PURPOSE: To investigate the relationships between tear osmolarity and various parameters for ocular and systemic disease in primary Sjögren's syndrome. METHODS: The medical records of 53 patients with primary Sjögren's syndrome were reviewed. Tear osmolarity using a TearLab® (TearLab™ Corp., San Diego, CA, USA) osmometer as well as other dry eye parameters such as tear break-up time, ocular staining score (Sjögren's International Collaboration Clinical Alliance [SICCA] ocular staining score, SICCA score), Schirmer-I score, symptoms with Ocular Surface Disease Index (OSDI), and Visual Analog Scale (VAS) were obtained. Systemic laboratory data and medication history were also collected. The correlations between the parameters were analyzed using the Spearman's rank correlation test. RESULTS: 53 patients with a mean age of 54.1 ± 13.2 years and female predominance (96.23%) were enrolled. The majority of patients (28.3%) were receiving systemic therapy for severe Sjögren's syndrome. The tear osmolarity in Sjögren's syndrome patients was 307 ± 13.6 (mOsm/L). Higher tear osmolarity was associated with lower tear film break-up time (BUT) scores and with higher SICCA scores. Tear osmolarity and the Schirmer test results were not significantly related. Higher tear osmolarity was paradoxically associated with lower VAS scores and lower OSDI scores. Neither current medication nor the salivary gland focus score showed significant associations with tear osmolarity. Although tear osmolarity was not associated with the SSA-Ro or SSA-LA titer, serum immunoglobulin G (IgG) level and serum erythrocyte sedimentation rate (ESR) level showed positive correlations with tear osmolarity. CONCLUSIONS: Tear osmolarity is positively correlated with the severity of dry eye and was associated with lower symptom severity. The significant associations of tear osmolarity with IgG and ESR suggest that high tear osmolarity may be correlated with autoantibody load and the systemic inflammatory state.
Blood Sedimentation ; Cooperative Behavior ; Dry Eye Syndromes ; Female ; Humans ; Immunoglobulin G ; Medical Records ; Osmolar Concentration* ; Salivary Glands ; Tears* ; Visual Analog Scale

OBJECTIVE: The purpose of this study was to estimate the effects of a jazz dance program on musculoskeletal pains of female telephone operators. METHOD: Ten female telephone operators with neck and upper extremity discomfort were studied. The jazz dance program was carried out three times a week for 12 weeks. The effect of the jazz dance program was assessed with visual analogue scale (VAS) and the pressure thresholds of muscles of right neck and shoulder (the upper trapezius, rhomboideus, infraspinatus, and levator scapulae) with pressure algometer before and after exercise in every week. RESULTS: There was significant increase of the pressure thresholds on four muscles of right neck and shoulder (p<0.05). There was significant decrease of the averages of VAS of neck and upper extremity (p<0.05). CONCLUSION: Jazz dance program is an effetive tool for the prevention and treatment of musculoskeletal pains in Visual Display Terminal (VDT) workers.
Computer Terminals ; Female ; Humans ; Muscles ; Musculoskeletal Pain* ; Neck ; Shoulder ; Superficial Back Muscles ; Telephone* ; Upper Extremity

PURPOSE: To evaluate the protective effect of applying an ophthalmic viscosurgical device (OVD) to the ocular surface during cataract surgery and its ability to prevent dry eye syndrome. METHODS: Twenty-four patients aged 50 to 75 years who underwent cataract surgery at Seoul National University Bundang Hospital and agreed to participate in the study were included and divided into two groups: a study group who underwent cataract surgery after application of an OVD to the ocular surface, and a control group who underwent cataract surgery without application of an OVD. DisCoVisc was used as the OVD in the study group, while other factors including surgical techniques and administration of anesthetic agents were performed in both groups in the same manner. Indicators of dry eye syndrome including ocular staining score, tear break-up time, and tear osmolality were analyzed. Ocular surface disease index and a visual analog scale were analyzed for dry eye symptoms, and the amount of balanced salt solution used during surface irrigation and operation time were also analyzed. RESULTS: Significant improvement in the tear break-up time, corneal ocular staining score, and ocular surface disease index score in the study group compared with the control group one week after operation (by the Mann-Whitney test). Use of OVD was associated with longer operating time. CONCLUSIONS: OVD applied to the ocular surface during cataract surgery had a protective effect on the ocular surface one week after surgery.
Anesthetics ; Cataract Extraction ; Cataract ; Dry Eye Syndromes ; Humans ; Osmolar Concentration ; Seoul ; Tears ; Visual Analog Scale

PURPOSE: This study aimed to evaluate the prognostic value of each component of the revised American Fertility Society (rAFS) classification system for the first recurrence of endometriosis after conservative laparoscopy. MATERIALS AND METHODS: As this was a retrospective cohort study, data were collected by reviewing medical records. A total of 379 women ages 18 to 49 years were included. Women who underwent conservative laparoscopy with histologic confirmation of endometriosis at Gangnam Severance Hospital between March 2003 and May 2010 were included. Individual components of the rAFS classification system as well as preoperative serum CA-125 levels were retrospectively analyzed to assess their prognostic values for recurrence of endometriosis. RESULTS: Of 379 patients, 80 (21.2%) were found to have recurrence of endometriosis. The median duration of follow-up was 19.0 months, and the mean age at the time of surgery was 31.8+/-6.7 years. In endometriosis of advanced stage, younger age at the time of surgery, bilateral ovarian cysts at the time of diagnosis, a rAFS ovarian adhesion score >24, and complete cul-de-sac obliteration were independent risk factors of poor outcomes, and a rAFS ovarian adhesion score >24 had the highest risk of recurrence [hazard ratio=2.948 (95% CI: 1.116-7.789), p=0.029]. CONCLUSION: Our results suggest that of the rAFS adnexal adhesion scores, the ovarian adhesion score rather than the tubal adhesion score was associated with a significantly increased risk of recurrent endometriosis. The preoperative serum CA-125 level may be also a significant prognostic factor for recurrence, as known. However, it seemed to only have borderline significance in affecting recurrence in the current study.
Adolescent ; Adult ; Cohort Studies ; Endometriosis/*classification/*surgery ; Female ; Fertility ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Laparoscopy/*methods ; Middle Aged ; Prognosis ; Recurrence ; Retrospective Studies ; Risk Factors ; *Tissue Adhesions ; Treatment Outcome ; United States

BACKGROUND: Hypotension often occurs after induction of general anesthesia. Although preload status has been considered as an important factor for the occurrence of this hypotension, there have been inconsistent results on this topic. The dynamic preload parameters have not been studied as a predictor of hypotension, and therefore we hypothesized that the passive leg raising (PLR) test, a dynamic preload parameter, could predict anesthesia-induced hypotension and conducted a prospective clinical study. METHODS: In 40 patients undergoing elective cardiac surgery, mean arterial pressure (MAP), stroke volume variation, stroke volume (SV) and cardiac index (CI) were measured using arterial line and FloTrac(TM)/Vigileo(TM) system before, during and after PLR test, respectively. Occurrence of anesthesia-induced hypotension was recorded. The ability of PLR test to predict hypotension was evaluated by receiver operating characteristic (ROC) curve analysis. RESULTS: The incidence of hypotension was 90%, which includes 12.5% of refractory hypotension. Changes in MAP and CI induced by PLR test predicted hypotension (area under ROC curves: 0.722 and 0.788, respectively). Changes in SV and CI induced by PLR test predicted refractory hypotension (area under ROC curves: 0.863 and 0.789, respectively). CONCLUSIONS: Our results suggest that PLR test can predict hypotension and refractory hypotension occurring after induction of anesthesia in patients undergoing cardiac surgery.
Anesthesia ; Anesthesia, General ; Arterial Pressure ; Blood Pressure ; Humans ; Hypotension ; Incidence ; Leg ; Prospective Studies ; ROC Curve ; Stroke Volume ; Thoracic Surgery ; Vascular Access Devices

BACKGROUND: The inflammatory response to cardiopulmonary bypass (CPB) surgery is believed to play an important role in the end organ dysfunction after open heart surgery. The effect of temperature on the post-bypass inflammatory response has been studied in normothermic and hypothermic patients. This study compared the influence on the systemic inflammatory response and postoperative morbidity in hypothermic cardiopulmonary bypass patients with those in patients in deep hypothermic circulatory arrest. METHODS: Fifty patients undergoing elective redo-valvular replacement or double valve replacement using a hypothermic cardiopulmonary bypass (26-28oC, H Group) and 9 patients undergoing an elective ascending aortic aneurysm replacement using deep hypothermic circulatory arrest (16oC, D Group) were prospectively investigated. The serum samples were collected to estimate the interleukin (IL)-6 and tumor necrosis factor (TNF)-alpha levels immediately after induction, 30 min after the initiation of the CPB, 30 min after weaning from the CPB, 2 hours after the CPB, 24 hours after the CPB. RESULTS: Patients preoperative and intraoperative characteristics (age, gender, aortic cross clamping time, cardiopulmonary bypass time) were not similar in the two groups. The serum level of IL-6 and TNF-alpha were also similar in the two groups. There were no statistical differences in the intubation time, ICU stay and oxygenation index (arterial PO2/inspired fraction of oxygen). There were also no statistical differences in the incidence of systemic inflammatory response syndrome and the APACHE II scores. CONCLUSIONS: Deep hypothermic circulatory arrest was not shown to produce a more profound inflammatory response or influence the postoperative morbidity than a hypothermic cardiopulmonary bypass.
Adult* ; Aortic Aneurysm ; APACHE ; Cardiopulmonary Bypass ; Circulatory Arrest, Deep Hypothermia Induced* ; Constriction ; Humans ; Incidence ; Interleukin-6 ; Interleukins ; Intubation ; Oxygen ; Prospective Studies ; Systemic Inflammatory Response Syndrome ; Thoracic Surgery* ; Tumor Necrosis Factor-alpha ; Weaning

Left ventricular outflow tract (LVOT) obstruction with systolic anterior motion (SAM) of mitral valve is not only limited to patients with hypertrophic cardiomyopathy. A diagnosis of LVOT obstruction with SAM is important because conventional inotropic support may potentially aggravate hemodynamic deterioration. We present a case of LVOT obstruction with SAM in a patient who underwent an emergent surgery for ascending aortic dissection with pericardial effusion. The patient showed refractory hypotension after standard pharmacologic interventions during induction of anesthesia. Transesophageal echocardiography (TEE) revealed LVOT obstruction with SAM and it was managed appropriately under the guidance of TEE. Intraoperative TEE can play an important role in diagnosis and management of LVOT obstruction with SAM caused by pericardial effusion.
Anesthesia ; Cardiomyopathy, Hypertrophic ; Echocardiography, Transesophageal ; Hemodynamics ; Humans ; Hypotension ; Mitral Valve ; Pericardial Effusion

An atrial septal aneurysm is well recognized abnormality of uncertain clinical relevance. An intraatrial aneurysm was demonstrated in the fossa ovalis of a 41-year-old woman who suffered an episode of cerebellar infarction with recurrent atrial fibrillation. The disorder is rarely treated surgically. Most patients with this condition are given life-long anticoagulation, a treatment that may have serious complications. We report a rare case of atrial septal aneurysm with recurrent atrial fibrillation and cerebellar infarction which receiving an appropriate diagnosis and curative treatment.
Adult ; Aneurysm* ; Atrial Fibrillation* ; Diagnosis ; Female ; Humans ; Infarction*

We performed a prospective cohort trial on 220 patients undergoing elective off-pump coronary artery bypass surgery and taking aspirin to evaluate the effect of aspirin resistance on myocardial injury. The patients were divided into aspirin responders and aspirin non-responders by the value of the aspirin reaction units obtained preoperatively using the VerifyNow(TM) Aspirin Assay. The serum levels of troponin I were measured before surgery and 1, 6, 24, 48 and 72 hr after surgery. In-hospital major adverse cardiac and cerebrovascular events, graft occlusion, the postoperative blood loss and reexploration for bleeding were recorded. Of the 220 patients, 181 aspirin responders (82.3%) and 39 aspirin non-responders (17.7%) were defined. There were no significant differences in troponin I levels (ng/mL) between aspirin responders and aspirin non-responders: preoperative (0.04 +/- 0.08 vs 0.03 +/- 0.06; P = 0.56), postoperative 1 hr (0.72 +/- 0.87 vs 0.86 +/- 1.10; P = 0.54), 6 hr (2.92 +/- 8.76 vs 1.50 +/- 2.40; P = 0.94), 24 hr (4.16 +/- 13.44 vs 1.25 +/- 1.95; P = 0.52), 48 hr (2.15 +/- 7.06 vs 0.65 +/- 0.95; P = 0.64) and 72 hr (1.20 +/- 4.63 vs 0.38 +/- 0.56; P = 0.47). Moreover, no significant differences were observed with regard to in-hospital outcomes. In conclusion, preoperative aspirin resistance does not increase myocardial injury in patients undergoing off-pump coronary artery bypass surgery. Postoperative dual antiplatelet therapy might have protected aspirin resistant patients.
Aged ; Aspirin/*administration & dosage ; Cohort Studies ; Coronary Artery Bypass, Off-Pump/*adverse effects ; Coronary Disease/*surgery ; Drug Resistance ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction/etiology ; Myocardial Reperfusion Injury/*prevention & control ; Platelet Aggregation Inhibitors/*administration & dosage ; Postoperative Hemorrhage/etiology ; Preoperative Care/methods ; Prospective Studies ; Stroke/etiology ; Troponin I/blood

BACKGROUND/AIMS: Prothrombin induced by Vitamin K Antagonist-II (PIVKA-II) and alpha-fetoprotein (AFP) subtype reacting with Lens Culinaris Agglutinin (AFP-L3) are known as specific tumor markers for HCC. Recently a more sensitive EIA method for PIVKA-II and an automatic analyzer with Liquid Phase Binding Assay method (LBA method) for AFP-L3 have been developed. The aim of this study was to evaluate the feasibility of PIVKA-II and AFP-L3 measured by newly developed methods as complementary tumor markers to AFP in the diagnosis of HCC. METHODS: The serum concentration of AFP, PIVKA-II, and a fraction of AFP-L3 were determined from 188 patients with HCC and 118 patients with various liver diseases including 46 with liver cirrhosis, 10 with chronic hepatitis, 50 with metastatic liver cancers, and 12 with benign tumors of the liver. AFP was measured by EIA, PIVKA-II by sensitive EIA, and AFP-L3 by the LBA method with LiBASys Auto-analyzer. The cutoff values for AFP, PIVKA-II, and AFP-L3 were 400 ng/mL, 40 mAU/mL, and 15%, respectively. RESULTS: The sensitivity and specificity of serum PIVKA-II were 69.2% and 76.5%, respectively. Sixty-two (51.2%) of 121 patients with HCC, in which AFP was less than 400 ng/mL were PIVKA-II positive. The sensitivity and specificity of serum AFP-L3 were 48.8% and 90.8%, respectively. When AFP-L3 was used in combination with PIVKA-II, 31 (46.3%) of the 67 patients with small less than 3 cm HCC were positive for at least one of these markers. CONCLUSION: PIVKA-II measured by sensitive EIA may be useful for the diagnosis of HCC with low AFP level. AFP-L3 and PIVKA-II may improve the detection rate of small HCCs less than 3 cm.
alpha-Fetoproteins ; Carcinoma, Hepatocellular* ; Diagnosis* ; Hepatitis, Chronic ; Humans ; Lens Plant ; Liver ; Liver Cirrhosis ; Liver Diseases ; Liver Neoplasms ; Prothrombin ; Sensitivity and Specificity ; Biomarkers, Tumor ; Vitamin K