A 6-year-old girl visited us with a 4-week history of inflammatory, pustular, tender patches and plaques on the scalp, and a 3-day history of multiple, erythematous, indurated, tender, subcutaneous nodules on both pretibial areas. A swab was taken from the scalp lesion and colonies of Tiichophyton mentagrophytes grew on culture. The histopathological findings of the leg nodule were consistent with erythema nodosum. The patient was treated with oral itraconazole and deflazacort, combined with topical potassium permanganate solution. Erythema nodosum regressed two weeks later and the kerion of the scalp regressed six weeks after starting the treatment, leaving residual scarring alopecia. The patient was diagnosed as erythema nodosum probably induced by kerion celsi, that has not been reported in the Korean literature.
Alopecia ; Child ; Cicatrix ; Erythema Nodosum* ; Erythema* ; Female ; Humans ; Itraconazole ; Leg ; Potassium Permanganate ; Scalp ; Tinea Capitis*

Actinomycosis is an oppoturnistic infection of actinomyces, which are relatively avirulent endogenous oral commensals. After trauma or infection, they breach the normally protective mucosal barriers to invade adjacent soft tissue structures. Lesions routinely contain other bacteria, the normal resident flora at the site of primary infection, which act synergistically with actinomyces species to provoke this unique infection, which range from an acute suppurative process to a chronic fibrotic process. According to epidemic studies about pelvic actinomycosis, it should be significantly related to IUD(intrauterine device). It is accounted that IUD cause chronic intrauterine infection, tissue injury and act as nucleus for parasitic infestation. Here we present a case of pelvic actinomycosis related to IUD with brief review of the concerned literature.
Actinomyces ; Actinomycosis* ; Bacteria

PURPOSE: To compare the intraocular pressure (IOP) measured by the pressure phosphene tonometer (PPT) and the Goldmann applanation tonometer (GAT) according to the feedback of the IOP measured by GAT and the use of the dominant hand during the measurement. METHODS: In a group of 40 eyes of 40 normal subjects in their twenties and thirties without diagnostic specificity, IOP was measured with PPT three times by themselves and with the GAT by one examiner on 3 different days. In 20 eyes of the feedback group, the subjects were informed of their IOP measured by GAT and were allowed to measure with PPT again. In each group, half of the eyes (20 eyes) were assigned to use the dominant hand to measure the IOP (dominant group) and the other half (20 eyes) were assigned in the other way (nondominant group). RESULTS: In feedback, nonfeedback and dominant groups, comparison of the first day showed statistically significant differences of mean IOP. But on the third day, there were no significant differences among all 4 groups and there were significant correlations. There was a stronger correlation between the two methods in the feedback group (r=0.721) than in the nonfeedback group. The correlation coefficient of all 40 eyes was 0.605 (p<0.001). CONCLUSIONS: PPT has a strong correlation with GAT in the range of normal IOP and is thought to be more useful as a self tonometer for the measurement of both eyes with the periodical measurement of IOP by GAT in clinics.
Hand ; Intraocular Pressure* ; Phosphenes* ; Sensitivity and Specificity

BACKGROUND: Aspiration of gastric contents is one of the most feared complications during anesthesia. But the routine preoperative order "NPO after midnight" produces thirst, hunger, irritability and other unpleasant experiences in elective inpatients. So, we evaluated the effect of preoperative clear fluid (orange juice) intake, with and without ranitidine, on gastric volume and pH. METHODS: Sixty unpremedicated adult patients, ASA class I or II, scheduled for elective operation were randomly divided into three groups. Group I (n = 20) fasted after midnight. Group II (n = 20) ingested orange juice 150 ml, 2 3 hours before anesthesia. Group III (n = 20) ingested orange juice 150 ml with ranitidine 150 mg, 2 3 hours before anesthesia. As soon as the patients were intubated and stabilized after induction, gastric contents were collected via 16 18 French Salem Sump tube. Gastric volume and pH were measured. RESULTS: Statistically significant differences were found between groups I and II on the hand and group III on the other, in both of gastric volume and pH. But there were no significant differences between groups I and II. CONCLUSIONS: These results suggest that preoperative clear fluid intake does not affect gastric volume and pH. Moreover, concomitant administration of ranitidine decreases gastric volume and increases pH.
Adult ; Anesthesia ; Citrus sinensis ; Hand ; Humans ; Hunger ; Hydrogen-Ion Concentration* ; Inpatients ; Ranitidine* ; Thirst

BACKGROUND: Aspiration of gastric contents is one of the most feared complications during anesthesia. But the routine preoperative order "NPO after midnight" produces thirst, hunger, irritability and other unpleasant experiences in elective inpatients. So, we evaluated the effect of preoperative clear fluid (orange juice) intake, with and without ranitidine, on gastric volume and pH. METHODS: Sixty unpremedicated adult patients, ASA class I or II, scheduled for elective operation were randomly divided into three groups. Group I (n = 20) fasted after midnight. Group II (n = 20) ingested orange juice 150 ml, 2 3 hours before anesthesia. Group III (n = 20) ingested orange juice 150 ml with ranitidine 150 mg, 2 3 hours before anesthesia. As soon as the patients were intubated and stabilized after induction, gastric contents were collected via 16 18 French Salem Sump tube. Gastric volume and pH were measured. RESULTS: Statistically significant differences were found between groups I and II on the hand and group III on the other, in both of gastric volume and pH. But there were no significant differences between groups I and II. CONCLUSIONS: These results suggest that preoperative clear fluid intake does not affect gastric volume and pH. Moreover, concomitant administration of ranitidine decreases gastric volume and increases pH.
Adult ; Anesthesia ; Citrus sinensis ; Hand ; Humans ; Hunger ; Hydrogen-Ion Concentration* ; Inpatients ; Ranitidine* ; Thirst

PURPOSE: To analyze the clinical features and natural history of acquired third, fourth, and sixth cranial nerve palsy. METHODS: We reviewed the medical records of 89 patients who were diagnosed with acquired third, fourth, and sixth nerve palsy from January 2003 to March 2005. The natural course of the disease and the factors affecting recovery were analyzed for the 66 patients who had their first ocular examination within 3 months from onset and were followed up for at least 6 months. RESULTS: The average age of onset was 50.1 years. The sixth cranial nerve was affected most frequently (n=43, 48.3%). Vascular disease (n=27, 30.3%) was most common etiology of cranial nerve palsy, followed by an undetermined cause (n=19, 21.3%). Of the 66 patients who had their first ocular examination within 3 months from onset and were followed up for at least 6 months, 40 (60.6%) patients showed a decrease in the angle of deviation by more than 10 prism diopters, and of these, 32 (48.5%) patients made a complete recovery from pareses. The recovery rates for patients with vascular disease or undetermined etiology (p=0.001), milder initial eyeball deviation and ocular motor restriction (p<0.001) were higher. CONCLUSIONS: In the natural course of the disease, the recovery rate of acquired third, fourth, and sixth nerve palsy was 60.6%. The most favorable prognosis occurred with vascular disease, undetermined etiology, and less severe paralysis on onset.
Abducens Nerve Diseases* ; Abducens Nerve* ; Age of Onset ; Cranial Nerve Diseases ; Humans ; Medical Records ; Natural History* ; Paralysis ; Paresis ; Prognosis ; Vascular Diseases

PURPOSE: To analyze the results of posterior capsule rupture (PCR) that occurred in the first 1000 cases performed by a newly trained phacoemulsification surgeon. METHODS: The medical records of 47 eyes of 45 patients who suffered PCR among the first 1000 cases of cataract surgery performed by one newly trained surgeon were reviewed. All surgeries started with the plan of phacoemulsification and there was no supervision by any experienced surgeon. RESULTS: Over the course of the series of 1000 cases, the PCR incidence rate steadily fell from 12% in the first 100 cases to 4.7% (47 cases) for all 1000 cases as the operator gained experience with the techniques. However, after the change of phaco machine and the technique of nucleus removal, the incidence increased abruptly to 11% and then decreased again. There was no significant difference in PCR incidence between surgeries of the first eye and the second eye of the 335 patients who underwent cataract surgery in both eyes by the surgeon (p=0.534). PCR occurred most commonly in the course of phacoemulsification (83.0%) and mainly in the eyes with severe nucleus sclerosis. CONCLUSIONS: In the early stages of the career of a phacoemulsification surgeon, the PCR incidence showed a learning curve that decreased with increasing experiences, then it increased again after the change of operational procedure before finally decreasing once more. In the surgery of the second eye, poor patient cooperation could be overcome with a careful approach, and PCR occurred most commonly in the course of phacoemulsification (83.0%).
Cataract ; Humans ; Incidence ; Learning Curve ; Medical Records ; Organization and Administration ; Patient Compliance ; Phacoemulsification* ; Polymerase Chain Reaction ; Rupture* ; Sclerosis

PURPOSE: To evaluate the long-term efficacy of pars plana vitrectomy (PPV) on refractory or recurrent macular edema due to branch retinal vein occlusion (BRVO) after intravitreal steroid or anti-vascular endothelial growth factor injections. METHODS: We retrospectively reviewed the medical records of patients with macular edema due to BRVO who underwent PPV after intravitreal triamcinolone acetonide or bevacizumab injections and followed-up for at least 12 months. The best corrected visual acuity (BCVA) and subfoveal macular thickness were measured at 1, 3, 6, 12 months postoperatively and were compared with the preoperative values. The patients received additional intravitreal injections if they had recurrence of macular edema after surgery. The frequency of intravitreal injections (per year) were compared pre- and postoperatively. RESULTS: A total of 41 eyes of 41 patients were included and the mean duration of follow up was 58.7 ± 30.0 (15 - 124) months. The BCVA (logMAR) at 1, 3, 6, 12 months postoperatively, and last follow up was 0.52 ± 0.42, 0.46 ± 0.38, 0.41 ± 0.26, 0.50 ± 0.34, and 0.49 ± 0.37, respectively, which was significantly different from the preoperative values (0.90 ± 0.47, p < 0.001). The subfoveal macular thickness at 1, 3, 6, 12 months postoperatively, and last follow up was 342.72 ± 84.10 µm, 365.02 ± 110.73 µm, 359.45 ± 119.28 µm, 360.96 ± 124.33 µm, and 329.34 ± 119.69 µm, respectively, which was also significantly different (p < 0.001) from the preoperative values (484.9 ± 112.8 µm, p < 0.001). The frequency of intravitreal injections was significantly decreased after surgery (3.58 ± 2.05 times/year vs. 0.60 ± 0.83 times/year, p < 0.001). CONCLUSIONS: Pars plana vitrectomy could improve BCVA, decrease subfoveal macular thickness, and decrease recurrence in BRVO patients with refractory or recurrent macular edema after intravitreal injection. PPV could be an effective treatment option for these patients.
Bevacizumab ; Endothelial Growth Factors ; Follow-Up Studies ; Humans ; Intravitreal Injections* ; Macular Edema* ; Medical Records ; Recurrence ; Retinal Vein Occlusion* ; Retinal Vein* ; Retinaldehyde* ; Retrospective Studies ; Triamcinolone Acetonide ; Visual Acuity ; Vitrectomy*