A Study for Risk Factors of Urinary Incontinence in CVA Patients

PURPOSE: It is known that the urinary incontinence can occur in cerebrovascular accident (CVA) patients and will be recovered after some time or persistent. Although it is generally thought that the consciousness level and activity function may be the major factors for recovery from or persistence of incontinence, only a few were studied. This study is to confirm whether or not the consciousness level and activity function affect the recovery from or persistence of incontinence. MATERIALS AND METHODS: We compared the consciousness level and activity function between 12 patients with CVA who recovered from the urinary incontinence during hospitalization and 12 patients with CVA who persist the incontinence at the time of discharge. We scaled the activity function by Barthel index from zero to 80 and consciousness level from zero to 10. RESULTS: In recovered group all patient had alert consciousness except one. Barthel index was zero in 4(33%) patients and remaining patients had variable Barthel index from 5 to 75. In incontinent group the consciousness level is variable ranged from zero to 10. The Barthel index was mainly zero(8/12, 75%). There is no siginificant difference in Barthel index between two groups but the continent group has higher consciousness level than incontinent group (P<0.05, Wilcoxon signed rank test). CONCLUSION: The activity function is not an important factor affecting the incontinence and it is thought that we can make many incontinent patients continent by actively helping the patient to move from bed to toilet or commode with timed or prompted voiding especially in case of alert consciousness.

Ocular Findings Associated with Long-term Chlorpromazine Therapy

Chlorpromazine has been widely used as anti-psychosis drug in psychiatry and its prolonged intake can cause pathologic changes in skin and eye preferentially. We performed ocular examinations on 17 patients(34 eyes) who have received long-term chlorpromazine therapy. In slit lamp biomicroscopic examination, changes on periocular skin, conjunctiva and retina could rarely be seen. However, deep punctate or granular corneal opacities were seen in 10 eyes (29.4%), anterior subcapsular stellate cataracts were seen in 12 eyes (35.3%) and photosensitive conjunctival injections were seen in 6 eyes (17.6%). Secretory function of tear decreased in 30 eyes (88.2%). Conclusively, in treating patients who have above findings of anterior segment, careful history taking about long term drug intake and periodic follow up are recommended.

A Case of Pleomorphic Adenocarcinoma (Malignant Mixed Tumor) of the Lacrimal Gland

Pleomorphic adenocarcinoma of the lacrimal gland is a rare malignant epithelial tumor. It is commonly metastasize to regional lymph node at early stage and sometimes to the lungs and bone. A 64-year-old man visited with complaints of progressive orbital protrusion and visual disturbance on his left eye for five months. CT scans demonstrated a huge mass on the superotemporal portion of the left orbit. Histopathological diagnosis of pleomorphic adenocarcinoma of the lacrimal gland was made. Bone scintigram and chest CT scans demonstrated distant metastases to the bone and lungs. We report a case of malignant mixed tumor of the lacrimal gland with mltiple distance metastases.

Visual Improvement following Acute Obstruction of the Retinal and Choroidal Blood Flows

The prognosis for useful vision after central retinal artery obstruction is generally considered poor, except in those cases with a patent cilioretinal artery. When the choroidal circulation is affected as well in the form of an ophthalmic artery obstruction, characteristically the visual loss is more severe and the retinal whitening is more intense and, the cherry-red spot may be present. We report a patient with partial visual improvement following acute obstruction of the retinal and choroidal circulations more than three hours.

Clear Lens Extraction for the Correction of High Myopia

Clear lens extraction and implantation of posterior chamber intraocular lens was performed on 12 eyes(7 patients) to correct high myopia. Average preoperative refractive error(spherical equivalent) was -19.08D with a range of -13.00D to -31.00D. 7 eyes(58.3%) achieved 0.5 or better uncorrected postoperative visual acuity and all eyes achieved 0.5 or better corrected visual acuity. In postoperative refractive errors, 4 eyes(33.3%) were 1.0D of emmetropia and 8 eyes(66.6%) were within 2.0D. In conclusion, clear lens extraction and posterior chamber intraocular lens implantation is a more favorable technique for correcting high myopia, but further study for complications such as retinal detachment, cystoid macular edema, and posterior capsular opacity and for precise results is needed.

A case of nonneurogenic neurogenic bladder (Hinman syndrome) / 대한비뇨기과학회지

Nonneurogenic neurogenic bladder is a condition in which the patient is with day and night wetting, infected urine, residual urine, reflux and upper tract damage without neurologic lesion or anatomical obstruction. Recently it is known that some patients with pediatric unstable bladder may contract their external sphincter to inhibit the detrusor contraction and pathological persistence of this "hold on" habit after they master a normal mature pattern of cortical control over the detrusor may result in nonneurogenic neurogenic bladder. The condition is reversible by bladder training with various methods. We report a case of nonneurogenic neurogenic bladder who is treated by self CIC after ileocecocystoplasty because bladder retraining has been failed due to high fever and severe frequency.