No abstract available.
Humerus*

Purpose: To define and evaluate the short-term clinical outcomes of the four-flanged technique for scleral fixation of a dislocated four-eyelet intraocular lens (IOL). Methods: Eleven eyes of 11 patients who underwent scleral fixation of dislocated four-eyelet intraocular lenses using a four-flanged technique were studied retrospectively. We measured the best-corrected visual acuity (BCVA), corneal endothelial cell density, intraocular pressure (IOP), spherical equivalent, astigmatism, IOL tilt and decentration, and postoperative complications. Results: The BCVA was 0.25 ± 0.11 logarithm of the minimal angle of resolution (logMAR) before surgery and 0.14 ± 0.12 logMAR 6 months later (p < 0.001). The corneal endothelial cell count was 2,427 ± 384 and 2,367 ± 298/mm2 before and after surgery, respectively (p = 0.285). The spherical equivalent was 6.02 ± 4.90 and 0.11 ± 0.36 before and after surgery, respectively. There was no significant difference in astigmatism before and after surgery. The mean IOL tilt and decentration were 2.44 ± 1.68° and 0.23 ± 0.09 mm, respectively. The refractive difference was 0.11 ± 0.24 diopters (D). Postoperative complications occurred in one eye; one flange lay outside the scleral tunnel, triggering hyperemia and conjunctival inflammation. Conclusions The four-flanged scleral fixation technique for a dislocated four-eyelet IOL improved the BCVA but did not significantly affect corneal endothelial cell loss. The procedure significantly reduced postoperative IOL tilt, decentration, and astigmatism, and may be a useful alternative to scleral fixation of a dislocated four-eyelet IOL.

To induce bone formation at ectopic site by tissue engineering and gene therapy, we transplanted collagen sponges containing rhBMP-7 transduced HEK 293 cells in the hypodermis of nude mice. Bone formation was investigated by histological and electron microscopic method at 3, 6, and 9 weeks after transplantation. At 9 weeks after transplantation, eosinophilic bony tissue was observed in the implanted collagen sponge and was confirmed as bone tissue by Von Kossa stain. In the transmission electron microscopic observation, the cells in newly formed bone tissue had eccentrically located nucleus and well developed rough endoplasmic reticulum (rER). Therefore, the cells were evaluated as osteoblasts. Those results suggest that it is possible to form a bone tissue in the ectopic site by transplantation of rhBMP-7 transduced HEK 293 cells. This will be contributed to push more advanced gene therapy for bone formation. However, the HEK 293 cell is unable to apply to the clinical gene therapy. Therefore it is worth to find more compatible cells for clinical application. In addition, collagen sponge is considered as an excellent scaffold and/or carrier for gene therapy and a good biomaterial for tissue engineering.
Animals ; Bone and Bones ; Bone Morphogenetic Protein 7 ; Collagen ; Endoplasmic Reticulum, Rough ; Eosinophils ; Genetic Therapy ; HEK293 Cells* ; Mice ; Mice, Nude* ; Osteoblasts ; Osteogenesis* ; Porifera ; Subcutaneous Tissue ; Tissue Engineering

To induce bone formation at ectopic site by tissue engineering and gene therapy, we transplanted collagen sponges containing rhBMP-7 transduced HEK 293 cells in the hypodermis of nude mice. Bone formation was investigated by histological and electron microscopic method at 3, 6, and 9 weeks after transplantation. At 9 weeks after transplantation, eosinophilic bony tissue was observed in the implanted collagen sponge and was confirmed as bone tissue by Von Kossa stain. In the transmission electron microscopic observation, the cells in newly formed bone tissue had eccentrically located nucleus and well developed rough endoplasmic reticulum (rER). Therefore, the cells were evaluated as osteoblasts. Those results suggest that it is possible to form a bone tissue in the ectopic site by transplantation of rhBMP-7 transduced HEK 293 cells. This will be contributed to push more advanced gene therapy for bone formation. However, the HEK 293 cell is unable to apply to the clinical gene therapy. Therefore it is worth to find more compatible cells for clinical application. In addition, collagen sponge is considered as an excellent scaffold and/or carrier for gene therapy and a good biomaterial for tissue engineering.
Animals ; Bone and Bones ; Bone Morphogenetic Protein 7 ; Collagen ; Endoplasmic Reticulum, Rough ; Eosinophils ; Genetic Therapy ; HEK293 Cells* ; Mice ; Mice, Nude* ; Osteoblasts ; Osteogenesis* ; Porifera ; Subcutaneous Tissue ; Tissue Engineering

Identification of the presence of chronic obstructive pulmonary disease in the elderly patient who was scheduled for surgery is vitally important. If appropriate therapeutic and preventive measures should not be instituted, tracheal intubation of the patient should be associated with a number of complications. We experienced a case of acute attack of asthma and pulmonary collapse during endotracheal intubation. A 54-year-old male who was scheduled for an emergency of primary corneo-scleral suture have had history of bronchial asthma. On the preoperative physical examination, there was no specific finding except expiratory wheezing. After endotracheal intubation with the aid of ketamine 2 mg/kg, pancuronium bromide 0.1 mg/kg and lidocaine 2 mg/kg, iv, acute asthmatic attack was appeared. Breathing sounds on the both lung fields can not be audible during manual ventilation and SpO(2) was dropped to 70% at F(1)O(2) 1.0. To relieve asthmatic attack, epinephrine(1: 1.000) 0.5 ml, sc, aminophylline 4 mg/kg, iv and methyprednisolone 1 mg/kg, iv were injected. Erosion of tracheal mucosa, blood clots and mucous plugs were found by the fibroptic bronchoscopy. After removal of blood clots and mucus, lung compliance and SpO2 were improved. The patient was discharged 7 days later without any complications or sequelae.
Aged ; Aminophylline ; Asthma* ; Bronchoscopy ; Emergencies ; Humans ; Intubation* ; Intubation, Intratracheal ; Ketamine ; Lidocaine ; Lung ; Lung Compliance ; Male ; Middle Aged ; Mucous Membrane ; Mucus ; Pancuronium ; Physical Examination ; Pulmonary Disease, Chronic Obstructive ; Respiratory Sounds ; Sutures ; Ventilation

Recently, new trials for the treatment of the vesicoureteral reflux have been proposed. These trials convince us of the need to reevaluate the ureterovesical junction and to reinvestigate the role of the detrusor muscle and the ureteral sheath. We studied forty adult and five infant human bladders and distal ureters. Microscopic sections were studied, taken serially from the ureterovesical junction and adjacent urinary bladder with the hematoxylin-eosin and the Gomori trichrome staining method. The slit shaped ureteral orifice was most commonly observed ( 57.0 %). The approximate ratio of the submucosal length to the intramural ureter was 2:3. Ureteral sheath consists of smooth muscle fibers (bundles) arranged in a helical fashion and loose connective tissues which envelope the distal ureter over a 3 cm distance to the juxtavesical portion. These structures are independent from the ureter proper. The muscle bundles of ureteral sheath are of 4 types: 1. Those which extend from the outer bladder wall to the juxtavesical ureters (JVU) and, 2. continuing from JVU, these become the detrusor muscle after entering the bladder. 3. Bundles run from the JVU to the trigone, and 4. bundles run to the trigone from the mid-circular layer of the detrusor muscle. In the bladder, most roof muscle bundles of ureteral sheath run to the upper portion of the trigone after crossing the intramural ureter ventrally. Most floor bundles run to the inferolateral portion of the bladder. In infants, the deep trigone and basal detrusor muscle are relatively thicker and not compactly organized. We conclude that ureteral sheath is of detrusor muscle origin. We suggest that ureteral sheath functions as a part of a preventive mechanism with compressing the intravesical ureter by contraction in voiding and filling phase independently against vesicoureteral reflux.
Adult ; Connective Tissue ; Humans ; Infant ; Muscle, Smooth ; Ureter ; Urinary Bladder ; Vesico-Ureteral Reflux

This study was carried out to reveal the epidemiologic characteristics of psoriasis in Korea. Seventeen university hospitals were engaged in this study, and the results were as follows : 1. The number of psoriasis patients during the 10 years from January 1977 to March 1987 was 1.05% of all the outpatients; the male to female-ratio was 1.08:1. 2. In the prospective study, the number of psoriasis patients was 2.3% of all the outpatients in 1987, 2.8% of all the outpatients in 1988 and the male to female ratio was 1.26:1. 3. The most prevalent age of onset was 20-29 years ; 81.1% were living in urban areas; and a family history was obtainable in 19.8% with parents holding the highest rank of 7.8%. 4. The most frequent duration of disease activity was under 5 years in 63.3%; the most common age for the worst condition was 20-29 yrs. The most common area size of skin involvement at the peak of the worst condition was less than 10%. 5. The most common initiating skin lesion began on the scalp in 20.2%, on the nail in 17.2%, pruritus in 63.0% with joint symptoms in 10.8%, and Koebner phenomena in 50.6%. 6. Emotional stress was the most common aggravating factor in 34.4%. The method of treatment that attained the best result was the combination therapy of oral medication and a topical agent. The best treatment modality was said to be the application of ointment with p.o.medication by as many as 28.4% of patients who took the leading rank. Photo-chemotherapy, effective with few complications, was not used much as it was not well-known in Korea until after 1980. Most people had an accurate knowledge of psoriasis.
Age of Onset ; Epidemiologic Studies* ; Epidemiology ; Female ; Hospitals, University ; Humans ; Joints ; Korea ; Male ; Methods ; Outpatients ; Parents ; Prospective Studies ; Pruritus ; Psoriasis* ; Scalp ; Skin ; Stress, Psychological

Purpose: We report five cases of cytomegalovirus (CMV) retinitis in immunocompetent patients with diabetes mellitus (DM). Methods: This was a retrospective observational case series of five immunocompetent patients with CMV retinitis. All patients had DM and variable degrees of DM retinopathy. After discovery of the retinitis, we assessed the patients in terms of ophthalmologic history, systemic conditions, underlying disease, and the medications used for treatment, such as immunosuppressants. This was followed by blood and immunology tests. None of the five patients were immunocompromised. We confirmed the diagnosis of CMV retinitis by polymerase chain reaction (PCR) analysis; samples were collected by anterior chamber paracentesis. All patients were treated with intravitreal antiviral injection until negative results were obtained for the anterior chamber PCR. Results: All five immunocompetent patients who had developed CMV retinitis, had a history of diabetes of at least 15 years. The average duration of diabetes was 17.4 ± 2.4 (15-20) years, the average HbA1c was 7.3 ± 0.5% (6.8-8.0%), and the average duration and numbers of Intravitreal antiviral injections were 23.8 ± 8.5 months (14-36 months) and 14.8 ± 3.2 times (10-18 times), respectively. Conclusions We report this case series because CMV retinitis can be complicated even in diabetic patients shown to be immunocompetent.

Purpose: To report a case of central serous chorioretinopathy (CSC) after high G-force exposure in a fighter pilot with rapid remission.Case summary: A 28-year-old male patient was transferred from a local clinic with metamorphopsia in the left eye. His visual acuity was 20/20 in both eyes. Fundus examination of his left eye showed serous retinal detachment. Fluorescein angiography revealed leakage, which led to a diagnosis of CSC. As a fighter pilot, he had been exposed repeatedly to high g-forces before symptoms occurred. His flying was then stopped, and a follow-up examination was scheduled. After two weeks, a fundus examination showed resolution of the subretinal fluid. Conclusions CSC can develop after high g-force exposure, with a rapid clinical course. When making a CSC diagnosis, the physician should confirm potential causative environments by performing a thorough review of the patient’s occupational history and promptly terminate the likely causes.

OBJECTIVE: Human papillomavirus (HPV) test was incorporated into the triage of lesser abnormal cervical cytologies: atypical squamous cells of undetermined significance (ASCUS) or low-grade squamous intraepithelial lesion (LSIL). This study aimed to evaluate the impact of age on the efficacy of HPV testing in patients with lesser abnormal cervical cytologies. METHODS: A total of 439 patients with ASCUS or LSIL were included. The association between age groups and the diagnostic performances of HPV test for high-grade cervical intraepithelial neoplasia (CIN2+) was evaluated. RESULTS: Median age was 44 years (range, 17 to 75 years). ASCUS was more frequently observed in older patients while LSIL was more common in younger patients (P=0.002). CIN2+ was found in 11.3% (32/284) of the ASCUS patients and 12.9% (20/155) of patients with LSIL. Older patients with ASCUS showed lower HPV infection rates (P=0.025), but not LSIL (P=0.114). However, the prevalence of CIN2+ was similar between the age groups with ASCUS or LSIL. In patients with ASCUS, the false negative rate of HPV test for CIN2+ was 6.2%. The false negative rate of the HPV test became higher with increasing of the age after the age of 50 (P=0.034). CONCLUSION: Our findings suggest that false negative rate of the HPV test for CIN2+ in ASCUS patients older than 50 years might become higher with increasing of the age. Negative HPV results in patients of the age >50 years with ASCUS should be carefully interpreted.
Cervical Intraepithelial Neoplasia ; DNA* ; Human Papillomavirus DNA Tests ; Humans ; Prevalence ; Triage ; Uterine Cervical Dysplasia