Ischemia Time up to 18 Hours Does not Affect Survival Rate of Replanted Finger Digits

PURPOSE: There are multiple dependent variables commonly attributed to survival of replanted digits. The ischemia time is thought to be a clinically relevant factor. However, controversy exists as large hand centers have reported successful replant outcomes independent of ischemic time. In this study, we present a single institution experience on the effect of ischemia time on the survival of completely amputated digits. METHODS: A retrospective review of a single institution experience was performed. This cohort included all comers who had suffered complete amputation of a digit (Zone 2-4) and underwent replantation from 2003 to 2009. Demographic information as well as injury mechanism, ischemic time, and replantation outcome were recorded for each patient. Chi-square was used to analyze the result. RESULTS: Mean age was 35.5 years old(2-69). Mean replantation survival was 89.5%(37/317). Survival rates were 94, 88, and 88% in respective groups of 0~6, 6~12, of >12 hours of ischemia time. In chi-square analysis, there was no difference with p value of 0.257. No other independent patient factors showed statistically significant relationship to replant survival rate. In the group with longest ischemia time(12~18 hours) replant survival rate was 88% (37/42). CONCLUSION: Prolonged ischemia time is commonly believed to be a contributing factor for replant survival. However, our experience has shown that survival rate is uniform up to 18 hours of ischemia.

Eccentric Macular Hole Formation After Macular Hole Surgery

PURPOSE: To report a case of eccentric macular hole formation after surgery for a traumatic macular hole. CASE SUMMARY: A 27-year-old man was admitted to our hospital because of baseball trauma to his left eye. A vitreous hemorrhage and Berlin's edema were found in the macula. One month later, a full thickness macular hole was detected. Vitrectomy and internal limiting membrane (ILM) peeling and gas injection were performed. Two months postoperatively, the primary macular hole was closed, but an eccentric macular hole temporal to the fovea was observed.

Three Cases of Urrets-Zavalia Syndrome Following Deep Lamellar Keratoplasty (DLKP)

PURPOSE: To report three cases of Urrets-Zavalia syndrome after deep lamellar keratoplasty. CASE SUMMARY: A retrospective chart analysis of two men who underwent deep lamellar keraplasty after corneal chemical burns and one woman who was treated with deep lamellar keratoplasty due to lattice dystrophy was performed. To maintain the anterior chamber depth and prevent formation of a double anterior chamber after deep lamellar keratoplasty, air or gas (C3F8) was injected into the anterior chamber for all three cases. After injections of air or gas (C3F8) into the anterior chamber, pupillary blocks occurred and intraocular pressures increased. Afterwards, intraocular pressures were well-controlled, but the pupil remained irreversibly fixed and dilated despite the use of miotics. CONCLUSIONS: Urrets-Zavalia syndrome, a postoperative complication, was first reported in a patient who underwent penetrating keratoplasty for keratoconus. This syndrome can also occur after deep lamellar keratoplasty on rare occasions.

IgA Nephropathy Associated with Chronic Urate Nephropathy / 대한신장학회지

IgA nephropathy is the most common primary glomerulonephritis and characterized by deposition of IgA in glomerular mesangial area. Chronic urate nephropathy is characterized by precipitation of uric acid crystals in the collecting ducts and medullary interstitium. We report a case of IgA nephropathy associated with chronic urate nephropathy. A 57 year old man underwent percutaneous renal biopsy for gross hematuria, generalized edema and renal failure. Renal biopsy showed typical findings of IgA nephropathy: increased mesangial matrix, cellular proliferation and positive staining of IgA. In addition, crystalline deposits of uric acid, which is typical of chronic urate nephropathy, were seen in the medullary interstitium.

The Potential Role of the Retinal Acuity Meter For Predicting Visual Outcome after Cataract Surgery

PURPOSE: To investigate the accuracy and usefulness of the retinal acuity meter (RAM) in predicting visual acuity after cataract surgery. METHODS: We randomly selected 47 eyes from 43 patients who underwent cataract surgery in our clinic. Preoperative BCVA and 3 month postoperative BCVA were measured by the Snellen chart, and we recorded the preoperative visual acuity by RAM. We also grouped the patients according to diabetic retinopathy and preoperative BCVA 20/100. By comparing the expected visual acuity by RAM with actual postoperative BCVA values, we analyzed the accuracy of the RAM's predictability after surgery. The cataract types and macular disease were taken under consideration when analyzing our results. RESULTS: Of the 47 eyes in our study, the postoperative Snellen visual acuity was predictable within three lines (90.9%) in 11 eyes with diabetic retinopathy and without macular disease. In the 36 eyes without diabetic retinopathy, the postoperative Snellen visual acuity was predictable within three lines (91.6%) of the cases. In both groups, the preoperative RAM acuity and postoperative BCVA were significantly correlated (R2=0.692, R2=0.812, p<0.05). In 41 eyes with preoperative BCVA 20/100 or more, the postoperative Snellen visual acuity was highly predictable in 95.1% (R2=0.763, p<0.05). However, in 6 eyes with preoperative BCVA levels less than 20/100, the postoperative Snellen visual acuity was not predictable (66.6 %). In the patients with both nucleosclerosis and posterior subcapsular opacity and in the patients with additional cortical opacity, the postoperative BCVA differed from the preoperative RAM acuity by more than three lines on the Snellen chart. CONCLUSIONS: RAM is useful in predicting postoperative visual acuity in cataract patients, but may be unreliable in the patients with combined cataract forms or with preoperative BCVAs less than 20/100.

Aging Effects on Dendritic Cells after Total Body Irradiation in Mice

BACKGROUND: It is still obscure how dendritic cells (DCs) can orchestrate whole immune reactions according to the host age. We studied changes of murine splenic DCs after total body irradiation (TBI), with regards to age. METHODS: Young (8~14 wk) and old (12~16 mo) C57Bl/6 mice were irradiated with a dose of 1,100 cGy and were assessed 6 h later for phenotypic and functional changes of the DCs. The mean fluorescence intensities and cytokine producing cell proportions were analyzed with the student's t-test. RESULTS: Interleukin-12 (IL-12), interferon (IFN gamma) and tumor necrosis factor (TNF alpha) producing classical DCs (cDCs) were more numerous in the young untreated mice than in the old mice. However, the number of these cells decreased in the young mice and increased in the old mice after TBI. IL-12, IFN gamma and TNF alpha producing plasmacytoid DCs (pDCs) were more frequent in the old mice than in the young mice before TBI both mice showed an increased frequency of cells producing these cytokines after TBI. Overall, the highest numbers of cDCs and pDCs producing IL-12, IFN gamma and TNF alpha were present in the old mice after TBI. In both the cDC and pDC populations, the old mice had a higher frequency of IL-10+ cells prior to TBI. After irradiation, the young mice had a higher frequency of IL-10+ cells. CONCLUSION: With TBI, the DCs showed dramatic differences between young and old mice. Young mice turned to an immuno-suppressive response whereas the old mice changed to an immuno-stimulation of DCs after TBI. From these dramatic aging effects, we hope to explain the different frequencies and severities of acute GvHD after allogeneic hematopoietic stem cell transplantation according to host age.

Outcome of Severe Aplastic Anemia Treated with Immunosuppressive Therapy Compared with Bone Marrow Transplantation

BACKGROUND: The response rates and survival following allogeneic bone marrow transplantation (BMT) or immunosuppressive treatment were compared in severe aplastic anemia (SAA) and the prognostic factors related with survival identified. METHODS: Medical data of SAA patients, treated with BMT or immunosuppressive therapy (IST) at the Ajou University Hospital, between January 1995 and December 2005, were retrospectively analyzed. RESULTS: A total of 43 patients were evaluable; 18 (41.9%) were treated with IST (antithymocyte globulin plus cyclosporine A plus steroid) and 25 (58.1%) with allogeneic BMT. In the IST group, the response rate was 77.8% (2 complete and 12 partial remissions), with two treatment failures. As later complications, acute myeloid leukemia developed in 1 patient and myelodysplastic syndrome developed in 2. In the BMT group, the response rate was 92.0% (18 complete and 5 partial remissions) (P<0.001). Six patients developed grade II to III acute graft-versus-host-disease (GVHD) and 3 developed chronic GVHD. The median survival time in all patients was 60.27 months, and the 5-year survival rates were 61.0 and 81.9% in the IST and BMT groups, respectively (P=0.144). The factors influencing the overall survival were an age under 40-years and a positive treatment response. CONCLUSION: This study shows that allogeneic BMT, compared to IST, resulted in good response andoverall survival rates in patients with SAA. However, the overall survival rate between the two groups was statistically insignificant. Our study suggests that younger age SAA patients, with HLA-matched BMT donors, may benefit more from allogeneic BMT.

Identification of Leukemia Surface Proteins Using a Proteomic Technique

BACKGROUND: Numerous cell surface proteins of leukemia cells such as CD33 and CD52 have been identified as diagnostic and therapeutic targets. Thus the profiling of the cell surface proteome and proteins restricted to specific leukemia(s) can provide a way to identify novel targets for leukemia diagnosis and therapy. However, there is a lack of data pertaining to the comprehensive analysis of surface membrane proteins because there are few effective strategies for profiling surface membrane proteomes. METHODS: We report on the application of quantitative proteomic techniques that incorporate affinity-capture and purification on monomeric avidin columns to identify all biotinylated cell surface proteins from leukemia cell lines. RESULTS: An analysis of a subset of biotinylated proteins among the different human leukemia cell lines using matrix-assisted laser desorption ionization and tandem mass spectrometry identified, among others, some widely expressed proteins in leukemia cells, such as CD11a, CD11c, CD18, CD31, CD44, and CD147, as well as a set of proteins identified as chaperone proteins, including HSP90, GRP78, GRP75, HSP70, HSP60 and protein disulfide isomerases. On the basis of their known functional roles, several of these proteins may participate in the progression of leukemogenesis and should be considered as potential markers of leukemia. CONCLUSION: Comprehensive profiling of the leukemia cell surface proteome provides an effective approach for the identification of commonly occurring proteins as well as proteins with restricted expression patterns to a specific cell line.

The Operative Mortality in Renal Transplant and Dialysis Patient for End-Stage Renal Disease Undergoing Major Abdominal Surgery / 대한이식학회지

PURPOSE: There are steadily increasing number of patients with end-stage renal disease in dialysis and renal transplants. A few reports described the outcome of patients in dialysis those undergoing major abdominal surgery, but in renal transplants such a report has not been reported. METHODS: We reviewed 43 patients who underwent major abdominal surgery including 22 patients undergoing dialysis (dialysis group), 7 patients undergoing dialysis with rejected renal transplants (rejected group), and 14 renal transplant with graft function (transplanted group). RESULTS: Emergency operation was performed in 24 (55.8%) patients : 12 in dialysis group, 5 in rejected group, and 7 in transplanted group, The indication of surgery included malignant disease in 16 (37.2%), bowel perforation in 9 (20.9%), adhesive ileus in 5 (11.6%), gastrointestinal bleeding in 4 (9.3%) and etc. The operative mortality rate was 25.6% (11/43) and developed all in emergency surgery including 2 in dialysis group (9.1% : 2/22), 4 in rejected group (57.1% : 4/11), and 5 in transplanted group (35.7% : 5/14). The most common diseases in operative mortality cases were bowel perforation in 4 and gastrointestinal bleeding in 3, The cause of death were sepsis in 5, and, pneumonia, heart failure, and disseminated intravascular coagulation in 2, respectively. CONCLUSION: The emergency major abdominal surgery in patients with renal transplantation and with rejected renal transplantation patients has high operative mortality rates than that of dialysis patients.

Clinical Characteristics of Takayasu's Arteritis

BACKGROUND AND OBJECTIVES: akayasu's arteritis is a disease of unknown etiology which has recently been reported to be a systemic disease. This is a prospective study of the clinical features and angiographic findings of Takayasu's arteritis from a single center. SUBJECTS AND METHODS: orty five patients were diagnosed as Takayasu's arteritis according to the Numano's diagnostic criteria, where patients satisfying at least one criterion from elevated ESR or CRP, arterial wall enhancement at MRA or CT angiography, or carotid tenderness are categorized into the active group. A disease duration of one year was used to define the division of the disease into either acute or chronic. Ueno's and Numano's classifications obtained through various imaging studies, were used. RESULTS: t the time of diagnosis, 60% of patients were in the active stage while 40% were in inactive stage. Levels of ESR, CRP and fibrinogen were found to differ significantly according to disease activity. The most common type of Takayasu's arteritis was type III according to the Ueno's classification, and type V according to the Numano's. The left subclavian artery was involved most frequently (78.5%). The most commonly involved segment of the aorta was the abdominal aorta (64.4%). Mean systolic blood pressure of the right arm in the renal artery stenosis group was 156+/-39 mmHg, which was significantly higher than that in the group without renal artery stenosis (113+/-46 mmHg) (p=0.005). ESR and CRP were correlated with aortic signal intensity on contrast-enhanced MR imaging (ESR;r=0.685, p=0.007/CRP;r=0.596, p=0.041). CONCLUSION: akayasu's arteritis is a disease of unknown causes, especially among young female patients, and exhibits nonspecific and various symptoms. ESR and CRP remain as valuable indicators of disease activity. The MR enhancement intensity of the arterial wall shows a positive correlation with both ESR and CRP level and it therefore may be correlated to disease activity and represent a useful diagnostic indicator.

A Case of Esophageal Atresia Associated with Malrotation and Segemental Dilatation of the Ileum

A case of esophageal atresia associated with malrotation and segmental dilatation of the ileum is described. To our knowledge, this is the first such report of this combination of features. The prenatal sonogram showed polyhydramnios. Esophageal atresia was diagnosed 3 days after birth. The diagnosis of malrotation and segmental dilatation of the ileum was made using a barium enema and an explolaparotomy 10 days after the first operation. The facts indicate that abnormal findings on a prenatal sonography and esophageal atresia may be associated with many congenital anomalies should be considered.

Superior Mesenteric Artery Syndrome due to an Abdominal Aortic Aneurysm in a Renal Transplant Recipient

Superior mesenteric artery syndrome (SMAS) is a rare disease and is seldom seen in patients with abdominal aortic aneurysms. We experienced a SMAS as a result of an enlarged abdominal aortic aneurysm in a 52 year-old female patient who had undergone renal transplant in the right iliac position 8 years previously. The abdominal aortic aneurysm was successfully resected without an extracorporeal bypass during crossclamping, and postoperatively the patient's symptoms were improved and her renal function was well preserved.

Association of Hypertension with Cluster of Obesity, Abnormal glucose and Dyslipidemia in Korean Urban Population / 예방의학회지

To examine the association of hypertension with cluster of obesity, abnormal glucose and dyslipidemia in Korean urban population, we conducted this cross-sectional study among 3027 men and 2127 women age 20-85 years who visited a prevention center between May 1991 and June 1995 for a multiphasic health check at St. Mary's Hospital, Seoul. By the self-administered questionnaire, the informations of educational attainments, monthly income, alcohol consumption, cigarette smoking, and physical excercise level were obtained. Height, weight, and blood pressure were measured by a trained nurse. The fasting blood sugar(FBS), total cholesterol, high density lipoprotein (HDL) cholesterol and triglyceride were tested by enzyme method. Low density lipoprotein (LDL) cholesterol was calculated by 'total cholesterol - HDL cholesterol - triglyceride/5'. For testing the differences of cardiovascular risk factors between hypertension and normotension group, t-test and x2 test were performed and for the age adjusted odds ratios of hypertension in persons with obesity, abnormal glucose, and dyslipidemia compared with normal, logistic regression was performed by using SAS pakage programme. The results obtained were as follows: 1. Age, weight, body mass index, blood glucose, total cholesterol, low density lipoprotein, triglyceride of hypertension group in men and women were significantly higher than normotension group, but height and high density lipoprotein of hypertension group only in women significantly lower than normotension group. The frequency of obesity (body mass index > or =25 kg/m2), abnormal glucose (> or = 120 mg/dl), hypercholesterolemia (> or =240 mg/dl), lower HDL cholesterol ( or =160mg/dl), and hypertriglyceridemia (> or =250 mg/dl) in hypertension group of men and women were significantly higher than normotension group. 2. Systolic and diastolic blood pressure were negatively correlated with hight, but positively with age, weight, BMI, total cholesterol, LDL cholesterol, and triglyceride in men and women. And BMI was positively correlated with fasting blood sugar, total cholesterol, LDL cholesterol and triglyceride but negatively with HDL cholesterol. 3. The odds ratios of hypertension were as follows in men and women : among persons who were obese compared with those nonobese, 2.53 (95% Confedence Intervals [C.I.] 2.08-3.07) and 2.22 (95%C.I. 1.71-2.87); among persons who were abnormal glucose compared with those normoglycemic, 1.43 (95%C.I 1.13-1.82) and 2.01 (95%C.I 1.36-2.94); and among persons who were dyslipidemia (hypercholesterolemia or lower HDL cholesterol or higher LDL cholesterol or hypertriglyceridemia) compared with those normal lipid, 1.59 (95%C.I 1.30-1.95) and 1.51 (95%C.I 1.16-1.96). After combined more than one risk factor, the odds ratios were increased. Among persons with cluster of obesity, abnormal glucose, and dyslipidemia, the odds ratio of hypertension was 2.25 (95%C.I 1.47-3.37) in men and 3.02 (95%C.I 1.71-5.30) in women. In conclusion, it was suggested that hypertension was associated with cluster of obesity, abnormal glucose, dyslipidemia in this Korean urban population.