PURPOSE: To evaluate the therapeutic effects of excimer laser phototherapeutic keratectomy (PTK) combined with amniotic membrane transplantation (AMT) in patients with symptomatic bullous keratopathy and poor visual potential. METHODS: Fifteen eyes of 15 patients were included. After mechanical removal of the epithelium, the central 7.0~7.5 mm zone was ablated with the excimer laser (ablation depth of 50 micrometer) and the peripheral cornea was additionally polished with other pulses of diameter 2.0 mm in an annular fashion. After PTK, the preserved amniotic membrane was sutured onto the cornea. Vision and symptom changes, epithelization time, statue of amniotic membrane, cosmesis, recurrence of bulla, and postoperative complication were analyzed. RESULTS: Mean follow-up period was 8.4 months (range, 6~20). Postoperative visual acuity improved or unchanged in 13 eyes (86.7%) and decreased by 1 line in 2 eyes (13.3%). Symptoms improved in all patients. Ten patients (66.7%) had complete resolution of symptoms. Mean epithelization time was 12.4 days, and cosmetic result was excellent or good in 13 eyes (86.7%). At last examination, though some patients showed a loss of amniotic membrane, epithelial bulla had not recurred in 14 eyes (93.3%). No postoperative complication was detected. CONCLUSIONS: Combined PTK and AMT is effective in symptom relief and prevention of recurrence in the treatment of bullous keratopathy.
Amnion* ; Cornea ; Epithelium ; Follow-Up Studies ; Humans ; Lasers, Excimer ; Postoperative Complications ; Recurrence ; Visual Acuity

OBJECTIVE: By using a functional magnetic resonance imaging (fMRI) technique we assessed brain activation patterns while subjects were viewing the living environments representing natural and urban scenery. MATERIALS AND METHODS: A total of 28 healthy right-handed subjects underwent an fMRI on a 3.0 Tesla MRI scanner. The stimulation paradigm consisted of three times the rest condition and two times the activation condition, each of which lasted for 30 and 120 seconds, respectively. During the activation period, each subject viewed natural and urban scenery, respectively. RESULTS: The predominant brain activation areas observed following exposure to natural scenic views in contrast with urban views included the superior and middle frontal gyri, superior parietal gyrus, precuneus, basal ganglia, superior occipital gyrus, anterior cingulate gyrus, superior temporal gyrus, and insula. On the other hand, the predominant brain activation areas following exposure to urban scenic views in contrast with natural scenes included the middle and inferior occipital gyri, parahippocampal gyrus, hippocampus, amygdala, anterior temporal pole, and inferior frontal gyrus. CONCLUSION: Our findings support the idea that the differential functional neuroanatomies for each scenic view are presumably related with subjects' emotional responses to the natural and urban environment, and thus the differential functional neuroanatomy can be utilized as a neural index for the evaluation of friendliness in ecological housing.
Adult ; Brain Mapping/*methods ; Emotions/physiology ; Environment ; Female ; Humans ; Image Processing, Computer-Assisted ; Linear Models ; Magnetic Resonance Imaging/*methods ; Male ; *Photic Stimulation

BACKGROUND: Currently the most common treatment modality of refractory ascites in patients with liver cirrhosis was large volume paracentesis, but this procedure usually needed albumin infusion and occasionally developed unwanted complications. By reason of albumin shortage in Korea and occasional unfavorable complications, we studied the usefulness of dialytic ultrafiltration as an another treatment modality of refractory ascites. METHODS: Dialytic ultrafiltration was done in 10 patients (total 48 times) with liver cirrhosis or hepatocellular carcinoma. Two drainage conduit (via 16 gauge angio-catheter) of input and output were made by puncture of patient's right and left lower quadrant abdomen. The initial ultrafiltration rate of dialyser was 250mL/min. Ascitic fluid was removed continuously until the filtration rate down at 50mL/min. After ultrafiltration, ascitic fluid contained concentrated albumin and large molecules was reinfused via input conduit. Pre-treatment and post-treatment level of blood chemistry, plasma renin concentration, aldosterone, and electrolytes in serum; total protein and albumin in ascites were measured. During the ultrafiltration, we closely observed the change of blood pressure, heart rates and mental status. RESULTS: The mean ultrafiltration time was 231+/-28min, ultrafiltrated volume was 5.15+/-1.41 L. During dialytic ultrafiltration, patient's blood pressure and heart rate were stable and there was no change of mental status. After dialytic ultrafiltration, blood urea nitrogen level significantly decreased from 30.5+/-23.7mg/dL to 25.7+/-20.2mg/dL; serum aldosterone level decreased from 807.3+/-301.1pg/ml to 431.1+/-187.2pg/ml in serum (P<0.01). The albumin level in the ascitic fluid significantly increased from 0.67+/-0.28g/dL to 1.90+/-1.16g/dL (P<0.01). Plasma renin concentration level tend to decreased (P=0.06). The patient's serum total protein, albumin, electrolytes, and creatinine were not changed. Complications of dialytic ultrafiltration were peritonitis (one case) and hypotension (one case). But these unwanted complications were readily managed by adequate antibiotics and intravenous fluid therapy. CONCLUSION: The dialytic ultrafiltration can be used effectively without albumin infusion in the treatment of refrartory ascites in patients with advanced liver cirrhosis.
Abdomen ; Aldosterone ; Anti-Bacterial Agents ; Ascites* ; Ascitic Fluid ; Blood Pressure ; Blood Urea Nitrogen ; Carcinoma, Hepatocellular ; Chemistry ; Creatinine ; Drainage ; Electrolytes ; Filtration ; Fluid Therapy ; Heart Rate ; Humans ; Hypotension ; Korea ; Liver Cirrhosis* ; Liver* ; Paracentesis ; Patient Rights ; Peritonitis ; Plasma ; Punctures ; Renin ; Ultrafiltration*

BACKGROUND/AIMS: To evaluate the therapeutic outcomes of the endoscopic submucosal dissection (ESD) technique for the treatment of gastric subepithelial tumors (SETs). METHODS: A systematic literature review was conducted using the core databases. Data on the complete resection rates and the procedure-related perforation rates were extracted and analyzed. A random effects model was then applied for this meta-analysis. RESULTS: In all, 288 patients with 290 SETs were enrolled from nine studies (44 SETs originated from the submucosal layer; 246 SETs originated from the muscularis propria layer). The mean diameter of the lesions ranged from 17.99 to 38 mm. Overall, the pooled complete resection rate was estimated to be 86.2% (95% confidence interval [CI], 78.9 to 91.3). If the analysis was limited to the lesions that originated from the submucosal layer, the pooled complete resection rate was 91.4% (95% CI, 77.9 to 97). If the analysis was limited to the lesions that originated from the muscularis propria, the pooled complete resection rate was 84.4% (95% CI, 78.7 to 88.8). The pooled procedure-related gastric perforation rate was 13% (95% CI, 9.4 to 17.6). Sensitivity analyses showed consistent results. Finally, publication bias was not detected. CONCLUSIONS: ESD, including endoscopic muscularis dissection, is a technically feasible procedure for the treatment of SETs. However, selection bias is suspected from the enrolled studies. For the development of a proper indication of ESD for SETs, further studies are needed.
Gastrointestinal Stromal Tumors ; Humans ; Publication Bias ; Selection Bias

BACKGROUND: Basal cell carcinoma(BCC) is the most common primary cutaneous neoplasm in Korea. Since the majority of BCCs occur on the head and neck and the goal of the BCC treatment is the complete removal of tumor, Mohs micrographic surgery is ideally suited for maximizing cure rate with minimizing tissue loss. OBJECTIVE: The purpose of this study is to evaluate the depth of excision as well as the lateral margins of BCC and to correlate these with the clinicopathologic aspects of the tumors. METHODS: Twenty patients with 21 BCCs (10 primary, 11 recurrent) diagnosed in the Department of Dermatology of Dong-A University Hospital from March, 1992 through December, 1993 were studied prospectively. RESULTS: 1. Sixty percent of tumors in primary BCCs in our series had a 2-mm maximal margin and 81.8% of recurrent BCC were eradicated with 4-mm or more lateral margin. 2. All the recurrent basal cell carcinomas (8 cases) measuring greater than 15-mm required more than 4-mm margin for the total removal. 3. More than 90% of BCC on the nose in our series required the removal of periosteum/perichondrium or the excision of whole layer. CONCLUSION: Mohs micrographic surgery is an appropriate tool to use in proposing guidelines for the treatment of skin cancer because the most accurate method of determining the actual extent of skin cancer can be achieved.
Carcinoma, Basal Cell* ; Dermatology ; Head ; Humans ; Korea ; Methods ; Mohs Surgery* ; Neck ; Nose ; Prospective Studies ; Skin Neoplasms

A 47-day-old male infant presented with fever, poor oral intake, irritability, and right-sided bluish buccal swelling. Contrast-enhanced computed tomography of the neck showed a round mass lesion of about 2.0x1.5 cm that suggested abscess formation in the right masticator space. Ultrasound-guided extraoral aspiration of the abscess at the right masseter muscle was successful. Staphylococcus aureus was identified in the culture from the aspirated pus and blood. Appropriate antibiotics were given and the patient recovered. The patient underwent follow-up ultrasonography that showed an improved state of the previously observed right masseter muscle swelling at about 1 month after hospital discharge. A masticator space abscess usually originates from an odontogenic infection in adults. We report a case of masticator space abscess in a 47-day-old infant in whom septicemia without odontogenic infection was suspected.
Abscess ; Adult ; Anti-Bacterial Agents ; Bacteremia ; Fever ; Follow-Up Studies ; Humans ; Infant ; Male ; Masseter Muscle ; Neck ; Sepsis ; Staphylococcus aureus ; Suppuration

The present study was designed to examine the effect of d-amphetamine on CA release from the isolated perfused model of the rat adrenal gland, and to establish its mechanism of action. D- amphetamine (10~100microM), when perfused into an adrenal vein of the rat adrenal gland for 60 min, enhanced the CA secretory responses evoked by ACh (5.32x10-3 M), excess K+ (5.6x10-2 M, a membrane depolarizer), DMPP (10-4 M, a selective neuronal nicotinic Nn-receptor agonist) and McN-A-343 (10-4 M, a selective M1-muscarinic agonist) only for the first period (4 min), although it alone has weak effect on CA secretion. Moreover, d-amphetamine (30microM) in to an adrenal vein for 60 min also augmented the CA release evoked by BAY-K-8644, an activator of the dihydropyridine L-type Ca2+ channels, and cyclopiazonic acid, an inhibitor of cytoplasmic Ca2+ ATPase only for the first period (4 min). However, in the presence of high concentration (500microM), d-amphetamine rather inhibited the CA secretory responses evoked by the above all of secretagogues. Collectively, these experimental results suggest that d-amphetamine at low concentrations enhances the CA secretion from the rat adrenal medulla evoked by cholinergic stimulation (both nicotininc and muscarinic receptors) as well as by membrane depolarization, but at high concentration it rather inhibits them. It seems that d-amphetamine has dual effects as both agonist and antagonist at nicotinic receptors of the isolated perfused rat adrenal medulla, which might be dependent on the concentration. It is also thought that these actions of d-amphetamine are probably relevant to the Ca2+ mobilization through the dihydropyridine L-type Ca2+ channels located on the rat adrenomedullary chromaffin cell membrane and the release of Ca2+ from the cytoplasmic store.
(4-(m-Chlorophenylcarbamoyloxy)-2-butynyl)trimethylammonium Chloride ; 3-Pyridinecarboxylic acid, 1,4-dihydro-2,6-dimethyl-5-nitro-4-(2-(trifluoromethyl)phenyl)-, Methyl ester ; Adrenal Glands ; Adrenal Medulla* ; Amphetamine ; Animals ; Calcium-Transporting ATPases ; Chromaffin Cells ; Cytoplasm ; Dextroamphetamine* ; Dimethylphenylpiperazinium Iodide ; Membranes ; Neurons ; Rats* ; Receptors, Nicotinic ; Veins

Mirizzi's syndrome (MS) caused by the retention of a stone in the cystic duct stump after cholecystectomy is rare. Most cases of MS are treated by surgical intervention. However, developments of endoscopic accessories and techniques have resulted in the recent introduction of endoscopic treatments for MS. Furthermore, in view of the postoperative morbidity caused by post-operative scarring, the endoscopic approach should be preferred to the surgical approach. In the described case, the authors were able to remove a remnant cystic duct stone endoscopically because the cystic duct stump was wide and non-tortuous. This case shows endoscopic retrograde cholangiopancreatography with mechanical lithotripsy can be utilized in suitable cases of type I MS development after cholecystectomy.
Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy ; Cicatrix ; Cystic Duct ; Lithotripsy ; Mirizzi Syndrome*

Intravesical bacillus Calmette-Guérin (BCG) immunotherapy is a common treatment modality for bladder cancer after transurethral resection of a bladder tumor. This therapy is generally safe, and development of a prostatic abscess with a prostatorectal fistula after intravesical BCG immunotherapy is a very rare complication. This finding was incidentally obtained by the authors, who examined a patient with colonoscopy for evaluation of abdominal pain. The patient was successfully treated with antitubercular drugs. To the authors’ knowledge, this is the first report of a patient with a tuberculous prostatic abscess with prostatorectal fistula after BCG immunotherapy in South Korea.
Abdominal Pain ; Abscess* ; Antitubercular Agents ; Bacillus* ; Colonoscopy ; Fistula* ; Humans ; Immunotherapy* ; Korea ; Mycobacterium bovis ; Prostate ; Tuberculosis ; Urinary Bladder Neoplasms

Primary ovarian angiosarcoma is very rare with only 27 cases reported so far in the medical literature. We report here on a rare case of ovarian microinvasive mucinous carcinoma that was coexistent with angiosarcoma in a 54-year-old woman. The tumor was a 26x19x10 cm-sized multilocular cystic mass with a 4x3 cm-sized solid hematoma-like nodule in the center. Microscopically, it was composed mostly of mucinous tumor of various grades from borderline to microinvasive carcinoma. The hematoma-like area turned out to be an angiosarcoma, composed of pleomorphic cells that formed slit-like spaces, spindle cells that formed short fascicles and anastomosing vascular channels with atypical endothelial cells. All these cells were positive for CD31, CD34 and factor VIII-related antigen. The patient developed peritoneal and pleural metastases, which were angiosarcoma and mucinous carcinoma, respectively. We believe this case is only the fourth example of an ovarian collision tumor of angiosarcoma and surface epithelial tumor.
Adenocarcinoma, Mucinous ; Cystadenocarcinoma, Mucinous ; Endothelial Cells ; Female ; Hemangiosarcoma ; Humans ; Middle Aged ; Mucins ; Neoplasm Metastasis ; Ovary ; von Willebrand Factor