PURPOSE: To investigate which spectral domain optical coherence tomography (SD-OCT) findings predict visual outcome after anti-vascular endothelial growth factor (VEGF) treatment in neovascular age-related macular degeneration (NV-AMD). METHODS: We reviewed the medical records of patients with treatment-naive NV-AMD who underwent three or more consecutive anti-VEGF injections. The patients were divided into three groups according to their changes of visual acuity (VA); improved (group I), static (group S), or worsened (group W). We assessed the incidences and values of all available SD-OCT findings of these groups, compared these findings between the three groups and compared the initial values with the post-treatment values. RESULTS: Better initial VA and longer external limiting membrane (ELM) length were associated with less change in VA after anti-VEGF treatment. The initial VA was mildly correlated with initial photoreceptor inner and outer segment junction (IS/OS) length and initial ELM length. The final VA was also mildly correlated with the final IS/OS length and the final ELM length. VA was significantly changed after anti-VEGF treatment in groups W and I. With regard to incidence, disruption of the IS/OS (IS/OS-D), disruption of the ELM (ELM-D) and ELM length differed significantly between the three groups, particularly ELM-D. The incidences of IS/OS-D and ELM-D in group I were significantly lower than those in groups S and W, and those in group S were also lower than those in group W. The ELM length in group I was significantly longer than it was in groups S and W, and the ELM length in group S was longer than that for group W. However, these three findings did not change after the anti-VEGF treatment. CONCLUSIONS: Initial IS/OS-D, ELM length and particularly ELM-D can be useful predictors of the visual outcome after anti-VEGF treatment in NV-AMD patients.
Aged ; Aged, 80 and over ; Angiogenesis Inhibitors/*therapeutic use ; Choroidal Neovascularization/*drug therapy/physiopathology ; Female ; Humans ; Intravitreal Injections ; Male ; Middle Aged ; Ranibizumab/*therapeutic use ; Retinal Photoreceptor Cell Inner Segment/pathology ; Retinal Photoreceptor Cell Outer Segment/pathology ; Tomography, Optical Coherence ; Vascular Endothelial Growth Factor A/antagonists & inhibitors ; Visual Acuity/*physiology ; Wet Macular Degeneration/*drug therapy/physiopathology

Progressive zosteriform macular pigmented lesion(PZMPL) is a chronic pigmentary dermatosis similar to progressive cribriform and zosteriform hyperpigmentation(PCZH). This dermatosis described by Simoes in 1980 is characterized by a uniformly tanned macular pigmented lesion in a zosteriform distribution preceded by multiple pruritic macular pigmentation in a part of the dermatome for a period. PZMPL is not a fully understood disease entity but it is thought to be a variant of PCZH. It is differentiated from PCZH by accompanying pruritus as a prodromal symptom, a characteristic clinical course, and histological findings such as pigmentary incontinence. We report herein a case of PZMPL in a 17 year-old girl with the pigmentary skin lesion extending from the left forearm to the left chest along the Blaschkos line. The histological findings revealed increased melanin pigments in the basal layer and focal pigmentary incontinence in the upper dermis. To our knowledge, this case is the first report of PZMPL in korea thought to be the same case reported by Simoes.
Adolescent ; Dermis ; Female ; Forearm ; Humans ; Korea ; Melanins ; Pigmentation ; Prodromal Symptoms ; Pruritus ; Skin ; Skin Diseases ; Thorax ; Triacetoneamine-N-Oxyl

No abstract available.
Asian Continental Ancestry Group* ; Humans ; Humans* ; Sarcoma, Kaposi*

No abstract available.
Child* ; Humans ; Tuberculosis, Meningeal*

Torsades de pointes is characterized by paroxysms of ventricular tachycardia at rates typically greater than 200 beats/min in which QRS morphology shows alternating polarity in an undulating pattern so that the complexes appear to be twisting about the beseline;this arrhythmia is virtually always associated with prolongation of the QT interval. Its importance lies not in its unusual structure but in the potentially fatal outcome if conventional treatment is administred. Torsades de pointes was diagnosed in 4 patients;the first with hypokalemia, the second with congenital QT prolongation syndrome, the third with amiodarone, the fourth with organophosphorous and hypokalemia. Treatment of these patients consisted of potassium supply, isoproterenol, lidocaine, phenobarbital, tenormin, phenytoin, cardioversion, atropine. Three patients improved successfully, but one patient died, as a direct result of the ensuing ventricular fibrillation and cardiac arrest on one hour after admission.
Amiodarone ; Arrhythmias, Cardiac ; Atenolol ; Atropine ; Electric Countershock ; Fatal Outcome ; Heart Arrest ; Humans ; Hypokalemia ; Isoproterenol ; Lidocaine ; Phenobarbital ; Phenytoin ; Potassium ; Tachycardia, Ventricular ; Torsades de Pointes* ; Ventricular Fibrillation

Amniotic fluid embolism (AFE) is a rare peripartum complication with a mortality rate of 61 to 86%. The main clinical manifestations include shock, acute pulmonary edema, neurologic signs, and coagulopathies. Most diagnosis of AFE is made on the postmortem examination of the maternal pulmonary vasculature, but antemortem confirmation of amniotic fluid material by aspiration of pulmonary blood is rare. We report the first case in Korea who survived from amniotic fluid embolism confirmed by the identification of amniotic fluid debris in pulmonary artery blood. Serial echocardiographic changes of left ventricle systolic dysfunction are also described with a brief review of literatures.
Amniotic Fluid* ; Autopsy ; Diagnosis ; Echocardiography ; Embolism, Amniotic Fluid* ; Female ; Heart Ventricles* ; Korea ; Mortality ; Neurologic Manifestations ; Peripartum Period ; Pregnancy ; Pulmonary Artery ; Pulmonary Edema ; Shock

BACKGROUND: Inflammatory mechanisms play an important role in acute brain ischemia, and they contribute to the functional outcome. The neutrophil-to-lymphocyte ratio (NLR) has recently been described as a predictor of clinical outcomes in patients with acute coronary syndrome. This study assessed the clinical significance of NLR as a new predictor of the outcome in patients with acute ischemic stroke. METHODS: The study included 371 patients diagnosed as acute ischemic stroke within 48 hours after the onset. All subjects were divided into three groups according to tertiles of the NLR in the initial blood test. Functional outcomes were divided into two groups at 3 months and 1 year after stroke onset: favorable (mRS 0~2) or unfavorable (mRS 3~6). RESULTS: The proportion of patients with mRS 0~2 (favorable outcome) decreased as the NLR increased from the first tertile to the third tertile at discharge (74%, 62.9 and 49.2, p<0.001) and at 3 months (74%, 66.9 and 42.7, p<0.001) and 1 year (67.5%, 64.5 and 41.1, p<0.001) after stroke. NLR was higher in patients with an unfavorable outcome than in those with a favorable outcome (3.88 vs. 2.27 at 3 months, p<0.01; 3.67 vs. 2.31 at 1 year, p<0.001). Multivariate analysis revealed that the significant predictors of an unfavorable outcome at 3 months were NLR in the highest tertile (OR 2.28, 95% CI 1.13~4.60), age (OR 1.04, 95% CI 1.01~1.07), and NIHSS score (OR 1.27, 95% CI 1.18~1.36) at admission. CONCLUSIONS: NLR at admission can be used as a predictor of functional outcome at 3 months after ischemic stroke.
Acute Coronary Syndrome ; Brain Ischemia ; Hematologic Tests ; Humans ; Lymphocytes ; Multivariate Analysis ; Neutrophils ; Prognosis ; Stroke

PURPOSE: This pilot study aimed to evaluate the efficacy and safety of subthreshold micropulse yellow (577-nm) laser photocoagulation (SMYLP) in the treatment of diabetic macular edema (DME). METHODS: We reviewed 14 eyes of 12 patients with DME who underwent SMYLP with a 15% duty cycle at an energy level immediately below that of the test burn. The laser exposure time was 20 ms and the spot diameter was 100 microm. Laser pulses were administered in a confluent, repetitive manner with a 3 x 3 pattern mode. RESULTS: The mean follow-up time was 7.9 ± 1.6 months. The baseline-corrected visual acuity was 0.51 ± 0.42 logarithm of the minimum angle of resolution (logMAR), which was improved to 0.40 ± 0.35 logMAR (p = 0.025) at the final follow-up. The central macular thickness at baseline was 385.0 ± 111.0 microm; this value changed to 327.0 ± 87.7 microm (p = 0.055) at the final follow-up. CONCLUSIONS: SMYLP showed short-term efficacy in the treatment of DME and did not result in retinal damage. However, prospective, comparative studies are needed to better evaluate the efficacy and safety of this treatment.
Aged ; Diabetic Retinopathy/diagnosis/physiopathology/*surgery ; Female ; Fluorescein Angiography ; Follow-Up Studies ; Humans ; *Laser Coagulation ; Lasers, Semiconductor/*therapeutic use ; Macular Edema/diagnosis/physiopathology/*surgery ; Male ; Middle Aged ; Pilot Projects ; Tomography, Optical Coherence ; Treatment Outcome ; Visual Acuity/physiology

We identified the early and late prognostic factors of acute myocardial infarction, and evaluated the clinical differences and the prognosis between Q-wave myocardial infarction and non-Q wave myocardial infarction. Total 146 patients who were managed from Jan 1987 to Aug. 1989 at hallym University hospital were evaluated. According to the presence or absence of Q wave on electrocardiogram, the patients were divided into two groups : a Q wave myocardial infarction group(QMI) and a non-Q wave myocardial infarction group (NQMI). Among 146 patients 109 patients(74.7%) had QMI and 37 patients(25.3%) had NQNI. The mean age, male to female ratio and serum cholesterol level were similar in both groups. But peak level of CPK was significantly higher in the QMI group than that in the NQMI group(P<0.01). Left ventricular end-systolic dimension and ratio of left ventricular dimension to wall thickness in the QMI group were significantly higher than that in the NQMI group(P<0.01). There were no significant differences between two groups in the incidences of mortality, postinfarction angina and re-infarction. During the in-hospital period female gender, old age(more than 60 years), Killip class at admission, early reinfarction and a history of hypertension were significant prognostic factors. main causes of death during the in-hospital period were ventricular tachyarrthymia, heart failure and cardiogenic shock. The incidences of mortality, heart failure and post-infarction angina during a mean follow-up period of 14 months (6~30months) were same in the two groups. The late prognostic factors were old age(more than 60 years), Killip class at admission, heart failure occured during follow-up period(P<0.001) and a history of diabetes mellitus(P<0.05). The patients with late postinfarction angina had more dilated left ventricular end-systolic demension(P<0.05) and lower fractional shortening(P<0.01) than those of patients without late postinfraction angina. There were no significant difference in long term survival rate between QMI group and NQMI group. Further prospective study should be performed to clarify the short and long term prognosis in patients with acute myocardial infarction treated by reperfusion.
Cause of Death ; Cholesterol ; Electrocardiography ; Female ; Follow-Up Studies ; Heart Failure ; Humans ; Hypertension ; Incidence ; Male ; Mortality ; Myocardial Infarction* ; Prognosis ; Reperfusion ; Shock, Cardiogenic ; Survival Rate

BACKGROUND: An autopersion balloon catheter(ABC) was developed to allow passive myocardial perfusion during balloon inflation, through a central and multiple side hole in the shaft proximal and distal to the balloon. The ABC affords greater safety in performing PTCA of high risk stenosis involving the near ostium of the right coronary, the proximal left anterior descending(LAD) just proximal to the left circumflex artery and left main equivalent coronary arteries. METHODS AND RESULTS: In case 1, a seventy five percent right coronary ostial stenosis was reduced to less than 10 percent residual narrowing after PTCA with the ABC. In case 2, a seventy five percent proximal LAD(just proximal to left cirumflex artery) stenosis was reduced to less than 20 percent residual narrowing after PTCA with the ABC. In case 3, coronary angiogram demonstrated a 40 percent stenosis in the distal left main coronary artery as well as 80 percent stenosis in the proximal LAD.PTCA with the ABC was performed without significant hemodynamic compromise, achieving a less than 20 percent and 40 percent residual stenosis of the distal left main and proximal LAD respectively. CONCLUSIONS: 3 patients who would have required CABG had PTCA using the ABC.This ABC significatly reduces ischemic symptoms and signs during PTCA, allowing prolonged of balloon inflation.
Arteries ; Catheters* ; Constriction, Pathologic ; Coronary Vessels ; Hemodynamics ; Humans ; Inflation, Economic ; Myocardial Ischemia* ; Perfusion