OBJECTIVE: This study was conducted in order to evaluate an education program for cardio-cerebrovascular high-risk patients. METHODS: To evaluate patients' quality of life, EQ-5D was used and an organized survey was conducted via calls and interviews for hypertension, diabetes patients who had visited the KHyDDI(Korea Hypertension Diabetes DaeguInitiative) education center or 70 clinics through out the nation. RESULTS: The subjects included 537 patients, 320 of who were in the clinic education and 217 of who were in the education center program. Sixty eight of the subjects went through the EQ-5D evaluation before and after the education program. In the EQ-5D index distribution of their quality of life before the education program, there was a statistically significant difference in gender(p<0.001) with higher points among males. Regarding age, there was a statistically significant difference between those aged over 65 years and under 65(p<0.001), with higher points in the group under the age of 65. Further, the EQ-5D 5 scope index was statistically significant different before and after receiving the education(p<0.05). CONCLUSION: Therefore, the KHyDDI staged education program is effective for improving the quality of life. Moreover, it could contribute to the complications of the disease through a variety of approaches by considering both gender and age.

Community health projects focusing on secondary prevention of diabetic macrovascular diseases have become increasingly common. In Daegu, Korea, a metropolitan hypertension diabetes management project has been developed in which community primary physicians refer clinic patients to education centers or clinical education teams for target education on lifestyle modification through technology-based information networks. Call centers provide information on lifestyle management and encourage continuous treatment through periodic calls and SMS. Integrative education is presented by doctors, dietitians, exercise specialists, and nurses. This project was developed in response to an educational need study of patients and educators. Patients participating in the program showed significant improvement in both self-efficiency and in clinical outcomes.
Diabetes Mellitus ; Humans ; Hypertension ; Information Services ; Korea ; Life Style ; Nutrition Therapy ; Secondary Prevention ; Specialization

PURPOSE: To report a case of malignant glaucoma in an eye vitrectomized 5 years previously due to endophthalmitis. CASE SUMMARY: A 55-year-old male visited clinic due to a painful right eye 2 days in duration. Five years ago, he suffered endophthalmitis in his right eye and underwent pars plana vitrectomy. On slit-lamp examination, shallow anterior chamber depth of 2 central corneal thickness and corneal edema were observed along with remnant cortical lens material behind the intraocular lens. Intraocular pressure was 68 mm Hg measured using applanation tonometry. Maximal medical treatment failed to lower the intraocular pressure on the first day of visit. The very next day, anterior chamber became shallower less than 0.5 central corneal thickness and intraocular pressure was 70 mm Hg. Posterior capsular syndrome was suspected on anterior optical coherence tomography and neodymium:yttrium-aluminum-garnet laser posterior capsulotomy was performed, however, normal anterior chamber could not be restored. Despite continuous medical therapy for 3 weeks, the patient's symptoms worsened and intraocular pressure increased over 99 mm Hg and therefore, the Ahmed glaucoma valve was implanted. One day after the operation, intraocular pressure decreased to 10 mm Hg and anterior chamber depth became deeper with the depth of over 5 central corneal thickness. At the final visit 4 months postoperatively, intraocular pressure and normal anatomy of the anterior segment were well maintained. CONCLUSIONS: Malignant glaucoma syndrome can occur even in vitrectomized eyes and capsular block syndrome can initiate this. Malignant glaucoma syndrome in a vitrectomized eye resistant to maximal medical treatment can be treated with Ahmed valve implantation.
Anterior Chamber ; Corneal Edema ; Endophthalmitis ; Glaucoma* ; Humans ; Intraocular Pressure ; Lenses, Intraocular ; Male ; Manometry ; Middle Aged ; Posterior Capsulotomy ; Tomography, Optical Coherence ; Vitrectomy

PURPOSE: To report a case of pigment dispersion syndrome and reverse pupillary block secondary to the implantation of implantable collamer lens (ICL) with a central hole (AQUA ICL®) that was treated with ICL removal and laser peripheral iridotomy (LPI). CASE SUMMARY: A 29-year-old woman with myopia in both eyes underwent implantation of AQUA ICL®. Four weeks postoperatively, the intraocular pressure (IOP) increased to 34 mm Hg and the patient showed pigment dispersion syndrome in both eyes. Since the IOP did not reduce with the maximum tolerable medical therapy, the ICLs were removed 8 weeks after implantation. The pigment dispersion subsided and IOP reduced shortly after ICL removal. However, 4 weeks after removal of ICL, posterior iris bowing and reverse pupillary block occurred in the right eye and the IOP increased to 46 mm Hg. LPI was performed in the right eye, and the reverse pupillary block was dissolved after a reduction in pigment dispersion. The IOP subsequently normalized to 13 mm Hg. Two weeks later, prophylactic LPI was performed in the left eye. Four weeks after prophylactic LPI, selective laser trabeculoplasty was performed on both eyes. As a result, the IOP was 11 mm Hg in the right eye and 12 mm Hg in the left eye after 4 weeks of treatment with topical IOP-lowering medications. CONCLUSIONS: The present case indicates that implantation of ICL with a central hole can lead to early postoperative pigment dispersion syndrome. When this condition persists and is accompanied by reverse pupillary block after ICL removal, LPI can be partially effective.
Adult ; Female ; Humans ; Intraocular Pressure ; Iris ; Myopia ; Trabeculectomy

Purpose: This study investigated the efficacy and safety of selective laser trabeculoplasty (SLT) in Korean patients with medically uncontrolled pseudoexfoliation glaucoma (PEXG). Methods: This retrospective observational study enrolled 43 medically uncontrolled PEXG patients who underwent a 360° SLT and were followed up for at least 12 months after SLT. The intraocular pressure (IOP) before and after SLT at 1 week, 1, 3, 6, and 12 months was evaluated. Treatment success was defined as an IOP reduction of ≥20% from the baseline and an IOP equal to lower than 22 mmHg without additional anti-glaucomatous intervention. Additionally, every follow-up medical record was reviewed to assess any possible side effects of SLT. Results: Based on the Kaplan-Meier survival analysis, the treatment success rate at 12 months after SLT was 41.9% (18 eyes). For the success group at the 12 months follow-up, SLT showed a mean IOP reduction of 10.3 ± 5.0 mmHg (from 25.6 ± 4.4 to 15.2 ± 2.9 mmHg; 39.3%, p < 0.05). Among the 25 eyes that were considered as the treatment failure group, 14 eyes underwent glaucoma filtering surgeries, four eyes received additional SLT, and further intervention and follow-up was refused for seven eyes. During the overall follow-up period, there were no significant adverse events. Conclusions SLT is a partially effective and safe procedure for lowering IOP in Korean patients with medically refractory PEXG. Therefore, it can be considered as one of the alternative treatment modalities in patients who are at high risk for conventional filtering surgery.

BACKGROUND: Urinary trypsin inhibitors (UTI) have been widely used for the treatment of diseases including disseminated intravascular coagulation, shock, and pancreatitis. Since UTI synthesis is likely to be reduced in patients who have undergone liver resection, the incidence of inflammatory reactions may be increasing accordingly. For such patients, the liver enzyme increases after the operation can reflect liver damage. The purpose of this study was to examine if ulinastatin can inhibit liver enzyme increases after liver resection. METHODS: After receiving Institutional Review Board approval, a retrospective chart review was performed on 201 patients who underwent hepatic resection from 2006 to 2010. We divided the records into the control (n = 69) and ulinastatin (n = 132) groups according to the use of intraoperative ulinastatin and compared the preoperative and postoperative laboratory test results. The number of patients who had > 400 U/L elevation of aspartate transaminase (AST) level after surgery was compared between the 2 groups. RESULTS: The mean AST, alanine transaminase (ALT), and total bilirubin levels after liver resection were significantly lower in the ulinastatin group than in the control group. The number of patients who showed an AST > 400 U/L after liver resection was significantly higher in the control group (odds ratio = 3.02). CONCLUSIONS: Ulinastatin attenuates the elevation of hepatic enzymes and bilirubin after liver resection.
Alanine Transaminase ; Aspartate Aminotransferases ; Bilirubin ; Disseminated Intravascular Coagulation ; Ethics Committees, Research ; Glycoproteins ; Hepatectomy ; Humans ; Incidence ; Liver ; Liver Function Tests ; Pancreatitis ; Retrospective Studies ; Shock ; Trypsin ; Trypsin Inhibitors

When a rapidly re-expanding lung has been in a state of collapse for more than several days, pulmonary edema sometimes occurs. This is called reexpansion pulmonary edema. In general, it most commonly occurs in patients with a large pneumothorax of long duration. In this case, a 15 year old female patient with a 2.3 cm sized bulla in the right lung developed right pneumothorax after anesthetic induction. Although early drainage by closed thoracostomy was performed, right pulmonary edema eventually occurred. It is unusual that vigorous reexpansion pulmonary edema developed even though early decompression was performed within one hour after development of pneumothorax.
Blister ; Decompression ; Drainage ; Female ; Humans ; Lung ; Pneumothorax ; Pulmonary Edema ; Thoracostomy

OBJECTIVE: This study was conducted to evaluate an education program for cardiocerebrovascular high-risk patients. METHODS: This program was developed according to Tyler's model for curriculum development. To evaluate the effects of this program, we measured clinical outcome change (weight, waist circumference, systolic blood pressure, diastolic blood pressure) and behavior change stages (checking blood pressure, blood sugar levels, doing physical activity, consistent maintenance of food intake, eating low amounts of salt, abstention from tobacco and alcohol) before and 4 weeks after participation in the education program. The group of subjects consisted of High-risk group patients who attended basic program(32 patients), and staged program(37 patients) during KHyDDI meetings from Oct. 2009 to May 2010. RESULTS: The staged educational program was developed three aspects(disease, nutrition and exercise)and three stages(basic, in-depth and individual education). In the staged education program, the evaluations were made by measuring clinical outcome and stage of behavior before and after education. Significant differences were found in waist circumference, systolic blood pressure, diastolic blood pressure, consistent maintenance of food intake(p<0.05), and eating low salt(p<0.001) and their self efficacy. CONCLUSION: In the practice-oriented staged education program, significant differences were found in the clinical outcomes and stage of behavior before and after education. Possible limitations of the study include the small number of participating subjects and the short follow-up management period, but the results indicate that continued application of this program could contribute to the prevention of cardiocerebrovascular diseases for the elderly patients with long periods of chronic diseases.
Aged ; Blood Glucose ; Blood Pressure ; Chronic Disease ; Curriculum ; Eating ; Follow-Up Studies ; Humans ; Hypertension ; Motor Activity ; Tobacco ; Waist Circumference

The familial environment may also play an important role in the epidemiology of HCV infection through vertical and horizontal transmission by infected household members. However, it is still controversial whether familial clustering of HCV occurs. We experienced a case of familial clustering of hepatitis C virus. A 10-year old girl presented with nausea, vomiting and anorexia for a month was diagnosed as hepatitis C. Her mother, grandmother, a maternal aunt and her daughter had contracted with HCV. Her laboratory findings showed AST/ALT 63/122 IU/L, positive anti-HCV Ab and HCV RNA (3.54 x 10(5) copies/mL). Pathologic findings of the liver biopsy revealed chronic hepatitis with minimal lobular activity, mild porto-periportal activity and mild portal fibrosis. After treatment with interferon-alpha 2b for 6 months, the clinical symptoms and laboratory findings were normalized.
Anorexia ; Biopsy ; Child ; Cluster Analysis* ; Epidemiology ; Family Characteristics ; Female ; Fibrosis ; Hepacivirus* ; Hepatitis C* ; Hepatitis* ; Hepatitis, Chronic ; Humans ; Interferon-alpha ; Liver ; Mothers ; Nausea ; Nuclear Family ; RNA ; Vomiting

Background: The purpose of this study is to examine the combined effects of organizational climate (OC) with emotional labor (EL) on turnover intention in Korean firefighters. Methods: The data were obtained from the study Firefighters Research: Enhancement of Safety and Health. A total of 4,860 firefighters whose main duty was providing “emergency medical aid” were included. To examine the effects of OC on the relationships between five subscales of EL and turnover intention, four groups were created using various combinations of OC (“good” vs. “bad”) and EL (“normal” vs. “risk”): (1) “good” and “normal” (Group I), (2) “bad” and “normal” (Group II), (3) “good” and “risk” (Group III), and (4) “bad” and “risk” (Group IV). Multivariate logistic regression analyses were performed to estimate the risk of turnover intention for the combinations of OC and EL. Results: The results showed turnover intention was significantly higher in the group with “bad” OC (17.7%) than in that with “good” OC (7.6%). Combined effects of OC and EL on turnover intention were found in all five subscales with the exception of Group I for emotional demands and regulation. Groups II, III, and IV were more likely to experience risks of turnover intention than Group I (p for trend <0.001). Conclusions A positive and cooperative OC plays a role in decreasing the risk of turnover intention and in attenuating the negative effects of EL on turnover intention in firefighters.