Purpose: To confirm that the phaco chop method using an illuminated chopper (iChopper; Oculight, Seongnam, Korea) can reduce cataract surgery complications, and that even beginners can safely and effectively perform phaco chop. Methods: We retrospectively analyzed the medical records of the first 30 phaco chop cases using illuminated chopper of four cataract surgeons. Four ophthalmologists had a variety of empirical backgrounds, from those who have experienced more than 10,000 cataract surgery, to beginners who have experienced 20 cataract surgery. Results: Of the total 120 eyes, two eyes (1.67%) had posterior capsule rupture. The chopping method was changed from phaco chop to stop and chop in three eyes (2.5%) including one eye with brown cataract with pseudoexofoliation syndrome and two eyes with nuclear opacity grade ≥5. Conclusions The rates of posterior capsule rupture of phaco chop using an illuminated chopper were very low in four surgeons with various experiences and who became proficient shortly in phaco chop.

ELISA has been used for the diagnosis of toxoplasmosis, but it is being gradually replaced by a rapid diagnostic test (RDT). We compared and analyzed ELISA and RDT results using the sera collected during 4 consecutive years from residents of Gyodong-do (Island), Incheon-city, Korea. Sera from 921, 993, 940, and 838 adult residents were collected on a yearly basis (2010–2013). ELISA was performed by using a crude extract of T. gondii RH strain antigen and IgG/IgM RDT mounted with recombinant fragment of major surface antigen (SAG1), GST-linker-SAG1A, were applied to the sera. Comparison between groups was analyzed by the Student’s t-test. The positive seroprevalence surged from 14.7% (135/921, 2010), 23.1% (231/993, 2011), 23.6% (222/940, 2012), and 32.1% (269/838, 2013) by ELISA. In contrast, RDT showed a more moderate increasing trend from 21.7% (200/921, 2010), 25.5% (253/993, 2011), 28.9% (272/940, 2012) and 33.1% (277/838, 2013). Discrepancies between ELISA and RDT were noted near the cut-off value. At the OD 0.15–0.24 range, RDT could detect 16.1% (169/1051) more positives, which suggests an early or acute toxoplasmosis, but at the OD 0.25–0.34 range, ELISA could detect 35.9% (92/256) more positives of possible chronic infections. Over the OD > 0.35 ELISA and RDT agreed in the majority of the cases. This surge in seroprevalence may be caused by the organic agriculture in addition to eating behavior or increase in pets among Koreans. These facts may be applied on a full-scale national survey using RDT to supplement ELISA to define the characteristics of the infection.
Adult ; Antigens, Surface ; Diagnosis ; Diagnostic Tests, Routine* ; Enzyme-Linked Immunosorbent Assay* ; Feeding Behavior ; Follow-Up Studies* ; Humans ; Incheon* ; Korea* ; Organic Agriculture ; Seroepidemiologic Studies* ; Toxoplasma ; Toxoplasmosis*

Bleomycin-induced pulmonary toxitity usually occurs in the elderly patients (graeatee than 70 years old), patients with a cumulative dose above 400 units, previous chest radiotherapy, oxygen therapy, and reanal failure. H owever, there are some reports of severe pneumonitis in that developed after dministering low bleomycin doses (less than 100 units). In sever bleomycin-induced pneumonitis in non-Hodgkin's lymphoma patients, the response to corticosteroid is poor and the mortality rate is very high, approximately 83%. Therefore, clinicians should have a low threshold for investigating and treating bleomycin-induced pneumonitis. Here, we report a case of severe bleomycin-induced pneumonitis as a complication of a non-Hodgkin's lymphoma treatment.
Aged ; Bleomycin ; Humans ; Lymphoma, Non-Hodgkin* ; Mortality ; Oxygen ; Pneumonia* ; Radiotherapy ; Thorax

PURPOSE: To evaluate efficacy and complication of stereotactic radiosurgery using stereotactic body frame. METHODS AND MATERIALS: From December 1997 to June 1999, 11 patients with primary and metastatic tumors were treated with stereotactic radiosurgery using stereotactic body frame(Precision Therapy(TM)). Three patients were treated with primary hepatoma and seven with metastatic tumor from liver, lung, breast, trachea and one with arteriovenous malformation on neck. We used vacuum pillow for immobilization and made skin marker on sternum and tibia area with chest marker and leg marker. Diaphragm control was used for reducing movement by respiration. CT-simulation and treatment planning were performed. Set-up error was checked by CT-Simulator before each treatment. Dose were calculated on the 80~90% isodose of isocenter dose and given consecutive 3 fractions for total dose of 30 Gy (10 Gy/fraction). RESULTS: Median follow-up was 12 months. One patient (9%) showed complete response and four patients (36%) showed partial response and others showed stable disease. Planning target volumes (PTV) ranged from 3 to 111 cc (mean 18.4 cc). Set-up error was within 5 mm in all directions (X, Y, Z axis). There was no complication in all patients. CONCLUSION: In primary and metastatic tumors, stereotactic radiosurgery using stereotactic body frame is very safe, accurate and effective treatment modality.
Arteriovenous Malformations ; Breast ; Carcinoma, Hepatocellular ; Diaphragm ; Follow-Up Studies ; Humans ; Immobilization ; Leg ; Liver ; Lung ; Neck ; Radiosurgery* ; Respiration ; Skin ; Sternum ; Thorax ; Tibia ; Trachea ; Vacuum

BACKGROUND: Most patients feel uneasy about visiting a clinic and thus the trust on their physicians can be affected by the physicians' attire, attitude and greeting. We aimed to investigate the difference between patients' and physicians' preferences to attires and greetings in clinics. METHODS: We conducted a questionnaire survey on 394 outpatients in a university hospital and on 169 doctors from five university hospitals. We questioned to the outpatients about their preference for physicians' dress style, how to address them and the method of greeting. We also questioned to the doctors about their own attire, attitude and etiquette. RESULTS: The patients preferred to be called 'OOO Nim' (54.0%), 'OOO Ssi' (29.2%), 'Hwanjabun' (16.2%) and 'Sunsaengnim' (2.5%). However, the physicians were used to calling patients 'Hwanjabun' (39.2%), 'OOO Nim' (29.6%), 'OOO Ssi' (24.5%) and 'Sunsaengnim' (1.2%) (P<0.001). Both the patients and the physicians preferred physicians'to wear white-gown (70.3% vs 78.7%) in a medical office. Inside the gown, a shirt and a necktie (66.2% vs 71.6%) were favored in both groups. Compared to the patients, the physicians thought that their attitude (23.1% vs 45.6%) and their attire (49.7% vs 55.6%) had a great effect on their professionalism. CONCLUSION: We found that the patients wanted to be called 'OOO Nim', but 'Hwanjabun' was most commonly used by the physicians. Both the patients and the physicians preferred white-gown. We also found that the physicians' attire and attitude were strongly associated with their professionalism.
Hospitals, University ; Humans ; Outpatients ; Surveys and Questionnaires

Autoimmune pancreatitis (AIP) is a rare pancreatic disorder of autoimmune etiology. It has characteristic clinical features, such as pancreatic parenchymal swelling and irregular narrowing of the main pancreatic duct due to plasma cell infiltration. It occurs mostly in Far East Asia. Although it generally involves whole pancreatic parenchyma, some cases demonstrate focal involvement of the pancreas or adjacent organs, which are often mistaken for cancer. We report a case of AIP that was confused with cholangiocarcinoma of the distal common bile duct (CBD). The patient experienced sudden development of jaundice with vague abdominal discomfort. Abdominal computed tomography revealed a well-enhanced lesion, and positron emission tomography showed high standard uptake value at the distal CBD, indicating malignant disease. However, pathological examination by surgical excision indicated focal-type AIP. This is believed to be the first case of focal-type AIP mimicking cholangiocarcinoma.
Asia ; Autoimmunity ; Cholangiocarcinoma ; Common Bile Duct ; Far East ; Humans ; Jaundice ; Pancreas ; Pancreatic Ducts ; Pancreatitis ; Plasma Cells ; Positron-Emission Tomography

BACKGROUND AND OBJECTIVES: Laryngotracheal stenosis (LTS) in burned patients with inhalation injury have features distinct from other stenosis after intubation or tracheotomy. However, the risk factors for LTS in burned patients with inhalation injury have not been thoroughly assessed. The aim of this study is to identify the risk factors for and evaluate the pattern of LTS in burned patients with inhalation injury. SUBJECTS AND METHOD: From May 2005 to April 2007, 227 burned patients with inhalation injury treated at the Hangang Sacred Heart Hospital, Hallym University Medical Center were investigated retrospectively. The risk factors analyzed for LTS in burned patients with inhalation injury were gender, age, duration of intubation, size of the endotracheal tube, previous tracheotomy, number of intubations, severity of inhalation injury. RESULTS: Among 81 patients who survived and could be followed up until the study period, 10 (12%) patients developed LTS. The stenosis involved the subglottis.cervical trachea (5), subglottis.cervical tracheal and glottis (1), glottis (4). According to Myer-Cotton classification, there were 6 (60%) patients with grade III, IV stenoses on subglottis.cervical trachea. The number of intubations and previous tracheotomy were found to be risk factors for the development of LTS in burned patients with inhalation injury. CONCLUSION: LTS by inhalation injury is usually shown on web at the anterior and posterior glottic areas or circumferential narrowing of the subglottis. Repeated endotracheal intubations and previous tracheotomy in patients with inhalation injury may increase the prevalence of LTS.
Academic Medical Centers ; Burns ; Burns, Inhalation ; Constriction, Pathologic ; Glottis ; Heart ; Humans ; Inhalation ; Intubation ; Intubation, Intratracheal ; Laryngostenosis ; Prevalence ; Retrospective Studies ; Risk Factors ; Trachea ; Tracheal Stenosis ; Tracheotomy

BACKGROUND: The aim of this study was to evaluate the response, survival, and toxicities of a less intensive combination of paclitaxel and carboplatin, which is used in advanced non-small cell lung cancer (NSCLC) patients older than 60 years of age including those with a poor performance status. METHODS: Thirty patients received 135 mg/m2 of paclitaxel on day 1, and carboplatin was administered to the patients on day 1 every 4 weeks over an area under the concentration-time curve of 6. RESULTS: The response rate was 40%, the median overall survival was 9.1 months (95% CI, 4.2 to 14 months), and the 1 year survival rate was 31%. The median progression-free survival was 7.7 months (95% CI, 3.1 to 12.2 months). In addition, the toxicities were generally mild and reversible. CONCLUSION: This study demonstrates that a less intensive combination of paclitaxel/carboplatin is active and well tolerated in advanced NSCLC patients who are older than 60 years including those with a poor PS 3~4.
Aged ; Aged, 80 and over ; Antineoplastic Combined Chemotherapy Protocols/adverse effects/*therapeutic use ; Carboplatin/administration & dosage/adverse effects ; Carcinoma, Non-Small-Cell Lung/*drug therapy/pathology ; Dose-Response Relationship, Drug ; Drug Administration Schedule ; Female ; Follow-Up Studies ; Humans ; Lung Neoplasms/*drug therapy/pathology ; Male ; Middle Aged ; Neoplasm Staging ; Paclitaxel/administration & dosage/adverse effects ; Sickness Impact Profile ; Survival Analysis ; Treatment Outcome

Bone marrow necrosis is most frequently diagnosed at postmortem examination. Antemortem diagnosis is uncommon. However, organized studies using either bone marrow biopsy specimens or autopsy material showed that bone marrow necrosis can be demonstrated in approximately one third of specimens. Bone marrow necrosis has been observed during the course of a wide variety of diseases, most commonly in association with acute and chronic leukemia, carcinoma, malignant lymphoma, infections, and sickle cell disease. We report one case of bone marrow necrosis due to miliary tuberculosis. Although appropriate diagnosis and treatment were performed, the patient expired.
Anemia, Sickle Cell ; Autopsy ; Biopsy ; Bone Marrow* ; Diagnosis ; Humans ; Leukemia ; Lymphoma ; Necrosis* ; Tuberculosis ; Tuberculosis, Miliary*

PURPOSE: To identify the prognostic factors related to tumor recurrence and progression in Korean patients with non-muscle-invasive bladder cancer (NMIBC). MATERIALS AND METHODS: Data were collected and analyzed for 2412 NMIBC patients from 15 centers who were initially diagnosed after transurethral resection of bladder tumor (TURBT) from January 2006 to December 2010. Using univariable and multivariable Cox proportional hazards models, the prognostic value of each variable was evaluated for the time to first recurrence and progression. RESULTS: With a median follow-up duration of 37 months, 866 patients (35.9%) experienced recurrence, and 137 (5.7%) experienced progression. Patients with recurrence had a median time to the first recurrence of 10 months. Multivariable analysis conducted in all patients revealed that preoperative positive urine cytology (PUC) was independently associated with worse recurrence-free survival [RFS; hazard ratio (HR) 1.56; p<0.001], and progression-free survival (PFS; HR 1.56; p=0.037). In particular, on multivariable analysis conducted for the high-risk group (T1 tumor/high-grade Ta tumor/carcinoma in situ), preoperative PUC was an independent predictor of worse RFS (HR 1.73; p<0.001) and PFS (HR 1.96; p=0.006). On multivariable analysis in patients with T1 high-grade (T1HG) cancer (n=684), better RFS (HR 0.75; p=0.033) and PFS (HR 0.33; p<0.001) were observed in association with the administration of intravesical Bacillus Calmette-Guérin (BCG) induction therapy. CONCLUSION: A preoperative PUC result may adversely affect RFS and PFS, particularly in high-risk NMIBC patients. Of particular note, intravesical BCG induction therapy should be administered as an adjunct to TURBT in order to improve RFS and PFS in patients with T1HG cancer.
Aged ; Carcinoma in Situ/*mortality/*pathology/therapy ; Disease Progression ; Disease-Free Survival ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local/*mortality/*pathology ; Prognosis ; Proportional Hazards Models ; Republic of Korea ; Retrospective Studies ; Risk ; Urinary Bladder Neoplasms/*mortality/*pathology/therapy