Purpose: We sought to evaluate the safety and effectiveness of patient-specific ocular prostheses produced by three-dimensional (3D) printing and the sublimation technique. A comparison with prostheses produced using manual manufacturing methods was then performed. Methods: To confirm the biological and physiochemical safety, cytotoxicity, systemic acute toxicity, intradermal reaction, and skin sensitization tests were conducted according to the International Organization for Standardization guidelines. The compressive strength of the prostheses was also tested. Further, a case series of three patients who wore the 3D printed prostheses for more than eight hours daily for 4 weeks was executed. Self-assessments by these individuals using a questionnaire and safety evaluations focusing on the occurrence of conjunctival inflammation or allergic reactions according to the Cornea and Contact Lens Research Unit criteria by slit-lamp examination and similarity assessment were completed. Results: The 3D printed ocular prostheses met the necessary qualifications per the biological and physiochemical safety tests, showing the absence of cytotoxicity, acute systemic toxicity, intradermal reactivity, and skin-sensitizing potency. Also, there was no difference in strength test results between previous ocular prostheses and the 3D printed ones. Self-assessment by the patients yielded satisfactory results, with no significant difference in the level of satisfaction reported for the 3D printed and previous handmade ocular prostheses. The 3D printed prosthesis did not trigger any side effects in the conjunctival sac and showed similar objective findings with respect to the color of the iris, sclera, and vessel patterns. Conclusions Our study confirms the biologic and physiochemical safety of 3D-printed ocular prostheses created using computer-aided design technology and a sublimation technique. The patients’ questionnaires and the judgment of the ophthalmologists/ocularists showed that the 3D printed ocular prosthesis was acceptable in function and appearance through a case series report.

BACKGROUND AND OBJECTIVES: The clinical association between migraine and vestibular symptoms has been indicated in many studies and it is believed that migraine-associated vertigo is one of the most common causes of spontaneous recurrent vertigo. SUBJECTS AND METHOD: We investigated the nature of vestibular and migrainous symptoms of 26 patients suffering vertigo associated with migraine and their responses to antimigrainous medications. Neurotologic tests such as oculomotor tests, calorictest, and audiometry were performed between attacks. RESULTS: A marked female predominance was found. The duration of rotational (77%) and/or to-and-fro vertigo (23%) lasted from a few seconds to several hours or, less frequently, even days. We found that patients showed vestibular abnormalities in central and peripheral types. In the symptom-free interval, 31% of the patients showed central oculomotor signs such as delayed saccadic latency and horizontal saccadic pursuit. On the other hand, 15% showed unilateral weakness in the caloric test and 15% showed positive results in the head thrust tests. Overall, 85% of patients experienced resolution or significant reduction of their attacks of vertigo with medication. CONCLUSION: Most patients with migraine-associated vertigo showed normal results on the vestibular tests and responded well to preventive medication. Migraine-associated vertigo caused various clinical manifestations and there should be relevant differential diagnosis for epiodic vertigo.
Audiometry ; Caloric Tests ; Diagnosis, Differential ; Dizziness ; Female ; Hand ; Head Impulse Test ; Humans ; Migraine Disorders ; Saccades ; Vertigo* ; Vestibular Diseases

OBJECTIVE: Vestibulo-collic reflex (VCR) has been thought to be a simple and reliable test in evaluating the vestibular function. But it can only be examined by actively contracting the sternocleidomastoid muscle (SCM) and it would be impossible to conduct the examination without the cooperation of the subject. The aim of this study was to demonstrate a new method for VCR in the absence of the subject's cooperation. METHOD: Records were collected from 20 volunteers. Each subject was properly positioned on the bed with the head flexed, ipsilaterally bent and contralaterally rotated. An active electrode was placed over the belly of the SCM. 100 dB clicks were delivered through headphones. We compared the active contraction and passive positioning of the SCM in terms of the P1 latency and amplitude. RESULTS: Vestibular-evoked myogenic potentials (VEMPs) were recorded without actively contracting the SCMs for all the subjects by using our new method. There was no difference in P1 latency and amplitude between the active contraction and passive positioning of the SCM. CONCLUSION: With our new method, VEMPs can be recorded without actively contracting the SCM. It may be useful for evaluating the vestibular function of children and patients who cannot cooperate.
Child ; Electrodes ; Head ; Humans ; Reflex* ; Vestibular Function Tests ; Volunteers

BACKGROUND: Although hepatic resection (HR) is the mainstay for the treatment of hepatocellular carcinoma (HCC), high recurrence rate (>60%) is major serious problem. Thus preoperative transarterial chemoembolization (TACE) has been proposed as a neoadjuvant treatment before HR. However, the effect of preoperative TACE in preventing recurrence for initially resectable HCC remains controversial. This study aims at assessing the role of preoperative TACE on the early and long-term outcome following resection of HCC. METHODS: Retrospective randomized analysis was performed. A total of 366 patients who had HR for HCC between January 1995 and December 2000, were included, 132 patients underwent preoperative TACE (TACE plus HR) and 234 patients did not (HR). Statistically no baseline characteristic difference in two groups. RESULTS: HR group was significantly higher than TACE plus HR group in disease-free survival rate and overall survival rate (p<0.001, p<0.01). In subgroup analysis, the disease-free survival rate of HR group was higher than TACE plus HR group in UICC T1-2 and UICC T3 (p<0.01 for both), whereas the difference in overall survival rate was significant only in UICC T3 (p<0.01). Those who achieved tumor necrosis of more than 95% by preoperative TACE showed comparable overall survival rate with HR group, while it was significantly lower in patients who demonstrated tumor necrosis of less than 95% (p<0.001). CONCLUSIONS: Preoperative TACE for initially resectable HCC may promote early and late tumor recurrence and reduces overall survival rate after surgery particularly in patients with advanced- stage tumors.
Carcinoma, Hepatocellular* ; Disease-Free Survival ; Humans ; Necrosis ; Neoadjuvant Therapy ; Recurrence ; Retrospective Studies ; Survival Rate

BACKGROUND/AIMS: Gastric variceal bleeding is a severe complication of liver cirrhosis with a high mortality. The purpose of this study was to determine the efficacy of transjugular intrahepatic portosystemic shunt (TIPS) in patients with gastric variceal bleedings and predictive factors for survival. METHODS: We retrospectively analyzed the medical records of 30 consecutive patients with gastric variceal bleedings from January 1998 to March 2001. The causes of cirrhosis were viral hepatitis in 17, alcohol in 12, and biliary cirrhosis in 1. Eighteen patients were in Child-Pugh class B and 9 in class C at the time of TIPS. The median follow-up period was 403 days (3-1,215 days). RESULTS: TIPS insertion was successful in all 30 patients. The portal pressure gradient (PPG) was significantly reduced from 23+/-8 mmHg to 11+/-5 mmHg (p<0.05). Hepatic encephalopathy, which developed in 3 patients and was aggravated in 1, was improved with medical therapy. Patients with non-alcoholic etiology experienced deterioration of liver function after TIPS. Those with alcoholic etiology did not. The 6-month and 1-year rebleeding rates were 22% and 41%, respectively. 56% of bleeding episodes were associated with stent dysfunction. The degree of PPG reduction and the development of stent dysfunction were independent predictive factors for rebleeding. The 6-month and 1-year survival rates were 83% and 79%. The causes of death were hepatic failure in 3 (37.5%), recurrent variceal bleeding in 3, and others in 2. Child-Pugh class C was the only prognostic factor for survival. CONCLUSIONS: TIPS was effective in acute hemostasis and the prevention of rebleeding in patients with gastric variceal bleeding. Especially, it can be safely applied to patients with alcoholic etiology and in Child-Pugh class A or B.
Adult ; English Abstract ; Esophageal and Gastric Varices/complications/*surgery ; Female ; Gastrointestinal Hemorrhage/*etiology ; Human ; Liver Cirrhosis/complications ; Male ; Middle Aged ; *Portasystemic Shunt, Transjugular Intrahepatic ; Recurrence

PURPOSE: Neonatal immune hemolytic jaundice due to blood group incompatibility is important to treat properly because of an early rise and a high peak of serum bilirubin level and a risk of kernicterus. The conventional therapeutic modalities for neonatal immune hemolytic jaundice due to blood group incompatibility are phototherapy and exchange transfusion. We evaluated the effect of intravenous immune globulin (IVIG) therapy on hyperbilirubinemia due to ABO incompatibility. METHODS: This study included 6 infants with hyperbilirubinemia due to ABO incompatibility who were admitted to the nursery of Eulji Medical Center, Nowon Hospital, from January 2000 to February 2001. All 6 infants had a positive direct Coombs test. Their serum bilirubin levels were above 12 mg/dl within 24hours of age and above 20 mg/dl after 24hours of age. They were treated with intensive phototherapy and IVIG. RESULTS: We classified the effective group when a decline in serum bilirubin level was more than 2 mg/dl in 3-4 hours after IVIG therapy, and the ineffective group when there was a decline in serum bilirubin level less than 2 mg/dl, a re-rise after the initial response to IVIG, or a decline after the combined therapy with intensive phototherapy and IVIG equal or less than that after intensive phototherapy alone. In the effective group (n=2), the average decline in serum bilirebin level was 4.1 mg/dl in 3-4 hours and 8.1 mg/dl in 12-16 hours after IVIG therapy, while in the ineffective group (n=4), the average decline was 1.9 mg/dl and 2.7 mg/dl, respectively. Five among 6 infants were treated with IVIG therapy and 1 infant was treated with exchange transfusion. No serious side effect was detected during and after IVIG therapy. CONCLUSION: We demonstrated the effectiveness of IVIG therapy in 2 infants out of six who were treated with intensive phototherapy and IVIG for hyperbilirubinemia due to ABO incompatibility. IVIG therapy could be considered if hyperbilirubinemia due to ABO incompatibility does not respond to intensive phototherapy alone. Further prospective and randomized studies would be needed.
Bilirubin ; Blood Group Incompatibility ; Coombs Test ; Humans ; Hyperbilirubinemia ; Immunoglobulins, Intravenous* ; Infant ; Jaundice* ; Kernicterus ; Nurseries ; Phototherapy

BACKGROUND/AIMS: A prospective study was performed to evaluate the efficacy of low dose administration of cisplatin (CDDP) and 5-fluorouracil (5-FU) by repeated arterial infusion via a percutaneously implantable port system (PIPS) for advanced hepatocellular carcinoma (phase II trial). METHODS: Ten patients with hepatocellular carcinoma belonging to TNM stage IV, but without extrahepatic spread, were enrolled. Nine patients had main portal vein thrombosis. All the patients were positive for HBsAg. Patients were repeatedly treated with an arterial infusion of CDDP and 5-FU (10 mg and 250 mg, respectively, for 5 hours on days 1-5) via a PIPS at four week intervals. The response was assessed by dynamic CT after two courses of chemotherapy. RESULTS: Insertion of PIPS was successful in 8 of 10 patients. Two patients could not receive a second course of chemotherapy because one died of progressive hepatic failure and the other developed local infection and pseudoaneurysm formation. All the remaining 6 patients exhibited tumor progression after two courses of chemotherapy. The median survival time was 89 days (range, 59-204). The causes of death were progressive hepatic failure in one patient and uncontrolled esophageal variceal bleeding in one patient. CONCLUSIONS: Arterial infusion chemotherapy with CDDP and 5-FU via a PIPS was not an effective treatment for patients with advanced hepatocellular carcinoma.
Aneurysm, False ; Carcinoma, Hepatocellular* ; Cause of Death ; Cisplatin* ; Drug Therapy ; Esophageal and Gastric Varices ; Fluorouracil* ; Hepatitis B Surface Antigens ; Humans ; Liver Failure ; Prospective Studies ; Venous Thrombosis

PURPOSE: To evaluate the efficacy and safety of transcatheter arterial chemoembolization(TACE) after coil embolization of the gastroduodenal artery in hepatocellular carcinoma cases with multiple collateral arteries caused by proper hepatic artery injury. MATERIALS AND METHODS: Between March 1997 and November 1998, a prospective trial of transcatheter arterial chemoembolization (TACE) was performed through collaterals from the gastroduodenal artery of 31 hepato-cellular carcinoma patients with extensive proper hepatic artery injury due to repeated TACE. Among this number, 16 (group A) underwent TACE after coil embolization of the right gastric and gastroduodenal artery. The other 15 patients (group B) underwent TACE without coil embolization. The two groups had the same T-NM stage and Child-Pugh status. During the follow-up period, group A underwent additional TACE 3.3 times, and group B 2.8 times. The therapeutic effect of TACE was evaluated with computed tomography and by measuring alpha-fetoprotein levels. Complications were evaluated by means of gastrofibroscopy, laboratory data, and evalvation of the patients clinical symptoms. The results obtained after six months and one year were compared within and between each group. RESULTS: At six months follow-up, CT findings had improved or were unchanged in 11 patients(69 %) in group A, and four patients(27 %) in group B(p=0.032). In ten patients in each group, the level of alpha-fetoprotein was above 200 ng/ml. Its level was decreased in five patients(50%) and three patients(30%), respectively. The six-month survival rate was 81 %(13/16) in group A and 67 %(10/15) in group B (p=0.43), while the one-year survival figures for these two groups were 50 %(8/16) and 20%(3/15), respectively(p=0.135). In group A, the CT findings were steady in five out of eight patients(63%), while in group B, CT findings showed that tumors with increased alpha-fetoprotein levels had increased in size and/or number. In group A, it was found that in two (33 %) of six patients whose initial alpha-fetoprotein level was over 200ng/nl, this level had decreased. Acute gastric ulcer was found in two patients in group A, and mild acute pancreatitis in one. One patient in group B was also found to have an acute gastric ulcer. CONCLUSION: In view of the advanced disease stage of patients for whom a long period has elapsed since initial diagnosis, TACE after coil embolization of gastric arteries may be a safe and acceptable method for use in the treatment of hepatocellular carcinoma with extensive hepatic artery injury.
alpha-Fetoproteins ; Arteries* ; Carcinoma, Hepatocellular* ; Diagnosis ; Embolization, Therapeutic* ; Follow-Up Studies ; Hepatic Artery* ; Humans ; Pancreatitis ; Prospective Studies ; Stomach Ulcer ; Survival Rate

BACKGROUND/AIMS: Transarterial chemoembolization (TACE) has been reported to be one of the useful palliative treatments in patients with unresectable hepatocelluar carcinoma. However, Bile duct injuries following TACE have been reported occasionally. In this study, we intended to clarify the incidence, pathogenic mechanisms and clinical implications of bile duct injuries following TACE. METHODS: A total of 950 consecutive patients with hepatocellular carcinoma (HCC) were subjected. 807 patients were treated with TACE. The remaining 143 were treated with transarterial chemoinfusion (TACI) of cisplatin. RESULTS: None of 143 HCC patients treated with TACI revealed to have any ischemic biliary injury radiologically. In contrast, out of 807 with TACE, 17 (2%) appeared to have biliary complications. Twelve out of 17 (71%) had bilomas at subcapsular area, three out of 17 (18%) had focal strictures at common hepatic duct or common bile duct with marked dilatation of intrahepatic bile ducts and two out of 17 (11%) had diffuse mild dilatation of intrahepatic bile ducts. Interestingly, two (17%) out of 12 bilomas were found at the lobe which was not embolized with Gelfoam. The median sessions of TACE to the occurrences of focal strictures tended to be longer compared with those of bilomas (median: 6 vs. 2.5; p=0.08). All three patients with focal strictures and four (33%) out of 12 patients with bilomas were associated with serious bacterial infections at presentation. CONCLUSIONS: Biloma seems to be caused by lipiodol rather than Gelfoam; focal strictures of large bile ducts by Gelfoam. It is suggested that adjustments of the amounts of lipiodol or Gelfoam and the sites or embolization may be required to reduce the ischemic biliary injuries following TACE.
Bacterial Infections ; Bile Ducts* ; Bile Ducts, Intrahepatic ; Bile* ; Carcinoma, Hepatocellular ; Cisplatin ; Common Bile Duct ; Constriction, Pathologic ; Dilatation ; Ethiodized Oil ; Gelatin Sponge, Absorbable ; Hepatic Duct, Common ; Humans ; Incidence ; Palliative Care

OBJECTIVES: Daytime drowsiness or sedation and changes in night sleep are commonly seen in patients treated with clozapine. There is, however, very limited informatio on their degree and nature during the course of treatment. The purpose of this study was to understand the sleep patterns in chronic schizophrenic patients with clozapine treatment over a period of 24 weeks. METHOD: The sleep pattern was evaluated using a set of 5-point scale questionnaire, to record subjective impressions of the night sleep induction, maintenance and quality, and daytime drowsiness and fatigue. In addition, unusual experiences associated with night sleep were recorded. The sleep questionnaire was repeatedly administered at baseline and at 1, 2, 4, 8, 12 and 24 weeks of drug treatment. At present, data on 12 patients has been collected. RESULTS: All the components of night sleep were significantly improved in th 1st through the 12 th week after treatment with clozapine. Daytime drowsiness was significantly higher in the 1st to the 2nd week after the treatment and fatigue was also significantly higher in the 1st to the 4th week after the treatment. Eight patients experienced noticeable increases in salivation during night sleep, and of these, one also reported frequent nocturnal urination and even enuresis. However, all these adverse factors did not affect the major sleep patterns. CONCLUSIONS: These finding suggest that the beneficial effects of clozapine on night sleep might last much longer than the undesirable effect of daytime drowsiness and fatigue. In other words, tolerance of the hypnotic action of clozapine might develop late and tolerance of the daytime drowsiness and fatigue might be evident earlier.
Clozapine* ; Enuresis ; Fatigue ; Humans ; Surveys and Questionnaires ; Salivation ; Sleep Stages ; Urination