Decreased Basal Tear Production Associated with General Anesthesia

Two types of tear secretion, basic and reflex, have been postulated. Basic secretion is thought to be a constant,slow secretion by the accessory lacrimal glands. Reflex secretion was defined as an increased rate of secretion caused by neural stimulation and thought to be secreted by the main lacrimal gland. The purpose of the present study is to measure the effect of general anesthesia and atropine on basal tear secretion in order to elucidate the association between basal tear secretion and autonomic nervous system. We studied the 84 cases of general operations that were performed between March 1998 and June 1998. Basal tear measurements were made before premedication, 5 minutes after injection of atropine, 10 minutes after general anesthesia and 1 hour after general anesthesia. Basal tear secretion was lower at 5 minutes after injection of atropine than before premedication and markedly decreased after induction of general anesthesia. Therefore, we think that basal tear secretion is closely related to the autonomic nervous system.

The Electrolyte Changes of Pig`s Lens in Experimentally Induced Cataract

Protein accounts for over one third of the human lens, the remaining two thirds being water. The other constotuents of the lens including lipids, amino acids, electrolytes and a variety of peptides and carbohydrates, account for about 1% of the lens wet weight. Since transparency of the lens is so highly dependent on protein order and structural integrity, it is not surprising that relatively small changes in any of these parameters might lead to the development of opacification resulting in a cataract.We have analyzed electrolytic differences between normal lens and lens of experimentally induced cataract to find the important factor in including cataract after we had extracted one hundred eight pig lenses. We divided these experimentally induced cataract into a group of normal lens capsule and another group of lenses which we performed with a 26 gauge needle. The sodium level was decreased in 15% mannitol solution and increased in normal saline. In every solution the potassium level was decreased. The chloride level was decreased in the 15% mannitol solution and increased in the normal saline solution. The calcium level also was decreased in mannitol and distilled water.Our results indicate that the potassium level of the experimentally induced cataracts decreased in any conditions and may be an important factor in inducing cataract.

Effect of Water Ingestion before Elective Surgery on Gastric Volume and pH in Adults / 대한마취과학회지

BACKGROUND: To decrease the risk of pulmonary aspiration of gastric contents, patients are routinely asked not to eat or drink anything for at least 6 to 8 hours before surgery. We studied to evaluate whether the volume and pH of gastric fluid immediately after induction of anesthesia is correlated with water ingestion. METHODS: Fifty patients, scheduled for elective surgery, were randomly divided into two groups. Control group(n=25) were fasted overnight and received no water. Experimental group(n=25) were fasted overnight and received 150 ml water approximately 2 hours before the induction of anesthesia. Gastric fluid was obtained via multiorifice gastric tube with the patient in three different positions. The volume of gastric fluid was recorded and its pH was measured. RESULTS: The gastric volumes were no differences between the two groups. The gastric pH values were significant differences. The incidence of patients with the high risk factors of gastric volume greater than 25 ml and pH less than 2.5 was decreased in experimental group. CONCLUSIONS: We concluded that surgical patients could be permitted to ingest 150 ml water approximately 2 hours before the induction of anesthesia.

Treatment of Chronic Corneal Ulcer with Nd-YAG Laser

The marginal epithelium of corneal ulcer is occasionally edernatous and detached from corneal stroma in chronic corneal ulcer. This leads to retard healing of corneal epithelium because the migration and adhesion of corneal epithelium are prevented. We performed Nd-YAG laser in chronic corneal ulcer, 6 eyes of 6 patients from July 1996 to December 1996. It was used to improve the healing of corneal epithelium. The patiente were treated with Nd-YAG laser using 0.8 to 1. 2mJ per pulse applied to the region of Bowman`s membrane in the margin of corneal ulcer. The mean number of laser spots in one procedure was 22 and the rnean frequency of Nd-YAG laser use in each patient was 2. 3 times. The Nd-YAG laser induced adhesion of corneal epithelium in all patients and improved the healing of corneal epithelium. Therefore, the treatment of Nd-YAG laser can become 8 useful procedure for chronic corneal ulcer accompanied with corneal epithelial detachment.

Estimaionof Intraocular Lens Power in Penetration Keratoplasty Combined with Intraocular Lens Implantation

The corneal triple procedure is that penetrating keratoplasty, extracapsular cataract extraction, and posterior chamber intraocular lens implantation are performed simultaneously and preoperative prediction of intraocular lens implant power is necessary to achieve the desired postoperative refractive status in eyes undergoing the triple procedure. Therefore we evaluated the important factors in determining intraocular implant power patients undergoing the triple procedure. A retrospective study was done on 12 eyes of 11 patients who underwent triple procedure between March 1993 and April 1997. Mean age was 52.9 years and mean follow-up period was 26.3 month(range, 4 to 53 months). The Mean postoperative spherical equivalent was -0.98+/-4.05D. Forty-two percents of patients were within +/-2.00D of emmetropia. The important factors in determining intraocular lens power of patients undergoing the triple procedure are axial length, corneal curvature, refractive status of the fellow eye, and donor/recipient size. If these values are unreliable, it is desirable for the corneal srurgeon to use mean axial length and mean corneal curvature to determine the intraocular implant power. The important factors in determining intraocular lens power of patients undergoing the triple procedure are axial length, corneal curvature, refractive status of the fellow eye, and donor/recipient size. If these values are unreliable, it is desirable for the corneal surgeon to use mean axial length and mean corneal curvature to determine the intraocular implant power.

Delayed Pneumothorax During General Anesthesia after Chest Injury: A case report / 대한마취과학회지

A 62-year-old female patient was scheduled for emergent explo-laparotomy under general anesthesia because of traffic accident. Preoperative checked chest x-ray showed multiple fractures of the ribs but didn't show the sign of pneumothorax or hemothorax. she had no dyspnea. Compared with previous value(PaO2; 210.5 mmHg), Arterial PO2 value(PaO2; 143.0 mmHg) was reduced significantly two hours after starting general anesthesia. Chest x-ray was taken in the operating room, which showed pneumothorax in the right side lung. The patient was treated with immediate closed thoracostomy. She recovered uneventfully three days later with complete resorption of the pneumothorax.

A Korean Pedigree of Paget Bone Disease / 대한내분비학회지

Paget bone disease(PBD) is usually focal, but can be wide spread disorder of the skeletal remodeling characterized by greatly increased osteoclast size and activity. It has extremely variable prevalence worldwide, being common in England and northern European countries and areas populated by their descendants, but strikingly uncommon in Asia, the middle east, Africa and Scandinavia. It's occurrence also shows familial clustering, some postulates autosomal dominant inheritance. Many studies have shown that paramyxoviruses may play a critical role in the etiology of this disorder. However, the precise etiology of PBD remains unknown.We describe a kindred with PBD in 3 successive generations. The propositus, a 55-year-old man, has panostotic PBD and giant cell reparative granuloma of pagets disease involving his head, mandible, abdomen and ileum, rare tumorous complication of Paget's disease. Bowed limbs were first noticed at age 25 years, and progressed for 20 years. Giant cell reparative granuloma began manifesting at age 45 years, and responded dramatically to high-dose dexamethasone therapy. His pretreatment biochemical finding were remarkable for elevated serum ALP, 765(normal 66-220 u/L) and osteocalcin, 154(normal 6.3-30.7 mg/ml), but normal serum calcium, phosphorous, 250HD and PTH. A nondecalcified iliac crest specimen demonstrated classic histopathologic 25OHD and PTH. A nondecalcified iliac crest specimen demonstrated classic histopathologic changes of PBD on light microscopy. His decreased father had a similar degree of bony deformities beginning at age 20 years, but had not been examined. His two asymptomatic daughters, 20 and 24-year-old, were both found to be affected with widespread PBD by bone scan, radiographic study, and their serum ALP levels, 939 and 435U/L, respectively. This is the first report of familial occurance of PBD and a case of giant cell reparative granuloma of Paget's disease in Korea, where PBD is very rare.

A Case of Primary Thyroid Lymphoma Involving Bone Marrow (Stage IVE) Assoeiated with Hashimoto's Thyroiditis / 대한내분비학회지

Primary lymphoma of the thyroid is a relatively rare malignant tumor of the thyroid. It is known to be frequently associated with Hashimoto's thyroiditis. In Korea, a few cases of primary lymphoma of the thyroid have been reported and most of these cases were in the stage I E or II E. Recently, we experienced a case of the primary thyroid lymphoma, stage IV E associated with Hashimoto's thyroiditis in a 70-year-old woman who presented with dysphagia and dyspnea due to rapidly enlarging neck mass.She was treated with combination chemotherapy(cyclophosphamide, adriamycin, vincristine and methylprednisolone) and local radiotherapy and achieved partial response with resolution of dysphagia and dyspnea.