PURPOSE: The present study evaluated the clinical results of phototherapeutic keratectomy (PTK) for refractory recurrent corneal erosion (RCE). METHODS: A total of 12 eyes from 11 RCE patients who had been initially treated with conservative therapy but suffered from recurrence, were treated using PTK with 193 nm excimer laser. The preoperative and postoperative best corrected visual acuity (BCVA), spherical equivalent, average keratometric value, re-epithelialization time, corneal haze, complications and recurrence were investigated. RESULTS: PTK was combined with photorefractive keratectomy in 1 eye. The mean follow-up time was 11.42 months. All 12 eyes were successfully treated and had no recurrence during the follow-up except 1 eye where the symptoms recurred 9 months postoperatively. Postoperative BCVAs were all better than the preoperative BCVAs. Mild myopic change (average -0.20 diopter) and increased average keratometric values (average 0.27 diopter) were noted in 11 eyes which were treated using PTK alone. The average re-epithelialization time was 5.63 days. No specific complication except mild corneal haze was found. CONCLUSIONS: PTK is a safe and effective treatment for refractory RCE in short-term follow-up.
Eye ; Follow-Up Studies ; Humans ; Lasers, Excimer ; Photorefractive Keratectomy ; Re-Epithelialization ; Recurrence ; Visual Acuity

Background: Although the modified Blalock-Taussig shunt remains the mainstay method of palliation for augmenting pulmonary blood flow in various congenital heart diseases, the shunt must be carefully designed to achieve the best outcomes. This study investigated the effect of shunt configuration on pulmonary artery growth and growth discrepancy. Methods: Twenty patients with successful modified Blalock-Taussig shunt takedown were analyzed. Pulmonary artery and shunt characteristics were obtained using computed tomography scans. Differences in the baseline and follow-up diameter ratios and growth in the ipsilateral and contralateral arteries were calculated. The angle between the shunt and pulmonary artery, as well as the distance from the main pulmonary artery bifurcation, were measured. Correlations between pulmonary arteries and shunt configurations were analyzed. Results: The median interval time between shunt placement and takedown was 154.5 days (interquartile range, 113.25–276.25 days). Follow-up values of the ipsilateral-to-contralateral pulmonary artery diameter ratio showed no significant correlation with the shunt angle (ρ=0.429, p=0.126) or distance (ρ=0.110, p=0.645). The shunt angle and distance from the main pulmonary bifurcation showed no significant correlation (ρ=-0.373, p=0.189). Pulmonary artery growth was negatively correlated with shunt angle (ipsilateral, ρ=-0.565 and p=0.035; contralateral, ρ=-0.578 and p=0.030), but not with distance (ipsilateral, ρ=-0.065 and p=0.786; contralateral, ρ=-0.130 and p=0.586). Conclusion Shunt configuration had no significant effect on growth imbalance. The angle and distance of the shunt showed no significant correlation with each other. A more vertical shunt was associated with significant pulmonary artery growth. We suggest a more vertical graft design for improved pulmonary artery growth.

Holt-Oram Syndrome is an autosomal dominant disorder characterized by the association of upper-limb abnormalities and congenital heart disease. A woman with no family history of genetic disease underwent antenatal sonography at 27 weeks' menstrual age to screen for fetal anomalies. Ultrasonography revealed abnormalities in the upper limbs. The limb abnormalities included abscence of bilateral thumbs and radius: the left humus was short. Pregnancy termination was performed. The postnatal chromosomal analysis revealed a normal 46XX karyotype and the autopsy finding confirmed the Holt-Oram syndrome. We report a case of Holt-Oram Syndrome in fetus with unaffected parents with brief of the literatures.
Autopsy ; Extremities ; Female ; Fetus ; Heart Defects, Congenital ; Humans ; Karyotype ; Parents* ; Pregnancy ; Radius ; Soil ; Thumb ; Ultrasonography* ; Upper Extremity

PURPOSE: To evaluate the complication incidence of 23-gauge pars plana vitrectomy day surgery. METHODS: A retrospective review was conducted on 79 eyes that underwent 23-gauge pars plana vitrectomy day surgery from September 2009 to September 2010. The main outcome measures included changes in best corrected visual acuity (BCVA), intraocular pressure (IOP), and presence of postoperative complications after the day surgery. RESULTS: The mean preoperative log MAR BCVA improved from 1.32 +/- 0.96 to 0.40 +/- 0.41 at 3 months after surgery (p < 0.05). There was no significant differences between the mean preoperative IOP and IOP on the 1st day after surgery (p > 0.05). At the end of surgery, suture placement was required for sclerotomy site leakage in 4 eyes (5.1%). There were 10 eyes (12.7%) with postoperative complications, including 7 eyes with increased IOP (8.9%), hypotony in 2 eyes (2.6%) and vitreous hemorrhage in 1 eye (1.3%), with no case requiring reoperation. CONCLUSIONS: The patients who underwent 23-gauge pars plana vitrectomy day surgery achieved visual improvement without serious complications postoperatively.
Ambulatory Surgical Procedures ; Eye ; Humans ; Incidence ; Intraocular Pressure ; Outcome Assessment (Health Care) ; Postoperative Complications ; Retrospective Studies ; Sutures ; Visual Acuity ; Vitrectomy ; Vitreous Hemorrhage

PURPOSE: To evaluate the complication incidence of 23-gauge pars plana vitrectomy day surgery. METHODS: A retrospective review was conducted on 79 eyes that underwent 23-gauge pars plana vitrectomy day surgery from September 2009 to September 2010. The main outcome measures included changes in best corrected visual acuity (BCVA), intraocular pressure (IOP), and presence of postoperative complications after the day surgery. RESULTS: The mean preoperative log MAR BCVA improved from 1.32 +/- 0.96 to 0.40 +/- 0.41 at 3 months after surgery (p < 0.05). There was no significant differences between the mean preoperative IOP and IOP on the 1st day after surgery (p > 0.05). At the end of surgery, suture placement was required for sclerotomy site leakage in 4 eyes (5.1%). There were 10 eyes (12.7%) with postoperative complications, including 7 eyes with increased IOP (8.9%), hypotony in 2 eyes (2.6%) and vitreous hemorrhage in 1 eye (1.3%), with no case requiring reoperation. CONCLUSIONS: The patients who underwent 23-gauge pars plana vitrectomy day surgery achieved visual improvement without serious complications postoperatively.
Ambulatory Surgical Procedures ; Eye ; Humans ; Incidence ; Intraocular Pressure ; Outcome Assessment (Health Care) ; Postoperative Complications ; Retrospective Studies ; Sutures ; Visual Acuity ; Vitrectomy ; Vitreous Hemorrhage

BACKGROUND: The objective responses of cisplatin and etoposide (PVP) combination chemotherapy as second-line therapy following CAV was high (40~50%) and, in several reports, PVP yields survival results that are at least as good as those obtained with cyclophosphamide or doxorubicin-based regimens and with less host-related toxicity in chemotherapy-naive patients. We conducted a phase II study to evaluate the effect of a combination of cisplatin and etoposide as a first-line therapy in patients with small cell lung cancer. METHODS: Sixty-one previously untreated small cell lung cancer patients with measurable lesion(s) received cisplatin(30 mg/m2 IV, day 1~3) and etoposide(100 mg/m2 IV, day 1~3). In patients with limited disease, after completion of 6 cycles of PVP chemotherapy, chest and prophylatic brain irradiation was performed in case of complete responder, chest irradiation only in partial responder. RESULTS: 1) Of 55 evaluable patients, 13(24%) had a complete response and 29(53%) had a partial response. 2) The median survival time was 55.8 weeks for all patients(N=55), 61.1 weeks for limited disease(N=31), 51.3 weeks for extensive disease(N=24). 3) The response duration was 29.1 weeks for responders(N=42). 4) There was no significant prognostic factors iufluencing response rates. 5) The toxicity was tolerable and there was no treatment-related deaths. CONCLUSION: The PVP combination chemotherapy as a first-line therapy was effective and well-tolerated in patients with small cell lung cancer.
Brain ; Cisplatin* ; Cyclophosphamide ; Drug Therapy ; Drug Therapy, Combination* ; Etoposide* ; Humans ; Small Cell Lung Carcinoma* ; Thorax

BACKGROUND: Portal triad clamping (PTC) during hepatic resection (Pringle maneuver, PM) can afford reduced intraoperative bleeding and bloodless surgical field. But inflow obstruction of blood to liver during PM can bring hemodynamic changes to the patient. This study was designed to evaluate the hemodynamic changes before, during and after PM application during hepatic resection. We also compared the hemodynamic effects of hepatic cooling before PM with/without portal decompression during PM. METHODS: The patients were divided into three groups; PM (P group, n=9), PM after hepatic cooling with 400 ml of 4oC lactated Ringer's solution (LR) (C+P group, n=13), PM after hepatic cooling and portal decompression with portocaval shunt (C+P+S group, n=7). Systemic vascular resistance index (SVRI), cardiac index (CI) and mean arterial pressure (MAP) were measured before, during and after PM. RESULTS: Portal pressure of C+P+S group (208.3+/-36.6 mmH2O) was lower than P (487.3+/-92.9 mmH2O) and C P (553.6+/-77.0 mmH2O) group during PM. CIs of P and C P group were decreased (15, 13% respectively) during PM. After reperfusion, CIs and SVRIs of P, C+P and C+P+S group were all increased (CI; 33, 26, 50%, SVRI; 30, 40, 50%, respectively) than end of PM. CONCLUSION: PM itself doesn't make abrupt hemodynamic change. Hepatic cooling with 4oC LR (400 ml) before PM increases MAP because of increased SVRI. Reperfusion after PM for 50 minutes, hemodynamic depression could occur by decreased SVRI, especially in case of decompressed portal pressure with portocaval shunt during PM.
Arterial Pressure ; Constriction* ; Decompression* ; Depression ; Hemodynamics* ; Hemorrhage ; Humans ; Liver ; Portal Pressure ; Reperfusion ; Vascular Resistance

BACKGROUND: Portal triad clamping (PTC) during hepatic resection (Pringle maneuver, PM) can afford reduced intraoperative bleeding and bloodless surgical field. But inflow obstruction of blood to liver during PM can bring hemodynamic changes to the patient. This study was designed to evaluate the hemodynamic changes before, during and after PM application during hepatic resection. We also compared the hemodynamic effects of hepatic cooling before PM with/without portal decompression during PM. METHODS: The patients were divided into three groups; PM (P group, n=9), PM after hepatic cooling with 400 ml of 4oC lactated Ringer's solution (LR) (C+P group, n=13), PM after hepatic cooling and portal decompression with portocaval shunt (C+P+S group, n=7). Systemic vascular resistance index (SVRI), cardiac index (CI) and mean arterial pressure (MAP) were measured before, during and after PM. RESULTS: Portal pressure of C+P+S group (208.3+/-36.6 mmH2O) was lower than P (487.3+/-92.9 mmH2O) and C P (553.6+/-77.0 mmH2O) group during PM. CIs of P and C P group were decreased (15, 13% respectively) during PM. After reperfusion, CIs and SVRIs of P, C+P and C+P+S group were all increased (CI; 33, 26, 50%, SVRI; 30, 40, 50%, respectively) than end of PM. CONCLUSION: PM itself doesn't make abrupt hemodynamic change. Hepatic cooling with 4oC LR (400 ml) before PM increases MAP because of increased SVRI. Reperfusion after PM for 50 minutes, hemodynamic depression could occur by decreased SVRI, especially in case of decompressed portal pressure with portocaval shunt during PM.
Arterial Pressure ; Constriction* ; Decompression* ; Depression ; Hemodynamics* ; Hemorrhage ; Humans ; Liver ; Portal Pressure ; Reperfusion ; Vascular Resistance

OBJECTIVE: To investigate whether patterns of dysphagia were associated with the location of the brain lesion and clinical factors in subacute stroke patients. METHOD: One hundred and seventy-eight first-ever subacute stroke patients who underwent videofluoroscopic swallowing study (VFSS) from January 2006 to April 2012 were enrolled in the present study. Swallowing-related parameters were assessed by VFSS. The location of brain lesions were classified into the cortical, subcortical, and brain stem. The degree of cognitive impairment and the independency of activities of daily living were assessed by the Korean version of mini-mental status examination and Korean version of modified Barthel index (K-MBI). Aphasia and hemineglect were assessed by Korean version of Western aphasia battery and line bisection test. These data were collected via retrospective chart review. RESULTS: A reduced laryngeal elevation and prolonged pharyngeal delay time were associated with brain stem lesion. Other swallowing parameters were not associated with lesion topology. Pyriform sinus residue was associated with the presence of aphasia and low K-MBI scores. Prolonged pharyngeal delay time was associated with the patient's age, type of stroke and brain stem lesion. CONCLUSION: Pyriform sinus residue was associated with clinical factors such as aphasia and K-MBI scores rather than with the location of brain lesion. However, reduced laryngeal elevation and prolonged pharyngeal delay time were predominant in brain stem lesions.
Activities of Daily Living ; Aphasia ; Brain Stem ; Brain* ; Deglutition Disorders ; Deglutition* ; Humans ; Pyriform Sinus ; Retrospective Studies ; Stroke*

OBJECTIVE: To investigate the prevalence of chronic obstructive pulmonary disease (COPD) in stroke patients, and to assess the difference in swallowing function between stroke patients with COPD (COPD group) and stroke patients without COPD (control group). METHODS: The subjects included 103 stroke patients. They underwent the pulmonary function test and were assigned to either the COPD group or the control group. Their penetration-aspiration scale (PAS) scores and functional dysphagia scale scores were compared by performing a videofluoroscopic swallowing study. The intergroup differences in lip closure, bolus formation, mastication, and the oral transit time, laryngeal elevation, cricopharyngeal dysfunction, oronasal regurgitation, residue in pyriform sinus and vallecula, pharyngeal transit time, aspiration, and esophageal relaxation were also compared. RESULTS: Thirty patients were diagnosed with COPD. The COPD group showed statistically higher PAS scores (4.67+/-2.15) compared to the control group (2.89+/-1.71). Moreover, aspiration occurred more frequently in the COPD group with statistical significance (p<0.05). The COPD group also showed higher occurrence of cricopharyngeal dysfunction, albeit without statistical significance. CONCLUSION: This study shows that a considerable number of stroke patients had COPD, and stroke patients with COPD had higher risk of aspiration than stroke patients without COPD.
Deglutition Disorders ; Deglutition* ; Humans ; Lip ; Mastication ; Prevalence ; Pulmonary Disease, Chronic Obstructive* ; Pyriform Sinus ; Relaxation ; Respiratory Aspiration ; Respiratory Function Tests ; Stroke*