PURPOSE: To investigate the results of Advanced Surface Ablation (ASA) coupled with "smoothing" to smooth the ablation surface after covering masking fluid. METHODS: ASA was performed in 61 eyes with ablation depth of more than 75 microm. The mean refractive error was -5.88 +/- 1.27 D and mean ablation depth was 102.93 +/- 12.06 microm. Smoothing was performed in all patients (mean depth 16.79 +/- 2.43 microm, mean diameter 8.77 +/- 0.16 mm). Customized Aspheric Transition zone (CATz) was used in the laser algorithm. RESULTS: The mean refractive error was -0.29 +/- 0.41 D at postoperative 6 months and 97% of patients had an UCVA of 1.0 or better at postoperative 6 months. There was no statistically significant difference in magnitude of high-order aberrations at postoperative 6 months. The magnitude of total spherical aberrations increase was 0.084 microm at postoperative 6 months (p<0.05, paired t-test). The cornea was maintained clear in the majority of eyes. CONCLUSIONS: Excellent results were obtained by ASA coupled with "smoothing" in high myopia patients with an ablation depth greater than 75 microm.
Cornea ; Eye ; Humans ; Masks ; Myopia ; Refractive Errors

PURPOSE: The purpose of this study was to analyze associated factors of primary radial nerve palsy and to evaluate clinical outcome for its treatment in patients with humerus shaft fracture. MATERIALS AND METHODS: We divided two groups of patients with (17 patients) and without (116 patients) primary radial nerve palsy and analyzed correlation between radial nerve injury and various parameters, including age, sex, cause of injury, AO classification, fracture type, fracture location, and presence of open fracture. We also evaluated configuration of nerve injury, presence of recovery, and recovery time. RESULTS: The overall prevalence of primary radial nerve palsy after humerus shaft fracture was 12.8% (17 palsies in 133 fractures). Younger age, AO type B, and distal 1/3 fractures showed significantly higher correlation with radial nerve palsy. No significant correlation was observed between radial nerve palsy and other parameters, including sex, cause of injury, fracture type, and presence of open fracture. Thirteen patients (76.5%) underwent early nerve exploration with internal fixation. Intraoperatively, all patients had continuity of radial nerve except one patient with segmental loss. At the final follow-up, 16 patients (94.1%) with radial nerve palsy had made a complete recovery. The mean time to complete recovery was 6.7 months. CONCLUSION: Primary radial nerve palsy after humerus shaft fracture was more common in young age, AO type B, distal 1/3 fractures. Early surgical exploration can be recommended to confirm the condition of the radial nerve if the fracture should be fixed.
Classification ; Follow-Up Studies ; Fractures, Open ; Humans ; Humerus* ; Paralysis* ; Prevalence ; Radial Nerve*

Objective: : Fixation of the C1–2 segment is challenging because of the complex anatomy in the region and the need for a high degree of accuracy to avoid complications. Preoperative 3D-computed tomography (CT) scans can help reduce the risk of complications in the vertebral artery, spinal cord, and nerve roots. However, the patient may be susceptible to injury if the patient’s anatomy does not match the preoperative CT scans. The intraoperative 3D image-based navigation systems have reduced complications in instrument-assisted techniques due to greater accuracy. This study aimed to compare the radiologic outcomes of C1–2 fusion surgery between intraoperative CT image-guided operation and fluoroscopy-guided operation. Methods: : We retrospectively reviewed the radiologic images of 34 patients who underwent C1–2 fusion spine surgery from January 2009 to November 2018 at our hospital. We assessed 17 cases each of degenerative cervical disease and trauma in a study population of 18 males and 16 females. The mean age was 54.8 years. A total of 139 screws were used and the surgical procedures included 68 screws in the C1 lateral mass, 58 screws in C2 pedicle, nine screws in C2 lamina and C2 pars screws, four lateral mass screws in sub-axial level. Of the 34 patients, 19 patients underwent screw insertion using intraoperative mobile CT. Other patients underwent atlantoaxial fusion with a standard fluoroscopy-guided device. Results: : A total of 139 screws were correctly positioned. We analyzed the positions of 135 screws except for the four screws that performed the lateral mass screws in C3 vertebra. Minor screw penetration was observed in seven cases (5.2%), and major pedicle screw penetration was observed in three cases (2.2%). In one case, the malposition of a C2 pedicle screw was confirmed, which was subsequently corrected. There were no complications regarding vertebral artery injury or onset of new neurologic deficits. The screw malposition rate was lower (5.3%) in patients who underwent intraoperative CT-based navigation than that for fluoroscopy-guided cases (10.2%). And we confirmed that the operation time can be significantly reduced by surgery using intraoperative O-arm device. Conclusion : Spinal navigation using intraoperative cone-beam CT scans is reliable for posterior fixation in unstable C1-2 pathologies and can be reduced the operative time.

Takayasu arteritis (TA) is a chronic inflammatory disease of unknown etiology that affects mainly the aorta, main aortic branches, and pulmonary arteries. Diverse neurological manifestations of TA have rarely been reported in children. Posterior reversible encephalopathy syndrome (PRES) is a neuroradiological condition that presents with headache, seizure, visual disturbances, and characteristic lesions on imaging. Inflammatory condition and severe hypertension in TA can cause PRES. We report of a 5-year-old girl with presumed TA who presented with PRES and chronic total occlusion in the renal artery. The findings on magnetic resonance imaging suggested PRES. Left nephrectomy was performed for total occlusion of the left renal artery, and the confirmatory diagnosis of TA was based on the pathologic findings of the renal artery.
Aorta ; Child ; Child, Preschool ; Diagnosis ; Female ; Headache ; Humans ; Hypertension ; Magnetic Resonance Imaging ; Nephrectomy ; Neurologic Manifestations ; Posterior Leukoencephalopathy Syndrome* ; Pulmonary Artery ; Renal Artery ; Seizures ; Takayasu Arteritis*

PURPOSE: Burkholderia cepacia is an aerobic, glucose-non-fermenting, gramnegative bacillus that mainly affects immunocompromised and hospitalized patients. Burkholderia cepacia has high levels of resistance to many antimicrobial agents, and therapeutic options are limited. The authors sought to analyze the incidence, clinical manifestation, risk factors, antimicrobial sensitivity and outcomes of B. cepacia urinary tract infection (UTI) in pediatric patients. METHODS: Pediatric patients with urine culture-proven B. cepacia UTI between January 2000 and December 2014 at Samsung Medical Center, a tertiary referral hospital in Seoul, Republic of Korea, were included in a retrospective analysis of medical records. RESULTS: Over 14 years, 14 patients (male-to-female ratio of 1:1) were diagnosed with B. cepacia UTI. Of 14 patients with UTI, 11 patients were admitted to the intensive care unit, and a bladder catheter was present in 9 patients when urine culture was positive for B. cepacia. Patients had multiple predisposing factors for UTI, including double-J catheter insertion (14.2%), vesico-ureteral reflux (28. 6%), congenital heart disease (28.6%), or malignancy (21.4%). Burkholderia cepacia isolates were sensitive to piperacillin-tazobactam and sulfamethoxazole-trimethoprim, and resistant to amikacin and colistin. Treatment with parenteral or oral antimicrobial agents including piperacillin-tazobactam, ceftazidime, meropenem, and sulfamethoxazole-trimethoprim resulted in complete recovery from UTI. CONCLUSION: Burkholderia cepacia may be a causative pathogen for nosocomial UTI in pediatric patients with predisposing factors, and appropriate selection of antimicrobial therapy is necessary because of high levels of resistance to empirical therapy, including aminoglycosides.
Amikacin ; Aminoglycosides ; Anti-Infective Agents ; Bacillus ; Burkholderia cepacia* ; Burkholderia* ; Catheters ; Causality ; Ceftazidime ; Child* ; Colistin ; Heart Defects, Congenital ; Humans ; Incidence ; Intensive Care Units ; Medical Records ; Republic of Korea ; Retrospective Studies ; Risk Factors ; Seoul ; Tertiary Care Centers ; Urinary Bladder ; Urinary Tract Infections* ; Urinary Tract* ; Vesico-Ureteral Reflux

Actinomycosis is a chronic, granulomatous suppurative disease caused by Actinomyces species. Actinomyces is an anaerobic, gram positive organism that requires special techniques for culture and isolation. Actinomycosis is characterized by formation of multiple abscesses, draining sinuses, abundant granulations (sulfur granule) and dense fibrous tissue. The three major clinical presentations include the cervicofacial, thoracic, and abdominal regions. Since A. israelii is a normal inhabitant of the oral cavity, to make a definitive diagnosis it must be recovered from closed tissue spaces, draining sinuses, or abscesses, or it must be shown to be invasive in histopathologic sections. The drug of choice is penicillin. Because of the dense fibrous tissue surrounding the colonies of organisms and the concentration of organisms in clusters, high doses of pharmacologic agents must be used for long periods, and radical surgical excision should accompany antibiotic therapy if possible. We report three cases of abdominal actinomycosis, preoperatively impressed as appendicitis and pelvic abscess, which was diagnosed by a histological study of operative specimens. The possible pathogenic mechanisms causing clinical symptoms are discussed.
Abscess ; Actinomyces ; Actinomycosis* ; Appendicitis ; Diagnosis ; Mouth ; Penicillins

Torsades de pointes is a polymorphic ventricular tachycardia associated with prolonged QT interval and increased U wave amplitude. It has been found to be induced by various drugs, electrolyte imbalances, and so on, but the mechanism of torsades de pointes has not been completely documented. Two hypotheses, early afterdepolarization and dispersion of repolarization have been known to be the possible mechanism. Terfenadine and astemizole are the antihistamines, known to be one of the etiologic agents of torsades de pointes, and factors associated with increased risk are significant liver disease, drug overdose, and concomitant administration of imidazole and macrolide antimicrobial drugs. There has been only one case reported that torsades de pointes had been induced by first-generation antihistamine, piprinhydrinate. We experienced a case of 43 year old male patient with torsades de pointes induced by first-generation antihistamine, hydroxyzine and treated successfully with drug cessation, MgSO
Adult ; Astemizole ; Drug Overdose ; Histamine Antagonists ; Humans ; Hydroxyzine* ; Isoproterenol ; Liver Diseases ; Male ; Tachycardia, Ventricular ; Terfenadine ; Torsades de Pointes*

Acute spontaneous subdural hematoma (SDH) of arterial origin is very rare. We report a case of acute spontaneous SDH that showed contrast media extravasation from cortical artery on angiograms. A 58-year-old male patient developed sudden onset headache and right hemiparesis. Brain CT scan demonstrated acute SDH at left convexity. The patient was drowsy mentality on admission. He had no history of head trauma. Cerebral angiography was performed and revealed a localized extravasation of the contrast media from distal cortical MCA branch. After angiography, the patient deteriorated to comatose mentality. Decompressive craniectomy for removal of SDH was performed. We verified the arterial origin of the bleeding and coagulated the bleeding focus. The histological diagnosis was aneurysmal artery. He recovered after surgery with mild disability. In a case of acute spontaneous SDH, the possibility of a cortical artery origin should be considered.
Aneurysm ; Angiography ; Arteries ; Brain ; Cerebral Angiography ; Coma ; Contrast Media ; Craniocerebral Trauma ; Decompressive Craniectomy ; Extravasation of Diagnostic and Therapeutic Materials ; Headache ; Hematoma, Subdural ; Hematoma, Subdural, Acute ; Hemorrhage ; Humans ; Male ; Middle Aged ; Paresis

A 31-year-old man was admitted to our hospital due to hydrocephalus with neurosarcoidosis. Ventriculo-peritoneal shunting was performed in the right lateral ventricle with intravenous methylprednisolone. Subsequently, after 4 months, additional ventriculo-peritoneal shunting in the left lateral ventricle was performed due to the enlarged left lateral ventricle and slit-like right lateral ventricle. After 6 months, he was re-admitted due to upward gaze palsy, and magnetic resonance image showed an isolated fourth ventricle with both the inlet and outlet of fourth ventricle obstructed by recurrent neurosarcoidosis. Owing to the difficulty of using an endoscope, we performed neuronavigator-guided ventriculo-peritoneal shunting via the left lateral transcerebellar approach for the treatment of the isolated fourth ventricle with intravenous methyl prednisolone. The patient was discharged with improved neurological status.
Adult ; Bays ; Central Nervous System Diseases ; Endoscopes ; Fourth Ventricle ; Humans ; Hydrocephalus ; Lateral Ventricles ; Magnetic Resonance Spectroscopy ; Methylprednisolone ; Paralysis ; Prednisolone ; Sarcoidosis ; Ventriculoperitoneal Shunt

No abstract available.
Cardioplegic Solutions* ; Ischemia*