Anterior Stromal Puncture with 26-Gauge Needle for Recurrent Corneal Erosion: A Report of Five Cases

PURPOSE: Recurrent corneal erosion (RCE) is a highly recurrent and intractable disease. None of the available conventional treatments has been shown to be specifically efficacious for RCE. Recently, many new methods were actively studied and used for RCE such as epithelial basement membranectomy, excimer laser therapeutic keratectomy, and anterior stromal puncture. We report 5 cases of RCE successfully cured using anterior stromal puncture with disposable 26-gauge needle. METHODS: A total of 5 eyes from 5 RCE patients, who had been initially treated with conventional therapy but suffered from recurrence, were treated using anterior stromal puncture with disposable 26-gauge needle from January 1999 to October 2001. We investigated the efficacy of this method over conventional therapy by retrospective review of their medical records. RESULTS: The average trial number per patient was 1.2 (once or twice). There was no recurrence of RCE in 5 patients after the final trial. CONCLUSIONS: We have shown that anterior stromal puncture with disposable 26-gage needle is a better method over conventional methods to cure RCE caused by trauma and epithelial basement membrane dystrophy.

Comparison of Wavefront Guided Customized Ablation vs. Conventional Ablation

PURPOSE: To compare the visual outcome and satisfaction rate after the wavefront guided ablation with the conventional ablation in laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) patients. METHODS: We performed a prospective study that included 182 eyes of 91 patients who were treated with LASIK (60 eyes) or PRK (122 eyes) using MEL 70 excimer laser system (Carl-Zeiss Meditec, Germany). We applied wavefront guided ablation on the right eye of each patient. The conventional ablation (control group) was performed on the left eye of the same patient. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), spherical equivalent refraction, high order aberrations and contrast sensitivity were evaluated preoperatively and after surgery. Satisfaction rate was evaluated after surgery. RESULTS: We found statistically insignificant improvement of BCVA in wavefront guided ablation group. There were no statistically significant differences in contrast sensitivity between wavefront guided ablation and conventional ablation. In LASIK group, we found statistically significant differences of high order aberrations; RMS HO (High order)(p<0.05) and in PRK group; Z (3, -1), Z (3, 3), Z (4, 0), Z (4, 2), RMS HO (p<0.05). There were no statistically significant differences between wavefront guided ablation and conventional ablation in patient's satisfaction. CONCLUSIONS: High order aberrations of wavefront guided ablation were less increased than of conventional ablation. These results indicate the potential role of the wavefront guided ablation in the field of refractive surgery.

Effect of Lidocaine and Ketorolac on Propofol Injection Pain / 대한마취과학회지

BACKGROUND: Propofol has a high incidence of pain with intravenous injection, and different methods have been used to minimize the incidence and severity of this pain. In this study, we have compared the effect of lidocaine pretreatment with that of ketorolac pretreatment on propofol injection pain. METHODS: Sixty children, aged 7 - 12 years, scheduled for general anesthesia were randomly divided into three groups; saline group (n = 20), lidocaine group (n = 20), and ketorolac group (n = 20). All patients were inserted with a 20 G or 22 G angiocatheter into the veins on the dorsal hand or antecubital fossa. After applying an arm tourniquet at an inflation pressure of 30 - 40 mmHg, the saline group received 2 ml of 0.9% saline, the lidocaine group received lidocaine 0.75 mg/kg mixed with 2 ml of 0.9% saline, and the ketorolac group received ketorolac 0.75 mg/kg mixed with 2 ml of 0.9% saline. The tourniquet was released 1 minute later, followed by an intravenous injection of 2.5 mg/kg of propofol. Pain and involuntary movement at propofol injection and changes of blood pressure and heart rate were compared. RESULTS: 1. The incidence of pain diminished significantly in the lidocaine group (15%) and the ketorolac group (25%) compared with the saline group (80%) at the time of injection of propofol and there was no significant difference between the lidocaine group and the ketorolac group. 2. The incidence of involuntary movement diminished significantly in the lidocaine group (grade 0: 80%, grade 1: 20%, grade 2: 0%) and the ketorolac group (grade 0: 65%, grade 1: 30%, grade 2: 5%) compared with the saline group (grade 0: 10%, grade 1: 25%, grade 2: 65%) at the injection of propofol and there was no significant difference between the lidocaine group and the ketorolac group. 3. Blood pressure and heart rate significantly increased after intubation in all groups. CONCLUSIONS: From the above results, both intravenous lidocaine and ketorolac pretreatment are effective in alleviating propofol injection pain and involuntary movement, but there is no significant difference between the lidocaine group and the ketorolac group.

Effect of Etomidate and Thiopental on Intraocular Pressure associatedwith Induction of Anesthesia and Tracheal Intubation(Facilitated with Succinylcholine) / 대한마취과학회지

BACKGROUND: Good control of intraocular pressure (IOP) during induction and maintenance of anesthesia is essential for the success of intraocular surgery. Etomidate produces a significant and somewhat greater reduction in IOP than thiopental. This study was designed to compare the effects of etomidate on IOP with those of thiopental in patients receiving succinylcholine, and in whom tracheal intubation was performed. METHODS: Forty ASA physical status I or II patients undergoing elective surgery were divided into thiopental group (n = 20) or etomidate group (n = 20). Intraocular pressure was measured before induction, 1, 2, and 3 minutes after administration of an intravenous induction agent, after administration of succinylcholne, immediately after intubation and 2 minutes after intubation. Systolic blood pressure and heart rate were recorded simultaneously. RESULTS: Both agents produced significant decreases in IOP after administration. At 3 minutes after administration of an agent and after administration of succinylcholine, the IOP of the etomidate group was significantly lower than that of the thiopental group (P< 0.05), but there were no significant differences between the groups in IOP at other stages. CONCLUSIONS: Etomidate is not a more effective intravenous induction agent to control the increase of intraocular pressure following tracheal intubation with succinylcholine than thiopental.

The Effects of Etomidate in the Strips of a Rat Thoracic Aorta / 대한마취과학회지

BACKGROUND: The minimal effect of etomidate on cardiovascular function sets it apart from other rapid fast-acting induction agents. Clinically, etomidate has been reported to cause minimal effects on systemic hemodynamics and PVR. There are few reports of direct effects of etomidate in pulmonary vessels or other vascular beds. METHODS: We studied the effects of etomidate on the tension of the aortic smooth muscle using an isolated rat thoracic aortic preparation. We studied the cumulative effect of etomidate in a rat thoracic aorta after phenylephrine (PE) pretreating, the cumulative effect of phenylephrine (PE) in a rat thoracic aorta with or without endothelium after etomidate pretreating, the effect of L-NAME and indomethacin and metylene blue in a rat thoracic aorta contractile response for phenylephrine after etomidate pretreating, and the effects of etomidate on a phenylephrine and ECF Ca2 induced contraction in a rat thoracic aorta. RESULTS: Etomidate produced dose-dependent relaxation and these relaxation responses were significantly less in a thoracic aorta with denuded endothelium than in a thoracic aorta with intact endothelium. Response of PE contraction with etomidate was increased by pretreatment with L-NAME and methylene blue, but was decreased by pretreatment with indomethacin in intact endothelium. Response of PE contraction had no significant change in Ca2 free, but Etomidate significantly attenuated the response of PE contraction to Ca2 entry. CONCLUSIONS: We have found that vasodilation produced by etomidate is endothelium-dependent and this effect is related with cyclooxygenase inhibition and also guanylate cyclase activation. In addition, a relaxation effect is caused by an extracellular Ca2 influx blockade through receptor-operated calcium channels.

1991 cancer incidence in Seoul, Korea: results of the Implementation Study of the Seoul Cancer Registry

This article presents the results of the Implementation Study of the Seoul Cancer Registry, which started in July, 1991 as a population based cancer registry in Seoul, Korea. The completeness and validity of the registered data were evaluated using Mortality/Incidence ratio (M/I ratio), Histologically Verified Cases (HV%), Primary Site Uncertain (PSU%), and Age Unknown (Age UNK%). Owing to the additional active surveillance, the completeness of the data turned out to be fairly acceptable, except for the aged over 75(Mortality/Incidence ratio was over 100%). Eventhough the Seoul cancer registry(SCR) has further way to go in the completeness especially among elderly persons, the validity of SCR data was also acceptable in terms of HV%, PSU%, and Age UNK%. However, PSU% and Age UNK% might need to be further reduced to be comparable with other well established cancer registries. The age standardized incidence rates(ASR) of all cancers between July 1, 1991 and June 30, 1992 were 232.4/100,000 in males and 147.9/100,000 in females. The top five major sites of cancers in Seoul were the stomach, liver, lung, colo-rectum, and bladder in order in males, and the uterine cervix, stomach, breast, colo-rectum, and liver in females. Those 5 cancer sites comprised 68.9% and 64.7% of the total cancer incidence in males and females, respectively.