The cataract extraction in traumatic cataract with corneal laceration is likely to be different from the ordinary cataract extraction in several points. We tried to know the problems of the operation, the visual outcomes and the postoperative complications in these eyes. In 25 traumatic cataract with corneal laceration, we performed cataract extraction and corneal suture at the same time in 11 eyes and at different time in 14 eyes. The intraoperative problems were difficult anterior capsulotomy, corneal opacity, difficult lens delivery etc.The major postoperative complications were anterior chamber inflammation, corneal edema, posterior capsular opacity and exudative pupillary membrane. In 23 eyes[92%], the visual acuity was increased more than 2 lines. Cataract extraction in traumatic cataract with corneal laceration was very effective surgery, and cataract extraction after primary corneal suture has done had good results in severe corneal laceration with suspicious posterior capsular rupture and non-fitted preoperative preparation.
Anterior Chamber ; Cataract Extraction ; Cataract* ; Corneal Edema ; Corneal Opacity ; Inflammation ; Lacerations* ; Membranes ; Postoperative Complications ; Rupture ; Sutures ; Visual Acuity

PURPOSE: Subtotal thyroidectomy has been the standard operation for Graves' disease in achieving a favorable outcome in recovery of euthyroid state. However, the postoperative outcomes following subtotal thyroidectomy differ by surgeon and postoperative thyroid dysfunctions develop as time passes. Here, we have studied the validity of total thyroidectomy for Graves' disease patients, with a comparison to subtotal thyroidectomy. METHODS: A total of 299 patients with Graves' disease underwent thyroid operation consecutively in Asan Medical Center, Seoul, Korea from December 1995 to December 2005. Among them, 241 cases had subtotal thyroidectomy and 43 had total thyroidectomy. The subtotal thyroidectomy cases were divided into 3 groups according to estimated remnant thyroid; <4 g, 4< or =~<6 g and > or =6 g. Also, according to postoperative thyroid function, the patients were divided into euthyroid, hypothyroidism and hyperthyroidism groups. The postoperative changes of thyroid function, postoperative complications and hospital days were analyzed. RESULTS: In subtotal thyroidectomy, postoperative thyroid function showed euthyroid in 25 (10.4%), hypothyroidism 206 (85.5%) and hyperthyroidism 10 (4.1%). However, total thyroidectomy showed no persistent hyperthyroidism or recurrence. The postoperative thyroid function state changed in 24 patients out of 148 who had more than 2 years postoperative follow-up. Hyper-functional changes developed with higher rates (Hypo-6 vs. hyper-18). The postoperative complication rate was higher in subtotal thyroidectomy including bleeding, hoarseness and hypocalcemia. CONCLUSION: In our study, the patients showing normal thyroid function after subtotal thyroidectomy were very limited and thyroid dysfunction developed continuously with time lapse, especially towards hyperthyroid state. Therefore, we suggest that total thyroidectomy should be considered as a treatment option in Graves' disease.
Follow-Up Studies ; Graves Disease ; Hemorrhage ; Hoarseness ; Humans ; Hyperthyroidism ; Hypocalcemia ; Hypothyroidism ; Korea ; Postoperative Complications ; Recurrence ; Thyroid Gland ; Thyroidectomy

Proliferative vitreoretinopathy is an abnormality in which the rhegmatogenous retinal detachment is complicated by proliferation of membrane on both surfaces of the detached retina and on the posterior surface of the detached vitreous gel. The contraction of these membranes, causing distortion and further elevation of the retina, is the most important cause of failure in retinal reattachment surgery. The author studied the ultrastructural features of preretinal and subretinal membranes which were removed during vitreous surgery in four patients with proliferative vitreoretinopathy. The results were as follows: 1. In the four preretinal membranes, five morphologically distinguishable cell types-retinal pigment epithelial cells, fibrous astrocytes, macrophages, fibrocytes and myofibroblasts-were observed, and the extracellular matrix was composed of collagen fibrils measuring 15-25nm in diameter. 2. In one subretinal membrane, retinal pigment epithelial cells, fibrous astrocytes and macrophages were observed and the major cell type was the retinal pigment epithelial cell. The diameter of the extracellular collagen fibrils was almost the same as that of the preretinal membranes. 3. In the preretinal and subretinal membranes, some of the fibrocytes and macrophages were believed to be derived from retinal pigment epithelial cells.
Astrocytes ; Collagen ; Epithelial Cells ; Extracellular Matrix ; Humans ; Macrophages ; Membranes* ; Retina ; Retinal Detachment ; Retinaldehyde ; Vitreoretinopathy, Proliferative

Intraocular hemorrhage is a major problem during the vitreous surgery, despite of improvements in instrumentation and operative methods. Infusion of thrombin has been reported as an efficacious method of control of intraocular hemorrhage in various vitreous surgery. In this study, 100 U/ml diluted thrombin was injected through the infusion system of Grieshaber manipulator into the vitrous cavity on the bleeding site instead of adding to the infusion solution in 10 cases of vitreous surgery including proliferative diabetic retinopathy, posttraumatic advanced proliferative vitreoretinopathy and giant retinal tear. As the result, all cases of intraocular hemorrhage were controlled within 2 min utes after the injection of thrombin, with the combined use of intraocular diathermy or elevation of intraoclar pressure. The amount of diluted thrombin which was injected in concentration of 100 U/ml, was less than 5ml. The 6 cases of postop erative complication were noted, including 2 cases of vitreous hemorrhage and 4 cases of hypopyon which were controlled within 5 days with topical steroid therapy.
Diabetic Retinopathy ; Diathermy ; Hemorrhage* ; Retinal Perforations ; Thrombin* ; Vitreoretinopathy, Proliferative ; Vitreous Hemorrhage

PURPOSE: We attempted to evaluate the outcomes of a newly inaugurated surgical technique of laparoscopic pyloromyotomy with microscope and stab incision (MS-LP) with right upper quadrant transverse open pyloromyotomy (RT-OP), which were performed in a single institution. METHODS: The outcome variables in terms of total anesthesia time, operative time, postoperative emesis, time to full-enteral feeding, postoperative hospital stay, cosmetic result score, medical cost, and postoperative wound complications were compared between the MS-LP and RT-OP groups. RESULTS: Fifty-one consecutive pyloromyotomy cases were enrolled; MS-LP (n=33) and RT-OP (n=18). There was no difference in age, pyloric thickness, and preoperative electrolyte levels between the two groups. The total anesthesia time and operative time of MS-LP were not significantly longer than that of RT-OP. Time to full-enteral feeding and postoperative hospital stay were shorter in MS-LP (20.0±18.3 vs. 35.3±14.8 hrs. and 2.4±1.3 vs. 3.4±1.2 days; p=0.047 and 0.050, respectively). The cosmetic result score and medical cost were significantly higher in MS-LP (9.1±1.0 vs. 7.3±1.2 in terms of scores and 3,501,950±1,093,147 vs. 2,522,474±68,605 in terms of KRW; p=0.001 and 0.021, respectively). No difference in postoperative wound complications was observed between the two groups. CONCLUSION: Laparoscopic pyloromyotomy with microscope and stab incision may suggest recovery benefits with a shorter time to full-enteral feeding and postoperative hospital stay, as well as better cosmetic results than RT-OP. However, MS-LP may induce higher costs.
Anesthesia ; Length of Stay ; Operative Time ; Postoperative Nausea and Vomiting ; Pyloric Stenosis, Hypertrophic* ; Wounds and Injuries

We recently encountered a patient with membranous obstruction of the inferior vena cava in whom the left superior intercostal and hemiazygos veins were dilated. At chest radiography, the dilation simulated the presence of a second aortic knob and descending thoracic aorta lateral to the originals, and an "aorta-in-aorta" appearance was thus created.
Aorta, Thoracic ; Humans ; Radiography ; Radiography, Thoracic* ; Thorax* ; Veins* ; Vena Cava, Inferior

The new onset of acanthosis nigricans in an adult-especially when the lesions appear on mucosal membranes such as the lips, periocular areas, and anus-may be indicative of an underlying tumor. Adenocarcinoma of the gastrointestinal tract is the most common malignancy-most often cancer of the stomach. A 72 years old female had disseminated, symmetrically distributed, brownish black pigmentation and papillary hypertrophy on the intertriginous and flexural areas for 12 months, and gastric adenocarcinoma was confirmed during the evaluation of internal malignancy. The cutaneous finding of acanthosis nigricans was a significant cutaneous marker of internal malignancy in this case.
Acanthosis Nigricans* ; Adenocarcinoma* ; Aged ; Female ; Gastrointestinal Tract ; Humans ; Hypertrophy ; Lip ; Membranes ; Pigmentation ; Stomach Neoplasms

BACKGROUND: Pulmonary complications following bonemarrow transplantation(BMT) are common and associated with a high mortality rate, We investigated the yield, safety, and impact of fiberoptic bronchoscopy(FOB) for diagnosis of postBMT pneumoniae. METHODS: From May 1997 to April 2000, 56 FOBs were performed in 52 post BMT patients for clinical pneumoniae. BMT patients with repiratory symptoms and/or pulmonary infiltrates had a thoracic HRCT(high resolution computed tomography) and bronchoscopic examination including BAL(bronchoalveolar lavage), TBLB(transbronchial lung biopsy), PSB(protected specimen brush). RESULTS: The characteristics of the subjects were as follows:37 males, 15 females, mean age of 31.3 years(17-45), 35 sibling donor allogenic BMTs, 15 nonrelated donor allogenic BMTs, and 2 autologous BMTs. Fiftynine percent of FOBs (33 FOBs, 31 patients) were diagnostic. Isolated pathogens included the following:12 cytomegalovirus(CMV) (21.4%), 7 pneumocystis carinii(PC) (12.5%), 11 CMV with PC (19.6%), 2 Mycobacaterium tuberculosis (3.6%), and 1 streptococcus (1.8%). Most of the radiographic findings were diffuse interstitial lesions. CMV pneumoniae had mainly diffuse interstitial nodular lesion, and PC pneumoniae had diffuse, interstitial ground glass opacity(GGO). When CMV was accompanied by PC, a combined pattern of nodular and GGO was present. Of the 56 cases(23.2%), 13 died of CMV pneumoniae(n=2), PCP(n=2), mixed infection with CMV and PC(n=3), underlying GVHD(n=1), underlying leukemia progression(n=1), or respiratory failure of unknown origin(n=4). There was no major complication by bronchoscopy. Only 3 cases developed minor bleedig and 1 episode temporary hypoxemia. CONCLUSION: Based on our findings, CMV and PC are the major causes of postBMT pneumoniae. In addition, BAL can be considered a safe and accurate procedure for the evaluation of pulmonary complications after BMT.
Anoxia ; Bone Marrow Transplantation* ; Bone Marrow* ; Bronchoscopy* ; Coinfection ; Diagnosis* ; Female ; Glass ; Humans ; Leukemia ; Lung ; Male ; Mortality ; Pneumocystis ; Pneumonia* ; Respiratory Insufficiency ; Siblings ; Streptococcus ; Tissue Donors ; Tuberculosis

PURPOSE: Ursodeoxycholic acid (UDCA) is known to decrease hepatic injury by promoting the biliary secretion of retained toxic endogenous bile acids in hepatobiliary diseases complicated by total parenteral nutrition (TPN). However, most studies have focused on treatment for complications after TPN. We investigated the preventive role of early administration of UDCA in TPN-induced hepatobiliary complications by a randomized, double-blind, placebo-controlled trial. METHODS: Between May 2000 and May 2002, thirteen patients, who were given TPN more than 10 days in the hospital, were assigned randomly to two groups. One was the case group (7 patients) who were given UDCA simultaneously with TPN regimen, and the other, the control group (6 patients) who were given placebo. Their age ranged from 1 day to 13 years. They were affected with diseases impossible for enteral nutrition, such as prematurity, cerebral palsy, chronic diarrhea, anorexia nervosa, pancreatitis, and cyclic vomiting. The duration of TPN ranged from 10 to 70 days. Hematologic parameters including liver function test were measured at regular intervals, and the duration, composition, administration rate, total calorie of TPN were recorded. The serum levels of total bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase were compared between groups after cessation of the study. RESULTS: The autoregressive coefficient of the control group was 0.4419 (p=0.0651) in bilirubin, -0.0431 (p=0.7923) in AST, 0.2398 (p=0.2416) in ALT, and 0.2459 (p=0.1922) in alkaline phosphatase by mixed procedure model when the parameters were referred to the case group. CONCLUSION: The serum level of total bilirubin did not increase in comparison with that of the control group, but statistically insignificant, when both TPN and UDCA were administered simultaneously from the beginning.
Alanine Transaminase ; Alkaline Phosphatase ; Anorexia Nervosa ; Aspartate Aminotransferases ; Bile Acids and Salts ; Bilirubin ; Cerebral Palsy ; Diarrhea ; Enteral Nutrition ; Humans ; Liver Function Tests ; Pancreatitis ; Parenteral Nutrition, Total ; Ursodeoxycholic Acid* ; Vomiting

STUDY DESIGN: This is a retrospective study analyzing survivorship of pedicle screw fixation in various spinal lesions. OBJECTIVES: To determine the survivorship of pedicle screw fixation and to assess the risk factors for the death of system. SUMMARY OF LITERATURE REVIEW: The previous reports of ten years survival rate of pedicle screw instruments was about eighty percent and the factors which influenced were bone quality, strength of instruments, design of instruments and compliance of patients. MATERIALS AND METHODS: Three hundred and thirty-eight patients(178 males and 160 females), treated by pedicle screw fixation from May 1988 to Dec. 1997, were analysed. Follow-up averaged 26.8months(3 to 116 months). The survival rates according to spinal lesions which caused spinal fixation, types of instruments, level of fusion and methods of fusion were predicted by life table method. The criteria of death were 1)breakage of screw or rod 2)gross bending of screw >5 degree 3)screw pullout and 4)dissociation of rod-screw coupling mechanism. RESULTS: Death of instrumentation was identified in twenty-six patients(7.7%). Of the 1,827 screws used, forty-three screws(2.4%) in twenty patients had broken(28) or bent(15). Thirty-nine Cotrel-Dubousset screws(3.5%) and four Diapason screws(1.6%) had involved. Four patients showed pullout of screws and two had dissociation of rod and screw. There was no rod broken. Life table calculations predicted the survivorship of instrumentation would be 88.7% at 10 years of follow-up. Single segment fixation showed higher survival rate than more than three segments fixation(93.3% vs 83.4%). Fracture had the lowest survival rate(78.3%). Screw failure was not influenced by the method of fusion. Suspected causes of death were collapse of disc space(12 patients), increased kyphosis(6), forceful reduction of fracture(3), infection(2), nonunion(2) and trauma(1). CONCLUSIONS: Ten year survival rate of pedicle screw fixaion was 88.7%. The survival rate was influenced by 1)number of fixed segments 2)cause of fixation .
Cause of Death ; Compliance ; Follow-Up Studies ; Humans ; Life Tables ; Male ; Retrospective Studies ; Risk Factors ; Survival Rate*