The Extent of Hippocampal Resection and Postsurgical Memory Change in Temporal Lobe Epilepsy / 대한간질학회지

BACKGROUND: This study was performed to investigate the relationship between the extent of hippocampal resection and the postsurgical memory outcome in temporal lobe epilepsy (TLE). METHODS: In 36 patients with TLE, the longitudinal distances of pre-surgical hippocampus and post-surgical hippocampal remnant were measured on 3 mm thick coronal MRI images perpendicular to the long axis of hippocampus. Memory tests were performed before and 1 year after the surgery. The relationships of the extent of hippocampal resection (EHR) and the asymmetry index of Wada retention memory scores (WAI) with postsurgical memory outcomes were tested. RESULTS: The ratios of post-surgical/pre-surgical scores in immediate and delayed verbal memory and immediate, delayed and recognition visual memory were not significantly correlated with the EHR. Only verbal recognition memory was positively correlated with the EHR. In TLE of the dominant hemisphere, the ratios of post-surgical/pre-surgical scores of verbal and visual memories were not significantly correlated with the EHR, but the WAIs were significantly correlated with the delayed visual memory changes (p<0.05). In TLE of the non-dominant hemisphere, the ratios of post-surgical/pre-surgical scores of delayed verbal and immediate visual memory (in percentiles) were positively correlated with the EHR (p<0.05). However, a linear regression analysis showed that none of postsurgical memory subtypes were significantly correlated with the EHR. CONCLUSIONS: This study suggests that the extent of hippocampal resection itself does not have a significant relationship with the outcome of postsurgical memory in patients with mesial TLE.

The Clinical Effects of the Silicone Intracanalicular Plug in Dry Eye Syndrome

To evaluate the efficacy of the intracanalicular silicone plug in dry eye, we performed lower horizontal canalicular occlusion with the Herrick lacrimal plug Twenty-eight of the 34 eyes(81 %) were able to discontinue or reduce to occasional use of the instillation of artificial tears and the remaining unsatisfactory 6 eyes were investigated by radiologic study for silicone plug. In 2 eyes, the plugs were invisible in radiologic study and the canaliculi were occluded repeatedly. In one of the four eyes with their plugs in place, upper canaliculus was occluded additionally. By thorough evaluation of the status of the plug by radiologic study and secondary attempt. 31 of the 34 eyes(91%) were able to discontinue or reduce to occasional use of the instillation of artificial tears. The intracanalicular plug has no protruded portion out of the puntum, so complications such as reflex tearing, conjunctival irritation, and loss of plug through the punctum, were not occurred. Waters' view with soft tissue density was effective in demonstration of silicone intracanalicular plug.

The Value of Computerized Tompgraphy in Diagnosis and Early Surgery of the Orbital Blow Out Fractuers

We compared the diagnostic accuracy of the simple x-ray with that of the computed tomography, and analyzed the surgical results according to the timing of operation in 52 patients with suspected orbital blowout fractures who complained diplopia after midfacial trauma. Of all the cases, 40 orbital fractures were confirmed with CT and forced duction test and the remaining 12 patients were thought to have transient functional impairment because the clinical signs were resolved with time. CT detected all the 40 actual fractures, so the dignostic accuracy(100%) was higher than that of the simple x-ray(75%) which detected 30 fractures of the 40 actual fractures(p=0.001). We operated 19 patients who have persistent diplopia, enophthalmos of more than 2 mm, and large fracture defect, and there was significant improvement of symptoms and signs in patients on whom operations were performed within 2 weeks after trauma rather than after 2 weeks.

Keratometric Cylinder Changes following Phacoemulsitication using Frown Incision and Linear Scleral Tunnel Incision with 10-0 nylon Interrupted Sutures

To evaluate surgically induced astigmatism in cataract surgery, we studied retrospectively a series of 30 eyes with 6.5mm sutureless frown incision(Group 1) and 30 eyes with linear scleral tunnel incision and 3 interrupt sutures using 100 nylon(Group 2). In all cases phacoemulsifications were performed and posterior chamber lenses were implanted. Group 1 showed the against-the-rule astigmatism at postoperative 2 week, and then the change of the astigmatism was minimal and still against-the-rule by postoperative 6 week and 3 month. In contrast, Group 2 showed with-therule astigmatism at postoperative 2 week and then showed the against-the-rule by postoperative 6 week and 3 month. There was no significant difference in the proportion of corrected visual acuity of 0.5 or better between two groups at postoperative 3 month, while uncorrected visual acuity of 0.5 or better was 93.3% in group 2, and 30.0% in group 1 at postoperative 3 month. In this study, it was found that the pattern of surgically induced astigmatism and uncorrected visual outcome in cataract surgery were different according to incision and suture techniques.