Two Cases of Flanged Intrascleral Fixation Performed with Vitrectomy and Air-fluid Exchange

Purpose@#We report two cases in which vitrectomy, air-fluid exchange, and flanged intrascleral fixation were employed to treat crystalline or intraocular lens dislocation associated with retinal detachment.Case summary: Two patients visited our clinic complaining of visual disturbance in the right and left eye respectively. At the initial visits, slit-lamp examination revealed subluxation of a crystalline lens (with zonulysis on the nasal side) in case 1 and dislocation of an intraocular lens (IOL) in case 2. Since retinal detachment was accompanied in both patients, they also underwent vitrectomy and air-liquid exchange during surgery. To fix the intraocular lens to the sclera, both ends of IOL haptics were cauterized using a low-temperature handheld device and flanged haptics had been deeply inserted into scleral tunnels. The intraocular pressure fell and vitreous hemorrhage developed immediately after surgery, but improved on additional treatment. At 18 and 6 months (cases 1 and 2) after surgery, the implanted IOLs were moved to the centers of the pupils without complications. @*Conclusion@#Flanged intrascleral fixation is stable and effective when treating a patient who requires vitrectomy and air-fluid exchange to deal with a retinal disease.

Exploratory evaluation of the role of cardiac troponin on the clinical outcome of patients visiting emergency department with or without chronic kidney disease

Objective@#Elevated levels of cardiac troponin in chronic kidney disease (CKD) patients admitted to the emergency department (ED) is not well understood and is often ignored. This study aimed to investigate the impact of cardiac troponin I (TnI) levels on the clinical outcome of patients visiting the ED with or without CKD. @*Methods@#In this retrospective single-center cohort study, we enrolled patients visiting the ED without a diagnosis of coronary artery disease (CAD). Elevated cardiac TnI was defined as being ≥99th percentile of the normal population (Siemens ADVIA Centaur TnI-Ultra≥0.040 ng/mL). The clinical outcomes of patients with CKD stage≤2 and CKD stage ≥3 were compared. The primary endpoint was the 180-day all-cause death, including cardiovascular and non-cardiovascular deaths. @*Results@#Among a total of 30,472 patients (median age, 61 years; male sex, 54.3%), elevated TnI was found in 4,377 patients (14.4%). There were 3,634 deaths (11.9%) including 584 cardiovascular (1.9%) and 3,050 non-cardiovascular deaths (10.0%). The risk of all-cause death increased in patients with elevated TnI in both CKD stage≤2 (hazard ratio [HR], 2.1; 95% confidence interval [CI], 1.9-2.3) and CKD stage≥3 (HR, 1.5; 95% CI, 1.4-1.7), and so did the risks of cardiovascular and non-cardiovascular death (HR, 1.2-4.7) (P<0.05, all). The association of elevated TnI with death risk was consistent in multivariate analyses and in most clinical subgroup analyses. @*Conclusion@#Elevated TnI was associated with higher 180-day mortality irrespective of renal function among patients visiting the ED without documented CAD. CKD patients visiting the ED with elevated TnI may warrant additional evaluation or careful follow-up even without the presence of CAD.

Effect of Watch-Type Haptic Metronome on the Quality of Cardiopulmonary Resuscitation: A Simulation Study / 대한의료정보학회지

OBJECTIVES: The aim of this study was to test the applicability of haptic feedback using a smartwatch to the delivery of cardiac compression (CC) by professional healthcare providers. METHODS: A prospective, randomized, controlled, case-crossover, standardized simulation study of 20 medical professionals was conducted. The participants were randomly assigned into haptic-first and non-haptic-first groups. The primary outcome was an adequate rate of 100–120/min of CC. The secondary outcome was a comparison of CC rate and adequate duration between the good and bad performance groups. RESULTS: The mean interval between CCs and the number of haptic and non-haptic feedback-assisted CCs with an adequate duration were insignificant. In the subgroup analysis, both the good and bad performance groups showed a significant difference in the mean CC interval between the haptic and non-haptic feedback-assisted CC groups—good: haptic feedback-assisted (0.57–0.06) vs. non-haptic feedback-assisted (0.54–0.03), p < 0.001; bad: haptic feedback-assisted (0.57–0.07) vs. non-haptic feedback-assisted (0.58–0.18), p = 0.005—and the adequate chest compression number showed significant differences— good: haptic feedback-assisted (1,597/75.1%) vs. non-haptic feedback-assisted (1,951/92.2%), p < 0.001; bad: haptic feedbackassisted (1,341/63.5%) vs. non-haptic feedback-assisted (523/25.4%), p < 0.001. CONCLUSIONS: A smartwatch cardiopulmonary resuscitation feedback system could not improve rescuers' CC rate. According to our subgroup analysis, participants might be aided by the device to increase the percentage of adequate compressions after one minute.

Risk factors in the progression of BK virus-associated nephropathy in renal transplant recipients

BACKGROUND/AIMS: BK virus-associated nephropathy (BKVAN) is an important cause of allograft dysfunction in kidney transplant recipients. It has an unfavorable clinical course, and no definite treatment guidelines have yet been established. Here, we report our center's experience with biopsy-proven BKVAN and investigate factors associated with its progression. METHODS: From January 2004 to April 2013, 25 patients with BKVAN were diagnosed by biopsy at Seoul St. Mary's Hospital. Of the 25 patients, 10 were deceaseddonor transplant recipients and 15 were living-donor transplant recipients. Three of the patients underwent retransplantation. The primary immunosuppressant used was tacrolimus in 17 patients and cyclosporine in eight patients. RESULTS: BKVAN was observed at a mean duration of 22.8 ± 29.1 months after transplantation. The mean serum creatinine level at biopsy was 2.2 ± 0.7 mg/dL. BKVAN occurred with acute rejection in eight patients (28%). Immunosuppression modification was performed in 21 patients (84%). Additionally, leflunomide and intravenous immunoglobulin were administered to 13 patients (52%) and two (8%), respectively. Allograft loss occurred in five patients (27.8%) during the follow- up period at 0.7, 17.1, 21.8, 39.8, and 41.5 months after the BKVAN diagnosis. Advanced stages of BKVAN, increased creatinine levels, and accompanying acute rejection at the time of BKVAN diagnosis increased the risk of allograft failure. CONCLUSIONS: The clinical outcomes in patients with biopsy-proven BKVAN were unfavorable in the present study, especially in patients with advanced-stage BKVAN, poor renal function, and acute allograft rejection.

Immunologic and non-immunologic complications of a third kidney transplantation

BACKGROUND/AIMS: Patients who undergo repeat kidney transplantations (KTs) are considered at high risk for experiencing immunologic and non-immunologic complications. In this study, we investigated the clinical outcomes, including medical and surgical complications, of patients who underwent a third KT at our center. METHODS: Between March 1969 and December 2012, a total of 2,110 KTs were performed at the Seoul St. Mary's Hospital. Of them, we examined 11 patients who underwent a third KT, and investigated the allograft outcomes and complication rates. RESULTS: The mean follow-up duration after KT was 72.4 ± 78.3 months. The mean age at KT was 38.2 ± 8.0 years, and seven patients (63.6%) were males. Nine patients (81.8%) underwent living-donor KT. A cross-match test yielded positive results in four of the nine patients, and all underwent pretransplant desensitization therapy. After KT, three patients (27.2%) showed delayed graft function. Acute rejection developed in four patients (36.4%), and surgical complications that required surgical correction occurred in three patients. Allograft failure developed due to acute rejection (n = 3) or chronic rejection (n = 1) in four patients. Allograft survival rates at 1, 5, and 10 years were 81.8%, 42.9%, and 42.9%, respectively; however, the allograft survival rate at 5 years was > 80% in patients who underwent KT only after results of the panel reactive antibody test became available. CONCLUSIONS: Thus, a third KT procedure may be acceptable, although aggressive pretransplant immune monitoring and patient selection may be required to reduce the risks of acute rejection and surgical complications.

Triple-negative breast cancer that progressed as estrogen receptor-positive skin metastases

No abstract available.

Adverse effects of 4-tert-octylphenol on the production of oxytocin and hCG in pregnant rats / 한국실험동물학회지

Endocrine-disrupting chemicals (EDCs) are exogenous substances that alter the structure or function of the endocrine system. 4-Tert-octylphenol (OP) is one of the most representative EDCs and has estrogenic effects. In this study, we examined the effects of ethinyl estradiol (EE) and OP on the pituitary gland, placenta, and uterus of pregnant rats. Expression levels of human chorionic gonadotropin (hCG), oxytocin (OT), and contraction-associated proteins (CAPs) were determined, and uterine contractile activity was measured by uterine contraction assay. EE and OP both increased mRNA expression of OT and hCG in the pituitary gland but not the placenta. Since OT and hCG control uterine contraction, we next examined CAP expression in the uterus. Expression of 15-hydroxyprostaglandin-dehydrogenase (PGDH) was upregulated by OP, whereas expression of other CAPs was unaffected. To clarify the effect of OP on uterine contraction in pregnant rats, uterine contraction assay was performed. The 17beta-Estradiol (E2) did not affect contraction of primary uterine cells harvested from pregnant rats in a 3D collagen gel model. However, OP showed different effects from E2 by significantly reducing contraction activity. In summary, we demonstrated that OP interferes with regulation of OT and hCG in the pituitary gland as well as PGDH in the uterus, thereby reducing uterine contraction activity. This result differs from the action of endogenous E2. Collectively, these findings suggest that exposure to EDCs such as OP during pregnancycan reduce uterine contractile ability, which may result in contraction-associated adverse effects such as metratonia, bradytocia, and uterine leiomyomata.

Usefulness of Serum Leucine-Rich Alpha-2 Glycoprotein as a Disease Activity Biomarker in Patients with Rheumatoid Arthritis

Our study aimed to investigate whether serum leucine-rich alpha-2-glycoprotein (LRG) levels are elevated in patients with rheumatoid arthritis (RA). In addition, we assessed their correlation with disease activity parameters and pro-inflammatory cytokine, tumor necrosis factor-alpha (TNF-alpha). Our study included 69 patients with RA and 48 age- and sex-matched healthy controls. Serum concentrations of TNF-alpha and LRG were determined by enzyme-linked immunosorbent assay. Serum LRG concentrations were significantly elevated in patients with RA compared with those in healthy controls (30.8+/-14.4 vs. 22.2+/-6.1 ng/mL; P or =2.6) were significantly higher than those in remission (DAS28<2.6) (36.45+/-14.36 vs. 24.63+/-8.81 ng/mL; P<0.001). Our findings suggest that serum LRG could contribute to the inflammatory process independent of TNF-alpha and it may be a novel biomarker for assessing inflammatory activity in patients with RA.

Usefulness of Serum Leucine-Rich Alpha-2 Glycoprotein as a Disease Activity Biomarker in Patients with Rheumatoid Arthritis

Our study aimed to investigate whether serum leucine-rich alpha-2-glycoprotein (LRG) levels are elevated in patients with rheumatoid arthritis (RA). In addition, we assessed their correlation with disease activity parameters and pro-inflammatory cytokine, tumor necrosis factor-alpha (TNF-alpha). Our study included 69 patients with RA and 48 age- and sex-matched healthy controls. Serum concentrations of TNF-alpha and LRG were determined by enzyme-linked immunosorbent assay. Serum LRG concentrations were significantly elevated in patients with RA compared with those in healthy controls (30.8+/-14.4 vs. 22.2+/-6.1 ng/mL; P or =2.6) were significantly higher than those in remission (DAS28<2.6) (36.45+/-14.36 vs. 24.63+/-8.81 ng/mL; P<0.001). Our findings suggest that serum LRG could contribute to the inflammatory process independent of TNF-alpha and it may be a novel biomarker for assessing inflammatory activity in patients with RA.

A Case of Acroosteolysis in Primary Hypertrophic Osteoarthropathy

Primary hypertrophic osteoarthropathy or pachydermoperiostosis is a rare hereditary disorder characterized by digital clubbing, pachydermia and periostosis. Its precise incidence and prevalence is still unknown due to the lack of controlled data. It occurs without any underlying causes and usually has a chronic course. Life expectancy may be of normal standards, but many patients develop multiple functional and cosmetic complications. So, it is important to diagnose this disease at an early stage and to treat the symptomat for the quality of life. We report a case of primary hypertrophic osteoarthropathy in a 68-year-old male with clinical features such as digital clubbing and pachydermia, radiographic findings of acroosteolysis and periosteal new bone formation.

Streptococcus Dysgalactiae Subspecies Dysgalactiae Infection after Total Knee Arthroplasty: A Case Report

Streptococcus dysgalactiae subspecies dysgalactiae (SDSD), Lancefield group C streptococcus, is an animal pathogen which often causes pyogenic infection in domestic animals. Human infection by SDSD has been reported as a cellulitis on the upper arm, but a prosthetic joint infection caused by SDSD after total knee arthroplasty (TKA) has not yet been reported in the literature demonstrating that its clinical manifestation and management have not been well established. In this case report, we aimed to present a case of SDSD prosthetic joint infection after TKA, which was successfully treated by two-stage re-implantation with an application of antibiotic-impregnated cement spacer.

A Case of Henoch-Schonlein Purpura Complicated by Acute Pancreatitis and Interstitial Pneumonitis

Henoch-Schonlein purpura (HSP) is a systemic vasculitis involving the skin, gut, joint and kidney that is characterized by immunoglobulin A (IgA)-dominant immune deposits in target organs. Gastrointestinal involvement is known to be relatively common, but acute pancreatitis and pulmonary involvement are rare in Henoch-Schonlein purpura. We experienced a case of a 46-year-old man who developed adult-onset HSP complicated by acute pancreatitis and interstitial pneumonitis. The patient received corticosteroid therapy at a dosage of 0.5 mg/kg. After corticosteroid therapy, patient's symptoms improved. We report here the first case of HSP complicated by acute pancreatitis and interstitial pneumonitis.

Korean consumers' perceptions of health/functional food claims according to the strength of scientific evidence

In this study, we investigated that consumers could differentiate between levels of claims and clarify how a visual aid influences consumer understanding of the different claim levels. We interviewed 2,000 consumers in 13 shopping malls on their perception of and confidence in different levels of health claims using seven point scales. The average confidence scores given by participants were 4.17 for the probable level and 4.07 for the possible level; the score for the probable level was significantly higher than that for the possible level (P < 0.05). Scores for confidence in claims after reading labels with and without a visual aid were 5.27 and 4.43, respectively; the score for labeling with a visual aid was significantly higher than for labeling without a visual aid (P < 0.01). Our results provide compelling evidence that providing health claims with qualifying language differentiating levels of scientific evidence can help consumers understand the strength of scientific evidence behind those claims. Moreover, when a visual aid was included, consumers perceived the scientific levels more clearly and had greater confidence in their meanings than when a visual aid was not included. Although this result suggests that consumers react differently to different claim levels, it is not yet clear whether consumers understand the variations in the degree of scientific support.

Kikuchi-Fujimoto's Disease with Adult Onset Still's Disease / 대한류마티스학회지

Kikuchi-Fujimoto's disease (KFD), or histiocytic necrotizing lymphadenitis, is a rare benign and self-limiting disease. KFD are confused with systemic autoimmune disease as they present with localized lymphadenopathy, fever, fatigue, arthritis, leukopenia. Furthermore as KFD can occur associated with other autoimmune disease, we need to diagnose carefully. Here, we describe a case of 27-year-old female patient, diagnosed as KFD, who subsequently developed adult onset Still's disesase (AOSD). As far as we know, this is the first case of KFD with AOSD in Korea.

Two Cases of Calcinosis Cutis Combined with Rheumatologic Disease / 대한류마티스학회지

The calcinosis, dystrophic soft tissue calcification, occurs in damaged or devitalized tissues normal calcium/phosphorus metabolism. It is the subcutaneous tissues of connective tissues disease ?primarily systemic lupus erythematosus, scleroderma, or dermatomyositis - and may involve a relatively localized area. The calcinotic accumulations may result in muscle atrophy, joint contractures, and skin ulceration complicated by recurrent episodes of local inflammation and infection. Calcinosis may be the source of both pain and disability in connective tissue disease patients. While various therapeutic modality have been used, no treatment has convincingly prevented or reduced calcinosis. We report two cases of calcinosis cutis combined with rheumatic disease.

The Effect of Early Diagnosis and Treatment on the Disease Activity and Joint Damages in Korean Patients with Rheumatoid Arthritis / 대한류마티스학회지

OBJECTIVE: We investigated the effect of the early diagnosis and treatment on the disease activity and joint damage in patients with rheumatoid arthritis (RA). METHODS: We enrolled 242 RA patients (male 50 patients, female 192 patients, mean age 49.7+/-13.5 years old) in this study. They were divided into two groups according to lag-time to diagnose RA from the onset of symptoms. 136 RA patients whose lag-time did not exceed 12 months were classified into early diagnosed RA group and 106 RA patients whose lag-time over 12 months were classified into delayed diagnosed RA group. Baseline date were assessed at the time of diagnosis. Disease activity was assessed by sums of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) during first year after diagnosis. Radiological joint damages were evaluated using modified Sharp score. RESULTS: At the time of diagnosis, the age of patients, ESR and platelet counts were significantly decreased, and hemoglobin level was significantly increased in early diagnosed RA group. Early diagnosed RA group showed lower sums of ESR and CRP than delayed diagnosed RA group significantly. Modified sharp score at the time of diagnosis and after treatment were significantly lower in early diagnosed RA group than delayed diagnosed RA group. The difference of modified sharp score between at the time of diagnosis and after treatment were lower in early diagnosed RA group than delayed diagnosed RA group too. CONCLUSION: The early diagnosis and treatment of RA reduced extent of joint damage and provoked better response to treatment significantly.

Clinical Characteristics of Late-onset Rheumatoid Arthritis / 대한류마티스학회지

OBJECTIVE: Late-onset rheumatoid arthritis (LORA) refereed as the subset of rheumatoid arthritis with age of onset over 60 years old, seems to differ from younger onset disease (YORA) by more equal sex distribution, a higher frequency of abrupt disease onset, more large joints involvement, more extraarticular manifestation, erythrocyte sedimentation test (ESR), and less rheumatoid factor (RF) positivity. We need data of LORA in Korea because of lack of data. METHODS: Two hundred and forty-two patients were studied retrospectively. We compared the difference with clinical manifestation, disease activity markers, RF, ANA, and radiologic changes between LORA and YORA. Sums of ESR and C-reactive protein (CRP) during first year after diagnosis were calculated through area under curve. Radiologic joint damages were evaluated using modified Sharp score. RESULTS: The gender ratio (female/male) was 1.54 in LORA and 6.43 in YORA (p<0.001). The duration of the diagnosis was longer in LORA than in YORA (25.2+/-27.0 months, 18.5+/-22.2 months, p=0.048). Tender and swollen joint, and involvement of joints were not different in the groups. ESR, CRP, platelet, and RF were higher with LORA. Sums of ESR and CRP were higher in LORA than in YORA (403.7+/-252.2 mm/hr, 25.6+/-41.1 mg/dL vs 281.4+/-201.3, 12.0+/-15.0). There was no difference of modified Sharp score in both groups. CONCLUSION: The LORA has an equal gender ratio, longer morning stiffness and disease duration, and higher levels of RF, platelet, ESR, CRP, and summation of ESR and CRP, which suggests that LORA may have poorer prognosis than YORA.

A Case Of Low Grade B Cell Mucosa Associated Lymphoid Tissue Lymphoma Of Jejunum Presenting Recurrent Lower Gastrointestinal Bleeding And Perforation / 대한내과학회지

The accurate diagnosis and localization of gastrointestinal bleeding may use many tests and procedures including serial hematocrits, angiography, scintigraphy, endoscopy, nasogastric aspiration, barium studies and surgery before success is achieved. However, lower gastrointestinal (GI) bleeding is difficult to localize despite above diagnostic procedures. We had experienced a case of mucosa associated lymphoid tissue (MALT) lymphoma of jejunum. In this case, a 61-year-old male was admitted to our hospital with recurrent lower GI bleeding. The cause of recurrent lower GI bleeding was not defined by extensive evaluation including gastrofiberoscopy, colonoscopy, mesenteric angiography, small bowel series. We diagnosed this case as low grade B cell MALT lymphoma after exploratory laparatomy due to bowel perforation.

Quality of Marital Life in Korean Patients with Fibromyalgia / 대한류마티스학회지

OBJECTIVE: Fibromylagia (FM) is a rheumatic disorder characterized by widespread bodily pain, tenderness, and fatigue. It has a major impact on the quality of life including the quality of marital life. The objectives of this study were to assess the quality of marital life in patients with FM in Korea and to identify the correlation of the quality of marital life with disease severity. MEHTODS: Subjects were the patient group, composed of 50 married patients with FM, and a comparison group composed of 50 healthy married adults with similar demographic characteristics. The quality of marital life was measured using the Korean-Marital Satisfaction Inventory (K-MSI). The K-MSI consists of two valid scales, one global affective scale, and eleven additional scales measuring specific dimensions of relationship distress. The clinical parameters were assessed by Korean Fibromyalgia Impact Questionnaire (KFIQ) and tender point, respectively from 50 patients with FM. RESULTS: Of the 50 subjects, 48 (96%) were women with mean (+/-SD) age of 52.6(+/-8.8) years. The mean (+/-SD) duration of disease was 25.7 (+/-19.8) months. The mean (+/-SD) scores of KFIQ and tender point count were 52.9 (+/-14.9) and 13.1 (+/-1.6), respectively. The T-score of most scales of K-MSI of FM patients were higher than that of healthy controls (p<0.01). The scores of KFIQ were positively correlated with the eight scales of K-MSI and negatively correlated with one scale (Role orientation) of K-MSI. The tender point count was positively correlated with only one of scale (Conflict with in-law) of K-MSI. CONCLUSION: The results suggest that the quality of marital life in Korean patients of FM is lower than healthy subjects. In a simple correlation analysis, KFIQ was a meaningful variable correlated with the quality of marital life.

A Case of Neurogenic Bladder Associated with Systemic Lupus Erythematosus / 대한류마티스학회지

Neurogenic bladder in systemic lupus erythematosus (SLE) has been considered to occur rarely. Myelopathy, cyclophosphamide treatment, vasculitis have been implicated as the causes of the bladder pathology in patients with SLE. In this report, we describe a 46-year- old female with SLE who simultaneously combined with the neurogenic bladder. The diagnosis of neurogenic bladder, attributed to peripheral neuropathy, was made on the basis of cystometrography and clinical symptom. Steroid therapy couldn't improve the clinical manifestation of neurogenic bladder despite the amelioration of the other lupus symptom.