Clinical Effects of Non-damaging Retinal Laser Therapy in Chronic Central Serous Chorioretinopathy

Purpose@#This study analyzed the effects of non-damaging retinal laser therapy (NRT) in patients with chronic central serous chorioretinopathy. @*Methods@#A retrospective study was conducted on patients with chronic central serous chorioretinopathy who were undergoing follow-up with NRT from November 2016 to February 2018. NRT was performed in patients who underwent intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection at least two times with no improvement in visual acuity and a reduced amount of subretinal fluid. Before and after treatment, logMAR best-corrected visual acuity (BCVA) evaluation and subretinal fluid (SRF) according to thickness measurements of the macula determined from optical coherence tomography imagery were performed over a period of at least 6 months. @*Results@#Eighteen eyes of 18 patients (11 male and 7 female) with chronic central serous retinopathy were treated with NRT. The mean age of patients was 54.6 ± 13.19 years old and the mean duration of follow-up was 9.75 ± 3.20 months. The central macular thickness decreased from 375 to 246 nm (p < 0.001) and BCVA improved from 0.48 to 0.40 (p = 0.028). SRF completely resolved in 55.56% of the patients after NRT. @*Conclusions@#In patients with chronic central serous chorioretinopathy, which did not improve even after intravitreal anti-VEGF injection, NRT is a relatively safe and effective treatment.

Using Computed Tomography: Predictive Factors for Recovery Time in Patients with Orbital Fracture with Diplopia

PURPOSE: To identify predictive factors for recovery time in patients with orbital fracture with diplopia through analysis of preoperative and postoperative computed tomography (CT) images and postoperative recovery time. METHODS: We retrospectively analyzed CT findings-preoperative: fracture size, type of fracture, fracture site, extraocular muscle (EOM) swelling, EOM and soft tissue injury, and the amount of soft tissue herniation; post-operative: degree of enophthalmos, and diplopia recovery period in 379 patients who underwent surgical treatment for orbital fracture between March 2006 and December 2015. RESULTS: The average postoperative follow-up period was 556.2 ± 59.5 days, and the mean duration of recovery was 23.9 ± 42.5 (range, 3–186) days. The recovery time of diplopia was significantly increased with the following preoperative CT findings: fracture size (small and medium < large) (p = 0.049), type of fracture (linear < hinge < comminuted, trap-door) (p < 0.01), fracture site (inferior < medial and both) (p < 0.01), EOM and soft tissue injury (prolapse and torsion, muscle entrapment, kinked muscle) (p < 0.01), and the amount of soft tissue herniation (small and medium < large) (p < 0.001). The mechanism of injury, sex, age, and the degree of enophthalmos were not related to the length of the diplopia recovery period. CONCLUSIONS: The length of diplopia recovery could be predicted by CT findings.

Investigation of the Changes in Refractive Surgery Trends in Korea

PURPOSE: To evaluate changes in clinical practice in the field of refractive surgery in Korea over the past 10 years. METHODS: A survey consisting of 59 multiple-choice questions regarding the preferred types of refractive surgery, excimer laser machine, and presbyopia surgery was mailed to 742 members of the Korean Society of Cataract and Refractive Surgery in January 2016, and 50 members responded to the survey. These data were compared with the 2005 or 2007 survey results.

Long-term Surgical Outcomes of Initial Postoperative Overcorrection in Adults with Intermittent Exotropia

PURPOSE: To evaluate the relationship between initial postoperative overcorrection and long-term surgical success in exotropia patients. METHODS: The medical records of 46 patients who underwent surgery for intermittent exotropia after the age of 18 were enrolled. Enrolled patients also had at least 2 years of postoperative follow-up. Based on the initial postoperative deviation at distance measured by prism and the alternating cover test at 1 week, patients were assigned to one of the following groups: group A included patients who demonstrated any esodeviation, while group B included patients who showed orthophoria to exodeviation of 10 prism diopters. The records were analyzed to determine the preoperative deviation with stereoacuity and postoperative deviations with stereoacuity at the follow-up examinations at the following intervals: 1 week; 1, 3, and 6 months; and 1 and 2 years. A comparison between groups for demographic data and preoperative and postoperative angles of deviation was performed using analysis of variance. RESULTS: Of the 46 patients with intermittent exotropia included in this study, 18 (39%) belonged to group A, while 28 (73%) belonged to group B. The postoperative angle of deviation for distant fixation until 2 years of follow-up showed statistically significant differences in each group (p < 0.003 in all comparisons). The amount of exodrift until 2 years in group A (from −9.7 ± 6.1 to 1.6 ± 3.7) was greater than that in group B (from 2.0 ± 2.7 to 6.8 ± 5.6). The long-term surgical success rate within 2 years of surgery was significantly better in group A than in group B (p = 0.027). The number of patients with intermittent diplopia and the duration of diplopia were greater in group A (n = 8) than in group B (n = 2). CONCLUSIONS: Long-term surgical success was achieved in 89% of patients who were initially overcorrected. Overcorrection of an average of 10 prism diopters at the first postoperative week was found to be associated with a more favorable long-term surgical outcome.

Thermal Ocular Surface Injury from Cooking Oil: Delayed Onset Transient Corneal Infiltration and Myopic Shift

No abstract available.

Development of Movement Analysis Program and Its Feasibility Test in Streotactic Body Radiation Threrapy / 의학물리

Respiratory gated radiation therapy and stereotactic body radiation therapy require identical tumor motions during each treatment with the motion detected in treatment planning CT. Therefore, this study developed a tumor motion monitoring and analysis system during the treatments employing RPM data, gated setup OBI images and a data analysis software. A respiratory training and guiding program which improves the regularity of breathing was used to patients. The breathing signal was obtained by RPM and the recorded data in the 4D console was read after treatment. The setup OBI images obtained gated at 0% and 50% of breathing phases were used to detect the tumor motion range in crenio-caudal direction. By matching the RPM data recorded at the OBI imaging time, a factor which converts the RPM motion to the tumor motion was computed. RPM data was entered to the institute developed data analysis software and the maximum, minimum, average of the breathing motion as well as the standard deviation of motion amplitude and period was computed. The computed result is exported in an excel file. The conversion factor was applied to the analyzed data to estimate the tumor motion. The accuracy of the developed method was tested by using a moving phantom, and the efficacy was evaluated for 10 stereotactic body radiation therapy patients. For the sine wave motion of the phantom with 4 sec of period and 2 cm of peak-to-peak amplitude, the measurement was slightly larger (4.052 sec) and the amplitude was smaller (1.952 cm). For patient treatment, one patient was evaluated not to qualified to SBRT due to the usability of the breathing, and in one patient case, the treatment was changed to respiratory gated treatment due the larger motion range of the tumor than treatment planed motion. The developed method and data analysis program was useful to estimate the tumor motion during treatment.

Evaluation of the Positional Uncertainty of a Liver Tumor using 4-Dimensional Computed Tomography and Gated Orthogonal Kilovolt Setup Images / 대한방사선종양학회지

PURPOSE: In order to evaluate the positional uncertainty of internal organs during radiation therapy for treatment of liver cancer, we measured differences in inter- and intra-fractional variation of the tumor position and tidal amplitude using 4-dimentional computed radiograph (DCT) images and gated orthogonal setup kilovolt (KV) images taken on every treatment using the on board imaging (OBI) and real time position management (RPM) system. MATERIALS AND METHODS: Twenty consecutive patients who underwent 3-dimensional (3D) conformal radiation therapy for treatment of liver cancer participated in this study. All patients received a 4DCT simulation with an RT16 scanner and an RPM system. Lipiodol, which was updated near the target volume after transarterial chemoembolization or diaphragm was chosen as a surrogate for the evaluation of the position difference of internal organs. Two reference orthogonal (anterior and lateral) digital reconstructed radiograph (DRR) images were generated using CT image sets of 0% and 50% into the respiratory phases. The maximum tidal amplitude of the surrogate was measured from 3D conformal treatment planning. After setting the patient up with laser markings on the skin, orthogonal gated setup images at 50% into the respiratory phase were acquired at each treatment session with OBI and registered on reference DRR images by setting each beam center. Online inter-fractional variation was determined with the surrogate. After adjusting the patient setup error, orthogonal setup images at 0% and 50% into the respiratory phases were obtained and tidal amplitude of the surrogate was measured. Measured tidal amplitude was compared with data from 4DCT. For evaluation of intra-fractional variation, an orthogonal gated setup image at 50% into the respiratory phase was promptly acquired after treatment and compared with the same image taken just before treatment. In addition, a statistical analysis for the quantitative evaluation was performed. RESULTS: Medians of inter-fractional variation for twenty patients were 0.00 cm (range, -0.50 to 0.90 cm), 0.00 cm (range, -2.40 to 1.60 cm), and 0.00 cm (range, -1.10 to 0.50 cm) in the X (transaxial), Y (superior-inferior), and Z (anterior-posterior) directions, respectively. Significant inter-fractional variations over 0.5 cm were observed in four patients. Min addition, the median tidal amplitude differences between 4DCTs and the gated orthogonal setup images were -0.05 cm (range, -0.83 to 0.60 cm), -0.15 cm (range, -2.58 to 1.18 cm), and -0.02 cm (range, -1.37 to 0.59 cm) in the X, Y, and Z directions, respectively. Large differences of over 1 cm were detected in 3 patients in the Y direction, while differences of more than 0.5 but less than 1 cm were observed in 5 patients in Y and Z directions. Median intra-fractional variation was 0.00 cm (range, -0.30 to 0.40 cm), -0.03 cm (range, -1.14 to 0.50 cm), 0.05 cm (range, -0.30 to 0.50 cm) in the X, Y, and Z directions, respectively. Significant intra-fractional variation of over 1 cm was observed in 2 patients in Y direction. CONCLUSION: Gated setup images provided a clear image quality for the detection of organ motion without a motion artifact. Significant intra- and inter-fractional variation and tidal amplitude differences between 4DCT and gated setup images were detected in some patients during the radiation treatment period, and therefore, should be considered when setting up the target margin. Monitoring of positional uncertainty and its adaptive feedback system can enhance the accuracy of treatments.

Treatment of Neglected Monteggia Fracture-Dislocation in Children / 대한정형외과학회잡지

PURPOSE: Our purpose is to evaluate the results of the operative treatment in neglected Monteggia fracture-dislocation in children. MATERIALS AND METHODS: We retrospectively analyzed 10 elbows in 10 patients who underwent surgery. All patients were classified as Bado type I, except one with type III. The mean duration of follow up was 2 years and 5 months. The mean age at the time of operation was 10 years and the mean time from injury to operation was 7 months. All 10 patients underwent open reduction of the radial head and reconstruction of annular ligament. Ulnar osteotomy was performed in 9 cases. Clinical assessment was done by Bruce et al.'s rating system. RESULTS: All 10 patients gained a mean of 35degrees of extension-flexion arc, however lost a mean of 29degrees of pronation-supination arc. And there were three complications, including dislocation of radial head in two patients and breakage of transarticular K-wire in one patient. According to Bruce et al.'s rating system, there were 4 excellent, 1 good, 3 fair, and 2 poor results. CONCLUSION: We found that the effect of the operative treatment of neglected Monteggia fracturedislocation in children was limited in majority of the patients. Particularly, the loss of pronation-supination arc was noticed postoperatively in most patients.

Mid to Long Term Evaluation of Elmslie-Trillat-Marquet procedure for Recurrent Patellar Subluxation or Dislocation

PURPOSE: To evaluate mid to long term results of Elmslie-Trillat-Marquet procedures for recurrent patellar subluxation or dislocation. MATERIALS AND METHODS: From May 1993 to February 2004, 21 knees in 20 patients who got Elmslie-Trillat-Marquet procedures were evaluated. Mean follow-up periods were 80.5 months. Clinical tests such as Lysholm knee scoring scale, IKDC subjective knee evaluation form, visual analog scale and radiological tests such as Insall-Salvati index and congruence angle were evaluated. RESULTS: Lysholm knee score was improved to average 91 points, IKDC knee score 82, visual analog scale 28. Q angle was improved from average 28degrees preoperatively to 12.5degrees. Insall-Salvati index and congruence angle were significantly corrected and no subluxation or dislocation were observed at final follow up. Fracture of tibial tubercle in 1 case which was treated with refixation and medial instability in 3 cases were observed. CONCLUSION: Elmslie-Trillat-Marquet procedure can be a useful method to correct patellofemoral malalignment in long term follow up but meticulous care to reduce the complication was needed.

Correlation between Progression of Compression and Bone Densiometry Index in Osteoporotic Compression Fracture of Thoracolumbar Spine

PURPOSE: To evaluate whether progression of compression correlates with bone densiometry index in patients who were treated conservatively for osteoporotic compression fracture of thoracolumbar spine. MATERIALS AND METHODS: Using the results of bone densiometry, 30 patients who were treated conservatively for osteoporotic compression fracture of thoracolumbar spine between March 2002 to March 2005 were categorized into 4 groups; above 80%, 70 to 80%, 60 to 70%, and below 60%. We compared the measurements of sagittal index and anterior vertebral height from the plain radiographs taken at the time of injury and following three consecutive months after the injury. RESULTS: Patients with lower bone densiometry index had greater amount of compression at the time of injury and more rapid progression of compression. We also found that progression of compression was lowest during the first month after injury in all groups. CONCLUSION: Patients with low bone densiometry index in osteoporotic thoracolumbar compression fracture are susceptible to more rapid progression of compression and should have early brace application and longer duration of treatment for osteoporosis.

Nonoperative Treatment of Isolated Lateral Malleolar Fracture

PURPOSE: To evaluate the results of conservative treatment for isolated lateral malleolus fracture without medial ankle injury. MATERIALS AND METHODS: From March 1999 to February 2003, 25 ankles in 25 patients were treated for isolated lateral malleolus fracture and followed for more than one year. Mean age was 46.9 years (range, 20~71 years). Cases without any swelling or tenderness on the deltoid area, or cases with minimal pain, swelling or tenderness on the deltoid area and medial clear space 1 mm or less on stress radiograph were included for the study. Immediate weight bearing was allowed with below-knee cast immobilization in all cases. RESULTS: All were supinatin-external rotation stage II injury and mean duration of cast immobilization was 6.3+/-1.6 weeks after injury. There was no case which showed widening of medial clear space during routine radiographic follow-up. There was no change in the degree of displacement in spite of immediate weight bearing with short leg cast on. CONCLUSION: Because the lateral malleolus fracture without medial injury can be managed nonoperatively, we need to differentiate this type of fracture to avoid unnecessary surgery, and for early return to normal daily activity.

Clinical Outcome and ECG Change in Patients with Acute Myocardial Infarction and Prodromal Angina

BACKGROUND AND OBJECTIVES: Ischemic preconditioning reduces the size of myocardial infarct in animal models, however its role in humans remains unclear. Clinical data suggests that episodes of angina immediately before acute myocardial infarction may be associated with a protective effect on the human myocardium. We performed an analysis on the effect of prodromal angina on infarct size, in-hospital outcome and newly developed Q-wave in patients with acute myocardial infarction. SUBJECTS AND METHODS: 65 patients who had received thrombolytic therapy were enrolled in the study. Eleven patients (17%) had experienced previous angina within 24 hours prior to acute myocardial infarction (group I), and the remaining 54 patients (83%) did not have a history of previous angina (group II). Killip class, cardiac enzyme, ECG findings, echocardiographic data and in-hospital outcomes were compared between the two groups. RESULTS: Group I tended to have lower peak creatine kinase (CK) and CK-MB levels, although the difference between the two groups in regards to the level of cardiac enzyme was statistically insignificant. Despite similar patient characteristics, Group I showed a lower incidence of heart failure during hospitalization than group II. 6/11 patients (55%) in group I and 47/54 (87%) in group II had a Q-wave at discharge ECG. Group I showed better left ventricular systolic function during admission. None of the DM patients (14 patients) had prodromal angina and 13 of 14 patients (93%) demonstrated Q-wave infarction. CONCLUSION: Prodromal angina prior to acute myocardial infarction as a marker of ischemic preconditioning may also confer beneficial effects in terms of in-hospital outcomes. Further studies concerning the long term outcomes of such cases are needed.

A Case of Ischemic Colitis Associated with Colonic Carcinoma / 대한소화기내시경학회지

The rare association of obstructing colorectal carcinoma and ischemic colitis in patients without an antecedent history of inflammatory bowel disease has been documented intermittently since the early 1960s after first case was described by Kremen in 1945. The etiology is not clear, but it is thought that sluggish mucosal blood flow and consequent ischemia occurs secondary to raised intraluminal pressure distally. The radiologic features are typically 'thumbprinting' appearence by the barium study, but maybe variable according to the stage of ischemic colitis. In many cases, radiologic features may be similar inflammatory bowel disease such as ulcerative colitis and may mask the presence of the predisposing carcinoma. Sigmoidoscopy or colonoscopy may detect irregular ulceration, mucosal friability, submucosal hemorrhage and bulging folds. The mucosa is usually covered by hemorrhagic and purulent exudate. We report a case of the ischemic colitis associated with sigmoid colon adenocarcinoma in 75-year- old man.

The Etiological Role of Legionella Pneumophila in Patients with Community-Acquired Pneumonia in Korea / 결핵

BACKGROUND: Legionella pneumophila has been recognized as an important cause of community-acquired pneumonia(CAP) requiring hospitalization. However, epidemiological data on the occurrence of legionella-related pneumonia is unavailable in Korea. The purpose of this study was to evaluated the etiological imprtance of legionella pneumophila serogroup 1 in patients hospitalized with CAP. METHOD: The CAP patient over 16 year-old were recruited from July 1999 to June 2000 at the Chunchon Sacred Heart Hospital. Fifty four patients (male 29, female 25, average age 63.8±15.3) were included in this study. A diagnosis of a legionella pneumophila infection was based on a urinary antigen test using the Binax Company enzyme immunoassay. The severity of pneumonia was assessed using the Fine's PORT scoring system. RESULT: The average Fine's PORT score was 99.7(±44.9). According to the risk classification proposed by the Infectious Disease Society of America, the number of patients in each class(from class I to class V) were 6(11.1%), 13(24.1%), 9(16.7%), 14(25.8%), and 12(22.2%), respectively. Thirty two patients(59.3%) were initially admitted to the intensive care unit. The mortality rate was 16.7%(9 in 54). In all patients, urinary antigens to Legionella pneumophila serogroup 1 were not detected. CONCLUSION: Legionella pneumophila may play little role in causing adult CAP in Korea. Therefore, the routine use of macrolide in the empirical treatment of the CAP patients based upon the ATS guidelines(1993) in Korea should be reevaluated.

A case of disseminated intravascular coagulation after tooth extraction in abdominal aortic aneurysm / 대한내과학회지

Disseminated intravascular coagulation (DIC) is the result of a severe underlying disorder that initiates massive activation of the coagulation system. We report an unusual case of 79-year-old man who developed DIC after tooth extraction in abdominal aortic aneurysm. He was referred to our hospital because of persistent bleeding after tooth extraction. Physical examination indicated a pulsating mass in abdomen. Abdominal computerized tomography (CT) scan revealed 70 mm diameter aneurysm of the abdominal aorta, extending from the renal infrahilar level to the common iliac artery, and his coagulation profile showed the features of DIC by revealing thrombocytopenia, hypofibrinogenemia, and increased level of fibrinogen degradation product (FDP). After he had received blood component therapy including fresh frozen plasma and continuous intravenous heparin infusion (4,800 U/day), the bleeding diathesis and coagulopathy improved. He refused to have definitive surgery for the aneurysm.

Effect of Antiliyolytic Agents on Glueose Metabolism in Thyrotoxic Patients / 대한내분비학회지

Decreased glucose tolerance is often found in patients with thyrotoxicosis but the pathogenetic mechanisms are poorly understood. Since the concentrations of free fatty acid are usually elevated due to increased lipolysis in thyrotoxicosis, the preferential oxidation of the free fatty acids may explain the decreased glucose tolerance in hyperthyroidism. The aim of this study was to investigate whether lowering plasma free fatty acid(FFA) by acipimox, a long-acting antilipolytic agent, could affect glucose metabolism in thyrotoxicosis. We performed intravenous glucose tolerance test with acipimox or placebo in 6 untreated thyrotoxicmen and 6 age-and body mass index(BMI)-matched controls. The following results were obtained.1) The basal plasma FFA concentration in thyrotoxic patients were significantly higher than those in controls(997.0+-303.4 uEq/L vs. 290.5+-169.1 uEq/L; p<0.01). 2) Plasma FFA concentrations decreased rapidly with acipimox ingestion in both controls and thyrotoxic patients.3) Plasma glucose concentrations were significantly lower with acipimox ingestion than with placebo in thyrotoxic patients from 17min after intravenous glucose load and to the end of the study.4) Plasma insulin concentrations in thyrotoxic patients with acipimox ingestion were higher at 5, 7 min after iv glucose load.5) In thyrotoxic patients, glucose disappearance rate(K_glucose) in acipimox treatment was significantly higher than that in placebo treatment(2.44+-0.84 vs. 1.58+-0.37;p<0.05). 6) K_glucose values were inversely correlated with basal FFA concentrations(r=-0.58, p<0.05). In summary, in thyrotoxic patients with elevated plasma FFA levels, acipimox lowered plasma FFA, which in turn improved glucose tolerance.

Cell density dependence of growth characteristics of rat thyroid cells(FRTL-5) stimulated by TSH and IGF-I / 대한내분비학회지

No abstract available.

A case of tuberous sclerosis with pulmonary involvement / 결핵

No abstract available.

The prevalence of intestinal helminthes in inhabitants of Cheju Do

The authors examined 3,169 fecal specimens from inhabitants of seven localities such as City, Eups and Myons in Cheju Do on July 1970 with cellophane thick smear technique. The results were analysed and summarized as follows: The overall egg positive rate of helminths was 82.2% and it was attributed to high rates of soil-transmitted helminths as in case of other parts in Korea. The infection rates of each species were; A. lumbricoides 44.3%, T. trichiurus 65.6%, hookworm 1.5%, T. orientalis 0.8%, C. sinensis 0.2%, P. westermani 0.4%, M. yokogawai 0.9%, Taenia sp. 12.7% and H. nana 1.4%. The infection rates of soil-transmitted helminths were relatively lower than those of mainland Korea especially in case of hookworm and T. orientalis. The proportion of unfertilized ova passers among the Ascaris infected case was 22.1%. The ova of heterophyids, most probably Metagonimus yokogawai were detected in lower percentage but discovered throughout the localities surveyed and in all age groups. It is certainly presumed that Metagonimus infection is autochthonous. The most interesting results were obtained in Taenia sp. infection and the higher rates were shown in rural area than in urbanized areas. The positive rates were within 5% in childhood and adolescence but abruptly increased up to 36.4 % in adults.

Santonin-kainic acid complex as a mass chemotherapeutic of Ascaris lumbricoides control in Korea

Santonin-kainic acid complex was evaluated as a chemotherapeutic of the mass treatment of the Ascaris lumbricoides infection in Korea. The results could be summarized as follows: The negative conversion rate was 82.9% in average in 4 treated groups. Some variations of negative conversion rate among the treated groups were noticed. The egg reduciton rate was 97.7% in average and the results were rather uniform among the three evaluated groups. By the analysis of egg reduction, it seems that the lightly infected cases whose E.P.G. were under 5,000 were resistant to treatment with the less reduced egg output. After the treatment with this complex, the number of egg discharged cases were reduced to 1.84% and the average number of discharge eggs per incompletely treated or untreated cases were reduced to 12.5% compared with the level of before-treatment egg output. The successive observations of the pattern of worm expulsion after drug intake was made. The worms were mostly expelled in the stool within 3 days, and 58.9% of total expelled worms were collected within 24-hour stool. The minimum length of the immature worms expelled was 7.6cm. Among the 659 Ascaris collected in the first-day stool from 91 rural people, 8.5% were in the range of 7.6-12.2 cm-long, immature worms. The sex ratio, male: female= 0.69: 1.