A clinical study on the AC/A ratio with 125 normal persons was performed by modified gradient method. AC/A ratio is a convergence response of an individual to a unit stimulus of accommodation. Through many studies on the AC/A ratio, the normal range of the AC/A ratio was 3 delta/D ~ 5 delta/D. The AC/A ratio can be changed by some drugs. The AC/A ratio is high in divergence excessive exotropia, pseudodivergence exotropia and non-refractive accommodative esotropia; on the other hand, the AC/A ratio is low in convergence insufficiency exotropia. Methods for the determination of the AC/A ratio are heterophoria method, gradient method, fixation disparity method. This study was performed by modified gradient method due to easy application. The mean of the AC/A ratios in this study was 4.55 delta/D, and the AC/A ratios ranged from 0.5 delta/D to 9.6 delta/D. 95 percentile ranged from 3.01 delta/D to 6.09 delta/D. The AC/A ratio in this study seems not to be correlated with age, sex and interpupillary distance.
Esotropia ; Exotropia ; Hand ; Humans ; Ocular Motility Disorders ; Reference Values ; Vision Disparity

A clinical study on the AC/A ratio with 125 normal persons was performed by modified gradient method. AC/A ratio is a convergence response of an individual to a unit stimulus of accommodation. Through many studies on the AC/A ratio, the normal range of the AC/A ratio was 3 delta/D ~ 5 delta/D. The AC/A ratio can be changed by some drugs. The AC/A ratio is high in divergence excessive exotropia, pseudodivergence exotropia and non-refractive accommodative esotropia; on the other hand, the AC/A ratio is low in convergence insufficiency exotropia. Methods for the determination of the AC/A ratio are heterophoria method, gradient method, fixation disparity method. This study was performed by modified gradient method due to easy application. The mean of the AC/A ratios in this study was 4.55 delta/D, and the AC/A ratios ranged from 0.5 delta/D to 9.6 delta/D. 95 percentile ranged from 3.01 delta/D to 6.09 delta/D. The AC/A ratio in this study seems not to be correlated with age, sex and interpupillary distance.
Esotropia ; Exotropia ; Hand ; Humans ; Ocular Motility Disorders ; Reference Values ; Vision Disparity

Pseudolymphoma, the term clinically synonymous with pseudotumor, is one of the lymphoproliferative disease which frequently causes unilateral proptosis in adults. The clinical manifestations and the pathologic pictures may resemble that of a true neoplasm. Recently, immunologic methods such as immunofluorescent and immunohistochemical study were popularly used in the diagnosis and study of lymphoproliferative diseases. We have experienced three cases of pseudolymphoma of the orbit which were diagnosed with PAP(proxidase-antiperoxidase) stain of the immunohistochemical method.
Adult ; Diagnosis ; Exophthalmos ; Humans ; Orbit ; Pseudolymphoma*

The oculopharyngeal muscular dystrophy is a distinct, clinically well-defined myopathy of later life inherited in an autosomal dominant fashion with complete penetrance. Blepharoptosis, dysphagia, lower leg weakness are the most prominent findings. It is a systemic myopathy which affects all voluntary muscles and appears to spare smooth and cardiac muscle. The authors experienced a case of the oculopharyngeal muscular dystrophy which showed characteristic signs and symptoms such as symmetric ptosis, dysphagia, and progressive external ophthalmoplegia, and the literature were reviewed.
Blepharoptosis ; Deglutition Disorders ; Leg ; Muscle, Skeletal ; Muscular Diseases ; Muscular Dystrophy, Oculopharyngeal* ; Myocardium ; Ophthalmoplegia, Chronic Progressive External ; Penetrance

Cellular schwannoma is a variant of schwannoma, and is diagnosed as malignant tumor in over one fourth of cases because of its cellularity, mitotic activity and the occasional presence of bone destruction. This tumor is a tumor with low malignant potential and usually occurs in peripheral nervous system, mainly in the posterior mediastinum and retroperitoneal space. But pelvic retroperitoneal cellular schwannoma is very rare. Recently, we experienced a case of pelvic retroperitoneal cellular schwannoma in a 42-year-old woman; in reporting the case a brief review of the literature is included.
Adult ; Female ; Humans ; Mediastinum ; Neurilemmoma* ; Peripheral Nervous System ; Retroperitoneal Space

PURPOSE: Several studies have demonstrated the superiority of endorectal coil magnetic resonance imaging (MRI) over pelvic phased-array coil MRI at 1.5 Tesla for local staging of prostate cancer. However, few have studied which evaluation is more accurate at 3 Tesla MRI. In this study, we compared the accuracy of local staging of prostate cancer using pelvic phased-array coil or endorectal coil MRI at 3 Tesla. MATERIALS AND METHODS: Between January 2005 and May 2010, 151 patients underwent radical prostatectomy. All patients were evaluated with either pelvic phased-array coil or endorectal coil prostate MRI prior to surgery (63 endorectal coils and 88 pelvic phased-array coils). Tumor stage based on MRI was compared with pathologic stage. We calculated the specificity, sensitivity and accuracy of each group in the evaluation of extracapsular extension and seminal vesicle invasion. RESULTS: Both endorectal coil and pelvic phased-array coil MRI achieved high specificity, low sensitivity and moderate accuracy for the detection of extracapsular extension and seminal vesicle invasion. There were statistically no differences in specificity, sensitivity and accuracy between the two groups. CONCLUSION: Overall staging accuracy, sensitivity and specificity were not significantly different between endorectal coil and pelvic phased-array coil MRI.
Aged ; Humans ; Magnetic Resonance Imaging/*methods ; Male ; Middle Aged ; Prostatectomy ; Prostatic Neoplasms/*diagnosis/surgery ; Sensitivity and Specificity

PURPOSE: Laparoscopic donor nephrectomy is associated with less postoperative pain and faster recovery times in living kidney donors. However, pneumoperitoneum, which is required in laparoscopic donor nephrectomy, can result in adverse effects on renal function in donors and recipients. We compared renal function in donors and recipients after hand-assisted laparoscopic donor nephrectomy (HALDN) and open donor nephrectomy (ODN). MATERIALS AND METHODS: Between January 1997 and January 2008, 241 live donor nephrectomies were performed by either HALDN (n=118) or ODN (n=123). Preoperative patient characteristics were not significantly different between the donors and recipients. We monitored the changes in serum creatinine levels of the donors and recipients preoperatively and on postoperative days 1, 5, 28, 84, and 365. RESULTS: The mean operative times of HALDN and ODN were 171 and 163 minutes (p=0.284), and the mean warm ischemic times were 292 and 236 seconds (p=0.207), respectively. The mean serum creatinine level in the recipients on postoperative day 1 was significantly higher after HALDN than after ODN (3.48 vs. 2.62 mg/dl, p=0.003). However, from postoperative day 5 to 1 year, there was no significant difference between the two groups. The mean serum creatinine level in the donors was not significantly different between the HALDN and ODN groups throughout the study period. CONCLUSIONS: Renal function recovery in the donors was similar with both HALDN and ODN. Graft renal function recovery after HALDN was comparable with that after ODN, except immediately after surgery (postoperative day 1).
Creatinine ; Humans ; Kidney ; Laparoscopy ; Living Donors ; Nephrectomy ; Operative Time ; Pain, Postoperative ; Pneumoperitoneum ; Recovery of Function ; Tissue Donors ; Transplants ; Warm Ischemia

PURPOSE: Robot-assisted laparoscopic radical cystectomy (RLRC) is a new option for the treatment of muscle-invasive bladder cancer, and case series for RLRC have been increasing recently. We report our operative technique and initial experiences with RLRC with extracorporeal urinary diversion. MATERIALS AND METHODS: Between October 2008 and November 2009, 17 consecutive patients with muscle-invasive bladder cancer underwent RLRC, pelvic lymph node dissection, and extracorporeal urinary diversion. Urinary diversion included 13 ileal conduits and 4 orthotopic neobladders (Studer method). Data were collected prospectively on patient demographics, intraoperative parameters, pathologic staging, and postoperative outcomes. RESULTS: The mean patient age was 63.7 years. The mean body mass index was 22.6 kg/m2. No patients had a history of previous abdominal surgery. The mean operative time was 379.1 minutes, including 32.6 minutes for pelvic lymph node dissection, 185.2 minutes for RLRC, and 159.4 minutes for urinary diversion. The mean estimated blood loss was 210.5 ml. The mean hospital stay was 20.7 days and the mean time to oral intake and ambulation was 5.0 and 1.3 days, respectively. There were no major perioperative complications. The pathologic reports showed urothelial cell carcinomas in all cases. CONCLUSIONS: Our initial clinical experiences indicate that RLRC with pelvic lymph node dissection and extracorporeal urinary diversion is a safe and feasible procedure with minimal blood loss and rapid recovery. Long-term follow up in a larger patient population is needed to determine the true oncological and functional benefit of this procedure.
Body Mass Index ; Cystectomy ; Demography ; Humans ; Length of Stay ; Lymph Node Excision ; Operative Time ; Prospective Studies ; Robotics ; Urinary Bladder Neoplasms ; Urinary Diversion ; Walking

PURPOSE: To evaluate the accuracy of radiologic tumor size for making decisions regarding nephron-sparing surgery of localized renal cell carcinomas (RCCs), we compared tumor size measured by a preoperative radiologic modality with that measured in the pathologic specimen. MATERIALS AND METHODS: Between January 2003 and December 2007, a total of 186 patients with pT1 or pT2 RCC underwent radical or partial nephrectomy at our institute. We excluded 11 patients who had preoperative arterial embolization (n=9) or positive surgical margins (n=2), and a total of 175 patients were included in this study. Radiologic size was defined as the largest diameter on computed tomography (CT), and pathologic size was defined as the largest diameter of the surgical specimen of the tumor. We retrospectively analyzed the difference between radiologic and pathologic tumor size. RESULTS: The radiologic and pathologic tumor sizes did not significantly differ (4.98+/-2.82 cm vs. 4.55+/-2.70 cm, respectively, p=0.152). In the subgroup analysis, the size difference was statistically significant only for tumor sizes of less than 6 cm. The size difference was largest in tumors of 3 to 4 cm, for which mean the radiologic size was 0.63+/-1.19 cm larger than the mean pathologic size (p=0.002). Histologic type had no significant influence on the difference between radiologic and pathologic size. CONCLUSIONS: The tumor size of RCCs in preoperative CT seems to correlate well with pathologic tumor size. However, CT imaging may overestimate the size of a tumor in the small mass group (less than 6 cm). These results should be considered when making decisions about nephron-sparing surgery.
Carcinoma, Renal Cell ; Humans ; Nephrectomy ; Retrospective Studies

STUDY DESIGN: Case report. OBJECTIVES: To report a case of epidural hematoma following cervical spinal fracture in a patient with ankylosing spondylitis. SUMMARY OF LITERATURE REVIEW: An early surgical intervention for acute epidural hematoma following cervical spinal fracture led to improvements in the patient's neurological deficits. MATERIALS AND METHODS: A 76-year-old male with ankylosing spondylitis presented with neck pain and motor weakness of both upper and lower extremities after falling. He sustained fractures of the C7 body and the spinous processes of C5 and C6. Magnetic resonance imaging showed an extensive epidural hematoma from C7 to T5. The authors performed decompression from C6 to T2, and posterior instrumentation and fusion from C4 to T3. RESULTS: An urgent surgical intervention was performed, and a good result was obtained. CONCLUSIONS: The authors describe an early surgical intervention in a case of acute epidural hematoma following cervical spinal fracture in a patient with ankylosing spondylitis.
Accidental Falls ; Aged ; Decompression ; Hematoma* ; Humans ; Lower Extremity ; Magnetic Resonance Imaging ; Male ; Neck Pain ; Spinal Fractures* ; Spondylitis, Ankylosing*