A Case of Keratitis Caused by Combined Infection of Multidrug-Resistant Acinetobacter Baumannii and Candida Parapsilosis

PURPOSE: To report a case of keratitis caused by Acinetobacter baumannii and Candida parapsilosis in a patient using 0.5% levofloxacin and 0.1% fluorometholone for an extended period of time. CASE SUMMARY: A 55-year-old male patient in the neurosurgery department with conjunctival injection and discharge in his left eye was consulted for ophthalmic evaluation and treatment. He was hospitalized in the state of akinetic mutism and given 0.5% levofloxacin and 0.1% fluorometholone for 2 years. On slit-lamp examination, a 3.5 x 4.5-mm dense stromal infiltrate with an overlying epithelial defect was observed. Corneal scraping culture revealed multidrug-resistant A. baumannii and C. parapsilosis. According to the susceptibility result, the patient was treated with topical 10% piperacillin/tazobactam and 0.125% amphotericin B hourly. The corneal ulcer healed gradually with corneal opacity remaining after 8 weeks of treatment. CONCLUSIONS: The authors of the present study report a case of treated multidrug-resistant A. baumannii and C. parapsilosis keratitis in a patient using topical antibiotics and steroid for an extended period of time.

Visual Outcome and Stability of Hydrogel Full-Optics Accommodative Intraocular Lens

PURPOSE: To report the visual outcome and to determine the stability of WIOL-CF(R) (GELMED, Praha, Czech Republic) hydrogel full-optics accommodative intraocular lens (IOL). METHODS: The present study evaluated 20 eyes of 10 patients who underwent routine cataract surgery and WIOL-CF(R) accommodative IOL implantation. Measurement included uncorrected/best corrected visual acuities (VA) at near and distant, degree of IOL decentration, degree of IOL tilting and anterior chamber depth on postoperative day 1, 1 month, 2 months, 6 months and 12 months. RESULTS: Result analysis was performed with 19 eyes of 10 patients, except for 1 complicated eye. At 12 months, the uncorrected distance VA of 11 eyes (57.9%) and 17 eyes (89.5%) were 20/25 and 20/40 or better, respectively. At 12 months, the uncorrected near VA of 12 eyes (63.2%) and 18 eyes (94.7%) were 20/25 and 20/40 or better, respectively. There was no statistically significant difference in anterior chamber depth (p > 0.05), IOL decentration (p > 0.05) and IOL tilting (p > 0.05) on postoperative day 1, 1 month, 2 months, 6 months and 12 months. CONCLUSIONS: The clinical results of cataract surgery with WIOL-CF were relatively satisfactory.

A Case of Stenotrophomonas maltophilia Keratitis Effectively Treated with Moxifloxacin

A 70-year-old man with a long history of diabetes mellitus presented to our hospital (Department of Ophthalmology, Sahm Yook Medical Center, Seoul, Korea) complaining of severe ocular pain and visual disturbance in his left eye that had started three days prior to admission. A round 3.7 x 5.0 mm dense central stromal infiltrate with an overlying epithelial defect was noted on slit-lamp examination. Following corneal scrapings and culture, topical 0.5% moxifloxacin and 0.5% tobramycin were administered hourly. A few days later, Stenotrophomonas maltophilia was isolated in a bacterial culture from a corneal specimen. According to the results of susceptibility tests, topical 0.5% moxifloxacin was given every hour and 0.5% tobramycin was stopped. The patient's clinical features improved steadily with treatment. The corneal epithelium healed rapidly, and the infiltrate resolved within four weeks of the initiation of treatment. The patient's best corrected visual acuity improved from hand motion to 20 / 25.

A Case of Stenotrophomonas maltophilia Keratitis Effectively Treated with Moxifloxacin

A 70-year-old man with a long history of diabetes mellitus presented to our hospital (Department of Ophthalmology, Sahm Yook Medical Center, Seoul, Korea) complaining of severe ocular pain and visual disturbance in his left eye that had started three days prior to admission. A round 3.7 x 5.0 mm dense central stromal infiltrate with an overlying epithelial defect was noted on slit-lamp examination. Following corneal scrapings and culture, topical 0.5% moxifloxacin and 0.5% tobramycin were administered hourly. A few days later, Stenotrophomonas maltophilia was isolated in a bacterial culture from a corneal specimen. According to the results of susceptibility tests, topical 0.5% moxifloxacin was given every hour and 0.5% tobramycin was stopped. The patient's clinical features improved steadily with treatment. The corneal epithelium healed rapidly, and the infiltrate resolved within four weeks of the initiation of treatment. The patient's best corrected visual acuity improved from hand motion to 20 / 25.

Analysis of Retinal Nerve Fiber Layer Thickness in Patients With Superior Segmental Optic Hypoplasia

PURPOSE: To analyze the thickness of the peripapillary retinal nerve fiber layer (RNFL) in patients with superior segmental optic hypoplasia (SSOH) using optical coherence tomography (OCT). METHODS: Ten eyes of 10 patients with SSOH and 20 eyes of 20 subjects as normal control were evaluated. The peripapillary RNFL thickness measured by Stratus OCT was compared between the two groups. RESULTS: The mean RNFL thickness was significantly different between SSOH patients (72.35+/-14.77 micrometer) and normal subjects (111.61+/-6.62 micrometer) (p<0.001). The extent to which the RNFL thickness was below 5 percentile of normal subjects on the TSNIT graph was from the 41.7+/-15.53 to 110.1+/-7.47 scan number, which corresponded mainly with the superior nasal region. Moreover, in a clock-hour analysis, the peripapillary RNFL thic kness of the SSOH patients decreased significantly from 10 o'clock to 6 o'clock compared to normal subjects (p<0.01). CONCLUSIONS: Peripapillary RNFL thickness in patients with SSOH was reduced in the superior, nasal, and inferior regions. Further studies involving larger populations of patients should be performed to verify these findings.

Intravitreal Bevacizumab for Treatment of Diabetic Macular Edema

PURPOSE: To evaluate the effect of intravitreal bevacizumab on visual function and retinal thickness in patients with diabetic macular edema (DME). METHODS: Thirty eyes of twenty-eight patients (mean age, 57.9+/-13.8 years) with DME were included in this study. Complete ophthalmic examination, including determination of best-corrected visual acuity (BCVA), stereoscopic biomicroscopy, and retinal thickness measurement by optical coherence tomography (OCT), was done at baseline and at each follow-up visit. All patients were treated with a 0.05 mL intravitreal injection containing 1.25 mg of bevacizumab. RESULTS: All patients completed 3 months of follow-up with a mean follow-up period of 5.26+/-2.39 months. The mean BCVA at baseline was 0.73+/-0.36 logMAR, which significantly improved to 0.63+/-0.41 (p=0.02), 0.58+/-0.36 (p=0.003), and 0.61+/-0.40 logMAR (p=0.006) at 1 week, 1 month, and 3 months. Final BCVA analysis demonstrated that 15 eyes (50%) remained stable and 12 (40%) improved > or =2 lines on BCVA. The mean central retinal thickness was 498.96+/-123.99 microm at baseline and decreased to 359.06+/-105.97 (p<0.001), 334.40+/-121.76 (p<0.001), 421.40+/-192.76 microm (p=0.035) at 1 week, 1 month, and 3 months. No ocular toxicity or adverse effects were observed. CONCLUSIONS: Intravitreal bevacizumab injection resulted in significant improvement in BCVA and central retinal thickness as early as 1 week after injection in patients with DME, and this beneficial effect persisted for up to 3 months. However, the slight reduction in this improvement at 3 months suggests that repeated bevacizumab injections might be necessary. To evaluate the long-term safety and efficacy, further prospective randomized controlled clinical trials will be needed.

Effects of Propofol on Phenylephrine Induced Vascular Smooth Muscle Contraction in Rat Thoracic Aorta / 대한마취과학회지

BACKGROUND: Propofol decreases arterial blood pressure. This has been ascribed to vasodilation and decreased cardiac output occuring separately or in combination. The goal of the present study was to assess the effects of propofol on the phenylephrine induced vasoconstriction in rat thoracic aortic rings. METHODS: All aortic rings were removed endothelium and isometric tension was recorded under a resting tension of 3 g. Isolated aortic rings were precontracted with phenylephrine (0.3micrometer) and propofol (1 to 100micrometer) was added cumulatively. We induced the phenylephrine preconstriction after treatment of verapamil 10micrometer in the other vascular rings. RESULTS: Propofol (1 to 100micrometer) attenuated phenylephrine (0.3micrometer) induced preconstriction dose-dependently. The administration of propofol (1 and 10micrometer) did not change the tonic constriction. The contractile response were significantly attenuated in verapamil pretreated rings but propofol did not affect on constriction in all dose range. CONCLUSIONS: Propofol attenuated phenylephrine precontracted rat thoracic aortic rings with inhibition of Ca2+ movement through the L-type calcium channel in the sarcolemmal membrane.

Effectiveness of Ondansetron and Midazolam in the Prevention of PONV after Thyroidectomy / 대한마취과학회지

BACKGROUND: The purpose of this study was to investigate the effectiveness of ondansetron and midazolam in the prevention of PONV after thyroidectomy. METHODS: One hundred nineteen women undergoing thyroidectomy under general anesthesia were randomized to receive midazolam 0.075 mg/kg (Group M, n = 41), ondansetron 4 mg (Group O, n = 39), or normal saline 10 ml (Group C, n = 39) intravenously. The incidence and severity of nausea, vomiting, and pain were assessed as 6 and 24 h after the end of surgery. RESULTS: The incidence of PONV was 34% in Group M, 46% in Group O, and 64% in Group C, which showed a significant difference between Group C and Group M, but not Group O. However, there were no significant differences between groups in pain scores and the incidence of sedation. CONCLUSIONS: We recommend the use of midazolam as an effective antiemetic after thyroidectomy.

Tracheal Rupture after the Use of Reused High Volume-low Pressure Endotracheal Tube : A case report / 대한마취과학회지

Tracheal rupture is a rare complication of tracheal intubation, but may result in pneumothorax, mediastinal emphysema, subcutaneous emphysema and other serious outcomes. Risk factors associated with tracheobronchial rupture include multiple vigorous attempts at intubation, inexperienced operator, intubating stylets, tracheal abnormalities, overdistension of tracheal or bronchial cuff, repositioning of tube without deflating the cuff, chronic obstructive airway disease and vigorous coughing while being intubated. We report a case of tracheal rupture after using single lumen endotracheal tube. A 41-year-old, 53 kg, female was operated for a repair of anterior cruciate ligament under general anesthesia in other hospital. Two hours later after the end of operation, facial swelling, dyspnea and chest pain developed. Chest computed tomography showed mediastinal emphysema. She was transferred to our hospital and bronchoscopy showed a rupture at posterior part of membranous portion 2 cm proximal to carina. Trachea was repaired and she was discharged from the hospital without complication.

The Prevalence of Benign Prostatic Hyperplasia: Community-based Study in Chungbuk Province / 대한비뇨기과학회지

PURPOSE: Study was done on the lower urinary tract symptoms(LUTS) associated with the benign prostatic hyperplasia(BPH) in the community based populations in Chungbuk province, and correlation among these symptoms, age, prostate volume, and flow rate was evaluated. MATERIALS AND METHODS: All men(764 men) living in Chungbuk province in Korea were invited to undergo measurements of peak flow rate, TRUS and to complete symptom scores and previously validated lifestyle questionnaire. RESULTS: Moderate to severe symptoms(symptom scores 8 or more) were found in 348 of our 695 samples(50.1%). A good correlation was observed between the total symptom score and quality of life questionnaire(r=0.68, P20 cm3, and IPSS > or =8, while the lowest prevalence rate of 7.64%(Chi-square 32.03, P20 cm3, an IPSS > or =8, peak flow rate 100 ml. CONCLUSIONS: Thus, the prevalence rates depended very much on the parameters used in case definition. Follow-up would establish the necessity of a work-up request and treatment for BPH and help determine the best clinical definition of BPH.

Spontaneous Rupture of Renal Pelvis with Unknown Etiology: A Case Report / 대한비뇨기과학회지

We experienced a case of extensive urinary extravasation by rupture of renal pelvis in 61-year old male with no predisposing factors or any prior clues. He was managed by primary closure and followed up for 6 months without any problem.

A Case of Emphysematous Prostatitis / 대한비뇨기과학회지

Emphysematous prostatitis is characterized by pockets of gas within the prostate due to gas-forming organisms. Although only one case of emphysematous prostatitis had been reported in the literature, it was incidental finding associated with emphysematous cystitis. We consider that it is the result of aerobic urinary tract infections or may be caused by gastrointestinal fistula or iatrogenic surgical and diagnostic instrumentation. We report a case of emphysematous prostatitis in a 66 years old male with diabetes mellitus.

A Case of Emphysematous Prostatitis / 대한비뇨기과학회지

Emphysematous prostatitis is characterized by pockets of gas within the prostate due to gas-forming organisms. Although only one case of emphysematous prostatitis had been reported in the literature, it was incidental finding associated with emphysematous cystitis. We consider that it is the result of aerobic urinary tract infections or may be caused by gastrointestinal fistula or iatrogenic surgical and diagnostic instrumentation. We report a case of emphysematous prostatitis in a 66 years old male with diabetes mellitus.

The Applications of Appendix in Urinary Reconstruction / 대한비뇨기과학회지

Under specific circumstances the appendix vermiformis may be an appropriate organ for replacement of a large ureteral defect or efferent loop in continent urinary diversion. Since 1995 we have applied the appendix in ureteral substitution (3 cases) and continent urinary diversion (3 cases). Primary diagnoses included complete lower ureteral stricture due to urinary tuberculosis (3 cases), invasive bladder tumor (1 case), areflexic neurogenic bladder (1 case), and contracted bladder (1 case). In all patients who have been replaced the ureter with appendix, clinical symptoms were markedly improved and degree of hydronephrosis decreased. Other patients with continent urinary diversion using appendix achieved dryness and low postoperative complications. we anticipate that the appendix will be used more commonly in the future as a ureteral substitute or continent urinary diversion as more urologists become more comfortable with it through its use in various reconstructive procedures.