In order to compare the influence of retrobulbar and peribulbar anesthesia technique to the change of intraocular pressure(IOP), we measured the IOP sequentially in 40 eyes of 40 patients(retrobulbar group: 20 eyes, peribulbar group: 20 eyes). The intraocular pressure was checked at one hour prior to operation, just after application of Honan apparatus with 30 mmHg for 30 minutes, just after the injcetion of anesthetics with technique retrobulbar and with peribulbar technique, and after digital massage for 5 minutes. Injected volume of anesthetics was 3 ml in retrobulbar technique and 6 ml in peribulbar technique. In retrobular group, the IOP mean was 16.55 mmHg at one hour prior to operation, 10.96 mmHg just after Honan application, 17.36 mmHg just after the injection of anesthetics and 10.38 mmHg after digital massage. In peribulbar group, the IOP mean was 16.97 mmHg at one hour prior to operation, 11.08 mmHg just after Honan application, 18.11 mmHg just after the injection of anesthetics and 11.31 mmHg after digital massage. The mean increase of IOP after the injection of anesthetics was 6.40 mmHg in retrobulbar group and 7.03 mmHg in peribulbar group. There was no statistical difference in the change of IOP between the two groups.(Student t-test, p>0.10).
Anesthesia* ; Anesthetics ; Intraocular Pressure* ; Massage

BACKGROUND: Surgical endarterectomy had been known to be the standard treatment modality in management of carotid stenosis. However, endarterectomy had several limitations in high-risk patients, particulary with coronary artery disease. Carotid angioplasty and stenting has been suggested to be a safer and more cost-effective alternative to carotid endarterectomy in the management of symptomatic carotid artery disease. The purpose of this study is to evaluate the feasibility and safety of elective carotid artery stent implantation in patients with carotid artery stenosis. METHOD: We treated 19 patients with symptomatic and asymptomatic stenosis of >60% in 19 carotid arteries with balloon angioplasty followed by elective stent implantation. Of all carotid stenting procedures, 18 stents were implanted in obstructing atherosclerotic plaques and in one for Takayasu's arteritis. Of all patients, 10 patients were symptomatic with a history of stroke or transient ischemic attacks which were ipsilateral to the treated carotid artery. 12 patients represented a high-risk subset with myocardial infarction, previous coronary artery bypass graft and coronary artery stenosis. 6 months follow up angiogram was done in 7 patients, a patient(Takayasu's arteritis) showed restenosis. Result: Angiographic and procedural success rate were 100%, and there were no acute or subacute stent thrombosis. Immediately after initial carotid stenting, the mean(+/-SD) stenosis was reduced from 74.9+/-13.6% to 10.2+/-8.7% and the minimal luminal diameter was increased from 1.4+/-0.8mm to 5.3+/-1.0mm corresponding to an acute gain of 3.9mm. There were no major or minor stokes during follow-up. CONCLUSION: Percutaneous carotid angioplasty with stenting is a safe and feasible procedure. It is associated with high immediate success rates and relatively low complications in the management of carotid artery stenosis. Carotid stenting seems to be a reasonable alternatives to medical management for the treatment of carotid stenosis in patients deemed to be poor candidates for standard carotid endarterectomy.
Angioplasty ; Angioplasty, Balloon ; Carotid Arteries* ; Carotid Artery Diseases ; Carotid Stenosis* ; Constriction, Pathologic ; Coronary Artery Bypass ; Coronary Artery Disease ; Coronary Stenosis ; Endarterectomy ; Endarterectomy, Carotid ; Follow-Up Studies ; Humans ; Ischemic Attack, Transient ; Myocardial Infarction ; Phenobarbital ; Plaque, Atherosclerotic ; Stents* ; Stroke ; Takayasu Arteritis ; Thrombosis ; Transplants

No abstract available.
Child* ; Humans ; Neurilemmoma* ; Neurofibromatosis 1

Spontaneous internal biliary fistula is not an uncommon complication of neglected cholelithiasis, peptic ulcer, and carcinoma. The indidence, as given by various authors, differs but seems to vary between 3 and 5% of all cases of biliary disease. Until development of endoscopy, diagnosis has depended on the presence of air or barium in the biliary tree as radiologic findings or symptoms. Recently endoscopic examination, biopsy in appropriate case, and cannulation of the fistula for precise radiographic delineation will help to make a diagnosis. The main typesof fistulas are cholecystoduodenal, cholecystocolic, choledochoduodenal. Cholecystogastric or choledochogastric fistula is very rare type of internal biliary fistulas. Recently we encountered two cases who had suffered from fever and right upper abdominal pain with pneumobilia as ultrasonographic findings. They were confirmed as having cholecystogastric fistula, and choledochogastric fistula due to complicated gallstones by ERCP and surgical exploration. So we report two cases of biliary-gastric fistula of these patients with a review of relevant literatures.
Abdominal Pain ; Barium ; Biliary Fistula ; Biliary Tract ; Biopsy ; Catheterization ; Cholangiopancreatography, Endoscopic Retrograde ; Cholelithiasis ; Diagnosis ; Endoscopy ; Fever ; Fistula ; Gallstones ; Gastric Fistula* ; Humans ; Peptic Ulcer

The incidence of inadvertent posterior capsular rupture at each stage of planned ECCE and posterior chamber intraocular lens implantation was studied. From June 1985 to Dec. 1986, 133 cases of planned ECCE for posterior chamber intraocular lens implantation were performed. Posterior capsular rupture with or without vitreous loss was developed in 11 cases(8.2%) out of 133. The rupture occurred during nuclear expression in 2 cases(1.5%), during cortical clean-up in 6 cases(4.5%), during remval removal of anterior capsular flaps in 2 cases(1.5%), during posterior chamber intraocular lens implantation in 1 case(0.7%), but during posterior capsule polishing in nocase(0%). Vitreous loss was combined with posterior capsular rupture in 6 cases(4.5%), but the other 5 cases were not associated with vitreous loss(3.7%). After management of vitreous loss by automated anterior vitrectomy in 10 cases, anterior chamber intraocular lens was implanted. But in the other 1 cases with mid posterior capsular rupture without vitreous loss, anterior chamber intraocular lens was implanted without anterior vitrectomy. A final visual acuity of 0.5 or better by 2 months postoperatively was observed in 10 cases out of 11(91%).
Anterior Chamber ; Incidence ; Lens Implantation, Intraocular* ; Lenses, Intraocular* ; Rupture* ; Visual Acuity ; Vitrectomy

We performed suture tension adjustment (STA) in 8 patients who had undergone penetrating keratoplasty with 10-0 nylon running suture closure. 3 to 8 weeks after the surgery, STA was done by loosening the suture tension at the steep meridian and tightening at the flat meridian, guided by automatic keratometery, keratoscopic finding and manifest refraction. Pre-STA astigmatism of 6.27 +/- 1.84 diopter(D) was changed to 1.94 +/- 1.40D immediately after the adjustment. Post-STA astigmatism regressed mostly within two weeks of adjustment, remaining stable thereafter: In one case, suture breakage occurred during adjustment, and resuturing was done using a new 10-0 nylon tied to the broken ends without serious sequela.
Astigmatism ; Humans ; Keratoplasty, Penetrating* ; Nylons ; Running* ; Sutures*

No abstract available.
Gingival Crevicular Fluid* ; Periodontal Diseases*

The application of stereotactic techniques and endoscopy dates back to the beginning of this century and is almost as old as neurosurgery itself. However, endoscopic techniques progressed slowly for several reasons. A reappraisal of endoscopic techniques become popular about 1985. The major indication of endoscope in neurosurgical field is intraventricular procedures. Recently it can be used selectively in the intraaxial mass lesion associated cavity. For example, cystic mass, with liquefied necrosis, blood clot can be approached with endoscope. Authors present its intraaxial application in basal ganglionic hematoma in three patients. Conventional stereotactic guidance of neuroendoscope was done and the hematoma was gently removed through continuous irrigation and suction under video-guidance. The clinical course was uneventful. Brief overview is given of this intraaxial neuroendoscopic procedure.
Endoscopes ; Endoscopy ; Ganglion Cysts* ; Hematoma* ; Humans ; Necrosis ; Neuroendoscopes ; Neurosurgery ; Stereotaxic Techniques ; Suction

Penetrating keratoplasty was performed in six eyes of granular corneal dystrophy. Vision was improved from worse than 0.05 to better than 0.4. Mean follow-up period is 14 months (12-18 months). Corneal deposits were stained for H and E. Masson trichrome, Wilder's reticulin and Luxol fast blue but not for PAS, Congo red and Oil red a stain. Electron micorscopic examination showed that polymorphic, electron dense rod-shaped bodies were present in the Bowman's layer and between stromal lamellae and in the interceliular space of corneal epithelium. And, for the first time we found a area looked like a transformation from normal stroma to the granular deposit.
Congo Red ; Epithelium, Corneal ; Follow-Up Studies ; Keratoplasty, Penetrating ; Reticulin

Occlusion therapy has been reported to improve the motor phase and sensory phase of exodeviations. We performed occlusion on the preferred eye in intermittent exotropia for three hours a day. Average follow-up time was 15.8 weeks. The frequency of tropic status of exodeviation was decreased in 21 cases(70%). In two cases intermitent pattern was changed to exophoria, and in one case, to exotopia. The size of the deviation angle was changed from 28.93 +/- 7.6 prism diopter(PD) to 24.03 +/- 7.9 PD(p<0.01). In 13 cases(43.3%) the size of the deviation angle decreased more than 6 PD, increased more than 6 PD in one case(3.3%), and in 16 cases(53.3%) the size of deviation angle showed no change. The preference pattern changed from monocular to alternating type in 5 cases. Stereopsis improved in 24% of the cases and did not deteriorate in Others.
Depth Perception ; Exotropia* ; Follow-Up Studies