The hallmark of exfoliation syndrome is the appearance of white granular deposits and dandruff-like flakes on the lens,iris and angle. The incidence of glaucoma is high,and due to zonular weakening, complications are likely to occur in cataract surgery. A histopathological study with electron microscopy was performed on the iris and conjunctival tissue in order to clarify the production process of exfoliation material in the eyes with exfoliation syndrome. The materials were obtained from 13 eyes with exfoliation syndrome during surgery for glaucoma or cataract. The clumps of microfibrils were observed in the extracellular matrix, and the exfoliation materials were closely related with microfibrils.It was found that the basic unit of the exfoliation materials was microfibril. The cellular degenerations were observed in the basement membrane of capillary endothelium, especially the cells near the iris vessels. The exfoliation materials were observed around the degenerated cells; the mature or immature exfoliation materials around the iris melanocyte which show the various degrees of degeneration. The more degeneration and melting of the cells, the larger amount of exfoliation materials. This study suggests that the exfoliation materials in the eyes with exfoliation syndrome are derived from the abnormal microfibril, abnormal basement membrane, and degenerated cell itself.
Basement Membrane ; Cataract ; Endothelium, Vascular ; Exfoliation Syndrome* ; Extracellular Matrix ; Freezing ; Glaucoma ; Incidence ; Iris ; Melanocytes ; Microfibrils ; Microscopy, Electron

We evaluated retrospectively the clinical records of 46 cases of Duanes retraction syndrome. The purpose of this study is to demonstrate a clinical characteristics of this syndrome and improvement of abnormal head posture and degree of deviation in 14 cases undergoing operation. Unilateral manifestation was in 42 cases and 4 cases were involved bilaterally. Left eye was involved predominantly in 29 cases (63.0%). The frequencies analyzed according to Hubers classification were that Type I was 64.3%, Type II 7.1%, and Type III 28.6% in unilateral cases. Of unilateral cases, compensatory face turn was exhibited in 65.2% of Type I, 100% of Type II, and 60.0% of Type III. In primary position, 44.4% of Type I had esodeviation, and 100% of Type II ad 83.3% of type III had exodeviation. The major concerns of most patients or their parents were the correction of strabismus and gaze limitation, but they hardly recognized abnormal head posture. The correction of abnormal head posture and strabismus was achieved in 78.6% postoperatively.
Classification ; Duane Retraction Syndrome* ; Esotropia ; Exotropia ; Head ; Humans ; Parents ; Posture* ; Retrospective Studies ; Strabismus

No abstract available.
Animals ; Cats* ; Reflex*

It is the purpose of this study to evaluate fusional status of 49 strabismic patients who showed orthophoria less than 10 prism diopters (PD) after surgery under alternate prism and cover test. We undertook the Worth 4-dot(W4D) test twice, reversing the position of the red/green glasses between the eyes for the second trial. Bagolini test was also performed in 31 of 49 cases. Nineteen of 49 case(18.4%) showed different results on the W4D test with red/green glasses after reversal at near or distance, either changing fusional status or changing laterality of suppression. Four of 31 cases (18.0%) showed different status of fusion or suppression between W4D and Bagolini tests. We think that it repeating test twice, with the red/green glass reversed between trials, and with combination of Bagolini test, provides better reliability of W4D test.
Artifacts* ; Eyeglasses ; Glass ; Humans ; Strabismus

Adjustable suture technique may be indicated for strabismus surgery when the surgical outcome will be uncertain. We used ketamine intramuscular injection for sedation the day, and performed adjustment after the surgery to enhance the postoperative success rate. The results were analyzed. The average age of the 29 pediatric patients was 53.5 +/-21 months and they were devided into 22 exotropia group and 7 esotropia group. The minimal postoperative observation period was 3 months(average 4.2+/-1.6 months). Among 22 exotropia patients, 13 patients were adjusted and the advancement amount was 1~2 mm. Esotropia was not adjusted. In the final follow-up evaluation, 19 exotropic patients(86.4%)and 7 esotropic patients showed the favorable outcome. However, 3 exotropic patients failed. Two were overcorrected and 1 was undercorrected. In 1 overcorrected case, the postoperative V pattern esotropia occurred. When the alignment can be measured and the picture of external eyes can be obtained, postoprative adjustment was possible after ketamine intramuscular injection. Since the degree of preoperative alignment and the precise evaluation of preadjustment alignment play an important role in determining the advancement amount, careful evaluation should be performed.
Anesthesia* ; Esotropia ; Exotropia ; Follow-Up Studies ; Humans ; Injections, Intramuscular ; Ketamine* ; Strabismus* ; Suture Techniques* ; Sutures*

OBJECTIVE: This study was performed to evaluate the feasibility, safety, and tolerance of early postoperative oral feeding in gynecologic patients who have underwent intra-abdominal surgery. Thus, we investigated the clinical efficacy of early postoperative oral feeding in gynecologic patients, prospectively. METHODS: From September 1998 to March 1999, we studied 80 gynecologic patients undergoing laparotomy at Department of Obstetrics and Gynecology, Yonsei University College of Medicine, prospectively. After surgery, the patients were grouped into two arms; the first early oral feeding group began a clear liquid diet on the first postoperative day and advanced to regular diet as tolerated. the second control group received nothing by mouth until return of bowel function. RESULTS: Although more patients in the study group developed nausea, the incidence of vomiting and abdominal distension were comparable in both groups. Time to development of bowel sound and flatus were significantly shorter in study group. Postoperative complications including pneumonia, atelectasis, wound complications, and febrile morbidity occurred insignificantly in both group. Postoperative changes in hematologic indices and electrolytes were comparable in both group. CONCLUSION: Early postoperative oral feeding in gynecologic patients undergoing intra-abdominal surgery is safe, well tolerated. We believe that re-evaluation of postoperative surgical care may increase our knowledge and better serve our patients.
Arm ; Diet ; Electrolytes ; Flatulence ; Gynecology ; Humans ; Incidence ; Laparotomy ; Mouth ; Nausea ; Obstetrics ; Pneumonia ; Postoperative Complications ; Prospective Studies ; Pulmonary Atelectasis ; Vomiting ; Wounds and Injuries

PURPOSE: We sought to evaluate the feasibility and outcomes of laparoscopic resection of giant hepatic cysts and surgical success, focusing on cyst recurrence. METHODS: From February 2004 to August 2011, 37 consecutive patients with symptomatic hepatic cysts were evaluated and treated at Dong-A University Hospital. Indications were simple cysts (n = 20), multiple cysts (n = 6), polycystic disease (n = 2), and cystadenoma (n = 9). RESULTS: The median patient age was 64 years, with a mean lesion diameter of 11.4 cm. The coincidence between preoperative imaging and final pathologic diagnosis was 54% and half (n = 19) of the cysts were located in segments VII and VIII. Twenty-two patients had American Society of Anesthesiologists (ASA) classification I and II, and nine had ASA classification III. Surgical treatment of hepatic cysts were open liver resection (n = 3), laparoscopic deroofing (n = 24), laparoscopic cyst excision (n = 4), laparoscopic left lateral sectionectomy (n = 2), hand assisted laparoscopic procedure (n = 2), and single port laparoscopic deroofing (n = 2). The mean fellow-up was 21 months, and six patients (16%) experienced radiographic-apparent recurrence. Reoperation due to recurrence was performed in two patients. Among the factors predicting recurrence, multivariate analysis revealed that interventional radiological procedures and pathologic diagnosis were statistically significant. CONCLUSION: Laparoscopic resection of giant hepatic cysts is a simple and effective method to relieve symptoms with minimal surgical trauma. Moreover, the recurrence is dependent on the type of pathology involved, and the sclerotherapy undertaken.
Cystadenoma ; Hand ; Humans ; Laparoscopy ; Liver ; Multivariate Analysis ; Recurrence ; Reoperation ; Sclerotherapy

BACKGROUND: Major respiratory problems during spinal anesthesia occur due to several causes, particulary, high spinal block, use of sedatives or opioids, and underlying cardiopulmonary diseases. Pulse oximetry has prevented most of these problems, but has not provided rapid and accurate information of the patient's ventilation. We measured end-tidal CO2 tension via the side-stream capnometer with a small rubber cannula and investigated its effectiveness in ventilatory monitoring under spinal anesthesia. METHODS: Nineteen patients were involved in this study. We performed spinal anesthesia with 0.5% heavy marcaine 12 mg (L3-4 interspace). After fixation of spinal sensory blockade level, 0.035 mg/kg of midazolam was administered intravenously to sedate the patient. A polyvinylchloride catheter with a rubber extending nasal cannula was used for sampling of respiratory gas. PETCO2 was measured at 15 minutes after spinal anesthetic injection (before sedation), and at 5 minutes after midazolam injection (after sadation). Arterial CO2 tension was also measured during PETCO2 measurement. RESULTS: There was no correlation of spinal maximal sensory blockade level with repiratory rate, PaCO2 and PETCO2. Linear regression analysis of arterial vs. end-tidal CO2 yielded a slope of 0.92, r=0.81 and p<0.001 (before sedation), and a slope of 0.98, r=0.79 and p<0.01 (after sedation). Arterial to end-tidal differences were 4.2+/-2.8 mmHg (before sedation) and 4.3+/-3.0 (after sedation), but there was no significant difference in comparing them with each other. Conclusions : We conclude that this form of PETCO2 measurement is useful in continuous, noninvasive monitoring of ventilation in patients under spinal anesthesia.
Analgesics, Opioid ; Anesthesia, Spinal* ; Bupivacaine ; Catheters* ; Humans ; Hypnotics and Sedatives ; Linear Models ; Midazolam ; Oximetry ; Rubber ; Ventilation

No abstract available.
Solvents*

PURPOSE: To report the challenging problems in the treatment of patients with chronic cavitary osteomyelitis that is refractory to conventional treatment methods, and to illustrate the author's newly designed fragmentary partial bone transport technique using the modification of the Ilizarov method. MATERIALS AND METHODS: Three patients with chronic cavitary osteomyelitis with a large cavitary bone defect of the tibia were treated with the author's newly designed biological fragmentary partial bone transport technique. RESULTS: After an average of 78 days of fragmentary partial bone transport, the cavitary bone defects were completely filled with the transported bone fragment, and the draining sinus disappeared without any evidence of active infection. The Ilizarov frame was removed on an average of 271.3 days after surgery. The mean total length of the distraction was 8.0 cm and the mean healing index was 33.9 days/cm. CONCLUSION: A fragmentary partial bone transport technique using the Ilizarov apparatus can solve the problem of chronic cavitary osteomyelitis of the tibia by filling the bone defect with new living bone without sacrificing the bony continuity and effectively eradicating the infection. Therefore, this new technique is an effective treatment for chronic cavitary osteomyelitis of the tibia.
Humans ; Ilizarov Technique ; Osteomyelitis* ; Tibia