Palpebral Conjunctival and Tarsal Stromal Tumor

No abstract available.

Choroidal Thickness at the Outside of Fovea in Diabetic Retinopathy Using Spectral-Domain Optical Coherence Tomography

PURPOSE: To evaluate choroidal thickness at the outside of the fovea in patients with diabetic retinopathy using spectral-domain optical coherence tomography. METHODS: We examined 87 eyes of 87 patients with diabetic retinopathy and 40 eyes of 40 normal patients. Patients with diabetic retinopathy were divided into 3 groups according to the grade of diabetic retinopathy and macular edema. The choroidal thickness was obtained at the fovea and outside of the fovea using enhanced depth imaging of Spectralis optical coherence tomography. One foveal and 8 peripheral images were selected and choroidal thickness was measured from the outer border of the retinal pigment epithelium to the inner scleral border. RESULTS: Subfoveal choroidal thickness was thinner with increasing severity of diabetic retinopathy. However, there was no significant difference between groups without the nasal side of the fovea. A statistically significant difference was observed over the fovea at the superotemporal area. CONCLUSIONS: The choroidal thickness outside of the fovea was thinner with the severity of diabetic retinopathy and was more pronounced in the superotemporal area.

Comparison of the Time Required for Panretinal Photocoagulation and Associated Pain between Navilas(R) and Conventional Laser Therapy in Diabetic Retinopathy

PURPOSE: To compare the pain scale and time necessary for panretinal photocoagulation (PRP) between Navilas(R) (OD-OS, Teltow, Germany) and conventional laser in diabetic retinopathy. METHODS: Fifteen patients who required PRP for diabetic retinopathy were enrolled in the present study. PRP was performed using Navilas(R) (5 x 5 array patterned system) in the superior, nasal and inferior areas, and using conventional laser at the temporal area 1 week later. Total time of laser application and number of laser shots were counted for calculating required time per 100 spots of each laser system. Immediately after the laser photocoagulation, patients were asked to quantify their pain on a visual analog pain scale (0 = no pain; 10 = worst pain). RESULTS: PRP using Navilas(R) required shorter time per 100 laser spots (27.7 sec vs. 102.0 sec, p < 0.001) and subjects had lower treatment-related pain than with the conventional laser system (3.3 vs. 6.9, p < 0.001). CONCLUSIONS: PRP using Navilas(R) can be considered as an efficient method for improving patient and operator's comfort with faster laser application and lower treatment-related pain.

Clinical characteristics of acute renal failure with severe loin pain and patchy renal vasoconstriction

BACKGROUND: Acute renal failure (ARF) with severe loin pain and patchy renal vasoconstriction (PRV) is a syndrome presenting with sudden loin pain after anaerobic exercise. We aimed to investigate the clinical characteristics and the efficacy of diagnostic imaging studies of patients with this syndrome. METHODS: We retrospectively selected 17 patients with ARF accompanied by loin or abdominal pain who showed multiple patchy wedge-shaped delayed contrast enhancements on a computerized tomography scan. Information about the clinical characteristics, including the nature of pain and combined symptoms, suspected causes, such as exercise, drug or alcohol intake, and renal hypouricemia, and the results of laboratory and imaging tests were gathered. RESULTS: The mean age of patients with episodes of ARF accompanied by loin pain was 23.0+/-6.5 (range 16-35) years old. Pain was mainly located in the loin (70.6%) or abdominal area (76.5%) and continued for approximately 3.5+/-4.0 days. Exercise was suspected as a primary cause of disease in 12 (70.6%) patients. Maximal serum creatinine was 5.42+/-3.16 (1.4-12.1) mg/dL 3.1+/-1.8 (1-7) days after the onset of pain. The peak level of serum uric acid was 9.41+/-2.91 (6.0-15.8) mg/dL. All of the patients recovered to near-normal renal function, and one patient showed hypouricemia after recovery. CONCLUSION: ARF with severe loin pain and PRV can present with loin or abdominal pain, even without a history of anaerobic exercise. Careful history taking and appropriate imaging studies are critical in the diagnosis and management of this syndrome.

Clinicopathologic Characteristics of C1q nephropathy / 대한신장학회지

PURPOSE: C1q nephropathy (C1qN) is a rare glomerulonephritis characterized by mesangial deposits, predominantly C1q, without the evidence of systemic lupus erythematosus (SLE). It showed various clinical courses, however, the clinicopathologic features of C1qN have not been well defined as yet. METHODS: We retrospectively reviewed the clinicopathologic features of 11 patients (0.8%) diagnosed as C1qN among 1,403 patients aged > or = 18 years who had undergone renal biopsy due to primary glomerular disease from Jan. 2000 to Jan. 2009. Diagnostic criteria of C1qN were as follows; 1) the presence of dominant or co-dominant immunofluorescence staining for C1q in the mesangium, 2) corresponding mesangial dense deposit by electron microscopy, and 3) lack of clinical evidence of SLE. RESULTS: The male-to-female ratio was 6:5 and their mean age was 41.1+/-22.6 yrs (range, 19-69 yrs). Eight patients presented with urinary abnormalities and three with nephrotic syndrome. At the time of biopsy, three patients had hypertension. The mean value of 24-hour urine protein was 4.4+/-5.5 g/day (range, 0.5-18.5 g/day). On light microscopy, normal glomerular architecture (4/11) and segmental sclerosis (7/11) were observed. Complete or partial remission was achieved in six of the seven patients treated with immunosuppressive agents (steroid and/or immunosuppressants). Among these patients, two using steroid monotherapy had relapsed. The mean follow-up duration was 14+/-11 months (range, 2-31 months) and renal function deterioration was observed in three patients. CONCLUSION: C1qN showed various clinical manifestations and prognosis. Therefore, additional studies are needed to fully define the clinicopathologic features.

Clinical Significance and Outcomes of Initial No Growth Peritonitis from Peritoneal Dialysis Patients: Role of Mycobacterial or Fungal Peritonitis / 대한신장학회지

PURPOSE: Peritoneal dialysis associated peritonitis (PD peritonitis) is an important complication in maintaining. There have been only a few reports on the clinical outcome of initial no-growth peritonitis (INGP). METHODS: We reviewed 332 episodes of PD peritonitis between January 2002 and August 2009. INGP was defined as PD peritonitis with no growth of etiologic microorganism within 3 days of peritonitis. INGP was compared with initial positive growth peritonitis (IPGP) in view of clinical manifestations and outcomes. RESULTS: We divided PD peritonitis episodes into two groups: INGP (n=90) and IPGP (n=242). Peritonitis-related mortality was 5.6% in INGP, while 0.8% in IPGP (p=0.017). Further relapse was noted in INGP (10.0%) than in IPGP (vs. 4.1%; p=0.041). Salvage antibiotics were used more frequently in INGP (21.1%) than in IPGP (vs. 11.6%; p=0.027). Odds ratio of INGP to IPGP for peritonitis-related mortality was 7.14 (95% CI 1.36-37.51; p=0.017). Growth of mycobacteria or fungi increased the risk of peritonitis-related mortality with an odds ratio of 18.11 (95% CI 2.99-109.89; p=0.013). In multivariate analysis, growth of mycobacteria or fungi was the only independent risk factor for peritonitis-related mortality with an odds ratio of 10.63 (95% CI 1.27-88.75; p=0.029). CONCLUSION: INGP revealed poorer outcome than IPGP. Higher growth rate of mycobacteria or fungi in INGP than in IPGP accounted for the poor outcome. Thus one should make vigorous efforts to detect surreptitious organism when there is no growth by 3 days, especially for the possibility of either mycobacteria or fungi.

A Case of Pulmonary Adenocarcinoma Developed on a Previous Lesion from Microscopic Polyangiitis / 대한신장학회지

This report examines a patient with pulmonary adenocarcinoma that developed on a previous lesion from microscopic polyangiitis. A 59-year-old woman had been diagnosed with microscopic polyangiitis in October of 1988 based on her clinical symptoms and serological tests, which were positive for anti-neutrophil cytoplasmic antibodies. Her glomerulonephritis had been well controlled with low-dose prednisolone. She presented in October of 2005 with vague chest discomfort and dyspnea on exertion. Physical examination was unremarkable. A non-contrast computed tomography (CT) scan of the chest showed patch ground-glass opacity at the right lower lobe of the lung. Because we did not believe the lesion to be a definite malignancy, we decided to follow up with chest images over a short interval. During the 18 months following the images, the lesion did not change. However, the opacity of the lesion increased slightly over the last two months, and a non-contrast CT scan of the chest was therefore performed. A CT scan showed persistent ground-glass opacity with a slightly solid portion. To diagnose the previous finding and possibly to provide treatment, a right lower lobectomy of the lung via video-assisted thoracoscopic surgery was performed. The pathologic review of the resected lung revealed an adenocarcinoma, stage pT1N0. After one year, fluorodeoxyglucose positron emission tomography was performed, and no evidence of a recurrent malignancy was found.

The Relationship between Recipients Age on the Development of Acute Rejection and Graft Survival in Kidney Transplantation / 대한신장학회지

PURPOSE: Previously, acute rejection (AR) episode in the elderly recipients was reported to be lower compared to that of young recipients. However, the relationship between the recipients age, incidence of AR, and graft survival has not been reevaluated recently. METHODS: Four hundred thirty-one recipients who had the first kidney transplantation were recruited, and we performed a retrospective study evaluating the incidence of AR, infectious episodes in one year, and graft and patient survival rates at 1 and 5 years. We divided recipients into 2 groups (age< 50, n=340 and age=50, n=91) and compared the outcomes. RESULTS: The incidence of AR was 18.8% in the younger group and 24.2% in the elderly group (p=NS). The incidence of infectious episodes was 24.7% in the younger group and 24.2% in the elderly group (p=NS). Five-year graft survival in the elderly was not significantly different from that in the younger group (90.8% vs. 91.8%). However, the patient survival at five year was different between the younger and the elderly groups (99.1% and 92.2%, respectively, p<0.05). CONCLUSION: Our findings suggest that recipients age would not influence the incidence of AR and graft survival. Therefore, the immunosuppression should be applied according to the conditions of recipients, not to recipients age.

Effect of peritoneal glucose load on plasma leptin concentration in continuous ambulatory peritoneal dialysis patients

This study was performed to investigate the effect of peritoneal glucose load on plasma leptin concentrations in the continuous ambulatory peritoneal dialysis (CAPD) performed on 13 non-diabetic ESRD patients. Plasma leptin and insulin concentrations were measured for 2 hours during a single 2 liter exchange of 1.5% glucose-based dialysate (SPD, n = 6), for 7 days of daily peritoneal dialysis (DPD, n = 7). In DPD, standard full volume (2,000 ml x 4 times/day) exchange was performed immediately after operation. In SPD, plasma leptin and insulin concentrations remained unchanged during the study. In DPD, the plasma leptin concentration increased significantly after CAPD on the first day (PD1) (11.2 +/- 5.4 to 17.0 +/- 6.0 ng/mL, p < 0.05) and this elevation seemed to persist until 7 days after operation. After CAPD, there was no significant day-to-day variation in peritoneal glucose absorption (391-465 cal). Oral intake seemed to decrease on operation day (PD0) and PD1 and then increased slowly. Plasma insulin and glucose concentrations did not significantly change after CAPD. Changes of leptin concentration were significantly correlated with the changes of peritoneal glucose absorption at PD1. In conclusion, continuous peritoneal glucose load may affect plasma leptin concentrations in CAPD patients.

Newly developing endoscopic devices--shadow optics and micromachine

Based on the newly-developed engineering technologies, many kinds of useful equipment have been available for minimally invasive surgery. Recently the time to connect clinical needs and advanced technologies has become faster. In this article, we have summarized the recent technologies for endoscopic surgeries. Shadow optic technologies for better geometric perception using dual illumination in a conventional 2-D monitor and "Overview optics" for a panoramic view with an additional visual system are introduced. Micromachine technology is very close to practical implementation for minimally invasive surgeries. Virtual Biopsy is the one of the hottest topics for the next generation of endoscopy. Stereoscopic and volumetric vision systems are still on the way, which should overcome the irritating goggles and stereo display devices. As well as operational theater that integrates all the required equipment with a computer-based system, including voice recognition, still requires the standard protocols to connect many kinds of devices from different manufacturers.

The Effect of Peritoneal Membrane Transport Characteristics on the Nutritional Status in Long-Term Continuous Ambulatory Peritoneal Dialysis(CAPD) Patients / 대한신장학회잡지

Protein-calorie malnutrition is common in CAPD patients and is associated with increased morbidity and mortality. There are many causes of malnutrition in CAPD patients, and it is well known that a large amount of protein loss through the peritoneal membrane is one of them. To investigate the effect of the peritoneal membrane transport characteristics on the nutritional status in long-term CAPD patients, we conducted a cross-sectional study on clinically stable 110 patients who performed CAPD for more than 2 years, using PET and measuring nutritional status by subjective global assessment (SGA), biochemical, anthropometric and urea kinetic parameters. Following results were obtained. 1) The patients were divided into 4 groups according to the PET results: high transporter(n=17, 15.5%), high average transporter(n=32, 29.1%), low average transporter(n=52, 47.3%) and low transporter(n=9, 8.1%). 2) Serum albumin levels(g/dl) in high transporter, high average transporter, low average transporter and low transporter were 3.5+/-0.4, 3.8+/-0.4, 4.1+/-0.4 and 4.3+/-0.3, respectively, and there was a significant difference between high transporter and low transporter(p<0.05). High transporter had significantly lower serum creatinine level(11.5+/-1.8mg/dl) than in low transporter(16.3+/-5.0mg/dl)(p<0.05), prealbumin level(mg/dl) was significantly lower in high transporter(29.8+/-5.1) than low average transporter(41.1+/-9.6) and low transporter(41.4+/-3.6) (p< 0.05). But, there were no significant differences in Hct, BUN, total cholesterol, transferrin and IGF-1 among the 4 groups. 3) Albumin loss through dialysate (g/day) was significantly more in high transporter(5.36+/-1.44) than in low average transporter(4.17+/-1.09) and low transporter(3.88+/-1.35)(p<0.05), and SCCr(L/wk/ 1.73 m2) was higher in high transporter(67.08+/-10.60) than in the others(high average transporter, 63.75+/-17.72; low average transporter, 54.92+/-14.54; low transporter, 49.03+/-8.93) (p<0.05). 4) Malnourished patients assessed by SGA were more in high transporter group (6/17, 35.3%) than in low transporer group (1/9, 11.1%)(p<0.05). 5) There were no statistically significant differences in NPCR, Weekly Kt/Vurea, and anthropometric parameters among the 4 groups. In conclusion, CAPD patients in high transporter group are more malnourished despite of more adequate dialysis with higher SCCr compared to those in low transporter group, which is resulted from large amount of protein and albumin loss through dialysate. Strict management and protein replacement therapy will be indicated in high transport CAPD patients to prevent protein malnutrition related morbidity and mortality.

Analgesic Effects of Epidural Bupivacaine, Alone or in Combination with Clonidine on Pain after Cesarean Section / 대한마취과학회지

Epidural clonidine produces analgesia via non-opioid mechanism and it may be used as an adju-vant to local anesthetics in obstetric analgesia. To evaluate the effects of epidural clonidine and bupivacaine for post-cesarean section analgesia, we designed a double-blind study. Sixty patients scheduled for elective cesarean section were divided into three groups. Group 1 (n=20) received 0.125% bupivacaine 2 ml/hour epidurally for 2 days. Group 2 (n=20) received 150 ug clonidine bolus, followed by 0.125% bupivacaine 2 ml/hour and clonidine 10 ug/hour for 2 days. Group 3 (n=20) received 150 ug clonidine bolus, followed by 0.125% bupivacaine 2 ml/hour and clonidine 20 ug/hour for 2 days. At the end of the cesarean section, above drug was administered epidurally. Postoperative analgesia was assessed by recording VAS(visual analogue scales) at 1, 2, 4, 8, 16, 32 and 48 postoperative hours. Sedation score, heart rate and systolic and diastolic blood pressure were also checked. The results were as follows: 1) VAS were significantly decreased in group 2 at 1~16 hours and in group 3 at 1~32 hours compared with group 1, They were decreased in group 3 compared with group 2 at 1~48 hours but no significance was seen between two groups. 2) The changes of systolic and diastolic blood pressures & sedation scores were not significantly different between any two groups. In summary, co-administration of clonidine and bupivacaine epidurally provided more profound analgesia compared with bupivacaine alone after cesarean section.

A Case of Persistent Left SVC Associated with Tricuspid Regurgitation

A persistent left superior vena cava is the most common anomaly of the superior caval system. Usually the persistent left superior vena cava is connected with the right atrium via the coronary sinus, resulting in no physiologic derangement : however in 7 to 8 percents of the patietns with a persistent left superior vena cava, the anomalous vessel communicates with the left atrim. In the absence of obstruction to the flow from the left atrium to the left ventricle. this anatomic situation usually results in right to left shunting of varying degress. We recently experienced a case of persistent left superior vena cava in a 52-year-old female who complained of chest discomfort, epigastric pain and dyspnea(NYHA functional class II). Cine-angiography showed that the contrast passed from the left SVC through the dilated coronary sinus into right atrium. And right sided SVC was not seen. The patient was treated with conservative measures and discharged with improved condition.

Vitamin B12 deficiency megaloblastic anemia after total gastrectomy / 대한혈액학회지

No abstract available.