A Comparison between Intravitreal Bevacizumab Injection and Placement of a Dexamethasone Implant to Treat Retinal Vein Occlusion Macular Edema

Purpose@#We evaluated the macular, functional and structural features of patients with retinal vein occlusion and macular edema. We measured the best-corrected visual acuity (BCVA), central foveal thickness, and the area of the foveal avascular zone area after intravitreal bevacizumab (IVB) treatment and placement of a dexamethasone implant (IVD). @*Methods@#We retrospectively reviewed 36 eyes of 36 patients with retinal vein occlusion and macular edema who underwent IVB treatment (20 eyes) and IVD placement (16 eyes). The parameters mentioned above were compared between the two treatment groups and the normal contralateral eyes after initial stabilization and 1 year later. @*Results@#The BCVA was significantly higher in the IVB than the IVD group after initial stabilization and 1 year later. The intraocular pressure was lower at initial stabilization in the IVB than the IVD group, but no difference was apparent after 1 year. There was no significant between-group difference in the central foveal thickness at any time, but the IVD group required fewer injections during initial stabilization than the IVB group. In terms of the foveal avascular zone area, both the superficial and deep layers of the IVB group increased significantly during the initial stabilization period and then decreased to 1 year; no changes were seen in the IVD group. @*Conclusions@#IVD treatment is associated with fewer injections than IVB treatment and a more stable retinal vasculature, but visual acuity may possibly decrease (because of cataract formation). Although IVB treatment improves visual acuity and reduces macular edema, this may be associated with an increased risk of macular ischemia given the need for repeated injections.

Association of isolated single umbilical artery with perinatal outcomes: Systemic review and meta-analysis

OBJECTIVE: The aim of this study was to evaluate the association between prenatally diagnosed isolated single umbilical artery (iSUA) and perinatal outcomes. METHODS: We searched Medline, Embase, the Cochrane Library, and KoreaMed from inception to January 2016, with no language or regional restrictions, for cohort and case-control studies reporting on the relationship of iSUA and perinatal outcomes. We assessed the odds ratios (ORs) and 95% confidence intervals (CIs) for the occurrence of small for gestational age, preterm birth, pregnancy-induced hypertension, neonatal intensive care unit admission, and perinatal mortality in fetuses with iSUA compared with those in fetuses with three vessel cord. RESULTS: Eleven articles totaling 1,731 pregnancies with iSUA met the selection criteria. Studies varied in design, quality, outcome definition, and results. Meta-analysis carried out within predefined groups showed that the presence of an iSUA was associated with small for gestational age (OR, 2.75; 95% CI, 1.97 to 3.83; P<0.00001), preterm birth (OR, 2.10; 95% CI, 1.72 to 2.57; P<0.00001), pregnancy-induced hypertension (OR, 1.62; 95% CI, 1.00 to 2.63; P=0.05), neonatal intensive care unit admission (OR, 2.06; 95% CI, 1.33 to 3.19; P=0.001), and perinatal mortality (OR, 2.29; 95% CI, 1.32 to 3.98; P=0.003). CONCLUSION: Pregnancies complicated by iSUA are at increased risk for small for gestational age, preterm birth, pregnancy-induced hypertension, neonatal intensive care unit admission and perinatal mortality. Further, large prospective cohort studies are required to improve the quality of prenatal counseling and the neonatal care for pregnancies with iSUA.

Indications for an Immediate Laparotomy in Patients with Abdominal Stab Wounds

PURPOSE: There is little controversy that a classic indication such as hemodynamic instability or any sign of peritoneal irritation requires an immediate laparotomy in the management of abdominal stab wounds. However, omental herniation or bowel evisceration as an indication for an immediate laparotomy is controversial. The purpose of this study was to evaluate the significance of these factors as indications for an immediate laparotomy. METHODS: The medical records of 98 consecutive abdominal stab wounds patients admitted to the Emergency Center of Masan Samsung Hospital from January 2000 to December 2006 were carefully examined retrospectively. Using multivariate logistic regression analysis, thirty-nine factors, including the classic indication and intraabdominal organ evisceration, were evaluated and were found to be associated with a need for a laparotomy. Also, the classic indication was compared with a new indication consisting of components of the classic indication and intra-abdominal organ evisceration by constructing a contingency table according to the need for a laparotomy. RESULTS: Multivariate logistic regression analysis revealed any sign of peritoneal irritation, base deficit, and age to be significant factors associated with the need for a laparotomy (p<0.05). The sensitivity, specificity, and accuracy rates of the classic indication were 98.6%, 72.0%, and 91.8%, respectively, and those of the new indication were 93.2%, 84.0%, and 90.8%, respectively. The differences in those rates between the above two indications were not significant. CONCLUSION: Intra-abdominal organ evisceration was not a significant factor for an immediate laparotomy. Moreover, the new indication including intra-abdominal organ evisceration was not superior to the classic indication. Therefore, in the management of abdominal stab wounds, the authors suggest that an immediate laparotomy should be performed on patients with hemodynamic instability or with any sign of peritoneal irritation.

Subcapital Stress Fracture of the Femur after Internal Fixation of Intertrochanteric Fracture: A case report / 대한정형외과학회잡지

Fracture of the femoral neck occurred after internal fixation of intertrochanteric fracture of the femur is very rare and have been described previously in terms of stress fracture, stress-riser fracture, Youngs modulus fracture or iatrogenic fracture in the literature. This fracture documented about 20 cases in the English literature and usually occurred in elderly patients with osteoporosis and it always occur in the subcapital region. We report a case of subcapital stress fracture of the femur occurred after internal fixation with compression hip screw of intertrochanteric femur fracture.

Limited Two Incision Technique in Carpal Tunnel Release / 대한정형외과학회잡지

Open carpal tunnel release surgery has heen the gold standard method of treatment for who did not respond to conservative treatment and whose neurologic symptoms were progressive. However, open carpal tunnel release using a standard incision frequently associated with delayed return of hand function, residual scar tenderness and pillar pain. So, two new alternative methods such as endoscopic carpal tunnel release and limited incision technique have developed. To define the role of the limited two incision technique, we anaiyzed the postoperative functional results of 40 cases in 33 patients. The patients were divided in two groups. Group A was standard incision group (23 cases in 19 patients) and Group B was limited two incision group (l7 cases in 14 patients). The postoperative functional results were analyzed statistically using chi-square test at postoperative 3, 6, 9 and l2 weeks. There were no significant differences in reliet of numbness and paresthesias in both groups. There was a statistically significant difference in relief of scar tenderness and pillar pain at postoperative 3 and 6 weeks in Group B. There was no significant complication in both groups. We can conclude that the limited two incision technique of carpal tunnel release is a safe procedure which allows rapid return of hand functions with reduced incidence of scar tenderness in the early postoperative stages.