PURPOSE: To study the relation between the progression of glaucoma and the expression of zone beta in primary open-angle glaucoma (POAG) and normal-tension glaucoma (NTG). METHODS: One hundred thirty eyes with POAG and 62 with NTG were enrolled in this study. We classified them based on the expression of zone beta and compared their optic nerve head parameters. We looked for changes in optic nerve head parameters depending on the expression of zone beta in patients who received HRT at least 1 year previously, and whose maximal intraocular pressure (IOP) during the follow-up periods was controlled under 21 mmHg. RESULTS: In the POAG patients, the group with zone beta had significantly larger cup-to-disc (C/D) ratio, and significantly smaller neural rim area and volume, than the group without zone beta. In the NTG patients optic nerve head parameters did not show statistically significant difference. Compared with the previous values, C/D ratio, neural rim area and volume showed significant progression in POAG with zone beta, but did not show significant change in POAG without zone beta and in NTG. CONCLUSIONS: In POAG, the expression of zone beta was associated with more severe optic nerve damage and faster progression than in patients without zone beta. In NTG, the expression of zone beta was not associated with significant changes in the optic nerve shape or the progression of glaucoma.
Atrophy* ; Follow-Up Studies ; Glaucoma* ; Glaucoma, Open-Angle* ; Humans ; Intraocular Pressure ; Optic Disk ; Optic Nerve

Recently, the incidence of revision total hip arthroplasty following primary total hip arthroplasty has increased. However, revision after primary total hip arthroplasty is usually much more difficult than the first time, and the results are typically not as satisfactory as that after most primary total hip arthroplasty procedures. Therefore, thoughtful and thorough preoperative planning will certainly provides the patient with the best opportunity for long-term success. In particular, location and size of acetabular bone defects dictate the type of acetabular component in revision in total hip arthroplasty. For most defects, a porous-coated hemispherical shell secured to host bone with multiple screws is the implant of choice. This reconstruction is feasible provided that at least 50% of the implant is in contact with host bone. When such contact is not possible, and there is adequate medial and peripheral bone, techniques using alternative uncemented implants can be used for acetabular reconstruction. Defects with greater bone loss or compromised columns require the use of either modular augments combined with a hemispherical shell, reconstruction cages, structural allografts, or impaction allograft. Therefore, we attempt to introduce the most commonly-adopted system for classification of acetabular defects and the necessary preoperative evaluation, intraoperative detail, and reported results of these acetabular revisions.
Arthroplasty ; Hip ; Humans ; Incidence ; Transplantation, Homologous

PURPOSE: The purpose of this study is to evaluate the clinical and radiological results of the trochanteric flip osteotomy in cases of femoral head fractures. MATERIALS AND METHODS: Between May 2000 and January 2012, we evaluated 14 cases of femoral head fractures treated by trochanteric flip osteotomy in combination with the Kocher-Langenbeck approach after a minimum follow-up of one year. There were 13 men and one woman and the average follow-up period was 36.4 months. The clinical results were evaluated according to Merle d'Aubigne-Postel scores and the Thompson-Epstein scoring scale and the radiological results were evaluated according to time to union of fractures and osteotomy site. We also evaluated the incidence of complications. RESULTS: At the last follow-up, mean Merle d'Aubigne-Postel score was 16.4 and 11 cases out of 14 patients presented with good to excellent, two cases presented with fair, and one case presented with a poor clinical result according to the Thompson-Epstein scoring scale. Radiologically all cases achieved union of fractures and osteotomy site and the mean time to union of the osteotomy site was 7.9 weeks. Complications included one case of heterotopic ossification which did not disturb hip function, two cases of avascular necrosis of the femoral head, and one case of post-traumatic osteoarthritis. CONCLUSION: The trochanteric flip osteotomy in the case of a femoral head fracture showed good clinical and radiological results through good visualization and accurate reduction of the fracture site. However, conduct of further studies including larger number of patients is needed in order to evaluate the incidence of complications such as avascular necrosis of the femoral head.
Female ; Femur ; Femur Head ; Follow-Up Studies ; Head ; Hip ; Humans ; Incidence ; Male ; Necrosis ; Ossification, Heterotopic ; Osteotomy

Background: Soft tissue fillers are increasingly used to rejuvenate and beautify the body and face. Unknown foreign materials that have not always been proven to be safe for human use have been used for injections in the past. Various commercial injectable materials have since been developed and are used; however, the number of complications has increased as soft tissue fillers have increased in use. Methods: A retrospective study of 39 patients with facial foreign body complications who underwent surgical treatment between March 2012 and February 2021 was conducted. Patient information was analyzed, and patient satisfaction was evaluated using a questionnaire after surgical treatment. A comparative statistical analysis was undertaken. Results: Patients who underwent procedures performed by unlicensed practitioners tended to be older at the time of presenting to the hospital (P=0.004). The degree of satisfaction after surgical repair was significantly lower following the direct approach than after the indirect approach using a bypass incision (P=0.044). The degree of satisfaction significantly decreased (P=0.001) as the number of operations the patient received increased. Conclusions When treating complications caused by foreign material injections, surgical removal is a more reliable method than treatment with medication or further injections; however, treatment decisions should be made thoughtfully, and many factors must be considered. Patient satisfaction can be improved by reducing the number of operations and making the appropriate corresponding incisions or excisions to treat the full range of symptoms caused by foreign substances and by indirectly using bypass incisions to mitigate post-surgery scars.

Background: Posttraumatic acquired facial deformities require surgical treatment, with optionsincluding scar revision, fat grafts, implant insertion, and flap coverage. However, each techniquehas specific advantages and disadvantages. Methods: From 2016 to 2018, 13 patients (eight with scar contracture and five with a depressedscar) were treated using dermofat grafts from the groin. The harvested dermofat was then insertedinto the undermined dead space after the contracture was released, and a bolster suture wasdone for fixation considering the patient’s contour and asymmetry. A modified version of the VancouverScar Scale and satisfaction survey were used to compare deformity improvements beforeand after surgery. Results: In most cases, effective volume correction and an aesthetically satisfactory contourwere maintained well after dermofat grafting, without any major complications. In some cases,however, lipolysis proceeded rapidly when inflammation and infection were not completely eliminated.A significant difference was found in the modified Vancouver Scar Scale before and aftersurgery, with a p-value of 0.001. The average score on the satisfaction survey was 17.07 out of 20points. Conclusion A dermofat graft with the groin as the donor site can be considered as an effectivesurgical option that is the simplest and most cost-effective method for the treatment of acquiredfacial deformities with scar contracture.

Background: It is difficult to completely fix nasal bone fractures with closed reduction, as it is often accompanied by septal cartilage damage, and this often results in postoperative secondary deformities. Thus, patients are often reluctant to undergo closed reduction surgery. The present study aimed to evaluate aesthetic and functional satisfaction, as well as satisfaction with and complications of closed reduction, according to nasal bone fracture type. Methods: The subjects were patients who underwent closed reduction under general anesthesia from January 2017 to December 2018. Based on the modified Murray classification, patients were classified into five groups according to the fracture site, septal fracture, and deviation. A total of 211 patients were sent a web-based survey on postoperative satisfaction and complications, as well as intention for revision and cosmetic surgery. Sixty-one patients (28.9%) responded. Results: There were no significant differences in aesthetic and functional satisfaction or satisfaction with closed reduction according to the fracture type, site, or severity. Postoperative functional complications developed in 14 of 61 patients (22.95%). With 10 out of 24 (41.67%) patients (p = 0.044), the bilateral fracture with septal fracture or prominent septal deviation type had a higher incidence of complications than the other types. Conclusion The incidence of complications is higher for bilateral fracture with septal fracture or prominent septal deviation compared to the other nasal bone fracture types. Therefore, long-term follow-up after closed reduction surgery for this fracture type can aid in establishing additional postoperative treatment plans and improving patient satisfaction.

Fever (body temperature above 38℃) is relatively common during the first few days after general anesthesia. Postoperative fever is usually caused by the inflammation induced by surgery and resolves spontaneously; however, it can be a manifestation of a serious complication such as malignant hyperthermia. We report a case of postoperative hyperthermia (body temperature > 40℃) that was refractory to conventional anti-pyretic measures and finally resolved with dantrolene administration.
Anesthesia, General* ; Dantrolene* ; Fever ; Humans ; Inflammation ; Malignant Hyperthermia* ; Postoperative Period

PURPOSE: Factors related to nonurologic postoperative complications of laparoscopic surgery in the urologic area were examined. The most significant factors were isolated and analyzed to establish ways to reduce the complication rate. MATERIALS AND METHODS: The medical records of 154 patients who had undergone laparoscopic surgery between March 2004 and March 2008 were reviewed. Age, anesthetic time, American Society of Anesthesiologists physical status classification, operative difficulty, blood loss (ml), body mass index (BMI), and complications were assessed. Complications were divided into 5 groups based on the modified Clavien classification. Grade 0 to 1 was defined as a no complication group and grades 2 to 5 as a complication group. The Armitage trend test was performed to study the relations between the factors and the complications. Univariate and multivariate analyses were performed to determine the risk ratio of each of the factors and the most significant factors. RESULTS: Complications tended to increase as the anesthetic risk and anesthetic time increased (p=0.011, 0.013, respectively). Operative difficulty and blood loss were related to complications (p=0.018, p<0.001, respectively). The univariate analysis revealed that blood loss of more than 400 ml compared with less than 200 ml had a risk ratio of 18.2. Moderate and hard operative difficulties had a significant risk ratio of around 4, and high anesthetic risk had a high risk rate of around 5. The multivariate analysis showed that blood loss and high anesthetic risk were independent risk factors of complications. CONCLUSIONS: Blood loss and high anesthetic risk proved to be independent factors that are associated with complications. Surgeons must keep in mind the patient's anesthetic risk and try to minimize blood loss during the operation to reduce complications after a laparoscopic surgery.
Body Mass Index ; Humans ; Laparoscopy ; Medical Records ; Multivariate Analysis ; Odds Ratio ; Postoperative Complications ; Risk Factors ; Urology

Malignant hyperthermia (MH) may lead to metabolic crisis of skeletal muscle in susceptible individuals following exposure to triggering agents such as volatile anesthetics or depolarizing muscle relaxants. MH is a rare and a potentially lethal disease, which can lead to cardiac arrest. We report a case of severe MH, in which the rapidly evolving signs of hypermetabolism eventually resulted in cardiac arrest. Despite conventional treatments following cardiopulmonary resuscitation, the patient's vital signs did not improve. Therefore, we applied extracorporeal membrane oxygenation for providing hemodynamic support.
Anesthetics ; Cardiopulmonary Resuscitation* ; Dantrolene ; Extracorporeal Membrane Oxygenation* ; Heart Arrest* ; Hemodynamics ; Humans ; Malignant Hyperthermia* ; Muscle, Skeletal ; Neuromuscular Depolarizing Agents ; Vital Signs

BACKGROUND: Patients who undergo urinary catheterization may experience postoperative catheter-related bladder discomfort (CRBD). Previous studies have indicated that drugs with antimuscarinic effects could reduce the incidence and severity of CRBD. Accordingly, this study was carried out to investigate whether nefopam, a centrally acting analgesic with concomitant antimuscarinic effect, reduces the incidence and severity of CRBD. METHODS: Sixty patients with American Society of Anesthesiologists physical status I and II and aged 18–70 years who were scheduled to undergo elective ureteroscopic litholapaxy participated in this double-blinded study. Patients were divided into control and nefopam groups, comprising 30 patients each. In the nefopam group, 40 mg nefopam in 100 ml of 0.9% saline was administered intravenously. In the control group, only 100 ml of 0.9% saline was administered. All patients had a urethral catheter and ureter stent inserted during surgery. The incidence and severity of CRBD, numerical rating scale (NRS) score of postoperative pain, rescue pethidine dose, and side effects were recorded in the post-anesthesia care unit after surgery. RESULTS: The incidence (P = 0.020) and severity (P < 0.001) of CRBD were significantly different between the control group and the nefopam group. The NRS score of postoperative pain (P = 0.006) and rescue dose of pethidine (P < 0.001) were significantly higher in the control group than in the nefopam group. CONCLUSIONS: Intravenous administration of nefopam in patients scheduled to undergo ureteroscopic litholapaxy reduced the incidence and severity of CRBD, NRS score of postoperative pain and analgesic requirements.
Administration, Intravenous ; Humans ; Incidence ; Lithotripsy* ; Meperidine ; Nefopam* ; Pain, Postoperative ; Stents ; Ureter ; Ureteroscopy ; Urinary Bladder* ; Urinary Catheterization ; Urinary Catheters