Treatment of an Enlarged Periprosthetic Leakage Using Filler Injection in Patients With Provox Prosthesis: A Case Report

Recently, the most commonly used method for voice rehabilitation in total laryngectomy patients is to maintain tracheoesophageal shunt speech after inserting a voice prosthesis. One of the most common side effects, besides valve deterioration, is periprosthetic leakage due to dilatation of the tracheoesophageal shunt. Tissue implantation may be considered as one of the conservative treatments before attempting surgical treatment. When tissue implantation is attempted more than once, the treatment success rate is close to 90%. The authors experienced a case in which an 86-year-old patient developed aspiration pneumonia due to periprosthetic leakage. The patient refused surgical treatment. He was treated successfully for injecting hyaluronic acid filler 3 times and has been without a leakage for 9 months. This procedure can be considered as an alternative method to treat periprosthetic leakage.

Severe Adverse Events of Periocular Acupuncture: A Review of Cases

Acupuncture is recognized as a component of alternative medicine and is increasingly used worldwide. Many studies have shown the various effects of acupuncture around the eyes for ophthalmologic or nonophthalmologic conditions. For ophthalmologic conditions, the effect of acupuncture on dry eye syndrome, glaucoma, myopia, amblyopia, ophthalmoplegia, allergic rhinoconjunctivitis, blepharospasm, and blepharoptosis has been reported. Recently, several studies on dry eye syndrome have been reported and are in the spotlight. However, given the variety of study designs and reported outcomes of periocular acupuncture, research is still inconclusive, and further studies are required. In addition, although a systematic and reliable safety assessment is required, to the best of our knowledge, there have been no reports of a literature review of ocular complications resulting from periocular acupuncture. This review collected cases of ocular injury as severe adverse events from previously published case reports of periocular acupuncture. A total of 14 case reports (15 eyes of 14 patients) of adverse events published between 1982 and 2020 were identified. This review article provides a summary of the reported cases and suggestions for the prevention and management of better visual function prognosis.

Characteristics of Hyaluronic Acid and Its Use in Ocular Surface Diseases Including Dry Eye

Hyaluronic acid (HA) is a polysaccharide found in the extracellular matrix of the epithelial, nervous, and connective tissues of vertebrates. It is widely used in the treatment of ocular surface diseases (OSDs), including dry eye, due to its high water-retaining capacity, viscoelasticity, and role as a signaling molecule in inflammation and wound healing. This paper reviews the physicochemical and biological properties of HA related to the treatment of OSDs and the results of published preclinical studies, clinical trials, and meta-analyses on the effects of HA eye drops on the tear film, the mechanism of action of HA eye drops, and its clinical effects and adverse events in OSDs, such as corneal/conjunctival epithelial defects, dry eye, and postoperative dry eye. This review should help inform clinical judgments by providing clinical evidence and precautions on the use of HA eye drops in OSDs, including dry eye.

Clinical Outcomes of Mini-scleral Contact Lenses in Eyes with Keratoconus

Purpose@#To analyze the clinical results of fitting mini-scleral contact lenses prescribed for vision correction in eyes with keratoconus, and the parameters of eyes related to the base curve radius (BCR) of the final prescribed lenses. @*Methods@#From January 2016 to March 2021, 24 patients (44 eyes) who used mini-scleral lenses for more than 3 months due to keratoconus were enrolled. The keratoconus stage before prescription, degree of corrected visual acuity improvement, follow-up period, and complications and causes of failure to maintain the lenses were analyzed. The correlations between the BCR of the final prescribed lenses and the morphological factors of the eyes were analyzed. @*Results@#The average Amsler–Krumeich keratoconus stage before wearing a lens was 2.2 ± 0.8 and 90.9% of patients had a corrected visual acuity improvement exceeding 2 lines. Excluding four eyes in two patients (9.9%) who gave up wearing mini-scleral lenses, the average duration of wearing lenses was 23.6 ± 17.8 months, and the average daily wearing time was 8.79 ± 3.14 hours. Complications were conjunctival injection in five eyes (three patients) and sterile keratitis and superficial punctate keratitis in one eye, respectively. The causes of failure to maintain the mini-scleral lens were injection in two eyes (one patient) and handling difficulty in two eyes (one patient), and they gave up after an average of 6 months. Only the radii of the anterior and posterior corneal best fit sphere before wearing the lens were found to have a significant positive correlation with the BCR of the finally prescribed lenses (p < 0.001). @*Conclusions@#Mini-scleral lenses provide relatively good vision improvement without serious complications in patients at various stages of keratoconus, and the BCR of the finally prescribed lens had a good correlation with the anterior and posterior corneal best fit sphere.

Long-term Analysis of Surgically Induced Astigmatism after Combined Vitrectomy and Cataract Surgery versus Cataract Surgery Alone

Purpose@#To compare the long-term changes in surgically induced astigmatism (SIA) in patients who underwent 23-gauge sutureless vitrectomy and cataract surgery together with patients who underwent cataract surgery only. @*Methods@#We retrospectively reviewed SIA changes for 1 year after surgery in patients who received only cataract surgery using phacoemulsification (group 1) and patients who underwent 23-gauge sutureless vitrectomy and cataract surgery together (group 2). Flat keratometry (K1), steep keratometry (K2), and astigmatism axis were measured with automatic keratometry before and after the surgery. Vector analysis was used to calculate SIA at 1, 3, 6, and 12 months postoperatively. We then examined whether the SIA values at each time point were different between the two groups. @*Results@#A total of 86 eyes were included in this study (group 1, n = 45; group 2, n = 41). The mean SIA values calculated at 1, 3, 6, and 12 months after surgery in group 1 were 0.83 ± 0.37, 0.69 ± 0.39, 0.60 ± 0.33, and 0.59 ± 0.33, respectively. In group 2, the values were 0.82 ± 0.47, 0.69 ± 0.38, 0.62 ± 0.28, and 0.61 ± 0.30, respectively. Over time, SIA decreased in both groups (all p < 0.001). There was no significant difference in the mean SIA between the two groups at each follow-up time point after surgery (p = 0.296, p = 0.728, p = 0.361, and p = 0.356, respectively). @*Conclusions@#When 23-gauge sutureless vitrectomy and cataract surgery were performed together, the astigmatism change caused by surgery did not show a significant difference compared with that of the group who received cataract surgery only. Thus, 23-gauge sutureless vitrectomy may not significantly affect corneal astigmatism.

Long-term Analysis of Surgically Induced Astigmatism after Combined Vitrectomy and Cataract Surgery versus Cataract Surgery Alone

Purpose@#To compare the long-term changes in surgically induced astigmatism (SIA) in patients who underwent 23-gauge sutureless vitrectomy and cataract surgery together with patients who underwent cataract surgery only. @*Methods@#We retrospectively reviewed SIA changes for 1 year after surgery in patients who received only cataract surgery using phacoemulsification (group 1) and patients who underwent 23-gauge sutureless vitrectomy and cataract surgery together (group 2). Flat keratometry (K1), steep keratometry (K2), and astigmatism axis were measured with automatic keratometry before and after the surgery. Vector analysis was used to calculate SIA at 1, 3, 6, and 12 months postoperatively. We then examined whether the SIA values at each time point were different between the two groups. @*Results@#A total of 86 eyes were included in this study (group 1, n = 45; group 2, n = 41). The mean SIA values calculated at 1, 3, 6, and 12 months after surgery in group 1 were 0.83 ± 0.37, 0.69 ± 0.39, 0.60 ± 0.33, and 0.59 ± 0.33, respectively. In group 2, the values were 0.82 ± 0.47, 0.69 ± 0.38, 0.62 ± 0.28, and 0.61 ± 0.30, respectively. Over time, SIA decreased in both groups (all p < 0.001). There was no significant difference in the mean SIA between the two groups at each follow-up time point after surgery (p = 0.296, p = 0.728, p = 0.361, and p = 0.356, respectively). @*Conclusions@#When 23-gauge sutureless vitrectomy and cataract surgery were performed together, the astigmatism change caused by surgery did not show a significant difference compared with that of the group who received cataract surgery only. Thus, 23-gauge sutureless vitrectomy may not significantly affect corneal astigmatism.

Long-term Effect of Orthokeratology Lenses on Axial Length Elongation in Myopia: 2-3 Years Follow-up Study

Purpose@#To evaluate the effect of orthokeratology lenses on axial length elongation and associated factors in eyes treated withorthokeratology lenses for 2-3 years. @*Methods@#Thirty-four eyes of 20 patients treated with orthokeratology lenses for more than 22 months were enrolled into the orthokeratology(OK) group. Uncorrected distant visual acuity, spherical equivalent, axial length, and high-order aberrations of theanterior cornea at baseline and during the follow-up period were analyzed retrospectively. Spectacle-wearing patients matchedwith the OK group patients by sex, age, refractive error and follow-up period were selected as a control group. To adjust for follow-upperiod differences, the 24-month conversion axial length changes were calculated and compared between the two groups. @*Results@#The 24-month conversion mean axial length change showed significant differences (0.50 ± 0.23 mm in the OK groupversus 1.00 ± 0.28 mm in the control group; p< 0.001). For the OK group, the age at starting OK lens (r = -0.572, p= 0.001)showed statistically significant correlation with axial elongation. The anterior corneal spherical aberrations (SA) and coma with 6mm pupil at last follow-up (SA: r = 0.543, p= 0.001; coma: r = 0.420, p= 0.017) and the total SA and total coma changes (ㅿSA:r = 0.518, p= 0.002; ㅿcoma: r = 0.420, p= 0.017) also showed a statistically significant correlation. The initial age and axiallength, the anterior corneal SA and ㅿSA values were identified as factors significantly correlated with axial length elongation bymultiple regression analysis. @*Conclusions@#The OK lens effectively suppressed axial length elongation during a 2-3 years treatment period. However, whenthe age of starting OK lens was younger and the anterior corneal spherical aberration during the follow-up period was larger, therisk of axial elongation was higher.

I Am Number 3 or 4?: Presidential Lecture at KSELS 2019

No abstract available.

Enhancement of antigen-specific humoral immune responses and protein solubility through conjugation of bacterial flagellin, Vibrio vulnificus FlaB, to the N-terminus of porcine epidemic diarrhea virus surface protein antigen S0

Porcine epidemic diarrhea (PED) is a highly contagious enteric swine disease. The large economic impact of PED on the swine industry worldwide has made the development of an effective PED vaccine a necessity. S0, a truncated region of the porcine epidemic diarrhea virus (PEDV) spike protein, has been suggested as a candidate antigen for PED subunit vaccines; however, poor solubility problems when the protein is expressed in Escherichia coli, and the inherent problems of subunit vaccines, such as low immunogenicity, remain. Flagellin has been widely used as a fusion partner to enhance the immunogenicity and solubility of many difficult-to-express proteins; however, the conjugation effect of flagellin varies depending on the target antigen or the position of the fusion placement. Here, we conjugated flagellin, Vibrio vulnificus FlaB, to the N- and C-termini of S0 and evaluated the ability of the fusion to enhance the solubility and immunogenicity of S0. Flagellin conjugation in the presence of the trigger factor chaperone tig greatly improved the solubility of the fusion protein (up to 99%) regardless of its conjugation position. Of importance, flagellin conjugated to the N-terminus of S0 significantly enhanced S0-specific humoral immune responses compared to other recombinant antigens in Balb/c mice. The mechanism of this phenomenon was investigated through in vitro and in vivo studies. These findings provide important information for the development of a novel PED vaccine and flagellin-based immunotherapeutics.

Prognostic influence of 3-dimensional tumor volume on breast cancer compared to conventional 1-dimensional tumor size

PURPOSE: The prognostic influence of 3-dimensional tumor volume (Tv) on breast cancer compared to conventional 1-dimensional tumor size (T) was investigated. METHODS: Analysis was performed on a cohort of 8,996 primary breast cancer patients who were initially diagnosed with TNM stage I–III. Tumor size was defined as the maximum tumor dimension, and Tv was calculated by the equation of (4π× r1 × r2 × r3)/3; r1, r2, and r3 were defined as half of the largest, intermediate, and shortest dimension of the tumor, respectively. Tv was classified into Tv1, Tv2, and Tv3 according to the cut off values of 2.056 cm3 and 20.733 cm3. RESULTS: The survival curves according to both the T and Tv categories were clearly differentiated (all P < 0.001), as were those for staging by T and Tv (all P < 0.001). In T1 and T2 tumors, the Tv1 group showed superior survival over the Tv2 group (T1, P < 0.001; T2, P = 0.001). Univariate and multivariate analysis both indicated that Tv was a significant prognostic factor (both P < 0.001). The receiver operating characteristic curve showed that the area under the curves were 0.712 (P < 0.001) for Tv and 0.699 (P < 0.001) for T. Positive correlations were observed between the number of positive nodes and T (coefficient = 0.325; P < 0.001), and between the number of positive nodes and Tv (coefficient = 0.321; P < 0.001). CONCLUSION: Tv classification works well for predicting the prognosis of breast cancer, and it is a better predictor than conventional T classification in several aspects. Further studies are needed to validate the practical usefulness of Tv classification in clinical settings.

Surgical Strategy for T2 Gallbladder Cancer: Nationwide Multicenter Survey in Korea

BACKGROUND: Although all guidelines suggest that T2 gallbladder (GB) cancer should be treated by extended cholecystectomy (ECx), high-level scientific evidence is lacking because there has been no randomized controlled trial on GB cancer. METHODS: A nationwide multicenter study between 2000 and 2009 from 14 university hospitals enrolled a total of 410 patients with T2 GB cancer. The clinicopathologic findings and long-term follow-up results were analyzed after consensus meeting of Korean Pancreas Surgery Club. RESULTS: The 5-year cumulative survival rate (5YSR) for the patients who underwent curative resection was 61.2%. ECx group showed significantly better 5YSR than simple cholecystectomy (SCx) group (65.4% vs. 54.0%, P = 0.016). For N0 patients, there was no significant difference in 5YSR between SCx and ECx groups (68.7% vs. 73.6%, P = 0.173). Systemic recurrence was more common than locoregional recurrence (78.5% vs. 21.5%). Elevation of cancer antigen 19-9 level preoperatively and lymph node (LN) metastasis were significantly poor prognostic factors in a multivariate analysis. CONCLUSION: ECx including wedge resection of GB bed should be recommended for T2 GB cancer. Because systemic recurrence was more common and recurrence occurred more frequently in patients with LN metastasis, postoperative adjuvant therapy should be considered especially for the patients with LN metastasis.

Pigmented Mass in the Anterior Chamber Suspected of Granuloma Caused by a Metallic Foreign Body

PURPOSE: To report on a patient with a brown pigmented mass in the anterior chamber suspected of a granuloma caused by a metallic foreign body and to review the relevant literature. CASE SUMMARY: A 63-year-old man presented with blurring in his right eye, which had initially began several years prior. Concentric corneoscleral brown pigmentation about 2 mm in diameter was found in the superonasal limbal area. A rectangular parallelepiped mass was observed in the superonasal anterior chamber, which was an even brown color with a small white portion, smooth-surfaced, and non-vascularized. The pupil was oval and dragged superonasally, possibly due to mild compression of the iris caused by the mass. In pre-enhanced orbital computed tomography, a round high signal intensity with a diameter of 3.0 mm was found in the superonasal anterior segment. Though excisional biopsy using the lamellar scleral flap was considered for exact diagnosis, this was not performed considering the clinical features are more indicative of granuloma than iris melanoma. Neither changes in the size of the mass nor the shape of the pupil were observed during the follow up period until 19 months after the first visit. CONCLUSIONS: When a pigmented mass in the anterior chamber is detected, benign and malignant iris tumors and granulomas should be considered for a differential diagnosis. The patient's exact past medical history and clinical features differentiating malignant and benign masses are important for proper diagnosis due to the difficulty in obtaining tissue diagnoses in some cases.

Effects of Ocular Parameters on Diameter of Well-fitted Rigid Gas Permeable Lens in Koreans

PURPOSE: To compare the differences of parameters of 9.3 mm and 8.8 mm rigid gas permeable lenses (RGP lenses) that were prescribed by trial lens fitting. METHODS: Ninety-three eyes of 49 patients were prescribed RGP contact lenses (YK spherical lens, Lucid Korea, Bonghwa, Korea) by a single ophthalmologist at the same hospital. We analyzed the differences of parameters of 9.3 mm and 8.8 mm rigid gas permeable lenses (RGP lenses) that were prescribed by trial lens fitting. Steep keratometric value (Ks), flat keratometric value (Kf), and corneal astigmatism (Kast) were measured by keratometer. Simulated steep keratometric value (Sim Ks), simulated flat keratometric value (Sim Kf), simulated corneal astigmatism (Sim Kast), white to white corneal diameter (WTW), and eccentricity were measured by corneal topography. We also analyzed the differences of back optic zone radius (BOZR) and lens power between the two groups. RESULTS: In this study, 40 eyes wearing 8.8 mm lenses and 53 eyes wearing 9.3 mm lenses were included. Keratometric value and eccentricity were significantly higher in the 8.8 mm lens group, while WTW and BOZR were significantly lower. Corneal astigmatism (Kast, Sim Kast) and lens power were not significantly different between the groups. CONCLUSIONS: RGP lenses with a smaller diameter were likely to be prescribed to patients with higher keratometric value, higher eccentricity, and shorter WTW, and the average BOZR of the prescribed RGP lenses with a smaller diameter was likely to be steeper.

Predictors of Morbidity and Mortality After Surgery for Intestinal Perforation

PURPOSE: An intestinal perforation is a rare condition, but has a high mortality rate, even after immediate surgical intervention. The clinical predictors of postoperative morbidity and mortality are still not well established, so this study attempted to identify risk factors for postoperative morbidity and mortality after surgery for an intestinal perforation. METHODS: We retrospectively analyzed the cases of 117 patients who underwent surgery for an intestinal perforation at a single institution in Korea from November 2008 to June 2014. Factors related with postoperative mortality at 1 month and other postoperative complications were investigated. RESULTS: The mean age of enrolled patients was 66.0 ± 15.8 years and 66% of the patients were male. Fifteen patients (13%) died within 1 month after surgical treatment. Univariate analysis indicated that patient-related factors associated with mortality were low systolic and diastolic blood pressure, low serum albumin, low serum protein, low total cholesterol, and high blood urea nitrogen; the surgery-related factor associated with mortality was feculent ascites. Multivariate analysis using a logistic regression indicated that low systolic blood pressure and feculent ascites independently increased the risk for mortality; postoperative complications were more likely in both females and those with low estimated glomerular filtration rates and elevated serum C-reactive protein levels. CONCLUSION: Various factors were associated with postoperative clinical outcomes of patients with an intestinal perforation. Morbidity and mortality following an intestinal perforation were greater in patients with unstable initial vital signs, poor nutritional status, and feculent ascites.

Ocular Manifestations of Sjögren Syndrome / 한양의대학술지

Sjögren Syndrome (SS) is one of the most frequent systemic autoimmune disorders, mainly involving the eye and mouth due to inflammation of lacrimal and salivary glands. Exocrine glands affected with a typical focal lymphocytic infiltration potentially lead to dry eyes and dry mouth. In addition to the known pathogenic mechanism of SS through autoimmunity, corneal neuropathy, as a peripheral neuropathy which is a relatively frequent extraglandular systemic manifestation of SS, recently draws attention as a possible pathogenic mechanism of ocular symptoms and dry eye induction. The diagnostic criteria of SS changed recently, proposed by the American College of Rheumatology/Sjögren's International Collaborative Clinical Alliance (ACR/SICCA) in 2012, and the ocular surface staining score is the only required test for ocular manifestation of SS. However, other diagnostic methods evaluating tear film status, though excluded from the new criteria, are still important for the staging and treatment planning, including direct observation of tear film, tear film break up time, Schirmer test, and measurement of the tear film levels of inflammatory mediators. Eye-specific symptoms and signs and ocular treatment options for SS including tear substitutes, secretogogue, topical anti-inflammatory therapy with corticosteroids and cyclosporine, punctal occlusion, autologous serum, and mucolytic therapy were summarized and discussed in this review article.

Farber Disease Misdiagnosed as Hemangioendothelioma / 소아외과

Farber disease (FD) is a rare lysosomal storage disorder that shows autosomal recessive inheritance. We report the case of a 58-month-old girl with FD, who was misdiagnosed with epithelioid hemangioendothelioma. The patient had undergone five surgeries for sacrococcygeal masses and three surgeries for scalp masses owing to misdiagnosis. Here, we describe this rare case of FD.

Differential Effects of Quercetin and Quercetin Glycosides on Human α7 Nicotinic Acetylcholine Receptor-Mediated Ion Currents

Quercetin is a flavonoid usually found in fruits and vegetables. Aside from its antioxidative effects, quercetin, like other flavonoids, has a various neuropharmacological actions. Quercetin-3-O-rhamnoside (Rham1), quercetin-3-O-rutinoside (Rutin), and quercetin-3-(2(G)-rhamnosylrutinoside (Rham2) are mono-, di-, and tri-glycosylated forms of quercetin, respectively. In a previous study, we showed that quercetin can enhance α7 nicotinic acetylcholine receptor (α7 nAChR)-mediated ion currents. However, the role of the carbohydrates attached to quercetin in the regulation of α7 nAChR channel activity has not been determined. In the present study, we investigated the effects of quercetin glycosides on the acetylcholine induced peak inward current (I(ACh)) in Xenopus oocytes expressing the α7 nAChR. I(ACh) was measured with a two-electrode voltage clamp technique. In oocytes injected with α7 nAChR copy RNA, quercetin enhanced I(ACh), whereas quercetin glycosides inhibited I(ACh). Quercetin glycosides mediated an inhibition of I(ACh), which increased when they were pre-applied and the inhibitory effects were concentration dependent. The order of I(ACh) inhibition by quercetin glycosides was Rutin≥Rham1>Rham2. Quercetin glycosides-mediated I(ACh) enhancement was not affected by ACh concentration and appeared voltage-independent. Furthermore, quercetin-mediated I(ACh) inhibition can be attenuated when quercetin is co-applied with Rham1 and Rutin, indicating that quercetin glycosides could interfere with quercetin-mediated α7 nAChR regulation and that the number of carbohydrates in the quercetin glycoside plays a key role in the interruption of quercetin action. These results show that quercetin and quercetin glycosides regulate the α7 nAChR in a differential manner.

Laparoscopic Totally Extraperitoneal Hernia Repair after Radical Prostatectomy or Lower Abdominal Surgery Except for Appendectomy: Experience of 35 Cases

PURPOSE: Laparoscopic totally extraperitoneal (TEP) hernia repair is known to be relatively difficult in cases with a history of lower abdominal surgery. We assess the feasibility of laparoscopic TEP hernia repair in those patients. METHODS: Thirty five patients with a previous history of radical prostatectomy or lower abdominal surgery who underwent laparoscopic TEP hernia repair for inguinal hernia were reviewed retrospectively. All operations were performed by a single experienced surgeon. RESULTS: Thirty three out of the 35 patients (94%) were men. Laparoscopic TEP hernia repair was performed successfully in 30 out of 35 cases. Twenty five cases (71%) were right inguinal hernia, 6 cases (17%) were left hernias, and 4 cases (11%) had an inguinal hernia on both sides. Five cases were converted to transabdominal preperitoneal (TAPP) (n=3) or open methods (n=2). Mean operation time was 111 minutes. The patient group with previous radical prostatectomy was the largest (n=22, 63%) and required a longer operation time (124 minutes). Blood loss was less than 50 cc in all cases. Average hospital stay was 1.2 days after surgery. Voiding difficulties requiring catheterization were observed in 13 cases (37%). CONCLUSION: Laparoscopic TEP hernia repair for a patient with previous history of radical prostatectomy or lower abdominal surgery except for appendectomy can be safely performed by an experienced surgeon, but is not recommended as a standard choice because of a longer operation time and higher conversion rate.

Long-term Outcomes and Risk Factors for Reoperation After Surgical Treatment for Gastrointestinal Crohn Disease According to Anti-tumor Necrosis Factor-alpha Antibody Use: 35 Years of Experience at a Single Institute in Korea

PURPOSE: Crohn disease is characterized by high rates of recurrence and reoperations. However, few studies have investigated long-term surgical outcomes in Asian populations. We investigated risk factors for reoperation, particularly those associated with anti-tumor necrosis factor-alpha (anti-TNF-alpha) antibody use, and long-term follow-up results. METHODS: We reviewed the records of 148 patients (100 males and 48 females) who underwent surgery for gastrointestinal Crohn disease and retrospectively analyzed long-term outcomes and risk factors. RESULTS: The mean age at diagnosis was 28.8 years. Thirty-eight patients (25.7%) received monoclonal antibody treatment before reoperation. A small bowel and colon resection was most commonly performed (83 patients, 56.1%). The median follow-up was 149 months, during which 47 patients underwent reoperation. The median interval between the primary and the secondary surgeries was 65 months, with accumulated reoperation rates of 16.5%, 31.8%, and 57.2% after 5, 10, and 15 years, respectively. Obstruction was the most common indication for reoperation (37 patients, 25.0%). In a multivariable analysis, age <17 years at diagnosis (A1) (odds ratio [OR], 2.20; P = 0.023), penetrating behavior (B3) (OR, 4.39; P < 0.001), and no azathioprine use (OR, 2.87; P = 0.003) were associated with reoperation. Anti-TNF-alpha antibody use did not affect the reoperation rate (P = 0.767). CONCLUSION: We showed a high reoperation rate regardless of treatment with anti-TNF-alpha antibody, which indicates that recurrent surgery is still needed to cure patients with gastrointestinal Crohn diseases. Younger age at primary operation, penetrating behavior, and no azathioprine use were significant factors associated with reoperation for gastrointestinal Crohn disease.

The Impact of Written Information on the Compliance with Contact Lens Care

PURPOSE: To evaluate the impact of written information on the compliance with proper contact lens (CL) care. METHODS: The patients prescribed CLs by a single ophthalmologist in a clinic from January 2008 to August 2009 were enrolled in the present study. The patients were randomly divided into 2 groups, the verbal and written information (VWI) group and verbal information (VI) group. The patients in the VWI group received verbal and written information on proper CL care and the VI group received the same information only verbally. Patients who were followed-up more than 2 weeks after CL wear were asked 10 questions regarding CL care and statistical analysis was performed for each question on CL care. The Mann Whitney U-test was used for comparison between the 2 groups and Pearson's test was used for the correlation analyses. RESULTS: A total of 23 patients were included in this study. Ten patients were assigned to the VWI group, and 13 patients to the VI group. The most desirable score for the CL care was 100 points. The VWI group showed 85.2 +/- 13.4 points and the VI group showed 71.5 +/- 10.1 points (p = 0.030, Mann-Whitney U-test). Of the 10 questions, daily replacement of the lens care solution and the use of tap water showed significant correlation with the discomfort induced by the CL and rinsing process before CL insertion showed significant correlation with the CL intolerance (p = 0.008, p = 0.004 and p = 0.015, respectively, Pearson's correlation test). CONCLUSIONS: The patients in the written information group showed better compliance for overall CL care. Adding the written information to the verbal explanation can enhance the patient's compliance with the proper CL care. Enhancing the compliance of CL care with written information can be expected to decrease the complications and improve the comfort of wearing CLs.