Purpose: To report recurrent idiopathic choroidal neovascularization (CNV) in an adolescent.Case summary: A 14-year-old male presented with reduced vision in the right eye, 3 weeks in duration. His best-corrected visual acuity (BCVA) was 0.2. He lacked any medical or ocular history, any family history of retinal disease, and any trauma history. Autorefraction yielded a spherical equivalent of -4.75 diopters. Neither posterior staphyloma nor myopic macular degeneration was apparent in a fundus photograph. However, the photograph revealed a greyish foveal lesion with a subretinal hemorrhage, but was otherwise unremarkable. Optical coherence tomography and fluorescein angiography revealed foveal CNV with a subretinal hemorrhage and fluid. As no feature known to cause CNV was apparent, we diagnosed idiopathic CNV and prescribed right-eye intravitreal ranibizumab injections. After treatment, the BCVA became 1.0, but the CNV continued to recur; he has received 26 intravitreal ranibizumab injections over the last 47 months. Conclusions Most idiopathic CNVs in adolescents are well-treated with fewer injections. However, CNV can continue to recur; multiple intravitreal injections and careful monitoring may be required.

Purpose: The results of the Hahn Chun Suk color test (Hahn test) and the Farnsworth-Munsell D-15 test (D-15 test) were compared in patients with acute optic neuritis. Methods: Patients with acute optic neuritis evaluated using both the Hahn and D-15 tests in the acute phase and 2 months later were evaluated. The results of the acute phase tests were compared. Correlations were sought between color deficiency and all of visual acuity, the visual field index (VFI), and the severity of optic disc edema. Changes in the test results 2 months later were also evaluated and correlated with other visual functions. Results: Twenty-seven eyes of 22 patients were enrolled. The mean patient age was 49.4 years and the logarithm of the minimum angle of resolution visual acuity 0.5. In the acute phase, the perception number was 10.06 in the Hahn test. On the D-15 test, the ‘strong’ grade predominated (40.7%). The concordance rates of severity and type were 55.6 and 54.5% between the two tests. In 9 of 12 eyes exhibiting inconsistent severity, the D-15 test afforded better results than did the Hahn test. A significant positive correlation was evident between the Hahn test results and visual acuity (r = 0.560, p = 0.002). The mean deviation (MD) and the VFI also correlated with the results of the Hahn test (r = -0.432, p = 0.027 for the MD; r = -0.517, p = 0.007 for the VFI). The D-15 test results correlated only with visual acuity (r = 0.476, p = 0.012). After 2 months, the results of both tests correlated significantly only with visual acuity. Conclusions In the acute phase, the concordances of the Hahn and D-15 test results were 55.6% in terms of severity and 54.5% in terms of type. The Hahn test results correlated with the visual acuity and VFI. In contrast, the D-15 test results correlated with visual acuity only.

PURPOSE: To evaluate the effect of intravitreal aflibercept according to subfoveal choroidal thickness in patients with polypoidal choroidal vasculopathy (PCV). METHODS: We retrospectively analyzed the medical records of 60 eyes from 60 patients with PCV treated with intravitreal aflibercept. The patients were followed for at least 6 months after the first injection. Using software, subfoveal choroidal thickness was manually measured as the distance from the hyper-reflective line of Bruch's membrane to the chorioscleral interface on optical coherence tomography. The patients were divided into three groups based on subfoveal choroidal thickness. Visual acuity, subfoveal choroidal thickness, central macular thickness and largest pigment epithelial detachment (PED) height, polyp regression rate, and dry macula rate were evaluated to analyze the anatomical and functional outcomes. RESULTS: Baseline mean subfoveal choroidal thickness were 178.50 ± 28.42 µm in the thin group (14 eyes, 23.3%), 287.03 ± 43.58 µm in the medium group (33 eyes, 55.0%), and 379.77 ± 17.09 µm in the thick group (13 eyes, 21.7%). Baseline age, sex, visual acuity, central macular thickness, and the largest PED height did not differ significantly among the three subgroups. Only the thin group showed significant improvement of visual acuity at 6 months (p = 0.005). Subfoveal choroidal thickness, central macular thickness, and largest PED height were significantly decreased after treatment in all subgroups and did not differ among the subgroups. Compared with the other groups, the thin subfoveal choroidal thickness group showed higher polyp regression rate at 3 months and higher dry macula rate at 6 months (p = 0.013 and p = 0.004, respectively). CONCLUSIONS: Intravitreal aflibercept injection was effective for the treatment of PCV, and thin subfoveal choroidal thickness was associated with better anatomical and functional outcomes.
Bruch Membrane ; Choroid* ; Humans ; Medical Records ; Polyps ; Retrospective Studies ; Tomography, Optical Coherence ; Visual Acuity

A microemulsion formulation of cyclosporine (CsE) is more bioavailable than conventional cyclosporine (CsA) in renal transplants. Because the risk of acute and chronic rejection is related inversely to cyclosporine bioavalability and cyclosporine has a low therapeutic window, these benefits of CsE with an improved pharmacokinetic profile on clinical efficacy are also of interest. To assess the long-term safety and tolerability of CsE, this comparable study was performed. One hundred thirty one primary living donor renal recipients were included in this study. They were divided two groups in the CsE group (N=50) and CsA group (N=81) who had been received either CsE or CsA as a main immunosuppressant since their transplantation for two years. There were no differences between two groups in initial dose at that time of transplantation, target trough level, strategies of anti-rejection therapy. Acute rejections occurred less frequently in CsE group than CsA group (9/50 vs. 28/81, p=0.041). No significant differences were noted in incidence of chronic rejection, graft loss, drug-associated com plications such as hypertension, diabetes mellitus, infection and survival rates of grafts and patients. Renal function, as measured by serum creatinine levels was comparable over time in both groups. The mean daily doses of CsE were higher than CsA group since post-transplant six months, but, no significant differences in trough levels between the two grups. There were marked decreases in standard deviation of daily doses and trough level those meant inter-individual variations in CsE group compared to those of CsA group. In conclusion, despite the more predictable and stabilized pharmacokinetic benefits in CsE group, no significant increases in the incidence of drug-associated adverse effects were observed within post-transplant two years. The safety, tolerability, efficacy of CsE and CsA were comparable.
Allografts* ; Creatinine ; Cyclosporine* ; Diabetes Mellitus ; Graft Rejection ; Humans ; Hypertension ; Immunosuppression ; Incidence ; Kidney Transplantation ; Living Donors ; Survival Rate ; Transplants

Benzbromarone is a uricosuric agent for hyperuricemia and gout. Some of its well-known side effects include hypersensitivity, renal calculi, and gastrointestinal problems. Although the drug was withdrawn from U.S. market due to severe hepatotoxicity, it is still available in some countries including Korea. We describe a 19-year-old male who was admitted with general weakness and azotemia after use of benzbromarone. A kidney biopsy revealed acute tubular necrosis without an evidence of urate nephropathy. After discontinuation of benzbromarone, the renal function returned to baseline. This is the first case of acute tubular necrosis associated with benzbromarone use.
Azotemia ; Benzbromarone ; Biopsy ; Gout ; Humans ; Hypersensitivity ; Hyperuricemia ; Kidney ; Kidney Calculi ; Korea ; Male ; Necrosis ; Transplants ; Uric Acid ; Young Adult

PURPOSE: The tunneled hemodialysis catheter has been widely used for a temporary or an alternative permanent vascular access in patients requiring hemodialysis. The tunneled hemodialysis catheter is also widely used for a reliable vascular access in children who need stem cell transplantation. METHOD: We reviewed the results of 150 catheters inserted in 108 patients for the duration of the indwelling catheter, the complication rate and the reasons for insertion and removal. RESULT: The mean duration of the indwelling catheter was 5.7 months (1 d~52.2 mo). In the stem cell transplantation group, the mean duration of the indwelling catheter was significantly longer than for the hemodialysis group (mean: 9.9 mo vs. 3.6 mo, P<0.05). Fifty-one catheters (39.8%) were removed due to complications. The most common complications were infection (n=23: 17.9%) and dislocation (n=15: 11.7%). In the hemodialysis group, the complication-related catheter removal was more frequent than in the stem cell transplantation group (43.9% vs. 32.6%, P<0.05). CONCLUSION: The tunneled hemodialysis catheter remains a reliable short-term vascular access for hemodialysis and a good vascular access in stem cell transplantation.
Catheterization, Central Venous ; Catheters* ; Catheters, Indwelling ; Child* ; Dislocations ; Humans ; Renal Dialysis* ; Stem Cell Transplantation

PURPOSE: In the passive Heymann nephritis (PHN) rat model of membranous nephropathy, complement induces glomerular epithelial cell injury and proteinuria, which is partially mediated by reactive oxygen species (ROS), TGF-beta, and COX-2. In the current study, we determined the effect of a selective COX-2 inhibitor (celecoxib) and vitamin C on the enzyme system associated with ROS, TGF-beta, and COX-2 in PHN. METHODS: Four groups of rats with PHN were dosed with polyethylene glycol vehicle (P; n=4), celecoxib (COXi; n=8), vitamin C (VC; n=8), or celecoxib and vitamin C (COXi+VC; n=8) from days 7-21. Each group was then divided into 2 subgroups reflecting the day of the experiment (day-14 and -21 subgroups). RESULTS: The urine protein was significantly reduced in the VC and COXi+VC groups (subgroup day- 14) compared to the P group (p<0.05). The glomerular TGF-beta expression was reduced in the COXi+ VC group (subgroup day-21) compared to the P group (p<0.05). Glomerular COX-2 expression was increased in the COXi, VC, and COXi+VC groups compared to the P group (p<0.05). The COXi, VC, and COXi+VC groups (subgroup day-21) had decreased activity of lipid peroxide and xanthine oxidase and increased activity of xanthine dehydrogenase, superoxide dismutase, GSH-Px, and catalase. This antioxidant activity was highest in the COXi+VC group (p<0.05). CONCLUSION: Selective COX-2 inhibitors possess antioxidant effects. The combination of a COX-2 inhibitor and vitamin C was more effective than COX-2 inhibitor or vitamin C alone in increasing antioxidant activity and decreasing TGF-beta.
Animals ; Antioxidants ; Ascorbic Acid ; Catalase ; Complement System Proteins ; Cyclooxygenase 2 ; Cyclooxygenase 2 Inhibitors ; Epithelial Cells ; Glomerulonephritis, Membranous ; Polyethylene Glycols ; Proteinuria ; Pyrazoles ; Rats ; Reactive Oxygen Species ; Sulfonamides ; Superoxide Dismutase ; Transforming Growth Factor beta ; Vitamins ; Xanthine Dehydrogenase ; Xanthine Oxidase

Background: This clinical trial was conducted to determine whether combined use of magnesium sulfate and vitamin C more significantly reduced postoperative fentanyl consumption and pain than magnesium sulfate or vitamin C alone. Methods: The prospective, double-blinded, randomized controlled study enrolled 132 patients scheduled for laparoscopic gynecologic surgery. The patients were randomly allocated to one of the four groups (n = 33 for each group; Group M [magnesium sulfate 40 mg/kg], Group V [vitamin C 50 mg/kg], Group MV [magnesium sulfate 40 mg/kg and vitamin C 50 mg/kg] and Group C [isotonic saline 40 ml]). Cumulative postoperative fentanyl consumption (primary endpoint measure), postoperative pain score by numeric rating scale, and postoperative nausea and vomiting were recorded at 1, 6, 24, and 48 h after discharge from the postanesthesia care unit. Results: Cumulative postoperative fentanyl consumption was significantly less in Groups M, V, and MV than in Group C at all time points. Group MV showed significantly less cumulative postoperative fentanyl consumption than Group M at postoperative 24 h (mean ± standard deviation, 156.6 ± 67.5 vs. 235.6 ± 94.6 μg, P = 0.001), as well as significantly less consumption than Groups M and V at postoperative 48 h (190.8 ± 74.6 vs. 301.0 ± 114.8 or 284.1 ± 128.6 μg, P < 0.001, P = 0.003, respectively). Conclusions Combined use of magnesium sulfate and vitamin C provides an additional benefit in postoperative pain management after laparoscopic gynecologic surgery in comparison to single administration of magnesium sulfate or vitamin C.

PURPOSE: The popliteal artery is the site of uncommon conditions such as popliteal artery entrapment syndrome (PAES), adventitial cystic disease (ACD) and aneurysmal disease. Because of their rarity, these nonatheromatous conditions are often not diagnosed until they reach an advanced stage. We conducted this retrospective study to analyse the clinical characteristics of popliteal arterial disease and to establish a proper diagnostic and therapeutic strategy. METHODS: Among the 31 patients who underwent an operation for popliteal arterial disease between Jan. 1986 and Dec. 1998 in SNUH, 14 patients with isolated popliteal arterial disease were included in this study, excluding 17 patients with combining significant arterial disease in other area. The symptoms, risk factors for vascular disease, laboratory findings, radiologic findings and the patency rate after operation were analyzed. RESULTS: The mean age of the patients were 38 years (12~64) and male-to-female ratio was 13:1. There were 6 cases of PAES, 2 cases of popliteal aneurysms, ACD and thromboangiitis obliterans respectively, and 1 case of atherosclerosis obliterans and embolism each. Arteriography was performed in all cases and duplex sonogram (5 cases), CT (2), CT angiography (3), and MR angiography (2) was performed additionally. For treatment of the arterial occlusion, bypass or interposition graft was done in all cases. Along with the arterial reconstruction, division of medial head of gastrocnemius muscle was done in 4 cases of PAES, excision in 1 case of ACD, and aneurysmectomy in 1 case of popliteal aneurysm. Patency rates of the graft after 1 and 3 years were 92% and 80.9% respectively. There was no limb or patient loss. CONCLUSION: Isolated occlusive disease of popliteal artery is mostly nonatheromatous condition such as PAES or ACD. Therefore those diseases should be suspected in young patient with leg ischemia without other risk factor for systemic vascular disease. Duplex ultrasound and CTA or MRA are accurate diagnostic tools to differentiate the lesions and make the proper therapeutic plan.
Aneurysm ; Angiography ; Atherosclerosis ; Embolism ; Extremities ; Head ; Humans ; Ischemia ; Leg ; Muscle, Skeletal ; Popliteal Artery ; Retrospective Studies ; Risk Factors ; Thromboangiitis Obliterans ; Transplants ; Ultrasonography ; Vascular Diseases

PURPOSE: Takayasu arteritis is an inflammatory arteriopathy which predominantly affects young females and involves the aorta and its major branches. There is little information on reconstructive arterial surgery for Takayasu arteritis. We aim to evaluate the effectiveness and safety of the operation performed for symptomatic Takayasu arteritis. METHOD: Eighteen patients (5 men and 13 women) with Takayasu arteritis treated surgically from 1985 to 1999 at Seoul National University Hospital were reviewed. RESULT: Hypertension was the main symptom in our patients. Four paitients initially underwent medical treatment. Eighteen patients have undergone 21 vascular procedures for the occlusive arterial disease. Surgical indications included renovascular hypertension (17), cerebrovascular insufficiency (3), and extremity ischemia (1). Twelve patients with renovascular hypertension treated by unilateral or bilateral aortorenal bypass. Six patients have undergone renal autotransplantation. Aorto-aortic bypass was performed in 4 abdominal aortic coarctation. Two patients with cerebrovascular ischemia were treated by aortocarotid bypass. One patient with upper extremity and cerebrovascular ischemia have undergone femoroaxillary bypass and axillovertebral bypass. There were no postoperative mortality or morbidity except acute renal failure in one patients with full recovery. Revision of the initial reconstruction has been required for recurrent renovascular hypertension in two patients. All patients except two showed beneficial effect after procedures for renovascular hypertension. CONCLUSION: Surgical treatment of symptomatic Takayasu arteritis is highly effective and safe. Symptomatic improvement and excellent long-term graft patency can be expected after arterial reconstrucion. Considering their young age, aggressive surgical intervention is needed in the patient with Takayasu arteritis.
Acute Kidney Injury ; Aorta ; Aortic Coarctation ; Autografts ; Cerebrovascular Disorders ; Extremities ; Female ; Humans ; Hypertension ; Hypertension, Renovascular ; Ischemia ; Male ; Mortality ; Seoul ; Takayasu Arteritis* ; Transplants ; Upper Extremity