PURPOSE: To evaluate the parameters affecting vaulting and correlation between preoperative crystalline lens rise and vaulting after implantable collamer lense (ICL) implantation. METHODS: A total of 53 eyes of 34 patients who underwent ICL implantation were examined retrospectively. White-to-white (WTW) and anterior chamber depth (ACD) were obtained from scanning topography (ORB scan) before surgery. Preoperative crystalline lens rise (CLR) and vaulting at 6 months after ICL implantation were measured using anterior segment optic coherence tomography (AS-OCT). Multiple regression analysis was performed to evaluate the factors affecting central vaulting. RESULTS: The mean preoperative crystalline lens rise was -120 +/- 219 microm, and mean central vaulting 6 months after surgery was 544 +/- 175 microm. Preoperative SE, WTW, ACD, and CLR were significantly correlated with vaulting at 6 months after surgery. With the use of meaningful variables, multiple regression analysis showed that CLR, WTW, ACD and SE, in that order of influence, had significant effects on vaulting and the multiple regression equation was obtained as follows: Vaulting (microm) = (160.913 x ACD (mm)) + (170.134 x WTW (mm)) + (-0.338 x CLR (microm)) + (-23.783 x SE (D)) - 2250.184. CONCLUSIONS: CLR had a stronger influence on vaulting after ICL implantation than the previously proven parameters: WTW, ACD, and SE. In addition to WTW, ACD and SE, CLR should also be considered a new criterion for estimating vaulting after ICL implantation.
Anterior Chamber ; Crystallins ; Eye ; Humans ; Lens, Crystalline ; Lenses, Intraocular ; Retrospective Studies

BACKGROUND: The aim of this study was to investigate the prevalence, clinical and laboratory findings of hereditary hemolytic anemia (HHA) in Korea from 1997 to 2006 and to develop the appropriate diagnostic approach for HHA. METHODS: By the use of questionnaires, information on the clinical and laboratory findings ofHHA diagnosed from 1997 to 2006 in Korea was collected and analyzed retrospectively. A total of 431 cases were enrolled in this study from 46 departments of 35 hospitals. RESULTS: The overall frequency of HHA did not change through the 10-year period for pediatrics but did show an increasing tendency for internal medicine. The overall male to female sex ratio did not show sex predominance (1.17:1), but a significant male predominance with a ratio of 1.49:1 was seen for pediatrics while a significant female predominance with a ratio of 1:1.97 was seen forinternal medicine. Of the total cases, 74.2% (282/431) were diagnosed before the age of 15 years. The etiologies of HHA were classified as red cell membrane defects, hemoglobinopathies, red cell enzyme deficiencies and unknown causes. There were 382 cases (88.6%) of red cell membrane defects with 376 cases (87.2%) of hereditary spherocytosis and 6 cases (1.4%) of hereditary elliptocytosis, 20 cases (4.6%) of hemoglobinopathies with 18 cases (4.2%) of beta-thalassemia, a case (0.2%) of alpha-thalassemia and a case (0.2%) of Hemoglobin Madrid, 7 cases (1.6%) of red cell enzyme deficiencies with 5 cases (1.2%) of glucose-6- phosphate dehydrogenase (G-6-PD) deficiency, a case (0.2%) of pyruvate kinase (PK) deficiency and a case (0.2%) of enolase deficiency, and 22 cases (5.1%) of unknown causes. The most common chief complaint in pediatric patients was pallor and that in adult patients was jaundice. In the red cell membrane defect group of patients, the level of hemoglobin was significantly higher than in adult patients. The mean corpuscular volume, mean corpuscular hemoglobin, corrected reticulocyte count, total and indirect bilirubin level and lactate dehydrogenase levels in the hemoglobinopathy group of patients were significantly lower than the values in the red cell membrane defect group of patients. The mean concentration of G-6-PD was 0.8+/-0.7U/1012RBC in the G-6-PD deficient patients, PK was 1.7U/1010 RBC in the PK deficient patient, and the level of enolase was 0.04U/g of Hb in the enolase deficient patient. CONCLUSION: The most prevalent cause of HHA in Korea during 1997 to 2006 was hereditary spherocytosis, but HHA by other causes such as hemoglobinopathy and red cell enzyme deficiency gradually increased with the development of molecular diagnostic methods and increasing general interest. However, the etiologies of HHA need to be pursued further in 5.1% of the patients. An systematic standard diagnostic approach is needed in a nationwide prospective study for correct diagnoses and appropriate management of HHA.
Adult ; alpha-Thalassemia ; Anemia, Hemolytic, Congenital* ; beta-Thalassemia ; Bilirubin ; Cell Membrane ; Diagnosis ; Elliptocytosis, Hereditary ; Erythrocyte Indices ; Female ; Hemoglobinopathies ; Humans ; Internal Medicine ; Jaundice ; Korea* ; L-Lactate Dehydrogenase ; Male ; Oxidoreductases ; Pallor ; Pathology, Molecular ; Pediatrics ; Phosphopyruvate Hydratase ; Prevalence ; Pyruvate Kinase ; Reticulocyte Count ; Retrospective Studies* ; Sex Ratio ; Surveys and Questionnaires

BACKGROUND: Renin-ngiotensin system (RAS) blockers have been used to delay the progression of various renal diseases, but these medications cause hyperkalemia and the elevation of serum creatinine which impede the continuation of the medications. So far, there have been no data on the changes of serum creatinine or serum potassium after withdrawal of the RAS blockers. METHODS: We reviewed medical records of 60 patients who stopped the RAS blockers due to the elevation of serum creatinine or hyperkalemia between March 1995 and May 2005. They were assigned to either the elevated creatinine group or the hyperkalemia group according to the cause of the withdrawal. RESULTS: In the elevated creatinine group (n=37), the serum creatinine and GFR values at the point of withdrawal were 4.0+/-1.8 mg/dL and 18.2+/-10.4 mL/min/1.73m2, respectively. After discontinuation of the medications, a decrease in serum creatinine and an increase in GFR were noted at one month. After one month, however, serum creatinine increased continuously up to 6 months. Serum potassium levels decreased significantly after the drug withdrawal until the end of the study period. In the hyperkalemia group (n=23), the serum creatinine and serum potassium values at the point of withdrawal were 3.0+/-1.0 mg/dL and 6.4+/-0.4 mEq/L, respectively. A significant decrease in serum potassium was also noted after the withdrawal and this decrease lasted up to 6 months. But the transient decrease of serum creatinine, observed in the creatinine group, was not seen in this group. CONCLUSION: It was found that there was a beneficial effect on serum creatinine and GFR immediately after the withdrawal of RAS blockers only when they were stopped due to elevation of the serum creatinine concentration. The serum potassium levels were consistently decreased after the withdrawal of RAS blockers in both elevated creatinine and hyperkalemia groups.
Angiotensin II* ; Angiotensin Receptor Antagonists ; Angiotensins* ; Creatinine* ; Humans ; Hyperkalemia ; Medical Records ; Potassium* ; Renal Insufficiency, Chronic*

BACKGROUND: Acute myelogenous leukemia (AML) is frequently encountered in elderly patients whereas intensive chemotherapy yield lower rate of complete remission (CR) and survival than young patients. This study was aimed to review the clinical features and treatment outcomes of elderly patients (>or=60) with AML. METHODS: We respectively reviewed the clinical features, laboratory findings and outcomes of treatment from the medical records of 115 patients with the elderly AML (>or=60), admitted in Seoul National University Hospital, between Jan.1995 and Dec.2004. RESULTS: Their median age was 66 (60~86) years with male predominance (M:F=68:47). Complete response rate in patients with conventional chemotherapy was 66.7% (42 of 63 patients; 95% CI 50.2~78.4). Median overall survival (OS) was 5.2 months with clinical benefit in the conventional chemotherapy group, compared to supportive or palliative group (11.5 vs 0.9months; p<0.0001). In between two age groups, the sixties (n=69) showed higher CR rate (69.0 vs 61.9%; p=0.9) and longer median overall survival (7.0 vs 4.4months; p=0.8) than patients group of the seventies (n=38) but without statistical significance. CONCLUSIONS: Conventional induction chemotherapy improved survival rate than palliative or supportive treatment.
Aged* ; Drug Therapy ; Humans ; Induction Chemotherapy ; Leukemia, Myeloid, Acute* ; Male ; Medical Records ; Prognosis ; Retrospective Studies* ; Seoul ; Survival Rate

BACKGROUND: The use of non-myeloablative stem cell transplantation (NST) has recently been increasing for treating the patients who cannot tolerate ablative hematopoietic stem cell transplantation (HSCT). Although graft-versus-host disease (GVHD) is one of the greatest problems in HSCT, the clinical effect of GVHD following NST is not clear. We undertook this study to evaluate the clinical manifestations of GVHD and the outcomes after NST. METHODS: From October 2000 to October 2004, 61 patients underwent NST with a fludarabine-based conditioning regimen. The cumulative incidence of GVHD and the survival rates were obtained from the Kaplan-Meier curves. RESULTS: With a median follow-up of 195 days, the estimate for overall three-year survival was 32%. The cumulative incidences of grades II~IV acute GVHD and chronic GVHD were 33% (18/53) and 78% (29/37), respectively. The response rates for acute and chronic GVHD were 33% and 89%, respectively. The survival rates of patients with acute and chronic GVHD were 27% and 89%, respectively. The median survival time was 6.5 months CONCLUSION: The incidence of GVHD after NST did not differ from that after ablative HSCT. This study suggests that the aggressive treatment of acute GVHD should be considered to improve the overall survival after NST.
Follow-Up Studies ; Graft vs Host Disease* ; Hematopoietic Stem Cell Transplantation* ; Hematopoietic Stem Cells* ; Humans ; Incidence ; Stem Cell Transplantation ; Survival Rate

Recent clinical trials showed that bortezomib, a novel proteasome inhibitor, had therapeutic activity in multiple myeloma. However, there was no data about the feasibility of bortezomib in Korean patients. We performed a pilot study of bortezomib in patients with relapsed or refractory myeloma (1.3 mg/m2 twice weekly for 2 week in a 3-week cycle). Seven patients were enrolled. The median age of patients was 59 yr. All patients previously received VAD (vincristine, doxorubicin and dexamethasone) and thalidomide chemotherapy. Three patients previously received alkylator-containing chemotherapy and 4 patients, autologous stem cell transplantation. Bortezomib monotherapy resulted in 3 partial remissions (43%), 3 no changes (43%) and 1 progressive disease (14%). One patient who had no response to bortezomib monotherapy experienced partial remission after addition of dexamethasone to bortezomib. The most common serious toxicity was thrombocytopenia (grade 3/4, 10 of 20 cycles (50%)) and grade 3 peripheral neuropathy was developed in 2 of 20 cycles (10%). Drug-related adverse event led to discontinuation of bortezomib in 1 patient. There was no treatment related mortality. Overall, bortezomib seems to be effective and feasible. Conduction of larger clinical studies on Korean patients is necessary to characterize clinical efficacy and safety of bortezomib more precisely.
Aged ; Antineoplastic Agents/administration & dosage/adverse effects/*therapeutic use ; Antineoplastic Combined Chemotherapy Protocols/adverse effects/therapeutic use ; Boronic Acids/administration & dosage/adverse effects/*therapeutic use ; Dexamethasone/administration & dosage/adverse effects ; Disease Progression ; Drug Resistance, Neoplasm ; Female ; Humans ; Korea ; Male ; Middle Aged ; Multiple Myeloma/*drug therapy ; Neoplasm Recurrence, Local ; Pilot Projects ; Pyrazines/administration & dosage/adverse effects/*therapeutic use ; Research Support, Non-U.S. Gov't ; Survival Analysis ; Thrombocytopenia/chemically induced ; Time Factors

BACKGROUND: To compare the mobilizing effects and toxicities of two different doses of cyclophosphamide (CY) plus lenograstim (glycosylated G-CSF), we performed a prospective randomized study by enrolling patients suffering with either high-risk Non-Hodgkin's lymphoma (NHL) or breast cancer undergoing ablative chemotherapy. METHODS: The NHL patients received 4 cycles of CHOP and the breast cancer patients received 2-3 cycles of FAC (FEC) adjuvant chemotherapy. Then, the patients were randomly allocated to receive CY 4 g/m2 (arm A) or 1.5 g/m2 (arm B) in combination with lenograstim. Large volume leukapheresis was carried out and it was continued daily until the target cell dose of 2x10 (6) CD34+ cell/kg was reached. RESULTS: Twenty-seven patients were enrolled in the study. The median number of leukaphereis sessions actually performed was 2.5 sessions in arm A and 3 sessions in arm B. The target cell dose was obtained with the median number of one leukapheresis session in both arms of the study (p=0.09). The collected number of CD34+ cells in the leukapheresis products was higher in arm A than arm B (22.4 vs. 9.9x10 (6) /kg, respectively, p=0.05). Grade III or IV leukopenia was present in 14/15 patients (94%) in arm A and in 1/12 patients (8%) in arm B (p< 0.0001). Grade III or IV thrombocytopenia was present in 8/15 patients (54%) in arm A, but this was not present in any patients of arm B (p=0.0004). Neutropenic fever occurred in 6/15 patients (40%) in arm A, and in 1/12 patients (8%) in arm B (p=0.09). The hematological recovery of the leukocytes and platelets after transplantation was not statistically different between the two doses. CONCLUSION: Low-dose CY plus lenograstim is a safe and effective mobilizing regimen.
Transplantation Conditioning ; Stem Cells/*drug effects ; Recombinant Proteins/administration & dosage/pharmacology ; Prospective Studies ; Myeloablative Agonists/*administration & dosage/pharmacology ; Middle Aged ; Male ; Lymphoma, Non-Hodgkin/*drug therapy ; Leukapheresis ; Humans ; *Hematopoietic Stem Cell Mobilization ; Granulocyte Colony-Stimulating Factor/*administration & dosage/pharmacology ; Female ; Drug Therapy, Combination ; Cyclophosphamide/*administration & dosage/pharmacology ; Chemotherapy, Adjuvant ; Breast Neoplasms/*drug therapy ; Adult

Intravascular large B-cell lymphoma (IVLBL) is a rare neoplasm characterized by proliferation of lymphoma cells within the lumina of small vessels. Neurological and skin involvements usually predominate. We would describe a 78-year-old woman presented with fever, multiple erythematous skin lesions, and language disturbance. The skin biopsy of breast revealed IVLBL and malignant cells were also seen in the bone marrow. Shortly after completion of six cycles of CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone) with clinical response, intracranial relapse with multiple brain masses occurred. The palliative whole brain radiation therapy was given and intensive chemotherapy should be investigated in the case presented here.
Aged ; B-Lymphocytes* ; Biopsy ; Bone Marrow ; Brain ; Breast ; Doxorubicin ; Drug Therapy* ; Female ; Fever ; Humans ; Lymphoma ; Lymphoma, B-Cell* ; Recurrence* ; Skin ; Vincristine

BACKGROUND: There are few therapeutic options for patients with multiple myeloma who relapse after autologous or allogeneic stem cell transplantation, or for patients who are refractory to conventional chemotherapy and not eligible for salvage high-dose therapy. Thalidomide, a potent antiangiogenic agent, has been suggested as an effective salvage therapy in refractory multiple myeloma. The aim of this study was to evaluate the efficacy and tolerance of thalidomide as a single agent as multicenter trial in Korea. METHOD: From February 2001 to September 2002, 28 patients from 4 institutions were included. At start of treatment, all patients had active disease and 17 (61%) had received at least one autologous transplantation. RESULTS: The serum or urine levels of paraprotein were reduced by at least 90 percent in two patients, at least 50 percent in three patients, and at least 25 percent in two patients; for a total response rate of 25 percent. 13 patients had stable disease and 8 patients had progressed. At least half of the patients had mild or moderate constipation and fatigue. More severe adverse effects were infrequent. CONCLUSION: This study confirms that thalidomide is an effective and safe agent in patients with relapsed or refractory multiple myeloma.
Autografts ; Constipation ; Drug Therapy ; Fatigue ; Humans ; Korea ; Multiple Myeloma* ; Recurrence ; Salvage Therapy* ; Stem Cell Transplantation ; Thalidomide* ; Transplantation, Autologous

BACKGROUND: Acinetobacter bacteremia is an emerging nosocomial infection. We tried to find significant risk factors associated with the prognosis of patients with Acinetobacter bacteremia. METHODS: Retrospective case-control study was designed. The odds ratio estimation and multiple logistic regression for the categorical variables and Mann-Whitney test for the continuous variables were done. RESULTS: From September 1, 1999 to December 31, 2000 there were 25 adult patients with Acinetobacter bacteremia in Ajou University Hospital and 24 patients were confirmed as hospital acquired. The median age and hospital length of stay before bacteremia was 52 years old and 9.5 days respectively. There were 16 male patients. The overall mortality was 45.8 % (11 of 24). Thus there were 11 cases (death) and 13 controls (survival) of mortality. Statistical analysis revealed statistically significant differences between cases and controls in the terms of types of wards, central venous catheter, mechanical ventilation, total parenteral nutrition, and multi-resistant organisms. The multiple logistic regression analysis revealed that the more significant independent factors associated with mortality were mechanical ventilation and multi-resistant organisms. CONCLUSION: Acinetobacter bacteremia is a significant nosocomial infection. Especially mechanical ventilation and multi-resistant organisms were independent risk factors associated with high mortality with Acinetobacter bacteremia.
Acinetobacter* ; Adult ; Bacteremia* ; Case-Control Studies ; Central Venous Catheters ; Cross Infection ; Humans ; Length of Stay ; Logistic Models ; Male ; Middle Aged ; Mortality ; Odds Ratio ; Parenteral Nutrition, Total ; Prognosis* ; Respiration, Artificial ; Retrospective Studies ; Risk Factors*