Purpose: To analyze the repeatability of manual measurement of foveal avascular zone (FAZ) area in an optical coherence tomography angiography (OCTA) image in high myopia. Methods: This study comprised patients with high myopia and controls. Two consecutive FAZ areas of the superficial and deep capillary plexus were obtained using OCTA. The intraclass correlation coefficient (ICC) and coefficient of variation (CV) were assessed, and univariate and multivariate generalized linear mixed models were conducted to identify factors related to repeatability. Results: Thirty eyes with high myopia and 34 eyes of healthy subjects were included in the study. The mean age in high myopia and control subjects was 55.5 and 60.8 years, respectively, the mean spherical equivalent was −9.98 and −0.55 diopters, and the mean axial length was 28.0 and 23.9 mm. The ICCs of FAZ area of the superficial capillary plexus (SCP) were 0.891 and 0.919, while the CVs were 8.8% and 8.5%. In measurement of the deep capillary plexus, the ICCs were 0.788 and 0.907, while the CVs were 11.2% and 11.0%, which were acceptable but exhibited lower repeatability than those of SCP. Multivariate analyses showed that older age (p = 0.030) and greater axial length (p = 0.005) were significantly associated with lower repeatability of SCP FAZ area measurements. In addition, greater axial length (p = 0.044) was a significant factor for lower repeatability of deep capillary plexus FAZ area measurements. Conclusions Manual measurement of FAZ area using OCTA exhibited relatively good repeatability for high myopia. Age and axial length affected repeatability and should be considered when analyzing FAZ areas in high myopia patients.

BACKGROUND: To evaluate the role of free fatty acids on the ischemic myocardium, influences of various free fatty acids upon transmembrane action potential and ATP-sensitive K+(KATP) channel activity were examined in the ventricular myocardium and single cardiac myocytes. METHODS: KATP channel activities were measured in the enzymatically (collagenase) isolated single rat ventricular cardiac myocytes by the method of the excised inside-out and the cell-attached patch clamp, and transmembrane action potentials were recorded using the conventional 3M-KCl microelectode techniques in the rat ventricular myocardium. RESULTS: Free fatty acids [FFAs; arachidonic acid (AA), linoleic acid (LA) and lysophosphatidylcholine (LPC)] reduced the KATP channel activity in a dose-dependent manner in the inside-out patch, and 50%-inhibition concentrations (IC50) were 88 +/- 11.2, 49 +/- 12.5, and 188 +/- 17.4 M respectively. Both frequency of channel opening and the mean open-burst duration were markedly decreased, but the amplitude of single channel currents were not changed by the FFAs. AA (50 micrometer) and LPC (50 micrometer) did not affect the dinitrophenol (DNP, 50 micrometer)-induced KATP channel activity, whereas LA (50 micrometer) had a tendency to reduce the activity. The channel inhibition effects by 10 micrometer AA in the inside-out patch were significantly augmented by diclofenac (10 micrometer), but was not changed by nordihydroguaiaretic acid. FFAs never stimulated KATP channel activity, even in the inside-out patch where KATP channel activity reduced in the presence of internal ATP (100 micrometer). Time for 90% repolarization (APD90) significantly increased during superfusion of the FFAs, to 22 (50 micrometer AA), 24 (50 micrometer LA), and 18 (50 micrometer LPC) % from those of the contol at the time of 10 min superfusion, but the other action potential characteristics were not changed by the FFAs. AA (10 micrometer) attenuated cromakalim (10 micrometer)-induced APD90 shortening effects. CONCLUSION: It was inferred that FFAs inhibit the KATP channel activity directly by themselves and/or indirectly by their metabolites in the rat ventricular cardiomyocytes, and therefore, duration of action potential lengthens to be a burden over the ischemic myocardium accounting for the injury of myocardium at the late stage of ischemia.
Action Potentials* ; Adenosine Triphosphate ; Animals ; Arachidonic Acid ; Cromakalim ; Diclofenac ; Fatty Acids, Nonesterified* ; Ischemia ; Linoleic Acid ; Lysophosphatidylcholines ; Masoprocol ; Myocardium* ; Myocytes, Cardiac ; Potassium Channels* ; Potassium* ; Rats*

Streptococcal toxic shock like syndrome is a rapidly progressive and a fatal disease like staphylococcal toxic shock syndrome. In spite of the wide expansion and development of potent antibiotics, streptococcal infection still threatens human being. Recently we experienced a patient with toxic shock like syndrome who was suffered from fever and neck pain with rapid progression to hypotension and multiorgan failure. Streptococcus pyogenes was proven in his throat culture which was done on admission. Pleural effusion and suspicious carditis with aortic and mitral valve regurgitation were examined on the third hospital day. He was treated successfully with antibiotics but we wanted to emphasize potentially fatal streptococcal toxic shock like syndrome in pediatric patients.
Anti-Bacterial Agents ; Fever ; Humans ; Hypotension ; Mitral Valve Insufficiency ; Myocarditis ; Neck Pain ; Pharynx ; Pleural Effusion* ; Shock, Septic* ; Streptococcal Infections ; Streptococcus pyogenes

PURPOSE: Human amniotic membrane has been used to variable ocular surface disorder. We report a case of the usefulness of amniotic membrane transplantation (AMT) for vernal keratoconjunctivitis "Shield ulcer". METHODS: A 12-year-old male patient was diagnosed to have vernal keratoconjunctivitis "Shield ulcer" and treated with medical therapy for four weeks. But he showed severe itiching, foreign body sensation, decreased visual acuity and continued to corneoconjunctival lesion and then, Amniotic membrane transplantation with stromal side down was performed after debridement of the ulcer bed and therapeutic contact lens was applied. RESULTS: At tenth day after AMT, ulcer size was decreased and corneal state was generally improved with restoration of visual acuity. One month after, he has been comfortable with improved visual acuity, giant papillae of upper tarsal conjunctiva was nearly complete remission. CONCLUSIONS: AMT is an effective method for managing vernal keratoconjunctivitis "Shield ulcer", that are refractory to conventional medical treatment.
Amnion* ; Child ; Conjunctiva ; Conjunctivitis, Allergic* ; Debridement ; Foreign Bodies ; Humans ; Male ; Sensation ; Ulcer* ; Visual Acuity

This study was conducted to evaluate the blood lead levels in 141 pregnant women who were not occupationally exposed to lead and their umbilical cord, arid to identify some differences in blood lead levels by living area. ; The subjects-were all delivered at St. Benedict Hospital in Pusan and the blood lead levels were measured by graphite furance atomic absorption spectrophotometer. The summarized results were as follows. 1. The geometric mean lead levels in maternal and cord blood were 8.0+/-1.8microgram/dl, 5.0+/-0.6lmicrogram/dl respectively. 2. Lead levels in maternal (8.7+/-1.7microgram/dl) and cord blood(5.4+/-0.7microgram/dl) of industrial area(n=24) were higher than residential area(n= 124) which were 7.9+/-1.7microgram/dl and 5.0+/-0.6microgram/dl respectively (p<0.05). 3. Maternal blood lead concentration was significantly correlated to cord blood lead concentration (r=0.6090, p<0.001), but other variables (maternal age, paternal smoking, birth weight, etc) were not correlated.
Absorption ; Birth Weight ; Busan ; Female ; Fetal Blood* ; Graphite ; Humans ; Occupations ; Paternal Age ; Pregnant Women ; Smoke ; Smoking ; Umbilical Cord*

PURPOSE: The phosphodiesterases (PDEs) are critical components in the cyclic AMP/protein kinase A and the cyclic GMP/phosphokinase G signaling pathways. The cAMP and cGMP pathways are regulated by activation and dissolution of PDEs. Benfotiamine, a lipophilic derivation of thiamine is known an activator of transketolase, is reported to prevent diabetic nephropathy by decreasing proteinuria and reducing oxidative stress. We did this study to investigate the effect of benfotiamine in type 2 diabetic rat kidneys. MATERIALS AND METHODS: We prepared 10 male Long-Evans Tokushima Fatty (LETO: control) and 20 male Otsuka Long-Evans Tokushima Fatty (OLETF) rats, which developed non-insulin-dependent diabetes mellitus (NIDDM) naturally. An oral glucose tolerance test confirmed diabetic development in the OLETF rats at 26 weeks. We classified 10 of the OLETF rats into Group I, the no treatment group and the other 10 into Group II, the treatment group. Group II received 100 mg/kg benfotiamine after developing DM. At 44 weeks, we checked kidney weight, serum glucose, free testosterone, insulin, total cholesterol, and triglyceride before sacrifice. We designed the primers for rat PDE5, PDE5A1, and PDE5A2 genes were carried out semiquantitive multiplex RT-PCR. Immunohistochemical staining was performed for monoclonal mouse anti-cGB-PDE5 and mouse monoclonal anti-smooth muscle alpha-actin. RESULTS: For the Control Group, Group I, and Group II, kidney weight was 2.13+/-0.23, 2.08+/-0.22, and 1.94+/-0.44 g; serum glucose was 279.50+/-56.79, 338.00+/-55.00, and 314.71+/-139.1 mg/dl; free testosterone was 1.46+/-1.08, 1.05+/- 0.42, and 0.72+/-0.56 pg/dl; insulin was 1.03+/-0.43, 1.09+/-0.83, and 1.15+/-1.08 ng/ml; total cholesterol was 86.83+/-4.79, 132.00+/-7.69, and 118.14+/-30.93 mg/dl; and triglyceride was 78.83+/-16.47, 177.83+/-75.62, and 194.57+/-92.57 mg/dl, respectively. All three groups expressed PDE5, PDE5A1, PDE5A2 mRNA, but Group I PDE5 mRNA expression was lower than that of Group C, II. However, the expression of PDE5A1 and PDE5A2 mRNA was not significantly different among the three groups. CONCLUSIONS: Serum cholesterol, triglyceride, and glucose were significantly higher in OLETF than in LETO rats. The PDEs were lower in diabetic rat (OLETF) kidneys and PDEs may play a significant role in the development of diabetic renal complications. Benfotiamine is suggested to increase expression of PDE5 mRNA in the type 2 diabetes rat kidney, but the difference in expression levels between PDE5A1 and PDE5A2 was not significant. These findings suggest that benfotiamine may play a specific role in diabetic changes of the rat kidney via a PDE5-related pathway, but it is not clear whether subtype PDE5A1 and PDE5A2 genes play a specific role.
Actins ; Animals ; Cholesterol ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Diabetic Nephropathies ; Diethylstilbestrol ; Glucose ; Glucose Tolerance Test ; Humans ; Insulin ; Kidney ; Male ; Mice ; Muscles ; Oxidative Stress ; Phosphoric Diester Hydrolases ; Phosphotransferases ; Protein Isoforms ; Proteinuria ; Rats ; Rats, Inbred OLETF ; RNA, Messenger ; Testosterone ; Thiamine ; Transketolase

The purposes of initial preservation solution are rapid cooling of the organ and washing out the intravascular components. After the introduction of University of Wisconsin (UW) solution, it has become the standard organ preservation solution in liver transplantation. However, due to several problems such as high viscosity and potassium concentration, let alone its cost, there has been several attempts to use UW solution in combination with other preservation solutions for initial perfusion of the graft during the organ harvest procedure. In order to evaluate the efficacy of Ringers' Lactated (RL) solution as an initial perfusion solution, we performed orthotopic hepatic allografts on dogs. In 4 dogs, UW solution was used as the initial perfusion solution and in the other 4, RL solution was used. After initial perfusion, UW solution was used successively for the preservation of the graft. All harvested grafts were stored in UW solution. Average cold ischemic time was 163.5 minutes for RL group and 159 minutes for UW group. The two groups were compared in terms of hematologic and biochemical markers before and after the transplantation. The extent of graft injury during cold ischemia and after reperfusion was also compared directly under light and electron microscope. There was no difference in cold and warm ischemic time, anhepatic time, and total operation time between the two groups. The groups did not differ in liver function test, complete blood count and coagulation profile. Histologic exams also showed similar changes between the two groups. In conclusion, RL solution can be used as the initial perfusion solution in hepatic transplantation.
Allografts ; Animals ; Biomarkers ; Blood Cell Count ; Cold Ischemia ; Dogs ; Hepatectomy* ; Humans ; Linear Energy Transfer ; Liver Function Tests ; Liver Transplantation* ; Liver* ; Organ Preservation ; Perfusion* ; Potassium ; Reperfusion ; Tissue Donors* ; Transplants ; Viscosity ; Warm Ischemia ; Wisconsin

Primary cardiac myxosarcoma is extremely rare, which is uncommon in primary cardiac tumors. We report a primary cardiac myxosarcoma in a 40-year-old female patient who was admitted to the hospital because of exertional dyspnea and palpitation. The patient underwent emergency operation immediately after the intracardiac (left atrium) tumor was discovered by an echocardiography. Palliative tumor removal was done and final pathologic diagnosis was primary cardiac myxosarcoma. She was discharged without complications.
Adult ; Diagnosis ; Dyspnea ; Echocardiography ; Emergencies ; Female ; Heart Neoplasms ; Humans ; Myxoma ; Myxosarcoma*

The infected endocarditis related permanent pacemaker occurs rare and most of them occur at generator pocket but endocarditis related permanant pacemaker lead itself occurs very rarely. The rate of infection after pacemaker implantation is reported as 0.13-7% or 0.13-19.9% and mortality rate is up to 24-33%. Focal inflammation of generator pocket is easily detected but it is difficult to diagnose endocarditis related pacemaker lead and it has poor prognosis. Especially, early diagnosis is most important because endocarditis related pacemaker is fatal. Thirteen years ago, a womon was inserted the permanent pacemaker and then only generator was removed after one month. We report a case that we had removed the pacemaker lead by open thoracostomy and cardiopulmonary circulation to treat endocarditis related pacemaker lead.
Early Diagnosis ; Endocarditis* ; Inflammation ; Mortality ; Prognosis ; Thoracostomy

BACKGROUND: Several studies have shown considerable disagreement when using the FEV1 and PEFR to assess the severity of an airflow obstruction. A differential classification of the severity of asthma would lead to serious differences in the evaluation and management of asthma. The aim of this study was to examine the relationship between the FEV1 and PEFR in asthma patients with mild symptoms. METHODS: In this study, the PEFR and FEV1 were obtained from 92 adult asthma patients with mild symptoms attending an outpatient pulmonary clinic. The mean differences and the limits of agreement in the paired measurements of the FEV1 and PEFR were calculated. RESULTS: There was a considerable correlation between the FEV1 and PEFR measurements when expressed as a % of the predicted values (r=0.686, p<0.01). The 95% limit of agreement (mean difference +/-1.96SD) between the FEV1 % and PEFR % were acceptable(-27.4%~33.8%). In addition, the weighted k(kappa) coefficient for the agreement between the FEV1 % and PEFR % was 0.74 (95% CI, 0.63-0.81), indicating excellent agreement between the two measurements. CONCLUSION: The spirometer (FEV1) and the Mini-Wright peak flow meter (PEFR) can be used interchangeably in adult asthma patients with mild symptom.
Adult ; Asthma* ; Classification ; Humans ; Outpatients ; Peak Expiratory Flow Rate*