To evaluate the character, management and clinical results of the posterior capsular rupture during cataract surgery, we retrospectively studied the cataract surgeries that were performed between May 1989 and Decemeber 1991. We discovered 64 eyes in which the posterior capsule was torn. The overall incidence of this complication was 4.4%. Our chart review of these surgical procedure revealed that the tear occurred most frequently during the nucleus removal(44%), occured more frequently at the periphery than the center and the extent was mostly below one-third of the whole posterior capsular surface(75%). We performed vitrectomy(58%) and peripheral iridectomy(14%). Posterior capsular lenses were implallted in 56 cases. The predicted power of lens calculated with SRK-II fomula and manufacturer's A-constant was approximately 0.46 diopter less than actual postoperative refraction. Final visual acuity of 20/40 or better was achieved in 73% of the 64 cases. Our results revealed that when properly managed, a torn posterior capsule is compatible with an excellent visual outcome.
Cataract* ; Incidence ; Retrospective Studies ; Rupture* ; Visual Acuity

BACKGROUND: Immune tolerance induction (ITI) can reduce inhibitors against factor VIII concentrates by 70-80%. In this study, we elucidated the characteristics of inhibitors and attempted to determine the proper indications and timing for ITI. METHODS: Subjects included hemophilia A patients registered at the Korea Hemophilia Foundation from 1991 through 2014. Inhibitors were classified as persistent and transient. Patients were classified into groups according to peak inhibitor titer: low (<2 BU/mL), moderate (2 to <5 BU/mL), high (5 to <10 BU/mL), and very high titer (≥10 BU/mL). RESULTS: Overall, 350 (21.4%) of 1,634 hemophilia A patients developed inhibitors at least once. Of these, 100 (6.1%) and 250 (15.3%) patients developed persistent and transient inhibitors, respectively. For transient inhibitors, the median peak titer was 1.0 BU/mL, persistent for median of 11.0 months (10.0, 8.0, 13.0, and 19.0 months in the low, moderate, high, and very high titer transient inhibitor groups, respectively). Overall, 95.8% (215), 72.2% (17), 52.4% (21), and 21.7% (97) of patients in the low, moderate, high, and very high titer groups became inhibitor-negative spontaneously, without ITI. CONCLUSION: Given the spontaneous disappearance of inhibitors and high cost of ITI, it is worthwhile to postpone ITI for 11 months unless the peak inhibitor titer is greater than 10 BU/mL.
Factor VIII ; Hemophilia A* ; Humans ; Immune Tolerance ; Korea ; Longitudinal Studies

The aim of this study was to evaluate the risk factors of recurrences after their first febrile convulsions in infants and young children. Dlinical studies were made on 187 cases of febrile convulsions who were admitted to the Department of pediatrics of wallace Memorial Baptist Hospital from March, 1990 to December, 1992. 1) 63 cases of 187 cases had recurrences after their febrile convulsions. Thus, the recurrence rate was 33.7%. 2) The male to female ratio was 2.1:1. And there were no significant differences in recurrence rates between sexes. 3) The recurrence rate was significantly higher in those whose initial febrile convulsions were developed before first 18 months of life than those whose initial convulsions were after 18 months of age (49.5% vs. 12.5%). 4) The time interval from initial attack to recurrence was within 12 months in 80% of cases. 5) Our study revealed that the seizure characteristics of the initial febrile convulsion are not important as predictive factors about the probability of recurrences. 6) Among the total 187 cases, family history were present in 52 cases (27.8%). And there were significantly higher recurrence rates if their families show the same history of febrile convulsion (63.5% vs. 22.2%). 7) The risk of recurrence was much higher in patients whose first febrile history of febrile convulsion at the same time.
Child ; Female ; Humans ; Infant ; Male ; Pediatrics ; Protestantism ; Recurrence ; Risk Factors ; Seizures ; Seizures, Febrile*

No abstract available.
Aorta* ; Pulmonary Artery*

BACKGROUND: Pachydermoperiostosis(PDP) is a rare genetic disease characterized by pachydermia, periostosis, arthralgia and finger clubbing. The pathogenesis of this disease is still unknown, but the concept that platelets and endothelial cells may play a major role in the developement of pachydermia is widely accepted nowadays, It is also suspected that several serum growth factors stimulate proliferation of soft tissue. OBJECTIVE: The purpose of this study was to investigate the pathogenesis of pachydermia in patients with pachydermoperiostosis through evaluating whether the fibroblasts from these patients have a higher proliferation rate than those from controls or whether the proliferation rate of those cells are affected by certain serum growth factors. METHOD: At first, we evaluated the proliferation rate of fibroblasts from patients and corntrols by the MTT colorimetric assay, and then the proliferation rate of fibroblasts from the prepuce of newborn infants under several conditions of media containing uncentrifuged patients serum, centrifuged patients serum, uncentrifuged control serum, or centrifuged control serum. RESULTS: The proliferation of fibroblasts from patients skin was slower than the control fibroblasts and fibroblasts derived from uninvolved skin of patients. The statistically significant highest proliferation rate was observed when fibroblasts were cultured in the uncentrifuged patients serum contained media and the order of proliferation was as follows: centrifuged patients serum, uncentrifuged control serum and centrifuged control serum condition at 20%, 10%, and 1% respectively. CONCLUSION: These results suggest that patients fibroblasts do not proliferate in vitro at a higher rate than control firoblasts. Fibroblasts in PDP may only play a role as target cells and certain serum factors are responsible for the pathogenesis of PDP.
Arthralgia ; Endothelial Cells ; Fibroblasts* ; Fingers ; Humans ; Infant, Newborn ; Intercellular Signaling Peptides and Proteins ; Osteoarthropathy, Primary Hypertrophic* ; Skin

This study was conducted to compare degeneration of retinal neurons in retina ischemia induced by sudden elevation of intraocular pressure(IOP)(Group A) with that by steady elevation of IOP(Group B). Adult male Sprague Dawley rats were used and IOP of 160-180mmHg was maintained for 90 min. Entraocular pressure of 160-180mmHg was achived in a second for Group A, while in one minutes for Group B. The neuronal damage in retina was ascertained by light microscopy and transmission electron microscopy at various time points after ischemic insult. In Group A, retinal neurons were destroyed severely in ganglion cell layer(GCL) and inner nuclear layer(INL) at 24hrs and the number of cells in ganglion cell layer(GCL) was decreased markedly. And some cells in GCL and INL were spread out in inner plexiform layer(IPL) by the 3rd day after ischemia. At each time point, both vecrosis and apoptosis were observed mainly by trasmission electron microscope. In group B, the retinal cell death was observed mainly in ganglion cell layer(GCL) at 24hrs and mainly in inner nuclear layer(INL) of 3 days after ischemia. The characteristics of the retinal injury after 3 days in Group B was similar to that after 24hrs in Group A. Therefore, cell death pattern was delayed in Group B compared with in Group A. With these results It was found that apoptosis as aell as necrosis of the retinal neurons were observed in retina ischemia induced by elevation of IOP cause faster neronal damage than slow elevation of IOP.
Adult ; Apoptosis ; Cell Death* ; Ganglion Cysts ; Humans ; Intraocular Pressure* ; Ischemia* ; Male ; Microscopy ; Microscopy, Electron, Transmission ; Necrosis ; Neurons* ; Rats, Sprague-Dawley ; Retina ; Retinal Neurons ; Retinaldehyde

In order to elucidate the mechanism of neuronal cell death induced by retina ischemia and reperfusion, we investigated expression of p53, Bcl-2, and ICE(interleukin converting enzyme) in retinal neuronal cell death. Adult male Spague-Dawley rats were used and their intraocular pressures were maintained between 160 and 180mmHg for 90 min to induce retina ischemia. Retinal cell death was observed by light microscopy from 4 hours and peaked at 24 hours after retinal ischemia. By the 3rd day after retinal ischemia, the number of cells in GCL was decreased markedly and some cells in GCL and INL were spread out in inner plexiform layer(IPL). Finally, the boundary between GCL and INL became obscure and a few alive cells were found in GCL and INL on 7 days after retinal ischemia. The thickness of the retina was also decreased in a time-dependent manner. IN the study of gene expression in retinal ischemil, p53 expression was increased prominently at 24 hours and 3 days and decreased at 7 days, while Bcl02 expression was increased slightly at 24 hours by RT-PCR and in situ hybridization. ICE expression was not changed in this model. The expression of p53 was also observed at 24 hours after retinal ischemia by immunohistochemistry. With these results it was found that cell death was increased from 4 hours to 3 days after retina ischemia and the thickness of retina decreased markedly during the same period. Delayed neuronal cell death in retina seemed to be correlated with the expression of p53 in the retina ischemia model.
Adult ; Animals ; Cell Death* ; Gene Expression ; Humans ; Ice ; Immunohistochemistry ; In Situ Hybridization ; Intraocular Pressure ; Ischemia* ; Male ; Microscopy ; Neurons* ; Rats ; Reperfusion* ; Retina* ; Retinal Neurons ; Retinaldehyde

As the health care system continues to evolve, there will be a shift in the care that physicians are asked to provide: from high-tech to patient-centered, from treatment-focused to prevention-focused. To improve the health of communities, health providers need to apply skills beyond those contained in the traditional biomedical model and must strive to encompass the community-based public health model. Physicians must function effectively within a multidisciplinary team in order to provide optimal health care in a setting of complex needs which far exceed the capacity of any one health discipline to address adequately. Students need first hand experience working with population issues in all learning settings - the hospital, the clinic and the community - to stimulate their interest in a population perspective. The medical education community needs to search for innovative, creative approaches to help the students develop the knowledge skills, and attitudes to practice. Community-oriented primary care (COPC) addresses the need to train practitioners in primary care practice that is community-responsive and that includes a public health perspective. It helps bridge the gap between academic medicine and the community it is designed to serve while fostering linkages among providers and community groups. It provides the structure for the various members of a public health team, often isolated from one another within their own institutions, to share ideas that focus on the need for integrity and simplicity in a community- responsive health care system. But perhaps most importantly, it restores the social contract between medicine and society.
Community Health Services ; Delivery of Health Care ; Education, Medical ; Foster Home Care ; Hand ; Humans ; Learning ; Preventive Medicine ; Primary Health Care* ; Public Health ; United States*

No abstract available.
Fistula*

BACKGROUND: Geriatric patients undergoing artificial joint replacement have increased not only in numbers but in age over the past years. These patients usually have accompanying comorbidities which may be increased by age itself and these comorbidities increases clinical challenge while undergoing anesthesia. METHODS: Raw data from 1992 to 2006 undergoing artificial joint replacement were collected and investigated retrospectively. Five-year periods of interest (POI) were created for analysis. POI I is five-year periods of interest from 1992 to 1996, POI II from 1997 to 2001 and POI III from 2002 to 2006. Changes in demographic variables and prevalence of a variety of comorbidities were statistically evaluated. RESULTS: We identified 4,196 patients in whom artificial joint replacement was performed between 1992 and 2006. Of those, 805, 1,212 and 2,179 were performed in POI I, POI II and POI III, respectively. The average age and the prevalence of hypertension and diabetes mellitus increased significantly. CONCLUSIONS: The prevalence of comorbid diseases among the patients undergoing artificial joint replacement has increased significantly for hypertension and diabetes mellitus. Also increase in average age of patients undergoing surgery as well as accompanying comorbidities pose an increased clinical challenge. A thorough preanesthetic evaluation and optimal anesthetic technique is necessary to decrease the morbidity and mortality in geriatric patients undergoing artificial joint replacement on the lower extremities.
Anesthesia ; Arthroplasty ; Comorbidity ; Diabetes Mellitus ; Humans ; Hypertension ; Joints ; Lower Extremity ; Prevalence ; Retrospective Studies