identified in as many as 10 percent of patients, Especially, the papillary type has the best prognosis and is associated with multiple tumors within the bile duct. We report a case that percutaneous transhepatic cholangiogram showed normal distal common bile duct, but the hepatic hilar confluence and ampulla of Vater lesion was confirmed as adenocarcinoma.
Adenocarcinoma ; Ampulla of Vater* ; Bile Ducts ; Biliary Tract* ; Carcinoma, Ductal ; Cholangiocarcinoma* ; Cholangiography ; Common Bile Duct ; Diagnosis ; Early Diagnosis ; Humans ; Pancreas* ; Prognosis

PURPOSE: We present a case of plexiform neurofibroma that extensively invaded cranial and temporal bone, eyelid, orbit and uveal tissues, showing signs of severe ptosis and proptosis and symptoms of headache and ocular pain. METHODS: A 24-year old woman visited our clinic with pain and progressive proptosis, which had persisted for 2 weeks. She had a history of congenital neurofibromatosis. There were multiple Cafe-au-lait spots on her extremities, trunk, and face. Also, she had severe ptosis in her upper left eyelid, proptosis, and a distorted and asymmetric facial form. The cornea was markedly edematous. An enhanced computed tomography scan revealed an uncertain circumscribed soft tissue mass with enlargement of the eyeball and orbit, coupled with sphenoid wing dysplasia and herniation of the dura mater into the orbit due to expansion and bony destruction of the superior orbital wall. Under general anesthesia, the patient underwent excision and histopathologic biopsy of intraocular neurofibroma through evisceration. RESULTS: The tumor had black-colored multilobular nodules whose dimensions were 1.5x1.2x0.4 cm. After a histopathologic examination, the tumor was determined to be a pigmentary hamartoma of the uvea. Based on the clinical and histologic findings, we diagnosed the patient with plexiform neurofibroma with type I neurofibromatosis.
Anesthesia, General ; Biopsy ; Cafe-au-Lait Spots ; Cornea ; Dura Mater ; Exophthalmos* ; Extremities ; Eyelids ; Female ; Hamartoma ; Headache ; Humans ; Neurofibroma ; Neurofibroma, Plexiform* ; Neurofibromatoses ; Orbit ; Temporal Bone ; Uvea ; Young Adult