PURPOSE: Viagra(sildenafil citrate) is a new oral medication that selectively inhibits phsphodiestarase-5(PDE5) in the corpus cavernosum to facilitate penile erection for the treatment for male impotence. We report a case of retinal hemorrhage associated with Viagra intake. METHOD: A 71-year-old male without known systemic disease visited with suddenly decreased visual acuity of 4 days duration in the Rt. eye. He intermittenly took 2 tablets of Viagra(50 mg) during 2 months and the symptom occurred 2 days after his last taking of Viagra. His corrected visual acuity was 0.3 in the Rt. eye and 1.0 in the Lt. eye. Several ophthalmologic examination was performed. RESULTS: Fundus exam revealed multiple dot hemorrhage with corresponding block fluorescence in the superior area of macula and superotemporal area of posterior pole. Inferonasal area visual field defect was detected by Goldmann perimetry and ERG finding was decreased maximal scotopic b wave ampitude. Ten weeks later, retinal hemorrhage was almost absorbed, but visual field defect and visual acuity did not improve.
Aged ; Erectile Dysfunction ; Fluorescence ; Hemorrhage ; Humans ; Male ; Penile Erection ; Retinal Hemorrhage* ; Retinaldehyde* ; Tablets ; Visual Acuity ; Visual Field Tests ; Visual Fields ; Sildenafil Citrate

PURPOSE: To investigate the results of Advanced Surface Ablation (ASA) coupled with "smoothing" to smooth the ablation surface after covering masking fluid. METHODS: ASA was performed in 61 eyes with ablation depth of more than 75 microm. The mean refractive error was -5.88 +/- 1.27 D and mean ablation depth was 102.93 +/- 12.06 microm. Smoothing was performed in all patients (mean depth 16.79 +/- 2.43 microm, mean diameter 8.77 +/- 0.16 mm). Customized Aspheric Transition zone (CATz) was used in the laser algorithm. RESULTS: The mean refractive error was -0.29 +/- 0.41 D at postoperative 6 months and 97% of patients had an UCVA of 1.0 or better at postoperative 6 months. There was no statistically significant difference in magnitude of high-order aberrations at postoperative 6 months. The magnitude of total spherical aberrations increase was 0.084 microm at postoperative 6 months (p<0.05, paired t-test). The cornea was maintained clear in the majority of eyes. CONCLUSIONS: Excellent results were obtained by ASA coupled with "smoothing" in high myopia patients with an ablation depth greater than 75 microm.
Cornea ; Eye ; Humans ; Masks ; Myopia ; Refractive Errors

A 24-year-old man presented with mental change, fever, abdominal pain, tenderness and palpable mass on the lower abdomen. He was a non-Korean engineer and did not accompany a legal guardian, so medical history taking was difficult due to his mental status. Brain magnetic resonance imaging showed multiple rim-enhanced lesions of the brain, and abdominal computed tomography showed huge paraspinal abscess. Chest X-ray and computed tomography showed poorly defined nodular opacities. We initially thought that this patient was infected with toxoplasmosis with typical cerebral image finding and immunoglobulin laboratory finding of cerebrospinal fluid and serum study. The abdominal abscess was confirmed as tuberculosis through the pathologic finding of caseous necrosis. We used anti-tuberculosis medication and anti-toxoplasmosis medication for almost 4 months, and then his clinical state and radiological findings were considerably improved.
Abdomen ; Abdominal Abscess ; Abdominal Pain ; Abscess ; Brain ; Fever ; Humans ; Immunoglobulins ; Legal Guardians ; Magnetic Resonance Imaging ; Medical History Taking ; Necrosis ; Thorax ; Toxoplasmosis ; Toxoplasmosis, Cerebral ; Tuberculosis ; Young Adult

PURPOSE: To measure the secretion of IL-8 from cultured human keratocytes after inoculation of conidia of A. fumigatus, and to compare the change of secretion of IL-8 following application of amphotericin B and dexamethasone. METHODS: Human corneal keraoctytes were cultured independently in vitro. The specimens were divided into 4 groups : Group I with only pure culture as control, Group II with conidia of A. fumigatus, Group III with conidia of A. fumigatus and amphotericin B, and Group IV with conidia of A. fumigatus and dexamethasone. The supernatants were aspirated from each group at different time intervals, and then were assayed for IL-8. RESULTS: Group II showed increased secretion of IL-8, at all selected time intervals except 12-h, in comparison with other three groups. Group III secreted IL-8 significantly less than the other groups(p<0.01). Group IV secreted IL-8 less than Group I and II at all selected time points(p<0.01), but more than Group III at the other time points except for 72-h(p<0.01). CONCLUSIONS: The secretion of IL-8 increased in the early stage of fungal keratitis but decreased in case of the administration of amphotericin B or dexamethasone. Amphotericin B was more potent than dexamethasone in decreasing the secretion of IL-8.
Amphotericin B* ; Aspergillus fumigatus* ; Aspergillus* ; Dexamethasone* ; Humans* ; Interleukin-8* ; Keratitis ; Spores, Fungal

No abstract available.
Animals ; Muscle, Smooth, Vascular* ; Nitric Oxide* ; Rats*

No abstract available.
Hepatocytes* ; Macrophages* ; Muscle, Smooth, Vascular* ; Nitric Oxide* ; Rhodiola*

PURPOSE : To evaluate MR image qualities we developed a new MRI phantom with the fixation structures necessary to position it into coil firmly. MATERIALS AND METHODS : We designed MRI phantom for eight evaluation items such as slice thickness accuracy, high contrast spatial resolution, low contrast object detectability, geometry accuracy, slice position accuracy, image intensity uniformity, percent signal ghosting and signal to noise ratio. For the positioning of phantom at coils, the fixation structures were set up on the surface of phantom. Six different MRI units were used for test the possibility for the clinical application and their image qualities were evaluated. RESULTS : We acquired appropriate MR image qualities enough for the evaluation on all used MR units and confirmed that their evaluations were within reliable values compared to real ones for some items. The positioning of our phantom into head coils with fixation structures worked well for proper imaging. CONCLUSION : We found that our prototype of MRI phantom had the possibility of clinical application for MR image quality assessment.
Head ; Magnetic Resonance Imaging* ; Quality Control ; Signal-To-Noise Ratio

PURPOSE: Alagille syndrome is a complex hereditary disorder that is associated with cardiac, hepatic, skeletal, ocular, and facial abnormalities. Mutations in the Notch signaling pathway, such as in JAG1 and NOTCH2, play a key role in embryonic development. A cardiac or hepatic presentation is a critical factor for determining the prognosis. METHODS: We conducted a retrospective study of 41 patients with Alagille syndrome or a JAG1 mutation between 1983 and 2013. RESULTS: The first presentations were jaundice, murmur, cyanosis, and small bowel obstruction at a median age of 1.0 months (range, 0-24 months). The JAG1 mutation was found in 27 of the 28 genetically-tested patients. Cardiovascular anomalies were identified in 36 patients, chronic cholestasis was identified in 34, and liver transplantation was performed in 9. There was no significant correlation between the severity of the liver and cardiac diseases. The most common cardiovascular anomaly was peripheral pulmonary stenosis (83.3%), with 13 patients having significant hemodynamic derangement and 12 undergoing surgical repair. A total bilirubin level of >15 mg/dL with a complex surgical procedure increased the surgical mortality (P=0.022). Eight patients died after a median period of 2.67 years (range, 0.33-15 years). The groups with fetal presentation and with combined severe liver and heart disease had the poorest survival (P<0.001). CONCLUSION: The group with combined severe liver and heart disease had the poorest survival, and a multidisciplinary approach is necessary to improve the outcome.
Alagille Syndrome* ; Bilirubin ; Cardiovascular Diseases ; Cholestasis ; Cyanosis ; Embryonic Development ; Female ; Heart Diseases ; Hemodynamics ; Humans ; Jaundice ; Labor Presentation ; Liver ; Liver Transplantation ; Mortality ; Pregnancy ; Prognosis ; Pulmonary Valve Stenosis ; Retrospective Studies

OBJECTIVE: Surgical treatment of posterior inferior cerebellar artery (PICA) aneurysms is challenging due to limited surgical accessibility. Endovascular approach has a benefit of avoiding direct injury to the brainstem or lower cranial nerves. Therefore, it has recently been considered an alternative or primary modality for PICA aneurysms. We retrospectively assessed outcomes following detachable coil embolization of saccular PICA aneurysms. METHODS: From February 1997 to December 2007, we performed endovascular procedures to treat 15 patients with 15 PICA aneurysms. Fourteen patients with 14 PICA aneurysms morphology of which was saccular were reviewed retrospectively. Twelve patients had ruptured aneurysms. The aneurysms arose from the PICA origin site (n = 12), the PICA lateral medullary segment (n = 1), or the PICA tonsilomedullary segment (n = 1). RESULTS: Complete aneurysm occlusion was achieved in 10 patients, residual neck in 3, and residual sac in one. Radiological follow-up was performed in 7 patients with mean duration of 34.7 months (range, 1-97 months) and showed stable or complete occlusion in 6 patients. There were no rebleeding or retreatment after endovascular treatment. Thromboembolism was the only procedure-related complication (n = 4 ; 28.6%). Asymptomatic PICA infarction occurred in two patients and symptomatic PICA infarction in two elderly patients with poor clinical grade. Of these procedural PICA infarction cases, 1 symptomatic PICA infarction patient developed ventriculitis and septic shock leading to death. The clinical outcome was good in 10 patients (71.4%). Conclusions: In the present study, detachable coil embolization has shown as an efficient modality for PICA saccular aneurysms challenging indications of microsurgery. However, thromboembolic complications should be considered, especially in poor clinical elderly patients with ruptured aneurysms.
Aged ; Aneurysm ; Aneurysm, Ruptured ; Arteries ; Brain Stem ; Cranial Nerves ; Endovascular Procedures ; Follow-Up Studies ; Humans ; Infarction ; Microsurgery ; Neck ; Pica ; Retreatment ; Retrospective Studies ; Shock, Septic ; Thromboembolism

BACKGROUND AND OBJECTIVES: The main indication for thyroidectomy are thyroid cancer, multinodular goiter, and Graves' disease. Most important complications of thyroidectomy are recurrent laryngeal nerve injury and hypoparathyroidism. The risk of complication depends on the extent of the operation, and skill and experiences of surgeon. The purpose of this study is to determine the incidence and predictive factors for complication after thyroidectomy. MATERIALS AND METHOD: We examined the records of 233 patients who underwent thyroidectomy at the Department of Otolaryngology, Hanyang University from 1994 to 2001. The postoperative complication including hypocalcemia, recurrent laryngeal nerve palsy and hematoma was identified and analysed. The rate of recurrent laryngeal nerve palsy was calculated on the number of nerve at risk of injury. There were 135 unilateral and 98 bilateral procedures. Nerves at risk is 329. The hypocalcemia was defined as a ionized calcium fell below 1.01 mEq/L. RESULTS: Among 233 patients, 3 patients (1.3%) had permanent hypocalcemia and 57 patients (24.5%) had transient hypocalcemia. According to surgical procedure total thyroidectomy with neck dissection was associated with an increased risk of transient hypocalcemia (63.6%). The incidence of temporary and permanent recurrent laryngeal nerve palsy was 0.9% (3/329) and 0.3% (1/329), respectively. The postoperative hematoma occurred in 7 patients (3%). CONCLUSION: The most frequent complication after thyroidectomy is transient hypocalcemia. Based on our results, thyroidectomy is a relatively safe procedure. Complications can be kept to a minimum by a through knowledge of the anatomy, by understanding thyroid pathology, and by meticulous hemostasis and delicate surgical technique.
Calcium ; Goiter ; Graves Disease ; Hematoma ; Hemostasis ; Humans ; Hypocalcemia* ; Hypoparathyroidism ; Incidence ; Neck Dissection ; Otolaryngology ; Pathology ; Postoperative Complications ; Recurrent Laryngeal Nerve Injuries* ; Recurrent Laryngeal Nerve* ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy ; Vocal Cord Paralysis