Longitudinal Changes in Layered Retinal Thickness during Axial Elongation in Healthy Myopic Eyes

Purpose@#To investigate longitudinal changes in foveal retinal sublayer thicknesses during axial elongation. @*Methods@#From February 2013 to September 2014, a prospective cohort was established comprising pediatric patients aged 0.05, linear mixed-effects model). @*Conclusions@#The foveal retinal sublayers maintained their thicknesses despite axial elongation, indicating that the foveal retinal structure, which is critical to visual acuity, is preserved even in elongated, myopic eyes.

Discrepancy between the Actual Clinical Status of Patients with Hepatocellular Carcinoma and Expectations from Hepatocellular Carcinoma Surveillance: a Single-Center Study

BACKGROUND/AIMS: The National Liver Cancer Screening Program (NLCSP) has been implemented for the past 15 years in Korea. However, the actual clinical experience in Korea is inconsistent with the expectations of the hepatocellular carcinoma (HCC) surveillance program. To evaluate the actual clinical situation of HCC diagnoses, we investigated disease severity in patients with HCC and the diagnostic environment. METHODS: From January 2011 to December 2015, all patients who were diagnosed with HCC in a single secondary hospital in Daejeon city were retrospectively enrolled in this study. Severity of HCC was evaluated according to the Barcelona Clinic Liver Cancer (BCLC) staging system. RESULTS: Over the course of 5 years, 298 participants were enrolled. The mean age of participants was 64.0 years. Positive hepatitis B surface antigen was confirmed in 134 patients (45.0%), 35 patients (11.7%) tested positive for anti-hepatitis C virus antibody, and 93 patients (32.2%) had more than 40 g/day of alcohol consumption. The proportions of patients according to BCLC stages were as follows: BCLC-0, 28 patients (9.4%); BCLC-A, 42 patients (14.1%); BCLC-B, 26 patients (8.7%); BCLC-C, 134 patients (45.0%); and BCLC-D, 68 patients (22.8%). The diagnostic environments were as follows: 19 patients were in the NLCSP group (6.4%), 114 in the group with presenting signs (38.3%), 110 in the regular outpatient care group (36.9%), and 55 patients in the incidental diagnosis group (18.5%). CONCLUSIONS: Most patients (67.8%) had advanced stage HCC at diagnosis, and curative treatment was not indicated due to the severity disease. Thus, the actual situation is far worse than the theoretical expectation of HCC surveillance, suggesting that many high-risk patients for HCC are missed in surveillance.

Factors Affecting ISNT Rule Satisfaction in Normal and Glaucomatous Eyes

PURPOSE: To determine the factors that influence the satisfaction of the ‘ISNT rule’ (neural rim width: inferior ≥ superior ≥ nasal ≥ temporal) in normal and glaucomatous eyes. METHODS: The medical records of patients that visited Boramae Medical Center, Seoul, Korea, were reviewed. Each group of normal and glaucomatous eyes was divided into subgroups based on whether or not they satisfied the ISNT rule. ISNT rule assessment was performed by measuring the rim width with stereoscopic optic disc photographs using ImageJ software. Logistic regression analysis was performed to determine the factors that affect ISNT rule satisfaction. RESULTS: Seventy-seven normal eyes and 97 glaucomatous eyes were included in the study. The ISNT rule was intact in 59 (76.6%) of the normal eyes and was violated in 71 (73.2%) of the glaucomatous eyes. Logistic regression analysis revealed a significant influence of axial length in violation of the ISNT rule in the normal eye group, while the mean deviation value was a significant factor for violation of the ISNT rule in the glaucomatous eye group. CONCLUSIONS: The ISNT rule should be cautiously applied when evaluating normal eyes with long axial lengths. In addition, the ISNT rule might not be as effective for detecting early glaucoma.

The Influence of Hearing Ability of Ordinary People on the Quality of Life / 보건행정학회지

BACKGROUND: In this research, we conducted an analysis to grasp the relationship between hearing and quality of life and to prepare effective troubleshooting. METHODS: In this study, we analyzed using the data of the 6th term of the National Health and Nutrition Survey of the Disease Management Headquarters. And, out of 7,380 people, 3,598 adults over the age of 40 years who participated in the hearing test were selected as final research subjects and analyzed. RESULTS: It was confirmed that the result of the analysis affects the quality of life based on hearing. The quality of life associated with hearing loss was unpleasant, motor ability, anxiety/depression, and everyday life affected in order of self management. And factors having an effect on the quality of life of the study subjects were found to be gender, elderly, unmarried, low hearing, low household income, absence of economic activity, and low teaching standards. CONCLUSION: The conclusion is that strengthening education for realistic management and prevention rather than treatment for unconditional hearing impairment will overcome low self esteem and loneliness and alleviate any uncomfortable life that people with hearing loss give. It is expected to be possible.

Cardiac diastolic dysfunction predicts poor prognosis in patients with decompensated liver cirrhosis

BACKGROUND/AIMS: Left ventricular diastolic dysfunction (LVDD) is an early manifestation of cardiac dysfunction in patients with liver cirrhosis (LC). However, the effect of LVDD on survival has not been clarified, especially in decompensated LC. METHODS: We prospectively enrolled 70 patients with decompensated LC, including ascites or variceal bleeding, at Daejeon St. Mary's Hospital from April 2013 to April 2015. The cardiac function of these patients was evaluated using 2D echocardiography with tissue Doppler imaging. The diagnosis of LVDD was based on the American Society of Echocardiography guidelines. The primary endpoint was overall survival. RESULTS: Forty-four patients (62.9%) had LVDD. During follow-up (22.3 months), 18 patients died (16 with LVDD and 2 without LVDD). The survival rate was significantly lower in patients with LVDD than in those without LVDD (31.1 months vs. 42.6 months, P=0.01). In a multivariate analysis, the Child-Pugh score and LVDD were independent predictors of survival. Moreover, patients with a ratio of early filling velocity to early diastolic mitral annular velocity (E/e') ≥ 10 (LVDD grade 2) had lower survival than patients with E/e' ratio < 10. CONCLUSIONS: The presence of LVDD is associated with poor survival in patients with decompensated LC. Therefore, it may be important to monitor and closely follow LVDD patients.

Rejuvenation Using Platelet-rich Plasma and Lipofilling for Vaginal Atrophy and Lichen Sclerosus

Vaginal atrophy is a common condition among peri- and post-menopausal women. Symptoms of vaginal dryness, pruritus, irritation, loss of subcutaneous fat, sparse pubic hair and dyspareunia occur due to decreased estrogen level. Estrogen-based treatments are effective. But many patients are reluctant to be treated due to health concerns. As alternatives, we explored the efficacy of platelet-rich plasma (PRP) and lipofilling. A 67-year-old female patient with vaginal atrophy was referred to our department. Treatment using estrogen cream had failed to improve patient's symptoms. Diminished volume and aged look of genitalia were also major concerns. We treated her using lipofilling mixed with PRP. A total of 40 cc of autologous fat mixed with PRP was transferred to labia majora. Lipofilling with PRP relieved the clinical symptoms. Missing fullness and tone was corrected and the augmented volume was well maintained. White patchy lesions of lichen sclerosus on labia minora also improved. Lipofilling with PRP relieved symptoms, restored contour of the labia majora and achieved remission of lichen sclerosus on labia minora. As vulvar lesions were repaired and the aged appearance of genitalia was rejuvenated, both functional and cosmetic outcomes were satisfactory. Lipofilling with PRP can be effective for vaginal atrophy and lichen sclerosus.

Use of Novel Oral Anticoagulant to Treat Pulmonary Thromboembolism in Patient with Ulcerative Colitis Superinfected Cytomegalovirus Colitis / 대한소화기학회지

Crohn's disease and ulcerative colitis are the two major types of inflammatory bowel disease, and affect mainly the gastrointestinal tract but also have extraintestinal sequelae, such as arterial and venous thromboembolism. Thromboembolic complications, particularly pulmonary thromboembolism, can be life threatening and require prompt management with anticoagulants. Conventional vitamin K antagonists have been used for the treatment of thromboembolic complications, but the development of novel oral anticoagulants has shifted the paradigm. We report a case of a 42-year-old female with ulcerative colitis who experienced an acute flare-up due to cytomegalovirus superinfection with pulmonary thromboembolism. She was treated with oral mesalamine, intravenous steroid and ganciclovir and low-molecular-weight heparin, followed by rivaroxaban, a novel oral anticoagulant. Her symptoms resolved after treatment, and no recurrence was noted during a 6-month post-treatment follow-up.

Biomechanical Analysis of Resorbable Barbed Suture Tenorrhaphy

PURPOSE: To evaluate the tensile strength and repair-site profile of a technique of resorbable barbed suture tenorrhaphy. METHODS: Forty-eight flexor digitorum profundus tendons were collected from the 8 adult cadavers. In the test group, the tendons were sutured using absorbent 2-0 barb knotless sutures in a 2-strand or 4-strand zig-zag pattern. In the control group, 2-0 Prolene and 3-0 polydioxanone (PDS) were used to suture the tendons using the 2-stand Modified Kessler method and the 4-strand cruciate suture method. Using a tensile force measurement machine, the breaking load (N) and the stiffness (N/mm) were measured. The types of rupture were categorized into suture breaking, knot rupture, and pullout. RESULTS: In the comparative analysis between the absorbent 2-0 Quill (Angiotech Pharmaceuticals, Canada) suture that used the 2-strand core suture and the 3-0 PDS and 2-0 Prolene sutures, the average breaking load for the 2-0 Quill suture was 26.83±7.47 N, and 21.96±6.78 N and 17.20±4.93 N for the 2-0 Prolene and 3-0 PDS sutures. In the comparison using the 4-strand core suture, the average breaking load for the 2-0 Quill suture was 62.50±13.34 N, and 22.35±5.72 N and 18.67±4.27 N for the 2-0 prolene and 3-0 PDS sutures. The most common type of rupture were knot rupture. CONCLUSION: For flexor tendon sutures using the absorbent barb sutures, compared to the conventional 2-0 Prolene or 3-0 PDS sutures, absorbent barbed sutures have a higher tensile strength.

Conjoined unification venoplasty for triple portal vein branches of right liver graft: a case report and technical refinement

Anomalous portal vein (PV) branching of the donor liver is uncommon and usually makes two, or rarely, more separate PV branches at the right liver graft. Autologous PV Y-graft interposition has long been regarded as the standard procedure, but is currently replaced with the newly developed technique of conjoined unification venoplasty (CUV) due to its superior results. Herein, we presented a case of CUV application to three PV openings of a right liver graft. The recipient was a 32-year-old male patient with hepatitis B virus-associated liver cirrhosis. The living liver donor was his 33-year-old sister who had a type III PV anomaly, but the right posterior PV branch was bifurcated early into separate branches of the segments VI and VII, thus three right liver PV branches were cut separately. We used the CUV technique consisting of placement of a small vein unification patch between three PV orifices, followed by overlying coverage with a crotch-opened autologous portal Y-graft. The portal Y-graft was excised and its crotches were incised to make a wide common orifice. Three bidirectional running sutures were required to attach the crotch-opened autologous portal Y-graft. After portal reperfusion, the conjoined PV portion bulged like a tennis ball, providing a wide range of alignment tolerance. The patient recovered uneventfully from the liver transplantation operation. The CUV technique enabled uneventful reconstruction of triple donor PV orifices. Thus, CUV can be a useful and effective technical option for reconstruction of right liver grafts with various anomalous PVs.

A Case of Myocardial Infarction Occurred after Endoscopic Submucosal Dissection under Bridging Therapy with Low Molecular Weight Heparin

Myocardial infarction (MI) is a complication that can occur after endoscopic submucosal dissection (ESD). However, very few reports are available about this complication. A 71-year-old male, who had two drug eluting stents inserted due to ischemic heart disease, was referred to the Division of Gastroenterology for ESD of a lesion suspicious of early gastric cancer. ESD was performed after dual antiplatelet agents were discontinued and bridging therapy with low molecular weight heparin (LMWH) was initiated. However, MI occurred immediately after the ESD procedure. A coronary angiogram did not show any significant stent thrombosis or restenosis. The patient recovered spontaneously. Here, we report a case of MI that occurred after ESD under bridging therapy with LMWH.

Long-Term Outcomes of Trabeculectomy in Korean Patients with Juvenile Open-Angle Glaucoma

PURPOSE: To evaluate the outcomes and prognostic factors of trabeculectomy with mitomycin C in Korean patients with juvenile open-angle glaucoma (JOAG). METHODS: A retrospective review was performed on 29 eyes with JOAG who had undergone trabeculectomy between January 2004 and January 2013. Intraocular pressure (IOP) and postoperative complications were monitored at 1 day preoperatively, at 1 day, 1 week, 1 month, 3 months, 6 months, and 12 months postoperatively, and at final follow-up after postoperative 18 months. Surgical success was defined as a final IOP of <21 mm Hg or <80% of preoperative IOP, regardless of the use of anti-glaucoma medication. Prognostic factors for surgical success or failure were analyzed by the Cox proportional hazards model. RESULTS: Mean (+/- standard deviation) age at trabeculectomy was 24.6 (+/- 8.9) years, and mean follow-up period was 24.3 (+/- 20.8) months. The overall success rate was 82.8% at final follow-up. The Kaplan-Meier cumulative probabilities of surgical success were 100% at 1 year, 87.4% at 2 years, and 78.7% at 3 years postoperatively. The Cox proportional hazards model failed to determine any significant factors that were associated with surgical failure. The three most frequent postoperative complications were immediately postoperative hypotony (n = 19, 65.5%), hypotony maculopathy (n = 8, 27.6%), and encapsulated bleb (n = 8, 27.6%), most of which were resolved after a minor procedure or observation. Two of 8 eyes with encapsulated bleb required a second surgery. There were no vision-threatening severe complications. CONCLUSIONS: Trabeculectomy with MMC may be an effective treatment in Korean JOAG patients.

Unilateral Pulmonary Edema: A Rare Initial Presentation of Cardiogenic Shock due to Acute Myocardial Infarction

Cardiogenic unilateral pulmonary edema (UPE) is a rare clinical entity that is often misdiagnosed at first. Most cases of cardiogenic UPE occur in the right upper lobe and are caused by severe mitral regurgitation (MR). We present an unusual case of right-sided UPE in a patient with cardiogenic shock due to acute myocardial infarction (AMI) without severe MR. The patient was successfully treated by percutaneous coronary intervention and medical therapy for heart failure. Follow-up chest Radiography showed complete resolution of the UPE. This case reminds us that AMI can present as UPE even in patients without severe MR or any preexisting pulmonary disease affecting the vasculature or parenchyma of the lung.

A Comparison of Cornell and Sokolow-Lyon Electrocardiographic Criteria for Left Ventricular Hypertrophy in Korean Patients

BACKGROUND AND OBJECTIVES: Electrocardiography (ECG) is a cost-effective and useful method for diagnosing left ventricular hypertrophy (LVH) in a large-scale study or in clinical practice. Among ECG criteria, the Cornell product (Cor P) and Sokolow-Lyon criteria were adopted by the European Society of Hypertension-European Society of Cardiology Guidelines but have different performances among races. The aim of this study was to compare the diagnostic performance of two voltage criteria in Korean patients. SUBJECTS AND METHODS: Electrocardiography and echocardiographic LV mass of 332 (159 male, 173 female) consecutive patients were analyzed. Cornell voltage criteria and the Cor P were compared with Sokolow-Lyon voltage (Sok V) and the Sokolow-Lyon product (Sok P). The sensitivities and specificities were estimated using a receiver-operating characteristics (ROC) curve in relation to the LVH diagnosis. The sensitivities and revised cut-off values were derived at specificity levels of 90, 95, and 100%. RESULTS: The Cornell-based criteria generally showed better performance than that of the Sok V criteria and Sok P in the area under the ROC curve analysis. The revised cut-off values for the Cornell voltage criteria (20 and 16 mm for males and females, respectively) showed an improved sensitivity (19.7 and 30.3% for males and females, respectively), with a high specificity of 95%. CONCLUSION: The Cornell-based criteria had better performance than that of the Sokolow-Lyon criteria in both Korean men and women. However, revised cut-off values are needed to improve accuracy.

A Case of Transient Mid-Ventricular Ballooning Syndrome after Cardiac Arrest / 대한내과학회지

Stress-induced cardiomyopathy is characterized by transient wall-motion abnormalities involving the left ventricular apex. Emotional or physical stress might play a key role in this reversible form of cardiomyopathy, but the etiology remains unclear. Clinical features of stress-induced cardiomyopathyare similar to those of acute coronary syndrome, but there is no significant stenosis in the coronary arteries. Recently, transient mid-ventricular ballooning syndrome, a variant form of stress-induced cardiomyopathy in which only the mid-ventricle is affected, has been reported. Here, we report a case of a 42-year-old female patient who developed transient mid-ventricular ballooning syndrome after cardiac arrest during autologous fat transplantation.

A Case of Transient Ischemic Attack and Cardiomyopathy Presented with Pheochromocytoma / 대한내과학회지

Patients with pheochromocytoma show a variety of clinical symptoms secondary to excessive catecholamine secretion. Major symptoms include hypertension, headache, hyperhidrosis, and palpitation. Stroke and myocardial infarction are known to occur in patients with pheochromocytoma, but the incidence is low. Here, we describe a 45-year-old female with a previous history of transient ischemic attack and a clinical presentation mimicking acute myocardial infarction with transient takotsubo-like myocardial dysfunction. A subsequent diagnostic examination revealed a left adrenal pheochromocytoma. The patient recovered with intensive medical treatment, including alpha- and beta-adrenergic blockade. Follow-up echocardiography revealed normalized cardiac function and wall motion. Thereafter, the patient underwent a laparoscopic left adrenalectomy without complications.

Neuroprotective Effect of Rapamycin in Optic Nerve Transection Model

PURPOSE: The present study investigated whether rapamycin activated autophagy in retinal ganglion cells (RGC) and evaluated its effect on RGC survival following optic nerve transection (ONT). METHODS: The activation of autophagy in RGCs after intravitreal injection of rapamycin was evaluated with the immunohistochemical staining of phospho-S6 ribosomal protein. Rapamycin or 0.1% DMSO was injected intravitreally immediately after ONT. At 1 and 2 weeks after ONT, the RGCs were counted. Rapamycin and autophagy inhibitors, 3-methyladenine or Wortmannin were co-injected intravitreally after ONT and the RGCs were counted 1 week later. RESULTS: Expression of phospho-S6 ribosomal protein was decreased in RGCs after intravitreal injection of rapamycin. The RGC number was significantly higher in the rapamycin group than in the control group 1 week after ONT. However, the RGC number was not different between the 2 groups 2 weeks after ONT. Repeated intravitreal injection of rapamycin at 1-week intervals showed neuroprotection 2 weeks after ONT. The RGC number was not different between the control group and the co-injection group of rapamycin-autophagy inhibitor. CONCLUSIONS: Activated autophagy by rapamycin was neuroprotective in RGC after ONT.

Swan-Ganz Catheter-Induced Pulmonary Artery Rupture and Atelectasis Caused by a Bronchial Thrombus / 대한내과학회지

The use of pulmonary artery catheters has increased considerably since the Swan-Ganz catheter was first introduced in 1970. It is extremely helpful in the management of critically ill patients and in pulmonary hypertension. However, its manipulation carries potential risks, including subclavian or carotid artery laceration, pneumothorax, thoracic duct laceration, phrenic nerve injury, air embolism, arrhythmias, infection, valvular damage, thrombosis, pulmonary infarction, and pulmonary artery rupture. Pulmonary artery rupture, albeit rare, remains a severe complication. Here, we present a patient who developed pulmonary artery rupture and total atelectasis of the left lung after placement of a pulmonary artery catheter.

Swan-Ganz Catheter-Induced Pulmonary Artery Rupture and Atelectasis Caused by a Bronchial Thrombus / 대한내과학회지

The use of pulmonary artery catheters has increased considerably since the Swan-Ganz catheter was first introduced in 1970. It is extremely helpful in the management of critically ill patients and in pulmonary hypertension. However, its manipulation carries potential risks, including subclavian or carotid artery laceration, pneumothorax, thoracic duct laceration, phrenic nerve injury, air embolism, arrhythmias, infection, valvular damage, thrombosis, pulmonary infarction, and pulmonary artery rupture. Pulmonary artery rupture, albeit rare, remains a severe complication. Here, we present a patient who developed pulmonary artery rupture and total atelectasis of the left lung after placement of a pulmonary artery catheter.

Change in Angle Parameters Measured by Anterior Segment Optical Coherence Tomography after Laser Peripheral Iridotomy Alone versus Laser Peripheral Iridotomy and Argon Laser Peripheral Iridoplasty

PURPOSE: To compare the changes in angle parameters after laser peripheral iridotomy (LPI) alone versus LPI and ALPI (argon laser peripheral iridoplasty) in primary angle closure patients by using anterior segment optical coherence tomography (AS-OCT). METHODS: A total of 25 eyes from 17 patients with narrow angles were enrolled in this present study. Eleven eyes in the LPI treatment group and 14 eyes in the LPI and ALPI combined treatment group were evaluated using AS-OCT. The anterior chamber depth (ACD), angle opening distance at 500 microm (AOD 500) and 750 microm (AOD 750), angle recess area at 500 microm (ARA 500) and 750 microm (ARA 750), trabecular-iris space area at 500 microm (TISA 500) and 750 microm (TISA 750), trabecular-iris angle (TIA) were measured. The pre- and post-treatment parameters were compared in each group. The parameter changes after laser treatment were also compared. RESULTS: AOD 500, AOD 750, ARA 500, ARA 750, TISA 500 and TISA 750 except ACD significantly increased following LPI treatment (p = 0.013, p = 0.010, p = 0.008, p = 0.003, p = 0.006, p = 0.003, p = 0.013, respectively, Wilcoxon signed rank test) and LPI and ALPI combined therapy (p = 0.001, p = 0.001, p = 0.001, p = 0.001, p = 0.001, p = 0.001, p = 0.001, respectively, Wilcoxon signed rank test). The AOD 500 difference, TISA 500 difference, and TISA 750 difference were significantly greater after LPI and ALPI combined therapy than after LPI treatment alone (p = 0.112, p = 0.147, p = 0.049, p = 0.037, respectively, Mann-Whitney U-test). CONCLUSIONS: The results from the present study showed LPI alone or LPI and ALPI combined therapy significantly widened the anterior chamber angle and combined therapy showed greater effect than LPI alone.

The Measurement of Flow Resistance in Drainage Implants Using Various Tube Ligation Methods

PURPOSE: To evaluate the flow resistance though the tube in a glaucoma drainage implant using various tube ligation methods. METHODS: To measure the flow resistance, the following tube ligation methods were designed and tested: Type 1: no ligation of Ahmed valve tube. Type 2: ligation of Ahmed valve tube with 8-0 Vicryl. Type 3: ligation of Molteno tube and a 6-0 Vicryl as an intra-luminal stent with 8-0 Vicryl. Type 4: ligation of Ahmed valve tube and three strands of 8-0 nylon as extra-luminal stents with 8-0 Vicryl. Type 5: ligation of Ahmed valve tube and a 6-0 Prolene as an extra-luminal stent with 8-0 Vicryl followed by removal of the Prolene for partial ligation. RESULTS: The pressure was maintained under 0.143 mm Hg in type 1. In type 2, the pressure increased to 6.688 mm Hg and dropped to approximately 6.384 mm Hg. In type 3, the pressure was maintained at 5.396 mm Hg which decreased to 3.572 mm Hg after stent removal. In type 4, the pressure was maintained at 5.700 mm Hg which dropped to 5.472 mm Hg after the 1st stent removal, to 5.016 mm Hg after the 2nd stent removal and to 4.180 mm Hg after the 3rd stent removal. In type 5, the pressure increased to 6.384 mm Hg and decreased to 5.624 mm Hg. CONCLUSIONS: The tube ligation along with extra-luminal stents followed by staged removal may provide prevention of hypotony and staged control of intraocular pressure after a glaucoma implant operation.