PURPOSE: To investigate the midterm outcome of limbal transplantation combined with continuous systemic immune suppression. METHODS: The medical records of 15 eyes in 14 patients who underwent limbal transplantation were reviewed retrospectively. All had been followed up for 6 months or more. Limbal transplantation was performed with 360 degrees of 0.19 mm partial corneal trephined tissues, accompanied with transient amniotic membrane transplantation. The procedure was accomplished with systemic cyclosporine or mycophenolate. We defined complete success as neither rejection nor epithelial defect; partial success as partial conjunctival ingrowth and neovascularization without epithelial defect; and graft failure as persistent epithelial defect or total conunctivalization with neovascularization. RESULTS: Mean age at surgery was 45.1 years. 9 eyes yielded complete success, 2 had partial success, and graft failure occurred in 4 on an average of 23.4 months postoperatively. Success including complete and partial success showed 67% incidence (4 of 6) of chemical burn, 33% (1 of 3) with Stevens-Johnson syndrome, and 100% (6 of 6) experienced another intractable ocular surface disease. Of 10 eyes (67%), which experienced graft rejection in an average of 2.7 months; 4 demonstrated full recovery with oral corticosteroid and enhanced immunosuppression, 2 presented with chronic graft rejection, and the other 4 ended in graft failure. CONCLUSIONS: Total success rate was revealed as 73.3% for on average 23.4 months in limbal transplantation with continuous systemic immune suppression, utilized for chronic intractable ocular surface disease.
Amnion ; Burns, Chemical ; Cyclosporine ; Graft Rejection ; Humans ; Immunosuppression ; Incidence ; Medical Records ; Retrospective Studies ; Stevens-Johnson Syndrome ; Transplants

PURPOSE: To investigate the midterm outcome of limbal transplantation combined with continuous systemic immune suppression. METHODS: The medical records of 15 eyes in 14 patients who underwent limbal transplantation were reviewed retrospectively. All had been followed up for 6 months or more. Limbal transplantation was performed with 360 degrees of 0.19 mm partial corneal trephined tissues, accompanied with transient amniotic membrane transplantation. The procedure was accomplished with systemic cyclosporine or mycophenolate. We defined complete success as neither rejection nor epithelial defect; partial success as partial conjunctival ingrowth and neovascularization without epithelial defect; and graft failure as persistent epithelial defect or total conunctivalization with neovascularization. RESULTS: Mean age at surgery was 45.1 years. 9 eyes yielded complete success, 2 had partial success, and graft failure occurred in 4 on an average of 23.4 months postoperatively. Success including complete and partial success showed 67% incidence (4 of 6) of chemical burn, 33% (1 of 3) with Stevens-Johnson syndrome, and 100% (6 of 6) experienced another intractable ocular surface disease. Of 10 eyes (67%), which experienced graft rejection in an average of 2.7 months; 4 demonstrated full recovery with oral corticosteroid and enhanced immunosuppression, 2 presented with chronic graft rejection, and the other 4 ended in graft failure. CONCLUSIONS: Total success rate was revealed as 73.3% for on average 23.4 months in limbal transplantation with continuous systemic immune suppression, utilized for chronic intractable ocular surface disease.
Amnion ; Burns, Chemical ; Cyclosporine ; Graft Rejection ; Humans ; Immunosuppression ; Incidence ; Medical Records ; Retrospective Studies ; Stevens-Johnson Syndrome ; Transplants

PURPOSE: Hepatoprotective effect of prostaglandin E1 (PGE1) has been verified in numerous animal experiments but not so apparent in clinical trials. Although the reason for this discrepancy in clinical results is still unknown, one possible explanation is the instability of PGE1. In this study, the hepatoprotective effect of lipo-PGE1, which is known to be stable during pulmonary circulation and have more targeting effect, was investigated in canine partial liver allotansplantation. In order to reckon in the possible injury during harvest of partial liver, lipo-PGE1 was infused from the start of living graft harvest procedure. METHODS: Mongrel dogs weighing about 25 kg were divided into control (n=6) and lipo-PGE1 (n=6) group. Partial liver allotransplantation was performed. In lipo-PGE1 group, lipo-PGE1 was slowly infused through splenic venous cannulation during the donor liver harvesting procedure (50 mg) and continuously infused (60 mg/day) for 48 hrs after reperfusion. The aspartate aminotransferase (AST), alkaline phosphatase (ALP), and lactate dehydrogenase (LDH) were monitored. RESULTS: The AST and ALP levels of the lipo-PGE1 group were significantly lower than that of the control group at both 1 hour and 48 hours after reperfusion. The LDH level in lipo-PGE1 group was lower at 1 hour and 48 hours after reperfusion, but no significant differences were shown between two groups. CONCLUSION: This study demonstrated the hepatoprotective effect of the lipo-PGE1 against ischemia-reperfusion injury in canine partial liver allotransplantation.
Alkaline Phosphatase ; Allografts* ; Alprostadil* ; Animal Experimentation ; Animals ; Aspartate Aminotransferases ; Catheterization ; Dogs ; Humans ; L-Lactate Dehydrogenase ; Liver Transplantation ; Liver* ; Pulmonary Circulation ; Reperfusion ; Reperfusion Injury ; Tissue Donors ; Transplants

The increasingly common use of obstetrical sonography has led to a growing number of prenatally diagnosed neuroblastomas. The two most important factors in the prognosis of clinical neuroblastoma are the age of the patient at diagnosis and the stage of the disease. Patients with disease at an earlier stage and well-differentiated tumors have a better prognosis than those with disease at a more advanced stage and poorly differentiated tumors. We have experienced a case of congenital neuroblastoma that was recognized prenatally by ultrasonography and identified as stage IV disease postnatally. We report the case with brief review of related literatures.
Diagnosis ; Humans ; Neuroblastoma* ; Prenatal Diagnosis ; Prognosis ; Ultrasonography ; Ultrasonography, Prenatal*

OBJECTIVE: To investigate the effect of the type of placenta and the portion of umbilical cord insertion on birthweight and growth discordancy in twin pregnancies. METHODS: We selected 120 twins of 146 multiple pregnancies between March, 2000 and March, 2002, and one fetus of all cases at least weighed 500 g or more and over 24 weeks of gestation. The fetuses were included that 44 twins (88 fetuses) had monochorionic placentas and the 76 twins (152 fetuses) had dichorionic placentas. The dichorionic twins were divided into two groups; one (38 twins, 76 fetuses) showed the fused type of placenta and the other (38 twins, 76 fetuses) showed the separate type of placenta. The types of umbilical cord insertion were also divided into the central portion and the peripheral portion, the peripheral portion was defined within 2 cm of margin of placenta, and included marginal and velamentous insertion of umbilical cord. Stastical analysis were performed with Student t-test and runs test. p<0.05 was defined significantly. RESULTS: 1. The central type of umbilical cord insertion in dichorionic placenta was more frequent than that of monochorionic placenta (p<0.01). 2. The dichorionic infants, regardless the number of placenta, who weighed more than monochorionic infants at birth (p<0.01). 3. Twin pairs with over 25% of growth discordancy were 16 cases (13.3%), which included 9 cases (9/76, 11.8%) of dichorionic placenta and 7 cases (7/44, 15.9%) of monochorionic placenta. The severe growth discordancy was more commonly developed in monochorionic twins than dichorionic twins (p<0.01). 4. Perinatal deaths in twin pairs with over 25% of GD were 12 cases, which included 3 cases (3/18, 16.7%) of dichorions, and 9 cases (9/14, 64.3%) of monochorions. Therefore, perinatal death was showed more commonly in monochorinic twin infants (p<0.01). CONCLUSION: The type of umbilical cord insertion affected the birthweight of dichorionic separated infants. Monochorionic placenta attributed to more severe growth discordancy and increased perinatal death rate than the dichorionic placenta. Antenatal detection of chorionicity and the portion of umbilical cord insertion may improve the perinatal outcome.
Chorion ; Female ; Fetus ; Humans ; Infant ; Mortality ; Parturition ; Placenta* ; Pregnancy ; Pregnancy, Multiple ; Pregnancy, Twin* ; Umbilical Cord*

Anticoagulation with heparin has been the standard management therapy of deep vein thrombosis during pregnancy. Pregnancy is generally considered as a contraindication for thrombolysis. However, anticoagulation therapy alone does not protect the limbs from post-thrombotic syndrome and venous valve insufficiency. Catheter-directed thrombolysis, combined with angioplasty and stenting, can remove the thrombus and restore patency of the veins, resulting in prevention of post-thrombotic syndrome and valve insufficiency. We report successful catheter-directed thrombolysis and stenting in two early gestation patients with a deep vein thrombosis of the left lower extremity.
Angioplasty ; Catheters ; Extremities ; Female ; Heparin ; Humans ; Lower Extremity ; Pregnancy ; Pregnancy Complications, Cardiovascular ; Pregnancy Trimester, First ; Stents ; Thrombosis ; Veins ; Venous Thrombosis ; Venous Valves

PURPOSE: To investigate the changes in corneal curvature after suture removal in penetrating keratoplasty. METHODS: Forty-six patients who underwent penetrating keratoplasty without any other surgery which may affect on the corneal keratometric values were included, and their data were retrospectively reviewed. The mean follow-up was 11.5 months and the average donor-recipient size gap was 0.47 mm. Corneal curvature was estimated by the Simulated Keratometric index in 17 eyes with continuous sutures and in 29 eyes with interrupted sutures. The changes of corneal curvature were compared between suture-removed and not suture-removed groups. RESULTS: In patients with continuous suture, the corneal curvature increased significantly from 47.12D at 5.1 months to 49.30D at 10.6 months after suture removal (p=0.002); in patients with interrupted suture, corneal curvature increased from 37.93D at 4.1 months to 42.44D at 11.5 months (p<0.001) after an average removal of 4.23 interrupted sutures, but it was not changed in each not suture-removed groups. CONCLUSIONS: Corneal curvature increased, on average, by 2.18D after one continuous suture removal and by 2.26D after an average of 2.12 interrupted sutures removal in penetrating keratoplasty. Prediction of keratometric value after removal of the sutures can be helpful to determine intraocular lens power in cataract surgery simultaneously combined with penetrating keratoplasty.
Cataract ; Follow-Up Studies ; Humans ; Keratoplasty, Penetrating* ; Lenses, Intraocular ; Retrospective Studies ; Sutures*

Heterotopic pregnancy is defined as simultaneous intrauterine and extrauterine pregnancy. The incidence of heterotopic pregnancy was about 1 to 30,000 pregnancies, but it has been increased. This increased incidence is explained by the rise in PID, pelvic surgery, IUD and assisted reproductive technologies-in vitro fertilization/gamate intrafallopian insemination/intrauterine insemination. Thus careful pelvic examination combined with serial beta-hCG determinations and transvaginal sonography to evaluate the adnexal region are necessary prerequisites for early diagnosis. We report a case of heterotopic pregnancy following in ovulation induction and intrauterine insemination with a brief review of literature.
Early Diagnosis ; Female ; Gynecological Examination ; Incidence ; Insemination* ; Ovulation Induction* ; Ovulation* ; Pregnancy ; Pregnancy, Ectopic ; Pregnancy, Heterotopic*

Chronic infection with Epstein-Barr virus (EBV) without previous immunodeficiency or immuno-suppressive therapy is relatively rare. Severe chronic active EBV (SCAEBV) infection was reported for the first time in 1984 as 'chronic mononucleosis syndrome', and diagnostic criteria were proposed. It is characterized by clinical features including fever, severe hepatosplenomegaly, lymphadenopathy, hematologic features such as anemia and thrombocytopenia, and elevated antibody titers to EBV. We experienced a 21-year-old woman who initially presented with fever and chronic fatigue; however, no definite diagnosis could be made at the time of admission. Three months after the initial admission, there was evidence of only splenomegaly and the patient had persistent, multiple, paraaortic lymphadenopathies in abdominal CT. Diagnostic splenectomy was performed, and SCAEBV infection with T-cell lymphoproliferative disorder was ultimately diagnosed.
Adult ; Chronic Disease ; Diagnosis, Differential ; Epstein-Barr Virus Infections/*complications/*diagnosis ; Female ; Humans ; Lymphoproliferative Disorders/*diagnosis/pathology/virology ; Severity of Illness Index ; Splenectomy ; *T-Lymphocytes ; Tomography, X-Ray Computed

PURPOSE: To evaluate visual outcome and the changes of contrast sensitivity (CS) after diffuse lamellar keratitis (DLK). METHODS: Using retrospective chart review, 48 eyes of 25 patients who underwent laser in situ keratomileusis (LASIK) with Visx S4 (VISX Inc., Santa Clara, CA) and M2 (Moria, France) and who were followed for at least six months were included. They were divided into two groups: DLK and non-DLK, by diagnosis of DLK or its absence after LASIK. Postoperative logMAR visual acuities and logCS measured using the VCTS(R) 6500 (Vistech Consultants, Inc., Dayton, OH) were compared with preoperative values in the DLK and non-DLK groups at three and six months after LASIK. RESULTS: There was no difference in logMAR visual acuity between the DLK and non-DLK groups until the sixth postoperative month. However, CS was significantly decreased at 12 and 18 cycle/degree compared with preoperative values (p=0.043 and p=0.045, respectively) in the DLK group, whereas CS was significantly increased at 12 cycle/degree in the non-DLK group (p=0.042) at six months. CONCLUSIONS: DLK seemed to be strongly associated with a postoperative decrease of CS.
*Visual Acuity ; Retrospective Studies ; Keratomileusis, Laser In Situ/*adverse effects ; Keratitis/*etiology/*physiopathology ; Humans ; *Contrast Sensitivity ; Adult