Purpose: We report a bitemporal visual field defect accompanied by optic chiasmal enhancement in a patient with ethambutol (EMB)-induced toxic optic neuropathy.Case summary: A 53-year-old woman presented with bilateral visual disturbance that had gradually worsened over the prior 2 months. She had been prescribed 800 mg EMB daily to treat pulmonary tuberculosis for the past 10 months but had stopped EMB 1 month prior because of visual disturbance. She had been prescribed 600 mg rifampicin and 1,000 mg clarithromycin daily for 11 months. Her visual acuity was 0.2 in the right eye and 0.1 in the left. Color vision was reduced. Automated perimetry demonstrated a bitemporal visual field defect, which was more severe in the left eye. Magnetic resonance imaging (MRI) of the optic chiasm revealed contrast enhancement in the body of the chiasm. The optic nerve of the left eye evidenced a higher signal intensity than did that of the right, consistent with the visual field test results. One month after her initial visit, the visual symptoms deteriorated further. We delivered high-dose, intravenous steroid pulse therapy (methylprednisolone 1,000 mg daily for 3 days). At the 1-year follow-up, the visual acuity was 0.4 in the right eye and 0.1 in the left. Conclusions Bitemporal hemianopia may develop in patients with EMB-induced toxic optic neuropathy. Enhancement of the optic chiasm, consistent with the visual field defect, could be observed in MRI.

Purpose: We evaluated surgical outcomes in pediatric patients with intermittent exotropia with and without a family history of exotropia surgery performed by the same surgeon. Methods: We conducted a retrospective review of the medical records of pediatric patients aged ≤ 18 years who underwent surgery for intermittent exotropia between September 2015 and December 2021. We compared surgical outcomes between patients with and without a family history of exotropia surgery performed using 1:1 propensity score matching. A successful surgical outcome was defined as achieving alignment between an exodeviation of 10 prism diopters (PD) and an esodeviation of 4 PD. Results: This study included 60 patients with a family history of exotropia surgery and 60 matched controls with no such history. Notably, the log-rank test revealed no significant differences in surgical outcomes between the two groups (p = 0.622). Furthermore, clinical characteristics, including the onset of exotropia, degree of ocular deviation, and age at surgery, were similar between first- and second-born siblings. Furthermore, no significant differences were observed in surgical outcomes between the two groups (p= 0.540). Conclusions Patients with a family history of exotropia surgery do not exhibit significantly different surgical outcomes compared to those with no such history. In addition, no significant differences were observed in surgical outcomes between the first- and second-born siblings.

BACKGROUND: Many physicians hesitate to discuss do-not-resuscitate (DNR) orders with patients or family members in critical situations. In the intensive care unit (ICU), delayed DNR decisions could cause unintentional cardiopulmonary resuscitation, patient distress, and substantial cost. We investigated whether the timing of DNR designation affects patient outcome in the medical ICU. METHODS: We enrolled retrospective patients with written DNR orders in a medical ICU (13 bed) from June 1, 2014 to May 31, 2015. The patients were divided into two groups: early DNR patients for whom DNR orders were implemented within 48 h of ICU admission, and late DNR patients for whom DNR orders were implemented more than 48 h after ICU admission. RESULTS: Herein, 354 patients were admitted to the medical ICU and among them, 80 (22.6%) patients had requested DNR orders. Of these patients, 37 (46.3%) had designated DNR orders within 48 hours of ICU admission and 43 (53.7%) patients had designated DNR orders more than 48 hours after ICU admission. Compared with early DNR patients, late DNR patients tended to withhold or withdraw life-sustaining management (18.9% vs. 37.2%, p = 0.072). DNR consent forms were signed by family members instead of the patients. Septic shock was the most common cause of medical ICU admission in both the early and late DNR patients (54.1% vs. 37.2%, p = 0.131). There was no difference in in-hospital mortality (83.8% vs. 81.4%, p = 0.779). Late DNR patients had longer ICU stays than early DNR patients (7.4 ± 8.1 vs. 19.7 ± 19.2, p < 0.001). CONCLUSIONS: Clinical outcomes are not influenced by the time of DNR designation in the medical ICU. The late DNR group is associated with a longer length of ICU stay and a tendency of withholding or withdrawing life-sustaining treatment. However, further studies are needed to clarify the guideline for end-of-life care in critically ill patients.
Advance Directives ; Cardiopulmonary Resuscitation ; Consent Forms ; Critical Illness* ; Hospital Mortality ; Humans ; Intensive Care Units ; Resuscitation Orders* ; Retrospective Studies ; Shock, Septic

Sarcoidosis can affect two or more members of the same family, and the reported occurrence of such familial sarcoidosis is variable from 0.5 to 14%. Recently we have experienced familial sarcoidosis affected mother and daughter, for the first time in Korea. Mother was diagnosed as Stage II sarcoidosis 4 years ago by transbronchial lung biopsy and cervical lymph node biopsy with compatible BAL finding in our hospital. This time, the daughter was admitted with bilateral hilar enlargement and anterior uveitis. Even though she had positive tuberculin skin test and atypical BAL finding(lymphocyte: 61%, CD4/CD8: 1.22). Transbronchial lung biopsy and mediastinal lymph node biopsy revealed noncaseating epithelioid granulorna without AFB. Slit lamp examination of the eyes showed severe anterior uveitis. Systemic steroid therapy was started due to progressive uveitis with antituberculous medication.
Biopsy ; Humans ; Korea* ; Lung ; Lymph Nodes ; Mothers ; Nuclear Family ; Sarcoidosis* ; Skin Tests ; Tuberculin ; Uveitis ; Uveitis, Anterior

The functional derangement of skeletal muscles which may be attributed to chronic hypoxia has been accepted as a possible mechanism of exercise impairment in patients with chronic obstructive pulmonary disease (COPD). The metabolc changes in skeletal muscle in patients with COPD are characterized by impaired oxidative phosphorylation early activation of anaerobic glycolysis and excessive lactate and hydrogen ion production with exercise. But the cause of exercise limitation in patients with chronic lung disease without hypoxia has not been known. In order to evaluate the change in the skeletal muscle metabolism as a possible cause of the exercise limitation in chronic lung disease patients without hypoxia, we compared the muscular metabolic data of seven male patients which had been derived from noninvasive 31P magnetic resonance spectroscopy(MRS) with those of five age-matched normal male control persons. 31P MRS was studied during the sustained isometric contraction of the dominant forearm flexor muscles up to the exhaustion state and the recovery period. Maximal voluntatry contraction(MVC) force of the muscle was measured before the isometric exercise, and the 30% of MVC force was constantly loaded to each patient during the isometric exercise. There were no differences of intracellular pH (pHi) and inorganic phosphate/phosphocreatine (Pi/PCr) at baseline, exhaustion state and recovery period between two groups. But pHi during the exercise was lower in patients group than the control group (p<0.05). Pi/PCr during the exercise did not show significant difference between two groups. These results suggest that the exercise limitation in chronic lung disease patients without hypoxia also could be attributed to the abnormalities in the skeletal muscle metabolism.
Anoxia ; Exercise ; Forearm ; Glycolysis ; Humans ; Hydrogen-Ion Concentration ; Isometric Contraction ; Lactic Acid ; Lung Diseases ; Lung* ; Magnetic Resonance Spectroscopy* ; Male ; Metabolism* ; Muscle, Skeletal* ; Muscles ; Oxidative Phosphorylation ; Protons ; Pulmonary Disease, Chronic Obstructive

No abstract available.
Cryptococcosis* ; Humans

Purpose: Patients with respiratory failure associated with neurological dysfunction often require mechanical ventilator support, which poses increased economic burden and ventilator-associated complications. A diaphragm pacing system (DPS) is an implanted device that provides respiratory support for such patients. In this systematic review, we reviewed the literature to assess the safety and efficacy of DPS for patients with respiratory failure resulting from amyotrophic lateral sclerosis (ALS) or cervical spinal cord injuries. Materials and Methods: The following databases were searched from July 10 to July 30, 2018: MEDLINE, EMBASE, Cochran library, KoreaMed, Research Information Sharing Service, Korean studies Information Service System, Korea Institute of Science and Technology Information, and Korean Medical database. The abstracts and full texts of the searched articles were reviewed by two reviewers. Results: The search keywords generated 197 articles: two randomized controlled trials, two case-control studies, and one case report involving patients with ALS; one cohort study, one case-control study, and two case reports involving patients with cervical spine injury; and one case report involving patients with both conditions were included. The primary outcome was safety profile (complications and adverse event) and efficacy (overall survival and sleep improvement). Complications and adverse events were more common in patients with ALS and spinal cord injury receiving DPS than in controls. Efficacy outcomes were inconsistent across ALS studies. Conclusion Based on safety and efficacy results, we do not support using DPS to manage respiratory failure in patients with ALS or cervical spine injury.

No abstract available.
Smoking* ; Tobacco Products*

OBJECTIVES: The aims of this study were to investigate the pattern of stress coping strategies and the effects of stress coping strategies on quality of life in patients with schizophrenia. METHODS: Stress coping strategies and quality of life were examined using Ways of Coping Checklist and Schizophrenia Quality of Life Scale for 98 patients with schizophrenia. Stress coping strategies were composed of problem-focused coping, social support seeking, emotion-focused coping, and wishful thinking. Among these, problem-focused coping and social support seeking were active coping strategies while emotion-focused coping and wishful thinking were passive coping strategies. Positive and Negative Syndrome Scale (PANSS) and Beck's Depression Inventory (BDI) were also administered. RESULTS: Active coping scores were higher than passive coping scores in patients with schizophrenia. Quality of life was higher in the active coping group compared to the passive coping group. Active coping usage was a significant predictor of higher quality of life even after controlling for gender, age, PANSS, and BDI scores. CONCLUSION: Patients with schizophrenia used more active coping strategies than passive coping strategies, which showed significant association with higher quality of life. A treatment program to provide education on use of active coping strategies in a proper and flexible way might contribute to enhanced quality of life in patients with schizophrenia.
Adaptation, Psychological ; Checklist ; Depression ; Education ; Humans ; Quality of Life* ; Schizophrenia* ; Stress, Psychological ; Thinking

It is well known that the murine T helper cell clones are divided by their lymphokine secretory activities. One is the Th-1 cell, producing IL-2 and IFN after stimulation and the other is the Th-2 cell, producing the IL-4 and IL-5. This study was undertaken to evaluate the immunomodulatory properties of the bacterial lipopolysaccharide(LPS) on the lymphokine production in vivo and in vitro. The results were as follows: There were no effects on the lymphokine secretion by the in vitro treatment of the LPS. The in vivo treatment of the LPS decreases the capability of the production of IL-2 and IFN , whereas it increases the capability of IL-4 production. The altered capacity of the lymphokine production was recovered about 2 weeks after the treatment of the LPS. There were no differences on the lymphokine production between E-coli LPS and salmonella LPS. The capacity of the lymphokine production was the same in the treatment of a non-heated LPS or heated-LPS. The lymphokine production of the mice which were desensitized by the long term treatment of the LPS was not different from the control mice. The in vitro treatment of RU486 can block the alterations of the lymphokine production after the treatment of the LPS. In summary, one can tell that the LPS increases the secretion of the IL-4 through the endogenous secretion of the glucocorticoids.
Animals ; Clone Cells ; Glucocorticoids ; Interleukin-2 ; Interleukin-4 ; Interleukin-5 ; Mice ; Mifepristone ; Salmonella ; T-Lymphocytes* ; T-Lymphocytes, Helper-Inducer