From March 1987 to July 1989, six patients (five dadults and one child) with lung abscess (size, 5-13cm in diameter) were treated with percutaneous aspiration and drainage. In each case, the puncture was made where the wall of the abscess was in contact with the pleural surface. An 8 to 10 Fr catheter was inserted for drainage. Five of 6 had a dramatic clinical response within 24 hours of the drainage. Percutaneous drainage was successful with complete abscess resolution in four and partial resolution in one patient. No response was seen in the rest one. The duration of drainage ranged from 7 to 18 days (average, 15.5days) in successful cases. One case of the failure in drainage was due to persistent aspiration of the neurologically impaired patient. In one patient, the abscess resolved after drainage but recurred after inadvertent removal of the catheter 7 days after insertion. In two patients, concurrent pleural empyema was resolved completely by the drainage. Computed tomography provided anatomic details necessary for choosing the puncture site and avoiding a puncture of the lung parenchyma. Percutaneous catheter drainage is a safe and effective method for treating patients with lung abscess.
Abscess ; Catheters* ; Drainage* ; Empyema, Pleural ; Humans ; Lung Abscess* ; Lung* ; Methods ; Punctures

PURPOSE: Mycobacterium tuberculosis usually affects the lungs, although it may involve various segments of the eye and cause severe visual loss if not treated properly. We report the case of Mycobacterium tuberculosis keratitis treated successfully with antituberculous medication and amniotic membrane transplantation. METHODS: A 48-year-old male patient diagnosed as cervical tuberculous lymphadenitis about 20 years ago was referred from other hospital. He complained about painless corneal opacity on right eye. And other systemic evaluation other than cervical lymphadenitis was not remarkable. On biomicrosopy, peripheral multiple corneal opacity and neovascularization were observed. Fortified tobramycin eyedrops and oral antituberculous medication were used preoperatively. Under local anesthesia, the lesion was removed, and lamellar keratoplasty with lyophilized cornea and amniotic membrane transplantation was performed. Amikacin eyedrops was used postoperatively. RESULTS: From postoperative day 15, corneal opacity was decreased gradually. CONCLUSIONS: Mycobacterium tuberculosis should be considered as one of the causes of keratitis manifesting painless corneal opacity concomitant with cervical tuberculous lymphadenitis. Proper examination and management are necessary.
Amikacin ; Amnion ; Anesthesia, Local ; Cornea ; Corneal Opacity ; Corneal Transplantation ; Humans ; Keratitis* ; Lung ; Lymphadenitis ; Male ; Middle Aged ; Mycobacterium tuberculosis* ; Mycobacterium* ; Ophthalmic Solutions ; Tobramycin ; Tuberculosis, Lymph Node

No abstract available.
Child* ; Drug Therapy ; Humans ; Radiotherapy

PURPOSE: To evaluate the clinical effect of amniotic membrane (AM) graft and drainage valve implantation for the treatment of bullous keratopathy combined with intractable glaucoma. METHODS: Total 15 patients (15 eyes) were analyzed who underwent the operation for bullous keratopathy combined with intractable glaucoma, from Feb. 2002 to Aug. 2003. Under retrobulbar anesthesia, Ahmed valve was implanted under the supratemporal conjunctiva and exposed valve was covered with AM. And then, AM graft was performed after lamellar keratectomy for treatment of keratopathy. Serial check of IOP, corneal status and complications were performed after operation and during follow up. RESULTS: Mean IOP at last follow up was 11 mmHg. Corneal epithelium was stabilized within 10days. No serious complication was found and the drainage tube was well positioned. Especially, there is no pain in all cases. CONCLUSIONS: AM graft and valve implantation was clinically effective method for treatment of bullous keratopathy, combined with intractable glaucoma.
Amnion* ; Anesthesia ; Conjunctiva ; Drainage ; Epithelium, Corneal ; Follow-Up Studies ; Glaucoma* ; Humans ; Transplants*

BACKGROUND: Cytokine-mediated ex vivo expansion has been proposed as a means of increasing the number of cord blood (CB) hematopoietic stem cells for transplantation. As well as stem cell number, stromal cells are necessary for functional maturation of hematopoiesis. The purpose of this study was to analyze the development of stromal cells during ex vivo expansion of CB CD34+ cells. METHODS: CD34+ cells were purified from CB by magnetic bead selection. The levels of of interleukin-3, interleukin-1 beta, interleukin-6, granulocyte macrophage-colony stimulating factor and tumor necrosis factor-alpha were measured in culture supernatants on 0, 1, 2, and 3 weeks, using ELISA techniques. CB CD34+ cells were expanded in Iscoves modified Dulbeccos medium in the presence of several cytokines. The expression of E-selectin, vascular cell adhesion molecule- 1, intercellular adhesion molecule- 1, platelet/endothelial cell adhesion molecule-1, von Willebrand factor, vimentin, and CD14 in newly developed stromal cells was examined by immunocytochemical method. Relevant extracellular matrix (ECM) proteins and proper cytokines were also assayed for the most suitable condition for expansion of stromal cells. RESULTS: Several cytokines were found to have been produced by CB CD34+ cells as well as bone marrow-derived CD34+ cells. During ex vivo expansion of CB CD34+ cells, stromal cells appeared in the culture by day 4 and expanded over the following 7- 10 days before being confluent by day 2 1. These cells expressed surface markers characteristic of cells of endothelial lineage. Furthermore, these stroaml cells also expanded effectively when treated with thrombopoietin+flt-3 ligand+stem cell factor+leukemia inhibitory factor or 0. 1% poly-L-lysine-coated wells. CONCLUSION: Stromal cells were developed during ex vivo expansion of CB CD34+ cells and that this development could be enhanced further by treating the stromal cells with cytokines or ECM.
Cell Adhesion ; Cytokines ; E-Selectin ; Enzyme-Linked Immunosorbent Assay ; Extracellular Matrix ; Fetal Blood* ; Granulocytes ; Hematopoiesis ; Hematopoietic Stem Cells ; Interleukin-1beta ; Interleukin-3 ; Interleukin-6 ; Stem Cells ; Stromal Cells* ; Tumor Necrosis Factor-alpha ; Vimentin ; von Willebrand Factor

PURPOSE: We report a case of orbital pseudotumor developed in an anophthalmic socket, presenting no typical symptoms or signs. METHODS: A 67-year-old woman was referred for treatment of necrotizing scleritis of her left eye and painful orbital pseudotumor of her right eye. The right eye had been removed 10 years previously. There was an irregular mass in superomedial portion of anterior orbit. Orbital MRI showed poorly defined T1 iso and low T2 signal intensity of a lesion in the medial anterior portion of the right orbit. Because systemic steroid administration was limited, 2 mg of betamethasone was injected locally, after which the size of the lesion was decreased and the orbital pain improved. CONCLUSIONS: The diagnosis of an orbital pseudotumor developed in an anophthalmic socket may be difficult because of the lack of typical eyeball-related signs or symptoms such as proptosis, red eye, or decreased vision. But, the easy access to the lesion can provide early and effective treatment through direct injection of glucocorticoid.
Aged ; Anophthalmos* ; Betamethasone ; Diagnosis ; Exophthalmos ; Female ; Humans ; Inflammation* ; Magnetic Resonance Imaging ; Orbit* ; Orbital Pseudotumor ; Scleritis

The purpose of this study is to characterize and compare the ultrastructural changes occurring during the in vivo cultivation of corneal epithelium on amniotic membrane (AM) at several different time points. Corneal burn patients (n=7) with a corneal epithelial defect and severe limbal damage were selected. Initially, AM transplantation with limbal autograft was performed at the acute stage of corneal burn to reconstruct the damaged ocular surface. One to six (mean interval; 3.3+/-1.2) months later, the central part of AM containing an in vivo expanded corneal epithelium was excised and retransplanted in adjacent lesions. The excised epithelium with AM was examined by electron microscopy and immunohistochemical study. By electron microscopy, one and two months after expansion, cultivated epithelium on AM showed an undifferentiated epithelium and an incomplete basement membrane (BM). But, after three months, the cultivated epithelium began to differentiate into a multilayered epithelium with a continuous BM with increased hemidesmosomes. These findings were further confirmed by immunohistochemical study, that cytokeratin K3 was expressed in the cultivated corneal epithelium and newly formed BM was partially positive of collagen IV at three months. At least 3 months may be needed for the proliferation and differentiation of in vivo cultivated corneal epithelium on AM.
Stem Cells/cytology ; Stem Cell Transplantation/*methods ; Middle Aged ; Microscopy, Electron ; Male ; Keratin-3/biosynthesis ; Immunohistochemistry ; Humans ; Epithelium, Corneal/cytology/*metabolism/*pathology/*transplantation ; Corneal Diseases/*therapy ; Burns/*surgery/therapy ; Biological Dressings ; Amnion/*ultrastructure ; Adult

PURPOSE: Ultraviolet rays, dust, and the human papilloma virus are well known as extrinsic risk factors in pterygium pathogenesis, but the intrinsic factors and nasal predominance related to the development of pterygium have not been fully ulucidated. Herein, we sought to determine whether the relative ischemic state of nasal bulbar conjunctiva affects the development of nasal predominance in pterygium pathogenesis. METHODS: Anterior segment fluorescein angiography was performed and the anterior bulbar conjunctival temperature was obtained to identify the presence of nasal ischemia. Tear samples were collected from both a normal and a patient group. The difference in SDF-1 (stromal cell-derived factor-1) was determined through ELISA and Western blot anyalyses. The excised pterygium tissues were immunohistochemically stained by antibodies for HIF-1 (hypoxia-inducible factor-1), SDF-1, and CXCR4. RESULTS: Results of the anterior segment fluorescein angiography showed that, the vascularity of the nasal limbus was lowest among each groups and the nasal filling time was significantly delayed in the patient group. The temperature of the nasal bulbar conjunctiva was lower than that of the temporal bulbar conjunctiva. The concentration of SDF-1 in tears was significantly higher in the patient group. In the immunohistochemical stain, HIF-1, SDF-1, and CXCR4 were revealed at epithelial basal cells or vascular endothelia in the stroma and the stained areas corresponded to each other. CONCLUSIONS: From the above results, we assumed that low nasal vascularity and temperature resulted in relative ischemic state and this hypoxic injury may be a major risk factor in pterygium development through the mobilization of endothelial progenitor cells by HIF-1 induced SDF-1 overexpression.
Antibodies ; Blotting, Western ; Conjunctiva ; Dust ; Enzyme-Linked Immunosorbent Assay ; Fluorescein Angiography ; Humans ; Intrinsic Factor ; Ischemia ; Papilloma ; Pterygium* ; Risk Factors ; Stem Cells ; Ultraviolet Rays

PURPOSE: We performed this study to evaluate the influence on tear film of infrared instrument by observing the morphologic change of the tear lipid layer and tear break-up time by Tearscope(R). METHODS: The subjects were 52 eyes from 26 people. After infrared hyperthermic therapy, we analyzed the change of the tear lipid layer by Tearscope(R) at 10 minutes, 6 hours, and 12 hours. We also observed the subjective symptoms of change related to dry eye syndrome and tear break-up time. RESULTS: Of the 26 normal cases, 20 were men and 6 were women. The mean age was 26.4 +/- 1.9 years. The subjective symptoms improved and the tear lipid layer showed a decrease of color fringe yellow-brown and color fringe multiple colors type, and an increase of waves and closed meshwork type 10 minutes and 6 hours following infrared treatment. Tear break-up time was also prolonged from preoperative value of 10.0 +/- 2.4 seconds to 11.0 +/- 2.7 and 11.1 +/- 2.9 seconds at 10 minutes and 6 hours, respectively, after infrared treatment, but this effect did not persist after 12 hours. Schirmer test value did not show significant change. No complication related to infrared treatment was noted. CONCLUSIONS: Infrared treatment may be considered a possible method of treating dry eye syndrome by increasing the stability of the tear lipid layer.
Dry Eye Syndromes ; Female ; Humans ; Male ; Tears*

No abstract available.
Anemia, Dyserythropoietic, Congenital*