OBJECTIVES: We compared the characteristics of the pain threshold and pain experience between demented group and non-demented group. METHODS: This study was part of Gangwon projects for early detection of dementia in 2010. We recruited 8302 local resident ages over 65 years old. Of theses, 1259 people who scored low MMSE were selected and 365 of them completed CERAD-K(Consortium to Establish a Registry for Alzheimer's disease). Finally, 90 in non-demented group and 57 in demented group(mild to moderate Alzheimer's disease) were analyzed. Pain threshold was experimentally measured by pressure algometer and we investigated the pain experience, by Brief pain inventory (BPI), a self-report test. RESULTS: In the demographic characteristics, there are more female, higher ages, lower education in the demented group. There was no significant difference between the two groups in the pain threshold. On the BPI results, 'shoulder pain', 'the number of pain' and 'interference of working' were significantly more prevalent in non-demented group. However, there are no significant differences between the groups in the 'pain severity', 'prevalence of pain' and 'pain treatment'. CONCLUSIONS: Demented group report less pain experience but, still perceived pain. It support previous studies that patient with dementia have increased pain tolerance but preserved pain threshold. Thus, active pain assessment and treatment for patients with dementia is needed.
Aged* ; Dementia* ; Education ; Female ; Gangwon-do ; Humans ; Pain Measurement ; Pain Threshold*

PURPOSE: We report a case of orbital cellulitis with subperiosteal abscess secondary to dental extraction. CASE SUMMARY: A 55-year-old man presented to the emergency department with severe erythematous, painful swelling of the left periorbital area and the upper cheek after extraction of the left maxillary molar and premolar teeth. Computed tomography scan demonstrated marked periorbital inflammation and medial displacement of the left lateral rectus muscle by subperiosteal abscess extending along the lateral orbital wall. After a 10-day course of intravenous broad spectrum antibiotics and a 7-day course of oral prednisolone, he achieved complete resolution of all clinical symptoms and signs. CONCLUSIONS: Physicians should keep in mind that orbital complications may occur after oral surgery. A high level of suspicion in a patient with preceptal signs and a history of recent tooth infection or extraction is needed to avoid missing a diagnosis.
Abscess ; Anti-Bacterial Agents ; Bicuspid ; Cheek ; Displacement (Psychology) ; Emergencies ; Humans ; Inflammation ; Middle Aged ; Molar ; Muscles ; Orbit ; Orbital Cellulitis ; Prednisolone ; Surgery, Oral ; Tooth

PURPOSE: We reviewed the clinical features and the treatment results of sensory heterotropia with the purpose of finding etiologic causes, factors influencing the the direction of deviation, and characterisitics of sensory deviations subsequent to cataract. METHODS: The charts of 134 patients diagnosed as sensory heterotropia in Chonbuk national university hospital between 1994 and 2001 were reviwed retrospectively. Visual acuity, the deviation in primary gaze, refractive error, the onset of vision loss and its etiology were analyzed. RESULTS: The major causative factor was cataract (29.1%) and anisometropic amblyopia (23.1%). When onset of visual impairment occurred between birth and the age of 5 years, 20 (33%) developed esotropia, and 41 (67%) developed exotrpia. In older children and adults, 9 (12%) developed esotropia, and 64 (88%) developed exotropia. A significant difference was noted between the age of onset and the type of horizontal strabismus (x2= 8.18, P<0.005). The difference between the refractive error in the sound eye and the type of deviation was statistically significant (x2=7.52, P<0.01). We found no correlation between the duration of visual impairment and the amount of deviation (P>0.05). While all of bilateral congenital cataract patients (4) had esotropia, unilateral congenital cataract patients showed exotropia to be predominated (4 of 5 eyes). The majority (17 of 21) of the sensory deviations subsequent to senile, traumatic cataract, uncorrected traumatic aphakia were converted from tropia to phoria, and showed the reduced angle of deviation after cataract operation or secondary IOL implantation. CONCLUSIONS: The age of onset of visual loss and the refractive error in the sound eye are thought to be the major factors influencing the direction of the deviation.
Adult ; Age of Onset ; Amblyopia ; Aphakia ; Cataract ; Child ; Esotropia ; Exotropia ; Humans ; Jeollabuk-do ; Parturition ; Refractive Errors ; Retrospective Studies ; Strabismus ; Vision Disorders ; Visual Acuity

PURPOSE: For patient with extreme myopia outside the suspected limit of single procedure alone, we performed Lasik as a secondary procedure for the correction of residual refractive error following phakic IOL implantation. METHODS: First, we made a corneal flap using ACS(Bauch & Lomb surgical/Chirom vision, Irvine, CA) due to the potential risk of endothelial damage by cornea-IOL contact during the flap dissection. One month later, phakic IOLs, Nuvita MA20 (Bauch & Lomb surgical/Chiron vision, Irvine, CA) implantation were done, and 4 months after IOL implantation, stromal ablation was performed with the eximer laser by using previously formed flap. RESULTS: Preoperative spherical equivalent refraction was -25.0 D of Rt eye, -24.0 D of Lt eye, and preoperative visual acuity was 20/500 (best spectacle corrected visual acuity; BSCVA: 20/50) of Rt eye, 20/200 (BSCVA: 20/40) of Lt eye. Spherical equivalent refraction following phakic IOL implantation was -4.25 D of Rt eye, -3.75 D of Lt eye and refractive cylinder was -1.0 D cyl x90 A, visual acuity was 20/100 (BSCVA: 20/40) of Rt eye, 20/100 (BSCVA: 20/40) of Lt eye. Spherical equivalent refraction at the last examination following LASIK was -0.75 D of Rt eye, -0.5 D of Lt eye and visual acuity was 20/25 (BSCVA: 20/25) of Rt eye, 20/25 (BSCVA: 20/25) of Lt eye. CONCLUSIONS: Bioptics by combined anterior chamber phakic intraocular lens and laser in situ keratomileusis is one of the effective methods for patients with refractive error of extreme myopia outside the suspected limits of single procedure alone. Longer follow-up of large number of cases is needed to fully assess the safety and complications.
Anterior Chamber* ; Follow-Up Studies ; Humans ; Keratomileusis, Laser In Situ* ; Myopia* ; Phakic Intraocular Lenses* ; Refractive Errors ; Visual Acuity

No abstract available.
Gastric Outlet Obstruction*

PURPOSE: Corneal bee sting is a relatively rare injury. The authors report the significant endothelial changes despite complete resolution of corneal injury after a corneal bee sting. CASE SUMMARY: Two males, ages 55 and 30, presented to our clinic for unilateral decreased visual acuity and eyeball pain after bee sting injuries. At the first visit, localized corneal stromal edema and epithelial defect were detected. One week after medical treatments, both patients achieved restoration of vision and resolution of corneal injury. In one patient, specular microscopy of the traumatized eye at one and five months showed a significant decrease in endothelial densities as compared with the contralateral eye. CONCLUSIONS: Corneal bee sting may cause significant endothelial changes despite complete resolution of clinical symptoms and injury. Specular microscopy should be considered in future intraocular surgeries.
Bees ; Bites and Stings ; Cornea ; Edema ; Endothelial Cells ; Eye ; Humans ; Male ; Microscopy ; Vision, Ocular ; Visual Acuity

No abstract available.
Thromboangiitis Obliterans

In order to investigate electrolyte changes in serum and urine diuretic therapy, we studied 98 patients with hypertension not optimally controlled by previous treatment. After we divied the patients into three gorups in randomized trial, group A were given Amiloride 10mg/day, group B were given Dihydrochlorothiazide 50mg/day, group C were given Amiloride 5mg/day combined with Dihydrochlorothiazide 25mg/day for 7 days. Blood pressure and electrolyte changes in serum and urine after diuretic theraphy for 7 days were as follows. 1) Serum sodium concentrations were not significantly changed in all three groups(P>0.05). 2) Serum potassium concentrations were increased in group A and C (P<0.05), but there were no significant changes in group B(P<0.05). 3) Urinary sodium exceretions were increased in all three groups(P<0.05). 4) Urinary potassium excretion were decreased in group A and C (P<0.05), but there were increased in group B (P<0.05). 5) Blood pressure were decreased in all three groups(P<0.05).
Amiloride ; Blood Pressure ; Diuretics* ; Electrolytes* ; Humans ; Hydrochlorothiazide ; Hypertension* ; Potassium ; Sodium

PURPOSE: To report a case of eyeball protrusion with optic chiasmal injury due to eyeball trauma. CASE SUMMARY: A 59-year-old male presented to the emergency room for right eyeball pain, eyeball protrusion and decreased visual acuity after collision with a metal pipe. On initial examination, the right eyeball was protruded, the patient could not perceive light, his pupil was dilated and did not respond to the light. The patient had a laceration of the lower canaliculi and the medial, superior and inferior rectus muscles were separated from the eyeball. Abnormal left pupil response was observed, and visual acuity of the left eye was 0.7. He underwent primary repair of the right medial, inferior and superior rectus muscles and reconstruction of the lower canaliculi. Because the visual field of the left eye at post-operative day 1 demonstrated temporal hemianopsia, an optic chiasmal injury was revealed on brain magnetic resonance imaging (MRI). The patient underwent left optic chiasmal decompression because the visual field was aggravated despite the immediate high dose of corticosteroid therapy. At post-operative 2 months, the patient's left visual acuity was 0.3 and the visual field was stable. CONCLUSIONS: Optic chiasmal injury should be considered and promptly diagnosed through visual field test and MRI when ipsilateral optic nerve injury with abnormal contralateral pupil response is caused by eyeball protrusion. Optic chiasmal decompression should be considered when traumatic optic nerve and chiasmal injuries do not respond to high-dose corticosteroid therapy.
Brain ; Decompression ; Emergencies ; Eye ; Hemianopsia ; Humans ; Lacerations ; Light ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Muscles ; Optic Chiasm ; Optic Nerve ; Optic Nerve Injuries ; Pupil ; Visual Acuity ; Visual Field Tests ; Visual Fields

PURPOSE: To report three consecutive cases of methazolamide-induced Stevens-Johnson syndrome. CASE SUMMARY: We describe three patients who were all prescribed methazolamide for treatment of ophthalmologic conditions. A 29-year-old man and a 47- year-old woman were prescribed methazolamide (100 mg/day) for the treatment of central serous chorioretinopathy (CSCR). A 66-year-old woman was prescribed methazolamide (100 mg/day) for acute glaucoma of the left eye for approximately two weeks. After taking the methazolamide, three patients were showed the pururitic maculopapular rashes on the whole body and the vesicular eruptions of the oral mucosa and conjunctiva. On the basis of medication histories, characteristic skin lesions and mucosal involvement, we diagnosed all three patients with methazolamide-induced Stevens-Johnson syndrome. All three patients were hospitalized and treated with intravenous steroids and antihistamines. Two of the three cases showed conjunctival pseudomembranes. In two cases, the skin lesions worsened during the first week of treatment, and then resolved without complications over the next two to three weeks. The condition of the 47-year-old female patient deteriorated rapidly to toxic epidermal necrolysis due to sensitivity to sulfa antibiotics. HLA- A24, B59 and Cw1 were detected in all three cases. CONCLUSIONS: In 2008, domestic production of acetazolamide was halted in Korea. Because of this, methazolamide is expected to be prescribed by ophthalmologists more commonly than in previous years. Complete medical histories should be taken before prescribing methazolamide to patients. HLA typing should be conducted whenever possible to screen patients before prescription of methazolamide.
Acetazolamide ; Adult ; Aged ; Anti-Bacterial Agents ; Central Serous Chorioretinopathy ; Conjunctiva ; Epidermal Necrolysis, Toxic ; Exanthema ; Eye ; Female ; Glaucoma ; Histamine Antagonists ; Histocompatibility Testing ; HLA-B Antigens ; Humans ; Korea ; Methazolamide ; Middle Aged ; Mouth Mucosa ; Prescriptions ; Skin ; Steroids ; Stevens-Johnson Syndrome