PURPOSE: We present our results in the reconstruction of medial orbital wall fractures using a transcaruncular approach. METHODS: Forty-five patients with isolated medial orbital wall fractures underwent reconstruction by transcaruncular approach in our clinic between May 2003 and October 2007, and were followed up for 6 months or more. RESULTS: Thirty-three males and 12 females were included in this study, with a mean age of 34.9 years. The most common indication for reconstruction were large sized fractures more than 50%. Operations were performed at a mean 11.9 days after trauma. Among 18 patients who had diplopia before the operation, 16 (89%) patients had symptom relief or improvement, and in the 2 patients where diplopia persisted, it did not in primary and down gaze and offered no difficulties in daily activities. Among 34 patients who had enophthalmos before the operation, most (n=30) of the patients had minimal enophthalmos not more than 2 mm, 4 patients had enophthalmos that exceeded 2 mm. CONCLUSIONS: Transcaruncular approach in reconstruction of isolated medial orbital wall fracture shows more satisfying functional and cosmetic results and can be preferred to isolated medial orbital wall fracture.
Cosmetics ; Diplopia ; Enophthalmos ; Female ; Humans ; Male ; Orbit

No abstract available.
Female ; Obstetric Labor, Premature* ; Pregnancy ; Ritodrine*

BACKGROUND: Apart from devaluing the basic skills of history taking and clinical examinations, the indiscriminate use of STAT tests is increasing in hospital practice. The purpose of this study is to evaluate the appropriateness of the STAT test requests in a tertiary care teaching university hospital. METHODS: We assessed the reasons for the STAT test requests on 644 patients (inpatients 338, emergency room patients 215, and outpatients 91), totaling 1,681 requests, during a 2 week period (between August 8 to 22, 1996) by discussing with the clinicians and nurses and/or reviewing the patient's records. RESULTS: Of 1,681 requests, 779 (46.3%) were considered inappropriate according to the criteria used to define categories. Inappropriate requests were detected in 45.1% (265/588) in wards, 49.0% (446/910) in the emergency room, and 37.2% (68/183) in the out patient department. The frequency of requests during the day showed two peaks: the first between 10 and 11 a.m., and the second between 3 and 4 p.m., which appears to indicate that the STAT tests are often requested for the convenience of the physician rather than true need of the patients. CONCLUSIONS: Many STAT tests are requested for reasons other than true emergencies. Inconsiderate, wasteful, and disruptive STAT test requests imposed an extra burden on the laboratory and resulted in a delay of reports on other true STAT or routine tests. Strategies to reduce the number of inappropriate STAT tests should be established in order to reserve the emergency service for situations of true need.
Emergencies ; Emergency Service, Hospital ; Humans ; Outpatients ; Tertiary Healthcare

Introduction: Ectropion is an eversion of the eyelid due to various causes, and it mainly develops in the lower lid. Usually it shows a slow progression, and it is classified as involutional, cicatricial, paralytic and congenital. Acute idiopathic bilateral lower lid ectropion is very rare; few cases have been reported worldwide, and none have been seen in Korea. CASE SUMMARY: A 79-year-old male patient visited our department with a six-day history of epiphora and lower lid eversion in both eyes. On slit-lamp examination, lower lid ectropion was present in both eyes, and mild corneal punctate epithelial erosion was also observed. Two weeks after conservative treatment, the lower lid eversion disappeared and the lower lid returned to its original position. No changes were observed three months after treatment. We report a case of acute idiopathic bilateral lower lid ectropion with a literature review.
Aged ; Ectropion ; Eye ; Eyelids ; Humans ; Lacrimal Apparatus Diseases ; Male

BACKGROUND: The prognostic indicators of patients who received massive transfusion were studied to assist management of high risk patients. METHODS: Medical records and laboratory data of 184 adult patients who received massive transfusions during 1996-1998 were reviewed. The indicators studied were outcome of treatment, cause of transfusion, age, sex, vital signs at admission, number of units of blood components, results of platelet counts (Plt), hematocrit (Hct), prothrombin time (PT), activated thromboplastin time (aPTT) and arterial blood pH (pH) performed within 24 hours after transfusion. RESULTS: The percent and mean age of survivor were 60.3% and 44.8 years old and nonsurvivor were 39.7 and 49.7, respectively. The frequency and survival rate by causative disorders were as follows: trauma 33.2% and 56%; liver disease 23.9% and 57%, cancer 13.6% and 56%, cardiovascular disorders 7.5% and 78.6%. Nonsurvivors had lower systolic and diastolic pressures in liver disease and cancer, and lower body temperature in trauma patients than those of survivors. In trauma patients nonsurvivors had lower Plt counts and pH, and prolonged PT and aPTT results than those of survivors. In cancer patients nonsurvivors showed lower Hct and pH, but those of liver disease patients showed only lower Plt counts. The average unit of blood components transfused per patient in nonsurvivors were 27.3 of RBC, 13.4 of FFP, and 15.2 of platelet concentrate, respectively. The percent of patients who were transfused more than 20 units of RBC was 28% in survivors, but 55% in nonsurvivors. CONCLUSIONS: It is concluded that the patients transfused with more than 20 units of RBC showed low systolic and diastolic pressures, body temperature, Plt counts, Hct and arterial blood pH, and prolonged PT and aPTT results appeared to be poor prognostic indicator of massive transfusions.
Adult ; Blood Platelets ; Body Temperature ; Hematocrit ; Humans ; Hydrogen-Ion Concentration ; Liver Diseases ; Medical Records ; Platelet Count ; Prognosis* ; Prothrombin Time ; Survival Rate ; Survivors ; Thromboplastin ; Vital Signs

Background: Quantitative viral load tests are essential for diagnosing and monitoring the response to antiviral treatment for hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus type 1 (HIV-1) infections. The Hologic Aptima Quant assay (Hologic Inc., USA) is a fully integrated and automated quantitative assay based on real-time transcription-mediated amplification technology using the Panthers system.In this study, we evaluated the performance of the Hologic Aptima Quant assay for measuring HBV, HCV, and HIV-1 viral load, and compared the results with those obtained with Abbott Alinity m system (Abbott Laboratories, USA). Methods: The reproducibility and linearity of the assay were evaluated in the present study. Additionally, the precision, analytical specificity, interference, and limit of detection (LOD) of each assay on the Panther system were evaluated. A comparative evaluation between the Hologic Aptima Quant assay and the Abbott Alinity m assay was conducted using clinical patient samples. Results: The results of the precision study demonstrated excellent total precision, with the coefficient of variation of precision being less than 5%. The linearity of the viral loads was excellent for all assays (correlation coefficient [R2 ] >0.99 for HBV, HCV, and HIV-1). Furthermore, the specificity of all assays was determined to be 100%. The LOD results were 10 IU/mL for HBV and HCV assays, and 20 copies/mL for HIV-1 assay, with 100% replicates being detected. Additionally, the viral load measured with the Hologic Aptima Quant assay was strongly correlated with that measured with Abbott Alinity m assay (R2 =0.94–0.97). Conclusions The Hologic Aptima Quant assay demonstrated excellent performance, with results being comparable to those obtained with the Abbott Alinity m assay for detecting HBV, HCV, and HIV-1 viral loads.

BACKGROUND: When local anesthetics for regional anesthesia is used, usually small amounts of bicarbonate are added for rapid onset. This addition gives the mixed solution a more alkaline pH. The following result is an increased unionized form of the local anesthetic and rapid penetration of the drug into tissue. Unfortunately, no data about adequate mixing volumes of domestic lidocaine and bicarbonate is available. METHODS: We examined six mixing pairs of two kinds of 2% lidocaines and three kinds of 8.4% bicarbonates for minimum volumes of bicarbonate to cause a precipitation of 2% 20 ml lidocaine. RESULTS: The mean volumes of bicarbonate to cause precipitation were 1.54 ml for Kwang-Myung lidocaine with Kwang-Myung bicarbonate, 2.90 ml for Kwang-Myung lidocaine with Dae-Won bicarbonate, 2.73 ml for Kwang-Myung lidocaine with Je-Il bicarbonate, 0.97 ml for Je-Il lidocaine with Kwang-Myung bicarbonate, 1.26 ml for Je-Il lidocaine with Dae-Won bicarbonate and 1.39 ml for Je-Il lidocaine with Je-Il bicarbonate. CONCLSIONS: We conclude that the Kwang-Myung lidocaine and the Je-Il lidocaine could cause precipitation when mixing with a smaller bicarbonate volume than foreign textbook recommended.
Anesthesia, Conduction ; Anesthetics, Local ; Bicarbonates ; Hydrogen-Ion Concentration ; Lidocaine

Varicella is usually considered to be a benign disease in healthy children; however, serious complications can occur such as necrotizing fasciitis and toxic shock syndrome. We describe a 38-month-old girl with necrotizing fasciitis and streptococcal toxic shock syndrome following varicella. She was previously healthy and vaccinated against varicella at 12 months of age. She had been diagnosed with varicella three days prior to presenting at our facility; she developed fever, vomiting, and painful swelling on her left flank. Her skin lesions worsened, she became lethargic, and had episodes of hypotension and coagulopathy. Necrotizing fasciitis on the left abdominal wall, buttocks, and left thigh was diagnosed by magnetic resonance imaging, and group A Streptococcus was isolated from a tissue culture. She was diagnosed as necrotizing fasciitis and streptococcal toxic shock syndrome, and successfully treated with repeated surgical debridement and fasciotomy, in addition to intensive antibiotics. Our experience suggests that necrotizing fasciitis in patients with varicella should be considered to be a rare complication even with widespread vaccine use. Early diagnosis and intensive treatment are required to prevent a fatal outcome.
Abdominal Wall ; Anti-Bacterial Agents ; Buttocks ; Chickenpox* ; Child* ; Child, Preschool ; Debridement ; Early Diagnosis ; Fasciitis, Necrotizing* ; Fatal Outcome ; Female ; Fever ; Humans ; Hypotension ; Magnetic Resonance Imaging ; Shock, Septic* ; Skin ; Streptococcus ; Streptococcus pyogenes ; Thigh ; Vomiting

Myocardial bridging is defined that short segments of coronary artery descend into the myocardium for a variable distance and each systolic contraction of these fibers can cause narrowing of the artery. Systolic narrow-ing may rarely be caused by connective tissue such as fibrous band. Myocardial ischemia, infarction and sudden death may be seen in some patients with myocardial bridging. Myocardial infarction in association with isolated myocardial bridges with systolic narrowing is uncommon. We report a case of Q wave myocardial infarction in a patient with angiographic systolic narrowing at the middle segment left anterior descending coronary artery which was caused by fibrous band.
Arteries ; Connective Tissue ; Coronary Vessels ; Death, Sudden ; Humans ; Infarction ; Myocardial Bridging* ; Myocardial Infarction* ; Myocardial Ischemia ; Myocardium

Gross hematuria is uncommon, and rarely associated with hydronephrosis in healthy children. We describe a 3-year-old boy who complained of gross hematuria and dysuria. He was diagnosed as cystitis with bilateral hydronephrosis, and treated with antibiotics and conservative therapy. Our experience suggests that cystitis with hydronephrosis can occur in healthy children presenting with gross hematuria.
Anti-Bacterial Agents ; Child ; Cystitis ; Dysuria ; Hematuria ; Humans ; Hydronephrosis ; Preschool Child