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1.
Article in Korean | WPRIM | ID: wpr-916445

ABSTRACT

Purpose@#To report four cases of toxic anterior segment syndrome after cataract surgery under intracameral 0.5% lidocaine anesthesia.Case summary: Four patients had a decrease in visual acuity within 3 days of undergoing cataract surgery. There was evidence of anterior chamber inflammation with corneal edema and opacity. Toxic anterior segment syndrome was diagnosed on the basis of negative microbial cultures and clinical features. Three patients were treated with systemic and topical steroids, and one was treated with topical steroids only. Three months postoperatively, three patients had good visual acuity without inflammation or corneal edema. However, one patient, who did not receive systemic steroids, exhibited persistent corneal edema and required endothelial keratoplasty. @*Conclusions@#Toxic anterior segment syndrome is a surgical complication that requires immediate treatment. Systemic steroids can be helpful with topical steroids. Clinicians should ensure that measures are taken to avoid contamination of surgical procedure with toxic substances to prevent toxic anterior segment syndrome.

2.
Article in Korean | WPRIM | ID: wpr-916436

ABSTRACT

Purpose@#To investigate the changes in intraocular cytokines after ranibizumab treatment in patients with polypoidal choroidal vasculopathy (PCV). @*Methods@#This multicenter, prospective study enrolled patients with PCV treated with three monthly ranibizumab followed by a pro re nata regimen for 24 weeks. Best corrected visual acuity, slit lamp examination, fundus photography, and optical coherence tomography were performed every 4 weeks. Aqueous humor was collected to measure intraocular cytokines at baseline, week 8, and the time of recurrence or week 20. The association of changes in intraocular cytokines with visual acuity, central macular thickness, central choroidal thickness, area of abnormal vessels, and polyp closure was assessed. @*Results@#This study included 25 eyes. The mean patient age was 70.3 ± 6.1 years. The vascular endothelial growth factor (VEGF) concentration decreased at week 8, but only interferon (IFN)-γ, tissue inhibitors of matrix metalloproteinases (TIMP)-2, and monocyte chemoattractant protein (MCP)-2 decreased at the time of recurrence. The recurrence interval was positively associated with the baseline epithelial-neutrophil activating peptide (ENA)-78, interleukin (IL)-17, leptin, and transforming growth factor-β1, and baseline central macular thickness was positively correlated with the baseline fibroblast growth factor-4 and IL-10. Thick central choroidal thickness was associated with a low basic fibroblast growth factor and high IFN-γ at baseline. The MCP-3 and Tie-2 levels decreased in two eyes with polyp closure. @*Conclusions@#Ranibizumab significantly reduced intraocular VEGF concentrations and consequently improved PCV. However, the cytokines IFN-γ, TIMP-2, and MCP-2, rather than VEGF, were associated with PCV recurrence. Further studies of intraocular cytokines involved in neovascularization in PCV are needed.

3.
Article in Korean | WPRIM | ID: wpr-916380

ABSTRACT

Purpose@#To report a case of poor visual prognosis complicated by residual subretinal fluid after use of the internal limiting membrane flap technique to treat macular hole retinal detachment in a patient with high myopia.Case summary: A 55-year-old male stated that he had experienced a transparent circle in the central visual field of the right eye for 1 month. His best-corrected visual acuity (BCVA) was 0.32 and the axial length of the right eye was 32.57 mm. Fundus examination revealed a macular hole with retinal detachment localized to the posterior pole. We performed vitrectomy, membrane peeling, internal limiting membrane peeling with inverted internal limiting membrane flap, and silicone oil injection. On day 1 after surgery, the macular hole was closed, but subretinal fluid was noticed in the macula. At 3 months after surgery, the BCVA was 0.16 and the silicone oil was removed. At 14 months after the first surgery, the subretinal fluid was completely absorbed, but leopard-pattern pigment degeneration became prominent and the macula exhibited ellipsoid zone disruption. The BCVA decreased to 0.1. @*Conclusions@#In patients exhibiting macular hole retinal detachment in the context of high myopia, an inverted internal limiting membrane flap may increase the macular hole closure rate but disturb subretinal fluid drainage. As persistent subretinal fluid may cause permanent retinal damage with a poor visual prognosis, the surgical method must be carefully chosen.

4.
Article in English | WPRIM | ID: wpr-915715

ABSTRACT

Purpose@#This study aimed to identify the prevalence of sarcopenia, obesity, and sarcopenic obesity and their association to radiographic knee osteoarthritis (OA) and knee pain in Korean menopausal women. @*Methods@#This study cross-sectional study utilized the data obtained from Korean National Health and Nutrition Examination Surveys (KNHANES) 2009-2011 which included 4,362 menopausal women. The participants were categorized based on their body composition and the prevalence of radiographic knee OA and knee pain were calculated. The effect of hormone therapy (HT) was analyzed as subcohort analysis. @*Results@#The prevalence of radiographic knee OA, knee pain, and both radiographic knee OA and knee pain were all highest in sarcopenic obese group and lowest in non-sarcopenic non-obese group. Among the non-sarcopenic people, the obese people showed higher ratio of only radiographic knee OA (57.64% vs. 41.54%, p < 0.001). When sarcopenic, the coexistence of obesity presented significantly higher ratio of radiographic knee OA, knee pain, and both radiographic knee OA and knee pain compared to sarcopenic without obesity (61.49% vs. 41.82%, 39.11% vs. 27.61%, 32.04 vs. 17.60%, all p < 0.001).Regarding the use of HT for longer than 1 year was not associated with statistically different ratio of neither radiographic knee OA nor knee pain. @*Conclusion@#The obesity in terms of sarcopenia have greater effect on knee OA compared to the obesity without sarcopenia and HT use of longer than 1 year is not associated with the prevalence of knee OA. Therefore, more preventive effort to knee OA should be focused on reducing body fat and increasing muscle in the postmenopausal women.

5.
Article in English | WPRIM | ID: wpr-913317

ABSTRACT

Triptorelin is a synthetic gonadotropin-releasing hormone agonist for the treatment of precocious puberty in children. Among the triptorelin side effects, drug hypersensitivity reactions, including anaphylaxis, can rarely occur, mostly after repeated exposure to the drug. We present a first case of an 8-year-old girl with central precocious puberty who developed anaphylaxis to the first injection of decapeptyl depot, which contains triptorelin acetate (D,L lactide coglycolide), dextran 70, and polysorbate 80. She showed 2 positive reactions in an intradermal test to decapeptyl depot, suggesting that it is an IgE-mediated reaction to one of its components. Considering this was the first exposure to tryptorelin, it might be a reaction to polysorbate. As there are many therapeutic products containing polysorbate which can cross-react with polyethylene glycols, physicians should pay attention to immediate reactions to drugs containing polysorbate.

6.
Article in English | WPRIM | ID: wpr-902336

ABSTRACT

Purpose@#To describe the development of multiple retinal hemorrhages after uncomplicated macular hole (MH) surgery, and to determine the associated factors. @*Methods@#The medical records of 163 patients (167 eyes) diagnosed with idiopathic MHs and who underwent surgery at Pusan National University Hospital between March 2016 and July 2018 were retrospectively reviewed. The development of retinal hemorrhages was evaluated using ultra-widefield fundus photographs. Multiple retinal hemorrhages were defined as three or more dot or blot hemorrhages that had not been observed before and during the surgery. The patients were divided into two groups according to the presence of multiple retinal hemorrhages. The variable parameters were compared between the two groups to find the risk factors. The associated factors were evaluated further for the independent factor using multiple logistic regression analysis. @*Results@#Multiple retinal hemorrhages were observed in 31 eyes (18.6%) after MH surgery. The associated factors were the surgical induction of posterior vitreous detachment (PVD) (p = 0.003), use of the internal limiting membrane flap technique (p = 0.028), and staining with Brilliant Blue G (BBG) (p = 0.003). Retinal hemorrhages were exclusively observed in eyes in which BBG was used. Surgical PVD induction was the only independent risk factor (odds ratio, 13.099; p = 0.013). No statistically significant differences were observed between the two groups in the postoperative visual outcomes and MH closure rate. Additionally, patients who underwent surgery for idiopathic epiretinal membrane during the study period were reviewed to validate the above findings. Multiple retinal hemorrhages were noted in only one case (0.4%) in which BBG was used after surgical induction of PVD. @*Conclusions@#Multiple retinal hemorrhages after MH surgery appear to be related to the intravitreal use of BBG in eyes that sustained mechanical damage because of surgical induction of PVD; however, they did not affect surgical outcomes.

7.
Korean Journal of Medicine ; : 139-142, 2021.
Article in English | WPRIM | ID: wpr-902238

ABSTRACT

Hypokalemia is a common finding in various clinical settings; it is associated with diuretic use and loss of potassium via the gastrointestinal tract. Less common causes are renal tubular acidosis, diabetic ketoacidosis, excess insulin, primary hyperaldosteronism, and medications, such as amphotericin B. Nafcillin, a narrow-spectrum penicillin class antibiotic, which is selectively prescribed for methicillin-susceptible Staphylococcal aureus infections, and is commonly associated with gastrointestinal side effects, such as nausea, vomiting, and abdominal pain. However, in rare cases it can cause hypokalemia, which is usually overlooked. Severe hypokalemia was detected in a 59-year-old male patient hospitalized due to traumatic cerebral hemorrhage who received 12 g of nafcillin per day for more than 2 weeks for sepsis caused by methicillin-sensitive Staphylococcus epidermidis. We confirmed the association between nafcillin and hypokalemia through further evaluation and a review of the relevant literature. Clinicians should be aware of hypokalemia as a complication when using high doses of nafcillin.

8.
Article in English | WPRIM | ID: wpr-901365

ABSTRACT

Purpose@#To compare the recurrence pattern, disease-free survival (DFS), and overall survival (OS) after curative surgery for pancreatic ductal adenocarcinoma (PDAC) in patients who underwent preoperative evaluation with CT alone or in combination with MRI, and to compare the prognosis according to the first recurrence site. @*Materials and Methods@#We retrospectively evaluated 152 patients who underwent R0 resection of PDAC. Preoperative CT or combined CT and MRI were performed for 103 and 49 patients, respectively. Two radiologists recorded the location and date of the first recurrence in consensus. The recurrence pattern, DFS, and OS were compared between the two groups. OS was analyzed according to the first recurrence site. @*Results@#In both groups, liver metastasis was the most common recurrence pattern. DFS (p = 0.247) or OS (p = 0.067) showed no significant difference between the two groups. OS according to the first recurrence site was the lowest for liver metastasis, followed by locoregional recurrence (p < 0.001). @*Conclusion@#There were no significant differences in the recurrence pattern, DFS, or OS between patients evaluated with preoperative CT alone or with CT and MRI after curative resection of PDAC. Liver metastasis was the most common tumor recurrence pattern with the lowest OS.

9.
Article in Korean | WPRIM | ID: wpr-901111

ABSTRACT

Purpose@#To report complications requiring surgical management related to intravitreal dexamethasone implant. @*Methods@#The medical records of patients who received intravitreal dexamethasone implant injection from June 2013 to March 2020 were reviewed retrospectively. Patients who had undergone intraocular surgical management within 6 months after implant injection, with the exception of cataract surgery, were included. Of them, only the cases in which the surgery was definitely related to complications with the Ozurdex implant were included. In these patients, underlying disease, intraocular pressure change, and the number of injections were analyzed. @*Results@#A total of 1,168 injections of 473 eyes (439 patients) were enrolled in the study. The mean number of injections was 2.5 per eye. The mean age was 61.4 ± 11.3 years. The complications requiring an additional surgical procedure occurred in six (0.5%) injections. Of them, four, one, and one eyes showed uveitis, diabetic macular edema, and branch retinal vein occlusion, respectively. Surgical management was performed to control the increased intraocular pressure in two eyes, inappropriate implant location in two eyes, scleral wound leakage in one eye, and retinal detachment in one eye. The incidence of severe complications requiring surgical management was high in cases with a history of previous vitrectomy (p = 0.007, Fisher’s exact test) and uveitis (p = 0.007, Fisher’s exact test). @*Conclusions@#Severe complications requiring surgical management occurred in 0.5% of cases (six cases) after intravitreal dexamethasone implant injections. These complications were related to a history of previous vitrectomy and uveitis. Five eyes recovered to favorable visual function after surgery, with the exception of one eye with retinal detachment.

10.
Article in Korean | WPRIM | ID: wpr-901092

ABSTRACT

Purpose@#To report the effect of an intravitreal dexamethasone implant on refractory posterior scleritis. @*Methods@#The medical records of patients treated with an intravitreal dexamethasone implant for non-infectious refractory posterior scleritis were retrospectively reviewed, including age, sex, duration of follow-up, and presence of associated systemic diseases. The duration until relapse, changes in visual acuity, number of implants, and side effects associated with the implant were also analyzed. @*Results@#Seven eyes from five patients were included. The mean age was 73.2 ± 12.5 years (59-92 years). Although all patients had been treated with high-dose systemic steroid, and immunosuppressants were added, the posterior scleritis was poorly controlled. The duration from the diagnosis to the first dexamethasone implant was a mean of 8.2 months (3-27 months). The scleritis was well controlled in all eyes until at least 2 months (2-5 months) after inserting the implant. An average of 2.1 (total of 15 times in the seven eyes) implants were inserted. No complications related to the implant were observed other than a temporary increase in intraocular pressure in one eye. @*Conclusions@#Intravitreal dexamethasone implants were an effective treatment option for refractory posterior scleritis.

11.
Article in Korean | WPRIM | ID: wpr-901039

ABSTRACT

Purpose@#We report ocular manifestations in two patients with 7q microdeletion. Case summary: (Case 1) A 62-day-old male infant was admitted to the ophthalmology outpatient department for ocular examination after being diagnosed with microdeletion of chromosome seven (7q36.2q36.3 deletion) in DNA microarray comparative genomic hybridization (DNA microarray CGH) and fluorescence in situ hybridization (FISH) tests. Fundus examination showed optic disc hypoplasia in both eyes and retinopathy of prematurity, accompanied by retinal hemorrhage in his right eye. Around the age of 24 months, the patient was diagnosed with intermittent exotropia with anisometropia and was prescribed spectacles. (Case 2) A 3-year-old male infant was referred to the ophthalmology clinic to evaluate poor fixation, which was found during rehabilitation therapy for cerebral palsy and developmental delay. Fundus examination showed an increased cup/disc ratio bilaterally. A flash visual evoked potential test indicated a decrease in amplitude in his right eye. Intermittent exotropia of forty prism diopters was observed. DNA microarray CGH and FISH tests performed at another hospital revealed microdeletion of chromosome seven (7q35 microdeletion) and CNTNAP2 gene loss. @*Conclusions@#When genetic anomalies associated with ocular development are identified, it is necessary to detect the ophthalmic abnormalities early and provide the appropriate treatment to allow for the development of normal visual function.

12.
Article in Korean | WPRIM | ID: wpr-901020

ABSTRACT

Purpose@#To report a case of unilateral progressive atypical acute zonal outer retinitis in a healthy young female.Case summary: A 32-year-old healthy woman presented with visual disturbance in the left eye for 1 week. Best corrected visual acuity was 0.4 in the left eye. No abnormal findings were detected on brain magnetic resonance imaging and a laboratory work-up. Zonal retinal opacity around the optic nerve disc was noticed in a fundus photo which was consistent with the outer retinal signal defect on optical coherence tomography and a defect in the central visual field from perimetry. Multiple evanescent white dot syndrome was suspected based on fluorescein angiography and indocyanine green angiography. Prednisolone was prescribed. Visual acuity was reduced to hand-motion after 10 days with extended zonal retinal opacity. No virus was detected by multiplex polymerase chain reaction of the aqueous humor. The lesion did not improve despite high-dose intravenous steroid and antiviral treatment. @*Conclusions@#Visual function was lost with the progression of outer retinitis. This case differed from previous cases as the outer retinitis progressed rapidly from the posterior pole to the peripheral retina. It was named fulminant progressive atypical acute zonal outer retinitis.

13.
Article in Korean | WPRIM | ID: wpr-901016

ABSTRACT

Purpose@#To analyze the clinical manifestations of culture-proven infective keratitis patients over a recent 10-year period. @*Methods@#We retrospectively reviewed the medical records of 956 cases of infective keratitis between January 2008 and December 2017 at eight tertiary hospitals. The study was performed to analyze the risk factors, causative microbial organisms, therapeutic outcomes, and prognosis. @*Results@#The most common risk factor of keratitis was trauma (33.2%). Initial visual acuity (V/A) was finger count or less in 449 eyes (47.0%). The common location of keratitis was central, and the size was 4 mm2 or less. Hypopyon was observed in 295 eyes (30.9%). Of the 1,039 cultured isolates, 443 (42.6%) grew Gram-negative bacteria with the most common being Pseudomonas aeruginosa. The most prevalent Gram-positive bacteria was Staphylococcus epidermidis, and fungi was Fusarium species. Surgical treatments were performed in 201 eyes (21.0%), followed by amniotic membrane transplantation (66 eyes) and evisceration (44 eyes). Final V/A was 20/100 or more in 422 eyes (44.1%). Gram-positive organisms were highly susceptible to moxifloxacin and vancomycin, and Gram-negative organisms were highly susceptible to levofloxacin and ceftazidime. An increase in resistance to these antibiotics was detected for Enterococcus and Pseudomonas. @*Conclusions@#In South Korea, infective keratitis occurs frequently in eyes with trauma. Staphylococcus epidermidis, Pseudomonas aeruginosa, and Fusarium species are commonly identified etiologies of microbial keratitis. The appropriate administered medical and surgical treatments of suspected infectious keratitis can lead to visual improvement with particular care taken to minimize infection related to resistant bacteria and fungal microbes as needed. An initial V/A of 0.02 or less, the presence of hypopyon, age of 65 years or more, and a central lesion were associated with poor clinical outcome of bacterial keratitis. Age of 70 years or more was a significant risk factor for poor clinical outcome of fungal keratitis.

14.
Journal of Stroke ; : 213-222, 2021.
Article in English | WPRIM | ID: wpr-900647

ABSTRACT

Background@#and Purpose Previous studies have assessed the relationship between cerebral vessel tortuosity and intracranial aneurysm (IA) based on two-dimensional brain image analysis. We evaluated the relationship between cerebral vessel tortuosity and IA according to the hemodynamic location using three-dimensional (3D) analysis and studied the effect of tortuosity on the recurrence of treated IA. @*Methods@#We collected clinical and imaging data from patients with IA and disease-free controls. IAs were categorized into outer curvature and bifurcation types. Computerized analysis of the images provided information on the length of the arterial segment and tortuosity of the cerebral arteries in 3D space. @*Results@#Data from 95 patients with IA and 95 controls were analyzed. Regarding parent vessel tortuosity index (TI; P<0.01), average TI (P<0.01), basilar artery (BA; P=0.02), left posterior cerebral artery (P=0.03), both vertebral arteries (VAs; P<0.01), and right internal carotid artery (P<0.01), there was a significant difference only in the outer curvature type compared with the control group. The outer curvature type was analyzed, and the occurrence of an IA was associated with increased TI of the parent vessel, average, BA, right middle cerebral artery, and both VAs in the logistic regression analysis. However, in all aneurysm cases, recanalization of the treated aneurysm was inversely associated with increased TI of the parent vessels. @*Conclusions@#TIs of intracranial arteries are associated with the occurrence of IA, especially in the outer curvature type. IAs with a high TI in the parent vessel showed good outcomes with endovascular treatment.

15.
Article in English | WPRIM | ID: wpr-899998

ABSTRACT

Weiss-Kruszka syndrome (WSKA), caused by heterozygous loss-of-function variants in ZNF462 gene, is a recently described and extremely rare genetic disorder. The main phenotypes include characteristic craniofacial features, ptosis, dysgenesis of the corpus callosum, and neurodevelopmental impairment. We report the first Korean boy with molecularly confirmed WSKA presenting with an atypical manifestation. A 16-year-old boy with a history of bilateral ptosis surgery presented with short stature (−3.49 standard deviation score) and delayed puberty. The patient showed characteristic craniofacial features including an inverted triangular-shaped head, exaggerated Cupid's bow, arched eyebrows, down-slanting palpebral fissures, and poorly expressive face. He had a mild degree of intellectual disability and mild hypotonia. Endocrine studies in the patient demonstrated complete growth hormone deficiency (GHD) associated with empty sella syndrome (ESS), based on a magnetic resonance imaging study for the brain that showed a flattened pituitary gland and cerebrospinal fluid space herniated into the sella turcica. To identify the genetic cause, we performed whole exome sequencing (WES). Through WES, a novel de novo heterozygous nonsense variant, c.4185del; p.(Met1396Ter) in ZNF462 was identified. This is the first case of WSKA accompanied by primary ESS associated with GHD. More clinical and functional studies are needed to elucidate this association.

16.
Article in English | WPRIM | ID: wpr-899923

ABSTRACT

Background@#The coronavirus disease 2019 (COVID-19) pandemic began in December 2019.While it has not yet ended, COVID-19 has already created transitions in health care, one of which is a decrease in medical use for health-related issues other than COVID-19 infection.Korean soldiers are relatively homogeneous in terms of age and physical condition. They show a similar disease distribution pattern every year and are directly affected by changes in government attempts to control COVID-19 with nonpharmaceutical interventions. This study aimed to identify the changes in patterns of outpatient visits and admissions to military hospitals for a range of disease types during a pandemic. @*Methods@#Outpatient attendance and admission data from all military hospitals in South Korea from January 2016 to December 2020 were analyzed. Only active enlisted soldiers aged 18–32 years were included. Outpatient visits where there was a diagnosis of pneumonia, acute upper respiratory tract infection, infectious conjunctivitis, infectious enteritis, asthma, allergic rhinitis, allergic conjunctivitis, atopic dermatitis, urticaria, and fractures were analyzed. Admissions for pneumonia, acute enteritis, and fractures were also analyzed. All outpatient visits and admissions in 2020 for each disease were counted on a weekly basis and compared with the average number of visits over the same period of each year from 2016 to 2019. The corrected value was calculated by dividing the ratio of total weekly number of outpatient visits or admissions to the corresponding medical department in 2020 to the average in 2016–2019. @*Results@#A total of 5,813,304 cases of outpatient care and 143,022 cases of admission were analyzed. For pneumonia, the observed and corrected numbers of outpatient visits and admissions in 2020 decreased significantly compared with the average of other years (P < 0.001). The results were similar for outpatient visits for acute upper respiratory tract infection and infectious conjunctivitis (P < 0.001), while the corrected number of outpatient visits for infectious enteritis showed a significant increase in 2020 (P = 0.005). The corrected number of outpatient visits for asthma in 2020 did not differ from the average of the previous 4 years but the number of visits for the other allergic diseases increased significantly (P < 0.001). For fractures, the observed and corrected numbers of outpatient visits and admissions in 2020 decreased significantly compared with the average of other years (P < 0.001). @*Conclusion@#During the COVID-19 pandemic, outpatient visits to military hospitals for respiratory and conjunctival infections and fractures decreased, whereas visits for allergic diseases did not change or increased only slightly. Admissions for pneumonia decreased significantly in 2020, while those for acute enteritis and fractures also decreased, but showed an increased proportion compared with previous years. These results are important because they illustrate the changing patterns in lifestyle as a result of public encouragement to adopt nonpharmaceutical interventions during the pandemic and their effect on medical needs for both infectious and noninfectious diseases in a select group.

17.
Article in English | WPRIM | ID: wpr-898223

ABSTRACT

Background@#Sarcopenia is defined as the loss of skeletal muscle mass and is associated with negative clinical outcomes. This study aimed to establish sex-specific cutoff values for the skeletal muscle area (SMA) and skeletal muscle index (SMI) at the third lumbar vertebral (L3) level using computed tomography (CT) imaging to identify sarcopenia in healthy Korean liver donors. @*Methods@#This retrospective study included 659 healthy liver donors (408 men and 251 women) aged 20 to 60 years who had undergone abdominal CT examinations between January 2017 and December 2018. Assessment of body composition was performed with an automated segmentation technique using a deep-learning system. Sex-specific SMA and SMI distributions were assessed, and cutoff values for determining sarcopenia were defined as values at either two standard deviations (SDs) below the mean reference value or below the fifth percentile. @*Results@#Using the SD definition, cutoff values for SMA and SMI were 117.04 cm2 and 39.33 cm2/m2, respectively, in men and 71.39 cm2 and 27.77 cm2/m2, respectively, in women. Using the fifth percentile definition, cutoff values for SMA and SMI were 126.88 cm2 and 40.96 cm2/m2, respectively, in men and 78.85 cm2 and 30.60 cm2/m2, respectively, in women. @*Conclusion@#Our data provide sex-specific cutoff values for the SMA and SMI at the L3 level measured by CT imaging in a healthy Korean population, which may be applicable for identifying sarcopenia in this population.

18.
Article in English | WPRIM | ID: wpr-897686

ABSTRACT

Background/Aims@#Hepatitis B core antibody (anti-HBc)-positive donors are used as an extended donor pool, and current guidelines recommend the usage of nucleos(t)ide analogues (NAs) as prophylaxis for preventing de novo hepatitis B virus infection (DNH). We analyzed the long-term outcomes of a large cohort of liver transplantation (LT) patients receiving anti-HBc-positive grafts and evaluated the risk of DNH when hepatitis B immunoglobulin (HBIG) monotherapy was used as prophylaxis. We also compared the cost-effectiveness of HBIG and NAs. @*Methods@#We retrospectively reviewed 457 patients with anti-HBc-positive grafts and 898 patients with anti-HBc-negative grafts who underwent LT between January 2001 and December 2018. We compared recipient characteristics according to the anti-HBc status of the donor, and compared the costs of using NAs for the rest of the patient’s life and using HBIG to maintain hepatitis B surface antibody titers above 200 IU/L. @*Results@#The 1-, 5-, and 10-year patient survival rates were 87.7%, 73.5%, and 67.7%, respectively, in patients with anti-HBc-positive grafts, and 88.5%, 77.4%, and 70.3%, respectively, in patients with anti-HBc-negative grafts (P=0.113). Among 457 recipients with anti-HBc-positive grafts, 117 (25.6%) were non-HBV recipients. The overall incidence of DNH was 0.9%. When using HBIG under insurance coverage, the cumulative cost was lower compared with using NA continuously without insurance coverage in Korea. @*Conclusions@#Anti-HBc-positive grafts alone do not affect patient survival or graft survival. HBIG monoprophylaxis has good outcomes for preventing DNH, and the patient’s long-term cost burden is low in Korea because of the national insurance system in this cohort.

19.
Article in English | WPRIM | ID: wpr-894632

ABSTRACT

Purpose@#To describe the development of multiple retinal hemorrhages after uncomplicated macular hole (MH) surgery, and to determine the associated factors. @*Methods@#The medical records of 163 patients (167 eyes) diagnosed with idiopathic MHs and who underwent surgery at Pusan National University Hospital between March 2016 and July 2018 were retrospectively reviewed. The development of retinal hemorrhages was evaluated using ultra-widefield fundus photographs. Multiple retinal hemorrhages were defined as three or more dot or blot hemorrhages that had not been observed before and during the surgery. The patients were divided into two groups according to the presence of multiple retinal hemorrhages. The variable parameters were compared between the two groups to find the risk factors. The associated factors were evaluated further for the independent factor using multiple logistic regression analysis. @*Results@#Multiple retinal hemorrhages were observed in 31 eyes (18.6%) after MH surgery. The associated factors were the surgical induction of posterior vitreous detachment (PVD) (p = 0.003), use of the internal limiting membrane flap technique (p = 0.028), and staining with Brilliant Blue G (BBG) (p = 0.003). Retinal hemorrhages were exclusively observed in eyes in which BBG was used. Surgical PVD induction was the only independent risk factor (odds ratio, 13.099; p = 0.013). No statistically significant differences were observed between the two groups in the postoperative visual outcomes and MH closure rate. Additionally, patients who underwent surgery for idiopathic epiretinal membrane during the study period were reviewed to validate the above findings. Multiple retinal hemorrhages were noted in only one case (0.4%) in which BBG was used after surgical induction of PVD. @*Conclusions@#Multiple retinal hemorrhages after MH surgery appear to be related to the intravitreal use of BBG in eyes that sustained mechanical damage because of surgical induction of PVD; however, they did not affect surgical outcomes.

20.
Korean Journal of Medicine ; : 139-142, 2021.
Article in English | WPRIM | ID: wpr-894534

ABSTRACT

Hypokalemia is a common finding in various clinical settings; it is associated with diuretic use and loss of potassium via the gastrointestinal tract. Less common causes are renal tubular acidosis, diabetic ketoacidosis, excess insulin, primary hyperaldosteronism, and medications, such as amphotericin B. Nafcillin, a narrow-spectrum penicillin class antibiotic, which is selectively prescribed for methicillin-susceptible Staphylococcal aureus infections, and is commonly associated with gastrointestinal side effects, such as nausea, vomiting, and abdominal pain. However, in rare cases it can cause hypokalemia, which is usually overlooked. Severe hypokalemia was detected in a 59-year-old male patient hospitalized due to traumatic cerebral hemorrhage who received 12 g of nafcillin per day for more than 2 weeks for sepsis caused by methicillin-sensitive Staphylococcus epidermidis. We confirmed the association between nafcillin and hypokalemia through further evaluation and a review of the relevant literature. Clinicians should be aware of hypokalemia as a complication when using high doses of nafcillin.

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