PURPOSE: To compare central macular thickness (CMT) and visual acuity outcomes after intravitreal injection of triamcinolone acetonide or bevacizumab for the treatment of diabetic macular edema (DME). METHODS: Fifty-one patients were randomly choosen to receive an intravitreal injection of either triamcinolone acetonide or bevacizumab. Patients were retrospectively reviewed, and 28 of 51 received an intravitreal injection of triamcinolone acetonide while the remaining 23 received bevacizumab injection. All patients underwent Snellen visual acuity testing, optical coherence tomography imaging and ophthalmoscopic examination at baseline and at four weeks following the injection. RESULTS: In the triamcinolone group, CMT decreased from 656.71+/-194.37 micrometer at baseline to 312.46+/-102.14 micrometer at the four-week follow-up visit, while in the bevacizumab group, CMT decreased from 582.17+/-151.02 micrometer at baseline to 453.09+/-172.39 micrometer at the follow-up (p<0.05). The LogMAR best-corrected visual acuity converted from the Snellen visual acuity significantly improved in the triamcinolone group (from 0.89+/-0.38 to 0.67+/-0.33) compared to the bevacizumab group (from 0.79+/-0.31 to 0.70+/-0.34) [p<0.05]. CONCLUSIONS: Intravitreal injection of triamcinolone may offer advantages over bevacizumab in the short-term management of DME, specifically with respect to improvement in CMT and visual acuity.
Antibodies, Monoclonal, Humanized ; Follow-Up Studies ; Humans ; Intravitreal Injections ; Macular Edema ; Retrospective Studies ; Tomography, Optical Coherence ; Triamcinolone ; Triamcinolone Acetonide ; Visual Acuity ; Bevacizumab

PURPOSE: To compare central macular thickness (CMT) and visual acuity outcomes after intravitreal injection of triamcinolone acetonide or bevacizumab for the treatment of diabetic macular edema (DME). METHODS: Fifty-one patients were randomly choosen to receive an intravitreal injection of either triamcinolone acetonide or bevacizumab. Patients were retrospectively reviewed, and 28 of 51 received an intravitreal injection of triamcinolone acetonide while the remaining 23 received bevacizumab injection. All patients underwent Snellen visual acuity testing, optical coherence tomography imaging and ophthalmoscopic examination at baseline and at four weeks following the injection. RESULTS: In the triamcinolone group, CMT decreased from 656.71+/-194.37 micrometer at baseline to 312.46+/-102.14 micrometer at the four-week follow-up visit, while in the bevacizumab group, CMT decreased from 582.17+/-151.02 micrometer at baseline to 453.09+/-172.39 micrometer at the follow-up (p<0.05). The LogMAR best-corrected visual acuity converted from the Snellen visual acuity significantly improved in the triamcinolone group (from 0.89+/-0.38 to 0.67+/-0.33) compared to the bevacizumab group (from 0.79+/-0.31 to 0.70+/-0.34) [p<0.05]. CONCLUSIONS: Intravitreal injection of triamcinolone may offer advantages over bevacizumab in the short-term management of DME, specifically with respect to improvement in CMT and visual acuity.
Antibodies, Monoclonal, Humanized ; Follow-Up Studies ; Humans ; Intravitreal Injections ; Macular Edema ; Retrospective Studies ; Tomography, Optical Coherence ; Triamcinolone ; Triamcinolone Acetonide ; Visual Acuity ; Bevacizumab

Status epilepticus is commonly defined as a condition characterized by an epileptic seizure that is so frequently repeated or so prolonged as to produce a fixed and enduring epileptic condition. Common etiologies are brain tumor, CNS infection, vascular insults, trauma, withdrawal of antiepileptic drug, and metabolic disturbance such as hypoglycemia, hypocalcemia, hyponatremia and hyperosmolarity caused by hyperglycemia, hypernatremia, and uremic encephalopathy etc. Although some cases of epilepsia partialis continua in the patient with nonketotic hyperglycemia were reported in the previous literature, we could hardly find the report that generalized convulsive status epilepticus was the initial symptom of nonketotic hypergycemia. We recently experienced three eases of nonketotic hyperglycemia who manifested generalized convulsive status epilepticus as a initial clinical feature. Two cases were completely controlled within a few hours after the correction of hyperglycemia and intravenous dilantinization. Another case was needed an additional phenobarbital administration to control the status epilepticus. In all cases, afterthen no further seizure occurred under the normal serum glucose level without use of antiepileptics.
Anticonvulsants ; Blood Glucose ; Brain Neoplasms ; Epilepsia Partialis Continua ; Epilepsy ; Humans ; Hyperglycemia* ; Hypernatremia ; Hypocalcemia ; Hypoglycemia ; Hyponatremia ; Phenobarbital ; Phenytoin ; Seizures ; Status Epilepticus*

Cerebral aneurysms associated with arteriovenous malformation (AVM) have been reported with a variable incidence, averaged 10% of total AVM cases. It has been AVM. We report four cases of the intracranial aneurysm associated with AVM. Three cases of aneurysm were located in distal portion of feeding artery, and one case was proximal on major feeding artery. And bleeding resulted from rupture of aneurysm. Three of them located in the posterior circulation. Removal of aneurysm and AVM was successfully accomplished in 3 cases.
Aneurysm ; Arteries ; Arteriovenous Malformations* ; Hemorrhage ; Incidence ; Intracranial Aneurysm ; Rupture

Acute infarction in the whole territory of the middle cerebral artery (MCA) can lead to massive cerebral edema, raised intracranial pressure and cerebral herniation which may result in come and death ultimately. There are same reports which mentioned that craniectomy or stroketomy was an effective life-saving procedure and favorable outcome would be expected after the procedure. In this study, the effect of decompressive partial temporal lobectomy was evaluated in twelve patients of extensive panhemispheric infarction of middle cerebral artery(MCA). We investigated radiologically proven patients of extensive panhemispheric infarction of MCA with impending herniation process, who were admitted to our hospital from March 1991 to June 1996, prospectively and retrospectively. Decompressive partial temporal lobectomy was performed in twelve patients and eighteen patients were treated by only conventional medical treatment(control group). Prognosis were compared between two groups to analyse the effect of the decompressive lobectomy. Fourteen out of the 18 controls(78%) and five out of 12 patients who were treated by decompressive lobectomy(41%) expired due to herniation process. The mortality between two groups was significantly different(P(0.05). Four patient had relatively good outcome(by Barthel index score) and all of them belonged to the decompressive lobectomy group. These results suggest that the decompressive lobectomy be an effective life saving procedure for malignant cerebral edema after a total MCA infarction.
Brain Edema ; Humans ; Infarction* ; Infarction, Middle Cerebral Artery ; Intracranial Pressure ; Middle Cerebral Artery* ; Mortality ; Prognosis ; Prospective Studies ; Retrospective Studies

BACKGROUND: To manage the EMS(emergency medical services) system effectively, departments, such as fire stations, emergency information centers, hospitals, and The Ministry of Health and Welfare, should exchange information that they own and/or gather during patient care and/or transportation. Medical records and information are very important for continuing the patient's care and for deciding on a treatment plan, but medical information is not exchanged fully in spite of its importance. METHOD: We analyzed the transfer medical reports that were written by medical doctors who transferred emergency patients to our hospital. The contents and the accuracy of the transfer medical records were analyzed and graded into 4 groups. Group A was fully described and was equipped with diagnosis, laboratory data, X-ray films; group B had a diagnosis and full laboratory data; group C had a diagnosis, but only partial laboratory data; and group D had only a diagnosis. RESULTS: Among 38,214 patients who visited our hospital from Jan. 2001 to Jun. 2001, 7,031 cases were transferred from other hospitals with transfer medical records. According to the accuracy and important contents of the transfer records, Group A occupied 1.9%, group B 5.2%, group C 32.5%, and group D, with only a diagnosis, 60.4%. In the case of our hospital, we delivered all emergency medical information by written paper(transfer note), E-mail, and web-based information system(cyber-AMC) to the doctors concerned with managing the patient. However, 93% of the medical records of patients transferred from other hospital contained insufficient information to adequately care for the emergency patients. In addition, most of the transferred patients had been transorted without prior information about transportation. CONCLUSION: Within the near future, a medical information center equipped with a computerized system should be operated to exchange medical data. As most general hospitals are operating the OCS(order communication system), EMR(electronic medical record), telemedicine, and PACS(picture-archiving communication system), medical information can be exchanged freely in real time if a code standard and HL7(Health Level 7) can be established.
Clinical Laboratory Techniques ; Diagnosis ; Electronic Mail ; Emergencies* ; Fires ; Hospitals, General ; Humans ; Information Centers ; Medical Records ; Patient Care ; Telemedicine ; Transportation ; X-Ray Film

Thyrotoxic periodic paralysis (TPP) is associated with hypokalemia and occurs sporadically and usually in young adult males. We report ten cases with TPP ; all were males, mean onset age was 32.4 years old. The duration of attack. Varied from 10 to 18 hours. The distribution of paralysis was confined to limb muscles; more severe in proximal limbs and lower extremities. Potassium levels during acute attack correlated with the severity of paralysis and ECG changes, but not with the severity of decrease in TSH level. In all cases, administration of potassium salts was successful in treatment of acute attack. A patient had further attack in spite of euthyroid state under the treatment of thyrotoxicosis for one year. Another patient was free from paralytic attacks by chronic administration of the potassium salt and acetazolamide without treatment of thyrotoxicosis.
Acetazolamide ; Age of Onset ; Electrocardiography ; Extremities ; Humans ; Hypokalemia ; Lower Extremity ; Male ; Muscles ; Paralysis* ; Potassium ; Salts ; Thyrotoxicosis ; Young Adult

BACKGROUND AND OBJECTIVES: Cisplatin is an ototoxic agent commonly used for the treatment of solid tumors. Recently, it has been recognized to cause apoptosis in tumor cells, kidney and cochlea. The Bcl-2 family are specific proteins which are a well-known group of death modulating factors. The aims of this study was to analyze the expression of Bcl-2 family for the time course after cisplatin injection. MATERIALS AND METHODS: Sprague-Dawley (SD) rats were injected intraperitoneally wtih either 20 mg/kg of cisplatin, or the same amount of saline water to be used as control. Cochleae were harvested 6, 12 and 24 hours after injection and compared to those of the control ones. TUNEL staining was performed to observe apoptotic cells. Immunohistochemistry and Western blotting were performed to investigate the expression of Bax and Bcl-2. RESULTS: Positively TUNEL-labeled nuclei were observed mainly in the outer hair cells (OHCs), inner hair cells (IHCs), supporting cells and marginal cells. Bax and Bcl-2 immunoreactivity was observed in stria vascularis, OHCs, IHCs and Deiter's cells in the groups harvested at 6 h and 12 h. Bax was expressed most highly at 6 h and Bcl-2 at 12 h. The western blotting method showed that in the group harvested at 24 h, the intensity of Bax and Bcl-2 expression showed no difference compared with those of the control group. CONCLUSION: The present results suggest that apoptotic mechanism in which Bax and Bcl-2 play an important role begins before 6 h and terminates within 24 h after a single injection of high dose cisplatin.
Animals ; Apoptosis* ; Blotting, Western ; Cisplatin* ; Cochlea* ; Hair ; Humans ; Immunohistochemistry ; In Situ Nick-End Labeling ; Kidney ; Rats* ; Rats, Sprague-Dawley ; Stria Vascularis ; Water

PURPOSE: The concurrent regimen of docetaxel, doxorubicin, and cyclophosphamide (TAC) has been categorized as a high-risk factor for febrile neutropenia (FN). The incidence of FN was reported to be as high as 17%–26% in studies conducted in Western countries. However, these rates may vary among different ethnic groups. This study aimed to evaluate the incidence of FN and its effect on prognosis following adjuvant TAC chemotherapy in Korean patients with advanced breast cancer. METHODS: We analyzed data from 187 patients who received 6 cycles of adjuvant TAC chemotherapy between July 2005 and December 2014. No patients received long-acting granulocyte-colony stimulating factor (G-CSF) as primary prophylaxis for FN due to guidelines for cost reimbursement in Korea. The incidence rates of FN, dose reduction of TAC, relative dose intensity (RDI), relapse-free survival (RFS), and overall survival (OS) were investigated. RESULTS: A total of 102 (54.5%) patients experienced FN, especially older patients (51 years vs. 49 years, p=0.045). RDI was lower in patients with FN than in those without (96.4% vs. 99.5%, p=0.001, respectively). Death was reported in 2 patients (2.35%) without FN and in 10 patients (9.80%) with FN (hazard ratio [HR]: 6.64; 95% confidence interval [CI]: 1.28 to 34.36; p=0.024). No significant differences in RFS (p=0.235) were found using Kaplan-Meier analysis. CONCLUSION The incidence of FN was significantly higher in Korea than in Western countries, and FN had a negative impact on the patients' prognosis. Primary prophylactic G-CSF should be prioritized in Korean patients with advanced breast cancer who receive adjuvant TAC chemotherapy.

BACKGROUND: Limited exercise capacity is common in the elderly. Kinetics of recovery oxygen consumption plays an important role in determining exercise capacity. This study was performed to evaluate the kinetics of recovery oxygen consumption as well as peak oxygen consumption during exercise and recovery in the elderly. METHODS: Thirty healthy volunteers were included for this study. They were divided into three groups according to their ages(20 to 39; 40 to 59; and over 60). All subjects performed symptomlimited maximal treadmill exercise. RESULTS: Peak oxygen consumption(pVO2, ml/min/kg) was gradually decreased with the age. Half-recovery time of peak oxygen consumption(T1/2VO2) was maintained from third to sixth decades without significant changes, and then rapidly delayed in the elderly. CONCLUSION: Kinetics of recovery oxygen consumption was rapidly and markedly delayed in the elderly and this may result in the exercise intolerance.
Aged* ; Healthy Volunteers ; Humans ; Kinetics* ; Oxygen Consumption* ; Oxygen*