Comparative Analysis of Clinical Outcome in Penetrating Keratoplasty Using Domestic or Imported Cornea

PURPOSE: To compare the survival of corneal grafts and the changes in endothelial cell density in penetrating keratoplasty using domestic or imported corneas. METHODS: Medical records of 236 eyes of 211 patients who underwent penetrating keratoplasty from November 2004 to August 2011 in Seoul National University Hospital and were followedup at least 1 year were retrospectively reviewed. After excluding the patients who received the combined surgeries with other surgeries except cataract surgery, the eyes were divided into 2 groups depending on the origin of donor tissue resulting in a domestic cornea group (108 eyes) and an imported cornea group (128 eyes). Recipient demographics, preoperative diagnosis, donor age, death-to-preservation time, death-to-operation time and pre-and postoperative visual acuities were compared between the 2 groups. Kaplan-Meier survival and changes in endothelial cell density were analyzed at 3, 6 and 12 months and then every year. RESULTS: The most common preoperative diagnoses were regraft and corneal opacity in the domestic and imported cornea groups, respectively, without statistical difference. Death-to-preservation time was 8.9 hours and 8.0 hours in the domestic and imported cornea groups, respectively, without statistical difference. However, death-to-operation time was longer in the imported cornea group (4.98 days) than in the domestic cornea group (2.18 days). There were no differences in pre- and postoperative visual acuities, decrease in annual changes in endothelial densities and survival up to 3 years between the 2 groups. In addition, the survival and decreased annual changes in endothelial densities were not different from each other in penetrating keratoplasty combined with cataract surgery or in penetrating keratoplasty for a corneal edema. CONCLUSIONS: Our study results suggest that clinical outcomes of the penetrating keratoplasty using imported corneas are comparable in efficacy when compared with the clinical outcomes using domestic corneas.

Infection Status of Endoparasites in Foreigner Workers Living in Cheonan City, Chungnam Province, Korea

At present, more than 500,000 foreigner workers, most of them from Asian countries with high parasitic infection rates, are working in Korea. Since investigation into the prevalence of parasitic infections in foreigner workers has not yet been conducted in Korea, the present study was performed to determine the parasitic infection status of foreigner workers living in Cheonan City, Chungcheongnam-do (Chungnam Province) and to plan, on that basis, effective control measures. From October to December 2013, the parasitic infection status of 231 foreigner workers employed at selected Cheonan-si small businesses was investigated by both stool examination and ELISA. A total of 60 individuals (26.0%) were found to be infected with parasites. The stool examination detected 14 positive cases (6.1%), and ELISA revealed 50 positive people (21.6%), for at least a kind of parasitic disease. The most common infection was cysticercosis (8.7%), followed by toxocariasis (7.8%) and clonorchiasis (7.4%). Since it was proved that parasitic infections were prevalent among foreigner workers living in Cheonan City, more comprehensive study is urgently needed in order to understand the nationwide status of parasitic infections in foreigner workers.

A Case of a Removal of Pyloric Stent That Was Partially Embeded in the Mucosa after Temporary Stenting for the Benign Pyloric Stenosis and It Was Removed Using Argon Plasma Coagulation / 대한소화기내시경학회지

Generally, self expandable metallic stents (SEMSs) are widely used for the treatment of malignant gastrointestinal stenosis due to their effectiveness and low complication rate. On the contraty, balloon dilatation or Bougie dilatation is commonly used for treating benign gastrointestinal stenosis as non-invasive methods. However, their such complications such as recurrence, hemorrhage and perforation are problematic when these dilation techniques are used. Temporary placement of a SEMS in a benign gastric outlet obstruction is expected to be a promising therapeutic modality despite of several major complications such as migration. Rarely, stent removal can, on rare occasions, be difficult or cause bleeding or perforation when the stent is embeded in the mucosa due to mucosal hyperplasia at the tips of the stent. We report here on a case of a stent, partially embeded in the mucosa after temporary stenting for treating a benign pyloric stenosis, which was successfully removed using argon plasma coagulation.

A Case of Endoscopic Stenting for Anastomotic Leakage after Total Gastrectomy / 대한소화기내시경학회지

Anastomotic leakage after gastrectomy has significant morbidity and mortality, and the mortality rate has been reported to be over 60%. There have been very few reports concerning endoscopic stenting for the management of anastomotic leakage. Successful treatment of anastomotic leakage with covered self-expanding metallic stents (stent) has recently been reported. A 62-year-old man with melena was diagnosed with advanced gastric cancer and he underwent total gastrectomy. At the 3rd day after surgery, anastomotic leakage was found by an upper gastrointestinal series (UGI). He underwent laparoscopic primary repair on the 5th day after surgery. The leakage resumed thereafter. At the 12th day after the primary repair, the leakage was successfully managed by stent insertion and the patient improved thereafter. At the 11th week after stent insertion, the stent was removed without complications and the leakage was completely closed. At 1 year after stent removal, no stricture has been found on the anastomosis site. We report here on a case of anastomotic leakage after gastrectomy, and this was completely managed by stent insertion.

A Case of Small Bowel Bleeding Treated by Single Balloon Enteroscopy in a Patient on Maintenance Hemodialysis / 대한신장학회지

Anemia is a common complication of hemodialysis. It reduces the quality of life and is recognized as adverse risk factor. The cause of anemia in CKD (chronic kidney disease) include lack of erythropoietin, gastrointestinal (GI) bleeding, hypothyroidism, hidden infection, and blood loss in hemodialysis. GI bleeding is not unusual complication in patient on maintenance hemodialysis, caused by uremia, medicine (NSAIDS, antiplatelet agents, anticoagulants), angiodysplasia, and ulcer. In CKD patients, GI bleeding is found in various sites over the whole bowel. Small bowel bleeding is one of the most common causes of obscure GI bleeding and constitutes 2-10% of all GI bleeding. Regarding the small bowel bleeding, diagnosis and treatment are much improved recently with the help of wireless capsule endoscopy and double or single balloon enteroscopy. We report a case of GI bleeding due to erosion of small bowel, which was diagnosed and treated with the single-balloon enteroscopy in patients on maintenance hemodialysis.

A Case of Foreign Body Induced Esophageal Perforation Repaired by Endoscopic Clipping / 대한소화기내시경학회지

An esophageal perforation is a potentially life threatening condition with a high mortality rate. Although primary surgical repair is the mainstay of treatment, non-surgical management can be attempted in selected patients. The successful endoscopic closure of an esophageal perforation with metallic clips was recently reported. We report a case of an esophageal perforation caused by a dog bone and mediastinitis treated by non-surgical management consisting of parenteral nutrition, antibiotics therapy and endoscopic clipping.

Transcaruncular Approach to Blowout Fractures of the Medial Orbital Wall

Transcutaneous and transconjunctival approaches are still frequently used to repair orbital wall fractures. However, medial orbital wall fracture remains a challenging area for plastic surgeons due to technical difficulties and postoperative scars. The transcaruncular approach is described and we present our experience with this approach to access the medial orbital wall in 10 patients with blowout fracture in the medial orbital region. All patients were corrected satisfactorily without cutaneous scar. The transcaruncular approach is a useful technique to repair medial orbital wall fractures.

Drug-induced Extraocular Myotoxicity Associated with Diplopia after Cataract Surgery

PURPOSE: To assess the myotoxicity of local anesthetics and antibiotics which are considered as the main causes of diplopia and extraocular motility disturbance following cataract surgery. METHODS: A total of 48 rabbits were classified into 4 groups. The control group received an injection of 0.3 ml normal saline in the subconjunctival space above the superior rectus muscle. The first experimental group received an injection of the same amount of a local anesthetic (2% lidocaine) in the same manner as the control group. The second group received an injection of 0.3 ml of a local anesthetic directly into the extraocular muscle (superior rectus muscle), the third group received an injection of 0.3 ml of an antibiotic (gentamicin) in the subconjunctival space above the superior rectus muscle. Histologic and electron microscopic changes following injections were compared over time in each group. RESULTS: Light microscopic findings showed that subconjunctival injections of antibiotics caused the most severe inflammatory and fibrotic reactions of the muscular fascicle, whereas subconjunctival injections of local anesthetics led to the least damage of the muscular fascicle and less infiltration of inflammatory cells. Changes in histological findings showed that necrotic muscle fibers and inflammatory cell infiltration at 1 week following injections. Basophilic myogenous satellite cells indicating regeneration of the damaged muscles appeared thereafter. At 2 and 4 weeks, the group injected with antibiotic showed local and consistent infiltration of inflammatory cells and fibrosis, whereas the groups injected with anesthetics showed regeneration of most of the damaged fascicle. CONCLUSIONS: In terms of temporary or permanent diplopia following an injection of local anesthetics or antibiotics after cataract surgery, toxicity of anesthetics or antibiotics on extraocular muscle is the main cause from these Results.

The Clinical Characteristics of Dissociated Vertical Deviation Combined with Exotropia

PURPOSE: The clinical characteristics and post-operative prognosis of dissociated vertical deviation (DVD) combined with exotropia was evaluated. METHOD & MATERIALS: The clinical appearance such as the frequency of DVD, vision, amount of deviation, stereoacuity, sensory abnormality, the presence of latent nystagmus, head tilting and operation results were evaluated in patients who were diagnosed with comitant exotropia followed by surgical correction with 3 month follow-up. RESULTS: Eight (16.0%) patients had exotropia combined with DVD, the combined DVD showed an angle of vertical deviation 15.88+/-7.26 delta, for the right eye and 13.50+/-6.55 deltafor the left eye in the primary position. All but 1 patient showed subnormal stereoacuity in the Titmus stereopsis test and most showed suppression in near and far in the Worth 4 dot test. Four (50%) patients were associated with latent nystagmus and one (12.5%) patient showed head tilting. Three months after the operation, all patients showed a residual DVD under 8 delta. CONCLUSION: DVD is frequently combined with exotropia and is associated with decreased stereoacuity, latent nystagmus, head tilting, inferior oblique overaction (IOOA), and superior oblique overaction (SOOA). DVD showed no relation to the amount of deviation of exotropia but was usually associated with a small angle of exotropia ( or =50 delta). The correction of DVD with exotropia showed satisfactory results.

Critical Pathways for Cesarean Section / 대한산부인과학회잡지

OBJECTIVES: The critical pathways provide high quality of medical services in a cost-effective manner. To investigate the decrease in length of hospital stay and increase of cost effectiveness by using critical pathways, we compared hospital stay, cost of treatment, and the patient's satisfaction before and after critical pathway use. METHODS: We made a critical pathway team, which consisted of obstetric staff members, a resident, two nurses, a pharmacist, two clerical staff members. We made critical pathways for the medical team and patients. A prospective evaluation of a critical pathway for cesarean section was used as a comparison for control patients. RESULTS: The data for 305 patients with a critical pathway were compared to those of 136 control patients. The mean hospital stay is shorter in critical pathway patients than control patients. The cost of treatment decreased and differences between DRG (Diagnosed Related Groups) and cost of treatment increased in critical pathway patients. CONCLUSIONS: Using critical pathways in cesarean section decreased the duration of hospital stay and increased cost effectivesess. The critical pathways were useful as a means to minimize cost while increasing patient satisfaction.