PURPOSE: To evaluate the therapeutic efficacy of intravitreal bevacizumab (IVB) in the treatment of branch retinal vein occlusion (BRVO) in eyes with normal tension glaucoma (NTG). METHODS: We included 16 NTG eyes and 48 age- and sex-matched eyes without NTG that had received IVB for BRVO with more than 6 months of follow-up. The main outcome measures were log MAR best-corrected visual acuity (BCVA) and central macular thickness (CMT) at baseline and 1, 3, and 6 months after IVB. We compared the results according to the comorbidity associated with NTG. RESULTS: The obstruction site of BRVO was significantly closer to the optic disc in eyes with NTG than in eyes without NTG. Baseline log MAR BCVA and CMT were similar between the two groups. After IVB, postoperative BCVA was significantly improved and CMT was significantly reduced, irrespective of the comorbidity associated with NTG. However, vision improvement was more limited in eyes with NTG, while CMT was similarly reduced compared with that in eyes without NTG. The mean numbers of injections were similar between the two groups, and there were no injection-related complications. CONCLUSIONS: IVB may have therapeutic efficacy in the treatment of BRVO associated with NTG. However, the comorbidity associated with NTG may limit vision improvement, although anatomic recovery of CMT is achieved.
Antibodies, Monoclonal, Humanized ; Comorbidity ; Eye ; Follow-Up Studies ; Low Tension Glaucoma ; Macular Edema ; Outcome Assessment (Health Care) ; Retinal Vein ; Retinal Vein Occlusion ; Retinaldehyde ; Vision, Ocular ; Visual Acuity ; Bevacizumab

urpose:Adipocyte specific hormone, leptin is thought to regulate appetite and body weight, and serum level of leptin correlate with body fat content not only in adulthood but also in childhood. Adults who received cranial irradiation for childhood acute lymphoblastic leukemia are prone to hypothalamic damage in the form of growth hormone deficiency and leptin insensitivity. The purpose of this study is to evaluate the effect of total body irradiation on serum leptin concentration at short- term follow-up. METHODS:Twenty-four acute leukemia patients undergoing bone marrow transplantation(BMT) were enrolled in this study. They were divided into total body irradiation(TBI) group(n=13) and non total body irradiation(NTBI) group(n=11). Body mass index and leptin concentration at 1 week before BMT and 1 day, 1 week and 4 weeks after BMT were checked. Serum leptin concentration was measured by RIA method. RESULTS:Leptin concentration was well correlated with BMI(r=0.689, P<0.05). BMI were 17.96+/-2.48, 17.58+/-2.39, 17.39+/-2.30, 17.74+/-2.31 in TBI group and 16.91+/-1.88, 16.53+/-1.91, 16.50+/-1.96, 16.78+/-1.82 in NTBI group at 1 week before BMT and 1 day, 1 week and 4 weeks after BMT. Lepin concentrations were 4.31+/-3.57ng/ml, 3.22+/-2.87ng/ml, 3.78+/-4.41ng/ml, 3.46+/-2.96ng/ml in TBI group and 3.46+/-1.84ng/ml, 2.60+/-1.11ng/ml, 2.71+/-1.61ng/ml, 3.61+/-3.27ng/ml in NTBI group at 1 week before BMT and 1 day, 1 week and 4 weeks after BMT. BMI was different at each time period(P<0.05) but not different between two groups. Lepin concentration was not different between two groups and at each time period. CONCLUSION: Serum leptin concentration was not changed, but BMI was significantly decreased by total body irradiation at short-term follow-up.
Adipose Tissue ; Adult ; Appetite ; Body Mass Index ; Body Weight ; Bone Marrow Transplantation* ; Bone Marrow* ; Child* ; Cranial Irradiation ; Follow-Up Studies ; Growth Hormone ; Humans ; Leptin* ; Leukemia* ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Whole-Body Irradiation*

PURPOSE: This study was carried out to evaluate the age and sex distribution, clinical manifestation, presence of the antithyroid antibody, the clinical outcome following antithyroid drug treatment in children with Graves' disease. METHODS: A total 45 children with Graves' disease were entered into the study. Diagnosis was based on clinical manifestation, elevated thyroid function and increased homogeneous 99mTc thyroid uptake on thyroid scan. All patient were treated with prophylthiouracil or methimazole, and assessed concerning about clinical symptoms and signs, existence of antithyroid antibody and states of thyroid function and outcome following antithyroid drug treatment during 3 years of therapy. Remission was defined as a euthyroid state without clinical manifestation and presence of TRAb, while relapse was defined as the recurrence of hyperthyroidism within 12 months of no medication after antithyroid therapy at least for 3 years. RESULTS: 1) The most prevalent age group was 10 to 15 years(82.8%) and female is more prevalent than male(M : F=1 : 14). 2) Goiter, emotional instability, hyperactivity, palpitation, sweating and exophthalmos are the most common symptoms in orders.3) The detection rate of TRAb, AMA and ATA before treatment were 93.3%, 86.7% and 62.2% respectively. 4) The euthyroid state showed in 36(80.0%) of 45 patients within 8 weeks after treatment. 5) The TRAb values remained positive in 27(60.0%) of 45 patients during the first 1 year of antithyroid therapy. 6) Remission rate was 58.8%(26 cases) and relapse rate of remission cases 73.1%. CONCLUSIONS: The present study suggests that children with Graves' disease will continue to require long term clinical and laboratory assessment after discontinuation of antithyroid drug therapy.
Child* ; Diagnosis ; Drug Therapy ; Exophthalmos ; Female ; Goiter ; Graves Disease* ; Humans ; Hyperthyroidism ; Methimazole ; Recurrence* ; Sex Distribution ; Sweat ; Sweating ; Thyroid Gland

Although joint infection with severe destruction remains a serious problem and severe bone loss is relative contraindication of arthrodesis, knee arthrodesis is most commonly a salvage procedure. Its goals are to relieve pain and restore the patient to functional level of activity. The purpose of this study is to evaluate the results and complications of Ilizarov method for knee arthrodesis in the presence of infection. We retrospectively reviewed the records of twelve patients who had managed with knee arthrodesis with Ilizarov method. Indications for the operation included a infected skeletal defect secondary severe open trauma in four patients, an infection at the site of an arthroplasty in three (with failure of previous arthrodesis with monofixator in one), an infected charcot joint in four and one pyogenic arthritis spreading from osteomyelitis of proximal tibia. The average age of the patients at the time of operation was fifty-three years (range twenty-two to eighty years). Follow-up averaged 17 months. The minimum follow up periods was 9 months. Average duration of Ilizarov fixator application was 7.2 months. In 3 cases we performed corticotomy and internal bone transport to treat large bone defect (17cm, 8cm, 6.5cm). Autoiliac bone graft was done in fusion site in two cases, and in three cases we performed bone graft at the docking site. Solid osseous union occured in each patient. There was no reinfection and nonunion. Average shortening was 3.4 cm. Complications were related to pin tract. When last seen, all patients were free of pain and could walk without cruthes or cane. Despite its pin tract problems, bulky cumbersome and expensive apparatus, the Ilizarov method is one of effective method for knee arthrodesis in the presence of infection and large bone loss especially.
Arthritis ; Arthrodesis* ; Arthropathy, Neurogenic ; Arthroplasty ; Canes ; Follow-Up Studies ; Humans ; Ilizarov Technique* ; Joints ; Knee Joint* ; Knee* ; Osteomyelitis ; Retrospective Studies ; Tibia ; Transplants

OBJECTIVE: To correlate the acromiohumeral distance (AHD) using tomosynthesis and rotator cuff (RC) pathology and various anatomical indices and to assess the diagnostic reproducibility of tomosynthesis for the evaluation of subacromial impingement. MATERIALS AND METHODS: A retrospective review of 63 patients with clinically suspected subacromial impingement was conducted. Two musculoskeletal radiologists independently measured the following quantitative data: the AHD on plain radiographs and the AHD at three compartments (anterior, middle, and posterior) using tomosynthesis, computed tomography (CT) arthrography, or magnetic resonance (MR) arthrography. To investigate the association between the AHD and RC pathology and various anatomical indices, we reviewed the arthroscopic operation record as the referenced standard. RESULTS: The size of rotator cuff tear (RCT) in full-thickness tears displayed a significant inverse correlation with the middle and the posterior tomosynthetic AHDs (p < 0.05). The results of an ANOVA revealed that the middle tomosynthetic AHD retained a significant association with the type of RCT (p = 0.042), and the posterior tomosynthetic AHD retained significance for the size of RCT in a full-thickness tear (p = 0.024). The inter-modality correlation exhibited significant agreement especially among the plain radiography, tomosynthesis, and CT or MR arthrography (p < 0.05). The intraobserver and interobserver correlation coefficients (ICCs) displayed excellent agreement (ICC = 0.896–0.983). The humeral head diameter and glenoid height were significantly correlated with patient height and weight. CONCLUSION: Acromiohumeral distance measurement using tomosynthesis is reproducible compared with other modalities.
Arthrography ; Humans ; Humeral Head ; Pathology ; Radiography ; Retrospective Studies ; Rotator Cuff* ; Shoulder ; Tears

No abstract available.
Shock, Septic*

PURPOSE: We attempt to distinguish the patterns of macular edema due to branch retinal vein occlusion (BRVO) and to find correlations between the 24 hour short-term and three month long-term therapeutic effects of an intravitreal bevacizumab injection. METHODS: Forty-four eyes in 44 patients with macular edema due to BRVO underwent an intravitreal bevacizumab injection. Ophthalmoscopic examinations, fluorescein angiographic evaluations, and optical coherence tomography (OCT) examinations performed made before the injections, after 24 hours, and at one, two and three month follow-ups. OCT yielded three patterns of macular edema: diffuse macular edema, cystoid macular edema, and serous retinal detachment. RESULTS: Macular edema significantly improved 24 hours after the injections. The change in central macular thickness after 24 hours had a statistically significant correlation with the three month central macular thickness (Pearson correlation, r=0.757 p=0.011). Cystoid macular edema showed better improvement than the others after 24 hours, but no differences after three months. CONCLUSIONS: OCT treatment 24 hours after an intravitreal bevacizumab injection was found to be highly correlated to the long term prognosis. It is therefore useful in determining therapy and predicting the progress of macular edema in patients with BRVO.
Antibodies, Monoclonal, Humanized ; Eye ; Fluorescein ; Follow-Up Studies ; Humans ; Macular Edema ; Prognosis ; Retinal Vein ; Retinal Vein Occlusion ; Retinaldehyde ; Tomography, Optical Coherence ; Bevacizumab

BACKGROUND: Both the Korean Society of Infectious Diseases and The Korean Center for Diseases Control recommended MMR (measles, mumps, rubella) vaccination to health care workers (HCWs) but this had rarely been applied mainly due to economic reasons. In this paper, we report a measles outbreak initiated by two inpatients and then spread to other nine infants and three HCWs. We also report that this outbreak was successfully contained by active infection control measures. METHODS: Measles cases were determined according to CDC clinical criteria and confirmed by the level of the measles-specific IgM antibody. Suspected patients were isolated in aeration-limited areas. After measles cases in HCWs were detected, people in 26 pediatric wards were screened for measles-specific IgG antibody. MMR (measle, rubella, mumps) vaccination was applied to HCWs who were negative for measles-specific antibodies or HCWs who were exposed but not sure of their vaccination status. RESULTS: From April 21 to June 4 in 2007, measles-infected patients consisted of eleven infants (11 months old in median age) and three HCW women. Antibody screening revealed that only 73% (19 out of 26) in pediatric wards were positive for measles-specific IgG. After a medical doctor was confirmed as measles-infected, health care worker exposed to measles patients were all vaccinated without antibody test. CONCLUSION: The precise level of anti-measles antibody in adults has to be revealed by further studies involving multiple organizations. This result could be helpful for establishing a proper health care policy of MMR vaccination.
Adult ; Antibodies ; Centers for Disease Control and Prevention (U.S.) ; Communicable Diseases ; Delivery of Health Care ; Disease Outbreaks ; Female ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Infant ; Infection Control ; Inpatients ; Mass Screening ; Measles ; Mumps ; Rubella ; Tertiary Care Centers ; Vaccination

PURPOSE: To report a case of bilateral serous retinal detachment associated with Alport's syndrome that resolved following intensive blood pressure control and electrolyte imbalance correction. CASE SUMMARY: A 50-year-old male patient presented with bilateral lenticonus and bilateral serous retinal detachment. Bilateral serous retinal detachment with retinal flecks characteristic of Alport's syndrome appeared along with the development of chronic renal failure and hypertension. The following kidney biopsy revealed Alport's syndrome. After 14 days, the serous detachment resolved and vision recovered following intensive blood pressure control and electrolyte imbalance correction fundus and FA results were nearly normal. CONCLUSIONS: In this case, bilateral serous retinal detachment in Alport's syndrome resolved with intensive blood pressure control and electrolyte imbalance correction. To the author's knowledge, this is the first case in South Korea with documentation of the onset and resolution of bilateral serous retinal detachment in Alport's syndrome.
Biopsy ; Blood Pressure ; Humans ; Hypertension ; Kidney ; Kidney Failure, Chronic ; Male ; Middle Aged ; Nephritis, Hereditary ; Republic of Korea ; Retinal Detachment ; Retinaldehyde ; Vision, Ocular ; Zinc Phosphate Cement

Ureteral obstruction causes increase in renal blood flow (RBF) and partial impairment of the autoregulation of RBF. Although increased renal prostaglandin production is responsible for the former, it is not clear whether or not it is also responsible for the latter. Therefore, we investigated the role which prostaglandins play in the autoregulation of RBF during an ureteral pressure elevation (40 cmH2O). Since the major mechanism of RBF autoregulation is the tubuloglomerular feedback studying the interaction between ureteral pressure and RBF autoregulation may reveal the role of prostaglandin in tubuloglomerular feedback. To pursue the purpose, six anesthetized dogs were prepared for the measurements of RBF, mean systemic and renal arterial pressure (RAP) and the manipulation of ureteral pressure. The autoregulation curves were determined during both control and elevation of the ureteral pressure, before and after the pretreatment with indomethacin, a cyclooxygenase inhibitor. The desired ureteral pressure was achieved by vertically elevating the water-filled reservoir connected to the ureteral catheter to 40 cm above the kidney level. In response to the elevation of the ureteral pressure, RBF increased from 170 +/- 8 ml cntdot min -1 to 189+/-8, and the systemic arterial pressure didn't change significantly. During spontaneous urine flow, RBF autoregulation was abolished when RAP was reduced to 59+/-3 mmHg. On the other hand, during the ureteral pressure elevation, the autoregulation curves shifted upward and rightward from control, and the pressure when RBF autoregulation was abolished was 74 +/- 3 mmHg. The pretreatment of the dogs with indomethacin failed to affect the lower limit of RBF autoregulation during both control (63 +/- 5 mmHg) and the elevated ureteral pressure (77 +/- 5 mmHg). Since RBF failed to increase in response to the elevated ureteral pressure, RBF autoregulation curves obtained during the elevated ureteral pressure shifted only rightward from indomethacin control. The results indicate that the increased intrarenal level of prostaglandin or prostaglandin-induced vasodilation does not appear to bear any relation to the reduction in the autoregulatory capacity during partial ureteral obstruction. It seems that the partial impairment of the autoregulation during acute ureteral obstruction is due to the consumption of tubuloglomerular feedback mechanism at spontaneous RAP and that prostaglandin is neither mediator nor effector of tubuloglomerular feedback mechanism.
Animals ; Arterial Pressure ; Dogs* ; Hand ; Homeostasis ; Indomethacin ; Kidney ; Prostaglandin-Endoperoxide Synthases ; Prostaglandins ; Prostaglandins I ; Renal Circulation* ; Social Control, Formal* ; Ureter* ; Ureteral Obstruction* ; Urinary Catheters ; Vasodilation