PURPOSE: The corneal change induced by refractive procedures influence both the postoperative refractive status and the ocular spherical aberration (SA). We evaluated changes in corneal SA after three types of surface ablation: phototherapeutic keratectomy (PTK), myopic photorefractive keratectomy (PRK), and myopic wavefront-guided laser epithelial keratomileusis (LASEK). METHODS: Twenty-six eyes (25 patients) were subjected to PTK 26 eyes (14 patients) to PRK, and 34 eyes (17 patients) to wavefront-guided LASEK. Corneal SA was measured with the iTrace in all patients both preoperatively and 6 months postoperatively. RESULTS: Six months after surgery, mean corneal SA was -0.173 +/- 0.171 micrometer in the PTK group, 0.672 +/- 0.200 micrometer in the PRK group, and 0.143 +/- 0.136 micrometer in the wavefront-guided LASEK group. The mean difference between the preoperative and postoperative corneal SA (DeltaSA) was -0.475 micrometer in the PTK group, 0.402 micrometer in the PRK group, and -0.143 micrometer in the wavefront-guided LASEK group. CONCLUSIONS: Surgically induced changes in corneal SA vary with procedure. The prediction of the pattern of SA change induced by various surface ablation procedures may be helpful for developing future surgical procedures.
Adult ; Aged ; Corneal Dystrophies, Hereditary/*surgery ; Corneal Wavefront Aberration/*surgery ; Female ; Follow-Up Studies ; Humans ; Keratomileusis, Laser In Situ/*methods ; Male ; Middle Aged ; Myopia/*surgery ; Photorefractive Keratectomy/*methods ; Prospective Studies ; Treatment Outcome

PURPOSE: The corneal change induced by refractive procedures influence both the postoperative refractive status and the ocular spherical aberration (SA). We evaluated changes in corneal SA after three types of surface ablation: phototherapeutic keratectomy (PTK), myopic photorefractive keratectomy (PRK), and myopic wavefront-guided laser epithelial keratomileusis (LASEK). METHODS: Twenty-six eyes (25 patients) were subjected to PTK 26 eyes (14 patients) to PRK, and 34 eyes (17 patients) to wavefront-guided LASEK. Corneal SA was measured with the iTrace in all patients both preoperatively and 6 months postoperatively. RESULTS: Six months after surgery, mean corneal SA was -0.173 +/- 0.171 micrometer in the PTK group, 0.672 +/- 0.200 micrometer in the PRK group, and 0.143 +/- 0.136 micrometer in the wavefront-guided LASEK group. The mean difference between the preoperative and postoperative corneal SA (DeltaSA) was -0.475 micrometer in the PTK group, 0.402 micrometer in the PRK group, and -0.143 micrometer in the wavefront-guided LASEK group. CONCLUSIONS: Surgically induced changes in corneal SA vary with procedure. The prediction of the pattern of SA change induced by various surface ablation procedures may be helpful for developing future surgical procedures.
Adult ; Aged ; Corneal Dystrophies, Hereditary/*surgery ; Corneal Wavefront Aberration/*surgery ; Female ; Follow-Up Studies ; Humans ; Keratomileusis, Laser In Situ/*methods ; Male ; Middle Aged ; Myopia/*surgery ; Photorefractive Keratectomy/*methods ; Prospective Studies ; Treatment Outcome

No abstract available.
Humans ; Thrombocytosis

PURPOSE: To predict the accuracy of preoperative refractive error measurement methods in wavefront-guided laser-assisted subepithelial keratectomy (LASEK) surgery and to formulate a nomogram for satisfactory surgical results. METHODS: The medical records of 30 patients (57 eyes) who had undergone wavefront-guided LASEK were reviewed. The ideal surgical ablation amount was defined as the sum of the real surgical ablation amount and the remaining refractive errors. Comparison between the ideal surgical ablation amount and preoperative refractive errors was made using autorefraction, manifest refraction, cycloplegic refraction, postcycloplegic refraction, wavescan, and iTrace aberrometer measurements. RESULTS: The refractive errors measured by the postcycloplegic refraction showed the closest relation with the ideal surgical amount, and the nomogram based on this refraction correlated statistically significantly with the ideal surgical ablation amount. The refractive error using the wavescan also showed more accurate refractive measurements than the autorefractor and iTrace aberrometer. CONCLUSIONS: Accurate manifest refraction immediately before surgery is the most important in determining the ablation amount. Additionally, the refractive errors measured with the wavescan, which is an aberrometer used for wavefront-guided LASEK, showed a minimal amount of errors. After reviewing the results, the nomogram based on these 2 methods can be concluded to possibly contribute to an increase in the accuracy of surgery.
Humans ; Keratectomy, Subepithelial, Laser-Assisted ; Medical Records ; Nomograms ; Refractive Errors

The present study was designed to observe the expression patterns of NF-kappa B and AP-1, redox-sensitive transcription factors, and Bcl-2 and Bax, apoptosis repressing and promoting factors, respectively, upon repetitive cycles of short ischemia and reperfusion. Nine and thirty five weeks old Sprague-Dawley rats were subjected to the 3, 6, and 10 cycles of the ischemic process for 5 minutes followed by reperfusion for 5 minutes. The rats were divided by 5 groups, according to the time after treatment, such as 0, 3, 6, 24 and 72 hours. For short ischemia and reperfusion, left common iliac artery was occluded 3, 6, and 10 times for 5 minutes of ischemia followed by 5 minutes of reperfusion using rodent vascular clamps and left rectus femoris muscles were removed. The expression profiles and distribution of NF-kappa B, AP-1, Bcl-2, and Bax which were observed using immunohistochemical staining methods with 6 microgram thick paraffin sections of the rectus femoris tissue were as follows: The distribution of NF-kappa B was increased as the cycles of ischemia and reperfusion increased up to 3 hours after treatment. This phenomenon was prominent in 35 weeks-old rats. The distribution of AP-1 was increased as the cycles of ischemia and reperfusion increased up to 3 hours after treatment. This phenomenon was prominent in 9 weeks-old rats. The distribution of Bcl-2 was decreased as the cycles of ischemia and reperfusion increased up to 3 hours after treatment. The extent of such reduction was more prominent in 35 weeks-old rats than 9 weeks-old rats. The distribution of Bax was increased as the cycles of ischemia and reperfusion increased up to 3 hours after treatment. After 3 hours of treatment, Bax positivity was gradually decreased in 9 weeks-old rats, but increased in 35 weeks-old rats to reach a peak at 24 hour after reperfusion. The extent of enhancement in 9 weeks-old rats was higher than that in 35 weeks-old rats. In summary, multiple episodes of short ischemia and reperfusion altered the expression profiles of NF-kappa B, AP-1, Bcl-2, and Bax in the rectus femoris muscle at the similar extents in 9 and 35 weeks-old rats. Such alterations were more more increased when the episodes were more repeated.
Animals ; Apoptosis ; Iliac Artery ; Ischemia* ; Muscles* ; NF-kappa B* ; Paraffin ; Quadriceps Muscle* ; Rats* ; Rats, Sprague-Dawley ; Reperfusion* ; Rodentia ; Transcription Factor AP-1* ; Transcription Factors

Amyloidosis is not a single disease entity but a term applied to a complex of disorders associated with deposition of insoluble fibrillar proteins in virtually pure form in various tissues of the body. This disease is encountered sometimes in America or Europe, but rarely in Korea. We had experienced one case of primary cardiac amyloidosis who was admitted to Won Kwang University Hospital due to dyspnea on exertion. This cardiac amyloidosis was confirmed by echocardiogram and endomyocardial biopsy with congo-red stain. We will report a case and review the pertinent medical literature.
Americas ; Amyloidosis* ; Biopsy ; Cardiomyopathies ; Dyspnea ; Europe ; Korea

Primary pericardial sarcomas are extremely rare. The authors report a case of a 46-yr-old woman in whom a large mediastinal mass was discovered. The patient presented with cough, dyspnea, and orthopnea. Diagnostic investigations, such as echocardiography, computed tomography, and exploratory thoracotomy provided the evidence of a large mass in the mediastinum, attached by a broad base to the superior portion of the pericardium. A excisional biopsy was performed, and histologic examination of a biopsy specimen showed undifferentiated sarcoma. However, the complete removal of the mass was impossible due to adhesion to the adjacent great vessels. After the completion of the chemotherapy the patient was completely asymptomatic. However, follow-up transesophageal echocardiography showed a residual 3x4 cm-sized mass. The patient received the radiotherapy with a total dose of 55 Gy over 6 weeks. At present, there is no evidence of disease progression.
Biopsy ; Cough ; Disease Progression ; Dyspnea ; Echocardiography ; Female ; Human ; Mediastinal Neoplasms/*diagnosis/radiography ; Middle Aged ; Prognosis ; Sarcoma/*diagnosis/radiography ; Tomography, X-Ray Computed

BACKGROUND: Adequate depth of anesthesia requires a sufficient amount of the agent to secure unconsciousness and other components of anesthesia as needed for that particular surgical procedure, without jeopardizing vital organ functions. To evaluate the relationship of depth of anesthesia to EEG, we studied the effects of increasing minimum alveolar concentration (MAC) of isoflurane (arousal, 1, 1.3, 1.5 MAC) on power spectral analysis of the EEG. METHODS: To determine 1 MAC, we studied sixty patients undergoing general anesthesia who were randomly allocated to receive isoflurane at several predetermined end-tidal concentration. A minimum of 15 min was allowed between induction and skin incision to allow steady state condition. Patients were observed for gross purposeful movement for 60 seconds after incision. The MAC was calculated using maximum likelihood solution to a logistic regression model. Another forty patients were randomly allocated to have their EEGs recorded. General anesthesia was induced with oxygen and isoflurane only. After loss of consciousness, succinylcholine 1.5 mg/kg was given and intubation followed. The EEG was recorded awake and after 15 min at steady state conditions of 1, 1.3 and 1.5 MAC isoflurane had been achieved. Spectral edge frequency 95% (SEF95), median spectral frequency (MSF), total power (TP) and relative power in the delta, theta, alpha and beta band were calculated. RESULTS: The MAC of isoflurane was 1.21 vol% (20 - 40 years) and 1.09 vol% (40 - 60 years). The distribution of spectral EEG indices of the EEGs were established and compared. The threshold value of SEF95 14 Hz to differentiate between arousal and 1.3 and 1.5 MAC had a sensitivity of 60.5% (1.3 MAC), 71% (1.5 MAC) and specificity of 74.4% (1.3 and 1.5 MAC) and that of MSF 5 Hz had a sensitivity of 71% (1.3 MAC), 81.5% (1.5 MAC) and specificity of 48% (1.3 MAC), 48.8% (1.5 MAC). CONCLUSIONS: With regard to the dose-related decrease in SEF95 and MSF under increasing end- expiratory concentrations of isoflurane as described in the present study, future studies may have todetermine whether EEG feedback control of volatile anesthetic administration may be used successfully. It seems that if neglected parts by MSF and SEF95, which are really true values are considered in the future studies, those would increase the sensitivity and specificity of EEG could be used as tool for determining depth of anesthesia.
Anesthesia ; Anesthesia, General ; Arousal ; Electroencephalography* ; Humans ; Intubation ; Isoflurane* ; Logistic Models ; Neurofeedback ; Oxygen ; Sensitivity and Specificity ; Skin ; Succinylcholine ; Unconsciousness

BACKGROUND: Postoperative hypothermia and shivering is a frequent event in patients during cesarean section under spinal anesthesia. We assessed the effect of preoperative warming during cesarean delivery under spinal anesthesia for prevention of hypothermia and shivering. METHODS: Forty five patients undergoing elective cesarean section were randomly assigned to three groups. Group F received warmed intravenous fluid (40degrees C). Group A patients were actively warmed by forced air-warming. Group C was the control group. Forced air-warming and warmed fluid was maintained for the 15 min preceding spinal anesthesia. Core temperature (tympanic membrane) and the skin temperature of arm and thigh were measured and shivering was graded simultaneously. RESULTS: The core temperature at 45 min decreased less in Groups F and A than Group C (-0.5degrees C +/- 0.3degrees C vs -0.6degrees C +/- 0.4degrees C vs -0.9degrees C +/- 0.4degrees C, respectively; P = 0.004). The arm temperature at 15 min and 30 min exhibited a greater increase in Group A than Group F and Group C (P = 0.001 and P = 0.012, respectively). Leg temperature increased similarly among the three groups. The incidence of shivering was significantly less in Group A and Group F than Group C (20%, 13.3%, and 53.3%, respectively; P = 0.035). CONCLUSIONS: Preoperative forced air-warming and warmed fluid prevents hypothermia and shivering in patients undergoing elective cesarean delivery with spinal anesthesia.
Anesthesia, Spinal ; Arm ; Cesarean Section ; Female ; Humans ; Hypothermia ; Incidence ; Leg ; Pregnancy ; Shivering ; Skin Temperature ; Thigh

PURPOSE: To evaluate the efficacy of 0.05% cyclosporine A on tear film parameters and corneal aberration after cataract surgery. METHODS: Patients who underwent cataract surgery were divided into 2 groups. Patients in Group I (23 eyes) were treated with cyclosporine A from 1 week before surgery to 3 months after surgery. Patients in Group II (24 eyes) underwent surgery without cyclosporine treatment. Tear film break-up time (BUT), Schirmer's test I, Oxford scheme, Ocular surface disease index (OSDI), and corneal aberrations were evaluated before surgery and at 1 and 3 months after surgery. RESULTS: In Group I, BUT was significantly improved at 3 months (p = 0.026) after surgery compared with the preoperative value. OSDI decreased significantly at 1 (p = 0.033) and 3 months (p = 0.003) after surgery compared with the preoperative value. However, there were no significant differences between preoperative and postoperative values of BUT and OSDI in Group II. Schirmer's test results and the Oxford scheme were not significantly changed in either group. Preoperative root mean square (RMS) total values were not different between the 2 groups, but was different at postoperative 3 months (p = 0.015). Group I had a significantly lower value for total RMS than Group II. In Group I, Coma 7 (Z3(-1)) (p = 0.018) and spherical aberration (Z4(0)) (p = 0.031) were significantly decreased after surgery. In Group II, Trefoil 6 (Z3(-3)) (p = 0.033) was significantly increased after surgery. CONCLUSIONS: 0.05% cyclosporine A may be effective for improving dry eye syndrome and corneal aberration after cataract surgery.
Cataract* ; Coma ; Cyclosporine* ; Dry Eye Syndromes ; Humans ; Lotus ; Tears*