PURPOSE: To evaluate the factors which affect the success rates of endoscopic endonasal dacryocystorhinostomy. METHODS: We analyzed 74 patients (95 eyes) who had undergone endoscopic endonasal dacryocystorhinostomy in Gachon Medical School, Gil Hospital between March 2000 and March 2003, and who were followed up for at least 6 months (range 6~13 months, mean 7.4 months). Surgical procedures, success rates, and complications of endoscopic endonasal dacryocystorhinostomy were evaluated. RESULTS: The primary success rate was 88.4% (84 of 95 cases) and the final success rate was 93.7% (89 of 95 cases), after 5 successful cases were added following revision. The success rate of the group with mitomycin C was statistically significantly higher than that of the group without it, but the interval of silicone tube removal from the operation or middle turbinectomy did not have any statistically significant effect on the success rate. In order of frequency, the postoperative complications were granuloma formation, nasal mucosa synechia, silicone tube prolapse, and membranous obstruction. CONCLUSIONS: Endoscopic endonasal dacryocystorhinostomy has the advantage of a similarly high success rate with external dacryocystorhinostomy and easy reoperation when performed with adequate procedures by an expert surgeon and followed up with proper postoperative management.
Dacryocystorhinostomy* ; Granuloma ; Humans ; Mitomycin ; Nasal Mucosa ; Postoperative Complications ; Prolapse ; Reoperation ; Schools, Medical ; Silicones

PURPOSE: To evaluate the effect of corneal flap thickness on visual prognosis and complications in LASIK. METHODS: A total of 251 eyes of 129 patients who had been followed up for 6 months or more after LASIK were evaluated retrospectively. The eyes were classified into two groups: group A of 34 eyes with corneal flap thickness of 100 m or less and group B of 217 eyes with corneal flap thickness of more than 100 m. Clinical outcomes, including uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), spherical equivalent (SE), myopic regression and complications, were compared between the two groups. RESULTS: In groups A and B, UCVA improved from 0.08 +/- 0.04 and 0.08 +/- 0.02 before surgery to 0.84 +/- 16 and 0.88 +/- 21 6 months after surgery, and SE changed from -6.36 +/- 2.46D and 6.07 +/- 2.81D to 0.29 +/- 0.72D and -0.17 +/- 0.81D 6 months after surgery, respectively, but there were no statistically significant differences between the two groups. BCVA, myopic regression and the incidence of complications also did not show any statistical difference. CONCLUSIONS: LASIK can be performed safely under thin corneal flaps of 100 m or less to leave enough residual corneal thickness.
Humans ; Incidence ; Keratomileusis, Laser In Situ* ; Prognosis ; Retrospective Studies ; Visual Acuity

PURPOSE: To describe a case of unilateral corneal keloid and present the clinical and histopathological findings and the management. METHODS: A 23-year-old Asian male patient was examined for a white spot on the left cornea that had been present since birth. On biomicroscopic examination, a well-demarcated vascularized corneal mass was found located nasal to the center. The pupil was displaced superiorly, and gonioscopic examination showed peripheral iridocorneal adhesion at 12 o'clock. The patient underwent penetrating keratoplasty. RESULTS: Histopathologic study showed a variously thickened epithelial layer, an absence of Bowman's layer, subepithelial fibrovascular hyperplasia, and an absence of dermal elements. These histopathologic findings suggested a congenital corneal keloid. The central graft cornea remained clear at 18 months after surgery and the patient was satisfied with the result. CONCLUSIONS: Penetrating keratoplasty may be an effective surgical option for congenital keloids in young adult patients.
Adult ; Corneal Diseases/*congenital/*pathology/surgery ; Humans ; Keloid/*congenital/*pathology/surgery ; Keratoplasty, Penetrating ; Male

PURPOSE: To report a case of squamous cell carcinoma of lacrimal sac which has never been reported in Korea so far to our knowledge. METHODS: A 55-year-old male who had a history of epiphora for three years and palpable mass along the inferomedial aspect of the right medial canthus for 3months underwent surgical excision of the mass and dacryocystorhinostomy, and postoperative adjuvant radiation therapy was followed after surgical excision. RESULTS: Pathologic diagnosis of the excised mass was well differentiated squamous cell carcinoma. There is no evidence of recurrence until postoperative 9 months and the patient shows good clinical course with normal visual acuity. CONCLUSIONS: Despite its lower incidence, primary tumor of the lacrimal sac is usually malignant with high tendency of recurrence and fatality. Clinician should have a high suspicion of this disease on the patients who have epiphora and lacrimal sac mass, and perform early surgical excision and pathologic diagnosis. In this study, we experienced a rare case of squamous cell carcinoma of lacrimal sac.
Carcinoma, Squamous Cell* ; Dacryocystorhinostomy ; Diagnosis ; Humans ; Incidence ; Korea ; Lacrimal Apparatus Diseases ; Male ; Middle Aged ; Recurrence ; Visual Acuity

Invasive aspergillosis is one of rare causes of mortality for the immune-compromised patients. We present a case of invasive aspergillosis complicated by the occlusion of the internal carotid artery and cerebral infarction in a patient with diabetes mellitus. Although initial biopsy did not find the pathogen, the repeated attempts of sampling showed aspergillosis. Combination of surgical removal of necrotic tissue and voriconazole medication improved symptoms and reduced the burden of infection.
Aspergillosis* ; Biopsy ; Carotid Arteries ; Carotid Artery, Internal* ; Cerebral Infarction* ; Diabetes Mellitus ; Humans ; Mortality ; Voriconazole

Sagittal synostosis with related functional aspects of elevated ICP, hydrocephalus, mental retardation and visual abnormalities, or with multiple suture synostosis, surgical correction is imperative. But, craniofacial surgery may impose a threat to an infant or small child. The blood volume in these patients is small and a minor hemorrhage may induce proportionately greater blood loss, resulting in a greater stress to the patient's system. Mortality resulting from craniofacial surgery is uncommon, mostly from operative hemorrhage and infections. Releasing the stenosis and reshaping the cranial vault is the primary operative goal. Authors sought to minimize surgical stress on the child and attain control of cranial vault reshaping by gradual distraction osteogenesis in treating children with sagittal suture synostosis. Three sagittal synostosis patients, aged from 11 months to 3 years old were treated. One of the patients had multiple suture synostosis. Patient follow-up ranged from 3 months to 3 years. Biparietal bone flap was elevated and external distraction devices were inserted. Distraction rate varied from 0.5 to 1mm/day, without a latency period. After a consolidation period of 2-3weeks, the devices were removed. Functional aspects of ICP and mental retardation subsided post surgery. Radiological follow-up showed cessation of enhancement of bone deposition at the frontal and occipital sutures. Excellent aesthetic results were accounted for in all three of the patients. Application of distraction osteogenesis in correcting sagittal craniosynostosis is very effective; surgical stress on the patients is minimal and controlled cranial vault reshaping is possible.
Blood Volume ; Child ; Child, Preschool ; Constriction, Pathologic ; Craniosynostoses* ; Follow-Up Studies ; Hemorrhage ; Humans ; Hydrocephalus ; Infant ; Intellectual Disability ; Latency Period (Psychology) ; Mortality ; Osteogenesis, Distraction* ; Sutures ; Synostosis

Hepatitis A virus (HAV) is mostly transmitted by the oral-fecal route. However, rare cases of transmission via blood transfusion still exist. A retrospective study was designed to trace a case of transfusion transmitted HAV (TTHAV) infection through the Post Donation Infection (PDI) system in Korea in 2006. We report here on a case of TTHAV that was identified through a lookback study. A 35-year old woman received 6 units of packed red cell transfusion when undergoing Caesarian section in a hospital. Ten days later, she developed a high fever and sore throat. Anorexia and abdominal pain developed in 45 days after transfusion. She was diagnosed with acute tonsillitis at the hospital, and she was not aware of her HAV infection at that time. Then, a donor informed the blood center of his HAV infection 10 days after donation to request his blood be discarded. The recipients of the blood were traced and epidemiological studies lead to the patient, which prompted her serum to be collected and tested. Finally, TTHAV was identified for this patient with positive anti-HAV IgG/IgM results. This is the first case of TTHAV to be identified through the HAV lookback study in Korea.
Abdominal Pain ; Anorexia ; Blood Transfusion ; Epidemiologic Studies ; Female ; Fever ; Hepatitis ; Hepatitis A ; Hepatitis A Antibodies ; Hepatitis A virus ; Humans ; Korea ; Palatine Tonsil ; Pharyngitis ; Retrospective Studies ; Tissue Donors ; Tonsillitis

Intussusception is a common surgical disorder in infancy. Intussusception in preterm infant is very rare and about 40 cases have been reported. Furthermore, double intussusception is extremely rare in children and there seems to be no such a case reported in preterm infant. We report a case of idiopathic double intussusception in the preterm infant, who was born at 25 weeks' gestation, underwent an explolaparotomy for bowel perforation on 39 days of life, and during the operation, an ileo-ileo-colic intussusception was found without a leading point.
Child ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Intussusception ; Pregnancy

Background: Various regional analgesia techniques are used to reduce postoperative pain in patients undergoing video-assisted thoracic surgery (VATS). This study aimed to determine the relative efficacy of regional analgesic interventions for VATS using a network meta-analysis (NMA). Methods: We searched the Medline, EMBASE, Cochrane Controlled Trial Register, Web of Science, and Google Scholar databases to identify all randomized controlled trials (RCTs) that compared the analgesic effects of the following interventions: control, thoracic paravertebral block (TPVB), erector spinae plane block (ESPB), serratus plane block (SPB), and intercostal nerve block (INB). The primary outcome was opioid consumption during the first 24-h postoperative period. Pain scores were also collected during three different postoperative periods: the early (0–6 h), middle (6–18 h), and late (18–24 h) periods. Results: A total of 21 RCTs (1391 patients) were included. TPVB showed the greatest effect on opioid consumption compared with the control (mean difference [MD] = −13.2 mg; 95% CI [−16.2, −10.1]). In terms of pain scores in the early period, ESPB had the greatest effect compared to control (MD = −1.6; 95% CI [−2.3, −0.9]). In the middle and late periods, pain scores showed that TPVB, ESPB and INB had superior analgesic effects compared to controls, while SPB did not. Conclusions TPVB had the best analgesic efficacy following VATS, though the analgesic efficacy of ESPBs was comparable. However, further studies are needed to determine the optimal regional analgesia technique to improve postoperative pain control following VATS.

Enterovirus 71 (EV71) is the predominant cause of hand, foot and mouth disease (HFMD). The antiviral activity of hederasaponin B from Hedera helix against EV71 subgenotypes C3 and C4a was evaluated in vero cells. In the current study, the antiviral activity of hederasaponin B against EV71 C3 and C4a was determined by cytopathic effect (CPE) reduction method and western blot assay. Our results demonstrated that hederasaponin B and 30% ethanol extract of Hedera helix containing hederasaponin B showed significant antiviral activity against EV71 subgenotypes C3 and C4a by reducing the formation of a visible CPE. Hederasaponin B also inhibited the viral VP2 protein expression, suggesting the inhibition of viral capsid protein synthesis.These results suggest that hederasaponin B and Hedera helix extract containing hederasaponin B can be novel drug candidates with broad-spectrum antiviral activity against various subgenotypes of EV71.
Blotting, Western ; Capsid Proteins ; Enterovirus* ; Ethanol ; Hand, Foot and Mouth Disease ; Hedera* ; Vero Cells