PURPOSE: This study was designed to determine the relationship between binocular function and the surgical outcome of intermittent exotropia. METHODS: The surgical outcome and binocular function were retrospectively investigated in 44 patients who had undergone surgery for intermittent exotropia with at least 6 months of post-operative follow-up. We evaluated visual acuity, age at operation, angle of exodeviation, fusional status with Worth-4-dot test and stereoacuity with Titmus test before and after surgery. RESULTS: A 'surgical success' defined as a final alignment of orthophoria, esotropia less than 5PD or exotropia less than 10PD at far primary position, was achieved in 31 patients (70%). The surgical outcome according to preoperative stereopsis and fusional status was not statistically significant. Whereas, there was a tendency toward more surgical success in patients with central fusion and the first postoperative day diplopia but statistically indifferent. There was an improvement of stereoacuity in 34 out of 44 patients after surgery. The fusional status was improved in 9 patients out of 44 patients. There was an improvement of postoperative binocular function regardless the surgical outcome. But the achievement of fine stereopsis below 100 seconds of arc and central fusion increased only in success group. CONCLUSIONS: The preoperative binocular function did not contribute significantly to the surgical outcome (p>0.05) and postoperative binocular function could be improved by surgical correction in both surgical success and failure group. But the better binocular function was achieved by successful surgical alignment.
Depth Perception ; Diplopia ; Esotropia ; Exotropia* ; Follow-Up Studies ; Humans ; Retrospective Studies ; Telescopes* ; Visual Acuity

No abstract available.
Centric Relation* ; Tooth Wear*

PURPOSE: Epinephrine itself exhibits some cardiotoxicity. However, it rarely induces cardiomyopathy when used in standard doses during surgery for local hemostasis. This paper reports a rare case of stress-induced cardiomyopathy in a young woman after the local infiltration of epinephrine. METHODS: Corrective rhinoplasty was planned in a 20-year-old woman. Lidocaine mixed with epinephrine 1:100,000 was injected around the skin of the nose and nasal septum after inducing anesthesia, which resulted in sinus tachycardia and hypotension. Postoperative ECG showed a T wave inversion in the lead V2 and echocardiography revealed transient hypokinesia in the cardiac apex. Cardiac enzyme was mildly elevated. RESULTS: Symptoms and laboratory findings improved considerably, and the patient was discharged from hospital without complications on the sixth day after surgery. CONCLUSION: The prognosis of catecholamine-induced cardiomyopathy is generally favorable. However, it is important to be aware of the possible adverse effects of local epinephrine infiltration. This case highlights the need for caution when using epinephrine.
Anesthesia ; Cardiomyopathies ; Echocardiography ; Electrocardiography ; Epinephrine ; Female ; Hemostasis ; Humans ; Hypokinesia ; Hypotension ; Lidocaine ; Nasal Septum ; Nose ; Prognosis ; Rhinoplasty ; Skin ; Surgery, Plastic ; Tachycardia, Sinus ; Young Adult

PURPOSE: This study was designed to evaluate the postoperative changes of astigmatism and corneal refractive power after surgical correction of epiblepharon using computerized topography. METHODS: The surgical data were investigated retrospectively before surgery and 1 month, 3 month after surgery in 23 patients who had undergone surgery for epiblepharon. We evaluated 8 points of the corneal refractive index, the corneal center and nasal, temporal, inferior 1.0 and 2.0 mm and superior 1.0 mm respectively. And the incidences and types of astigmatism were evaluated before and after surgery. RESULTS: After surgery, we observed corneal flattening at all points according to corneal topography, but corneal refractive changes were statistically insignificant except for inferior 1.0mm point (P< 0.05). Mean astigmatism was decreased after surgery and statistically significant 3 month after surgery (P< 0.05). Mean corneal refractive change on vetical meridian was prominent compared to horizontal meridia and statistically significant 3 month after surgery (P< 0.05). CONCLUSIONS: In epiblepharon, children corneal topographic changes were observed due to reduction of corneal irritation and pressure by cilia and lower eyelid after surgery. Astigmatic changes were progressed 3 month after surgery and with-the-rule astigmatism was observed mainly before and after surgery. But corneal refractive changes were prominent on vertical meridian, and therefore there was a tendency toward improvement of with-the-rule astigmatism.
Astigmatism ; Child* ; Cilia ; Corneal Topography ; Eyelids ; Humans ; Incidence ; Refractometry ; Retrospective Studies

Purpose: This study aimed to determine the correlation between various clinical results, including recurrence in patients with breast cancer, and preoperative blood composition ratio and postoperative pathological results. Methods: A total of 444 patients who underwent surgery were included, and the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), and postoperative pathological results were classified into postoperative cancer stages to confirm the association with various clinical results, including recurrence. Results: The median age of the patients was 51 years. The stages were divided into 1, 2, 3, and 4. Additionally, stages 1 and 2 comprised one group and stages 3 and 4 comprised another group. The cut-off values of the NLR, PLR, and MLR were confirmed to be 1.43, 158.84, and 0.21, respectively. It was noted that the association with recurrence was higher in the group with hormone receptor negative (p<0.001), higher stage (p<0.001), and underwent neoadjuvant chemotherapy (p<0.001). In the association with blood composition ratio and recurrence, survival was high in the PLR group with a high cut-off value (p=0.004). There was no significant relationship in the NLR and MLR groups. In the disease-free survival and overall-survival curves, only the PLR group showed a significant association of 0.003 and 0.001, respectively. The NLR and MLR groups did not show any significant result. Conclusion No significant association with recurrence and mortality was confirmed in the NLR and MLR groups. However, the preoperative blood test in the high PLR group showed recurrence and mortality rate were high.

Purpose: Breast cancer is the most common cancer in Korean women and the number of cases is increasing. We have found various histopathological differences in breast cancer and are using this knowledge for treatment. Various factors may help determine the progression of cancer in patients. The expression of lymphovascular invasion, a pathologic factor, denotes a poor prognosis. We analyzed the characteristics of patients showing lymphatic invasion. Methods: Data from 606 patients with breast cancer who underwent surgery between 2006 and 2016 were collected. We analyzed various pathologic factors in patients with or without lymphatic invasion expression. Results: Mean age was 52.0±11.2 years (range 29-83 years) and mean follow-up duration was 57.3 months (range 3−125 months). Pathologically, breast cancer types were invasive ductal carcinoma (552, 91.2%), invasive lobular carcinoma (21, 3.4%), and other pathologies (33, 5.4%). Number of patients in stages I, II, III, and IV were 299 (49.3%), 223 (36.8%), 82 (13.7%), and 2 (0.02%), respectively. Immunohistochemistry revealed 396 (65.3%) estrogen receptor (ER)-positive cases, 287 (47.3%) progesterone receptor (PR)-positive cases, and 139 (22.9%) human epidermal growth factor receptor 2 (HER2)-positive cases. Seven patients had local recurrence and 41 patients had distant metastasis, which included 14 bone, 7 lung, 5 liver, and 15 multiple metastases. Seventeen patients showed lymphatic invasion, while 24 patients were without lymphatic invasion. Significant association was observed between T and N stages and lymphatic invasion (p<0.001). No significant correlation was observed between lymphatic invasion and ER (p=0.073), HER2 (p=0.553). However, there was a significant correlation between lymphatic invasion and PR (p=0.044). Overall survival and disease free survival rates were significantly worse in the presence of lymphatic invasion (p<0.01, 0.011, respectively). Conclusion Lymphatic invasion was associated with T and N stages, overall survival and disease free survival. More careful observation and treatment strategy is needed, especially in locally advanced breast cancer.

PURPOSE: The management of central venous catheters (CVCs) and catheter thrombosis vary among centers, and the efficacy of the methods of management of catheter thrombosis in CVCs is rarely reported. We investigated the efficacy of bedside thrombolysis with urokinase for the management of catheter thrombosis. MATERIALS AND METHODS: We retrospectively reviewed data from patients who had undergone CVC insertion by a single surgeon in a single center between April 2012 and June 2014. We used a protocol for the management of CVCs and when catheter thrombosis was confirmed, 5,000 U urokinase was infused into the catheter. RESULTS: A total of 137 CVCs were inserted in 126 patients. The most common catheter-related complication was thrombosis (12, 8.8%) followed by infection (8, 5.8%). Nine of the 12 patients (75%) with catheter thrombosis were recanalized successfully with urokinase. The rate of CVC recanalization was higher in the peripherally inserted central catheter (PICC) group (87.5%) than the chemoport group (50%). Reintervention for catheter-related thrombosis was needed in only 2.2% of patients when thrombolytic therapy using urokinase was applied. Age <60 years (P=0.035), PICC group (P=0.037) and location of the catheter tip above the superior vena cava (P=0.044) were confirmed as independent risk factors for catheter thrombosis. CONCLUSION: Thrombolysis therapy using urokinase could successfully manage CVC thrombosis. Reintervention was rarely needed when a protocol using urokinase was applied for the management of CVC thromboses.
Catheters ; Central Venous Catheters ; Humans ; Retrospective Studies ; Risk Factors ; Thrombolytic Therapy* ; Thrombosis ; Upper Extremity Deep Vein Thrombosis* ; Urokinase-Type Plasminogen Activator* ; Vena Cava, Superior

In this study, antioxidant and free radical scavenging activities of the natural antioxidative compound, pyrogallol-phloroglucinol-6,6'-bieckol (PPB) isolated from brown algae, Ecklonia cava was assessed in vitro by measuring the radical scavenging activities (DPPH, alkyl, hydroxyl, and superoxide) using electron spin resonance (ESR) spectrometry, intracellular reactive oxygen species (ROS) scavenging activity, and DNA damage assay. According to the results of these experiments, the scavenging activity PPB against difference radicals was in the following order: DPPH, alkyl, hydroxyl, and superoxide radicals (IC50; 0.90, 2.54, 62.93 and 109.05 microM). The antioxidant activities of PPB were higher than that of the commercial antioxidant, ascorbic acid. Furthermore, PPB effectively inhibited DNA damage induced by H2O2. These results suggest that the natural antioxidative compound, PPB, can be used by the natural food industry.
Ascorbic Acid ; DNA Damage ; Electron Spin Resonance Spectroscopy ; Food Industry ; Phaeophyta ; Reactive Oxygen Species ; Spectrum Analysis ; Superoxides

Congenital anomalies or normal variants of the pancreatic duct are in most cases asymptomatic and are found incidentally while conducting imaging studies (such as a MRCP and a CT scan) for other reasons. The frequency of pancreatic duct variants has been reported to be about 9% of the general population; the most common type is a bifid configuration of the major and minor pancreatic ducts. Though most patients with pancreatic duct variants do not have any symptoms, a small number may develop jaundice or gallstones. By reporting the case of a patient with a variant pancreatic duct who developed acute pancreatitis after undergoing screening endoscopy and biopsy, this study aims to warn of the possible risks of screening endoscopy or biopsy in the second portion of the duodenum.
Biopsy ; Duodenum ; Endoscopy ; Endoscopy, Digestive System ; Gallstones ; Humans ; Jaundice ; Mass Screening ; Pancreatic Ducts ; Pancreatitis

BACKGROUND: Atrial fibrillation (AF) is a well-established risk factor for stroke. Interestingly, ischemic stroke increases risk of incident AF in patients without prior diagnosed AF. For better risk stratification for post-stroke AF, we studied left atrial (LA) size and mechanical function using two-dimensional (2D) speckle tracking imaging in patients with acute ischemic stroke. METHODS: A total of 227 patients (132 males, age 67 ± 12) with acute ischemic stroke without a history of AF underwent 2D transthoracic echocardiography and speckle tracking imaging for the assessment of LA volume index and global LA longitudinal strain (LALS). From clinical variables, the CHA2DS2-VASc score and National Institute of Health Stroke Scale (NIHSS) were calculated in each patient. Post-stroke AF was defined as newly diagnosed AF during the course after ischemic stroke. RESULTS: Post-stroke AF occurred in 25 patients (11%). Patients with post-stroke AF were older and showed a higher tendency of CHA2DS2-VASc score, significantly higher log NIHSS, larger LA volume index and lower global LALS than those without. In multivariate analysis, global LALS was an independent predictor for post-stroke AF (hazard ratio 0.90, 95% confidence interval 0.83.0.97, p < 0.01) after controlling for confounding factors. Furthermore, global LALS provided incremental predictive value for post-stroke AF over the CHA2DS2-VASc score, NIHSS, and LA volume index. The global LALS < 14.5% better distinguished post-stroke AF (area under the curve 0.837, sensitivity 60%, specificity 95%, p < 0.01) than CHA2DS2-VASc score. CONCLUSION: Global LALS as a marker of LA mechanical function has incremental predictive value for post-stroke AF in patients with acute ischemic stroke.
Atrial Fibrillation* ; Echocardiography ; Heart Atria ; Humans ; Male ; Multivariate Analysis ; Risk Factors ; Sensitivity and Specificity ; Stroke*