The medical records of 206 eyes of 206 consecutive patients who underwent pars plana vitrectomy between March 1994 and October 1998, were reviewed retrospectively to determine the incidence and risk factors of postoperative intraocular pressure elevation. The mean follow-up period was 104.2 weeks. Early(within 7 days of surgery)and late postoperative intraocular pressure elevation(>21mmHg)occurred in 83 eyes(40.3%)and 84 eyes(40.7%), respectively. Injection of the gas increased the incidence of early postoperative intraocular pressure elevation significantly(Chi-square univariate analysis;P=0.046, Multivariate logistic regression analysis;odds ratio=1.928, confidence interval 1.079~3.480). Patients undergoing pars plana vitrectomy with gas tamponade must be carefully followed after surgery due to high incidence of postoperative intraocular pressure elevation.
Follow-Up Studies ; Humans ; Incidence ; Intraocular Pressure* ; Logistic Models ; Medical Records ; Retrospective Studies ; Risk Factors* ; Vitrectomy*

PURPOSE: To evaluate the influence of peripapillary atrophy on the progress of diabetic retinopathy. METHODS: Interval between the diagnosis of diabetes and the onset of diabetic retinopathy was compared between 77 eyes of 50 patients with peripapillary atrophy and 253 eyes of 172 patients without peripapillary atrophy who visited the Korea university ophthalmology department between January 2002 and May 2002, No one had glaucoma or high myopia. Pepipapillary atrophy was classified by severity and compared. RESULTS: Time to the onset of nonproliferative diabetic retinopathy was longer in the patients with peripapillary atrophy (13.7 years) than the patients without peripapillary atrophy (11.2 years) (p Atrophy* ; Diabetic Retinopathy* ; Diagnosis ; Glaucoma ; Humans ; Korea ; Myopia ; Ophthalmology

BACKGROUND: One of the most serious risks of epidural anesthesia is total spinal blockade from unintentional dural puncture. We evaluated the glucose test and the thiopental precipitation test to differentiate cerebrospinal fluid (CSF) from local anesthetics (LA). METHODS: (1) Experiment 1: CSF from twenty patients was serially diluted with 2% lidocaine or 0.5% bupivacaine. The ratio of CSF to LA-CSF mixture (CSF/(LA+CSF)) was from 0 to 1.0 at an interval of 0.1. We measured the glucose level of each sample with blood sugar meter. (2) Experiment 2: CSF from a hydrocephalus patient was serially diluted and its glucose level of each sample was measured in the same way as Experiment 1. We performed a urine stick test with each sample. Ten anesthetists blinded to the nature of the sample were asked to identify the results of the tests. (3) Experiment 3: Two milimeters of 2.5% thiopental was respectively mixed with local anesthetics, the amount of which was from 0.1 to 1.0 ml at an interval of 0.1 ml. Sixteen anesthetists blinded to the nature of sample were asked to identify the results of the tests. RESULTS: (1) Experiment 1: We can measure glucose level at CSF/(LA +CSF) of 0.5 in 2% lidocaine group and 0.6 in 0.5% bupivacaine group. (2) Experiment 2: We can detect glucose at lower level of CSF/(LA +CSF) by glucose meter than urine stick test (p<0.05). (3) At least 0.35 ml of 2% lidocaine and 0.29 ml of 0.5% bupivacaine was needed respectively to detect precipitation. CONCLUSION: We suggest that blood glucose meter be used instead of glucose test strip. For thiopental precipitation test, we have to adjust the amount of thiopental depending on the amount of test fluid.
Anesthesia, Epidural* ; Anesthetics, Local* ; Blood Glucose ; Bupivacaine ; Cerebrospinal Fluid* ; Glucose ; Humans ; Hydrocephalus ; Lidocaine ; Punctures ; Thiopental

BACKGROUND: One of the most serious risks of epidural anesthesia is total spinal blockade from unintentional dural puncture. We evaluated the glucose test and the thiopental precipitation test to differentiate cerebrospinal fluid (CSF) from local anesthetics (LA). METHODS: (1) Experiment 1: CSF from twenty patients was serially diluted with 2% lidocaine or 0.5% bupivacaine. The ratio of CSF to LA-CSF mixture (CSF/(LA+CSF)) was from 0 to 1.0 at an interval of 0.1. We measured the glucose level of each sample with blood sugar meter. (2) Experiment 2: CSF from a hydrocephalus patient was serially diluted and its glucose level of each sample was measured in the same way as Experiment 1. We performed a urine stick test with each sample. Ten anesthetists blinded to the nature of the sample were asked to identify the results of the tests. (3) Experiment 3: Two milimeters of 2.5% thiopental was respectively mixed with local anesthetics, the amount of which was from 0.1 to 1.0 ml at an interval of 0.1 ml. Sixteen anesthetists blinded to the nature of sample were asked to identify the results of the tests. RESULTS: (1) Experiment 1: We can measure glucose level at CSF/(LA +CSF) of 0.5 in 2% lidocaine group and 0.6 in 0.5% bupivacaine group. (2) Experiment 2: We can detect glucose at lower level of CSF/(LA +CSF) by glucose meter than urine stick test (p<0.05). (3) At least 0.35 ml of 2% lidocaine and 0.29 ml of 0.5% bupivacaine was needed respectively to detect precipitation. CONCLUSION: We suggest that blood glucose meter be used instead of glucose test strip. For thiopental precipitation test, we have to adjust the amount of thiopental depending on the amount of test fluid.
Anesthesia, Epidural* ; Anesthetics, Local* ; Blood Glucose ; Bupivacaine ; Cerebrospinal Fluid* ; Glucose ; Humans ; Hydrocephalus ; Lidocaine ; Punctures ; Thiopental

No abstract available.
Humans

No abstract available.
Humans

The laryngeal mask airway (LMA) has been used with increasing frequency for many purposes. It is one of its advantages that there is no need of muscle relaxants to insert the LMA. So it can be used to look into the movement of glottis during spontaneous respiration. We report a case using a fiberoptic bronchoscope via the laryngeal mask under the impression of cricopharyngeal incoordination. The patient was a 17-days-old and 3.36-kg infant. After injecting glycopyrrolate 0.05mg and propofol 10mg intravenously, a size-1 LMA was inserted. Fiberoptic bronchoscope was inserted through the LMA. We could see the movement of vocal cords normal. Also, no structural abnormality was seen in the larynx and trachea. After removal of the LMA, conventional suspension laryngoscopy was performed to examine the epiglottis and hypopharynx. We could successfully assess the movement and/or structure of vocal cord and trachea. Fiberoptic bronchoscopy via the laryngeal mask airway may be a safe and convinient method in infants.
Ataxia ; Bronchoscopes ; Bronchoscopy* ; Epiglottis ; Glottis ; Glycopyrrolate ; Humans ; Hypopharynx ; Infant ; Laryngeal Masks* ; Laryngoscopy ; Larynx ; Propofol ; Respiration ; Trachea ; Vocal Cords

BACKGROUND: Patient controlled analgesia (PCA) is now a widely accepted method of postoperative pain control. It usually begins at postanesthetic care unit, but it takes time to achieve satisfactory level. We have studied the differences in the onset of analgesic effects between starting PCA preoperatively and starting PCA postoperatively. METHODS: Forty patients for subtotal gastrectomy were randomized to two groups. In group I, we started PCA at postanesthetic care unit, in group II, PCA was begun immediately after the induction of anesthesia. We visited each patient and measured 10 cm-visual analgue scale (VAS) score at 3, 6, 9, 12 and 15 hours after the end of operation. We also measured the time taken from the end of operation to extubation. RESULTS: There were no differences in VAS score between two groups on 3 hour. But at 6, 9, and 12 hour, VAS score was significantly lower in group II (P < 0.05). On 15 hour there was no difference between two groups again. There was no significant difference in extubation time between two groups. Preemptive analgesia was not observed in group II. CONCLUSIONS: We concluded that starting PCA immediately after induction of anesthesia can achieve effective analgesia more rapidly than starting PCA at postanesthetic care unit. VAS score was lower than 3 after 12 hours after the end of operation in group II and we speculated that starting PCA 15 hours prior to operation would maximize the analgesic effect of PCA because there was approximately three hours time difference between the two groups.
Analgesia ; Analgesia, Patient-Controlled* ; Anesthesia ; Gastrectomy ; Humans ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Visual Analog Scale

Objective The aim of this study was to evaluate the clinicopathologic findings of eight patients with primary cancer of fallopian tube diagnosed and treated in the department of Obstetrics and Gynecology, University of Ulsan, Asan Medical Center for nine years. Methods Demographic characteristics, symptoms, signs, stage, tumor grade, mode of therapy and survival of patients were reviewed retrospectively. Results The patients with primary cancer of fallopian tube constituted 0.4% of all gynecologic malignancies encountered during this period. The age of patients ranged 42 to 70 years(mean+/- S.D.; 53.9+/-9.9) and half of patients were postmenopausal and two patients were nulliparous. Patients were treated by simple or radical hysterectomy and bilateral salpingoophorectomy with or without omentectomy and five patients received postoperative chemotherapy. The FIGO surgical stages of the patients were I(4 cases), II(2 cases), III(1 case) and IV(1 case). There were 3 cases of adenocarcinoma, 3 cases of malignant mixed Mullerian tumor, 1 case of undifferentiated carcinoma and 1 case of serous cystic tumor of low malignancy potential. Serum CA 125 values were followed during treatment and decreased during clinical remission and increased at the time of tumor progression. The mean follow-up duration was 24.3(+28.3) months and 7 patients were alive free of disease and one patients with stage Ic died of the disease. Conclusion Primary fallopian tube cancer is an extremely rare malignancy of the female genitalia and preoperative diagnosis of this disease is difficult. Cytoreductive surgery and postoperative combination chemotherapy seem to be effective treatment and CA 125 value could reflect the disease status during the treatment and follow-up of patients.
Adenocarcinoma ; Carcinoma ; Chungcheongnam-do ; Diagnosis ; Drug Therapy ; Drug Therapy, Combination ; Fallopian Tube Neoplasms ; Fallopian Tubes* ; Female ; Follow-Up Studies ; Genitalia, Female ; Gynecology ; Humans ; Hysterectomy ; Obstetrics ; Retrospective Studies ; Ulsan

Clear cell carcinoma of the ovary is a clinicopathologic entity with distinct morphologic characteristics and known to be associated with poor prognosis irrespective of stage and prognostic benefits of chemotherapy have not been evidently demonstrated. This represents 2-3.6% of all ovarian malignancies. From October, 1991 to January, 1998, nine patients with primary clear cell carcinoma of the ovary treated in the deptartment of Gynecology and Obstetrics, University of Ulsan, Asan Medical Center were identified, and clinical and histologic review(including architectural pattern, mitotic activity, nuclear grading) was performed retrospectively. The age of the patients ranged from 30 to 67 year(mean+S.D.; 46.0+11.8) and the mean parity was 1.2 (+1.3). Five(55.6%) of nine patients had elevated level of CA 125. The size of the tumors varied from 3 cm to 20 cm with the mean maximal diameter of 12.1 (+6.3) cm. The FIGO stages of the patients were IC(6 cases, 66.7%), IIC (2 cases, 22.2%) and IV(1 case, 11.1%). All patients except one were treated by total abdominal hysterectomy and bilateral salpingoophorectomy with or without omentectomy and pelvic lymph node dissection. All except two were received postoperative chemotherapy with regimens such as CEC (cyclophosphamide + epirubicin + carboplatin), TC(taxol + carboplatin), CC(cyclophosphamide + carboplatin) or CAP (cyclophosphamide + adriamycin + cisplatin). The mean follow-up duration was 14.6 (+ 8.6) months and 8 patients were free of disease and one patient with stage IV disease died of disease during postoperative chemotherapy(4 months after surgery).
Chungcheongnam-do ; Doxorubicin ; Drug Therapy ; Epirubicin ; Female ; Follow-Up Studies ; Gynecology ; Humans ; Hysterectomy ; Lymph Node Excision ; Obstetrics ; Ovary* ; Parity ; Prognosis ; Retrospective Studies ; Ulsan