Effect of Photodynamic Therapy and Intravitreal Triamcinolone Acetonide on Choroidal Neovascularization in Age-related Macular Degeneration

PURPOSE: To evaluate the safety and visual outcome of intravitreal triamcinolone acetonide combined with photodynamic therapy for subfoveal choroidal neovascularization in patients with age-related macular degeneration. METHODS: We evaluated 32 eyes of 32 patients with choroidal neovascularization due to age-related macular degeneration. The study group received photodynamic therapy and intravitreal triamcinolone acetonide (combined group), while the control group received photodynamic therapy only (PDT group). RESULTS: Three months after treatment, no difference was detected between the two groups in visual acuity changes (p>0.05), but the leakage in fluorescein angiography and macular edema in optical coherent tomography decreased (p<0.05) in the combined group. The retreatment rate in the combined group (6.0%) after 3 months was lower than that of the PDT group (53.3%). CONCLUSIONS: Photodynamic therapy with intravitreal triamcinolone acetonide to choroidal neovascularization reduced the retreatment rate at 3 months significantly. These results may have been be due to the short-term anti-inflammatory effect of steroids.

Comparison of Higher-order Aberrations (HOAs) between Wavefront-guided Laser in Situ Keratomileusis and Laser Epithelial Keratomileusis

PURPOSE: To compare the change in higher-order aberrations (HOAs) in the treatment of myopia between two different Wavefront-guided excimer ablations: laser in situ keratomileusis (LASIK) and laser assisted subepithelial keratomileusis (LASEK). METHODS: One hundred and four eyes of 52 patients were treated with wavefront-guided LASIK while 104 eyes of 54 patients were treated with wavefront-guided LASEK. Pupil size, best-corrected visual acuity (BCVA), uncorrected visual acuity (UCVA), manifest refraction, corneal topography, pachymetry, and wavefront aberrations were examined preoperatively. BCVA, UCVA, manifest refraction, and wavefront aberrations were measured at 1 and 3 months postoperatively. The Hartmann-Shack aberrometer (WaveScan, VISX) was used to measure the overall wavefront aberrations for scotopic pupils. RESULTS: The wavefront error of HOAs did not increase postoperatively in either group compared with preoperative values. Normalized polar Zernike coefficients compared between preoperative and postoperative values showed a statistically significant increase in spherical aberration term in the wavefront-guided LASIK group (p<0.001). Comparing normalized polar Zernike coefficients values between the two groups, the spherical and 2nd coma aberrations at postoperative 1 month in wavefront-guided LASEK were significantly higher than those of the wavefront-guided LASIK group (p=0.002, both). CONCLUSIONS: HOAs did not increase in either wavefront-guided LASIK or wavefront-guided LASEK compared to the previous conventional methods. However, the average RMS wavefront error of the HOAs was lower in the wavefront-guided LASIK group at 1 month postoperatively (p=0.0004).

Comparison of Short-term Surgical Outcomes of Ahmed Glaucoma Valve Implant between 96 mm2 and 184 mm2 of the Surface Area

PURPOSE: To compare the short-term surgical outcomes of Ahmed glaucoma valve implant with a surface area between 96 mm2 and 184 mm2. METHODS: The outcomes of thirteen eyes of 13 patients with refractory glaucoma who had undergone 96 mm2-sized Ahmed glaucoma valve implantation were compared with those of 13 eyes of 13 patients with 184 mm2-sized Ahmed glaucoma valve implantation. RESULTS: Average age and preoperative intraocular pressure (IOP) were statistically indistinguishable between the two groups (p=0.54 and 0.40, respectively). Average follow-up period and final IOP were also statistically similar (p=0.15 and 1.00, respectively). Comparing the overall IOPs and the numbers of antiglaucoma medications, the IOP of postoperative day 1 with the 184 mm2-group was only relatively lower (p=0.07). The 2-year success rates were 18.0% for the 96 mm2-group and 69.2% for the 184 mm2-group (Ed-there is no respective comparison here) with Kaplan-Meier survival analysis (p=0.0018). The rates of complications and re-operation were similar between the two groups. CONCLUSIONS: The average postoperative IOPs were not statistically different between the two groups. However, the success rate was better in the 184 mm2-group than in the 96 mm2-group.

A Study for Manufacturing Light Artificial Eye

PURPOSE: To manufacture a light artificial eye that is lighter in weight than a conventional artificial eye and to correct the problems resulting from the long-term use of artificial eyes in anophthalmic patients. METHODS: The light artificial eyes were manufactured by substituting their posterior portions with a lightweight material, polystyrene. The conventional artificial eyes manufactured with polymethylmethacrylate (PMMA) and sold by the American Optical Corporation were used as the control. The control was grouped according to 3, 4, and 5 grams in weight with 8 sets in each group. The light artificial eyes that have the same volume and shape as the conventional ones was compared in terms of the reduction rates of weight with each group. RESULTS: The reduction rates of weight in the light artificial eyes were 22.6%, 40.2%, and 46.7% in the 3-, 4-, and 5-gram groups, respectively. In addition, the light artificial eyes showed significant statistical differences from the conventional ones. CONCLUSIONS: The light artificial eye, the posterior portion of which was substituted with a lightweight material, showed a significant reduction in weight, and the rate of weight reduction was higher with the heavier groups. Therefore, the lightweight artificial eye, which has fewer side effects to the orbit and adnexa, could contribute to the rehabilitation of the anophthalmic patients.

Irrigation-suction System for Management of Deep Sternal Wound Infection after Open Heart Surgery: Four cases / 대한흉부외과학회지

Deep sternal wound infection (with or without acute mediastinitis) is a serious complication of open heart surgery, with high rates of associated morbidity and mortality, and prolonged hospitallization. The result of treatment largely depends on timely diagnosis and appropriate surgical management. Postoperative deep sternal wound infections in 4 cases were successfully treated with extensive debridement, pressurized jet irrigation with antibiotic solution, sternal refixation by Robicsek method, and dilute antibiotic irrigation via irrigation-suction system. We report 4 cases with review of articles.

Repair of Left Ventricular Free Wall Rupture after Acute Myocardial Infarction: Application of Pericardial Patch Covering and Fibrin Glue Compression: A case report / 대한흉부외과학회지

Left ventricular rupture after acute myocardial infarction is a serious complication with high mortality. Emergency operation is usually the only available treatment. A 76-year-old female with persistent chest pain and syncopal attacks was admitted. Transthoracic echocardiography showed the pericardial effusion and generalized hypokinesia of the inferolateral wall of left ventricle. Coronary angiography revealed a total occlusion of the first diagonal branch. After percutaneous transluminal coronary angioplasty with coronary stent and insertion of intraaortic balloon pump, emergency operation was performed. Under cardiopulmonary bypass and cardiac arrest with cold blood cardioplegia, coronary artery bypass graft with saphenous vein, pericardial patch covering on the rupture area with 6-0 polypropylene running sutures, and fibrin glue compression under the patch were performed. We present a case of left ventricular (free wall) rupture after acute myocardial infarction.

Increased Expression of Intracellular HLA-DM but Not on the Surface of Blood Monocyte-derived Dendritic Cells During Maturation

Cutaneous dendritic cells (DCs), Langerhans cells (LCs) and dermal dendritic cells (DDCs), are present in an immature state. The maturation of DCs is crucial for initiating an immune response. Since HLA-DM has an important role for antigen presentation, an increase in HLA-DM expression according to the maturation of blood monocyte-derived dendritic cells (MoDCs), which have similar characteristics with DDCs, is expected. Therefore, the aim of this study was to determine whether or not HLA-DM expression in MoDCs is related to maturation at each culture day (from day 0 to day 13) by flow cytometry. This was compared with the functional changes related to the maturation of MoDCs. MoDCs were generated by culturing human peripheral blood monocytes in the presence of GM-CSF and IL-4 for 7 days, which were followed by subsequent treatment with a cytokine cocktail (GM-CSF, IL-4, IL-1beta, TNF-alpha, IL-6 and PGE2) for the maturation of MoDCs. The intracellular HLA-DM was expressed in the immature MoDC. A sudden 3 to 8 fold increase in the intracellular HLA-DM expression was observed after treatment with a cytokine cocktail. HLA-DM was weakly expressed on the surface of the immature MoDC, but it seemed to be decreased with maturation. This study indicated that the intracellular HLA-DM expression increased, but not on the MoDC surface during maturation. This was despite the fact that HLA-DM expression was noted not only on the surface but also in the intracellular in the MoDC.

A Clinical Study of Mitral Valve Repair for the Treatment of Mitral Valve Insufficiency

BACKGROUND AND OBJECTIVES: Mitral valve repair is the main procedure for the treatment of mitral valve insufficiency. The aims of this study were to review the applied techniques. and to evaluate postoperative residual mitral valve insufficiency, to compare preoperative and postoperative cardiac functions and dimensions, to compare the effects of rigid and flexible ring annuloplasty, and to assess overall freedom from valve failure-related reoperation. SUBJECTS AND METHODS: From March 1996 to September 1999, 34 patients underwent mitral valve repair for the treatment of mitral valve insufficiency at our department. This group comprised ten males and twenty four females, aged 8 to 65 years. The causes of mitral valve insufficiency were of degenerative origin in 12 patients, rheumatic in 10, congenital in 9, cardiomyopathic in 2, and ischemic in 1. The applied valve repair techniques included annuloplasty, quadrangular resection, leaflet slicing, cleft repair, chordae shortening, chordae transfer, secondary chordae resection, new chordae formation, papillary muscle splitting, commissuroplasty, and commissurotomy. RESULTS: There was no early or late mortality. We encountered 8 residual mitral valve insufficiencies (more than grade II), 2 of which worsened and eventually required correction by valve replacement. There were no statistical differences seen between the effects of rigid and flexible ring annuloplasty on left ventricular function either before or 1 year following annuloplasty. The cardiac dimensions decreased significantly. The actuarial freedom from valve failure-related reoperation was 93.01% at 43 months. CONCLUSION: Mitral valve repair with preserved valvular apparatus showed that the repaired valves functioned well and cardiac dimensions recovered satisfactorily. There were no statistical differences between the effects of rigid and flexible ring annuloplasty on cardiac functions and dimensions either before or 1 year following annuloplasty.

Compression Sclerotherapy for Varicose Veins / 대한흉부외과학회지

BACKGROUND: Although sclerotherapy is an established procedure in treating varicose veins, a wide disparity remains in the rates of success. The purpose of this study was to evaluate the effectiveness and complications of sclerotherapy in combination with compression. MATERIAL AND METHOD: From December 2000 to September 2001, a combined total of 50 legs in 39 patients with primary varicose veins were treated with sodium tetradecyl sulfate as sclerosant with the empty vein technique. Immediately after the injection, local compression was increased by a cotton wool roll, and additional compression was obtained with class II medical compression hosiery. Patients were evaluated at 5 days, 1 week, 2 weeks, and 6 weeks for degree of improvement and complications. RESULT: There were 36 women and 3 men ranging in age from 26 to 66 years, with a mean age of 45.3 years. Good sclerosing results were obtained in all patients. Of fifty legs, five had minor complications, two small intravascular clots, two pigmentations, and one compression-related bulla, which needed no treatment. CONCLUSION: The use of a cotton wool roll for local compression is highly effective, and sclerotherapy in combination with compression is safe and effective in the treatment of varicose veins.

Closure of VSD in a Patient with Tracheostoma: A case report / 대한흉부외과학회지

Open heart surgery in a patient with tracheostoma by standard median sternotomy increases the risk of wound infection or mediastinitis. In adults, the risk of mediastinal infection is decreased by using the high tracheostomy and minimally invasive approach for cardiac surgery. However the modified surgical approach is needed in infants due to their short neck. We have successfully performed the closure of ventricular septal defect, using the transverse sternotomy, in an infant with tracheostoma due to tracheomalacia.

Esophageal Reconstruction for Hypopharyngeal Stricture After Severe Corrosive Injury / 대한흉부외과학회지

Between 1987 and 1995, eleven patients with severe chronic corrosive stenosis of the hypopharynx and esophagus underwent surgical restoration of digestive continuity at Inje University Seoul Paik Hospital. There were 7 male and 4 female patients aged from 21 to 47 years (mean, 34 years). The caustic material was acid in 6 patients and alkali in 5 patients. The esophagus was reconstructed using the right colon in 9 and left colon in 2. The cervical approach and the side of proximal anastomosis depended on the status of the pyriform sinus of the hypopharynx. In the neck, J-formed incision was made along the sternocleidomastoid muscle. The sternohyoid and thyrohyoid muscles were divided transversely to expose the thyroid cartilage. Hypopharyngeal opening for proximal anastomosis was made by reverse triangular formed resection of the thyroid cartilage after elevation of perichondrium. Immediately after operation, dysphagia and aspiration into trachea were common, so training of swallowing was required. Feeding gastrostomy was usually maintained for 3 months until restoration of swallowing function was confirmed. There was graft necrosis in 3 patients, who were treated with jejunal free graft. Revisional procedures for stenosis of cervical anastomosis in 3 patients consisted of widening of pharyngocecostomy site in 2 and resection of adhesive band in one. Return of normal swallowing assuring normal nutrition was obtained in 10 of 11 cases.

Clinical Analysis of Primary Mediastinal Tumors / 대한흉부외과학회지

We reviewed 40 cases of primary mediastinal tumors which were operated on at Seoul Paik Hospital from September, 1987 to December, 1995. Of these, 18 were male and 22 were female. The patient ranged in age from 4 years to 68 years with a mean age of 34.1 years. The most common symptoms included chest pain(12.5%), cough(12.5%), dyspnea(7.5%), and palpable neck mass(7.5%), and symptoms were absent at the time of diagnosis in 37.5% of cases. Chest roentgenography and computed tomography(CT) were performed in all patients, and magnetic resonance imaging(MRI) in 5 patients, and transthoracic needle aspiration (TTNA) performed in 22 patients. The sensitivity of TTNA was 72.7%(16 of 22 patients). The lesion was located 60% in the anterosuperior mediastinum, 35% in the posterior mediastinum, and 5% in the middle mediastinum. The primary tumors included thymic neoplasms(11 cases), germ cell tumors(7 cases), neurogenic tumors(10 cases) and a miscellaneous group. The malignant tumors(12.5%) were invasive thymoma(3 cases), spindle cell sarcoma(1 case), and non-Hodgkin's lymphoma(1 case). A complete excision was done in all 35 benign tumors and 3 malignant tumors. There was no operative mortality, and postoperative complications occurred in 3 cases.

Mycotic Aneurysm of the Superior Mesenteric Artery: Report of 2 Cases / 대한흉부외과학회지

We have experienced two cases of mycotic aneurysms of the superior mesenteric artery. The first case originated from septic embolism of infective endocarditis and the second case originated from salmonella enteritis eight months before. The aneurysms were diagnosed by abdominal ultrasonography and comfirmed by computed tomogram and angiography but the blood culture was negative in both cases at the time of the surgery. Both patient were successfully treated by resection only and the restorations of vascular continuity were not neccesary because of adequate collateral circulations to the intestine. Both patient's postoperative courses were uneventful after the follow up of one year and nine months, respectively.

Ruptured Aneurysm of Descending Thoracic Aorta due to Salmonella Arteritis: 1 case report / 대한흉부외과학회지

A very rare case of mycotic aneurysm in the descending thoracic aorta due to salmonellosis was treated in our hospital. The patient was a 62 year-old male who 48 days before the operation was admitted to the department of internal medicine complaining of fever, nausia, vomiting, and loose stool. He was treated for 35 days and discharged. Three days after discharge, however, the patient was readmitted to the hospital complaining of right upper quadrant abdominal pain. Fever developed on the third hospital day, and on the eighth hospital day, the patient complained of back pain and epigastric pain. A simple chest x-ray showed evidence of hemothorax in the left plueral space, and therefore, computed tomography of the chest was done. The patient was diagnosed as a ruptured mycotic aneurysm of the descending thoracic aorta, and was transferred to our Department of Thoracic and Cardiovascular Surgery. The aneurysm and infected tissues was widely debrided, and the site was then patched with a Dacron graft. Salmonella choleraesuis was identified in the blood and aneurysm cultures, and antibiotics were administered for 6 weeks according to the sensitivity of the organism. The patient experienced no complication thereafter and for the last three months since the operation, he has been leading a healthy and normal social life.

Embolectomy of Arteries of Extremities: Clinical analysis of 26 cases / 대한흉부외과학회지

We present a retrospective analysis of arterial embolectomies performed at the Inje University Seoul Paik Hospital. During the period of March 1987 - Feburary 1996 twenty-six patients underwent embolectomies, eighteen patients were male and eight patients were female, mean age of patients was 56.8 years. Rest pain was the chief complaint in 24 patients, the remaining two patients complained of long term history of claudication after recovery of acute symtoms. But only 10 patients had sensory/motor symtoms. Heart was the most common source of embolization and frequent predisposing factor of embolism was ischemic heart disease in 8 cases and valvular heart disease in 11 cases. The sites of embolization were upper extremities artery in 6 cases, saddle embolism in 2 cases, lower extremities artery in 18 cases and the most common site of embolism was femoral artery in 11 cases. Preoperative angiography was taken in the diagnosis and planning of the embolectomy in 13 patients while in the other patient preoperative angiography was not taken. Only two cases were operated within the golden period of 6 hours and other cases were operated in more than 6 hours after embolization. In all patients, the Fogarty embolectomy catheter was used without bypass surgery via bachial ateriotomy in the embolism of upper extremities artery, bilateral groin approaches in the saddle embolism and transfemoral approach in the embolism of lower extremities artery. However 3 patients were re-operated via transpopliteal approach in the distal poplitiotibial embolism. Eighteen patients received perioperative anticoagulation therapy by heparin or fraxiparine and wafarin was used in 17 patients at the time of discharge and the indication of anticogulation was patients of valvular heat disease and/or atrial fibrillation, peripheral artery atherosclerosis and recurrent embolism. Postoperative results of the embolectomy were as follows: fouteen pateints had excellent results, five cases had symtom improvement after re-operation, B.K. amputation in 1 case who had sever atherosclerosis of lower extremities, recurrent embolism in 1 case and death in 2 cases the cause of death were acute renal failure and cerebral artery embolism, respectively. The complications of the embolectomy were reperfusion syndrome, pseudoaneurysm and intimal dissection in one case each. Conclusively the problems of embolism is delayed diagnosis and increasing number of old aged patient who had suffered ischemic heart diease. Preoperative angiography was not always needed for embolectomy. Selective anticoagulation therapy can decrease incidence of re-embolism. In the distal poplitiotibial embolism, seletive embolectomy of tibial artery was difficult.

Embolectomy of Arteries of Extremities: Clinical analysis of 26 cases / 대한흉부외과학회지

We present a retrospective analysis of arterial embolectomies performed at the Inje University Seoul Paik Hospital. During the period of March 1987 - Feburary 1996 twenty-six patients underwent embolectomies, eighteen patients were male and eight patients were female, mean age of patients was 56.8 years. Rest pain was the chief complaint in 24 patients, the remaining two patients complained of long term history of claudication after recovery of acute symtoms. But only 10 patients had sensory/motor symtoms. Heart was the most common source of embolization and frequent predisposing factor of embolism was ischemic heart disease in 8 cases and valvular heart disease in 11 cases. The sites of embolization were upper extremities artery in 6 cases, saddle embolism in 2 cases, lower extremities artery in 18 cases and the most common site of embolism was femoral artery in 11 cases. Preoperative angiography was taken in the diagnosis and planning of the embolectomy in 13 patients while in the other patient preoperative angiography was not taken. Only two cases were operated within the golden period of 6 hours and other cases were operated in more than 6 hours after embolization. In all patients, the Fogarty embolectomy catheter was used without bypass surgery via bachial ateriotomy in the embolism of upper extremities artery, bilateral groin approaches in the saddle embolism and transfemoral approach in the embolism of lower extremities artery. However 3 patients were re-operated via transpopliteal approach in the distal poplitiotibial embolism. Eighteen patients received perioperative anticoagulation therapy by heparin or fraxiparine and wafarin was used in 17 patients at the time of discharge and the indication of anticogulation was patients of valvular heat disease and/or atrial fibrillation, peripheral artery atherosclerosis and recurrent embolism. Postoperative results of the embolectomy were as follows: fouteen pateints had excellent results, five cases had symtom improvement after re-operation, B.K. amputation in 1 case who had sever atherosclerosis of lower extremities, recurrent embolism in 1 case and death in 2 cases the cause of death were acute renal failure and cerebral artery embolism, respectively. The complications of the embolectomy were reperfusion syndrome, pseudoaneurysm and intimal dissection in one case each. Conclusively the problems of embolism is delayed diagnosis and increasing number of old aged patient who had suffered ischemic heart diease. Preoperative angiography was not always needed for embolectomy. Selective anticoagulation therapy can decrease incidence of re-embolism. In the distal poplitiotibial embolism, seletive embolectomy of tibial artery was difficult.

Clinical Study of Subarterial Ventricular Septal Defect

PURPOSE: The incidence of subarterial ventricular septal defect(SA VSD) ranges 25-30% among oriental patients with VSDs, which is greater than 5% reported in western. Natural history of the disease is characterized by progressive aortic valve prolapse(AVP), frequently subarterial VSD, we evaluated clinical characteristics emphasizing on the incidence of AVP and the degree of AI as aging. METHODS: Study subjects consisted of 140 patients, who were diagnosed as subarterial VSD and operated in Seoul paik Hospital during a 5 year period from Jan.1988 to Dec. 1992. The data were analyzed detrospectively as to clinical profiles, data of cardiac catheterization, frequencies of AVP, and AI in 5 each age group, operative methods, postoperative complications and mortality. RESULTS: The incidence of subarteial VSD was 34.6% of total operated VSD cases. Data of preoperative cardiac catheterization showed mean values of Qp/Qs and systolic pulmonary artery pressure, 1.43+/-0.47 and 33.8x16.4mmHg in each. Aortic valve prolapses and aortic insufficiencies were observed in 70.0% and 20.7% among patients, which showed increasing tendencies as ages increased. As operative methods, patch closures through main pulmonary artery were done mainly. In mild cases without AI or with grade I AI, simple VSD closures were performed but in more a advanced cases, 10 aortic valvuloplasties and additional 2 aortic valve replacements were performed. Total mortality rate was 2.1%. CONCLUSIONS: In the management of subarterial VSD, early elective closure regardless of shunt volume is important to prevent progressive aortic valve prolapse leading to aortic insufficiency.

Operated DeBakey Type III Dissecting Aortic Aneurysm: Review of 12 cases

PURPOSE: We evaluated the indications of operation and radiologic findings in 12 operated DeBakey type III aortic dissections. MATERIAL AND METHODS: We retrospectively reviewed radiologic findings of 12 operated DeBakey type III aortic dissections, using CT, MRI, or aortography, and correlations were made with clinical course of the patients. RESULTS: Three cases were uncomplicated dissections. There were aneurysm rupture in 4 cases, impending rupture in 4 cases, occlusion of common lilac artery in 2 cases, occlusion of renal artery in 1 case, and compression of bronchus and esophagus by dilated aorta in 1 case. Associated clinical sign and symptoms were chest and back pain in 12 cases, claudication in 3 cases, dyspnea and dysphagia in 1 case, hoarseness in 1 case, and hemoptysis in 1 case. Post-operative complications were death from aneurysm rupture in 1 case, paraplegia in 2 cases, acute renal failure in 3 cases, and hemopericardium in 1 case. CONCLUSION: Although medical therapy is preferred in management of DeBakey type Ill aortic dissection, surgical treatment should be considered in patients with radiological findings of aortic rupture, impending rupture, occlusion of aortic major branches.

Management of in fected axillo-bifemoral graft: A case report / 대한흉부외과학회지

No abstract available.

5 cases of congenital esophagobronchial fistula in adult / 결핵

No abstract available.