Traumatic Posterior Chamber Intraocular Lens Dislocation into the Subconjunctival Space

Purpose@#Here we report a case of posterior chamber intraocular lens (IOL) dislocation into the subconjunctival space (pesudophacocele) following ocular trauma.Case summary: A 66-year-old male presented with ocular pain and decreased vision in the right eye following trauma with a metallic rod. The patient had a history of trabeculectomy, glaucoma drainage device implantation, transscleral cyclophotocoagulation, and cataract surgery for uveitic glaucoma and a cataract in the right eye. On examination, vision was hand movement, the intraocular pressure was 3 mmHg, and subconjunctival hemorrhage and hyphema were observed. After the resolution of hemorrhage, uveal tissue prolapse was seen nasally behind the corneal limbus and the IOL was found to be dislocated into the nasal subconjunctival space. There were no changes in the filtering bleb and tube compared to the pre-trauma status. The IOL was removed through a conjunctival incision because the patient refused any active treatment. @*Conclusions@#Pesudophacocele developed in a patient who had a history of glaucoma and cataract surgery in the injured eye. The IOL could not be assessed immediately after the trauma because of subconjunctival hemorrhage and hyphema. When the status of IOL is unclear or suspected to be dislocated after trauma, the possibility of pseudophacocele should be considered, in addition to the dislocation into the vitreous cavity.

Correlation between Interocular Asymmetry of Corneal Hysteresis and Visual Field Defect in Glaucoma

Purpose@#To evaluate the relationship between interocular asymmetries of corneal hysteresis (CH) and visual field defects in Korean patients with glaucoma. @*Methods@#A total of 444 eyes from 222 participants with glaucoma in at least one eye were enrolled. CH was measured using an ocular response analyzer (Reichert Technologies Inc). Eyes of each participant were classified into “better eye” and “worse eye” based on the mean deviation (MD) value of visual field test. The correlation between interocular differences in intraocular pressure, axial length, central corneal thickness, CH, and MD values was evaluated using Spearman correlation analysis. To exclude the possible effect of antiglaucoma medication on corneal properties, additional analyses were performed on eyes without any glaucoma treatment at the time of CH measurement (treatment-naive group). @*Results@#Median (interquartile range) MD value was –3.71 dB (–6.87 to –1.30 dB) in the better eye and –10.20 dB (–16.32 to –5.62 dB) in the worse eye. When the correlation between the asymmetry of the MD value and asymmetry of intraocular pressure, axial length, central corneal thickness, and CH were evaluated, only interocular differences in CH were significantly associated with interocular differences in MD values (rho = 0.214, p = 0.001). Among the 222 participants, 60 (27.0%) were treatment-naive group. In these eyes, interocular differences in CH were also significantly associated with interocular differences in the MD values (rho = 0.285, p = 0.029). @*Conclusions@#The interocular asymmetry of CH was significantly correlated with the interocular asymmetry of visual field defects in glaucoma.

Comparison of Diagnostic Power Among OCT Parameters According to Peripapillary Atrophy in High Myopic Glaucoma

PURPOSE: To evaluate diagnostic power to detect glaucoma in high myopic eyes with peripapillary atrophy among optical coherence tomography (OCT) parameters. METHODS: Fifty eyes of 31 glaucoma patients with myopia of -6.00 diopters or less and a peripapillary atrophy (PPA) were classified into a group with a PPA located beyond the circumpapillary OCT scan circle (group A) and a group with a PPA confined within the scan circle (group B). Circumpapillary retinal nerve fiber layer (cpRNFL), total macula (TM), and ganglion cell-inner plexiform layer (GCIPL) thickness were measured in each group and the diagnostic power of each measurement was compared by area under the receiver operating characteristic curve (AUC). RESULTS: There were no significant differences in the age, gender, intraocular pressure, optic disc size, and mean deviation between the 2 groups. The spherical equivalent of group A was significantly larger than group B (mean -11.9 vs. -7.3 diopters, p = 0.002). In group A, the AUC of average GCIPL thickness was significantly higher than average cpRNFL and average TM thickness (p 0.05). CONCLUSIONS: Assessment of GCIPL parameters is a useful technique for glaucoma diagnosis in patients with high myopia and PPA extending beyond circumpapillary OCT scan circle.

The Value of Preoperative Coagulation Screening in Children Undergoing Surgery

BACKGROUND: To evaluate the usefulness of preoperative screening for coagulation disorders in children who have undergone surgery. METHODS: From January 2003 to December 2005, we prospectively evaluated laboratory and bleeding histories in 1,911 children between the ages of one year and 15 years. All of the patients had preoperative coagulation screening with a measurement of complete blood count, prothrombin time and activated partial thromboplastin time. The sensitivity, specificity and positive and negative predictive values following a preoperative coagulation-screening test were evaluated by a comparison of the type of surgery and bleeding complications that occurred during and after surgery. RESULTS: There were no patients with previously proven coagulopathies or suspicious medical histories. Among the 1,911 cases, a subset of 22 patients had persistent abnormalities detected after laboratory testing. In two of the 22 patients, lupus anticoagulant was detected and in one of the 22 patients, a factor VIII deficiency was discovered. There were 46 patients that had postoperative bleeding and required hospitalization extension or readmission for stanching. Among the 46 patients, 44 patients demonstrated normal coagulation after testing and two patients demonstrated abnormal coagulation after testing. Following a preoperative coagulation-screening test, a low sensitivity (0.04) and positive predictive value (0.09) were determined. CONCLUSION: For the prediction of perioperative bleeding, the use of a coagulation-screeningtest showed a very low positive predictive value. Many false positive laboratory tests coupled with the relative rarity of inherited and acquired coagulopathies raises doubt about the overall value of routine preoperative coagulation screening in children.

Role of Caveolin-1 in Indomethacin-induced Death of Human Hepatoadenocarcinoma SK-Hep1 Cells

Caveolin-1 (CAV1) is an integral membrane protein that may function as a scaffold for plasma membrane proteins and acts as a tumor suppressor protein. One causative factor of chemotherapy- resistant cancers is P-plycoprotein (P-gp), the product of the multidrug resistance-1 gene (MDR1), which is localized in the caveolar structure. Currently, the interactive roles of CAV1 and MDR1 expression in the death of cancer cells remain controversial. In this study, we investigated the effects of indomethacin on the cell viability and the expression levels of MDR1 mRNA and protein in a CAV1- siRNA-mediated gene knockdown hepatoma cell line (SK-Hep1). Cell viability was significantly decreased in CAV1-siRNA-transfected cells compared with that of control-siRNA-transfected cells. Furthermore, the viability of cells pretreated with CAV1 siRNA was markedly decreased by treatment with indomethacin (400micrometer for 24 h). However, the protein and mRNA levels of MDR1 were unchanged in CAV1-siRNA-transfected cells. These results suggest that CAV1 plays an important role as a major survival enzyme in cancer cells, and indomethacin can sensitively induce cell death under conditions of reduced CAV1 expression, independent of MDR1 expression.

Changes in Pathogens and Antibiotic Sensitivities in very Low Birth Weight Infants with Neonatal Sepsis

PURPOSE: To set up an appropriate treatment plan for neonatal sepsis by investigating changes in pathogens and antibiotic sensitivities. METHODS: The medical records of very low birth weight infants (VLBWI) admitted to the neonatal intensive care unit (NICU) of the Eulji University Hospital between January 2000 and June 2006 were retrospectively reviewed. The culture reports were analyzed for causative microorganisms and antibiotic sensitivities. RESULTS: Among 164 neonates, 19 neonates (11.6%) had 26 episodes of culture-proven sepsis. Very late onset sepsis was the most common type. The dominant pathogens of sepsis included Klebsiella pneumoniae, Streptococcus spp., coagulase negative Staphylococcus and Enterobacter spp., and were mostly multi-drug resistant. CONCLUSION: For the appropriate treatment of neonatal sepsis, proper use of antibiotics through the periodic review and understanding of changes of the microorganisms and antimicrobial sensitivities is necessary to prevent multi-drug resistant microorganisms and to avoid excessive use of broad-spectrum empiric antibiotics.

The influence of GABAAgamma2 genetic polymorphism on the emergence agitation induced by sevoflurane / 대한마취과학회지

BACKGROUND: Sevoflurane is one of the most popular anesthetics, used in pediatric anesthesia, but emergence agitation is more common with using sevoflurane as compared to that with using the other inhalation anesthetics. Sevoflurane exerts its effect on gamma-aminobutyric acid (GABA) ergic transmission. This study aimed to investigate if genetic variations at the GABRgamma2 (single nucleotide polymorphism [SNP] 211037 C/T, nucleotide position 3145 in intron A/G) on the 5q33 chromosome were associated with the development of emergence agitation when sevoflurane is used. METHODS: One hundred fourteen, pre-school aged patients who were to undergo tonsillectomy and adenoidectomy were included in this study. Anesthesia was induced with 5 mg/kg of thiopental sodium, 0.02 mg/kg of atropine and 0.1 mg/kg of vecuronium, and this was maintained with 3% sevoflurane and 50% N2O in oxygen. The incidence of emergence agitation and the emergence agitation scores were assessed at 0 min, 10 min, 20 min and 30 min after arriving at the post anesthetic care unit (PACU). Genomic DNA from peripheral leukocytes was isolated using the QIAamp Blood Minikits and the GABRgamma2 genetic polymorphisms were analyzed by performing polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. RESULTS: There were no significant differences of the emergence agitation scores among the genotypes in the GABRgamma2- SNP211037 C/T and GABRgamma2-nucleotide position 3145 in intron A/G. There was a trend in which the AA group in the GABRgamma2- nucleotide position 3145 in intron A/G has a lower incidence of emergence agitation compared with the non-AA group, but this was without statistical significance (P = 0.07). CONCLUSIONS: There is a possibility that the GABR2 genetic polymorphism may affect the development of emergence agitation when sevoflurane is used in pediatric anesthesia.

The sustaining effect of three polymers on the release of chlorhexidine from a controlled release drug device for root canal disinfection / 대한치과보존학회지

The aim of this in vitro study was to evaluate the suitability of using chitosan, poly (lactide-co-glycolide) (PLGA), and polymethyl methacrylate (PMMA) to control the release of chlorhexidine digluconate (CHX) from a prototype of controlled release drug device (CRD) for root canal disinfection. Four different prototypes with different formulations were prepared. Group A (n = 12); The device (absorbent paper point) was loaded with CHX as control. Group B (n = 12); same as group A, but the device was coated with chitosan. In Groups C and D, the device was treated in the same way as group A and then coated three times with 5% PMMA (Group C, n = 12), or coated three times with 3% PLGA (Group D, n = 12). The devices were randomly allocated to experimental groups of 12 each. All CRD prototypes were soaked in 3 mL distilled water. The concentrations of CHX were determined using a UV spectrophotometer. The surface characteristics of each prototype were observed using a scanning electron microscope. The result showed that release rate of CHX was the greatest in the non-coated group, followed by the chitosan-coated group, the PLGA-coated group, and the PMMA-coated group (P < 0.05). Pores were observed on the surface of the prototypes that were coated with PLGA and PMMA. When the pore size was smaller, the release rate was lower. This data indicate that polymer coating can control the release rate of CHX from the CRD prototypes.

Comparison of Nursing Activities Reflected in Nursing Notes and In-depth Interviews of Nurses in an Acute Hospital / 간호학회지

PURPOSE: The purpose of this study was to compare the nursing activities delineated by interview of nurses with those on nursing notes. METHOD: The participants of interview were 18 nurses working in medical and surgical units of a large hospital in Seoul. Each nurse was asked to choose one patient who demand most nursing care among her patients. The nurse was then interviewed to describe what her nursing activities for the patient was that day. The audio-taped interview was transcribed and the content was analyzed by researchers. Nursing notes of each nurses' patients were copied and the content analyzed by researchers. Finally, themes from the interview data and those from nursing notes were compared. RESULT: Activities related to emotional or psychological nursing, education for patient and families, and problem solving related to treatment or nursing procedure were most often omitted in nursing notes. Most of the documentation in nursing notes were related to physical condition of patients or physician's orders. Nurses described that they will do better recording if they were given less patient care responsibility, had better nursing knowledge, had better recording system, and received more training on nursing record. CONCLUSION: Nursing notes did not reflect nursing activities properly. Few independent nursing roles were documented in the nursing notes. Development of nursing education program and nursing record system is needed for improvement of nursing record.

Clinical Observation for Prematurity and Low Birth Weight Infant

No abstract available.