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: To evaluate the changes of refraction and anterior chamber depth in pseudophakia with the single-piece intraocular lenses (IOLs) and the three-piece IOLs after cataract surgery. METHODS: This single-center prospective study comprised of 34 eyes in 27 cataract patients who underwent cataract surgery. Eighteen eyes of seventeen patients received the single-piece IOLs, and sixteen eyes of fifteen patients received the three-piece IOLs. At one day, one week, and six months after cataract surgery, the refraction, corneal thickness, and anterior chamber depth of both groups were measured and analyzed. RESULTS: The refraction after cataract surgery was not significantly different from the preoperative predictive refraction in both IOL groups. The corneal thickness increased significantly as compared with preoperative value at operative day in both groups. However, after 1 week postoperatively, there was no statistically significant difference between the preoperative and the postoperative corneal thickness. The anterior chamber depth of the single-piece IOL group decreased constantly, and the decrease was statistically significant at 6 months postoperatively. In the three-piece group the anterior chamber depth was stationary and there was no statistically significant change from 1 day postoperatively. CONCLUSIONS: There was remarkable difference of the changes of anterior chamber depth after cataract surgery between the single-piece and the three-piece IOL groups. In particular, the relative decrease of anterior chamber depth of the single-piece IOL group would affect the postoperative refractive errors.
Anterior Chamber* ; Cataract ; Humans ; Lenses, Intraocular* ; Prospective Studies ; Pseudophakia ; Refractive Errors

PURPOSE: To investigate the clinical characteristics of patients with pseudophakic negative dysphotopsia after cataract surgery and to analyze the risk factors of pseudophakic negative dysphotopsia as well as the postoperative effects on patient's satisfaction. METHODS: This study included 1,020 eyes of 690 patients who underwent phacoemulsification and posterior chamber lens insertion between January 2010 and March 2012. Retrospective chart review was conducted to evaluate the prevalence of negative dysphotopsia according to the site of clear corneal incision during cataract surgery and the type of implanted intraocular lens (IOL). The clinical outcome of Neodymium:yttrium-aluminium-garnet (Nd:YAG) laser anterior capsulotomy in negative dysphotopsia patients was evaluated. Using a telephone survey, patients were asked to subjectively answer 18 questions regarding satisfaction after cataract surgery, the severity of visual symptoms and the effect of negative dysphotopsia in their daily life. RESULTS: Negative dysphotopsia developed in patients who underwent uneventful cataract surgery and successful implantation of IOL in the bag. The patients' vision was corrected up to 20/20 (0.00 log MAR) and HVF P60-4 showed no abnormality in their visual field. There were significantly more patients with the SN60WF IOL who reported negative dysphotopsia but no other factors associated with the prevalence of negative dysphotopsia. During the telephone survey, patients complained of difficulties in their daily life related to the negative dysphotopsia symptoms and reported decreased satisfaction after cataract surgery. CONCLUSIONS: Although negative dysphotopsia can decrease the patient's satisfaction after cataract surgery, the genesis of negative dysphotopsia and an objective method to test for negative dysphotopsia is necessary. Therefore, a prospective large study should be conducted to evaluate the cause and treatment of negative dysphotopsia.
Cataract ; Humans ; Lenses, Intraocular ; Phacoemulsification ; Prevalence ; Pseudophakia ; Retrospective Studies ; Risk Factors ; Telephone ; Visual Fields

PURPOSE: To investigate the clinical characteristics of patients with pseudophakic negative dysphotopsia after cataract surgery and to analyze the risk factors of pseudophakic negative dysphotopsia as well as the postoperative effects on patient's satisfaction. METHODS: This study included 1,020 eyes of 690 patients who underwent phacoemulsification and posterior chamber lens insertion between January 2010 and March 2012. Retrospective chart review was conducted to evaluate the prevalence of negative dysphotopsia according to the site of clear corneal incision during cataract surgery and the type of implanted intraocular lens (IOL). The clinical outcome of Neodymium:yttrium-aluminium-garnet (Nd:YAG) laser anterior capsulotomy in negative dysphotopsia patients was evaluated. Using a telephone survey, patients were asked to subjectively answer 18 questions regarding satisfaction after cataract surgery, the severity of visual symptoms and the effect of negative dysphotopsia in their daily life. RESULTS: Negative dysphotopsia developed in patients who underwent uneventful cataract surgery and successful implantation of IOL in the bag. The patients' vision was corrected up to 20/20 (0.00 log MAR) and HVF P60-4 showed no abnormality in their visual field. There were significantly more patients with the SN60WF IOL who reported negative dysphotopsia but no other factors associated with the prevalence of negative dysphotopsia. During the telephone survey, patients complained of difficulties in their daily life related to the negative dysphotopsia symptoms and reported decreased satisfaction after cataract surgery. CONCLUSIONS: Although negative dysphotopsia can decrease the patient's satisfaction after cataract surgery, the genesis of negative dysphotopsia and an objective method to test for negative dysphotopsia is necessary. Therefore, a prospective large study should be conducted to evaluate the cause and treatment of negative dysphotopsia.
Cataract ; Humans ; Lenses, Intraocular ; Phacoemulsification ; Prevalence ; Pseudophakia ; Retrospective Studies ; Risk Factors ; Telephone ; Visual Fields

Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by severe headaches with or without other acute neurological symptoms, and diffuse segmental constriction of cerebral arteries that resolves spontaneously within 3 months. A 44-year-old woman underwent heart transplantation due to primary amyloidosis with heart involvement. She started to have a seizure after three hours after the heart transplantation, and her consciousness was not recovered. Computed tomography and transcranial doppler sonography were used to diagnose RCVS, and contracted vessels were recovered after oral nimodipine administration.
Adult ; Amyloidosis ; Cerebral Arteries ; Consciousness ; Constriction ; Female ; Headache ; Heart Transplantation* ; Heart* ; Humans ; Nimodipine ; Seizures ; Ultrasonography, Doppler, Transcranial ; Vasoconstriction*

OBJECTIVE: The authors investigated whether rotenone induces cellular death also in non-dopaminergic neurons and high concentration of potassium ion can show protective effect for non-dopaminergic neuron in case of rotenone-induced cytotoxicity. METHODS: Neuro 2A cells was treated with rotenone, and their survival as well as cell death mechanism was estimated using 3-(4, 5-Dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium(MTT) assay, Lactate dehydrogenase(LDH) release assay, fluorescence microscopy, and agarose gel electrophoresis. The changes in rotenone-treated cells was also studied after co-treatment of 50mM KCl. And the protective effect of KCl was evaluated by mitochondrial membrane potential assay and compared with the effects of various antioxidants. RESULTS: Neuro 2A cells treated with rotenone underwent apoptotic death showing chromosome condensation and fragmentation as well as DNA laddering. Co-incubation of neuro 2A cells with 50mM KCl prevented it from the cytotoxicity induced by rotenone. Intracellular accumulation of reactive oxygen species(ROS) resulting by rotenone were significantly reduced by 50mM KCl. Potassium exhibited significantly similar potency compared to the antioxidants. CONCLUSION: The present findings showed that potassium attenuated rotenone-induced cytotoxicity, intracellular accumulation of ROS, and fragmentation of DNA in Neuro 2A cells. These findings suggest the therapeutic potential of potassium ion in neuronal apoptosis, but the practical application of high concentration of potassium ion remains to be settled.
Antioxidants ; Apoptosis* ; Cell Death ; DNA ; Electrophoresis, Agar Gel ; Lactic Acid ; Membrane Potential, Mitochondrial ; Microscopy, Fluorescence ; Neurons* ; Oxygen ; Potassium* ; Rotenone

Central anticholinergic syndrome (CAS) can be caused by many anesthetic drugs. Early diagnosis and treatment are very important because untreated CAS may result in a life-threatening condition. Physostigmine, though not available in Korea, is the only drug which can confirm and treat CAS. A forty five year old patient underwent open heart surgery due to patent foramen ovale. Anesthetic agents which were used for anesthetic induction and maintenance were midazolam, fentanyl and isoflurane. Following anesthesia, he showed irritated and excited behavior and delayed recovery from anesthesia more than 3 h after operation in the ICU, even though flumazenil and naloxone were given to rule out the residual anesthetic effect. After physostigmine 4 mg was administered intravenously, he calmed down and became more coherent. There was no evidence of neurologic deficit in the following brain MRI and neurologic examination. We report the first case of CAS confirmed with physostigmine in Korea.
Anesthesia ; Anesthetics ; Anticholinergic Syndrome* ; Brain ; Delayed Emergence from Anesthesia ; Early Diagnosis ; Fentanyl ; Flumazenil ; Foramen Ovale, Patent ; Heart* ; Humans ; Isoflurane ; Korea ; Magnetic Resonance Imaging ; Midazolam ; Naloxone ; Neurologic Examination ; Neurologic Manifestations ; Physostigmine* ; Thoracic Surgery*

PURPOSE: To report cases of complications after using punctual plugs with a literature review. METHODS: We studied 3 complicated cases after the use of punctual plugs: a 46-year-old female with recurrent mucopurulent discharge, a 42-year-old male with a pinkish mass over the punctum, and a 29-year-old female with recurrent epiphora. RESULTS: The 46-year-old female was diagnosed with canaliculitis caused by actinomyces, the 42-year-old male with chronic pyogenic granuloma, and the 29-year-old female with canalicular obstruction. All 3 cases improved after proper treatments. CONCLUSIONS: Complications after the use of punctal plugs are not common but they can be significant. They have to be used carefully after through evaluation and obtained proper informed consents from the patient.
Actinomyces ; Adult ; Female ; Granuloma, Pyogenic ; Humans ; Lacrimal Apparatus Diseases ; Male ; Middle Aged ; Canaliculitis

OBJECTIVE: To assess the static balance under the virtual moving surround (VMS) in healthy young and elderly adults. METHOD: There were twenty four healthy young adults and thirty nine healthy elderly aged 60 and older. Each group was tested with forceplate during quite standing with eyes opened, closed and under the VMS for static balance. The VMS was stimulated with a head-mounted display (HMD). The parameters for static balance were total sway path distance and area. RESULTS: All static balance parameters of healthy elderly were significantly increased in all conditions when compared with parameters of young adults. In the young adults and elderly, total sway path distance and sway area were significantly different under the VMS. In the healthy elderly, total sway path distance and sway area were significantly increased under the VMS as much as eyes closed. CONCLUSION: In the healthy adults, the VMS could provoke the significant postural sway during static standing. VMS can be used as a tool to evaluate and treat of the patients with static balance dysfunction.
Adult ; Aged ; Humans ; Young Adult

Objective: This study aimed to investigate the impact of the coronavirus disease 2019 (COVID-19) outbreak on the emergency department length of stay (ED-LOS) and outcomes of patients admitted with pneumonia. Methods: This was a retrospective observational study that included adult pneumonia patients admitted to the emergency department during the period from February to July 2019 and the corresponding period in 2020. After the COVID-19 outbreak, many changes occurred in medical systems, causing prolonged ED-LOS. We divided ED-LOS into pre-, mid-, and post-ED-LOS and compared ED-LOS, hospital LOS and in-hospital mortality rates of pneumonia patients during the above-mentioned periods. In addition, a multivariable logistic regression analysis was performed to identify the risk factors leading to in-hospital mortality in 2020. Results: A total of 365 patients were included in the study. Pre-ED-LOS, mid-ED-LOS, post-ED-LOS, and in-hospital mortality in the 2020 group were significantly higher than those of the 2019 group (P<0.05). Mid-ED-LOS (odds ratio [OR], 1.474; P=0.001) and post-ED-LOS (OR, 1.098; P=0.024) were identified as being independently associated with an increased risk of in-hospital mortality in 2020. Conclusion Our study shows that ED-LOS and in-hospital mortality increased after the COVID-19 pandemic. Mid-ED-LOS and post-ED-LOS were independently associated with an increased risk of in-hospital mortality in patients with pneumonia in 2020.