This study examined the relation between anger-coping types and hypertension in employed men aged 40-60 who consented to participate during the biannual physical checkup in the department of health management in 1988. The subjects analyzed were five hundred thirteen excluding those having hypertension history and/or current antihypertensive medications. Anger-coping types were constructed from the Harburg's model with two hypothetical anger-provoking situations involving wife and boss. Hypertensives were defined more than 140mmHg systolic blood pressure and/or 90mmHg diastolic blood pressure. Hypertensives were one hundred fifty two(29.6%) and those who suppressed their anger were 61.6%0 and 62.8% in wife and boss situations respectively. Items of anger, guilt, protest, and suppressed anger in wife situation showed odds ratios of 0.78-0.94 without statistical significance. But four items in boss situation showed odds ratios more than 1, especially anger-in types of anger item had 1.58 times the prevalence of hypertension of anger-out types(95% confidence intervals(CI) 1.06~2.35) and subjects who indicated that suppressed their anger had 1.55 times the prevalence of hypertension of those who expressed their anger(95% CI l.03~2.32). For anger suppressed vs. expressed types of total suppressed anger index, prevalence of hypertension was 1.31(95% CI 0.83~2.08). After adjusting for age, body mass index, smoking and drinking, the odds ratios were slightly increased in both situations except guilt items compared with univariate analysis. These results suggest that the relation between Harburg's anger-coping model and hypertension is replicated partially in this subjects.
Anger ; Blood Pressure ; Body Mass Index ; Drinking ; Guilt ; Humans ; Hypertension* ; Male ; Odds Ratio ; Prevalence ; Smoke ; Smoking ; Spouses

There have been several reports that classical unilateral lateral rectus recession of 7-8mm obtained the high rate of undercorrection in the surgical treatment of intermittent exotropia of 15-20PD, at 4 years of age or older. We evaluated surgical correction amount, success rate between unilateral lateral rectus recession of 7-8mm and 11-12mm, and amount of abduction limiations of 11-12mm recession. Mean surgical correction amount were 9.1+/-4.5PD in 7-8mm recession group, and 14.4+/-3.0PD in 11-12mm recession group.The difference of surgical correction amount between the two groups was statistically significant(p<0.05). The percentage of undercorrection over 8PD were 66.7% in 7-8mm group, none in 11-12mm recession group. Abduction limitation was minimal in 12mm recession group. In conclusion, 11-12mm unilateral lateral rectus recession had more decreased rate of undercorrection than 7-8mm unilateral lateral rectus recession group in the treatment of intermittent exotropia of 15-20PD, at 4 years of age or older.
Exotropia*

To determine and compare the AC/A ratio in normal subjects, the AC/A ratio was measured by three different methods;near gradient method, distant gradient method and heterophoric method. The 33 normal subjects were enrolled in this study. All of them met the following criteria:(1)no known ocular disorders such as anisometropia, strabismus, and amblyopia.;(2)refractive error under -4D and corrected visual acuity more than 0.9.;(3)stereoacuity of 40 arc sec on Titmus test. The AC/A ratio was measured under full correction of the refractive error. Ages ranged from 6 to 25 years with a mean age of 16 years. The mean refractive error of the subjects was -1.33 D in right eye and -1.38 D in left eye. The near gradient method showed a mean AC/A ratio of 3.36:1 ranging from 1.33 to 4.67 ;the distance gradient method showed a mean ratio of 1.79:1 ranging from 0.67 to 3 ;and the heterophoric method showed a mean ratio of 5.71:1 ranging from 4.13 to 9. There was no significant difference in the AC/A ratio between the sexes and in the AC/A ratio between ages less than 11 years and more than 11 years. Different AC/A ratio values were obtained using three different methods. Among the three methods, the heterophoric method tended to give a higher value than the gradient method, and the near gradint method tended to give a higher value than the distance gradient method.
Anisometropia ; Refractive Errors ; Strabismus ; Visual Acuity

PURPOSE: This study examines the change in distance from the corneal limbus to the insertion of the rectus muscles before and after disinsertion and retraction with a pair of fixation forceps during strabismus surgery. METHODS: In 38 strabismus patients, on 30 medial rectus muscles and 38 lateral rectus muscles, before and after disinsertion and retraction with a pair of fixation forceps, the distances from the corneal limbus to the upper, middle and lower parts of the insertion of the medial and lateral rectus muscles marked with methylene blue solution were measured. RESULTS: The distances between the corneal limbus and upper, middle and lower parts of the insertion after the disinsertion were reduced on, average 0.23 mm, 0.28 mm, and 0.18 mm, for the medial rectus muscle, respectively, and 0.21 mm, 0.28 mm, and 0.15 mm, for the lateral rectus muscle, respectively (P<0.05). The percentage of cases in which the advance from the corneal limbus to the insertion was greater than 0.5 mm was 33.3% for the medial rectus muscle, and 21.1% for the lateral rectus muscle. The lateral rectus muscle was disinserted, fixed with a pair of forceps, and subsequently, the distance from the upper, middle and lower parts to the corneal limbus were reduced to 0.36 mm, 0.43 mm, and 0.30 mm, respectively (P<0.05). The percentage of cases that advanced more than 1.0 mm was 13.2 %. The changes in distance from the upper, middle, and lower parts of insertion toward the limbus after disinsertion and retraction were 0.15 mm 0.15 mm, 0.16 mm, respectively (P<0.05). CONCLUSIONS: When performing the recession of the lateral rectus muscle, disinsertion of the rectus muscle, may result in a change of the site of insertion, which in turn might influence the outcome of strabismus surgery.
Humans ; Limbus Corneae ; Methylene Blue ; Muscles* ; Strabismus ; Surgical Instruments

We attempted to predict the success, undercorrection, overcorrection rate at postoperative 1 year by examining alignment at postoperative 1 day and find out the relationship between alignment of postoperative 1 day and 1year. Forty-six patients with intermittent exotropia underwent bilateral lateral rectus recession at Keimyung university, Dongsan medical center and fifty-seven patients underwent unilateral medial rectus resection and lateral rectus recession at Catholic university, St.Mary`s hospital. The alignment at postoperative 1 day was classified as the overcorrected with 11-20PD, the overcorrected with 1-10PD,the orthotropia, and the undercorrected with residual exotropia of 1-10PD. There was a statistically significant relationship between alignment at postoperative 1 day and 1 year in unilateral medial rectus resection and lateral rectus recession and bilateral lateral rectus recession (r=0.74, r=0.51, p<0.05). Those patients who were overcorrected 1-20PD had a significantly higher success rate than those undercorrected 1-10PD at postoperative 1 day (p<0.05). In the unilateral medial rectus resection and lateral rectus recession group,postoperative 1 day alignment of 1-10PD resulted in the highest success rate of 73.7%. In the bilateral lateral rectus recession group,postoperative 1 day alignment of 11-20PD showed the highest success rate of 76.9%. There were no significant differences in the success rate,undercorrection rate, and overcorrection rate between the two kinds of surgery at postoperative 1 year. As a result, the alignment at postoperative 1 day can be one of the predictive factors of future surgical outcome. The initial postoperative overcorrection of 11-20PD in bilateral lateral rectus recession and overcorrection of 1-10PD in unilateral medial rectus resection and lateral rectus recession can lead to good results.
Exotropia ; Humans

PURPOSE: We report a case of Type 3 Waardenburg syndrome accompanied by intermittent exotropia, which had not previously been encountered in Korea along with the literature study. METHODS: A 5-year-old boy visited as a result of hypochromic heterochromic iridum in the right eye. Suspecting Type 3 Waardenburg syndrome, plain radiography, a hearing test, an alternate prism cover test and fundus examinations were performed and the presence of lateral displacement of the lacrimal puntum was evaluated. RESULTS: The presence of hypochromic heterochromic iridum, dysplasia of the left thumb, sensorineural deafness, dystopia canthorum along with a lateral displacement of the lacrimal puntum, albinism of the posterior pole upon a fundus examination, and intermittent exotropia with a 20 prism diopters of deviation were found. CONCLUSIONS: This patient showed the 4 criteria for a diagnosis of Type 3 Waardenburg syndrome including hypochromic heterochromic iridum, dystopia canthorum along with lateral displacement of the lacrimal puntum, sensorineural deafness, and a muscular system abnormality, i.e., dysplasia of the left thumb. He also showed intermittent exotropia.
Albinism ; Child, Preschool ; Deafness ; Diagnosis ; Exotropia ; Hearing Tests ; Humans ; Korea ; Male ; Radiography ; Thumb ; Waardenburg Syndrome*

After retrobulbar, peribulbar and direct muscle injection of 2% lidocaine in rabbit eyes, we examined the ultrastructural changes of superior and inferior rectus muscles from 30 minutes to 30 days after injections. Physiologic saline was injected in control group as the same method. The purpose of this study is as followings : (1) to determine the myotoxic effect of the anesthetic and subsequent regeneration of muscle fibers; (2) to compare the myotoxic effects among retrobulbar, peribulbar and direct muscle injection; and (3) to evaluate toxic effect to optic nerve. The lesions of retrobulbar and peribulbar injection resulted in the degeneration of the muscle fibers on the surface of extraocular muscles. In contrast, large internal lesion were frequently observed in the muscles that received direct injections of 2% lidocaine. No ultrastructural damages of optic nerve were observed. With these anesthetic methods, initial damages were restored by regeneration up to 30 days. The myotoxic effects of retrobulbar and peribulbar injection seem to be less harmful than that of direct muscle injection of 2% lidocaine in rabbits. This results suggest that the intentional or accidental direct muscle injection of local anesthetics during surgery may cause strabismus especially in elderly patients who have poor muscle regeneration capacity.
Aged ; Anesthesia, Local* ; Anesthetics, Local ; Humans ; Lidocaine ; Muscles ; Optic Nerve ; Rabbits ; Regeneration ; Strabismus

To investigate the effect of graded recession and anteriorization of the overaction inferior oblique muscle, we performed graded recession and anteriorization of inferior oblique muscle in 34 patients(44 eyes) with dissociated vertical deviation(DVD) and/or inferior oblique overaction(IOOA). By the degree of IOOA, graded recession and anteriorization were done 4mm back and 2mm temporal to inferior rectus insertion in 6 eyes, 4mm back in 11 eyes, 3mm back in 6 eyes, 2mm back in 1 eye, 1mm back in 13 eyes, 0.5mm back in 1 eyes, and 0mm, parrallel in 6 eyes. The amount of graded recession and anteriorization was statistically correlated with the degree of change in IOOA(r=0.82, p<0.05) after surgery. Of the 44 eyes, 33(75%) had normal inferior oblique action after surgery. Of the 6 eyes with abnormal oblique function, 4 eyes had overaction of +1, 1 eye had overaction of +2, 1 eye had underaction of -1, 5 eyes had limitation of elevation in upward gaze which did not show hypotropia in primary position. The unilateral recession and anteriorization caused contralateral IOOA in 1 patient. In conclusion, graded recession and anteriorization of the inferior oblique is effective in the surgical management IOOA and DVD. However, to avoid postoperative limitation of elevation and occurrence of contralateral IOOA, we suggest graded recession and anteriorization be used bilaterally when possible.
Humans

Both atypical Brown syndrome (ABS) and inferior rectus restriction of double elevator palsy (DEP) are characterized by monocular limitations of upgaze in primary, abducted position as well as abducted position. Futhermore, they exhibit resistance of elevation in adduction during forced duction test and should be considered in the differential diagnosis. We gained several differential points from 6 year-old female with ABS and a 12 year-old female with DEP due to inferior rectus restriction (IRR). In forced duction test under general anesthesia, ABS exhibited resistance of elevation in adduction and IRR of DEP showed resistance of elevation in all upward direction. DEP showed an impairment of Bell`s phenomenon and mild pseudoptosis preoperatively in which ABS never showed. ABS displayed divergence in upgaze producing V-pattern, and further limitation of upgaze in adduction than DEP. Superior oblique lengthening procedure using silicone expander was performed for ABS. Ipsilateral inferior rectus and contralateral superior rectus recession were performed for IRR of DEP. The results for elevation in adduction, primary position and abduction were satisfactory in both diseases. In conclusion, the direction of resistance in forced duction test, Bell` s phenomenon, the degree of elevation in abducted and abducted position, presence of pseudoptosis and divergence in upgaze producing 3 V-pattern may be helpful to differentiate ABS from IRR of DEP.
Anesthesia, General ; Child ; Diagnosis, Differential* ; Elevators and Escalators* ; Female ; Humans ; Paralysis* ; Silicones

No abstract available.
Child, Preschool* ; Humans