PURPOSE: To investigate the efficacy of anterior chamber paracentesis in intravitreal triamcinolone acetonide injection (IVTA). METHODS: A prospective, randomized clinical trial was conducted on 30 eyes of 30 patients undergoing IVTA. Eyes were randomly divided into two groups, those which had undergone anterior chamber paracentesis (Group 1, 15 eyes) and those which had not (Group 2, 15 eyes). We analyzed postoperative changes in intraocular pressure (IOP) in each group. RESULTS: In group 1, the mean preoperative IOP was 15.33+/-1.72 mmHg; postoperative IOP at 2 and 15 minutes was 7.80+/-1.47 and 11.73+/-1.67 mmHg, respectively. In group 2, there was significant elevation of IOP (46.73+/-8.26 mmHg) 2 minutes after the injection, although this was reduced to the normal range (16.13+/-2.61 mmHg) within 15 minutes. CONCLUSIONS: Routine anterior chamber paracentesis seems to be inappropriate considering the brief elevation in IOP that immediately follows IVTA.
Anterior Chamber* ; Humans ; Intraocular Pressure ; Intravitreal Injections ; Paracentesis* ; Prospective Studies ; Reference Values ; Triamcinolone Acetonide ; Triamcinolone*

Medical records of 27 patients(34 eyes)with upper and lower eyelid retraction were reviewed to evaluate the surgical efficacy from September 1987 through September 1999 at the Department of Ophthalmology, Yeungnam University College of Medicine. The causes of 23 patients(28 eyes)with the upper eyelid retraction revealed ptosis overcorrection(12 eyes), thyroid ophthalmopathy(7 eyes), trauma(6 eyes)and congenital deformity(3 eyes). Recession of upper eyelid retractors was performed in all cases and combined M u llerectomy was carried out in 4 eyes of thyroid ophthalmopathy. Preserved sclera was used as a spacer in 2 eyes. For the 4 patients(6 eyes)with lower eyelid retraction, recession of lower eyelid retractors was performed and preserved sclera was used in 4 eyes. After the follow-up periods of 6 to 60 months(mean 27 months), 25 eyes(89%)of the upper eyelid retractions and all of the 6 lower eyelid retractions showed good cosmetic appearance. Postoperative problems included asymmetry of upper eyelid contour(1 eye), overcorrection(4 eyes), and undercorrection(2 eyes). Advancement of levator aponeurosis was performed in 2 overcorrected cases with good result. Recession of the upper or lower eyelid retractors with or without M u llerectomy allowed satisfactory appearance for the patients with upper and lower eyelid retraction. Spacer material of the preserved sclera was used for the patients with severe eyelid retraction.
Eyelids* ; Follow-Up Studies ; Humans ; Medical Records ; Ophthalmology ; Sclera ; Thyroid Gland

Because of the significant reduction in complications from transfusion owing to the development in the technique of preservation of blood, the tendency of hemoglobinuria during anesthesia and surgery has decreased. it seems that there are many causes of hemoglobinuria, and its prognosis is varied. The incidence of Rb negative blood in Korea is no more than 0.2%. Therefore, such a rare blood type may be presserved by freesing for longterm storage. But this freesing and thawing of blood leads to partial hemolysis of the red cells. A case of hemoglobinuria occured during transfusion of Rh negative type B frozen blood.
Anesthesia* ; Erythrocytes* ; Hemoglobinuria* ; Hemolysis ; Incidence ; Korea ; Prognosis

Ankylosing spondylitis is a chronic inflammatory disease that characteristically involves the sacroiliac and spinal joints; less frequently other musculoskeletal articular structures, the eyes and the heart may be affected. A 49 year old male patient was admitted to our hospital to be operated upon for a periappendiceal abscess. The patient has been suffering from ankylosing spondylitis for 18 years and was unable to flex or extend his neck due to cervical and lumbosacral ankylosing spondylitis. Regional anesthesia was tried through L1-2 interspace, which was poorly defined radiologically, but neither a spinal or epidural block from both the lateral and midline were successful due to the bony resistance. Oral endotracheal intubation was performed with an #8 rubber shaped like a "hocky stick". The anesthetic problems of a patient with ankylosing spondylitis are discussed.
Abscess ; Anesthesia* ; Anesthesia, Conduction ; Heart ; Humans ; Intubation, Intratracheal ; Joints ; Male ; Middle Aged ; Neck ; Rubber ; Spondylitis, Ankylosing*

For extremity surgery, tourniquet is placed routinely. With deflation of the tourniquet, the metabolic product is flushed into the systemic circulation and theoretically poses a potential for toxic reactions. In actual fact, these are rare events with this technique. Vigilant monitoring will detect cardiovascular depression at this time. By the tourniquet application, lactic acidemia, abnormal coagulopathy, hypotention, hyperkalemia, increased PaCO2, and production of noxious oxygen free radicals were reported following the release of the tourniquet. But the serial changes of metabolic derangement, degree of lactic acidemia following the use of the tourniquet were not exactly known. To confirm the safety of the pneumatic tourniquet use for two hours, the serial changes of lactic acid levels, acid-base status, potassium concentration, concentration of respiratory gaaes (arterial and end-tidal CO2,) and also hypotension, dysrhythmias and respiratory pattern following release of the tourniquet were studied. Patients were anesthetized with 1% halothane, 50% nitrous oxide and 50% oxygen. Ventilation was maintained by the ventilator to keep the end-tidal CO2, to 4.0% just before the release, and then respiratory parameters (respiratory rate, tidal volume) were constantly maintained through the study. The data were measured from arterial samples or monitors with the following interval; just before tourniquet apply (BTA), before tourniquet release (BTR), at 1, 3, 5, 15 and 30 minutes after the tourniquet release (ATR 1 m, 3m, 5 m, 15 m 30 m). Data measured before the tourniquet apply were used as control values. All data were analyzed by the paired t-test with control. Changes of mean values of each time in one parameter were analyzed by one-way ANOVA. Correlationships between the parameters and duration of ischemia induced by the tourniquet were analyzed by simple regression. The results of this study were as follows; 1) The arterial concentration of lactic acid was maximally increased at 3 minutes after tourniquet release and not returned to control value until 30 minutes after tourniquet release. 2) End-tidal CO, was reached to maximal values of 5.3% at 5 minutes after release of tourniquet. Accompanying theses changes, spontaneous respiration was recovered from the controlled ventilation in 11 patients out of 13 and fought with mechanical ventilator due to asynchronism of respiratory cycles. 3) Mild metabolic acidosis showing the decreased arterial pH and increased PaCO2, in arterial blood gas analysis was maintained in 30 minutes following the release of tourniquet. 4) There were no significant changes of concentrations of potassium. 5) Three episodes of mild hypotension were observed out of 13 patients, but dysrhythmias and other significant clinical changes not observed through the study. The above results showed the possibility of lactic acidemia and changes of respiratory pattern by increased PaCO2, after release of the tourniquet may occur. More intent monitoring is needed to the patients who have had the metabolic derangement in acid-base balance and increased intracranial pressure in application of tourniquet on limbs.
Acid-Base Equilibrium ; Acidosis ; Blood Gas Analysis ; Depression ; Extremities ; Free Radicals ; Gases* ; Halothane ; Humans ; Hydrogen-Ion Concentration ; Hyperkalemia ; Hypotension ; Intracranial Pressure ; Ischemia ; Lactic Acid ; Lower Extremity* ; Nitrous Oxide ; Oxygen ; Potassium ; Respiration ; Tourniquets* ; Ventilation ; Ventilators, Mechanical

From Sept. 1980 to Jan. 1981 twenty three cases of epidural anesthesia for cesarean section were performed at St. Mary's Hospital, Catholic Medical College, Seoul, Korea. The choice of anesthesia for cesaren section is still controversial. But the popularity of epidural anesthesia for elective cesarean section continues to grow even though the thechnique offers no advantage in terms of the biochemical condition of the mother and child. Marcaine which is a new stable, long-acting local anesthetics, was recently introduced to our department. A comparative study between marcaine and lidocaine application to the lumbar epidural anesthesia was performed. The results were as follows: 1) All of the 0.25% marcaine group revealed inadequate anesthesia for cesarean section. 2) Muscle relaxing effect of the 0.5% Marcaine group was revealted to be inferior to that of 2% lidocaine group. 3) Average time of onset of anesthesia was 24 min with marcaine and 18 min with lidocaine respectively. 4) Duration of single epidural injection of marcaine was 27.9+/-47 min and that of lidocatine was 122+/-31 min which revealed the duration of epidural anesthesia with marcaine was longer than that of lidocaine-about one hour. 5) The post operative pain was controlled successfully by means of continuous epidural technique with either 1.0% lidocaine or 0.25% Marcaine.
Anesthesia ; Anesthesia, Epidural* ; Anesthetics, Local ; Bupivacaine ; Cesarean Section* ; Child ; Female ; Humans ; Injections, Epidural ; Korea ; Lidocaine ; Mothers ; Pregnancy ; Seoul

The bleomycin is a chemotherapeutic agent useful in the treatment of selected neoplasms, including non-seminomatous testicular carcinoma. An increased incidence of respiratory failure postoperatively in patients previously treated with bleomycin has been reported. And an increase in the toxicity of high concentration of oxygen in oxygen therapy has been demonstrated in rodents after administration of bleomycin. However, the use of an enriched inspired oxygen concentration 41% was reported not hazardous in a testicular cancer population who were exposed to significant doses of bleomycin. The pulmonary toxicity of bleomycin therapy in combination with high oxygen exposure is still controversial. The aim of this study is to analyze the effect of exposure to 50% oxygen in the mice pretreated with bleomycin. Bleomycin were administered intraperitoneally to the mice, 4 mg/ kg twice a week for 5 weeks. After administeration of bleomycin to the mice, the half of the miee, the experimental group, were exposed to 50% oxygen for 24 hours. And the other control group were exposed to room air. Morphometric analysis with light microscopy was performed to the following parameters; number of total pulmonary cell count, percentage of consolidation of lung parenchyma and degree of intensity of fibrosis of lung parenchyma. The area of diseased lung was increased in mice given with bleomycin and hyperoxia compared with that of those treated with bleomycin only. The results were as follows, l) In the control group given 4 mg/kg bleomycin and room air, the number of total pulmo- nary cell count were 36.21+/-6.53/10(-8) m(2) and the percentage of consolidation was 1.2+/-0.4%. 2) In the experimental group given with 4 mg/kg bleomycin and 50% oxygen for 24 hrs, the number of total pulmonary cell count were 59.67+/-9.13/10(-8) m(2) and the percentage of area of consolidation of lung parenchyma was 5.8+/-2.3%, 3) Fibrosis of the lung parenchyma was seen only in the experimental group to which oxygen was given after administration of bleomycin. In conclusion, this study demonstrated that hyperoxia potentiated the pulmonary damage by bleomycin in the mice.
Animals ; Bleomycin* ; Cell Count ; Fibrosis ; Humans ; Hyperoxia* ; Incidence ; Lung ; Mice ; Microscopy ; Oxygen ; Respiratory Insufficiency ; Rodentia ; Testicular Neoplasms

STUDY DESIGN: A retrospective study of perioperative complications was performed in elderly patients undergoing posterior decompression and fusion for lumbar degenerative conditions. OBJECTIVES: To identify the perioperative complications and to analyze the influence of posterior decompression and fusion on the occurrence of the morbidity. SUMMARY OF BACKGROUND DATA: Because of the better long-term results, the decompression and fusion with instrumentation have been recently recommended for treatment of degenerative lumbar disease in the elderly. However, the perioperative complication rate and their correlating factors have not been adequately defined. MATERIALS AND METHODS: A retrospective review of the medical charts of fifty-one patients aged 65 years or older operated during June 1997 to July 1998 was undertaken. The minimum follow-up required for inclusion was three months. All medical and surgical perioperative complications directly related to the surgical procedure were noted. The association of fusion levels and other factors with the occurrence of perioperative complications were analyzed. RESULTS: Perioperative complications occurred in 17(33.3%) of the 51 patients. Seven patients(13.7%) had at least one major complication, 5(9.8%) had at least one minor complication and 9(17.6%) had insignificant complications. Hematoma and wound infection were the most common surgical complications. Paralytic ileus was the most common medical complication. There was no difference in the rate of perioperative complications between the long and short fusion groups. An age of more than seventy-five years at the time of surgery was associated with a higher risk of complications. There was no statistically significant relationship between the perioperative complications and sex diagnosis, operative time, type of bone grafting, amount of blood transfusion, or preoperative comorbidity of the patients. CONCLUSION: Perioperative complications were quite common in the present series, occurring in 33.3% of the patients. An age over seventy-five years was a risk factor for associated with morbidity. The number of levels fused and the comorbidity did not associated the development of the complications.
Aged* ; Blood Transfusion ; Bone Transplantation ; Comorbidity ; Decompression ; Diagnosis ; Follow-Up Studies ; Hematoma ; Humans ; Intestinal Pseudo-Obstruction ; Operative Time ; Retrospective Studies ; Risk Factors ; Wound Infection

STUDY DESIGN: This is a retrospective study. OBJECTIVES: The purpose of the study was to determine the efficacy of pedicle screw fixation in treatment of congenital scoliosis. SUMMARY OF BACKGROUND DATA: Surgical correction of rigid congenital scoliosis often ends up in less than satisfactory results. Pedicle screw fixation, enabling a rigid fixation with improved holding power may enhance the correction of these tenacious deformities. METHODS: Twenty one congenital scoliosis treated by combined anterior release and posterior correction were analyzed after minimum follow up of 2 years (range 2-9 years). There were 11 males and 10 females. The mean age was 21.1 years (range: 11.2-29.4 years). They were divided into two groups by the posterior fixation method used. The group treated by multiple hook fixation (HF) comprised 11 patients with an index curve of 67+/-2 0degree. The group by multiple pedicle screw fixation (SF) comprised 10 patients with an index curve of 61+/-26degree. There was no statistical difference in the preoperative index curve characteristics between the two groups. RESULTS: Immediately after the surgery, the mean index curve was 37.0degreein the HF group and 29.9degreein the SF group showing a correction of 44.7+/-19% and 49+/-17% respectively. At the final follow up, the curve was 46.9degreein the HF group and 32.3degreein the SF group showing a loss of correction of 21+/-22% and 7+/-2% respectively. CONCLUSIONS: Pedicle screw fixation is an effective method of treating congenital scoliosis, offering an improved correction and maintenance.
Congenital Abnormalities ; Female ; Follow-Up Studies ; Humans ; Male ; Retrospective Studies ; Scoliosis*

Brunner's gland hamartomas are rare duodenal tumors with characteristic pathologic featmes. The usual clinical presentation is nonspecific symptoms, obstructive symptoms, or intestinal bleeding. The majority of these tumors are less than 3 cm in diameter. In cases of larger size, the manifestations are usually intestinal obstruction or intestinal bleeding. The cases with massive gastrointestinal bleeding and severe anemia, requiring transfusion are rare. The diagnosis is made by radiologic studies and gastroduodenoscopy. The treatment of Brunner's gland hamartomas should be conservative, since they are not premalignant, However, the lesions originate in the submucosa, so the confimative diagnosis usually cannot be made by endoscopie biopey. For definitive diagnosis and relief of symptoms, the lesions must be removed surgically or endoscopically. Endoscopic excision is indicated if the tumar is pedunculated. We recently experienced a case of Brunner's gland hamartoma of about 5.5 cm in diameter with intestinal bleeding, requiring transfusion and intussusception. Preoperative diagnosis was submucosal tumor, such as lymphoma, with duodeno-duodenal intussusception. After surgical removal, the resected specimen showed the histologic features of Bruaner's gland hamartoma.
Anemia* ; Diagnosis ; Duodenum ; Hamartoma* ; Hemorrhage ; Intestinal Obstruction ; Intussusception* ; Lymphoma