PURPOSE: To investigate the long-term results of transscleral fixation of posterior chamber intraocular lens (IOL) for unstable posterior capsular supporting structure. METHODS: We performed a retrospective review of 67 patients (67 eyes) with unstable posterior capsular supporting structure who underwent transscleral fixation at Soonchunhyang University Bucheon Hospital from March 2005 to January 2013. Transscleral fixation without scleral flap was performed by a single surgeon. We analyzed the causes of transscleral fixation and compared postoperative best-corrected visual acuity (BCVA) and spherical diopter. RESULTS: Among the 67 eyes of 67 patients, the causes of transscleral fixation included IOL subluxation (33 cases, 49.2%), IOL dislocation (11 cases, 16.4%), intraoperative posterior capsule rupture (8 cases, 11.9%), aphakia associated with previous intraocular surgery (7 cases, 10.4%), crystalline lens disorder with zonular dialysis (4 cases, 5.9%) and IOL opacity (4 cases, 5.9%). The mean BCVA before surgery was 1.26 +/- 0.94 (log MAR) and the visual acuity improved to 0.59 +/- 0.71, 0.60 +/- 0.69, 0.58 +/- 0.70, 0.55 +/- 0.70, 0.60 +/- 0.58 and 0.66 +/- 0.70 (1 week, 1 month, 3 months, 1 year, 3 years and 5 years, respectively, after the surgery; p < 0.05). CONCLUSIONS: Posterior chamber IOL transscleral fixation in unstable posterior capsular supporting structure is effective for increasing visual acuity and spherical diopter. Specifically, the most improvement was observed at one month after surgery. Transscleral fixation is an adequate surgical procedure for fast improvement of visual acuity with long-term effects.
Aphakia ; Dialysis ; Dislocations ; Gyeonggi-do ; Humans ; Lens, Crystalline ; Lenses, Intraocular* ; Retrospective Studies ; Rupture ; Visual Acuity

Intrabronchial nerilemmoma is very rare disease. Neurilemmoma has been thought to arise from schwann cell, has been reported to occur in almost any anatomic location. The incidence of primary neurogenic tumors of the lung has been estimated to be 0 to 2 percent of all lung tumors. These tumors are predominantly(75%) associated with neurofibromatosis of von Recklinghausen's disease. To our knowledge, no case of benign solitary endobronchial neurilemmoma has been reported in Korea. This paper presents a case of benign solitary endobronchial neurilemmoma with a brief review of the pertinent literature. A 19 year old female visited our medical hospital with the symptoms of chest discomfort and pain. Bronchoscopy and chest CT scan revealed a mass on the left upper 1obar bronchus. Left upper lobectomy was performed successfully and histological section revealed a neurilemmoma.
Bronchi ; Bronchoscopy ; Female ; Humans ; Incidence ; Korea ; Lung ; Neurilemmoma* ; Neurofibromatoses ; Neurofibromatosis 1 ; Rare Diseases ; Thorax ; Tomography, X-Ray Computed ; Young Adult

PURPOSE: In the present study, a case of posterior surface opacification of a silicone intraocular lens (IOL) in a patient with asteroid hyalosis (AH) is reported. CASE SUMMARY: 76-year-old male was referred to our clinic with IOL opacification in his left eye. The patient had uneventful cataract surgery 7 years prior with the same silicone IOL implanted in both eyes. Three years after surgery, posterior capsular opacity was observed in his left eye and neodymium:YAG (Nd:YAG) laser capulotomy was performed. After posterior capsulotomy, opacification of the IOL's posterior surface was observed on slit lamp examination. IOL exchange was performed and the explanted IOL was analyzed using a light microscope and a scanning electron microscope with energy dispersive X-ray spectroscopy for elemental analysis of the deposits. The calcification was on the posterior surface of the IOL and composed mainly of calcium and phosphorus, the main components of AH. The right eye showed clear IOL with intact posterior lens capsule. CONCLUSIONS: Surgeons performing cataract surgery should consider the possibility of surface calcification of silicone IOLs in eyes with AH before IOL selection for implantation.
Aged ; Calcium ; Cataract ; Humans ; Lenses, Intraocular* ; Male ; Phosphorus ; Posterior Capsulotomy ; Silicon* ; Silicones* ; Slit Lamp ; Spectrometry, X-Ray Emission ; Surgeons

PURPOSE: To report clinical characteristics of thyroid-associated ophthalmopathy (TAO) in patients who previously underwent total thyroidectomy for thyroid cancer or a benign mass of the thyroid. MATERIALS AND METHODS: Of the patients who were diagnosed with TAO from March 2008 to March 2012, we performed a retrospective chart review on those who had undergone total thyroidectomy for thyroid cancer or a benign mass of the thyroid before the occurrence of ophthalmopathy. RESULTS: Of the 206 patients diagnosed with TAO, seven (3.4%) met the inclusion criteria. The mean age of the subjects was 47.4 years, and all were female. Six patients were diagnosed with papillary thyroid cancer, and one was diagnosed with a benign mass. The duration between total thyroidectomy and onset of TAO ranged from 3-120 months (median 48 months). Ophthalmic manifestations varied among cases. Except for the patient who was diagnosed with a benign mass, all patients showed hyperthyroid status and were under Synthroid hormone treatment at the time of TAO development. Five of these six patients had positive levels of thyroid-stimulating hormone (TSH) receptor autoantibodies. CONCLUSION: TAO rarely develops after total thyroidectomy, and the mechanism of TAO occurrence is unclear. However, most patients showed abnormalities in thyroid function and TSH receptor autoantibodies.
Adult ; Aged ; Autoantibodies/blood ; Carcinoma ; Carcinoma, Papillary/immunology/surgery ; Female ; Graves Ophthalmopathy/*diagnosis/immunology ; Humans ; Male ; Middle Aged ; Postoperative Complications/etiology/immunology/pathology ; Receptors, Thyrotropin ; Retrospective Studies ; Thyroid Neoplasms/complications/*surgery ; Thyroidectomy/adverse effects/*methods ; Thyrotropin/blood ; Treatment Outcome

BACKGROUND: Left ventricular diastolic filling is an important determinant for maintenance of cardiac output during hemodialysis. Few investigators have studied the influence of hemodialysis on diastolic function. To evaluate the change of left ventricular systolic and diastolic function, we performed M-mode and Doppler echocardiopraphic studies before and after hemodialysis. METHODS: The study population consisted of 30 patients(15 patients were male, mean age 45+/-10 years) with CRF on maintenance henodialysis. They have normal left ventricular systolic function(Fractional shortening > 30%) and no evidence of valvular heart disease or regional wall motion abnormalities. The ejection fraction(EF) was measured using M-mode echocardiography and Doppler indices such as peak E velocity, peak A velocity, isovolumetric relaxaion time(IVRT), deceleration time(DT), and left ventricular ejection time(LVET) obtained from Doppler echocardiography. The index of myocardial performance(IMP) was calculated from each of the Doppler velocity indices. RESULTS: The weight reduction after hemodialysis was 2.1+/-1.0kg(p<0.0001). After hemodialysiss, there was some decrease in blood pressure(p<0.05), but no significant change in heart rate, EF and fractional shortening, mean VCF, peak A velocity, and DT. And significant in IVRT and IMP(p<0.05, p<0.0001) were noted. CONCLUSTION: In conclusion, preload reduction is the main mechanism that accounts for changes in Doppler diastolic indices after hemodialysis. And and increased IMP suggests that diastolic function may be aggravated after gemodialysis, and that implies impaired left ventricular filling and disturbed left ventricular compliance.
Cardiac Output ; Compliance ; Deceleration ; Echocardiography* ; Echocardiography, Doppler ; Heart Rate ; Heart Valve Diseases ; Humans ; Male ; Renal Dialysis* ; Research Personnel ; Weight Loss

BACKGROUND AND OBJECTIVES: Heart failure rarely occurs in patients with thyrotoxicosis (6%), with half of the cases having left ventricular dysfunction (LVD). Although a few studies reported isolated right heart failure in thyrotoxicosis, there has been no evaluation of relationship between LVD and right ventricular dysfunction (RVD). SUBJECTS AND METHODS: We enrolled 12 patients (mean age: 51+/-11 years, 9 females) diagnosed as having thyrotoxicosis with heart failure and LVD {left ventricular ejection fraction (LVEF) <40%}, and divided them into two groups {Group I with RVD defined as tricuspid annular plane excursion (TAPSE) less than 15 mm and Group II without RVD}. Clinical features, laboratory variables, and echocardiographic parameters were compared between two groups. RESULTS: RVD was found in 6 (50%) patients. On admission, there were no significant differences between the two groups in clinical features, laboratory variables, or echocardiographic parameters including atrial fibrillation {6 vs. 5, not significant (NS)}, heart rate (149+/-38 vs. 148+/-32/min, NS), LVEF (36.7+/-9.5 vs. 35.1+/-6.3%, NS), or the tricuspid regurgitation peak pressure gradient (TRPPG, 30.9+/-2.0 vs. 36.3+/-9.3 mmHg, NS). After antithyroid treatment, all achieved an euthyroid state and both ventricular functions were recovered. All data, including the recovery time of LVEF and the change of heart rate between two groups, displayed no significant differences. CONCLUSION: In half of patients, RVD was combined with thyrotoxicosis-associated LVD. There were no differences in clinical factors or hemodynamic parameters between patients with and without RVD. This suggests that RVD is not secondary to thyrotoxicosis-associated LVD.
Atrial Fibrillation ; Heart Failure ; Heart Rate ; Hemodynamics ; Humans ; Stroke Volume ; Thyrotoxicosis ; Tricuspid Valve Insufficiency ; Ventricular Dysfunction, Left ; Ventricular Dysfunction, Right ; Ventricular Function

Percutaneous transluminal coronary angioplasty (PTCA) is a relatively safe and effective procedure in the treatment of coronary artery disease, but complications related to dilating catheters and guide wires such as coronary artery dissection, spasm, rupture, and perforation can be. Pericardial tamponade is a rare complication of cardiac catheterization, and prompt diagnosis and proper management are important in lifesaving. We report 4 patients who developed pericardial tamponade following PTCA, presumably from coronary artery or right ventricular perforation. All 4 patients received heparin during PTCA and temporary pacemaker was placed in the right ventricle. Pericardial tamponade was recognized in the catheterization laboratory in 1 patient, within 3 hours after leaving the laboratory in 3 patients. Emergent pericardiocentesis was performed in all patients. Three patients recovered and one patient died.
Angioplasty, Balloon, Coronary* ; Cardiac Catheterization ; Cardiac Catheters ; Cardiac Tamponade* ; Catheterization ; Catheters ; Coronary Artery Disease ; Coronary Vessels ; Diagnosis ; Heart Ventricles ; Heparin ; Humans ; Pericardiocentesis ; Rupture ; Spasm

BACKGROUND: Excessive exposure to reactive oxygen species (ROS) or decreased antioxidants leads to damage of proteins, lipids, and DNA. Previous studies suggest that oxidative stress may be important in the pathogenesis of atopic dermatitis. OBJECTIVE: To investigate whether oxidative stress is increased in atopic dermatitis patients compared to a normal control group, we examined DNA damage, lipid peroxidation, ROS production and antioxidant expression. METHODS: Patients with atopic dermatitis (n=16; mean Scoring Atopic Dermatitis [SCORAD] index=53.06) were investigated compared to a normal control group (n=25). To examine DNA damage in the cellular level, we performed comet assays on lymphocytes and granulocytes taken from patients and control group. To measure lipid peroxidation products, urine and plasma malondialdehyde (MDA) levels were analyzed. To examine intracellular redox in lymphocytes, ROS were measured using flow cytometry. Expression of superoxide dismutase (SOD) 1, 2 antioxidants were analyzed using reverse transcription polymerase chain reaction (RT-PCR). RESULTS: Atopic dermatitis patients showed severe DNA damage compared to the control group in both lymphocytes (1.89 and 1.51, respectively, p<0.05) and granulocytes (2.07 and 1.58, respectively, p<0.05). While urine MDA levels were not significantly different between groups (1.64 and 1.13 microM/g respectively, p>0.05), plasma MDA levels were significantly increased in atopic dermatitis patients compared to controls (1.45 and 0.80 microM/g respectively, p<0.005). ROS production by activated lymphocytes was increased in atopic dermatitis patients compared to controls. SOD 1, 2 were expressed in all atopic dermatitis patients without significant increase compared to controls. CONCLUSION: Increased DNA damage, lipid peroxidation and ROS production in lymphocytes as indices of oxidative stress were observed in moderate to severe atopic dermatitis patients compared to normal control. Although precise mechanism of oxidative stress on the pathogenesis of atopic dermatitis is not defined yet, decreasing ROS exposure or augmenting antioxidant defenses may be alternative therapeutic approaches for atopic dermatitis.
Antioxidants ; Comet Assay ; Dermatitis, Atopic* ; DNA ; DNA Damage ; Flow Cytometry ; Granulocytes ; Humans ; Lipid Peroxidation ; Lymphocytes ; Malondialdehyde ; Oxidation-Reduction ; Oxidative Stress ; Plasma ; Polymerase Chain Reaction ; Reactive Oxygen Species ; Reverse Transcription ; Superoxide Dismutase

OBJECTIVE: To evaluate the usefulness of transvaginal ultrasound measurements of cervical length before and after elective prophylactic cervical cerclage in predicting preterm delivery before 32 weeks of gestation. METHODS: Women who underwent an elective cerclage operation at 14 to 19 weeks of gestation and who delivered between January 2004 and December 2009 were enrolled in this study (n=52). Ultrasonography was performed to measure cervical length before and after cerclage. The primary outcome was defined as preterm delivery before 32 weeks of gestation. A receiver operating characteristic curve was used to determine the most discriminating cut-off values of ultrasonographic cervical parameters predictive of preterm delivery before 32 weeks of gestation. RESULTS: Among the 52 patients studied, ten delivered before 32 weeks of gestation. Among the ultrasonographic cervical parameters compared, only the cervical length after cerclage was significantly different (shorter) in patients who delivered before 32 weeks of gestation (P=0.037) compared to that of those who delivered after 32 weeks of gestation in univariate and multivariate analyses (odds ratio, 0.402; 95% confidence interval, 0.174 to 0.925; P=0.021). The receiver operating characteristic curve showed that a cervical length of 25 mm or less after cerclage was predictive of preterm delivery before 32 weeks of gestation (area under curve, 0.71; 95% confidence interval, 0.56 to 0.87; P=0.029) with a sensitivity of 91.0% and a specificity of 30.0%. CONCLUSION: Patients with a cervical length less than 25 mm after elective cerclage may be at higher risk of preterm delivery before 32 weeks of gestation.
Cerclage, Cervical* ; Female ; Humans ; Multivariate Analysis ; Pregnancy ; Premature Birth ; ROC Curve ; Sensitivity and Specificity ; Ultrasonography

BACKGROUND/AIMS: As the population ages, endoscopic retrograde cholangiopancreaticography (ERCP) is being used increasingly as a diagnostic and therapeutic tool for elderly patients with pancreatobiliary disease. The aim of this study was to assess the outcomes, safety and complications associated with ERCP performed in the elderly patients. METHODS: We retrospectively reviewed the medical record of 596 patients who were 50 years of age or older and underwent ERCP from January 2005 to September 2010. The patients were classified into two groups according to the age: non-elderly, 50-74 years old and elderly, > or =75 years old. Comparisons were made between two groups. RESULTS: Five hundred and ninety-six patients (132 elderly and 464 non-elderly patients) were enrolled. The success rate of ERCP was 89.4% in the elderly and 91.9% in the non-elderly. The major complications were occurred in 11 patients of the elderly and 16 of the non-elderly, and the complication rate was significantly higher in the elderly compared to the non-elderly (8.3% vs. 3.4%, p=0.011). Pancreatitis occurred in 2 elderly patients and 10 non-elderly patients (1.5% vs. 2.1%, p=1.0). There was a higher rate of bleeding in the elderly patients (4.5% vs. 1.3%, p=0.01). CONCLUSIONS: ERCP is effective and safe even in elderly patients. Outcomes of diagnostic and therapeutic ERCP in the elderly patients were similar to those in non-elderly patients. Elderly patients undergoing ERCP carried similar risk of pancreatitis but a higher risk of bleeding and perforation compared to non-elderly patients.
Aged ; Aged, 80 and over ; Cholangiopancreatography, Endoscopic Retrograde/*adverse effects ; Female ; Hemorrhage/etiology ; Humans ; Male ; Middle Aged ; Pancreatitis/etiology