Change of coronary artery indices according to coronary dominance pattern in early childhood / 소아과

PURPOSE: Coronary arterial lesion assessment in children can be difficult, depending on the coronary dominance pattern. Although it is easier to determine coronary dominance with echocardiography in children than in adults, it is still difficult. This study aimed to examine the coronary dominance pattern according to the objective coronary artery (CA) indices. METHODS: The CA diameter, aortic valve annulus, and abdominal aorta of 69 children without any cardiovascular disease were measured with cross-sectional echocardiography at Chungnam National University Hospital. To evaluate the coronary dominance pattern, echocardiography was primarily used; additionally, coronary computed tomographic angiography or coronary angiography (CAG). Coronary dominance was determined according to the status of the CA that gives rise to the posterior descending artery. RESULTS: The mean age was 4.02±2.78 years, and the mean body surface area (BSA) was 0.70±0.22 m². Right dominance was present in 78% and left in 22% of the subjects. In those with left dominance, the CA to aortic valve annulus diameter ratio was 0.125±0.021 in the right coronary artery (RCA) and 0.255±0.032 in the left coronary artery (LCA). In those with right dominance, the corresponding ratio was 0.168±0.028 in the RCA and 0.216±0.030 in the LCA (P<0.05). Significant differences were also found in the diametric ratios of the CA to BSA and abdominal aorta (P<0.05). CONCLUSION: The CA indices showed significant difference according to the coronary dominance pattern in early childhood. It is possible to indirectly determine the coronary dominance pattern with the CA indices in children using echocardiography. The accuracy of coronary artery lesion diagnosis can be improved by taking coronary dominance into account.

Thickness in Ganglion Cell-Inner Plexiform Layer on Spectral-Domain Optical Coherence Tomography after Cataract Surgery

PURPOSE: To assess changes in ganglion cell-inner plexiform layer (GCIPL) thickness after cataract surgery using spectral-domain optical coherence tomography (OCT). METHODS: Forty-three eyes of 33 patients, who underwent cataract surgery were imaged with spectral-domain OCT before and after surgery to measure peripapillary retinal nerve fiber layer (RNFL) and GCIPL thickness, signal strength (SS), quadrant, 12 clock-hour RNFL thickness and sectoral GCIPL thickness. RESULTS: The postoperative SS, RNFL and GCIPL thickness were higher than before surgery (p < 0.05). Multivariate analysis showed that endothelial cell count and preoperative SS were significantly correlated with SS changes in RNFL parameters and preoperative SS was significantly correlated with SS changes in GCIPL parameters. Univariate analysis indicated that age was significantly correlated with RNFL thickness changes in RNFL parameters and no factor was correlated with GCIPL thickness in GCIPL parameters (p < 0.05). CONCLUSIONS: Cataracts may decrease peripapillary RNFL and GCIPL thickness measurements and SS on OCT scans. Peripapillary RNFL and GCIPL thickness measurements should be interpreted with caution in eyes with significant cataracts.

Cytotoxicities and Anti-Fibrotic Effects of Pirfenidone and Mitomycin C on Human Fibroblasts

PURPOSE: The cytotoxicities and anti-fibrotic effects of mitomycin C and pirfenidone on human dermal fibroblast were evaluated. METHODS: Initially, 24-hour cell cultures were exposed to transforming growth factor (TGF)-beta1, different concentrations of mitomycin C, and pirfenidone solutions in order to evaluate cytotoxicity. Expressions of fibronectin, collagen type 1, alpha smooth muscle, and beta-actin were evaluated by real-time reverse transcription-polymerase chain reaction (RT-PCR) and western blot in mitomycin C solutions at concentrations of 4 microg/mL and 20 microg/mL, and in pirfenidone solutions at 250 microg/mL and 500 microg/mL. RESULTS: In comparison to cell cultures exposed to TGF-beta1 solutions, cytotoxicities were increased in solutions of mitomycin C at 4 microg/mL, 20 microg/mL, 40 microg/mL and pirfenidone at 500 microg/mL, 750 microg/mL, 1,000 microg/mL (p < 0.05, Mann Whitney U-test). The results of real-time RT-PCR show that expressions of fibronectin, collagen type 1, and alpha smooth muscle were significantly more decreased in all concentrations of mitomycin C and pirfenidone compared to those in TGF-beta1 solution. In western blot analysis, expressions of fibronectin and alpha smooth muscle were decreased in all concentrations of mitomycin C and pirfenidone compared to TGF-beta1 solution. CONCLUSIONS: Both drugs have cytotoxicities and anti-fibrotic effects, but pirfenidone was found to have less cytotoxicity and mitomycin C was found to have more anti-fibrotic effects when compared to each other.

Reproducibility of Peripapillary Retinal Nerve Fiber Layer Thickness Measured by Spectral Domain Optical Coherence Tomography in Pseudophakic Eyes

PURPOSE: To assess the reproducibility of circumpapillary retinal nerve fiber layer (cpRNFL) thickness measurement (measurement agreement) and its color-coded classification (classification agreement) by Cirrus spectral domain optical coherence tomography (OCT) in pseudophakic eyes. METHODS: Two-hundred five participants having glaucoma or glaucoma suspected eyes underwent two repeated Cirrus OCT scans to measure cpRNFL thickness (optic disc cube 200 x 200). After classifying participants into three different groups according to their lens status (clear media, cataract, and pseudophakic), values of intra-class coefficient (ICC), coefficient of variance, and test-retest variability were compared between groups for average retinal nerve fiber layer (RNFL) thicknesses and that corresponding to four quadrant maps. Linear weighted kappa coefficients were calculated as indicators of agreement of color code classification in each group. RESULTS: ICC values were all excellent (generally defined as 0.75 to 1.00) for the average and quadrant RNFL thicknesses in all three groups. ICC values of the clear media group tended to be higher than those in the cataract and pseudophakic groups for all quadrants and average thickness. Especially in the superior and nasal quadrants, the ICC value of the cataract group was significantly lower than that of the clear media and pseudophakic groups. For average RNFL thickness, classification agreement (kappa) in three groups did not show a statistically significant difference. For quadrant maps, classification agreement (kappa) in the clear media group was higher than those in the other two groups. CONCLUSIONS: Agreement of cpRNFL measurement and its color code classification between two repeated Cirrus OCT scans in pseudophakic eyes was as good as that in eyes with clear crystalline lens. More studies are required to ascertain the effect of lens status on the reproducibility of Cirrus OCT according to different stages of glaucoma patients.

Changes in Optic Nerve Parameter Measurements on Spectral-Domain Optical Coherence Tomography, after Cataract Surgery

PURPOSE: To assess changes in peripapillary retinal nerve fiber layer (RNFL) thickness and optic nerve head parameters after cataract surgery by using spectral-domain optical coherence tomography (OCT). METHODS: Twenty-nine eyes of 26 patients, who underwent cataract surgery, were imaged with spectral-domain OCT before and after surgery to measure peripapillary RNFL thickness and optic nerve head parameters, signal strength (SS), quadrant, 12 clock-hour RNFL thickness, rim area, disc area, cup/disc area ratio, vertical cup/disc ratio, and cup volume. RESULTS: The postoperative RNFL thickness and SS were higher than before surgery (p < 0.05). Regarding optic nerve head parameters, rim area was 0.07 +/- 0.10 mm2 higher than before surgery and disc area, cup/disc area ratio, vertical cup/disc ratio, cup volume were 0.07 +/- 0.15 mm2, 0.04 +/- 0.04, 0.03 +/- 0.05, 0.04 +/- 0.06 mm3, respectively, lower than before surgery (p < 0.05). CONCLUSIONS: Cataracts may decrease peripapillary RNFL thickness measurement and SS on OCT scans and change other optic nerve head parameters. Peripapillary RNFL thickness and optic nerve head parameter measurements should be interpreted with caution in eyes with significant cataracts.

Characterization of Incidentally Detected Adrenal Pheochromocytoma

BACKGROUND: In approach to an adrenal incidentaloma, early exclusion of pheochromocytoma is clinically important, due to the risk of catecholamine crisis. The aims of this study are to investigate the characteristics of incidentally detected pheochromocytomas, compared with that of the other adrenal incidentalomas, and to compare these characteristics with those of symptomatic pheochromocytomas. METHODS: In this retrospective study, we reviewed the medical records of 198 patients with adrenal incidentaloma from 2001 to 2010. We analyzed the clinical, laboratory and radiological data of pheochromocytomas, in comparison with those of the other adrenal incidentalomas. We also compared the characteristics of these incidentally detected pheochromocytomas with the medical records of 28 pathologically proven pheochromocytomas, diagnosed based on typical symptoms. RESULTS: Among the 198 patients with adrenal incidentaloma, nineteen patients were diagnosed with pheochromocytoma. Pheochromocytomas showed larger size and higher Hounsfield unit at precontrast computed tomography (CT) than did non-pheochromocytomas. All pheochromocytomas were larger than 2.0 cm, and the Hounsfield units were 19 or higher in precontrast CT. When both criteria of size > 2.0 cm and Hounsfield unit > 19 were met, the sensitivity and specificity for the diagnosis of pheochromocytoma were 100% and 79.3%, respectively. Compared with patients with pheochromocytoma, diagnosed based on typical symptoms, patients with incidentally detected pheochromocytoma were older, presented less often with hypertension, and showed lower levels of 24-hour urine metanephrine. CONCLUSION: Adrenal incidentaloma with < 2.0 cm in size or < or = 19 Hounsfield units in precontrast CT imaging was less likely to be a pheochromocytoma. Patients with incidentally discovered pheochromocytoma showed lower catecholamine metabolites, compared with those patients with symptomatic pheochromocytoma.

Multivessel Thromboembolism Associated with Dysfunction of Protein S

Protein S is a vitamin K-dependent coagulation factor that acts as an anticoagulant. Deficiency of protein S increases the risk of thromboembolic events. We report a case of isolated protein S deficiency in a 39-year-old woman suffering arterial occlusion in both lower legs. She underwent a surgical procedure using thrombectomy and balloon angioplasty of her left lower extremity. Later, she had right trans-tibial amputation because of the reperfusion injury. Throughout the evaluation of thromboembolic events, we diagnosed a large thrombus in the right atrium and an asymptomatic pulmonary thromboembolism. The patient was successfully treated with right atrial thrombectomy and systemic anticoagulation. Careful evaluation for protein S levels may be necessary in patients with arterial thromboembolic events, especially young adults.

Multivessel Thromboembolism Associated with Dysfunction of Protein S

Protein S is a vitamin K-dependent coagulation factor that acts as an anticoagulant. Deficiency of protein S increases the risk of thromboembolic events. We report a case of isolated protein S deficiency in a 39-year-old woman suffering arterial occlusion in both lower legs. She underwent a surgical procedure using thrombectomy and balloon angioplasty of her left lower extremity. Later, she had right trans-tibial amputation because of the reperfusion injury. Throughout the evaluation of thromboembolic events, we diagnosed a large thrombus in the right atrium and an asymptomatic pulmonary thromboembolism. The patient was successfully treated with right atrial thrombectomy and systemic anticoagulation. Careful evaluation for protein S levels may be necessary in patients with arterial thromboembolic events, especially young adults.

Relationship between the Retinal Thickness Analyzer and the GDx VCC Scanning Laser Polarimeter, Stratus OCT Optical Coherence Tomograph, and Heidelberg Retina Tomograph II Confocal Scanning Laser Ophthalmoscopy

PURPOSE: To assess the relationship between the retinal thickness analyzer (RTA) parameters, and those of the GDx VCC scanning laser polarimeter (GDx VCC), Stratus OCT optical coherence tomography (Stratus OCT), and Heidelberg retinal tomograph II confocal scanning laser ophthalmoscopy (HRT II). METHODS: Twenty-nine primary open-angle glaucoma patients were retrospectively included in this study. Measurements were obtained using the RTA, GDx VCC, Stratus OCT, and HRT II. We calculated the correlation coefficients between the parameters of RTA and those of the other studies. RESULTS: Among the optic disc parameters of RTA, the cup volume was best correlated with Stratus OCT (R=0.780, p<0.001) and HRT II (R=0.896, p<0.001). Among the posterior pole retinal thickness parameters, the posterior pole abnormally thin area (PPAT) of the RTA and the inferior average of the GDx VCC were best correlated (R=-0.596, p=0.001). The PPAT of the RTA and the inferior maximum of the Stratus OCT were best correlated (R=-0.489, p=0.006). The perifoveal minimum thickness (PFMT) of the RTA and the cup shape measurement of the HRT II were best correlated (R=-0.565, p=0.004). CONCLUSIONS: Many RTA optic disc parameters were significantly correlated with those of the Stratus OCT and HRT II. The RTA posterior pole retinal thickness parameters were significantly correlated with those of the GDx VCC, Stratus OCT and HRT II. The RTA optic disc and posterior pole retinal thickness parameters may be valuable in the diagnosis of glaucoma.

Outcomes of 6 Hour Part-time Occlusion Treatment Combined with Near Activities for Unilateral Amblyopia

PURPOSE: To evaluate the outcome of the part-time occlusion therapy with near activities in monocular amblyopic patients according to gender, age, severity of amblyopia, and the cause of amblyopia. METHODS: Fifty eight patients who were prescribed part-time occlusion therapy with near activity from July 1998 to October 2004, were included in this retrospective study. All patients were divided into groups by gender, age, severity of amblyopia, and the cause of amblyopia. Main outcome measures were best corrected visual acuity, line improvement, and success rate. RESULTS: At the end of patch therapy, visual acuity improved from baseline by an average of 3.2+/-2.5 lines (0.33+/-0.26 log MAR), and follow-up period was 19.71+/-14.61 months (1.62+/-1.20 years). At the last follow-up, visual acuity improved from baseline by an average of 3.7+/-2.4 lines (0.38+/-0.26 log MAR), and follow-up period was 37.41+/-25.83 months (3.08+/-2.12 years). The success rate was 86% (50 patients) at the end of patch therapy. In 44 patients out of 50 patients (88%), the visual acuity was maintained. While 43 patients out of 47 patients who were less than 7 years old (91%) achieved success, 7 patients out of 11 patients 7 years or older (64%) achieved success (p=0.035). CONCLUSIONS: Six-hour part-time occlusion treatment combined with near activities appears to be favorable in treating 58 children during follow-up of mean 3.08 years. The significant factor was the age at initial treatment.