PURPOSE: Kawasaki disease is notorious for coronary arterial complication which is usually developed as a febrile disease in early childhood. Increased polymorphonucleus(PMN) cell levels in acute phases may be associated with the pathophysiology of Kawasaki disease. We studied the relationship between coronary arterial dilatation and elastase activity which was excreted from PMN cell and roles as an important factor for vasculitis. METHODS: Ten patients diagnosed with Kawasaki disease in Yonsei University Medical Center were examined between November, 2001 and January, 2002. In addition, 15 patients with other febrile diseases were also examined. Echocardiography was done in patients with Kawasaki disease on the first day of admission and four weeks after the onset of the disease. At each time, venous samples were drawn and separated into plasma and leukocytes. In patients with other febrile disease, samples were drawn on admission. Elastase activities in plasma and neutrophil extracts were measured. RESULTS: The significant increased plasma elastase activity, 6.19+/-0.74 U/mL, found in Kawasaki disease patients compared with the other febrile disease patients, 4.86+/-1.17 U/mL(P<0.05). And there was no significance between the above two diseases in terms of the elastase activity in neutrophil extracts. The relationship between initial elastase activity and the coronary arterial complication which was shown in subacute phase wasn't significant. CONCLUSION: Plasma elastase activity was increased in Kawasaki disease significantly, but the initial plasma elastase activity in the acute phase could not reflect the range of coronary arterial complication.
Academic Medical Centers ; Dilatation* ; Echocardiography ; Humans* ; Leukocyte Elastase* ; Leukocytes ; Mucocutaneous Lymph Node Syndrome* ; Neutrophils* ; Pancreatic Elastase ; Plasma ; Vasculitis

PURPOSE: To present a case report of fungal keratitis related to prolonged overnight use of orthokeratology contact lenses. METHODS: A 13 year-old girl presented with a corneal ulcer in her left eye refractory to antibacterial medication. She had a history of wearing orthokeratology contact lenses overnight for seven months. RESULTS: The organism Aspergillus was isolated by corneal scraping, the contact lens itself, and from the storage case. The patient was treated with topical fluconazole and Natamycin pimaricin in addition to oral itraconazole, resulting in a resolution of the ocular lesion. CONCLUSIONS: The risk of fungal infection as a potential complication of the use of overnight orthkeratology contact lenses should be considered when using these lenses.
Adolescent ; Aspergillus ; Contact Lenses ; Corneal Ulcer ; Female ; Fluconazole ; Humans ; Itraconazole ; Keratitis* ; Natamycin

PURPOSE: To present a case of corneal toxicity caused by therapeutic duplication during treatment of acanthamoeba keratitis as a complication of contact lens use. CASE SUMMARY: A 12-year-old girl with a history of wearing orthokeratology contact lenses and a 14-year-old girl with a history of wearing cosmetic contact lenses presented with ocular pain, injection, and decreased visual acuity. They were diagnosed as having acanthamoeba keratitis based on slit lamp examination, confocal microscopy and culture. After the patients were treated with polyhexamethylene biguanide (PHMB) and chlorhexidine, corneal epithelial defect and erosion occurred. Use of chlorhexidine was stopped, and PHMB was used to treat patients and recovery of the corneal epithelium with improvement in symptoms of acanthamoeba keratitis was found. CONCLUSIONS: Using PHMB and chlorhexidine together in treating acanthamoeba keratitis increases the risk of corneal toxicity. Therefore, these drugs should be avoided in combination.
Acanthamoeba ; Acanthamoeba Keratitis* ; Adolescent ; Child ; Chlorhexidine ; Contact Lenses ; Epithelium, Corneal ; Female ; Humans ; Keratitis* ; Microscopy, Confocal ; Visual Acuity

PURPOSE: This study analyzed the relationship between intraocular pressure (IOP) and health parameters, including waist circumference, in healthy Koreans. METHODS: A total of 6169 healthy participants underwent automated multi-phasic tests including tonometry, automated perimetry, and fundus photography. Parameters of these patients including height, weight, degree of obesity, body fat percentage, waist circumference, body mass index, and body muscle rate, were recorded. The subjects were divided into six age groups by decades ranging from 20~29 years to over 70 years. Multiple regression analysis was used to examine the relationship between IOP and the parameters mentioned above. RESULTS: The mean age of the participants was 47.87 years, and 3015 (51.1%) of the participants were men. The mean IOP was 13.58+/-3.1 mmHg, and was significantly higher in men than in women (p<0.05). The prevalence of ocular hypertension was 2.0% in men and 2.2% in women. IOP was associated with gender, age, height, weight, degree of obesity, body fat percentage, waist circumference, and body mass index (p<0.05). The relation between IOP and age showed a significantly negative tendency (p<0.05). Height, weight, degree of obesity, body fat percentage, waist circumference, and body mass index had a significantly positive relation with IOP (p<0.05). There was no significant relation between IOP and body muscle percentage (p>0.05). CONCLUSIONS: Because increased IOP is associated with several health parameters that can be modified by diet and exercise such as weight, body fat percentage, body mass index, and waist circumference, it is recommended that these be reduced.
Adipose Tissue ; Body Mass Index ; Body Weight ; Diet ; Female ; Glaucoma ; Humans ; Intraocular Pressure ; Male ; Manometry ; Muscles ; Obesity ; Ocular Hypertension ; Photography ; Prevalence ; Visual Field Tests ; Waist Circumference

Erythropoietic protoporphyria(EPP) is an inherited inborn error of porphyrin metabolism caused by decreased activity of the enzyme ferrochelatase. EPP is characterized clinically by photosensitivity to visible light commencing in childhood, and biochemically by elevated red cell free protoporphyrin levels. We report herein a case of EPP which occurred in a 44-year-old man and his family. He had suffered from immediate photosensitivity since he was 4 years old. He was presented with burning, erythema, scars and waxy thickening of the sun-exposed skin. Red cell free protoporphyrin level was elevated and urinary porphyrins were normal. Histopathologically, homogeneous eosinophilic materials that stained with PAS were deposited in perivascular area of upper dermis. He was managed with light restriction and sunscreen.
Adult ; Burns ; Child, Preschool ; Cicatrix ; Dermis ; Eosinophils ; Erythema ; Ferrochelatase ; Humans ; Light ; Metabolism ; Porphyrins ; Protoporphyria, Erythropoietic* ; Skin

PURPOSE: To compare the efficacy of photodynamic therapy (PDT) using verteporfin combined with intravitreal bevacizumab and bevacizumab monotherapy in polypoidal choroidal vasculopathy (PCV). METHODS: Twenty-six eyes, diagnosed with PCV were reviewed retrospectively. They were divided into two groups: combined treatment (COMB) and bevacizumab monotherapy (BEV). Visual acuity, fluorescein angiography (FA) and indocyanine green angiography (ICG) results were reviewed to compare changes in the polypoidal vessels and the branching vascular networks. RESULTS: Among 26 eyes of 26 patients, there were 12 eyes in the COMB group and 14 eyes in the BEV group. Follow-up periods were about 42 weeks and 48 weeks for the respective groups. In the COMB group, visual acuity improved from log MAR 0.92 to 0.56, whereas visual acuity in the BEV group changed only minimally from log MAR 0.98 to 0.97. In the COMB group, the polypoidal vessel resolved in six eyes. In the BEV group, the polypoidal vessel resolved in one eye. In the COMB group, the vascular network resolved in one eye, improved in ten eyes, and did not change in one eye. In the BEV group, the vascular network did not change in any of the 14 eyes. CONCLUSIONS: Combined treatment with PDT and intravitreal bevacizumab resulted in a more prolonged effect, induced the resolution of polypoidal vessels more effectively than did bevacizumab monotherapy, and is expected to reduce recurrence and retreatment.
Angiography ; Animals ; Antibodies, Monoclonal, Humanized ; Choroid ; Comb and Wattles ; Eye ; Fluorescein Angiography ; Follow-Up Studies ; Glycosaminoglycans ; Humans ; Indocyanine Green ; Photochemotherapy ; Porphyrins ; Recurrence ; Retreatment ; Retrospective Studies ; Triazenes ; Visual Acuity ; Bevacizumab

PURPOSE: To evaluate the relationship between intraocular pressure (IOP) and age, blood pressure and obesity index inocular hypertensive patients. METHODS: A total of 2684 ocular hypertensive patients underwent automated multi-phasic testing, including fundus photography, blood pressure and assessment of obesity. The subjects were divided into six age groups by decades ranging from 20~29 years to over 70 years of age. The relationships between factors were examined using multiple regression analysis. RESULTS: The mean participant age was 48.0+/-11.0 years, and 1,777 (66.3%) participants were male and 907 (33.7%) were female. The mean intraocular pressure (IOP) was 22.04+/-2.2 mmHg and was significantly higher in males than in females (p=0.023). The IOP was associated with mean blood pressure, gender and obesity index. After adjustment for mean blood pressure and obesity index, the relationship between IOP and age showed a significantly negative tendency (p<0.001). The relationship between IOP and obesity index adjusted for age and mean blood pressure had a significantly positive tendency (p<0.001), regardless of gender. The relationship between IOP and mean blood pressure adjusted for age and obesity index showed a significantly positive tendency (p=0.00014). CONCLUSIONS: IOP was associated with the mean blood pressure and obesity index. Regardless of gender, IOP decreased with age but increased with hypertension. It is necessary to check IOP regularly, especially in ocular hypertensive patients with systemic hypertension.
Blood Pressure ; Female ; Humans ; Hypertension ; Intraocular Pressure ; Male ; Obesity ; Ocular Hypertension ; Photography

PURPOSE: To report a case of retinal contusion with the complication of exudative retinal detachment causing delayed visual disturbance. CASE SUMMARY: A 28-year-old man presented with visual disturbance of the left eye. Three days prior, a soccer ball hit him on his left eye, and he visited a local clinic. His visual acuity was 0.9. Fundus examination revealed a lesion of the macula, which was diagnosedas retinal contusion. Two days later, visual acuity decreased to 0.3 and he was referred to us. At presentation, his visual acuity was 0.125. A gray to white lesion around the superotemporal vascular arcade, and exudative retinal detachment involving the fovea associated with the lesion were found. Subretinal fluid collection was confirmed with optical coherence tomography (OCT). Fluorescein angiography showed diffuse leakage over the contusion, and fluorescein was pooled in the detached area. At 15 days, subretinal fluid was resolved on OCT and vision was improved to 0.8. CONCLUSIONS: We suggest that leakage from the contusion caused delayed exudative retinal detachment and decrease of visual acuity. Visual acuity improved with resolution of the subretinal fluid. Though the visual acuity was good in spite of a severe retinal contusion on the perifoveal area, the possibility of exudative retinal detachment and delayed visual disturbance shoud be considered.
Adult ; Contusions ; Eye ; Fluorescein ; Fluorescein Angiography ; Humans ; Retinal Detachment ; Retinaldehyde ; Soccer ; Subretinal Fluid ; Tomography, Optical Coherence ; Vision, Ocular ; Visual Acuity

PURPOSE: The pathophysiology of hypogammaglobulinemia in nephrotic syndrome (NS) remains unknown. We evaluated the differences in the distribution of anti-bacterial antibodies and anti-viral antibodies, and those of immune antibodies and natural antibodies in steroid-sensitive NS. MATERIALS AND METHODS: We examined the antibody status of 18 children who had routine vaccinations. The levels of immnunoglobulin G (IgG), the IgG subclasses, and the antibodies induced by vaccinations such as diphtheria-pertussis-tetanus and measles-mumpsrubella were analyzed in children with steroid-sensitive NS. RESULTS: There was a positive correlation between the albumin and IgG values (r = 0.6, p < 0.01), and the four IgG subclasses were all evenly depressed in the nephrotic children during the acute stage of the disease. The antibodies induced by bacterial antigens were depressed and the seropositivity of anti-viral antibodies tended to be lower than those of age-matched control children during the acute stage. The depressed immune antibody status recovered rapidly in the remission stage of NS, despite corticosteroid treatment. CONCLUSIONS: IgG levels correlated positively with albumin levels, and all antibodies, including immune and natural antibodies, were depressed in the acute stage of NS. Our results suggest that hypogammaglobulinaemia in NS may be associated with intravascular homeostasis of oncotic pressure.
Adolescent ; Antibodies, Bacterial/immunology ; Antibodies, Viral/immunology ; Case-Control Studies ; Child ; Child, Preschool ; Female ; Humans ; Immunoglobulin G/immunology ; Male ; Nephrotic Syndrome/*drug therapy/*immunology ; Steroids/*therapeutic use

According to the size of nevus, congenital nevomelanocytic nevi(CMN) could be divided as small, medium, and large or giant. Giant CMN is well known as precursor for malignant melanoma, but the risk of malignant transformation in small or medium-sized CMN is the subject of controversy. We report a case of 54-year-old man who was diagnosed as malignant melanoma arising medium -sized CMN on the trunk. Local wide excision was performed but distant metastases were found 5 year later.
Humans ; Melanoma* ; Middle Aged ; Neoplasm Metastasis ; Nevus*