Path to Diagnosis and Clinical Characteristics of Advanced Glaucoma at Initial Diagnosis: a Tertiary Single Center Experience

Purpose@#As routine health examinations become more common, many patients first diagnosed with glaucoma have advanced glaucoma. We analyzed the routes to diagnosis and the characteristics of patients initially diagnosed with advanced glaucoma. @*Methods@#We retrospectively retrieved the medical records of patients first diagnosed with advanced glaucoma in our tertiary care center. The inclusion criteria were a mean deviation (MD) less than -12 dB on the visual field test, accompanied by structural damage. All patients were classified in terms of unilateral/bilateral disease, the intraocular pressure before medication, and lens status. We divided patients into those with monocular or binocular advanced glaucoma, high- or normal-pressure glaucoma, and those who were pseudophakic or phakic. @*Results@#We included 73 patients of mean age 69.3 years. The visual field test MD was -19.6 dB. In those with binocular advanced glaucoma, incidental ophthalmic examination was the most common means of diagnosis (52.2%). Central-island visual field defects were the most common defects (54.2%). In those with monocular advanced glaucoma, glaucoma-associated symptoms most commonly triggered diagnosis (46.9%). Both superior and inferiorvisual field defects were the most common defects (42.8%). Glaucoma-associated symptoms were present in 68.2 and 22.8% of patients with high- and normal-pressure glaucoma, respectively. Central-island visual field defects were present in 43.6 and 29.4% of those with high- and normal-pressure glaucoma, respectively. @*Conclusions@#We analyzed the routes to diagnosis and the clinical characteristics of patients with advanced glaucoma. In those with binocular disease, glaucoma was most commonly diagnosed on incidental ophthalmic examination. Central-island visual field defects were the most common defects in patients with binocular and high-pressure glaucoma, and the pseudophakic group. A multi-center longitudinal study on risk factors for delayed glaucoma diagnosis is needed.

Long-term Intraocular Pressure Elevation after Primary Angle Closure Treated with Early Phacoemulsification

PURPOSE: To assess long-term changes in intraocular pressure (IOP) and the development of glaucoma after early phacoemulsification in acute primary angle closure. METHODS: Retrospective chart review of acute primary angle closure patients treated with phacoemulsification in attack eyes versus fellow eyes. Within a month after the angle closure attack, all subjects underwent cataract surgery and were divided into two groups: group A received cataract surgery on their attack eyes. Group B also received cataract surgery on their fellow eye after phacoemulsification of the attack eyes. Study outcomes were the prevalence of IOP rise (occurrence of IOP >21 mmHg) and the incidence of newly developed glaucoma. RESULTS: Eighty-nine eyes were included, with 62 attack eyes in group A and 27 fellow eyes in group B. Group A (14 eyes, 22.58%) had a higher cumulative rate of IOP rise than group B (3 eyes, 11.11%) at 12 months (p = 0.001). Newly developed glaucoma was not observed in group B; however, 6 patients in group A developed glaucoma during the 12-month follow-up period (p < 0.001). CONCLUSIONS: The attack eyes treated with phacoemulsification showed a significantly higher prevalence of IOP rise and newly developed glaucoma than fellow eyes that received phacoemulsification. These findings suggest that there is a possibility of IOP rise and development of glaucoma even when angle closure and successful IOP control have apparently been achieved after phacoemulsification.

A single emergency center study on the Canadian Syncope Risk Score applied to a patients visited with syncope in Korea

OBJECTIVE: Syncope is mostly benign, but it can also be caused by a life-threatening situation. In Korea, no studies have investigated application of the Canadian Syncope Risk Score (CSRS) to patients with syncope; therefore, this study was started to evaluate the usefulness of CSRS. METHODS: A total of 222 patients who visited the emergency room with syncope for one year from January 2016 to December 2016 were enrolled in this study. Patients were divided into two groups, a serious adverse events (SAE) group and a non-serious adverse events group. The scores of the nine CSRS variables were added and the CSRS was then calculated after the addition. RESULTS: The CSRS score for patients with SAE ranged from 0 to 8. The CSRS score was 18.6%, 31.7%, 55.6%, and 58.8% for 0, 1, 2, and 3, respectively. In the case of CSRS 0 and 1, 17 patients (81.0%) and 11 patients (84.6%) were non-cardiac. In the case of CSRS 2, 7 were non-cardiac (70.0%). In the case of CSRS 3, 6 cases (60.0%) were cardiogenic and 4 cases (40.0%) were non-cardiogenic. The area under the receiver operating characteristic curve of CSRS to predict SAE was 0.71. Setting the CSRS cutoff value to 0, we found that sensitivity and specificity of predicting SAE was 67.19% and 67.09%, respectively. CONCLUSION: CSRS may be difficult to predict for acute intracranial disease or acute hemorrhagic disease requiring transfusion; therefore, it is necessary to supplement it further.

Novel Adjuvant Method to Assist Localisation of a Cyclodialysis Cleft

PURPOSE: To introduce a novel adjuvant technique to locate cyclodialysis cleft using a laser pointer in a gonioscopic view. CASE SUMMARY: A 36-year-old man complaining of blurred vision in his left eye after blunt trauma 2 weeks prior was referred to our hospital. Gonioscopy showed a cyclodialysis cleft from 3 to 4 o'clock and fundus revealed hypotonic maculopathy. After the failure of medical treatment, we tried various interventions such as injection of viscoelastic agent into the anterior chamber and intravitreal gas tamponade with transconjunctival cryotherapy. Since those were not successful, we decided to treat the patient with direct cyclopexy. For the preoperative localization of the cleft, we tried a new technique that uses a laser pointer. On gonioscopic examination, an assistant shot the laser toward the limbal area where the suspicious cleft was located. We were able to precisely locate the cyclodialysis cleft if the laser pointer light was seen through the cleft in the gonioscopic view. With the aid of a laser a pointer, the cleft was successfully closed. CONCLUSIONS: Localization with a laser pointer is simple, safe, rapid, and helpful for planning surgical repair of a cyclodialysis cleft without expensive equipment.

Long-Term Intraocular Pressure Outcome in Fellow Eyes with Angle-Closure Glaucoma after Laser Iridotomy and Phacoemulsification

PURPOSE: To evaluate long-term change in intraocular pressure (IOP) in the fellow eyes after laser iridotomy and early phacoemusification with laser iridotomy in patients with acute angle-closure glaucoma. METHODS: We performed a retrospective, comparative chart review of 62 patients with acute angle-closure glaucoma; 35 patients (Group A) who underwent only prophylactic laser iridotomy on fellow eyes and 27 patients (Group B) who underwent prophylactic laser iridotomy and early phacoemusification on fellow eyes. Patients were followed up at 1 day, 1 week and 1, 3, 6 and 12 months. IOP change was analyzed after laser iridotomy 1 hour and at every follow-up. In addition, visual acuity and complications of laser iridotomy and phacoemusification were determined. RESULTS: In Group A, the mean IOP increase in fellow eyes occurred within 1 month after laser iridotomy (initial, 15.9 ± 5.0 mm Hg; final, 15.9 ± 2.6 mm Hg), However, in Group B, the mean IOP of fellow eyes was maintained up to 12 months without an increase in IOP (initial, 17.0 ± 3.3 mm Hg; final, 13.3 ± 2.8 mm Hg) Among the fellow eyes, 13 patients in Group A (37.14%) and 4 patients in Group B (14.81%, p = 0.032) underwent further medical therapy. The initial visual acuity of fellow eyes in Group A was 0.78 ± 0.21 and 0.71 ± 0.22 in Group B, and at the final visit, 0.73 ± 0.31 in Group A and 0.93 ± 0.27 in Group B (p = 0.003). CONCLUSIONS: We found that most fellow eyes treated with laser iridotomy and phacoemulsification maintained satisfactory IOP and good vision. These results support that laser iridotomy and phacoemulsification in the fellow eye with acute angle-closure glaucoma is a reasonable prophylactic treatment.

Clinical Outcomes of Early Phacoemulsification after Laser Iridotomy in Acute Angle-closure Glaucoma

PURPOSE: To evaluate long-term change in intraocular pressure (IOP) in eyes undergoing laser iridotomy (LI) and early phacoemulsification after LI in patients with acute angle-closure glaucoma (AACG). METHODS: The retrospective, comparative chart review included patients with AACG, Group A who underwent only LI and Group B who underwent early phacoemulsification within 1 month after LI. Patients were followed up on day 1; week 1; and months 1, 3, 6, and 12 after LI. IOP changes were studied. RESULTS: This study included a total 99 eyes from 99 patients, 37 in group A and 62 in group B. The mean IOP were not significantly different between the two groups at the initial visit or 1 month later. However, group B showed a consistently lower mean IOP that that of group A at 3, 6, and 12 months (p= 0.003, <0.001, <0.001, respectively). The prevalence of IOP increase to greater than 21 mmHg was 3 (8.11%), 5 (13.51%), and 5 patients (13.51%) in group A and 0, 2 (5.41%), and 1 patients (1.61%) in group B at 3, 6, and 12 months, respectively. Group B showed a significantly lower prevalence of IOP increase (p = 0.050, 0.038, 0.026). CONCLUSIONS: We found that patients treated with early phacoemulsification after LI had better outcomes of well-maintained IOP compared to those undergoing LI alone. For AACG patients with coexisting cataract, early phacoemulsification after LI can be considered as a reasonable treatment to maintain IOP.

Use of PCR with Sequence-specific Primers for High-Resolution Human Leukocyte Antigen Typing of Patients with Narcolepsy

BACKGROUND: Narcolepsy is a neurologic disorder characterized by excessive daytime sleepiness, symptoms of abnormal rapid eye movement (REM) sleep, and a strong association with HLA-DRB1*1501, -DQA1*0102, and -DQB1*0602. Here, we investigated the clinico-physical characteristics of Korean patients with narcolepsy, their HLA types, and the clinical utility of high-resolution PCR with sequence-specific primers (PCR-SSP) as a simple typing method for identifying DRB1*15/16, DQA1, and DQB1 alleles. METHODS: The study population consisted of 67 consecutively enrolled patients having unexplained daytime sleepiness and diagnosed narcolepsy based on clinical and neurological findings. Clinical data and the results of the multiple sleep latency test and polysomnography were reviewed, and HLA typing was performed using both high-resolution PCR-SSP and sequence-based typing (SBT). RESULTS: The 44 narcolepsy patients with cataplexy displayed significantly higher frequencies of DRB1*1501 (Pc= 0.003), DQA1*0102 (Pc=0.001), and DQB1*0602 (Pc=0.014) than the patients without cataplexy. Among patients carrying DRB1*1501-DQB1*0602 or DQA1*0102, the frequencies of a mean REM sleep latency of less than 20 min in nocturnal polysomnography and clinical findings, including sleep paralysis and hypnagogic hallucination were significantly higher. SBT and PCR-SSP showed 100% concordance for high-resolution typing of DRB1*15/16 alleles and DQA1 and DQB1 loci. CONCLUSIONS: The clinical characteristics and somnographic findings of narcolepsy patients were associated with specific HLA alleles, including DRB1*1501, DQA1*0102, and DQB1*0602. Application of high-resolution PCR-SSP, a reliable and simple method, for both allele- and locus-specific HLA typing of DRB1*15/16, DQA1, and DQB1 would be useful for characterizing clinical status among subjects with narcolepsy.

Predicting the Treatment Response Using a Direct Sequencing Method for EGFR in Non-Squamous, Non-Small Cell Lung Cancer / 대한내과학회지

BACKGROUND/AIMS: Epidermal growth factor receptor (EGFR) mutations in non-small cell lung cancers (NSCLCs) have emerged as a key predictive biomarker for EGFR tyrosine kinase inhibitor (EGFR-TKI) treatment and should be the primary standard for selecting patients for first-line treatment with EGFR-TKIs. This retrospective study evaluated the ability of direct DNA sequencing to predict the EGFR-TKI response. METHODS: We sequenced exons 18-21 of the EGFR tyrosine kinase domain from genomic DNA isolated from 122 NSCLCs, using paraffin-embedded tissues or cytological specimens. Mutation status was compared with clinicopathological features. Clinical outcomes were assessed based on EGFR genotypes. RESULTS: EGFR gene mutations were identified in 36 patients. EGFR mutations were significantly more frequent in non-smokers or light smokers than in heavy smokers (44.8% vs. 10.9%, p < 0.001) and in females than in males (41.8% vs. 19.4%, p = 0.007). The response rate to EGFR-TKIs in patients with an EGFR mutation was 42.1% (8/19), in contrast to 18.9% (7/37) in patients without a mutation (p = 0.064). Patients with an EGFR mutation had significantly prolonged progression-free survival (8.5 vs. 1.5 months; p = 0.003) and overall survival (40.0 vs. 13.3 months; p = 0.006) with EGFR-TKI treatment, compared with patients without a mutation. Among the 15 patients who responded to EGFR-TKIs, 46.7% (7/15) had wild-type EGFR by the direct sequencing method. CONCLUSIONS: EGFR-TKIs conferred substantial clinical benefit in patients with NSCLCs and EGFR mutations. Detection of an EGFR mutation currently relies on direct sequencing, which cannot be performed on small diagnostic specimens, and the method lacks sensitivity. Sensitive assays are needed to detect EGFR mutations in routine clinical samples.

New HLA Nomenclature (2010) and Its Clinical Application in Koreans / 대한진단검사의학회지

Human leukocyte antigen (HLA) gene region encodes a set of HLA molecules functioning critical roles in immune response. Each HLA gene locus shows extensive polymorphism with ever-increasing number of alleles. The HLA nomenclature system for alleles defined by DNA typing was first established in 1987 and has been revised several times. Recently, it has been revised again with a new frame that can accommodate ever-increasing number of new alleles. The new system has also introduced the novel suffixes, P and G, to simplify reporting of ambiguous strings of alleles in typing reports. This review introduces the HLA nomenclature system-2010 in conjunction with its clinical application in Koreans.

Human Leukocyte Antigen Class II Association with Spontaneous Recovery from Hepatitis B Virus Infection in Koreans: Analysis at the Haplotype Level

It has been speculated that human leukocyte antigen (HLA) alleles are associated with the outcome of hepatitis B virus (HBV) infection although the data obtained from various populations have shown some inconsistencies. A total of 464 HBVinfected Korean individuals (80 spontaneously recovered [SR] and 384 chronically infected [CI]) were selected to investigate the association of HLA class II alleles with the viral clearance and persistence. Our results showed that: 1) multiple HLA class II alleles and haplotypes were associated with viral clearance (DRB1*1302, DRB1*1502, DQB1*0302, DQB1*0609, and related-haplotypes) and persistence (DRB1*0701, DQB1*0301, and related-haplotypes); 2) DRB1*1302 and DQB1* 0609 were more strongly associated with viral clearance. And the association of DQB1*0609 (pc=0.0084; OR, 7.24) with vial clearance was much stronger than previously recognized, DRB1*1302 (pc=0.0038; OR, 4.34); and 3) linkage to a specific DPB1 allele in a haplotype strengthened the association with viral clearance, although DPB1 itself was not associated with the outcome. These results indicate the existence of multiple factors controlling viral clearance in the HLA class II gene region. Further extended investigation on the genetic factors related to the outcome of HBV infection will provide valuable insights into the understanding of the mechanisms involved.

Genetic Variation in the HLA-DRB1 and the Response to Treatment of Rheumatoid Arthritis with Etanercept: Preliminary Study / 대한류마티스학회지

OBJECTIVE: To investigate the roles of genetic variation in the HLA-DRB1 as predictors of response to etanercept treatment in rheumatoid arthritis (RA) patients. METHODS: Clinical responses of 66 patients treated with etanercept were determined according to the ACR criteria (ACR20 and 70). HLA-DRB1 typing and further subtyping of all alleles were performed by polymerase chain reaction, sequence-specific oligonucleotide probe hybridization, and direct DNA sequencing analysis. We tested whether genetic variation in the HLA-DRB1 influenced on the responses to 12 weeks of etanercept therapy. Univariate and multivariate analyses were performed to compare allele and genotype distribution between responders and nonresponders. RESULTS: When allelic association with etanercept response was analyzed with ACR20 and ACR 70 criteria for shared epitope alleles (HLA-DRB1 *0101, *0401, *0404, *0405, *0410, *1001, and *1406 alleles) and protective alleles (HLA-DRB1*0701, *0802, *1301, *1302, *1403, and *1405 alleles), there was no association with etanercept efficacy. When ACR20 nonresponders were compared with ACR70 responders, there was no significant association. Next, we tested genotypic association for shared epitope carriage status. The presence of HLA-DRB1 alleles encoding the shared epitope (1 and 2 copies) was marginally associated with nonresponse effect for ACR 70 response (OR=0.27, 95% CI=0.08~0.93, P=0.045). CONCLUSION: There was no influence of genetic variation in the HLA-DRB1 on the response to treatment of RA with etanercept.

M. tuberculosis Somatic Antigen Specific CD8+T cell Responses in BCG-Vaccinated Subjects / 결핵및호흡기질환

BACKGROUND: The immune responses mediated by CD8+T cells are known to be significant in controlling M. tuberculosis infections. In order to determine the role of cytotoxic CD8+T cells in the protective immune mechanism in latently infected subjects, this study examined whether or not the cytotoxic immune responses of CD8+T cells specific to the M. tuberculosis somatic antigens are induced in BCG vaccinated healthy subjects. METHODS: Cytotoxicity and IFN-gamma elispot assays were used to investigate the activities of CD8+T cells specific for the thyA30-38 peptide epitope in circulating peripheral blood mononuclear cells (PBMC) from BCG-vaccinated HLA-A*0201 and A*0206 subjects. RESULTS: The results indicate the cytotoxic and IFN-gamma immune responses of CD8+T cells specific for thyA30-38 were induced in BCG vaccinated healthy subjects. CONCLUSION: The cytotoxic and IFN-gamma responses by CD8+T cells specific for the M. tuberculosis somatic antigens are induced in BCG-vaccinated subjects, and appear to be involved in the protective immune mechanism in latently infected people against a M. tuberculosis infection.

The Study of MHC class I Restricted CD8+ T Cell Mediated Immune Responses against Mycobacterium tuberculosis Infection: Evidence of M. tuberculosis Specific CD8+ T Cells in TB Patients and PPD+ Healthy Individuals

BACKGROUND: The protective immunity against tuberculosis (TB) involves both CD4+ T cells and CD8+ T cells. In our previous study, we defined four Mycobacterium tuberculosis derived peptide epitopes specific for HLA-A*0201 restricted CD8+ T cells (ThyA30-38, RpoB127-135, 85B15-23, PstA175-83). In this study, we investigated the immune responses induced by these peptide specific CD8+ T cells in latently and chronically infected people with TB. METHODS: We characterized these peptide specific CD8+ T cell population present in PBMC of both TB patients and PPD healthy people using IFN-gammaelispot assay, intracellular staining and HLA-A2 dimer staining. RESULTS: The frequency of peptide specific CD8+ T cell was in the range of 1 to 25 in 1.7x10(5) PBMC based on ex vivo IFN-gamma elispot assay, demonstrating that these peptide specific CD8+ T cell responses are induced in both TB patients and PPD people. Short term cell lines (STCL) specific for these peptides proliferated in vitro and secreted IFN-gamma upon antigenic stimulation in PPD+ donors. Lastly, HLA-A*0201 dimer assays indicated that PstA175-83 specific CD8+ T cell population in PPD+ healthy donors is heterogeneous since approximately 25~33% of PstA175-83 specific CD8+ T cell population in PPD+ healthy donors produced IFN-gamma upon peptide stimulation. CONCLUSION: Our results suggest that MHC class I restricted CD8+ T cell mediated immune responses to M. tuberculosis infection are induced in both TB patients and PPD+ people; however, the CD8+ T cell population is functionally heterogeneous.

The Results of Molteno Implant Surgery

PURPOSE: The author evaluated the outcome of the Molteno implant drainage device in refractory glaucoma. METHODS: A retrospective study was performed on 17 eyes of 17 patients that had undergone Molteno implantation for glaucoma unresponsive to conventional treatment from May 1997 to February 2001 at our hospital. Complete success was defined as a postoperative intraocular pressure of less than 21 mmHg (but over 5 mmHg) at last visit without glaucoma medications, and qualified success was the same pressure as above with glaucoma medications and with no additional glaucoma surgery, phthisis, or removal of Molteno implant. RESULTS: The total success was 70.6% (41.2%, complete; 29.4%, qualified). There was a significant difference in number of antiglaucoma medications between preoperative and postoperative. Postoperative relief of ocular pain or headache was statistically significant. CONCLUSIONS: The Molteno implant surgery offers a reasonable outcome in eyes with intractable glaucoma. The proper management will result in less complications and a better control of intraocular pressure.

A Case of Pseudophakic Malignant Glaucoma

PURPOSE: Malignant glaucoma is a rare secondary glaucoma characterized by a flat anterior chamber with increased intraocular pressure (IOP). It may occur after intraocular surgery, trauma, inflammation, the use of miotic agents, and so on. We report a case of malignant glaucoma after uncomplicated phacoemulsification with foldable intraocular lens implantation (IOL) using scleral tunnel incision. METHODS: A 74-year-old woman underwent a phacoemulsification with foldable IOL implantation in her left eye. Ten days after cataract surgery, she had severe ocular pain, a high IOP, and a flat anterior chamber. Pupillary block was suspected, and a peripheral iridectomy was done. But she was referred to our hospital for evaluation of persistent IOP elevation with flat anterior chamber. A diagnosis of pseudophakic malignant glaucoma was made, and we performed a core vitrectomy through peripheral iridectomy site. The anterior chamber deepened postoperatively with control of IOP. On the fourth postoperative day, she developed flattening of the anterior chamber with IOP elevation. A recurrence of malignant glaucoma was diagnosed, and anterior vitrecomy with a widening of previous iridectomy wound was done. RESULTS: Postoperatively, the patient had normal IOP, a deep anterior chamber and improved visual acuity. We got successful results from a surgical anterior vitrecomy through peripheral iridectomy site.

Brimonidine 0.2% versus Apraclonidine 0.5% for Controlling Intraocular Pressure Elevation after Q-switched Nd:YAG Laser Posterior Capsulotomy

PURPOSE: To compare the effectiveness of 0.2% brimonidine tartrate and that of 0.5% apraclonidine hydrochloride for controlling IOP elevation after Nd:YAG laser capsulotomy. METHODS: Thirty eyes were given with 0.2% brimonidine (group 1) and fourteen eyes with 0.5% apraclonidine (group 2) before and after the procedure. Fifteen eyes served as untreated controls (group 3). Intraocular pressure and visual acuity were measured preoperatively and 1 hour, 3 hours, 24 hours, and 1 week postoperatively in all cases. RESULTS: The postoperative mean intraocular pressures of group 3 (14.97+/-3.58, 16.47+/-3.93 mmHg) at 1 hour and 3 hours were statistically significant higher than those of group 1 (11.23+/-3.43, 11.50+/-3.01mmHg), and those of group 2 (10.79+/-3.51, 11.57+/-3.03 mmHg)(p< 0.05), but, there were no statistically significant differences in mean IOP at 1 hour and 3 hours between group 1 and group 2 (P=0.569, P=0.610). At 1 hour and 3 hours, there was no case of IOP elevation of 5 mmHg above baseline in group1 and group 2. but, there were 5 cases (33.3%) at 1 hour and 6 cases (40%) at 3 hours in group 3. CONCLUSIONS: This result suggests that 0.2% brimonidine and 0.5% apraclonidine are equally effective for preventing acute IOP elevation after Nd:YAG laser capsulotomy, that is, 0.2% brimonidine is an effective and well-tolerated agent for preventing acute IOP rises after Nd:YAG laser posterior capsulotomy.

Visual Fields Measured with SWAP(Short Wavelength Automated Perimetry) in Normal Korean

PURPOSE: Previous results from many studies indicate that SWAP(short wavelength automated perimetry) is superior to standard white-on-white perimetry for assessing early glaucomatous visual field defects and progression in glaucomatous field loss. The standard normal data of SWAP in Humphrey field analyzer were gathered from normal North American. Therefore, it was necessary to evaluate the visual fields measured with SWAP in normal Korean. METHODS: Central 30-2 threshold tests with blue-on-yellow mode were performed in 96 eyes of 48 normal subjects with Humphrey Field Analyzer. RESULTS: The average value of foveal threshold, mean deviation(MD), pattern standard deviation(PSD), short-term fluctuation(SF), and corrected pattern standard deviation(CPSD) were 22.1+/-4.2 dB, -5.37+/-3.27dB, 3.29+/-0.94 dB, 1.90+/-0.67 dB, 2.48+/-1.15dB, respectively. The frequency of abnormal value on SWAP(p<0.5%) was 29.2% in foveal threshold and 11.5% in MD, which was higher than fundamental data of perimetry. As the age increased, foveal threshold decreased(r=-0.365), PSD and CPSD increased(r=0.321 and 0.283, respectively)(p<0.05). CONCLUSIONS: This study is limited due to the small study group and because the test was performed on single session. Further study is needed for understanding the relationship between SWAP and early structural change of optic nerve and retinal nerve fiber layer.

Correlations Between HLA-Cw*0602 and Clinical Picture in Korean Psoriatic Patients / 대한피부과학회지

BACKGROUND: HLA-Cw6 has the strongest individual association with psoriasis in many racial groups, and associations with the positive family history and early age at onset have been noted in many studies. OBJECTIVE: The aim of this study was to investigate whether Cw6 correlate with the clinical parameters of Korean psoriatic patients. METHODS: One hundred and twelve unrelated patients with psoriasis, and 166 healthy controls were examined with regard to Cw*0602, using a PCR-SSP method. We divided the patients into two groups according to Cw*0602 positivity, and compared two groups with reference to several clinical parameters. RESULTS: The results are summarized as follows: 1. Cw*0602 was found in 69.6% of the 112 patients, but only in 9.0% of the 166 healthy controls(p<0.05, RR=23.1). 2. The presence of Cw*0602 correlated with early age at onset(26.1 vs. 32.5 years, p<0.05), and Cw*0602 was present in 75.0% of the patients with early onset(p<0.05, RR=30.2). 3. The presence of Cw*0602 did not correlate with a positive family history of psoriasis among the first-degree relatives, but correlated with an overall positive family history (p<0.05). 4. There were no positive correlations with arthritis, the history of inpatient treatment, the clinical type of psoriasis, and onset or exacerbation after upper respiratory infection. CONCLUSION: The presence of Cw*0602 correlated with a positive family history for psoriasis and early age at onset, but did not correlate with arthritis, the history of inpatient treatment, the clinical type of psoriasis, and onset or exacerbation after upper respiratory infection.

How Reliable is Sputum PCR Test in the Diagnosis of Pulmonary Tuberculosis When Sputum Smear is Negative? / 결핵

BACKGROUND: Recent technological developments have introduced a new method to identifying M. tuberculosis complex DNA in clinical samples directly. The direct amplification test (DAT) is approved for identifying M. tuberculosis complex in respiratory specimens that are smear-positive for acid-fast bacilli (AFB). When there is a discrepancy between the AFB smear and DAT, no information on their clinical utility is currently available. In this study, the diagnostic reliability of DAT was investigated in suspected pulmonary tuberculosis patients whose sputum AFB smear was negative. METHODS: From June 1, 1998 through May 30, 1999, 909 patients with presumed active pulmonary tuberculosis were enrolled. A sputum AFB stain, culture, DAT and /or biopsy were performed. using the criteria of clinical tuberculosis or confirmed tuberculosis, the positive predictive value of DAT in diagnosing pulmonary tuberculosis was investigated. RESULTS: The positive predictive value of DAT was 82.1% by the clinically active tuberculosis criteria. However, it decreased to 61.5% when diagnosis was restricted to only to culture positive or biopsy proven cases. The false positive rate of DAT was 18.0%. CONCLUSION: The DAT is a valuable diagnostic method in suspected patients whose sputum AFB is was negative.

Clinical Significance of PCR-Based Rapid Detection of Mycobacterium tuberculosis DNA in Peripheral Blood / 결핵

BACKGROUND: Since the advent of AIDS, tuberculosis has become a major public health problem in the western society. Therefore, it is essential that pulmonary tuberculosis be rapidly diagnosed. Light microscopic detection of acid-fast organisms in sputum has traditionally been used for rapidly diagnosing tuberculosis. However positive smears are only observed in about one-half to three-quarters of cases. Studies using PCR for diagnosing pulmonary tuberculosis disclosed several shortcomings suggesting an inability to distinguish between active and treated or in active tuberculosis. In this study, the clinkcal significance of a PCR-bases rapid technique for detecting Mycobacterium tuberculosis DNA in peripheral blood investigated. MATERIALS AND METHODS: From July 1, 1998 through to August 30, 1999, 59 patients with presumed tuberculosis, who had no previous history of anti-tuberculosis medication use whithin one year prior to this study were recruite and followed up for more than 3 months. AFB stain and culture in the sputum and/or pleural fluids and biopsies when needed were performed. Blood samples from each of the 59 patients were obtained in order to identify Mycobacterium Tuberculosis DNA by a PCR test. RESULTS: 1) Forty five out of 59 patients had a final diagnosis of tugerculosis; Twenty eight were confirmed as having active pulmonary tuberculosis by culture or biopsy. Four were clinkcally diagnosed with pulmonary tuberculosis. The othe 13 patients were diagnosed as having tuberculous pleurisy (9) and extrapulmonary tuberculosis (4). 2) Fourteen patients showed a positive blood PCR test. The PCR assay correctly identified active tuberculosis in 13 out of 14 patients. The overall sensitivity and specificity of this blood PCR assay for diagnosing tuberculosis were 29% and 93%, respectively. The positive predictive value was 93%, the negative predictive value was 29% and diagnostic accuracy was 44%. 3) Six out of 14(43%) patients with blood PCR positive tuberculosis were immunologically compromised hosts. 4) A simple chest radiograph in blood PCR positive tuberculosis patients showed variable and inconsistent findings. CONCLUSION: A peripheral blood PCR assay for Mycobacterium tuberculosis is not recommended as screening method for diagnosing active tuberculosis. However, it was suggested that the blood PCR assay could contribute to an early diagnostic rate due to its high positive predictive value.