Although this vascular anomaly, angiomatosis retinae, was initially observed over 85 years ago, and although excellent clinical description of the lesion exist in the literature, treatments for the angiomatosis retinae is difficult and unless the condition is in its early stages, impossible but available symptomatic therapy. Two cases of the angiomatosis retinae, the first, 11 year old girl, von Hippel disease, early stage of vascular dilatation and angiomatous formation, and the second, 15 year old boy, von Hippel-Lindau disease, the final stage of glaucoma and destruction of the eye, are reported. Intravenous fluorescein angiography has been demonstrated, the retinal vascular malformations in von Hippel-Lindau disease are distributed focally and not diffusely, The retinal veins showing greater changes than the arteries are disclosed. This paper presents the fluorscein angiographic findings of von Hippel-Lindau disease and discusses the treatments and the pathologic findings of angiomatosis retinae with literatures related to von Hippel-Lindau disease.
Adolescent ; Arteries ; Child ; Dilatation ; Female ; Fluorescein Angiography ; Glaucoma ; Humans ; Male ; Retinal Vein ; Retinaldehyde ; Vascular Malformations ; von Hippel-Lindau Disease*

The auther has presented recently treated 2 cases of squamous cell cancer, which are found in the lower lid in 25 years old male, and a tumd arising from the lacrimal sac in 47 years old female. It was reviewed clinically with the literature.
Adult ; Carcinoma, Squamous Cell* ; Female ; Humans ; Male ; Middle Aged ; Neoplasms, Squamous Cell

Authors experienced a case of acute optic neuritis, 12 years old female patient, following scarlet fever which is rare among bacterial origin in ophthalmological aspects. On the first day of admission, the visual acuities of 0.04(N.C.) in right eye and 0.2 (N.C.) in left eye, blurring of disc margins (OU), central scotoma (OD), and high antistreptolysin O titer (A.S.T.O.) were noted. After bed rest and medical treatment with corticosteroid, penicillin, and vitamin B12 for two and a half months, the visual acuities and antistreptolysin O titer were recovered completely.
Antistreptolysin ; Bed Rest ; Child ; Female ; Humans ; Optic Neuritis* ; Penicillins ; Scarlet Fever* ; Scotoma ; Visual Acuity ; Vitamin B 12

Authors experienced a case of acute optic neuritis, 12 years old female patient, following scarlet fever which is rare among bacterial origin in ophthalmological aspects. On the first day of admission, the visual acuities of 0.04(N.C.) in right eye and 0.2 (N.C.) in left eye, blurring of disc margins (OU), central scotoma (OD), and high antistreptolysin O titer (A.S.T.O.) were noted. After bed rest and medical treatment with corticosteroid, penicillin, and vitamin B12 for two and a half months, the visual acuities and antistreptolysin O titer were recovered completely.
Antistreptolysin ; Bed Rest ; Child ; Female ; Humans ; Optic Neuritis* ; Penicillins ; Scarlet Fever* ; Scotoma ; Visual Acuity ; Vitamin B 12

BACKGROUND: Most current reseatch using prognostic scoring systems in critically ill patients have focused o prediction using the first intensive care unit(ICU) day data or daily updated data. Usually the mean ICU length of stay in Korea is longer than in the western world. Consequently, a more cost-effective and practical prognostic parameter is required. The principal aim of this study was to assess the prognostic value of the seventh day(7th day : the average mean ICU length of stay) APACHE III score in a medical intensive care unit. METHODS: 241 medical ICU patients from July 1997 to April 1998 were enrolled. The 1st and 7th scores were measured by using the APACHE III scoring system and compared between survivors and non-survivors. Logistic regression analysis was performed to determine the relationship between the 1st and 7th APACHE III scores and the mortality risk. RESULTS: 1) The mean length of stay in the ICU was 10.3±13.8 days. 2) The mean 1st and 7th day APACHE III scores were 59.7±30.9 and 37.9±27.7. 3) The mean 1st day APACHE III scores was significantly lower in survivors than in non- survivors(49.9±23.8 vs 86.3±32.3 P<0.0001). 4) The mean 7th day APACHE III scores was significantly lower in survivors than in non- survivors(30.1±18.5 vs 80.1±30.4, P<0.0001). 5) The odds ratios among the 1st and 7th day APACHE III scores and the mortality rate were 1.0507 and 1.0779 respectively. CONCLUSION: These results suggest that the seventh day APACHE III scores is as useful in predicting the outcome as is such like the first day APACHE III score. Therefore, in comparison to the daily APACHE III score, measuring the 1st and 7th day APACHE III scores are also useful for predicting the prognosis of critically ill patients in terms of cost-effectiveness. It is suggested that the 7th day APACHE III score is useful for predicting the clinical outcome.
APACHE* ; Critical Illness ; Humans ; Intensive Care Units* ; Critical Care* ; Korea ; Length of Stay ; Logistic Models ; Mortality ; Odds Ratio ; Prognosis ; Survivors ; Western World

PURPOSE: A single institute trial of combination chemotherapy, with paclitaxel and cisplatin, in patients with metastatic breast cancer, having failed previous combination chemotherapy, was performed. MATERIALS AND METHODS: Patients were only eligible for this study if there disease had progressed, following treatment with previous chemotherapy, in either an adjuvant or a metastatic setting. Paclitaxel 175 mg/m2 was administered as a 3-hour continuous infusion on day 1, and cisplatin 80 mg/m2 was administered for 2 hours on day 2, with adequate hydration. This was repeated every 3 weeks, and continued until one of the following events occurred: disease progression, unacceptable adverse effect or treatment refusal by the patient. Intercurrent palliative radiotherapy, or concurrent hormonal therapy, was permitted, depending on each patient's status. All the endpoints were evaluated under the principle of intention to treat analysis. RESULTS: A total of 24 patients entered the study, and 18 had at least one measurable lesion, but 6 did not. The objective response rate of the 18 patients was 50%(9/18). Two were complete responses and seven showed partial responses. The median response duration, progression free and overall survival were 5.3 months (range, 4~18), 6 months (95% CI, 5~7) and 12 months (95% CI, 7~17), respectively. 67% of the planned dose was administered. Out of a total 135 cycles administered, about 20% of cycles showed grade 3 or 4 leukopenia and 7% showed grade 3 thrombocytopenia. Two patients suffered from pneumonia, and one experienced neutropenic fever. Mucositis, greater than grade 3, existed in three cases. No treatment related deaths were reported. CONCLUSION: The combination chemotherapy, with paclitaxel and cisplatin, was active in the treatment of metastatic breast cancer patients having failed previous chemotherapy.
Breast Neoplasms* ; Breast* ; Cisplatin* ; Disease Progression ; Drug Therapy ; Drug Therapy, Combination* ; Fever ; Humans ; Intention to Treat Analysis ; Leukopenia ; Mucositis ; Paclitaxel* ; Pneumonia ; Radiotherapy ; Thrombocytopenia ; Treatment Refusal

BACKGROUND: Surfactant proteins are important in the regulation of the surfactant secretion, synthesis and recycling. Glucocorticoids are known to have primary or secondary effects on gene expression and can alter the rate of gene transcription. The hydrophilic and hydrophobic surfactant protein have been shown to be upregulated by glucocorticoids in vitro but its regulation in vivo, however, is not well established. The authors carried out nuclear run on assays to determine wheather glucocorticoids altered the transcription rate of SP-A, SP-B and SP-C genes. METHODS: Adult rats were given the 2 mg/kg dose of subcutaneous dexamethasone for 2 days and sacrified at 2 days. The transcription rate of SP-A, SP-B and SP-C genes were measured by nuclear run on assays. RESULTS: Treatment with 2 mg/kg dexamethasone increased transcription of SP-A gene (1.6-fold) and SP-C gene (1.3-fold) compared to the control for SP-A and SP-C after 2 days, which were not statistically significant. The rate of gene transcription for SP-B at 2 days after 2 mg/kg dexamethasone administration was significantly increased by 5.3-fold compared to the control for SP-B (p<0.005). The rates of gene transcription for hydrophilic and hydrophobic surfactant proteins, even in the hydrophobic surfactant proteins SP-B and SP-C were different. CONCLUSIONS: The authors conclude that the difference in dexamethasone sensitivity may indicate that the three surfactant protein genes contain glucocorticoid response elements with different affinities for receptor in vivo.
Adult ; Animals ; Dexamethasone ; Gene Expression ; Glucocorticoids ; Humans ; Pulmonary Surfactants ; Rats ; Recycling ; Response Elements

BACKGROUND: Clostridium difficile is a major cause of nosocomial infectious diarrhea. Nosocomial clusters of C. difficile disease have been ascribed to the transfer of the organism form patient to patient. The aim of this study was to survey the nosocomial acquisition of C. difficile infection and to evaluate the efficacy and efficiency of epidemiologic typing systems by molecular analysis of the isolates. METHODS: A surveillance study for C. difficile acquisition was performed in patients admitted to neurology ward (NW) and medical intensive care unit (MICU) in an 800-bed tertiary-care hospital from August 1998 to October 1998. Stool specimens were taken weekly for culture of C. difficile. All isolates were examined for toxin B gene by PCR assay. Three molecular typing methods, including pulsed-field gel electrophoresis (PFGE), ribotyping, and arbitrarily primed polymerase chain reaction (AP-PCR) were used to differentiate individual strains of C. difficile isolates. Their performance characteristics were compared according to the consensus guidelines by the European Society for Clinical Microbiology and Infectious Disease. RESULTS: A total of 38 C. difficile strains were isolated from 308 stool cultures. The period prevalence was 7.4/1000 patient-days and 21.2/1000 patient-days in the NW and MICU, respectively (P=0.034). The acquisition incidence of C. difficile infection was 1.85/ 1,000 patient-days and 5.33/1,000 patient-days in NW and MICU, respectively. The toxin B gene was detected in 38% (8/21) of C. difficile isolates; 62.5% from diarrheal patients and 23% from asymptomatic patients. In a comparison of the three typing systems, the typeability was 0.444 by PFGE, 0.972 by AP-PCR and 1 by ribotyping, and the discrimination index was 0.975 by PFGE, 0.810 by AP-PCR and 0.777 by ribotyping. All three typing systems were highly reproducible. AP-PCR was the least costly and most rapid method. CONCLUSION: The relatively high prevalence of C. difficile infection in the hospital might indicate a potential nosocomial spread, even though the acquisition incidence was low. AP-PCR appears to be an efficacious and efficient method for the epidemiologic study of C. difficile infection, and its suboptimal discriminative power may be enhanced by complementary PFGE.
Clostridium difficile* ; Clostridium* ; Communicable Diseases ; Consensus ; Diarrhea ; Discrimination (Psychology) ; Electrophoresis, Gel, Pulsed-Field* ; Epidemiologic Studies ; Humans ; Incidence ; Intensive Care Units ; Molecular Typing* ; Neurology ; Polymerase Chain Reaction* ; Prevalence ; Ribotyping*

BACKGROUND: Clostridium difficile is a major cause of nosocomial infectious diarrhea. Nosocomial clusters of C. difficile disease have been ascribed to the transfer of the organism form patient to patient. The aim of this study was to survey the nosocomial acquisition of C. difficile infection and to evaluate the efficacy and efficiency of epidemiologic typing systems by molecular analysis of the isolates. METHODS: A surveillance study for C. difficile acquisition was performed in patients admitted to neurology ward (NW) and medical intensive care unit (MICU) in an 800-bed tertiary-care hospital from August 1998 to October 1998. Stool specimens were taken weekly for culture of C. difficile. All isolates were examined for toxin B gene by PCR assay. Three molecular typing methods, including pulsed-field gel electrophoresis (PFGE), ribotyping, and arbitrarily primed polymerase chain reaction (AP-PCR) were used to differentiate individual strains of C. difficile isolates. Their performance characteristics were compared according to the consensus guidelines by the European Society for Clinical Microbiology and Infectious Disease. RESULTS: A total of 38 C. difficile strains were isolated from 308 stool cultures. The period prevalence was 7.4/1000 patient-days and 21.2/1000 patient-days in the NW and MICU, respectively (P=0.034). The acquisition incidence of C. difficile infection was 1.85/ 1,000 patient-days and 5.33/1,000 patient-days in NW and MICU, respectively. The toxin B gene was detected in 38% (8/21) of C. difficile isolates; 62.5% from diarrheal patients and 23% from asymptomatic patients. In a comparison of the three typing systems, the typeability was 0.444 by PFGE, 0.972 by AP-PCR and 1 by ribotyping, and the discrimination index was 0.975 by PFGE, 0.810 by AP-PCR and 0.777 by ribotyping. All three typing systems were highly reproducible. AP-PCR was the least costly and most rapid method. CONCLUSION: The relatively high prevalence of C. difficile infection in the hospital might indicate a potential nosocomial spread, even though the acquisition incidence was low. AP-PCR appears to be an efficacious and efficient method for the epidemiologic study of C. difficile infection, and its suboptimal discriminative power may be enhanced by complementary PFGE.
Clostridium difficile* ; Clostridium* ; Communicable Diseases ; Consensus ; Diarrhea ; Discrimination (Psychology) ; Electrophoresis, Gel, Pulsed-Field* ; Epidemiologic Studies ; Humans ; Incidence ; Intensive Care Units ; Molecular Typing* ; Neurology ; Polymerase Chain Reaction* ; Prevalence ; Ribotyping*

BACKGROUND: Rhinovirus is an important precipitating factor in acute exacerbation of asthma and COPD. Rhinovirus has short incubation period, causing transient inflammatory process and then has spontaneous resolution. We hypothesized that alterations in anti-inflammatory cytokines are present at sites of rhinoviral infection and these alterations contribute to the transient nature of rhinovirus-induced inflammation and symptomatology. To test this hypothesis, we characterized time-sequenced alterations in anti-inflammatory cytokines elaboration from human bronchial epithelial cells (HBEC). METHODS: We compared the ability of rhinovirus-infected HBEC to produce anti-inflammatory cytokines with controls. We infected HBEC, BEAS-2B with rhinovirus 14 obtained from American Type Culture Collection. We harvested the supernatants from rhinovirus infected BEAS-2B cells and the controls at 2hr, 4hr, 8hr, 12hr, 24hr, 48hr from inoculation time. We measured the concentration of interleukin(IL)-1 Ra(receptor antagonist), IL-1 sRII(soluble receptor type II), IL-4, transforming growth factor(TGF)-beta by ELISA kits. RESULTS: Rhinovirus-infected BEAS-2B cells increased the production of IL-1 Ra, IL-1 sRII from 24hr and produced outstandingly compared with the controls at 48hrs. However, the production of IL-4 and TGF-beta was so minimal that there was no significant difference between the rhinovirus-infected BEAS-2B cells and the controls. CONCLUSIONS: Our results demonstrate that rhinovirus elaborates the IL-1 Ra and IL-1 sRII but not TGF-beta, IL-4. At the beginning of rhinoviral infection, the elaboration of IL-1 Ra, IL-1 sRII was so minimal but notably increased at 48hrs. with slower kinetics. These results suggest the possibility of rhinovirus- induced IL-1 Ra, IL-1 sRII to contribute to the spontaneous resolution.
Asthma ; Cytokines* ; Enzyme-Linked Immunosorbent Assay ; Epithelial Cells* ; Humans* ; Inflammation ; Interleukin-1 ; Interleukin-4 ; Kinetics ; Precipitating Factors ; Pulmonary Disease, Chronic Obstructive ; Rhinovirus* ; Transforming Growth Factor beta