The Effect of Anti-glaucoma Eyedrops and 0.1% Fluorometholone on Myopic Regression after LASIK or LASEK

PURPOSE: To evaluate the effect of combined medical treatment with anti-glaucoma eyedrops and 0.1% fluorometholone on visual acuity and refractive errors in patients complaining of blurred vision due to myopic regression after laser-assisted in-situ keratomileusis (LASIK) or laser-assisted sub-epithelial keratectomy (LASEK). METHODS: This study comprised 155 patients (155 eyes) who were diagnosed with myopic regression after LASIK or LASEK and received medical treatment from January 2015 to January 2016. The visual acuity and refractive errors were compared before and after medical treatment and evaluated to determine whether the results differ between LASIK and LASEK. RESULTS: The mean time of medical treatment was 64.1 ± 36.8 months after surgery. The responder group whose vision was improved and whose myopic error was decreased after medical treatment was comprised of 63 patients (41%). Their visual acuity in this group improved -0.21 ± 0.11 logMAR, and the amount of myopic error decreased 0.56 ± 0.32 diopters. The full responder group was 24 patients (15%), and the partial responder group was 39 patients (26%). The frequency of response to medical treatment was higher after LASIK than after LASEK, but the difference was not statistically significant. CONCLUSIONS: The combined medical treatment with anti-glaucoma eyedrops and 0.1% fluorometholone was effective in 41% of patients with regard to visual acuity improvement when used for post-LASIK or post-LASEK myopic regression. The medical treatment was effective after both LASIK and LASEK.

A Case of Emphysematous Pyelonephritis Complicated with Septic Pulmonary Embolism / 대한신장학회지

Emphysematous pyelonephritis is an unusual, severe gas-forming infection of renal parenchyma and its surrounding areas. It is a rare cause of septic pulmonary embolism. We report on a case of emphysematous pyelonephritis complicated with renal vein thrombosis and septic pulmonary embolism with review of the literature. A 51-year-old diabetic woman was admitted to our hospital with symptoms of fever, diffuse abdominal pain and nausea. Her initial laboratory findings showed pyuria and leukocytosis. She was diagnosed with acute pyelonephritis with abscess formation on contrast enhanced abdominal CT. She was treated with antibiotics and percutaneous abscess aspiration, but progressed to emphysematous pyelonephritis complicated with renal vein thrombosis and septic pulmonary embolism. Finally she underwent the left total nephrectomy.

A Case of Klebsiella pneumoniae Peritonitis in CAPD Patient with Liver Abscess / 대한신장학회지

A 42-year-old male was hospitalized with abdominal pain, dyspnea, and turbid peritoneal fluid. He was diagnosed with hypertension, diabetes and started continuous ambulatory peritoneal dialysis (CAPD) 11 months ago. He was treated with intraperitoneal cefazolin and ceftazidime, and then white blood cell counts of dialysate decreased. Incidentally, liver abscess was found in chest CT performed for the evaluation of dyspnea, and patient was febrile persistently. So percutaneous abscess drainage was done by pigtail catheter. We changed the antibiotics to ceftriaxone and metronidazole, and hemodialysis was started. Klebsiella pneumoniae was cultured from peritoneal fluid and blood simultaneously. We concluded that liver abscess is a primary cause of CAPD peritonitis.

Can Cilostazol Improve the Patency Rate of Native Arteriovenous Fistula in Hemodialysis Patients? / 대한신장학회지

PURPOSE: Vascular access failure is the most common reason for hospitalization among hemodialysis (HD) patients. Cilostazol, which has antiplatelet action and vasodialtory effects, significantly reduces the risk of restenosis after percutaneous coronary intervention in many patients. We conducted this study to evaluate the relationship between the use of antiplatelet agents, especially cilostazol, and arteriovenous fistula (AVF) patency in HD patients. METHODS: A total of 241 patients underwent native AVF creation from January 2001 to December 2008. Among these patients, we selected 86 patients excluding 38 patients (15.8%) with primary technical failure, 49 patients without complete data and 68 patients used cilostazol less than 1 month. Demographic characteristics, medication history and fistula failure rate were collected and analyzed to elucidate the effect of cilostazol to native AVF. RESULTS: From all groups, AVF failure occurred in 24 patients (27.9%). 28 patients received cilostazol (62.3 %) and mean duration of cilostazol therapy was 229.5+/-115.7 days. All patients were classified into two groups according to cilostazol (Cilostazol [n=28, 32.6%] vs. non-Cilostazol [n=58, 67.4%]. There was no statisticallly significant difference in failure rate between the two groups (32.1% vs. 25.9%, p=0.543). In diabetes group, patients who received statin have much lower AVF failure rate (0% vs. 32.4%, p=0.024). Logistic regression analysis showed that female was independent risk factor for access failure (HR 5.549, CI 1.104-27.877, p=0.037). CONCLUSION: Cilostazol and other antiplatelet agent had a no significant association with AVF patency. Female was an independent risk factor for access failure.

The Preoperative Prognostic Factors for Outcome After LASEK Using the MEL60

PURPOSE: To investigate the preoperative clinical factors affecting the refractive outcome after laser-assisted subepithelial keratomileusis (LASEK). METHODS: This retrospective study was conducted on 58 patients (116 eyes) who underwent bilateral LASEK using the MEL60. The outcome efficacy and predictability of LASEK was examined by analyzing data including age, gender, preoperative uncorrected visual acuity, preoperative refraction (spherical equivalent and cylindrical diopter), central corneal thickness, tear breakup time, and Schirmer test through multiple logistic regression analysis. RESULTS: The preoperative factor associated with postoperative uncorrected visual acuity was the amount of preoperative spherical equivalent. Greater preoperative spherical equivalent was associated with decreased efficacy. Predictability was also associated with the amount of preoperative spherical equivalent. Greater preoperative spherical equivalent was associated with decreased predictability. The other preoperative factors including sex, age, preoperative uncorrected visual acuity, amount of preoperative cylinder diopter, intraocular pressure, tear breakup time, Schirmer test and central corneal thickness did not show any association with efficacy or predictability. CONCLUSIONS: The preoperative spherical equivalent was determined as the most important prognosis factor in LASEK, as it is in PRK or LASIK.

Clinical features of acute kidney injury in the elderly / 대한내과학회지

BACKGROUND/AIMS: The number of elderly individuals continues to increase, as does the incidence of acute kidney injury (AKI). There are few data concerning the clinical features and prognosis in AKI in the elderly in Korea. METHODS: Patients over 80 years old admitted to our hospital with a diagnosis of AKI between January 2004 and December 2005 were evaluated. Etiology, clinical, and prognostic variables were analyzed. RESULTS: The mean age was 82.6+/-2.2 years. The cause of AKI was dehydration (37.1%), infection (33.9%), bleeding (8.1%), contrast material (4.8%), drugs (4.8%), obstruction (3.2%), cardiogenic shock (3.2%), renal infarction (1.6%), rhabdomyolysis (1.6%), and hepatorenal syndrome (1.6%). The mortality rate was 29.0% and the major cause of death was pneumonia (50.0%). Based on the univariate analyses, albumin, serum sodium, number of failing organs, ventilatory support, need for a vasopressor, ICU care, sepsis, and infection were all significant factors discriminating between survivors and non-survivors (p<0.05). CONCLUSIONS: AKI in the elderly is not a different entity from that encountered in other age groups and age alone should never be a drawback to appropriate therapy.

Short-term Effect of Intravitreal Bevacizumab Injection Preventing Panretinal Photocoagulation-Induced Macular Edema in Proliferative Diabetic Retinopathy

PURPOSE: To investigate the effect of intravitreal bevacizumab injection in preventing panretinal photocoagulation (PRP)-induced macular edema and visual dysfunction in proliferative diabetic retinopathy. METHODS: We conducted a prospective study of 40 consecutive eyes (20 patients) with proliferative diabetic retinopathy whose visual acuity (logMAR) was 0.2 or less, foveal thickness (microm) was 280 or less, and retinopathy was bilaterally symmetrical. In Group 1 (20 eyes), PRP was performed with intravitreal bevacizumab injection 1 week before the initiation of PRP, but in Group 2 (20 eyes) PRP alone was performed. In all eyes, PRP was completed using the same technique. Best corrected visual acuity (BCVA) and foveal and parafoveal thicknesses were measured before treatment and 1 and 3 months after PRP. RESULTS: Before treatment, the mean BCVA and foveal and parafoveal thicknesses were not statistically significantly different between the two groups (p>0.05). At 1 and 3 months after PRP, the mean BCVA improved and the foveal and parafoveal thicknesses were significantly smaller in Group 1 than in Group 2 (p<0.05). CONCLUSIONS: Intravitreal bevacizumab injection before PRP could help prevent PRP-induced macular edema and visual dysfunction in patients with proliferative diabetic retinopathy and good vision.

Short-term Effect of Intravitreal Bevacizumab Injection Preventing Panretinal Photocoagulation-Induced Macular Edema in Proliferative Diabetic Retinopathy

PURPOSE: To investigate the effect of intravitreal bevacizumab injection in preventing panretinal photocoagulation (PRP)-induced macular edema and visual dysfunction in proliferative diabetic retinopathy. METHODS: We conducted a prospective study of 40 consecutive eyes (20 patients) with proliferative diabetic retinopathy whose visual acuity (logMAR) was 0.2 or less, foveal thickness (microm) was 280 or less, and retinopathy was bilaterally symmetrical. In Group 1 (20 eyes), PRP was performed with intravitreal bevacizumab injection 1 week before the initiation of PRP, but in Group 2 (20 eyes) PRP alone was performed. In all eyes, PRP was completed using the same technique. Best corrected visual acuity (BCVA) and foveal and parafoveal thicknesses were measured before treatment and 1 and 3 months after PRP. RESULTS: Before treatment, the mean BCVA and foveal and parafoveal thicknesses were not statistically significantly different between the two groups (p>0.05). At 1 and 3 months after PRP, the mean BCVA improved and the foveal and parafoveal thicknesses were significantly smaller in Group 1 than in Group 2 (p<0.05). CONCLUSIONS: Intravitreal bevacizumab injection before PRP could help prevent PRP-induced macular edema and visual dysfunction in patients with proliferative diabetic retinopathy and good vision.

A Case of Primary B-cell Lymphoblastic Lymphoma of the Orbit in a Pediatric Patient

PURPOSE: We report a case of orbital B-cell lymphoblastic lymphoma in a 7-year-old boy. METHODS: A 7-year-old boy presented with proptosis and periorbital swelling of his left eye following a periorbital blunt trauma 1-month prior. During the course of routine ophthalmologic and radiologic examinatinos, the swelling spontaneously subsided without specific treatment. An outpatient follow-up was planned, but the swelling recurred 6 months later. An orbital CT and MRI showed an irregular mass with an indistinct margin in the left orbit, for which an incisional biopsy was performed. RESULTS: The orbital mass consisited of monotonous small to medium sized lymphoid cells with evenly dispersed open chromatin, thin nuclear membrane and inconspicuous nucleoli. Immunohistochemistry revealed that the cells were positive for CD79a and TdT, but negative for CD3 and CD5. These findings were compatible with a diagnosis of B cell lymphoblastic lymphoma. CONCLUSIONS: Lymphoblastic lymphoma of the orbit should be suspected and considered in the differential diagnosis for children with acutely progressing orbital mass.

The Comparison of the Effects of Various Crystalloid Solutions on the Resuscitation in Rabbits with Acute Hemorrhagic Shock / 대한마취과학회지

BACKGROUND: The purpose of this study is to evaluate what kind of crystalloid solution could function as the best buffer and correct the metabolic acidosis most effectively in rabbits with hemorrhagic shock. METHODS: Twenty eight rabbits were bled until mean arterial pressure(MAP) became 70% of control. Thirty minutes after hemorrhagic shock fluid resuscitation was started with either plasmalyte or Hartmann's solution or 0.9% normal saline until MAP returned to 90% of the control. Hemodynamic and blood gas study, plasma lactate and electrolyte concentration were measured before, during, and 30 minutes after recovery from shock. RESULTS: The amount of shed blood to reduce MAP to 70% of control ranged 76~87 ml. And the volume for fluid resuscitation was 274~324 ml. There was no statistically significant difference among the three groups. The pH decreased during shock in all group and still decreased after resuscitation in Hartmann's solution and normal saline. But it increased significantly after resuscitation in plasmalyte. Lactate was increased in all group during shock and decreased by 22 and 23 mg/dl after resuscitation in plasmalyte and normal saline. But it still increased by 40 mg/dl in Hartmann's solution. Serum potassium level decreased significantly after resuscitation with normal saline. Serum calcium level decreased significantly after resuscitation with plasmalyte and normal saline. CONCLUSION: With the above results the plasmalyte which has pH closer to that of normal blood might be able to avoid the metabolic acidosis and maintain acid-base equilibrium effectively after fluid resuscitation in acute hemorrhagic shock.

The Local Anesthetic Effect of Meperidine on the Direct Myocardial Depression in Isolated Ventricular Myocardium / 대한마취과학회지

BACKGROUND: The effects of various concentration (20, 50, 100 micrometer) of meperidine were studied in isolated guinea pig and rat ventricular papillary muscles. METHODS: Isometric force of guinea pig ventricular papillary muscle was examined in normal and 26 mM K+ Tyrode's solution. Experiments using rat and guinea pig papillary muscle under normal and low Na+ (40 mM), respectively, were performed to evaluate the effect on Ca2+ release from the sarcoplasmic reticulum (SR). Normal and slow action potentials (APs) were evaluated by using conventional microelectrode technique. Rapid cooling contractures were performed. RESULTS: Meperidine caused dose-dependent depression of peak force from rested-state (RS) to 3 Hz stimulation rates in guinea pig papillary muscles. Conduction block was frequently noted at high stimulation rates (2 and 3 Hz) at 150 micrometer meperidine. ~40% depression of peak force was shown at RS contraction under low Na+ Tyrode's solution, although contractile depression was not shown at RS and low stimulation rates in rat papillary muscles. 100 micrometer naloxone did not reverse the contractile depression caused by 100 micrometer meperidine. Either depression of dV/dt-max from 0.1 to 3 Hz stimulation rates or rate-dependent depression among 1, 2 and 3 Hz could be observed at 150 micrometer meperidine. In 26 mM K+ Tyrode's solution, 50 and 100 micrometer meperidine caused dose-dependent depression of early and late force development. In slow APs, changes of dV/dt-max were not shown at 100 micrometer meperidine. ~40% depression of contracture induced by rapid cooling following 2 Hz stimulation rates was shown at 100 micrometer meperidine. CONCLUSION: The direct myocardial depressant effect of meperidine seems likely to be caused by local anesthetic properties of meperidine, not by the opioid action. Inhibition of SR Ca2+ release, and decreased intracellular Ca2+ secondary to Na+ channel blocking action of meperidine may at least in part be related to direct myocardial depression.

Age-related Difference of the Vagal Reflex and Baroreceptor Reflex under General Anesthesia with Enflurane / 대한마취과학회지

BACKGROUND: Baroreceptor reflex responds to the decrease in blood pressure caused by drug, dehydration, or severe bleeding. Vagal reflex caused by direct pressure on vagus nerve, the traction, or lung inflation develops bradycardia and severe arrhythmia. Lung inflation elicits a vasodepressor reflex, resulting in stimulation of the vagus nerve which causes a decrease in sympathetic outflow. METHODS: 75 patients who had elective surgery were divided into 3 groups according to the age, such as group I: or = 65 years of age. Lung inflation test has been performed at 20 cmH2O for 20 seconds. Baroreceptor was stimulated by lowering blood pressure with intravenous infusions of nitroglycerin. Baroreceptor sensitivity was assessed by measuring the decrease in blood pressure. Vagal reflex sensitivity was calculated by the subtraction of G2 (baroreceptor reflex sensitivity after introglycerin infusion) from G1 (heart rate response to lung inflation). RESULTS: Baroreceptor reflex induced by hypotension and vagal reflex originated from lung influe-nced the heart rate inversely when lung inflated. Baroreceptor reflex sensitivity was highest in younger patients and lowest in older patients when nitroglycerin infused. Vagal reflex sensitivity was highest in older patients and lowest in younger patients. CONCLUSIONS: Baroreceptor reflex was most sensitive in younger patients, but vagal reflex was moresensitive in older patients.