Short-term Safety Evaluation of Resident-performed Intravitreal Injection

Purpose@#This study evaluated the short-term safety of resident-performed intravitreal injections. @*Methods@#We retrospectively reviewed the medical records of 503 patients (503 eyes) treated for the first time in our hospital from January 2018 to October 2020 via intravitreal bevacizumab, ranibizumab, aflibercept, or triamcinolone acetonide injections by residents or retina specialists. In terms of short-term ophthalmic complications, patients were followed-up 1 day, 1 week, and 1 month after injection. @*Results@#A total of 503 eyes of 503 patients were included. Intravitreal injections were given to 211 and 292 eyes by residents (the resident group) and retina specialists (the retina specialist group), respectively. There were no between-group differences in baseline characteristics except in terms of the indications for injection. Intraocular pressure elevation >5 mmHg occurred in two eyes (0.95%) in the resident group and five (1.71%) in the retina specialist group, but the difference was not statistically significant. Subconjunctival hemorrhage occurred in 29 eyes (13.74%) of the resident group and 32 eyes (10.96%) of the retina specialist group; again, the difference was not statistically significant. No case of noninfectious endophthalmitis occurred in the resident group but two (0.68%) cases occurred in the retina specialist group; again, the difference was not significant. There were two (0.95%) cases of infectious endophthalmitis in the resident group and one (0.34%) case in the retina specialist group; again, the difference was not significant. No corneal erosion, traumatic lens damage, vitreous hemorrhage, or retinal tearing or detachment were noted in either group. @*Conclusions@#Resident-performed intravitreal injections appear to be safe.

Changes of Left Ventricular Function , Left Atrial Function , and Pulmonary Venous Flow Patterns in Patients with Acute Myocardial Infarction / 대한내과학회지

OBJECTIVES: Acute myocardial infarction decreases left ventricular systolic and diastolic function. Left ventricular diastolic function is usually assessed with the left ventricular filling patterns. Abnormal left ventricular tilling patterns after acute myocardial infarction can be classified as relaxation abnormality, pseudonormalization, and restriction, but sometimes the differentiation between pseudonormalization and the normal pattern is difficult. To assess left ventricular systolic and diastolic function, and left atrial function after acute myocardial infarction, M-mode, two-dimensional, pulsed Doppler, and automated border detection echocardiography were performed. To complement the information obtainable from the mitral flow patterns, pulmonary venous flow patterns were also analysed to assess the left ventricular filling patterns. METHODS: Twenty six patients (mean age 60+/-10) underwent echocardiographic examination 7 to 14 days after acute myocardial infarction. Twenty healthy persons(mean age 57+/-12) were served as a control group. Various indexes were obtained with M-mode, two-dimensional, pulsed Doppler, and automated border detection echocardiography RESULTS: 1) Mean age, sex ratio, heart rate, body mass index were not different between patient and control groups. There were five patients with hypertension in patient group. Left ventricular mass index of patient group was greater than that of control group (163+/-43g/m2 vs. 109+/-22g/m2, P<0.0D1). 2) Patients had decreased cardiac index(2.35+/-0.53L/min/m2 vs. 3.02+/-0.70L/min/m2, P<0.05) and left ventricular ejection fraction(55+/-12% vs. 62+/- 0.4%). There was a negative correlation between left ventricular regional wall motion score and ejection fraction(r=-0.71; P<0.001). 3) In patients, peak mitral flow velocity at atrial contraction(A) was higher(73+/-11cm/sec vs. 63+/-13 cm/sec; P<0.01), E/A ratio was lower(0.77+/-0.28 vs. 1.01+/-0.25; P<0.01), and left ventricular isovolumic relaxation time was longer(126+/-34msec vs. 97+/-21msec; P<0.005). 4) Patients had smaller systolic time-velocity integral(13.0+/-3.30cm vs. 14.8+/-2.83cm, P=0.056) and diastolic time-velocity integral(9.18+/-2.21cm vs. 11.2+/-2.77cm, P<0.01). 5) Relaxation abnormality of left ventricular filling patterns, which was classified by E/A ratio of less than 1, was more frequently founded in patients than in controls(45%). Four patients had E/A ratio of greater than 1; SV/DV ratio was greater than 1 in two and less than 1 in others. 6) End-diastolic area of left atrium(minimal area) was larger in patients(11+/-1.9cm2 vs. 9.6+1.4cm2, P<0.01). Therefore, patients showed decreased atrial emptying index and expansion index. Patients had a greater extent of left atrial area decrease resulting from atrial contraction. CONCLUSION: Patients with acute myocardial infarction showed a decreased left ventricular systolic function and a relaxation abnormality 7 to 14 days after attack, Minimal area of left atrium increased and left atrial function decreased.

A Case of Adrenocortical Adenoma Associated with Incidental Pheochromocytoma / 대한내분비학회지

The coexistence of adrenal cortical tumor and pheochromocytoma was extremely rare. A total of 25 reported cases showing evidence of hyperfuction of the adrenal cortex and pheochromocytoma were noted in the literature. Of those twenty cases were coexistence of pheochromocytoma and adrenocortical hyperplasia and only five cases were coincident pheochromocytoma and adreno-cortical adenoma. Recently, we experienced a case of adrenocortical adenoma associated with incidental pheochrmocytoma. A 55-year-old woman complained of progressive weight gain and epigastric discomfort. Hormonal and radiologic studies revealed Cushings syndrome with a left adrenal tumor. Adrenalectomy was performed and the gland actually had two nodules on its surface, one pheochromocytoma and the other cortical adenoma. This patient was the first case of pheochromocytoma with adrenocortical adenoma in Korea. We report the case with a review of literature.