Missing data such as appropriateness ratings in clinical research are a common problem and this often yields a biased result. This paper aims to introduce the multiple imputation method to handle missing data in clinical research and to suggest that the multiple imputation technique can give more accurate estimates than those of a complete-case analysis. The idea of multiple imputation is that each missing value is replaced with more than one plausible value. The appropriateness method was developed as a pragmatic solution to problem of trying to assess "appropriate" surgical and medical procedures for patients. Cataract surgery was selected as one of four procedures that were evaluated as a part of the Clinical Appropriateness Initiative. We created mild to high missing rates of 10%, 30% and 50% and compared the performance of logistic regression in cataract surgery. We treated the coefficients in the original data as true parameters and compared them with the other results. In the mild missing rate (10%), the deviation from the true coefficients was quite small and ignorable. After removing the missing data, the complete-case analysis did not reveal any serious bias. However, as the missing rate increased, the bias was not ignorable and it distorted the result. This simulation study suggests that a multiple imputation technique can give more accurate estimates than those of a complete-case analysis, especially for moderate to high missing rates (30 - 50%). In addition, the multiple imputation technique yields better accuracy than a single imputation technique. Therefore, multiple imputation is useful and efficient for a situation in clinical research where there is large amounts of missing data.
Cataract Extraction/*methods ; Humans ; Logistic Models ; Research Support, Non-U.S. Gov't

The preoperative diagnosis of the masked bilateral superior oblique palsy (SOP) is very diffcult, so the clinical manifestation is very important. We studied to determine diagonostic criteria of the masked bilateral SOP. Among 24 patients. who were diagnosed as unilateral SOP preoperatively, 5 patients developed postoperative masked bilateral SOP. 2 patients had been diagnosed masked bilateral SOP preoperatively. We compared 17 cases of unilateral SOP with seven cases of masked bilateral SOP about V-shift, head tilt test and the degree of excyclotorsion. The mean V-shift of the masked SOP patients was 5.3PD and that of the unilateral SOP patients was 1.5PD(p=0.09). The mean excyclotosion difference between the primary position and downgaze was 9.7 degree in masked cases and 2.6 degree in unilateral ones respectively (p=0.35). The mean difference of hyperdeviation the right versus the left tilted head position was 22PD in masked cases and 18.1PD in unilateral ones (p=0.35). The cases of excyclotorsion difference over 5 degrees between primary and downgaze were five(71%) in masked cases but none in unilateral cases(p=0.0001). So above finding may be strongly suggested as diagnosing the masked bilteral SOP.
Diagnosis* ; Head ; Humans ; Masks* ; Paralysis*

Infantile fibrosarcoma is a rare malignant soft tissue tumor occurring especially in newborn and young children under 2 years. We experienced three cases of infantile fibrosarcoma presenting in the neonatal period. Case 1 presented with a multiseptated cystic mass on his left thigh at birth that was diagnosed as lymphangioma. After picibanil injection, we noted the size of the mass doubled and a solid lesion was prominent in the magnetic resonance image. Case 2 was found to have a reddish mass on his lower back mimicking hemangioma. Over 2 weeks, the mass grew rapidly with internal hemorrhaging. Case 3 was noted to have an encircling mass around the splenic flexure, which developed into congenital bowel obstruction. All of the tumors were resected completely, but microscopic resection margin was not clear in two patients. The two patients received adjuvant chemotherapy and all patients are well without evidence of recurrence.
Chemotherapy, Adjuvant ; Child ; Colon, Transverse ; Fibrosarcoma ; Hemangioma ; Humans ; Infant, Newborn ; Lymphangioma ; Magnetic Resonance Spectroscopy ; Parturition ; Picibanil ; Recurrence ; Thigh

No abstract available.
Anxiety* ; Depression*

No abstract available.
Angiofibroma* ; Carbon Dioxide* ; Carbon* ; Lasers, Gas* ; Sirolimus* ; Tuberous Sclerosis*

In third nerve palsy, the functions in the four of the six extraocular muscles are compromised and its treatment is the most difficult problem in the paralytic strabismus. In surgical method, large recession and resection of horizontal rectus muscles, lateral rectus muscle transposition to medial rectus muscle and superior oblique muscle transposition are used for strabismus surgery on oculomotor nerve palsied eye. We compared the results of two methods of surgical correction. In three eyes, lateral muscle transpositions to medial rectus muscle were performed. On the last follow up examination (men; 6.7 months), two eyes resulted in severe hypertropia and unacceptable ocular alignment and no improvement of limited adduction. In six eyes of whom superior oblique muscle transpositions were performed, all resulted in acceptable ocular alignment, no hypertropia, and the limitations of adduction were improved markedly. Therefore, in the treatment of third nerve palsy, sperior oblique muscle transposition is more effective than lareral rectus muscle transposition to medial rectus muscle.
Exotropia* ; Follow-Up Studies ; Muscles ; Oculomotor Nerve Diseases* ; Oculomotor Nerve* ; Strabismus

BACKGROUND: Normal renal function and health have been recognized as important factors in living donors after kidney donation. The purpose of this study was to evaluate the health status and health-promoting lifestyle in living donors after kidney donation. METHODS: A total of 678 living-kidney donors were counted in our center from January 1990 to December 2011. Only 84 donors agreed to participate in the survey by telephone. We received consent for participation in our survey from 48 donors (57.1%). Data were collected from May to August 2013 using donor characteristics, health status, and Health Promoting Lifestyle Profile I (HPLP-I). RESULTS: The donors were predominantly female (62.5%) and the average age was 48.9+/-11.8 years, and the average period after nephrectomy was 9.7+/-5.7 years. The characteristics of donors included ideal body weight (37.5%), overweight (37.5%) in body mass index, and good health status (81.3%). Most donors underwent an annual medical check-up (56.2%), no health problem (81.3%), and no disease (64.6%). However, one patient was treated with dialysis for renal failure due to diabetes. The total average score for HPLP-I was 128.3+/-13.9. Higher than average scores (116.3+/-19.1) were observed for the general middle-aged woman. There were statistically significant differences in self-realization and nutrition in subsection of HPLP-I. Self-realization showed a higher score for Christian (F=2.743, P=0.041) and good health (F=3.389, P=0.017). Nutrition showed a higher score for overweight, obesity (F=6.783, P=0.000), and older than 60 (F=3.854, P=0.009). CONCLUSIONS: Most living kidney donors were healthy after their donation and had relatively high scores for health-promoting lifestyle. However, one patient had a serious health problem. In addition, younger, longer period after donation, and the rare health examination of donors showed a lower health-promoting lifestyle. Designed and continuous health-care management after transplantation is needed for kidney donors.
Body Mass Index ; Dialysis ; Female ; Humans ; Ideal Body Weight ; Kidney Transplantation ; Kidney* ; Life Style* ; Living Donors* ; Nephrectomy ; Obesity ; Overweight ; Renal Insufficiency ; Telephone ; Tissue Donors

Pain relief becomes a major concern when treating patients with rib fractures so adequate ventilation must be maintained. Many techniques have been described for the management of frectured ribs, including systemic analgesics, intercostal nerve blockade, intrathecal morphine, epidural bupivacaine and epidural morphine. This case report illustrates the successful use of epidural narcotics in a patient with multiple fractured ribs.
Analgesics ; Bupivacaine ; Humans ; Intercostal Nerves ; Morphine ; Narcotics* ; Rib Fractures ; Ribs* ; Ventilation

The popular term malignant hyperthermia syndrome (MHS) refers to a clinical syndrome classically observed during general anesthesia. It is characterized by a rapidly increasing .temperature and a high mortality rate. A case of MHS was experienced which developed 60 minutes after induction of general anesthesia with thiopental sodium, succinylcholine, halothane, N2O and 02. High fever, muscle rigidity and cyanosis developed and were followed by arrythmia and unstable blood pressure. Anesthesia was terminated and vigorous emergency treatment was attempted. The patient died about 6 hours after induction of anesthesia.
Anesthesia ; Anesthesia, General ; Arrhythmias, Cardiac ; Blood Pressure ; Cyanosis ; Emergency Treatment ; Fever ; Halothane ; Humans ; Malignant Hyperthermia* ; Mortality ; Muscle Rigidity ; Succinylcholine ; Thiopental

No abstract available.