The Analysis of Prognostic Factors in Patients with Decompensated Liver Cirrhosis Admitted to the Medical Intensive Care Unit / 대한구급학회지

BACKGROUND: Patients with decompensated liver cirrhosis usually resulted in admission to the intensive care unit (ICU) during hospitalization. When admitted to the ICU, the mortality was high. The aim of this study is to identify multiple prognostic factors for mortality and to analyze the significance of prognostic survival model with each scoring system in patients with decompensated liver cirrhosis who was admitted to the ICU. METHODS: From January 2008 to December 2008, 60 consecutive patients with decompensated liver cirrhosis were admitted in the ICU and retrospectively reviewed. Prognostic models used were Child-Turcotte-Pugh (CTP), model for end-stage liver disease (MELD), model for end-stage liver disease with incorporation of serum sodium (MELD-Na), acute physiology and chronic health evaluation (APACHE) II, and sequential organ failure assessment (SOFA). The predictive prognosis was analyzed using the area under the receiver's operating characteristics curve (AUC). RESULTS: The median follow up period was 20 months, and ICU mortality was 17% (n = 10). A total of 24 patients (40%) died during the study period. The average survival of five prognostic models was related with the severity of the disease. All of the five systems showed significant differences in the cumulative survival rate, according to the scores on admission, and the MELD-Na had the highest AUC (0.924). Multivariate analysis showed that bilirubin and albumin were significantly related to mortality. CONCLUSIONS: The CPT, MELD, MELD-Na, APACHE II, and SOFA may predict the prognosis of patients with decompensated liver cirrhosis. The MELD-Na could be a better prognostic predictor than other scoring systems.

Gene Expression Changes in a Rat Model of Oxygen-Induced Retinopathy

PURPOSE: To identify altered patterns of retinal mRNA expression in a rat model of oxygen-induced retinopathy (OIR). METHODS: Sprague-Dawley rats from P2 to P14 were exposed to hyperoxia (80% oxygen) to induce OIR and then returned to normoxic conditions. Control rats were sustained in room air. Retinal gene expression between the rats of OIR and the controls was compared using cDNA microarray analysis. Reverse transcriptase polymerase chain reaction (RT-PCR) was used to verify the microarray results. RESULTS: Among a total of 12,731 cDNAs analyzed by mircroarray, 13 genes were strongly up- or down-regulated (>2-fold change over controls) in the OIR rats. We found a significant increase in expression of 10 genes (CaM-kinase II inhibitor; acidic nuclear phosphoprotein 32 family, member A; vascular endothelial growth factor; interferon alpha-inducible protein 27-like; similar to enthoprotin, epsin 4, clathrin interacting protein; nidogen [entactin]; tubulin, beta5; fibrillin-1; spectrin beta2; and stearoyl-coenzyme A desaturase 2) and a significant decrease in expression of 3 genes (myelin-associated oligodendrocytic basic protein, heat shock protein, and decorin) in OIR rats compared to controls. CONCLUSIONS: We confirmed changes in expressions of various retinal genes in a rat model of OIR by microarray and RT-PCR. This study should contribute to the understanding of genetic indicators associeated with OIR.

The Effects of Occlusion Therapy in Patients With Anisometropic Amblyopia Aged 8 Years and Older

PURPOSE: To compare the effects of full-time and part-time occlusion therapy in patients who had been diagnosed with anisometropic amblyopia after age eight and have begun treatment. METHODS: We included patients eight years old or older who had been diagnosed with anisometropic amblyopia. They were treated with full-time or part-time occlusion therapy and followed up for at least six months. Treatment was considered successful when visual acuity was increased by two lines or more. RESULTS: There were 26 total patients. There were 14 part-time and 12 full-time occlusion therapy patients in the respective groups. Visual acuity for the amblyopic eyes was significantly improved while the non-amblyopic eyes did not show any significant differences after the treatment. The changes in the visual acuity were significantly larger for the full-time treatment group compared to the part-time treatment group. The full-time occlusion group showed a significant difference in visual acuity of the amblyopic eyes after treatment. Lower visual acuity of an amblyopic eye at the first visit led to a greater improvement in visual acuity after the treatment. CONCLUSIONS: With good compliance, occlusion therapy for anisometropic amblyopia can be successful even if it is initiated after eight years of age.

A Case of Chorioretinal Coloboma in Triple X Syndrome

PURPOSE: To report the case of a child with triple X syndrome presenting with exotropia and chorioretinal coloboma. CASE SUMMARY: A one-year-old female infant presented with 35PD exotropia in the primary position. The patient had poor fixation of the right eye, and a fundus examination showed chorioretinal coloboma in the inferior region of her right eye. The patient also exhibited syndactyly of the right hand. Brain magnetic resonance imaging revealed a well-defined 2 cm cyst in the right cerebellum. Upon chromosomal study, the patient's karyotype was found to be 47, XXX. CONCLUSIONS: When infants or children present with ophthalmologic findings such as strabismus and coloboma, systemic conditions and congenital problems should be considered.

An Analysis of Orbital Reconstruction with Bioresorbable Plate Through Orbital Volume Assessment

PURPOSE: To evaluate the early effect of orbital reconstruction with MacroPore(R) by assessment of orbital volume through orbital computed tomography (CT) in cases of orbital wall fracture METHODS: We performed orbital reconstruction with MacroPore(R) in patients with orbital wall fracture smaller than 3 cmx2 cm. Orbital CT was done preoperatively and 6 months postoperatively. We then evaluated the results by measuring the orbital volume through Rapidia 2.8 program. RESULTS: The study comprised 14 patients. The site of fracture was the medial wall in one patient, inferior in seven, and both medial and inferior in six patients. The site of insertion of MacroPore(R) was the medial wall in one patient, inferior in 12, and both medial and inferior walls in one. The mean volume of the affected orbit before operation was 20.23+/-2.78 cm3, that of the unaffected orbit was 18.27+/-2.24 cm3 (p-value=0.000), and the mean volume of the affected orbit after operation was 19.06+/-2.57 cm3, that of the unaffected orbit was 18.06+/-2.24 cm3 (p-value=0.000). The mean enophthalmos before operation was 1.00+/-0.62mm, and after operation was 0.64+/-0.46 mm. The mean difference of orbital volume between the affected and the unaffected orbits before operation was 1.96+/-0.33 cm3, and 1.00+/-0.87 cm3 after operation (p-value=0.000). The mean volume of the affected orbit before operation was 20.23+/-2.77 cm3, and 19.06+/-2.57 cm3 after operation (p-value=0.000). Each cubic centimeter decrement in volume caused a 0.67+/-0.68 mm mean decrease of enophthalmos. CONCLUSIONS: We concluded that MacroPore(R) was safe orbital implant and effective in decreasing the orbital volume at early orbital reconstruction in cases of orbital wall fracture smaller than 3 cmx2 cm through a comparison of orbital volume before and after operation.

A Case of Photodynamic Therapy of Juxtafoveal Choroidal Neovascularization in Angioid Streaks

PURPOSE: To report a case of verteporfin photodynamic therapy (PDT) for juxtafoveal choroidal neovascularization (CNV) secondary to angioid streaks. CASE SUMMARY: An 54-year-old male presented with metamorphopsia of the right eye. It was diagnosed as juxtafoveal CNV secondary to angioid streaks and treated with verteporfin PDT-Best corrected visual acuity (BCVA) and macular thickness by optical coherence tomography (OCT) were measured. Over 14 month follow-up period, baseline BCVA was 0.3 and it increased to 0.4 by the final examination, while macular thickness decreased from 264 micrometer to 229 micrometer. No side effects of PDT were noted. CONCLUSIONS: Verteporfin PDT for CNV-associated with angioid streaks does not appear to significantly alter the course of the disease undergoing enlargement and disciform transformation of the neovascular process. However, we expected that the actual clinical findings improved during short term follow-up. The severity of symptoms of CNV-associated with angioid streaks in a single patient varies over time, so long-term follow-up and careful examination is needed.