PURPOSE: To study theeffect of micro incision (1.8 mm) and small incision (2.2 mm and 2.8 mm) coaxial phacoemulsification on surgically induced astigmatism (SIA) and high-order aberrations (HOA) of anterior and posterior corneal surface. METHODS: The present randomized clinical study included 32 eyes having a 1.8-mm, 38 eyes having a 2.2-mm, and 30 eyes having a 2.8-mm corneal incision. SIAs were measured at 1 and 3 months postoperatively. HOAs included coma, trefoil, and spherical aberration. The coma-root mean square (RMS) and trefoil-RMS were evaluated at 1 month after the cataract operation. RESULTS: Surgically induced astigmatisms were 0.41 +/- 0.30 diopter (D) in the 1.8-mm incision group, 0.47 +/- 0.21 D in 2.2-mm group and 0.71 +/- 0.50 D in the 2.8-mm group. The SIA of the 1.8-mm group was smaller than the other groups (p = 0.002). There was no statistically significant difference in coma, spherical aberration of the corneal anterior surface and trefoil, or spherical aberration of the posterior surface among the 3 groups at 1 month after surgery. CONCLUSIONS: Incision size contributes to postoperative corneal astigmatism. Phacoemulsification cataract surgery with less than 2.8-mm incision does not significantly influence the corneal aberrationsof anterior and posterior corneal surfaces.
Astigmatism ; Cataract ; Coma ; Eye ; Lotus ; Phacoemulsification

BACKGROUND: This study was designed to evaluate the effect of continuous intravenous infusion of esmolol on the heart rate and blood pressure, after ketamine induction and endotracheal intubation. METHODS: With informed consent, forty patients with ASA physical status 1 were randomly divided into two groups. Esmolol group received the continuous intravenous infusion of esmolol (at 500 microgram/kg/min for 1 minute as a loading dose and at 300 microgram/kg/min until 7 minutes after endotracheal intubation as a maintenance dose) and saline group received normal saline at the same volume-rate. 2 mg/kg of ketamine and 0.15 mg/kg of vecuronium were given at 4 minutes after the test drugs. Intubation was performed at 3 minutes after the induction. The changes of blood pressure, heart rate and rate pressure product were measured at different time intervals (preinduction, preintubation, immediately after intubation and postintubation 1, 3, 5 and 7minutes). RESULTS: In the esmolol group, the changes of systolic blood pressure, diastolic blood pressure, heart rate and rate pressure product were significantly attenuated when compared with the saline group. The changes in heart rate at preintubation and intubation were not statistically significant when compared with the baseline value within the esmolol group. CONCLUSIONS: It is concluded that the infusion of esmolol attenuated the hemodynamic changes following ketamine induction and endotracheal intubation, but it is still needed to find the dosage of esmolol.
Anesthetics ; Blood Pressure* ; Heart Rate* ; Heart* ; Hemodynamics ; Humans ; Informed Consent ; Infusions, Intravenous* ; Intubation ; Intubation, Intratracheal* ; Ketamine* ; Sympathetic Nervous System ; Vecuronium Bromide

Fibromatosis can occur at various sites, but intracranial fibromatosis is exceptionally rare. Here, we report a case of intracranial fibromatosis arising in the suprasellar area of a 52-year-old woman who had undergone a surgery at that site. A computed tomography scan revealed a heavily calcified, highly enhancing, poorly demarcated mass in the left sellar area that extended into the left suprasellar, parasellar areas, and orbital apex and completely encased the left distal inferior cerebral artery. Histologic and immunohistochemical features were compatible with those of fibromatosis, although the cellularity was focally higher than usual. The etiology of extra-abdominal fibromatosis is unknown, but physical injuries such as trauma and irradiation have been reported to be associated with its occurrence. Although fibromatosis is rare in the intracranial area, it should be considered as a differential diagnosis when an intracranial mass occurs at a previously injured site.
Central Nervous System ; Cerebral Arteries ; Diagnosis, Differential ; Female ; Fibroma ; Fibromatosis, Aggressive ; Humans ; Middle Aged ; Orbit ; Sella Turcica

Fibromatosis can occur at various sites, but intracranial fibromatosis is exceptionally rare. Here, we report a case of intracranial fibromatosis arising in the suprasellar area of a 52-year-old woman who had undergone a surgery at that site. A computed tomography scan revealed a heavily calcified, highly enhancing, poorly demarcated mass in the left sellar area that extended into the left suprasellar, parasellar areas, and orbital apex and completely encased the left distal inferior cerebral artery. Histologic and immunohistochemical features were compatible with those of fibromatosis, although the cellularity was focally higher than usual. The etiology of extra-abdominal fibromatosis is unknown, but physical injuries such as trauma and irradiation have been reported to be associated with its occurrence. Although fibromatosis is rare in the intracranial area, it should be considered as a differential diagnosis when an intracranial mass occurs at a previously injured site.
Central Nervous System ; Cerebral Arteries ; Diagnosis, Differential ; Female ; Fibroma ; Fibromatosis, Aggressive ; Humans ; Middle Aged ; Orbit ; Sella Turcica

Left ventricular false tendon, also called moderator bands, anomalous cords, accessory bands or false chordae tendinae, has been known as simple anatomical without clinical importance. But the possible relationship with Still's type murmur and ventricular arrhythmia were reported recently. The incidence of false tendon was known as 0.5-6.1% variably. In Korea, there are no reports about left ventricular false tendon till now. The authors examined 2,052 patients' echocaediograms and clinical manifestations retrospectively to find the incidence and potent clinical significance of false tendons. The incidence in present study was 1.02% and there was no specific relationship between false tendon and cardiovascular diseases. The authors observed Still's type musical murmur in 5 patients out of 21 and ventricular premature beats in 2 patients out of 10 without other cardiovascular diseases. One of them showed nonsustained ventricular tachycaedia during Holter ECG monitoring. The most frequent echocardiographic site of attachment was from basal inter-ventricular septum to lelft ventricular free wall and false tendon attached to papillary muscle was least frequently observed.
Arrhythmias, Cardiac ; Cardiac Complexes, Premature ; Cardiovascular Diseases ; Echocardiography ; Electrocardiography ; Humans ; Incidence ; Korea ; Music ; Papillary Muscles ; Retrospective Studies ; Tendons*

In 2008, Korea has enacted new ordinances about the role of estheticians, but this law can be interpreted ambiguously, restricting hiring of estheticians in medical clinics. The purpose of the study is to obtain information about medical-esthetic systems in other countries. We have taken a survey of this object from 30 OECD & Asian countries, and the questionnaires returned from a total of 22 countries (Australia, Austria, Canada, Denmark, Finland, France, Germany, Hungary, Japan, Netherlands, New Zealand, Norway, Portugal, Slovak Republic, Spain, Switzerland, Turkey, United Kingdom, United States, Singapore, Israel, and Thailand), were used for the final analysis. The results are summarized as follows. In most countries, estheticians working independently deal with only healthy, normal skin. In most countries, estheticians working independently have no right to operate any medical instruments. In all 17 countries that returned the questionnaires medical clinics can employ estheticians, and only theses estheticians who belong to the medical clinics can handle the non-invasive medical instruments under the supervision of doctors. In 17 countries that have related legal regulations, nurses, under the control of doctors, can perform wider range of duties in various settings than estheticians. The survey concludes that the duties of estheticians are closely related with medical skin care services and estheticians can perform various non-invasive medical procedures only under the control of doctors. From consulting a variety of medical-esthetic systems in other countries, we propose that the estheticians be allowed to work in medical clinics to provide better medical services for the patients and to make more chances of employment for themselves.
Asian Continental Ancestry Group ; Austria ; Canada ; Denmark ; Employment ; Finland ; France ; Germany ; Great Britain ; Humans ; Hungary ; Israel ; Japan ; Jurisprudence ; Korea ; Netherlands ; New Zealand ; Norway ; Organization and Administration ; Portugal ; Questionnaires ; Singapore ; Skin ; Skin Care ; Slovakia ; Social Control, Formal ; Spain ; Switzerland ; Turkey ; United States

Identification of patients with combined valvular prolapse has important clinical imlications, because such patients appear to be early surgical candidates. Detection of combined valvular prolapse became more feasible with development of 2-dimentional echocardiography and the incidence of combained mitral and valve prolapse is reported to be variable from 3% to 24%. The authors found a case of combined mitral and aortic valve prolapse detected by 2-dimensional echocardiography. This 30-years-old male patient who admitted because of peptic ulcer bleeding revealed a prolapse of anterior mitral leaflet with regurgitation and also a prolapse of the right coronary cusp into the left ventricular outflow tract but without evidence of aortic regurgutation by Doppler echocardiogram. he discharged without surgical intervention and needs further observation.
Aortic Valve Prolapse* ; Aortic Valve* ; Echocardiography ; Hemorrhage ; Humans ; Incidence ; Male ; Mitral Valve ; Peptic Ulcer ; Prolapse

No abstract available.
Cardiomyopathy, Dilated* ; Carnitine* ; Estrogens, Conjugated (USP)*

PURPOSE: To determine causative factors of persistent diplopia after local anesthesia for ophthalmic surgery. METHODS: Prism and alternate cover test in the diagnostic positions of gaze and ductions/versions testing were performed in 26 patients with persistent diplopia six months after local anesthesia. Lancaster test, Bielshowsky head tilt test, double Maddox rod test, funduscopic examination for torsion, forced duction test, force generation test, tensilon test, thyroid function test, and/or orbit CT were done when necessary. RESULTS: Most of the patients (24 patients, 92%) did not have diplopia before local anesthesia. Of the thirteen patients with strabismus resulting from trauma to extraocular muscles, eleven patients showed vertical rectus overaction (10 superior recti, 1 inferior rectus) and two patients, mild vertical rectus underaction. Eight patients were presumed to have sensory deviation. In the remaining patients, one patient had childhood esotropia and another, old superior oblique palsy. Three patients showed a small vertical deviation without any specific cause. CONCLUSIONS: Fifty percent of diplopia was related with the surgical trauma to extraocular muscles, in which overactions (42%) were more common than underactions (8%). Thirty-five percent of the patients were presumed to have sensory deviation, which suggested the importance of preoperative examination for strabismus as well as the explanation about the risk of postoperative diplopia before surgery.
Anesthesia, Local* ; Diplopia* ; Edrophonium ; Esotropia ; Head ; Humans ; Muscles ; Orbit ; Paralysis ; Strabismus ; Thyroid Function Tests

Subcutaneous emphysema is a complication of the pneumoperitoneum necessary to perform laparoscopy and will be seen more often as laparoscopic techniques are applied to a growing number of intraabdominal procedures. We report a case of subcutaneous emphysema and hypercarbia without pneumothorax or pneumomediastinum during laparoscopic cholecystectomy, which was treated by multiple puncture with 18G needle on emphysematous site. The suspected cause is inadvertent subcutaneous insufflation of carbon dioxide through the trocar sites by increased intra-abdominal pressure for the establishment of pneumoperitoneum. Immediate recognition, evaluation, and treatment of subcutaneous emphysema is necessary since this can be life-threatening complication.
Carbon Dioxide ; Cholecystectomy, Laparoscopic* ; Insufflation ; Laparoscopy ; Mediastinal Emphysema ; Needles ; Pneumoperitoneum ; Pneumothorax ; Punctures ; Subcutaneous Emphysema* ; Surgical Instruments