To evaluate the postoperative prognostic factors of pars plana vitrectomy for the proliferative diabetic retinopathy, the authors studied retrospectively the surgical results of 65 eyes that have been followed over 6 months postoperatively. The surgical results were varied according to the indication. Seventy six percent of eyes with vitreous hemorrhage obtained final vision of 5/200 or better. Similar results were obtained in 73% of eyes with macular traction detachment, 47% of eyes with rhegmatogenous-traction detachment. Rhegmatogenous-traction detachment has less favorable outcome than vitreous hemorrhage and macular traction detachment. Factors associated with a favorable visual prognosis were as follows: (1) preoperative visual acuity of 5/200 or better, (2) the avoidance of performing lensectomy, (3) the avoidance of using intraocular gas bubbles, (4) the absence of preoperative retinal detachment. Thirteen eyes resulted in anatomic failure ; vitreous hemorrhage was the cause of failure in 4 eyes(31%) and anterior hyaloid fibrovascular proliferation in 3 eyes(23%), The causes of poor visual outcome included optic atrophy in 3 eyes, ischemic maculopathy in 2 eyes, submacular fibrosis in 1 eye and cataract in 1 eye.
Cataract ; Diabetic Retinopathy* ; Fibrosis ; Hemorrhage ; Optic Atrophy ; Prognosis ; Retinal Detachment ; Retrospective Studies ; Traction ; Visual Acuity ; Vitrectomy* ; Vitreous Hemorrhage

PURPOSE: Keratomileusis was performed in rabbits to investigate the effects of corneal epithelium on the corneal stromal keratocyte apoptosis and the effect of human IL-1alpha and TNFalpha on apoptotic genes in human corneal stromal cells was evaluated. METHODS: Fifty six New Zealand white rabbits underwent corneal flap procedure and corneal epithelium was inserted between the corneal flap and underlying stroma. Keratocyte apoptosis was detected with the TUNEL assay. Gene array technique was used to evaluate changes in apoptosis gene in human stromal fibroblasts in response to human recombinant IL-1alpha and TNFalpha in vitro. RESULTS: Keratocyte apoptosis was significantly greater in group for flap with insertion of peripheral epithelium at 4 hours after surgery(p=0.0249). IL-1alpha or TNFalpha regulated the expression of several genes (insulin like growth factor, stress activated protein kinase, GTP binding protein, IGFBP4) up and down in human stromal fibroblasts in culture. CONCLUSIONS: We think that the differences in the stromal cell apoptosis after keratomileusis were due to stromal cell response to various factors of inserted corneal epithelium. We found various new apoptosis gene expression in cultured human keratocytes mediated by IL-1alpha and TNFalpha that were secreted in corneal epithelium. These genes likely trigger the apoptosis of keratocyte following epithelial insertion associated with corneal surgery.
Apoptosis* ; Epithelium ; Epithelium, Corneal* ; Fibroblasts ; Gene Expression ; GTP-Binding Proteins ; Humans ; In Situ Nick-End Labeling ; Keratomileusis, Laser In Situ ; Protein Kinases ; Rabbits ; Stromal Cells ; Tumor Necrosis Factor-alpha

Eales disease is an uncommon idiopathic vasoproliferative retinal disease that primarily affects the peripheral retina. We experienced a 17-year-old male patient who was referred to our clinic because of retinal hemorrhage at the superior temporal quadrant of his left eye. After excluding other causes of branch retinal vein occlusion with medical evaluation, the primary branch retinal vein occlusion was diagnosed. During the follow-up period, retinal vasculitis developed in the peripheral retina of his both eyes along with rapid development of the neovascularization in the left eye. Eales disease was diagnosed. In spite of scattered laser photocoagulation, vitreous hemorrhage eventually occurred, requiring pars plana vitrectomy. We emphasize the occurrence of the branch retinal vein occlusion in young patient with Eales disease.
Adolescent ; Follow-Up Studies ; Humans ; Light Coagulation ; Male ; Retina ; Retinal Diseases ; Retinal Hemorrhage ; Retinal Vasculitis ; Retinal Vein Occlusion* ; Retinal Vein* ; Retinaldehyde* ; Vitrectomy ; Vitreous Hemorrhage

Usual managements of flat anterior chamber following filtering surgery are deepening of anterior chamber using cycloplegics and mydriatics, and pressure patch technique compressing the fistula. But the pressure patch technique may worsen chamber depth problem because exact compression on the filtering area is difficult by pressure patching. Prolonged pressure patching may also cause deterioration of filtering function. The tampon with glaucoma shell provides enough resistance to excessive outflow, allows the anterior chamber to reform promptly, and can prevent choroidal separation. We treated the flat anterior chamber following trabeculectomy using glaucoma shell in 7 eyes. The anterior chamber in each eye was restored promptly within 2-4 days after the placement of glaucoma shell. Glaucoma shell is easy to handle, gives minimal discomfort to patient, and may need less time to restore flat anterior chamber than pressure patching.
Anterior Chamber* ; Choroid ; Filtering Surgery ; Fistula ; Glaucoma* ; Humans ; Mydriatics ; Trabeculectomy*

Glechoma longituba is a common medicinal plant that is common in wet and sunny land. This plant is used to treat various illnesses including jaundice and edema. But, ingestion of the plant can cause severe pain and swelling on lip and mouth. We experienced three cases that had oral pain and sensory change after ingestion of G. longituba, which we report with a literature review.
Eating ; Edema ; Jaundice ; Lamiaceae ; Lip ; Mouth ; Paresthesia ; Plants ; Plants, Medicinal

Superwarfarin, such as brodifacoum, is a highly lethal vitamin K antagonist used as a rodenticide. Brodifacoum has a particularly long half-life in the body, which ranges to several months, and therefore requires prolonged treatment with antidotal vitamin K. We experienced a case whereby an 18-year-old male was presented to the hospital with a severe bleeding disorder. It was discovered that he had ingested brodifacoum rodenticide with intent to commit suicide. Despite continual treatment with vitamin K, the bleeding disorder persisted for several months before he recovered. We report this case with literature review.
4-Hydroxycoumarins ; Adolescent ; Half-Life ; Hemorrhage ; Humans ; Male ; Suicide ; Vitamin K ; Vitamins

PURPOSE: The success of cardiopulmonary resuscitation (CPR) depends on how soon after a heart attack the intervention is done and on how the quality of the CPR is. Although in Korea there are several CPR education courses, CPR done by bystanders to an attack remains very low. This might be related to different causes such as the complexity of the CPR sequence and the difficulty of learning CPR, specifically ventilation maneuvers. The American Heart Association (AHA) has recently recommended 'Hands Only(TM) CPR', without ventilation, for bystander rescuers. In the present study, we investigated the educational effects of 'Hands Only(TM) CPR' in elementary school students. We further analyzed the effects of this variable on CPR skill learning and retention for a 3 months period. METHODS: We selected two groups of 5th grade elementary school students to perform this study. One group received CPR education with ventilation (CPR with ventilation group); the other received 'Hands Only(TM) CPR' education ('Hands Only(TM) CPR' group). The Laerdal PC Skill Reporting system was used for both education sessions and for evaluation immediately after the sessions. Skill performance data, together with ventilation data and compression data were recorded for further comparisons. RESULTS: There were no differences between the two groups regarding chest compression (average rate, average duty cycle, registered with no error, average depth, etc.). The average chest compression count per minute was 118+/-12/min in the 'Hands Only(TM) CPR' group and 85+/-13/min in the CPR with ventilation group (p=0.001). Registered adequate compression depth was 23+/-29% in the 'Hands Only(TM) CPR' group and 23+/-31% in the CPR with ventilation group (p=0.962). The total hands off time was 18+/-7 seconds in the 'Hands Only(TM) CPR' group and 40+/-11 seconds in the CPR with ventilation group. After 3 months there were still no differences in chest compression between the two groups. The average count per minute at 3 months was 109+/-15/min in the 'Hands Only(TM) CPR' group and 83+/-17/min in the CPR with ventilation group (p=0.001). Registered adequate compression depth was 26+/-31% in the 'Hands Only(TM) CPR' group and 31+/-35% in the CPR with ventilation group (p=0.334). The total hands off time was 12+/-5 seconds in the 'Hands Only(TM) CPR' group and 31+/-12 seconds in the CPR with ventilation group (p=0.001). CONCLUSION: The 'Hands Only(TM) CPR' program in elementary school children increased the chest compression rate. However, there was no between groups difference in adequate compression depth. We were unable to demonstrate that the 'Hands Only(TM) CPR' education program in elementary school children led to a better effect.
American Heart Association ; Cardiopulmonary Resuscitation ; Child ; Hand ; Heart ; Humans ; Korea ; Learning ; Retention (Psychology) ; School Health Services ; Thorax ; Ventilation

Insular carcinoma of the thyroid is a rare thyroid malignancy, and this was named in 1984 by Carcangiu when he described its characteristic histology. Histologically, insular carcinoma is characterized by uniform cells arranged in distinct nests or an insular pattern that contain variable numbers of small follicles. Clinically and morphologically, it is considered to be in an intermediate position between well-differentiated carcinoma of the thyroid (papillary or follicular) and undifferentiated or anaplastic carcinoma of the thyroid. This thyroid malignancy is distinctive, aggressive and often lethal. However, most authors believe it to be an independent entity. The prognosis of this tumor is worse than that of classic differentiated thyroid carcinoma, and most authors advise aggressive therapy, which can achieve pro-longed survival in some cases. We describe here a patient (a 42 years-old woman) who was managed with completion thyroidectomy after unilateral lobectomy of the thyroid with confirmation of the permanent pathology as insular carcinoma. I-131 ablation (175 mCi) was performed on the remnant thyroid tissues after follow-up of I~131 whole-body scanning.
Carcinoma ; Follow-Up Studies ; Humans ; Pathology ; Prognosis ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroidectomy

PURPOSE: Dynamic changes in the dimensions of the left ventricle (LV) during cardiac arrest might influence the efficacy of CPR. However, the relationship between change in LV dimensions during cardiac arrest and CPR hemodynamics and outcomes have not yet been addressed. In the present study, we investigated changes in left ventricular volume and area during prolonged, untreated ventricular fibrillation (VF); we related those change to coronary perfusion pressure (CPP) during CPR and resuscitation outcomes. METHODS: In 12 domestic male pigs weighing 40+/-3 kg, VF was electrically induced and left untreated for 15 min. CPR was performed for 5 min prior to defibrillation. CPR was continued until the return of spontaneous circulation (ROSC) or for a maximum of 15 minutes. Mean aortic pressure and right atrial pressures were measured and CPP was calculated. LV dimensions were continuously assessed by echocardiographic measurement during the 15 minutes of interval VF. RESULTS: Six animals were successfully resuscitated. During the 15 minute interval of VF, LV area and volume were reduced in all animals. In animals that were not resuscitated, LV dimensions were significantly lower than those in resuscitated animals (p<0.01). These differences were observed after 10 minutes of VF. The animals with greater reduction in LV dimension during VF achieved significantly lower CPP during CPR in contrast to animals with larger LVs during VF. CONCLUSION: Greater decreases in LV volume and area during cardiac arrest are associated with low CPP during CPR and poor resuscitation outcomes. LV dimensions prior to starting CPR might therefore modulate the effectiveness of resuscitation interventions.
Animals ; Arterial Pressure ; Atrial Pressure ; Cardiopulmonary Resuscitation ; Heart Arrest ; Heart Ventricles ; Hemodynamics ; Humans ; Male ; Perfusion ; Piperazines ; Resuscitation ; Swine ; Ventricular Fibrillation

Antibiotic Prophylaxis ; Chronic Periodontitis ; Diagnosis ; Drug Users ; Endocarditis ; Heart Defects, Congenital ; Humans ; Incidence ; Mortality ; Oral Health ; Rheumatic Heart Disease ; Tooth Extraction