The Usefulness of External Bandage Suture for Management of Bleb after Trabeculectomy with Mitomycin C

PURPOSE: To evaluate the usefulness of external bandage suture for bleb-related management that follows trabeculectomy with mitomycin C. METHODS: External bandage sutures were performed on 10 patients having hypotony maculopathy, persistent low intraocular pressure (IOP) caused by either hyperfiltration or focal leakage, or a persisting large bleb caused by hyperfiltration and who received trabeculectomy using mitomycin C as an adjuvant treatment. The changes in IOP measured before and 4 weeks after the procedure along with complication incidences were evaluated. RESULTS: The mean IOP 4 weeks after the procedure compared with the mean IOP prior to the procedure increased from 5.8 +/- 2.0 mm Hg (3.0-9.0 mm Hg) to 14.1 +/- 8.5 mm Hg (4.0-32.0 mm Hg), with statistical significance (p = 0.008). After the procedure, improvement in visual acuity was observed but without statistical significance. One patient had persistent focal leakage from an avascular bleb and conjunctival advancement with removal of the avascular conjunctiva was performed. CONCLUSIONS: An external bandage suture can be a good alternative for correction of post-trabeculectomy hypotony and severe chemosis with minimal effect on blebs while correcting focal leakage and hyperfiltration.

The Analysis of the Clinical Findings and Effects of Biodegradable Collagen Matrix in Trabeculectomy

PURPOSE: To observe the effects of biodegradable collagen matrix (OculusGen(TM)) on filtering bleb formation and maintenance and to investigate its clinical effects and usefulness in trabeculectomy. METHODS: Ophthalmologic examinations were preformed 1 day, 2 weeks, 1 month, 2 months, 3 months, 6 months, and 12 months postoperatively in the case and control groups. The clinical findings of the filtering bleb were observed, and the clinical effects measured by mean intraocular pressure and complications were evaluated in both groups. RESULTS: The success rates were 76% in the case group and 88% in the control group, and there were no significant differences between the case and control groups. In the case group, postoperative conjunctival injection persisted for more than 1 month with increasing severity, while ultrasound biomicroscopy revealed increased echogenicity of the subconjuctival and tenon tissue with no definite space-occupying effect. CONCLUSIONS: Trabeculectomy utilizing collagen matrix showed similar clinical results compared to the current traditional trabeculectomy; slit-lamp and ultrasound biomicroscopy findings did not reveal any advantageous changes to filtering bleb function.

Bilateral Retrobulbar Hemorrhage and Visual Loss Following Traumatic Asphyxia

Retrobulbar hemorrhage and permanent visual loss are rare presentations following traumatic asphyxia. In this case, bilateral permanent visual disturbance developed in a woman after chest-crushing trauma without direct trauma to the orbits. A computed tomography scan confirmed bilateral retrobulbar hemorrhages. An ophthalmologic exam revealed bilateral subconjunctival hemorrhages and severe lid edema. Despite high-dose steroid therapy, visual recovery was limited, and optic nerve atrophy developed. Ischemia of the optic nerve associated with retrobulbar hemorrhage may be postulated as one of the causes of permanent visual impairment following traumatic asphyxia.

Alterations in Membrane Transport Function and Cell Viability Induced by ATP Depletion in Primary Cultured Rabbit Renal Proximal Tubular Cells

This study was undertaken to elucidate the underlying mechanisms of ATP depletion-induced membrane transport dysfunction and cell death in renal proximal tubular cells. ATP depletion was induced by incubating cells with 2.5 mM potassium cyanide (KCN)/0.1 mM iodoacetic acid (IAA), and membrane transport function and cell viability were evaluated by measuring Na+-dependent phosphate uptake and trypan blue exclusion, respectively. ATP depletion resulted in a decrease in Na+-dependent phosphate uptake and cell viability in a time-dependent manner. ATP depletion inhibited Na+-dependent phosphate uptake in cells, when treated with 2 mM ouabain, a Na+ pump-specific inhibitor, suggesting that ATP depletion impairs membrane transport functional integrity. Alterations in Na+-dependent phosphate uptake and cell viability induced by ATP depletion were prevented by the hydrogen peroxide scavenger such as catalase and the hydroxyl radical scavengers (dimethylthiourea and thiourea), and amino acids (glycine and alanine). ATP depletion caused arachidonic acid release and increased mRNA levels of cytosolic phospholipase A2 (cPLA2). The ATP depletion-dependent arachidonic acid release was inhibited by cPLA2 specific inhibitor AACOCF3. ATP depletion-induced alterations in Na+-dependent phosphate uptake and cell viability were prevented by AACOCF3. Inhibition of Na+-dependent phosphate uptake by ATP depletion was prevented by antipain and leupetin, serine/cysteine protease inhibitors, whereas ATP depletion-induced cell death was not altered by these agents. These results indicate that ATP depletion-induced alterations in membrane transport function and cell viability are due to reactive oxygen species generation and cPLA2 activation in renal proximal tubular cells. In addition, the present data suggest that serine/cysteine proteases play an important role in membrane transport dysfunction, but not cell death, induced by ATP depletion.

Secondary Glaucoma and Sclerokeratitis After Cosmetic Eye Whitening by Regional Conjunctivectomy with Mitomycin C Application

PURPOSE: To report a case of secondary glaucoma and sclerokeratitis after cosmetic eye whitening by regional conjunctivectomy with Mitomycin C application. CASE SUMMARY: A 69 year-old man was referred to our clinic for a left ocular pain and ocular hypertension sustained for 3 months after cosmetic eye whitening by regional conjunctivectomy with Mitomycin C application for chronic conjunctival hyperemia. On first examination, the scleromalacia and large conjunctival epithelium defect in the nasal quadrant of the limbus area and diffuse sclerokeratitis were observed. Conjunctival and episcleral vessel deficit were seen except superior 30% portion in the left eye. The anterior chamber depth in the left eye was very shallow compared to the right eye and cell reaction in the left anterior chamber was detected. Intraocular pressure (IOP) in the left eye was 28 mmHg after Cosopt(R) and 15% mannitol 500 ml use. Glaucomatous cupping was detected. During follow-up, left IOP increased over 40 mmHg despite the maximal medical treatment and the progression of visual field defects was detected, so then left phacoemulsification, Ahmed valve implantation and amnion membrane transplantation were done. After surgery, the conjunctival epithelial defect and sclerokeratitis were improved much and IOP was regulated 20~30 mmHg without medication. Digital massage was done 2 times per day for decreasing IOP and wound remodeling after 1 month. At 3 month after surgery, the conjunctival epithelial defect recurred and scleromalacia was also progressed, so then we performed autoconjunctival flap and amnion membrane transplantation in left eye. The conjunctival epithelial defect were recovered completely, IOP was regulated 24~36 mmHg without medication, and 20~24 mmHg with Cosopt.(R) The compliance of patient is very poor, further management may be needed for IOP control. CONCLUSIONS: Cosmetic eye whitening by regional conjunctivectomy with Mitomycin C application can cause serious complications such as scleromalcia and secondary glaucoma. This case shows that particular care should be taken in order to minimize these complications.

Cisplatin-induced Alterations of Na+-dependent Phosphate Uptake in Renal Epithelial Cells

Cisplatin treatment increases the excretion of inorganic phosphate in vivo. However, the mechanism by which cisplatin reduces phosphate uptake through renal proximal tubular cells has not yet been elucidated. We examined the effect of cisplatin on Na+-dependent phosphate uptake in opossum kidney (OK) cells, an established proximal tubular cell line. Cells were exposed to cisplatin for an appropriate time period and phosphate uptake was measured using [32P]-phosphate. Changes in the number of phosphate transporter in membranes were evaluated by kinetic analysis, [14C]phosphonoformic acid binding, and Western blot analysis. Cisplatin inhibited phosphate uptake in a time- and dose-dependent manner, and also the Na+-dependent uptake without altering Na+-independent uptake. The cisplatin inhibition was not affected by the hydrogen peroxide scavenger catalase, but completely prevented by the hydroxyl radical scavenger dimethylthiourea. Antioxidants were ineffective in preventing the cisplatin-induced inhibition of phosphate uptake. Kinetic analysis indicated that cisplatin decreased Vmax of Na+-dependent phosphate uptake without any change in the Km value. Na+-dependent phosphonoformic acid binding was decreased by cisplatin treatment. Western blot analysis showed that cisplatin caused degradation of Na+-dependent phosphate transporter protein. Taken together, these data suggest that cisplatin inhibits phosphate transport in renal proximal tubular cells through the reduction in the number of functional phosphate transport units. Such effects of cisplatin are mediated by production of hydroxyl radicals.

Significance of Small Dense Low-Density Lipoprotein as a Risk Factor for Coronary Artery Disease and Acute Coronary Syndrome

Small dense LDL (sd-LDL) has recently emerged as an important coronary artery disease (CAD) risk factor. This study was performed to investigate how LDL particle size is related to CAD and acute coronary syndrome (ACS). Blood samples were collected from 504 patients that underwent coronary angiography to evaluate chest pain. The LDL particle size of these samples was measured. The mean LDL particle size was smaller in patients with angiographically proven CAD than in the controls (26.41+/-0.95 vs 26.73+/-0.64nm, p < 0.001), and was negatively correlated with the Framingham risk score (r=-0.121, p=0.007). Patients with more extensive CAD had smaller LDL particles. LDL particle size was also smaller in patients with acute coronary syndrome as compared to non-ACS patients (26.09+/-1.42 vs 26.54+/-0.63nm, p=0.011). These results suggest that sd-LDL is independently associated with the incidence and extent of CAD, and can be a risk factor for the development of ACS in the Korean population.

Time-Phasic Development of Nitrate Tolerance According to the Hemodynamic Responses and the Expression of Phosphodiesterase 1A1

BACKGROUND AND OBJECTIVES: Time-phasic development of nitrate tolerance in cardiovascular diseases is very important because it can contribute to the advent of blunted vasodilation or rebound ischemia even during continuous NTG treatment. In such a condition, we should change the therapeutic regimen of nitrate treatment to prevent the worsening of symptoms. MATERIALS AND METHODS: We created a nitrate-tolerant rat model using an osmotic minipump, and we examined the hemodynamic response to bolus NTG infusion in vivo. We checked the phosphodiesterase (PDE) 1A1 mRNA and protein level by relative quantitative RT-PCR and western blot analysis. We used 8-cpt-cGMP for investigating the development of a time-phasic nitrate tolerance mechanism after nitrate infusion. RESULTS: NTG-treated rats revealed a significant decrease in NTG-induced MAP drop (nitrate tolerance) from 1-day and this continued to the third day. The mRNA and protein levels of PDE1A1 similarly increased during these periods. CONCLUSION: This study revealed the development of time-phasic nitrate tolerance from the the aspects of in vivo hemodynamic responses and PDE 1A1 gene expression, and our work supports the need for further investigation to come up with a different therapeutic strategy and new drugs.

Cardiac Involvement in Patients with Duchenne Muscular Dystrophy

BACKGROUND: Cardiac involvement in Duchenne muscular dystrophy (DMD) is common, but usually latent without symptoms or signs in the initial period of disease. This study investigated the incidence and predictor of cardiac involvement in DMD patients. METHOD: From January 2000 to June 2005, we enrolled 45 patients with DMD (aged 20.2+/-3.0 years) who admitted to the Yongdong Severance Hospital. Electrocardiography and transthoracic echocardiography was done to evaluate the cardiac function. RESULT: Electrocardiographic abnormalities were present in 80.1% of patients. Sinus tachycardia was most common (50%). LVEF was decreased (46.7+/-13.8%), and 56% of the patients had diastolic dysfunction. Patients with pulmonary involvement were older (20.7+/-3.8 vs 17.6+/-2.8 years, p=0.028), and patients with reduced LVEF (<50%) had longer duration of disease (11.4+/-4.4 vs 14.3+/-2.4 years, p=0.04). However, on multivariate analysis, age, duration of disease, pulmonary involvement, dyspnea symptom, electrocardiographic abnormality was not an independent predictor for LV systolic dysfunction in adolescent and adult patients with DMD. CONCLUSION: Cardiac involvement in adolescent and adult patients with DMD was frequently observed independent of age, duration of disease, pulmonary involvement, and dyspnea symptom. Therefore, more active cardiac investigation is required in patients with DMD, even without clinical suspicion.

Serum Levels of Advanced Glycation End Products Are Associated with In-Stent Restenosis in Diabetic Patients

The formation of advanced glycation end products (AGEs), in various tissues has been known to enhance immunoinflammatory reactions and local oxidant stresses in long standing diabetes. Recently, AGEs have been reported to play a role in neointimal formation in animal models of arterial injury. We attempted to determine whether the serum levels of AGEs are associated with coronary restenosis in diabetic patients. Blood samples were collected from diabetic patients with coronary artery disease undergoing stent implantation and the serum levels of AGEs were analyzed by the fluorescent intensity method. The development of in-stent restenosis (ISR) was evaluated by a 6-month follow-up coronary angiography. A total of 263 target lesions were evaluated, in 203 patients. The ISR rate in the high-AGE (> 170 U/ml) group (40.1%) was significantly higher than in the low-AGE group (< or =170 U/ml) (19.6%) (p < 0.001). Furthermore, multivariate analysis revealed that a high level of serum AGEs is an independent risk factor for the development of ISR (odds ratio, 2.659; 95% CI, 1.431-4.940; p=0.002). The serum levels of AGEs constitute an excellent predictive factor for ISR, and should be one of the guidelines for medical therapy and interventional strategy to prevent ISR in diabetic patients.

A Case of Riedel's Thyroiditis in a Patient with a History of Subacute Thyroiditis / 대한내분비학회지

Riedel's thyroiditis is a rare form of chronic thyroiditis, characterized by a fibroinflammatory process which partially destroys the thyroid, often involving surrounding tissues. The relationship of Riedel's thyroiditis to other forms of thyroiditis is not clear. A case of Riedel's thyroiditis in a 51-year-old female patient, admitted with a previous diagnosis of subacute thyroiditis, is reported. She was first diagnosed with subacute thyroiditis based on clinical manifestation and radiologic and laboratory results. She was treated with glucocorticoid for 8 weeks. The follow-up lasted for 12 months. However, three years later she underwent a thyroidectomy operation due to an enlargement of the thyroid nodule and suspicion of malignancy. Histopathologic examination confirmed that she had Riedel's Thyroiditis. Until now, few case of Riedel's thyroiditis in patients with a history of subacute thyroiditis have been reported in the literature. Although the etiology of Riedel's thyroiditis is unknown, it may develop in the course of subacute thyroiditis.

A Case of Antiphospholipid Antibody Syndrome Accompanied by Valvular Heart Disease and Moya Moya Syndrome

A case of antiphospholipid antibody syndrome, accompanied by valvular heart disease and Moya moya syndrome, has never been reported. Here, we report on a case that had mitral regurgitation and Moya moya syndrome, associated with antiphospholipid antibody syndrome secondary to systemic lupus erythematosus. This patient underwent a mitral valve replacement for mitral valve regurgitation. The postoperative course was uneventful, and the pathological findings of the mitral valve showed a degenerative change, due to chronic inflammation, a proliferative fibrous change and calcification, but without thrombus formation. However, the patient returned to the hospital with a cerebral hemorrhage, which was caused by Moya moya syndrome. Surgical drainage was performed, and the patient was discharged without any complications. The patient is on anticoagulation and immunosuppression drugs, with no problems to date.

A Case of Eosinophilic Pustular Folliculitis in a Patient with AIDS / 대한피부과학회지

Eosinophilic pustular folliculitis, first described by Ofuji, is characterized by recurrent crops of pruritic follicular papules and pustules that occur mainly on face, trunk and extremities. Since late 1980, many cases of eosinophilic pustular folliculitis have been reported in patients with the acquired immunodeficiency syndrome(AIDS). The distinguishing features of HIV-associated eosinophilic folliculitis include a different clinical presentation, the universal presence of pruritus and the absence of leukocytosis. A 26-year-old woman, who was HIV-seropositive, had erythematous follicular papules and pustules on face and anterior chest. Clinically and histologically, we confirmed eosinophilic pustular folliculitis. We report a case of eosinophilic pustular folliculitis in a patient with AIDS.

Small-Bowel Obstruction in Patients with a Previous History of Abdominal Surgery due to Cancer

PURPOSE: The purpose of this study was to analyze the clinical features and to assess the risk factors in the treatment of small-bowel obstructions. METHODS: This retrospective clinical report was based on the medical records of 67 patients who were treated between Jan. 1992 and Dec. 1999 and who had had a history of abdominal surgery due to cancer. RESULTS: The distribution of primary cancer was as follows: stomach cancer 36 (53.7%), colorectal cancer 25 (37.3%), uterine and ovarian cancer 4 (6.0%), and other cancers 2 (3.0%). The mean interval from the primary operation to the development of a small- bowel obstruction was 27 months. Conservative treatment produced a successful outcome in 36 patients (59.0%), but recurrences of obstruction were noted in 18 of those patients. There were 34 operations in 30 patients. The initial success rate of operative treatment was 80% (24/30), obstructions recurred in 6 patients. The causes of obstructions in the surgically treated patients were adhesion (53.3%) and recurrence of cancer (46.7%). The postoperative complication rate was 44.1%, and the mortality rate was 20.0%. The mean survival time of the patients with benign causes of obstruction was significantly longer than that of the patients with malignant causes of obstruction (46 months vs 11 months). CONCLUSION: In the treatment of such patients, conservative treatment should be considered first. However if conservative treatment fails, surgery should be done without hesitation, especially in patients with no definite evidence of recurrence.

Numb-Chin Syndrome in Malignant Hematologic Diseases

'Num-chin syndrome', isolated mental neuropathy, is a rare manifestaion of malignant hernatologic diseases, but important sign for early diagnosis and prediction of clinical course and prognosis. Here we report 7 cases of numb-chin syndrome; one in leukemic transformation of malignant lymphoma, one in blastic crisis of chronic myelogenous leukemia and 5 in acute leukemia Two cases of acute leukemia revealed the 'numb-chin sign' in early course of disease before the diagnosis of leukemia and other three in aggravating state of acute leukemia. The therapeutic response and prognosis was poor and 5 cases expired in a few months.