Purpose: To assess the clinical outcomes of scleral buckling (SB) without subretinal fluid drainage (SRFD) on primary rhegmatogenous retinal detachment (RRD). Methods: The medical records of patients with RRD treated via SB without SRFD from March 2009 to Feb 2018 were retrospectively reviewed. Cases with histories of previous intraocular surgery (except cataract removal) were excluded. The primary and final surgical success rates were the main outcome measures. Pre- and post-operative visual acuity and intraocular pressure (IOP), factors that might affect the surgical success rate, secondary operative procedures, re-operation rates, and complications were analyzed. Results: A total of 66 eyes of 66 patients were included. The mean patient age was 38.9 ± 18.6 years and the mean symptom duration 19.23 ± 25.14 days. The retinae were reattached after single surgeries on 57 eyes (success rate 86.36%); the final success rate was 100% after a second operation (when necessary). Of the nine eyes requiring additional surgery, seven required vitrectomy and two vitrectomy combined with buckle revision. The mean preoperative logMAR visual acuity of 0.578 ± 0.647 improved to 0.518 ± 0.512 at 1 month after surgery (p < 0.001) and to 0.262 ± 0.372 at the last follow-up visit (p < 0.001). The postoperative IOP was higher than the preoperative IOP at 3 months (p = 0.024). Conclusions Scleral buckling without SRFD used to treat primary RRD afforded a high reattachment rate (compared to those of previous reports employing vitrectomy or scleral buckling with SRFD). Given the possible complications of SRFD, our method may be a safe and feasible surgical option, affording good results with few complications in patients with primary RRD.

Purpose: To assess the clinical outcomes of scleral buckling (SB) without subretinal fluid drainage (SRFD) on primary rhegmatogenous retinal detachment (RRD). Methods: The medical records of patients with RRD treated via SB without SRFD from March 2009 to Feb 2018 were retrospectively reviewed. Cases with histories of previous intraocular surgery (except cataract removal) were excluded. The primary and final surgical success rates were the main outcome measures. Pre- and post-operative visual acuity and intraocular pressure (IOP), factors that might affect the surgical success rate, secondary operative procedures, re-operation rates, and complications were analyzed. Results: A total of 66 eyes of 66 patients were included. The mean patient age was 38.9 ± 18.6 years and the mean symptom duration 19.23 ± 25.14 days. The retinae were reattached after single surgeries on 57 eyes (success rate 86.36%); the final success rate was 100% after a second operation (when necessary). Of the nine eyes requiring additional surgery, seven required vitrectomy and two vitrectomy combined with buckle revision. The mean preoperative logMAR visual acuity of 0.578 ± 0.647 improved to 0.518 ± 0.512 at 1 month after surgery (p < 0.001) and to 0.262 ± 0.372 at the last follow-up visit (p < 0.001). The postoperative IOP was higher than the preoperative IOP at 3 months (p = 0.024). Conclusions Scleral buckling without SRFD used to treat primary RRD afforded a high reattachment rate (compared to those of previous reports employing vitrectomy or scleral buckling with SRFD). Given the possible complications of SRFD, our method may be a safe and feasible surgical option, affording good results with few complications in patients with primary RRD.

Diabetic retinopathy(DR) is the leading cause of new onset blindness among working-aged groups in industrialized countries, and its incidence is expected to increase along with the rising incidence of diabetes mellitus. Primary interventions such as strict glycemic control, tight blood pressure regulation, and lipid-lowering therapy can significantly reduce the risk of DR occurrence and progression. Currently, laser photocoagulation is the mainstay of treatment of proliferative DR and some cases of diabetic macular edema (DME). However, a considerable number of DR patients still suffer from severe visual impairment in spite of the application of laser photocoagulation and even of pars plana vitrectomy. Considering the limitations of current DR treatments, ongoing efforts have been devoted to the development of new therapeutic strategies, and it has become necessary to focus on pharmacologic treatment. Since inflammation has been identified as playing a substantial role in the pathogenesis of DR, corticosteroids with an anti-inflammatory effect can be included in the treatment of DR, though this may cause cataract and intraocular pressure elevation. The recent discovery of inhibitors of vascular endothelial growth factor is a revolutionary event in the management of DR, specifically DME. Some new agents aiming at the process of angiogenesis and increased vascular permeability are still under investigation, offering hope for a more effective future treatment of this sight-threatening disease. This paper reviews the current state of knowledge of the clinical presentation, preventive management, and clinical therapeutic strategies of DR and DME.
Adrenal Cortex Hormones ; Blindness ; Blood Pressure ; Capillary Permeability ; Cataract ; Developed Countries ; Diabetes Mellitus ; Diabetic Retinopathy* ; Hope ; Humans ; Incidence ; Inflammation ; Intraocular Pressure ; Laser Coagulation ; Light Coagulation ; Macular Edema ; Vascular Endothelial Growth Factor A ; Vascular Endothelial Growth Factors ; Vision Disorders ; Vitrectomy

PURPOSE: To report a case of nonarteritic anterior ischemic optic neuropathy (NA-AION) with an atypical visual field defect after intraocular surgery.CASE SUMMARY: A 61-year-old male presented with a visual field defect in his right eye 1 day after uneventful cataract surgery with pars plana vitrectomy for epiretinal membrane. His best-corrected visual acuity (BCVA) in the right eye was 20/400 with a relative afferent pupillary defect. A color vision test revealed failure only in the right eye. A slit-lamp examination revealed no abnormality in the anterior part of the eyes. A fundoscopic examination also revealed no abnormality in the posterior part of the eyes, including the optic disc. The Humphrey visual field test revealed a nasal vertical defect in the right eye. Orbital and brain magnetic resonance imaging were normal. After 14 days from the initial symptom, fundus photography and optical coherence tomography revealed an optic disc swelling and splinter hemorrhage. Fluorescein angiography revealed a delayed filling on the temporal half of the optic disc and inferotemporal peripapillary choroid. A diagnosis of NA-AION was made. The patient was treated with oral steroids and aspirin. After 3 months, the BCVA was 20/125. The visual field defect was maintained and segmental atrophy developed on the superior and inferior sides of the right optic disc. CONCLUSIONS AION may present as vertical hemianopsia. With the risk factors of ischemic optic neuropathy, the possibility of AION should be considered in the differential diagnoses of postoperative visual impairments or field defects after intraocular surgery.

STUDY DESIGN: This is a retrospective study that focused on the perioperative complications when performing posterior arthrodesis for treating degenerative lumbar disorders in elderly patients. OBJECTIVES: We wanted to analyze the perioperative risk factors and the complications associated with posterior lumbar decompression and arthrodesis in patients who were sixty-five years of age or older. SUMMARY OF LITERATURE REVIEW: Lumbar arthrodesis is commonly done in elderly patients to treat degenerative spine problems. These patients may be at an increased risk for complications because of their age and their associated medical conditions. MATERIALS AND METHODS: We studied 111 patients who were over 65 years old and they were able to be followed up for more than 3 months after performing posterior arthrodesis during the recent 5 years. Sixty-one patients who had undergone posterolateral fusion (PLF) were classified as group A, and 50 patients who had undergone posterior lumbar interbody fusion (PLIF) using a PEEK cage were classified as group B. We analyzed their rates of complications and the causative factors, according to operative methods and age, and these complications occurred within 12 weeks after the operations. RESULTS: Complications occurred for 43 patients of group A, and for 26 patients of group B. The differences in the rates of complications were statistically significant, and group A had a more complications than did group B. The relations between medical problems and the incidence of perioperative complications were statistically significant for both groups. CONCLUSIONS: Elderly patients with medical problems should be made aware that they are at an increased risk for surgical complications, and attention hould be paid to controlling the blood loss and limiting the operative time. The PLIF using a PEEK cage was identified as a procedure that could reduce the perioperative complications.
Aged ; Arthrodesis ; Decompression ; Humans ; Incidence ; Ketones ; Operative Time ; Polyethylene Glycols ; Retrospective Studies ; Risk Factors ; Spine

Behcet's disease (BD) involves multisystem vasculitis of unknown origin. Ocular manifestations of BD mostly include bilateral panuveitis and retinal vasculitis, which are very challenging to treat. Interferon alfa-2a (IFN) has been recently introduced for treating refractory Behcet uveitis, mainly in Germany and Turkey. Nonetheless, there is so far no consensus about the ideal treatment regimen of IFN for Behcet uveitis. We report our experience of IFN treatment in five Korean BD patients with refractory uveitis. All patients complained of oral ulcers; one patient had a positive pathergy test and 2 showed the presence of HLA-B51. Immunosuppressive agents used prior to IFN treatment included cyclosporine and methotrexate. The IFN treatment was commenced with a dose of 6-9 MIU/day for 7 days, adjusted according to individual ocular manifestations, tapered down to 3 MIU three times in a week, and then discontinued. All patients showed positive response to IFN treatment; 50% of them showed complete response without additional major ocular inflammation during the follow-up period. Other BD symptoms also improved after IFN treatment in most cases. After treatment, the relapse rate and the required dose of oral corticosteroid were decreased in most cases, showing a significant steroid-sparing effect. However, the visual acuity was not improved in most cases due to irreversible macular sequelae. Despite the small sample size of this study, we suggest that, in Korean patients, IFN is an effective treatment modality for BD uveitis as was observed in German and Turkish patients.
Adult ; Behcet Syndrome/complications/diagnosis/*drug therapy ; Chronic Disease ; Cyclosporine/therapeutic use ; Female ; Humans ; Immunosuppressive Agents/administration & dosage ; Interferon-alpha/*therapeutic use ; Male ; Recombinant Proteins/therapeutic use ; Recurrence ; Remission Induction ; Treatment Outcome ; Turkey ; Uveitis/diagnosis/*drug therapy/etiology ; Visual Acuity

BACKGROUND: Pain following shoulder surgery is usually severe and difficult to control using conventional postoperative pain control maneuvers. Therefore, we investigated the pain control efficacy, PONV (postoperative nausea vomiting) and complications by the use of a continuous brachial plexus block in patients who had undergone shoulder surgery. METHODS: Thirty three shoulder surgery patients were enrolled in this study. According to the Borgeat's modified lateral technique, 30 ml of 0.37% ropivacaine were injected into the patients, which was followed by insertion of a continuous brachial plexus catheter into the plexus sheath. The operation was then conducted under general anesthesia, and postoperative pain was evaluated in the recovery room 12, 24, 36, and 48 hr after surgery. In addition, nausea and vomiting was calculated using the visual analogue scale (VAS) and sedation was evaluated using the modified Ramsay score. A total of 400 ml of 0.2% Ropivacaine was administered at a rate of 8 ml/hr to control the postoperative pain for 2 days. In addition, other neurological complications were investigated, and the catheter tips were cultured after they were removed to determine if any infection had occurred. RESULTS: The postoperative pain scores were below 2 on the 10 cm VAS, and the level of nausea and vomiting was also satisfactorily (< 2/10 cm VAS). In addition, the mean sedation score of the patients in the recovery room was 2. There were complications including motor weakness (24%), dyspnea (15%), Hornor's syndrome (9%), postauricular numbness (9%) and metallic taste (3%), however, there were no patients who complained of neurological symptoms after one month of follow-up, and no signs of infection were found when the results of catheter tip cultures were evaluated. CONCLUSIONS: The use of a continuous interscalene brachial plexus block is a feasible method of postoperative pain control for patients who undergo major shoulder surgery.
Anesthesia, General ; Brachial Plexus* ; Catheters ; Dyspnea ; Follow-Up Studies ; Humans ; Hypesthesia ; Nausea ; Nerve Block ; Pain, Postoperative ; Postoperative Nausea and Vomiting ; Recovery Room ; Shoulder* ; Taste Disorders ; Vomiting

Naringenin (NAR) as one of the flavonoids observed in grapefruit has been reported to exhibit an anti-cancer activity. Activating transcription factor 3 (ATF3) is associated with apoptosis in human colon cancer cells. This study was performed to investigate the molecular mechanism by which NAR stimulates ATF3 expression and apoptosis in human colon cancer cells. NAR reduced the cell viability and induced an apoptosis in human colon cancer cells. ATF3 overexpression increased NAR-mediated cleaved PARP, while ATF3 knockdown attenuated the cleavage of PARP by NAR. NAR increased ATF3 expression in both protein and mRNA level, and increased the luciferase activity of ATF3 promoter in a dose-dependent manner. The responsible region for ATF3 transcriptional activation by NAR is located between -317 and -148 of ATF3 promoter. p38 inhibition blocked NAR-mediated ATF3 expression, its promoter activation and apoptosis. The results suggest that NAR induces apoptosis through p38-dependent ATF3 activation in human colon cancer cells.
Activating Transcription Factor 3 ; Apoptosis* ; Cell Survival ; Citrus paradisi ; Colon* ; Colonic Neoplasms* ; Flavonoids ; Humans* ; Luciferases ; RNA, Messenger ; Transcriptional Activation

OBJECTIVE: Chlamydia trachomatis is one of the most common causative microorganism in pelvic inflammatory disease (PID). In this infection tubal obstruction, infertility, tubal pregnancy and recurrent pelvic infection has involved. Also, perinatal infection, spontaneous abortion and preterm labor of pregnant women increased in chlamydia infection. This study was performed to investigate the prevalence rate and clinical characteristics of Chlamydia trachomatis in symptomatic women. METHODS: From March, 2003 to March, 2004, in OB-Gyn development, endocervical swab were obtained in 218 patients (137 impatients of PID and 81 outpatients) by Amplicor Chlamydia Transfer Kits and Human papilloma virus kit. They were studied on history taking, physical examination, laboratory test, and polymerase chain reaction for the detection of Chlamydia trachomatis. Also, in this study we investigated the prevalence of human papilloma virus and N. gonorrhea in the Chlamydia infection group. RESULTS: The prevalence rate of Chlamydia trachomatis was 27.5% (61/218) in pelvic inflammatory disease. As regarding the age distribution of Chlamydia trachomatis positive group was the high prevalence rate in twenties (52.8%). Chlamydia infection was related to the history of artificial abortion, oral contraception, occupation status, history of gynecologic disease (PID, Ectopic pregnancy). Women with chlamydial infection were 2.5 times greater risk of coincidal HPV infection and 2 times greater risk of coincidal N. gonorrhea infection and both were statistically significant. CONCLUSION: The prevalence rate of Chlamydia infection is higher than any other sexually transmitted disease and Chlamydia infection has serious complication on reproduction. It appears weak symptom and detection is difficult. Therefore the screening and treatment of Chlamydia trachomatis are necessary to decrease the prevalence and prevention of complication.
Abortion, Spontaneous ; Age Distribution ; Chlamydia Infections ; Chlamydia trachomatis* ; Chlamydia* ; Contraception ; Fallopian Tube Diseases ; Female ; Genital Diseases, Female ; Gonorrhea ; Humans ; Infertility ; Mass Screening ; Obstetric Labor, Premature ; Occupations ; Papilloma ; Pelvic Infection ; Pelvic Inflammatory Disease* ; Physical Examination ; Polymerase Chain Reaction ; Pregnancy ; Pregnancy, Tubal ; Pregnant Women ; Prevalence ; Reproduction ; Sexually Transmitted Diseases

Midtrimester genetic amniocentesis is an important diagnostic tool in prenatal genetic diagnosis and counseling. We can identify karyotypes with metaphase chromosome analysis of cultured amniocytes. Marker chromosomes are defined as unidentified structurally abnormal chromosomes. Incidence of marker chromosomes in the previous reported studies was 0.6-1.5/1,000. They occurred more frequently with advanced maternal age. Ascertainment of chromosomal origin is important because it may be associated with malformation and developmental abnormalities. Recently, identification of the origin and composition of marker chromosomes has been made possible by the use of fluorescent in situ hybridization (FISH). Most marker chromosomes are known to be originated from chromosome 15 or 22, X, Y. We have experienced a case of non-15, non-22 marker chromosome prenatally detected in amniocentesis and FISH, so we reported it with a brief review of literature.
Amniocentesis ; Chromosomes, Human, Pair 15 ; Counseling ; Diagnosis ; Female ; Humans ; In Situ Hybridization, Fluorescence ; Incidence ; Karyotype ; Maternal Age ; Metaphase ; Pregnancy ; Pregnancy Trimester, Second