PURPOSE: To investigate the change of retinal volume according to anterior segment refractive power using contact lens by spectral domain optical coherence tomography (SD-OCT). METHODS: The retinal volume was measured using a SD-OCT (Heidelberg retinal angiography Spectralis + OCT, Heidelberg Engineering, Heidelberg, Germany) in 60 subjects without any underlying disease. The same examiner performed a 31-section macular volume-scan at 240 µm intervals, re-measured the same area by changing the refractive power of the anterior segment by wearing soft contact lenses of +6.0 diopters and −6.0 diopters. By using the ImageJ software to calculate the cross-sectional area and of the cross-sectional area and the volume was measured. RESULTS: The mean age of the participants was 25.6 ± 1.5 years and the mean axial length was 25.7 ± 1.57 mm. The volume of the posterior pole retina measured without the contact lens was 13.48 ± 0.05 and the mean volume of the retina measured with +6.0 diopter and −6.0 diopter contact lens in the same patient was 13.47 ± 0.07 mm³ and 13.48 ± 0.05 respectively. The mean volume was significantly lower(p = 0.036) in the measurement with the +6.0 diopter lens than in the measurement without the lens, and the mean volume was significantly higher in the measurement with the +6.0 diopter lens (p = 0.042). The change in retinal thickness was increased with longer axial length (r = 0.32, p < 0.05), but the central foveal thickness did not correlate with anterior corneal power (p = 0.463). CONCLUSIONS: The volume of the retina measured using the SD-OCT is affected by the refractive power of the anterior segment and the axial length. Therefore, it is necessary to consider the change of refractive index because it can change the retinal volume measured by SD-OCT.
Angiography ; Contact Lenses, Hydrophilic ; Humans ; Refractometry ; Retina ; Retinaldehyde ; Tomography, Optical Coherence

Hip fracture is one of the most common traumatic fractures in geriatric patients. With the increase in the geriatric population, physicians are more concerned about anesthetic management of these patients and a lot of articles have been published in relation to geriatric hip fracture. Due to age related comorbidities and physical status, perioperative management of these patients are complex and related to mortality and morbidity. Anesthesia and pain control for these patients are directly related to the postoperative outcome. This article summarizes the most recent opinions about perioperative management of geriatric hip fracture patients at the point of preoperative evaluation, anesthetic managements, and pain control.
Anesthesia ; Arthroplasty, Replacement, Hip ; Comorbidity ; Hip Fractures ; Hip* ; Humans ; Mortality

Zinc is an antioxidant trace mineral, scavenging free radicals and known to be involved in inflammatory reactions. The prevalence of atherogenic diseases such as coronary heart disease (CHD) are increasing in Korean adults of middle age and elderly. The increased cell damage from free radicals and inflammation have been implicated in etiology of CHD, and the evidence is accumulating that low zinc status is involved in the prevalence of this inflammatory atherogenic disease. However, little is known about the zinc status of Korean CHD and its relationship with dietary zinc intake and zinc bioavailabilty. In this study the serum zinc levels of male patients with CHD over 40 yrs. were compared with that of healthy adult males and its associations with dietary zinc intake and zinc bioavailabilty affecting factors were examined. Serum zinc level was measured by HANARO research reactor using neutron activation analysis (NAA) method. The overall proportion of patients with zinc deficiency, serum zinc concentrations below 74.0 microgram/dL was 32.8% compared to the 10.3% in healthy group. The average serum zinc levels were 80.7 microgram/dL and 88.3 microgram/dL in patients and healthy group, respectively, showing significantly low zinc status in CHD patients compared to healthy group. The intake of nutrients such as energy, carbohydrate, iron, and copper of CHD patients was significantly higher compared to that of the healthy group. In addition, the intake of calcium, iron, and protein from vegetable foods was significantly higher in CHD patients than that of healthy group. The dietary zinc intake was 12.7+/-4.5 mg and 11.5+/-6.9 mg in CHD patients and control group, respectively, which showed no difference. The phytate intake of patients group, which is 1389.0 mg, was significantly higher than the control group which showed 1104.8 mg. However, the ratio of phytate :zinc or phytate *calcium :zinc per 1000 kcal energy intake did not show any difference between two groups. The serum zinc levels did not show any correlation with zinc or factors that affect the bioavailability of zinc. The dietary factors influencing the zinc status were not found in CHD patients.
Adult ; Aged ; Biological Availability ; Calcium ; Copper ; Coronary Disease* ; Energy Intake ; Free Radicals ; Humans ; Inflammation ; Iron ; Male* ; Middle Aged ; Neutron Activation Analysis ; Phytic Acid ; Prevalence ; Vegetables ; Zinc*

Objective: There has been a consistent import of Plasmodium falciparum malaria into South Korea. As artesunate has been shown to reduce malaria related mortality in other countries, we sought to evaluate the treatment outcomes of P. falciparum malaria with artesunate. Methods: We retrospectively reviewed demographic (age, sex, travel history, and year of admission) and clinical data (sign and symptoms, laboratory findings, complications, treatment outcome) of patients with imported P. falciparum malaria diagnosed between 2014 and 2019. Results: A total of 55 patients with P. falciparum malaria were included, of which 36.4% had severe P. falciparum malaria. Their mean (±standard deviation) age was 42.6 (±12.8) years. Overall, the median length of hospital stay was 6 days (interquartile range, 4-9; range, 3-36) and 21.8% of the patients needed intensive care unit (ICU) care. The overall mortality rate was 3.6%. In patients with severe P. falciparum malaria, half of the patients (50.0%) needed ICU care and the mortality rate was 10.0%. Conclusion This is the first study to report the outcomes of imported P. falciparum malaria treated with artesunate. The mortality rate for severe P. falciparum malaria in this study was higher than that in other non-endemic countries. Further studies are needed to evaluate the effect of treatment of P. falciparum malaria with artesunate.

Cervical plexus blocks (CPBs) have been used in various head and neck surgeries to provide adequate anesthesia and/or analgesia; however, the block is performed in a narrow space in the region of the neck that contains many sensitive structures, multiple fascial layers, and complicated innervation. Since the intermediate CPB was introduced in addition to superficial and deep CPBs in 2004, there has been some confusion regarding the nomenclature and definition of CPBs, particularly the intermediate CPB. Additionally, as the role of ultrasound in the head and neck region has expanded, CPBs can be performed more safely and accurately under ultrasound guidance. In this review, the authors will describe the methods, including ultrasound-guided techniques, and clinical applications of conventional deep and superficial CPBs; in addition, the authors will discuss the controversial issues regarding intermediate CPBs, including nomenclature and associated potential adverse effects that may often be neglected, focusing on the anatomy of the cervical fascial layers and cervical plexus. Finally, the authors will attempt to refine the classification of CPB methods based on the target compartments, which can be easily identified under ultrasound guidance, with consideration of the effects of each method of CPB.
Airway Obstruction ; Analgesia ; Anesthesia ; Cervical Plexus Block* ; Cervical Plexus* ; Classification ; Head ; Methods ; Neck ; Ultrasonography

Background: Commonly used epidural or systemic analgesics for pain control after hip surgery carry risk for potential adverse effects. In contrast, the quadratus lumborum block (QLB) utilizes a simple and easy fascial plane technique and provides a wide area of sensory blockade. Thus, the QLB may be beneficial as analgesia after total hip arthroplasty. CaseHere, we report the case of an 83-year-old man who received a continuous transmuscular QLB as part of a multimodal analgesia after hardware removal and total hip arthroplasty. The patient received a continuous infusion of 0.2% ropivacaine at 8 ml/h through an indwelling catheter in addition to patient-controlled analgesia with intravenous fentanyl and oral celecoxib. The patient’s pain scores did not exceed 4, and no additional analgesics were required until postoperative day 5. Conclusions Transmuscular QLB may be a suitable option for multimodal analgesia after total hip arthroplasty.

Background: The retro superior costotransverse ligament space (RSS) block, reported as a novel target in paraspinal block, involves the spreading of local anesthetics into the thoracic paravertebral space through slits around the superior costotransverse ligament . This blocks not only the dorsal rami but also the ventral rami, achieving a reliable complete sensory blockade. Case: We performed an RSS block at the T5, T7, and T9 levels on both sides for postoperative analgesia in two patients who underwent laparoscopic gastrectomy. Both patients showed complete sensory blockade from T4 to L1 on the anterior, lateral, and posterior chest walls in the recovery room. The resting and dynamic pain scores were 0 at 30 min and 6 h postoperatively. The pain score consistently remained below 3 throughout postoperative period. Conclusions The RSS block provided effective postoperative analgesia in laparoscopic gastrectomy through definitive complete sensory blockade.

Background: The retro superior costotransverse ligament space (RSS) block, reported as a novel target in paraspinal block, involves the spreading of local anesthetics into the thoracic paravertebral space through slits around the superior costotransverse ligament . This blocks not only the dorsal rami but also the ventral rami, achieving a reliable complete sensory blockade. Case: We performed an RSS block at the T5, T7, and T9 levels on both sides for postoperative analgesia in two patients who underwent laparoscopic gastrectomy. Both patients showed complete sensory blockade from T4 to L1 on the anterior, lateral, and posterior chest walls in the recovery room. The resting and dynamic pain scores were 0 at 30 min and 6 h postoperatively. The pain score consistently remained below 3 throughout postoperative period. Conclusions The RSS block provided effective postoperative analgesia in laparoscopic gastrectomy through definitive complete sensory blockade.

Background: The retro superior costotransverse ligament space (RSS) block, reported as a novel target in paraspinal block, involves the spreading of local anesthetics into the thoracic paravertebral space through slits around the superior costotransverse ligament . This blocks not only the dorsal rami but also the ventral rami, achieving a reliable complete sensory blockade. Case: We performed an RSS block at the T5, T7, and T9 levels on both sides for postoperative analgesia in two patients who underwent laparoscopic gastrectomy. Both patients showed complete sensory blockade from T4 to L1 on the anterior, lateral, and posterior chest walls in the recovery room. The resting and dynamic pain scores were 0 at 30 min and 6 h postoperatively. The pain score consistently remained below 3 throughout postoperative period. Conclusions The RSS block provided effective postoperative analgesia in laparoscopic gastrectomy through definitive complete sensory blockade.

Background: The retro superior costotransverse ligament space (RSS) block, reported as a novel target in paraspinal block, involves the spreading of local anesthetics into the thoracic paravertebral space through slits around the superior costotransverse ligament . This blocks not only the dorsal rami but also the ventral rami, achieving a reliable complete sensory blockade. Case: We performed an RSS block at the T5, T7, and T9 levels on both sides for postoperative analgesia in two patients who underwent laparoscopic gastrectomy. Both patients showed complete sensory blockade from T4 to L1 on the anterior, lateral, and posterior chest walls in the recovery room. The resting and dynamic pain scores were 0 at 30 min and 6 h postoperatively. The pain score consistently remained below 3 throughout postoperative period. Conclusions The RSS block provided effective postoperative analgesia in laparoscopic gastrectomy through definitive complete sensory blockade.