A study for time sequential expression of IL-1 alphaand IL-6 after irradiation on rat lung / 대한내과학회지

BACKGROUND: One of the limitation during the irradiation of malignant tumor is hazard to normal tissue although it is important and effective tool for treating malignant tumor. We studied the role of interleukin-1 alpha (IL-1alpha) and interleukin-6 (IL-6) in the radiation-induced lung injury especially on fibrosis. METHODS: We irradiated right-side lungs of thirty Sprague-Dawley rats with single fraction of 20 Gy and then sacrificed the animals until 20th week at intervals of two weeks. Both irradiated and unirradiated lung tissues were stained hematoxilin and eosin, Masson trichrome, reticulin and immunohistochemical staining for IL-1alpha and IL-6. The degree of the staining for IL-1alpha and IL-6 were examined semiquantitatively. RESULTS: Two weeks after irradiation interstitial edema and capillary congestion appeared, followed by increase of the monocytes infiltration and proteinaceous material during 4th and 8th week. After eight weeks of irradiation, collagen and reticulin fibers were detected along alveolar wall. 12th to 20th week, fibrosis in interstitium, decreased number of alveoli and thickening of bronchial wall were observed. The degree of immunohistochemical staining for IL-1alpha and IL-6 was increased rapidly during the first three week and then decreased slowly, but remain incresed until 20th week. CONCLUSION: Our Study demonstrate the early and persistent elevation of cytokines IL-1alpha and IL-6 by immunohistochemical stain in rat lung following pulmonary irradiation. We think cytokines are produced immediately after irradiation, make collagen genes turn on and perisist until the expression of late effects become apparent pathologically and clinically.

A case of mantle cell lymphoma associated with tuberculous pleurisy / 대한내과학회지

Mantle cell lymphoma is relatively rare and generally difficult to differentiate from other types of lymphoma. The clinical course is very aggressive. We recently experienced a very rare patient with pleural mantle cell lymphoma associated with pleural tuberculosis. A 60-year-old female patient was admitted because of dyspnea. Chest films revealed pleural effusion. Analysis of pleural effusion was not diagnostic, but we started therapeutic trial for tuberculosis. After 2 months of anti-tuberculosis medication, the pleural effusion was not improved. We repeated pleural biopsy. Histologic finding was chronic inflammation but AFB culture was positive. After another 3 months of medications for tuberculosis, there was no improvement. We repeated pleural biopsy and thoracentesis. Repeated biopsy and the result of flow cytometry of pleural effusion were consistent with mantle cell lymphoma. We started chemotherapy for lymphoma. After three cycles of chemotherapy, pleural effusion was decreased, but she worsened and died of hepatic failure probably due to viral hepatitis.

Prevalence of Drug-resistances in Patients with Pulmonary tuberculosis and Its Association with Clinical characteristics at One Tertiary Rcferral Hospital in Pusan, Korea / 결핵

BACKGROUND: The incidence of drug-resistant tuberculosis has recently decreased in Korea. However, it is still one of the major obstacles in treating pulmonary tuberculosis. This study was performed to determine the prevalence and clinical characteristics associated with drug-resistance in pulmonary tuberculosis at the tertiary referral hospital in Pusan, Korea. METHODS: The medical records of 138 patients, who had been diagnosed as active pulmonary tuberculosis were retrospectively reviewed, and results of drug susceptibility from May 1997 to June 2000. The relationships among those with a history of previous tuberculosis treatment, the extent of lung involvement, the presence of cavities on the initial chest X-ray films and patterns of drug resistance were analyzed. RESULTS: The total number of patients who had drug resistance to at least one drug was 55(39.9%). Among them 34(24.6%) had resistance to isoniazid(INH) and rifampin(RFP). There was drug resistance in 20(22%) of 91 patients without previous tuberculosis therapy, and among them 9(9.9%) were multi-drug resistant. Thirty-two(74.5%) out of 47 patients with previous therapy were drug-resistant and 25(53.2%) were multidrug resistant. For all 138 patients, resistance to INH was the was the most common(34.1%), followed by RFP(26.1%) and ethambutol(EMB)(14.5%). Drug resistance to INH, RFP, PZA and streptomycin(SM) were independently assiciated with a history of previous treatment(odds ratio;9.43, 0.09, 8.93 and 21.6 respectively, p<0.01). The extent of lung involvement on the chest films was significantly associated with the drug resistance to INH and RFP(odds ratio;2.12 and 2.40 respectively, p<0.01). The prevalence of drug resistance to RFP, INH and RFP was significantly more common in patients with a cavitary lesion on the chest films by multivariate analysis(odds ratio;4.17 and 4.81 respectively, p<0.05). CONCLUSION: This study revealed that patients with a prior treatment history for pumonary tuberculosis, and the presence of a cavitary lesion on chest films had a higher prevalence of anti-tuberculosis drug resistance. A very careful clinical and microbiological examination is needed for patients with such characteristics.

Two Cases of Tuberous Sclerosis Patients with Renal Anomaly / 대한신장학회잡지

Tuberous sclerosis is a rare disease, which occurs sporadically or hereditarily and is recognized by its neurological and dermatological manifestations and may be accompanied with renal anomalies. The classical triad is composed of seizure, mental retardation and adenoma sebaceum on face. We experienced two cases of tuberous sclerosis in sporadic forms by mutation without any familial history which suggests the diseases were occurred by mutation rather than by autosomal dominant inheritance. In the first case, a 24-year-female patient with hypertension and abnormal renal function tests which were noted on the routine prenatal check at 32 weeks of gestation delivered normally at 37 weeks. The daughter of patient had seizure when she was 6 years old and was diagnosed as polycystic kidney disease by abdominal computed tomography. This case developed sporadic form of disease without familial history but, the daughter of patient might inherited by autosomal dominant form. The patient's clinical feature was characterized by history of epilepsy, painless abdominal mass due to polycystic kidney disease, abnormal renal function, skin abnormalites including angiofibroma and shagreen patch. Abdominal computed tomography demonstrated numerous variable sized cysts throughout both kidney. In second case, the patient was a 32-year-female patient complaining of 5kg weight gain, abdominal distension due to palpable masses. Her clinical feature was characterized by bilateral huge renal angiomyolipoma with normal renal function and skin abnormality such as erythematous papule on the face. Abd CT and MRI revealed huge angiomyolipoma of about 15cm X 18.5cm X 30cm and 14.5cm X 18cm X 30cm respectively. We presented the two cases with brief review of the literatures.

Prevalence of Hepatitis G Virus Infection in Patients with Chronic Renal Failure / 대한간학회지

BACKGROUNDS/AIMS: To investigate the prevalence and clinical implications of hepatitis G virus (HGV) infection in patients with chronic renal failure, a cross-sectional study of 131 hemodialysis patients and 33 kidney transplantation recipients was conducted. METHODS: HGV RNA was amplified by reverse-transcription (RT) polymerase chain reaction (PCR) assay with primers from the 5'-untranslated region of the viral genome. RESULTS: The prevalence of HGV infection in patients with chronic renal failure was 25%(41/164). The following factors were taken into consideration: the mean age(43.15+/-11.97 years vs 46.46+/-13.08 years), the male to female ratio(2.15:1 vs 1.86:1), the mean of the dialysis duration(4.58+/-3.18 years vs 3.90+/-3.31 years), transfusion history (75.6% vs 62.6%), the mean of the ALT level during the prior 6 months(25.78+/-21.50 IU/L vs 23.00+/-59.49 IU/L), and the amount of transfusion(6.22+/-8.03 units vs 5.74+/-9.44 units). The anti-HCV(4.88% vs 8.94%) showed no difference between HGV RNA positive and negative group. The HBsAg positive ratio was 19.5% and 5.81% in HGV RNA positive group and negative group, respectively. CONCLUSION: The prevalence of HGV infection in patients with chronic renal failure was 25%. There was a higher rate of HBsAg positivity in the HGV RNA positive group rather than in the negative group. HGV infection did not seem to be associated with clinically significant hepatitis.

The Clinical Characteristics of Hepatitis-B Virus Associated Membranous Nephropathy and Membranoproliferative Glomerulonephritis / 대한신장학회잡지

Chronic hepatitis B viral infection causes membranous nephropathy and membranoproliferative glomerulonephritis. Patients with positive serum HBsAg with membranous nephropathy or membranoproliferative are considered as hepatitis B virus associated glomerulonephritis(HBV-GN) in epidemic areas of hepatitis B viral infection. To elucidate the clinical difference between hepatitis B virus-associated membranous nephropathy and membranoproliferative glomerulonephritis, and idiopathic membranous nephropathy and membranoproliferative glomerulonephritis, the authors conducted a clinical study including 71 cases of patients with renal biopsy proven diagnoses. Among the patients with hepatitis B virus antigenemia, the pathologic diagnoses were 7 membranous nephropathy(HBV-MN), 13 membranoproliferative glomerulonephritis(HBV-MPGN) but patients with mixed pattern of both membranous nephropathy and membranoproliferative glomerulonephritis were excluded. For the patients with idiopathic glomerulonephritis, 35 of membranous nephropahty(MN) and 16 cases of membranoproliferative glomerulonephritis (MPGN) were enrolled in this study. The patients of HBV-GN groups had more than 80% of HBe antigenemia. The nephrotic range proteinuria presented more frequently in HBV-MN(86%) than in MN group(54%). The cases of HBV-MPGN group(4 cases, 31%) showed nephrotic range proteinuria less frequently than those with MPGN(69%, p< 0.05) and significant discrepancy existed in HBV- MN vs HBV-MPGN and HBV-MPGN vs MPGN. The cases with decreased serum C3 level below normal were over 50% of HBV-GN and MPGN group except MN group. Serum levels of SGOT and SGPT were significantly elevated in HBV-MN and HBV- MPGN groups than those of MN and MPGN groups, respectively(p<0.05). The number of cases with increased SGOT, SGPT and gamma-GTP were 4(57%), 2 (29%) and 1(16%) in HBV-MN and 15(83%), 12(67%) and 9(75%) cases in HBV-MPGN group, in respectively. The cases developed progressive renal functional impairment during follow-up period of at least one year were 3 of 5(60%) in HBV-MN, 2 of 8 (25%) in MPGN and 3 of 9(33%) in HBV-MPGN groups which were significantly more than 2 of 22 cases(9%) in MN group(respectively p<0.05, not in HBV-MPGN vs MN). The renal functional impairment rate defined by the ratio of patients with their serum creatinine elevated above 2mg/dL over 3 months in each group was more rapidly increased in HBV-MPGN and HBV-MN than the idiopathic groups by Kaplan-Meier statistic analysis. We suggest that the patients with HBV-associated glomerulonephropathy seem to have worse prognosis in terms of renal functional impairment than those with idiopathic types of glomerulonephropathy with same pathology.

The Effect of Tissue Plasminogen Activator on Premacular Hemorrhage

Early vitrectomy is recommended for eyes with premacular hemorrhage, which facilitates fibrovascular proliferation and macular traction. To assess the effect of tissue plasminogen activator(tPA)on the absorption of premacular hemorrhage, we injected tPA(25 microgram)into the vitreous cavity of 13 eyes with premacular hemorrhage and followed for 30 days. We classified the type of hemorrhage according to the site of hemorrhage and the presence of posterior vitreous detachment(PVD). Four eyes had complete PVD following vitrectomy, 4 eyes had a hemorrhage in the subhyaloid space and 5 eyes had a hemorrhage in the subinternal limiting membrane. The mean absorption time of hemorrhage after tPA injection was 5. 5 days in 4 eyes of complete PVD and 12. 7 days in the remaining types. Visual acuity improved in 9 eyes, remained stable in 3 eyes and worsened in 1 eyes following tPA injection. Five eyes required pars plana vitrectomy due to recurrent vitreous hemorrhage and macular traction. TPA seemed to be considered another method of treatment in the eyes of premacular hemorrhage, especially in the vitrectomized eyes or eyes with complete PVD.

Prediction of Steroid Responsiveness in Adult Minimal Change Nephrotic Syndrome Using Urinary beta2-Microglobulin / 대한신장학회잡지

Urinary protein per se causes renal tubular injury and stimulates immunologic reaction. The extent of proximal tubular injury can be estimated by measuring the amount of 24 hours urinary beta2-microglobulin (U beta2-MG). The aim of this study was whether U beta2-MG level could predict the response to the initial steroid treatment for the patients with minimal change nephrotic syndrome (MCNS). We analyzed 58 adult patients (33 M, 25 F), aged 33+/-15 years (range 16-76), with biopsy-proven MCNS treated with 40 to 60mg of oral prednisolone daily up to 16 weeks. The responsiveness (44 cases) inculded complete and partial remission or steroid resistance (14 cases). No difference was found between the steroid responsive and resistant group with regard to age, BUN, serum creatinine, albumin, cholesterol, and urinary protein. The levels of U beta2- MG (microgram/g creatinine) were 250808+/-478917 and 1648+/-2386 in resistan ia Kwang-Yul Chang, et al.:Prediction of Steroid Responsiveness in Adult Minimal Change Nephrotic. Syndrome Using Urinary beta2-Microglobulint group and responsive group, respectively (P<0.05). The cut off value was 400microgram/ g creatinine with 78% of sensitivity and 48% of specificity. The likelihood ratio for the resistance was 2.5 to 2.8 with the U beta2-MG levels over 400 ug/g creatinine and was 0.2 to 0.3 below that value. Multivariate analysis confirmed that higher U beta2- MG level was associated with a lower likelihood of steroid responsiveness, independent of age, sex, creatinine, serum protein, and urinary protein. This study showed that the pretreatment U beta2- MG level may be used to identify subgroup of patients with MCNS who are more likely to be responsive to initial steroid treatment.

A Study of Treatment in Adult Patients with Idiopathic Membranous glomerulonephritis / 대한내과학회지

OBJECTIVE: We aimed to compare efficacy of treatment between steroid therapy and steroid-chlorambucil combination therapy in patients with adult-onset idiopathic membranous glomerulonephritis (MN). METHODS: A series of 31 biopsy-proved idiopathic MN patients was analyzed retrospectively to estimate effect of treatment with steroid and/or cytotoxic agent. All patients (male 15, female 16, mean age of 37 years old) presented a full-blown nephrotic syndrome (proteinuria >3.0gm/day, serum albumin <3.0mg/dL, edema) at the initiation of treatment and were observed for at least 6 months (mean follow up period: 28 +/- 23 months). Clinical and laboratory information were obtained at the time of presentation and at last follow up. Each patient was assigned to one of the following protacols. 1) Steroid therapy prednisolone 40 or 60mg/day (single dose) for 16 weeks. 2) Steroid-Chlorambucil combination therapy: for 6 months with three cycles of methylprednisolone pulse therapy (lgm 1V for 3 days), prednisolone 0.5mg/kg/day for 27 days, then chlorambucil 0.2mg/kg/day for 28 days. 3. Cyclophosphamide 2mg/kg/day for 28 days. RESULTS: 1) Final status in total 31 cases irrespective of therapeutic modality were complete remission in 5 (16%) cases, partial remission in 9 (29%) cases, no response in 12 (41%) cases, spontaneous complete remission in 1 cases, and spontaneous partial remission in 1 case. 2) After initial steroid therapy (in 25 cases), We observed no response in 17 (68%) case, partial remission in 3 (12%) cases, complete remission in 3 (12%) cases, and spontaneous partial remission in 2 (8%) cases. 3) The combination therapy (steroid and chlorambucil) tried in 10 cases results in 5 (50%) cases of partial remission, 2 (20%) cases of complete remission, 1 (10%) case of spontaneous partial remission, and 2 (20%) cases of no response. 4) During follow up period, renal functional deterioration was absent in any case and final albumin levels were significantly increased (p<0.05). CONCLUSION: Steroid-chlorambucil combination protocol is considered to be a more effective treatment with higher rate of overall remission compared to steroid therapy. Idiopathic MN itself seems to have a relatively benign course when considering that renal function was preserved in all cases without progression to chronic renal failure and that a few cases of spontaneous remission could be observed. For the limitation in number of cases and duration of follow up in this study, it needs prospective controlled study of more larger scale with long-term follow up to get a more reliable results.

A Case of Light Chain Deposition Disease Associated with Renal Amyoidosis / 대한신장학회잡지

Light chain deposition disease of kidney is characterized by deposition of monoclonal immunoglobulin light chain and electron-dense material in glomerular and tubular basement membrane and usually associated with multiple myeloma or other plasma cell dyscrasia. With light chain deposition disease affecting kidney, three clinical patterns have been recognized; nephrotic syndrome, rapidly progressive renal failure and slowly progressing chronic renal failure. The majority of patients present proteinuria and renal insufficiency. Cytotoxic therapy has been considered as treatment of choice. Favorable effect of melphalan given together with prednisone has been reported in a few cases. A 64-year-old male was admitted with generalized edema and exertional dyspnea, and was presumptively diagnosed as congestive heart failure and hypertension. He also presented increased serum creatinine and nephrotic range proteinuria. Urine protein electrophoresis and urine and serum immunoelectrophoresis revealed monoclonal gammopathy of IgG kappa type. Work up for multiple myeloma including bone marrow biopsy showed results compatible with smoldering myeloma. Renal biopsy showed findings of light chain deposition disease and Congo-red positive amyloidosis. After we treated the patient with melphalan and predinsone for two cycles, amount of proteinuria and serum creatinine were decreased.

Complications of Perfluorocarbon Liquids as an Intraoperative Tool

Perfluorocarbon liquids(PFCLs) have recently been used to facilitate surgery in a variety of condition, including proliferative vitreoretinopathy, giant retinal tears, diabetic tractions, retinal detachment with a rhegmatous component, dislocated crystalline lenses. Although the ocular toxicity of PFCLs has been evaluated in a number of animal studies, few reports have focused on ocular complications associated with their clinical use. We evaluated complications of PFCLs as an intraoperative tool in a series of 55 patients. We had used two kinds of PFCLs, Vitreon(perfluorophenanthrene) and DK-line(perfluorodecaline) intraoperatively. 10 eyes had intraoperative complications. Subretinal PFCLs(6 eyes), subretinal hemorrhage(3 eyes), subretinal hemorrhage with subretinal PFCLs(1 eye) were observed. Postoperative complications of PFCLs as an only intraoperative tool were preretinal small dreplets(4 eyes), subretinal small droplets(4 eyes) and small dreplets in anterior chamber(2 eyes). In case of posterior retinal break, careful injection should be considered. Postoperative small residual droplet of perfluorocarbon in sub- and preretinal space did not cause any toxic effects in these patients. But remained droplet in anterior chamber should be removed to avoid significant corneal toxity.

Different TCR Vbeta Usage in Consecutive Synovial Inflammation Affecting Both Knee Joints of a Rheumatoid Arthritis Patient / 대한류마티스학회지

OBJECTIVE: To understand T cell role in the immunopathogenesis of rheumatoid arthritis(RA), authors investigated Vbeta usage of T cell receptor(TCR) in different onset RA lesion of the same patient using a reverse transcriptase-polymerase chain reaction. The current pathogenic model of RA plays a critical role in CD4+ T cells, which are thought to be able to recognize a disease-relevant antigen in the joint. In this model, activation of a certain, specific, antigen induced T cells plays a pivotal role in the development and maintenance of chronic inflammation. To search a common clone in different onset of inflammatory joints will furnish the most exact information about T cells which play a role at initiation and perpetuation of synovitis. Here, We first characterized the change in TCR Vbeta shape with elapsing time between the two joints that have the consecutive inflammation . METHODS: Synovial fluids and peripheral blood were obtained from a patient with active RA who had two successively developing inflammatory joints with 1 week interval(the right knee joint(RT) was involved first and the left knee joint(LT) later). RT-PCR technology was employed to examine synovial fluid and peripheral T cells. Oligonucleotide primers specific for individual TCR Vbeta gene families were used to amplify the TCR gene products in a semiquantitative assay of their relative utilization in fresh T cells subpopulations(CD4+, CD8+ T cells). RESULTS: The CD4+ T cells with TCR Vbeta 1(LT: 4.78%, RT: 2.17%), Vbeta 2(LT: 5.84%, RT: 0. 63%), Vbeta 5.1 (LT: 3.40%, RT: 1. 07%), Vbeta 5. 2 (LT: l. 91%, RT: 0. 31%), Vbeta 8(LT: 4. 20%,RT: 0. 19%), Vbeta 9(LT: 2. 61%, RT: 0. 12beta), Vbeta 10(LT: 4. 08%, RT: l. 27%), Vbeta 12(LT: 4. 53%, RT: 0. 99%), Vbeta 22 (LT: 3. 85%, RT: 0. 38%), Vbeta 23(LT: 3. 99%, RT: 0. 63%) were used more predominantly in the left knee joint than in the right knee joint while Vbeta 15 and 18 were used far more in the right knee joint. The CD8+ T cells were used less frequently in the left side than in the right side except the Vbeta 3, 4 and 7 families. CONCLUSIONS: Among the CD4+ T cells, TCR Vbeta 1, 2, 5. 1, 5. 2, 8, 9, 10, 12, 22, 23 families might play a key role in early symptomatic synovitis in RA. The role of TCR Vbeta 15 and 18 families increase in progressing synovitis with time. On the other hand, the late recruitment of CD8+ T cells in the inflamed site might be related to nonspecific inflammatory reaction.

Effects of Extracellular Chloride Ions on the Catfish Retinal Neurons

The catfish (Ictalurus punctatus) retinal neurons were investigated by using the intracellular recording techniques to analyze the function of the chloride ions in the light responses and the ionic mechanisms of the depolarizing actions by GABA. Experiments were performed in the superfused retina-eyecup preparation. The retina was exposed by exicising the cornea, iris, and vitreous. A piece of absorbent tissue with a hole large enough to expose the retina was centered over the eyecup to serve as a wick to draw off the superfusate. Diffuse light stimuli were generated by light-emitting diode positioned above the eyecup. The recordings were made with the use of borosilicate glass micropipettes fashioned from' omega dot' capillary tubing filled with 2 M potassium acetate. Voltage recordings were obtained using an amplifier and amplified signals were recorded on a storage oscillocope, penwriter, and a data recorder. In the catfish retina, the dark membrane potentials were depolarized and the light evoked responses were enhanced in the chloride"-free medium on the catfish horizontal cells. The amplitude of the light evoked potentials were increased by chloride free Ringer's solution on the ON- and OFF-bipolar cells. But the dark membrane potentials were hyperpolarized on the ON-bipolar cell and depolarized on the OFF-bipolar cells in the chloride free medium. The chloride free Ringer's solution changed the light response from ON-sustained to OFF-sustained without any change in amplitude on the ON-sustained cell. The depolarizing actions by GABA on the horizontal cells were maintained in chloride-free environment. But GABA did not abolished the light evoked potentials of the horizontal cell and the ON-sustained cell under the chloride free environment. The results suggest that chloride ion has important roles on the signal transmission of the dark periods in the catfish retina and the depolarizing actions by GABA on the neurons in the catfish retina might be chloride dependent.

Effects of Cataract Surgery on Diabetic Retinopathy

The course of diabetic retinopathy following cataract extraction was studied prospectively in 45 eyes of 33 diabetics for 4-50 weeks(average duration: 20 weeks). The results were as follows: 1. Twenty two(81.4%) of the 29 eyes with preoperative existence of diabetic retinopathy showed a statistically higher incidence of postoperative progression of diabetic retinopathy than eight(50%) of the 16 eyes with no pre-existing diabetic retinopathy(p0.05). 4. Nephropathy is the most common preoperative systemic disease and eighteen of the 19 eyes showed the postoperative progression of diabetic retinopathy. There was no statistically significant difference regarding fasting blood sugar, pp2hr, HbA1c, total cholesterol, triglyceride, or the presence of hypertension, atherosclerosis, cardiac disease, and anemia. The only significant difference was related to the presence of nephropathy(p<0.05).

The Tissue Changes of Filtering Site Following Glaucoma Filtration Surgery with Various Mitomycin C Concentrations

The most common cause of the postoperative failure of glaucoma filtration surgery(GFS) is scarring secondary to fibroblast proliferation and fibrosis at the interface of the episclera and conjunctive. To inhibit this process, mitomycin C(MMC) has been studied experimentally, both in vivo and in vitro. In evaluating the toxicity of MMC, we observed the inhibition of fibroblast proliferation and of fibrosis by light microscope, and the ultrastructual changes of the sclera by transmission electron microscope following the soaking of MMC during GFS in rabbit eyes. The sixty rabbits which comprised this study were divided into four groups; the first control group(I) was soaked with the BSS during GFS, the second(II), the third(III), and the fourth(IV) group were soaked with the 0.2 mg/ml, 0.5 mg/ml, and 0.5 mg/ml MMC soaked groups, respectively, during GFS as experimental groups. On histologic examination, the degree of proliferation of fibroblasts with fibrosis and infiltration of lymphocytes in MMC soaked groups was less than those of BSS soaked group at 2 weeks and 2 months after GFS. At six months after GFS, there was ultrastructural evidence of degenerative changes of scleral fibroblasts such as clumping of nuclear chromatin, wrinkling of nuclear membrane, and cystic dilatation of rough endoplasmic reticulum in MMC soaked groups. Higher concentration of MMC caused more degenerative changes in cellular structures. These results surggested that the scar formation after GFS could be significantly suppressed by a single application of MMC during surgery, and MMC could be0 used effectively in cases of poor prognosis of GFS. Further experiments need to be conducted to determine the optimal concentration, exposure time, and application method of MMC.

Clinical Evaluation of Multiple Punctate Epithelial Erosion

The 747 corneal epithelial erosion cases were evaluated clinically from January 1986 to February 1988 at Catholic University Medical College, St. Mary's Hospital. The results were as follows: 1. Out of 747 corneal epithelial erosion cases, 286 cases(38.3%) and 283 cases(37.9%) resulted from mechanical and postoperative causes, respectively. 2. The large number of cases were foung in the age group of 1 to 9 years(21.9%) and in the ages older than 60 years(l9.8%), which were in proportion to the said causes. 3. The onset of corneal erosion after cataract extraction within postoperative 3 weeks(56.1%) was most common. There were 115 cases(45.3%) in which corneal erosions developed after the cataract extraction lasted up to 2 weeks. 4. The cure rate of corneal erosion was 85.0%(635 cases), and in corneal erosion developed after cataract extraction was 89.8%(254 cases). 5. There was no statistical significance in the frequency of corneal erosions developed after cataract extraction among diabetics and nondiabetics.

Clinical Evaluation of Corneal Trasplantion of 326 Cases

Corneal transplantation of three hundred and twenty five cases operated at the Department of Ophthalmology, Kangnam St. Mary's Hospital, Catholic University Medical College from May 1980 to December 1987 were clinically evaluated. The follow up period ranged from 1 month to 6 years(mean: 3 3/4 years). Major causes of corneal opacity were keratitis(105 eyes, 32.3%) and trauma(50 eyes, 15.4%), followed by keratoconus(50 eyes, 15.4%) and bullous keratopathy(46 eyes, 14.2%). There were 233 eyes of partial penetrating keratoplasty, 59 eyes of lamellar keratoplasty, 4 eyes of keratoplasty with IOL implantation and 29 eyes of prostho-keratoplasty. Success rate was 74.3% by maintaining clarity among 220 eyes out of 296 eyes except of cases of prostho-keratoplasty. Among the 76 eyes with graft opacity, 35 eyes were caused by graft rejection and 19 eyes, by bullous keratopathy. Among the cases of keratoplasty, 112 eyes showed postoperative bestcorrected visual acuity of 0.5 or higher(35.2%), 134 eyes were between 0.1 and 0.4(42.1%), and 246 eyes were 0.1 or higher(77.3%). Corneal endothelial cell density change from before the corneal transplantation was 42.3% decrease at 1 year post-operatively and 18.4% decrease at 3 months postoperatively.