OBJECTIVETo explore the relationship between the classification and degree of diabetic macular edema (DME) and the stages of diabetic retinopathy (DR), diabetic duration, classification of diabetes, use of insulin, and visual loss.

METHODSWe retrospectively analyzed the stages of DR, diabetic duration, classification of diabetes, use of insulin, and visual loss in 1 172 DR patients with fundus fluorescein angiography (FFA). The occurrence of DME in DR in each stage and the relationships between its related factors were analyzed.

RESULTSIn 1 172 patients, 633 eyes in 394 patients had DME (33.62%), including 265 (41.86%) with focal DME and 368 (58.14%) with diffuse DME. There were 246 (38.86%) eyes with mild DME, 189 (29.86%) with moderate DME, and 198 (31.28%) with severe DME. Significant correlations exhisted among the classification of DME (r = 0.975, P = 0.025), the degree of DME (r = 1.000, P = 0.000), and the stage of DR. DME deteriorated with the increase of the stages of DR. The visual loss significantly correlated with the degree of DME (r = -0.984, P = 0.003). The visual acuity was lower in patients with diffuse DME than those with focal DME. The diabetic duration significantly correlated with the classification and degree of DME (r = 0.962, P = 0.009). DME was mostly seen in patients with a disease course of six years or longer, and its severity and incidence increased along with the prolonged period. Also, The incidence of DME increased in patients with type 2 diabetes and patients who used insulin.

CONCLUSIONThe classification and degree of DME correlates with the stages of DR, diabetic duration, the classification of diabetes, the use of insulin, and visual loss.

Diabetic Retinopathy ; classification ; complications ; epidemiology ; Humans ; Insulin ; therapeutic use ; Macular Edema ; classification ; epidemiology ; etiology ; Retrospective Studies ; Vision Disorders ; complications ; epidemiology

Adolescent ; Adult ; Brain Edema ; epidemiology ; Hazardous Substances ; Humans ; Male ; Middle Aged ; Occupational Health ; Prospective Studies ; Pulmonary Edema ; epidemiology ; Railroads ; Young Adult

OBJECTIVETo compare the effect and safety of the no-flip method versus the external method in Shang Ring circumcision.

METHODSWe searched relevant randomized controlled trials published in China and abroad comparing the no-flip method and external method of Shang Ring circumcision. Based on the Cochrane Handbook for systematic review, two reviewers independently eval- uated the quality of the included studies and abstracted relevant data, followed by a meta-analysis using the statistical software Review Manager 5.1.0.

RESULTSTotally 7 studies with 1 200 cases were included. Compared with the external method, the no-flip method was associated with a lower total rate of complications (RR = 0.40, 95% CI: 0.18, 0.87, P = 0.02), a lower incidence of postop- erative edema (RR = 0.28, 95% CI: 0.09, 0.81, P = 0.02), and a lower 24 h postoperative pain score (MD = -0.35, 95% CI: -0.55, -0.14, P < 0.001).

CONCLUSIONThe no-flip method of Shang Ring circumcision was superior to the external method for its advantages of fewer complications, lower incidence of postoperative edema, and mild postoperative pain. However, our findings need further support by more high-quality randomized controlled trials.

China ; Circumcision, Male ; adverse effects ; instrumentation ; methods ; Edema ; epidemiology ; Humans ; Male ; Pain Measurement ; Pain, Postoperative ; epidemiology ; Randomized Controlled Trials as Topic

Poststreptococcal glomerulonephritis (PSGN) is one of the most recognized diseases in pediatric nephrology. Typical clinical features include rapid onset of gross hematuria, edema, and hypertension, and cases are typically preceded by an episode of group A β-hemolytic streptococcus pharyngitis or pyoderma. The most common presenting symptoms of PSGN are the classic triad of glomerulonephritis: gross hematuria, edema, and hypertension . However, patients with PSGN sometimes present with unusual or atypical clinical symptoms that often lead to delayed diagnosis or misdiagnosis of the disease and increased morbidity. Additionally, the epidemiology of postinfectious glomerulonephritis (PIGN), including PSGN, has changed over the past few decades. This paper reviews atypical clinical manifestations of PSGN and discusses the changing demographics of PIGN with a focus on PSGN.
Delayed Diagnosis ; Demography ; Diagnostic Errors ; Edema ; Epidemiology ; Glomerulonephritis* ; Hematuria ; Humans ; Hypertension ; Nephrology ; Pharyngitis ; Pyoderma ; Streptococcus

Female ; Humans ; Incidence ; Infant ; Male ; Oxygen ; metabolism ; Prospective Studies ; Pulmonary Edema ; diagnosis ; epidemiology ; Respiration ; Respiration, Artificial

For the past several decades, tremendous efforts have been made to decrease the complications of diabetes, including diabetic retinopathy. New diagnostic modalities like ultrawide field fundus fluorescein angiography and spectral domain optical coherence tomography has allowed more accurate diagnosis of early diabetic retinopathy and diabetic macular edema. Antivascular endothelial growth factors are now extensively used to treat diabetic retinopathy and macular edema with promising results. There remains uncertainty over the long term effects and the socioeconomic costs of these agents.
Diabetic Retinopathy* ; Diagnosis ; Endothelial Growth Factors ; Epidemiology ; Fluorescein Angiography ; Macular Edema ; Tomography, Optical Coherence ; Uncertainty ; Vascular Endothelial Growth Factor A

Claude's syndrome is a distinctive brainstem syndrome characterized by ipsilateral third cranial nerve palsy with contralateral hemiataxia and is due to an intrinsic or extrinsic lesion in the midbrain. We report a case of Claude's syndrome caused by neurocysticercosis infection. A 68 year-old Asian man was admitted to our hospital because of ataxia, left ptosis, and diplopia. Brain magnetic resonance imaging (MRI) showed a cystic lesion in the midbrain, which was surrounded by ring enhancement and peripheral edema. Neurocysticercosis infection was diagnosed by the cerebral spinal fluid study. The patient was treated with albendazole and steroids. A follow-up brain MRI three months later demonstrated the disappearance of a surrounding brain edema and rim enhancement. The most common cause of Claude's syndrome is cerebrovascular disease and malignancy. However, there is no report caused by neurocysticercosis infection. Therefore, if we encounter Claude's syndrome, we should consider neurocysticercosis infection as one of the etiologic factors.
Aged ; Albendazole/therapeutic use ; Brain/pathology ; Brain Stem Infarctions/complications/*diagnosis/*epidemiology ; Edema/pathology ; Humans ; Magnetic Resonance Imaging/methods ; Male ; Neurocysticercosis/complications/*diagnosis/*epidemiology ; Steroids/therapeutic use

BACKGROUND/AIMS: Clinical manifestations of intestinal yersiniosis include enterocolitis, mesenteric adenitis, and terminal ileitis presenting with fever, right lower quadrant pain, and leukocytosis. According to a previous Korean study in 1997, Yersinia was revealed in two among 15 adult patients with mesenteric adenitis (13%). However, recent reports on the prevalence of Yersinia infection in adult patients are few. The aim of this study was to investigate the prevalence of Yersinia infection in adult patients with acute right lower quadrant pain. METHODS: Adult patients (>18 years) who visited Eulji medical center, due to acute right lower quadrant pain were enrolled prospectively from December 2007 to July 2009. Abdominal CT, stool culture, serologic test for Yersinia, and Widal test were performed. RESULTS: Among 115 patients, 5 patients were excluded due to positive Widal test or salmonella culture. In 110 patients, abdominal CT showed right colitis in 20 (18.2%), terminal ileitis in 16 (14.5%), mesenteric adenitis in 13 (11.8%), acute appendicitis in 10 (9.1%), acute diverticulitis in 7 (6.4%), non specific mucosal edema in 36 (32.7%) and no specific lesion in 8 (7.3%). Two (1.8%) of the 110 patients had antibodies to Yersinia. One patient showed acute enteritis and the other patient was diagnosed with acute appendicitis and underwent appendectomy. No Yersinia species were grown on stool or tissue culture. CONCLUSIONS: Nowadays, among adult Korean patients presenting with acute right lower quadrant pain, there have been few incidences of Yersinia infection.
Abdominal Pain/*microbiology ; Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Antibodies/blood/immunology ; Appendicitis/epidemiology ; Colitis/epidemiology ; Diverticulitis/epidemiology ; Edema/epidemiology ; Female ; Humans ; Ileitis/epidemiology ; Lymphadenitis/epidemiology ; Male ; Middle Aged ; Prevalence ; Prospective Studies ; Tomography, X-Ray Computed ; Yersinia/*isolation & purification ; Yersinia Infections/*diagnosis/*epidemiology

Laryngeal edema developed in 10.1% of studied patients with congenital heart disease after cardiac surgery. The 181 patients were divided into two groups; those with laryngeal edema (group 1) and those without laryngeal edema (group 2). The mean ages in group 1 and 2 were 10 and 22.9 months. Group 1 patients were younger on average than those of group 2 (p< 0.05). The differences in the cardiopulmonary bypass time and anesthesia time between the two groups were not statistically significant. The duration of intubations and ventilatory support before and after the onset of laryngeal edema and the period of the ICU stay were longer in group 1 than in group 2 (p< 0.05). A predictor of postextubation laryngeal edema was not found in our patients from above mentioned parameters. We conclude that the higher incidence of laryngeal edema may be due to young age (most were under 1 year of age), and duration of intubation and ventilatory support.
Adolescent ; Child ; Child, Preschool ; Heart Defects, Congenital/*surgery ; Human ; Incidence ; Infant ; Infant, Newborn ; Intubation, Intratracheal/*adverse effects ; Laryngeal Edema/epidemiology/*etiology ; Postoperative Care ; Postoperative Complications ; Risk Factors

OBJECTIVEAcute intracranial hypertension/cerebral edema (ICH/CE) is an increase in brain volume caused by an absolute increase in cerebral tissue water content. Severe ICH/CE is often associated with a higher mortality and higher neurological consequence rate in intensive care unit. However, little relevant information is available on critical condition of central nervous system in children. The aim of this survey was to study the causes, clinical epidemiology and risk factors of critical illness with ICH/CE in pediatric intensive care unit (PICU).

METHODSCase records of critically ill patients with ICH/CE admitted to PICU in Children's Hospital Affiliated to Shanghai Jiaotong University during the period from January, 1999 to December, 2003 were reviewed for causes, case fatality rate, prognosis and relationship with multiple organ dysfunction syndrome (MODS). Univariate analyses were performed to identify risk factors associated with ICH/CE.

RESULTSDuring the 5 years, 1446 cases with critical illnesses were admitted and ICH/CE developed in 216 patients. The leading causes of ICH/CE were central nervous system infection (27.8%), accidental injuries (22.4%), and sepsis (10.2%). The overall mortality of the patients with ICH/CE was 29.2%. The mortality showed no significant change during the years from 1999 to 2003 (chi(2) = 0.371, P = 0.985). There was no significant difference in mortality of patients with ICH/CE between those with and without neurological diseases (chi(2) = 0.546, P = 0.460). Univariate analyses involving 12 factors indicated the following risk factors: younger age, number of failed organ, lower pediatric critical illness score, underlying diseases, abnormal respiration and change in size of pupil (P < 0.05 or < 0.001). The following factors were not associated with higher risk of death from ICH/CE: sex, organ of primary disease, Glasgow coma score ( 7) on admission, elevated blood pressure and anterior fontanelle change (P > 0.05).

CONCLUSIONSThe mortality of ICH/CE remains high since 1999. Central nervous system infection, accidental injuries, and sepsis were leading causes of ICH/CE in PICU of the hospital. Children who had ICH/CE due to younger age, lower pediatric critical illness score, and complicated with MODS had a higher mortality rate.

Acute Disease ; Brain Edema ; mortality ; Child ; China ; epidemiology ; Critical Illness ; Hospitals, University ; Humans ; Intensive Care Units, Pediatric ; statistics & numerical data ; Intracranial Hypertension ; mortality ; Prognosis ; Retrospective Studies ; Risk Factors