No abstract availalbe.
Fluid Therapy*

This discussion will highlight the following 9 specific points that related to metabolic acidosis caused by various toxins. The current recommendation suggests that alcohol dehydrogenase inhibitor fomepizole is preferred to ethanol in treatment of methanol and ethylene glycol poisoning, but analysis of the enzyme kinetics indicates that ethanol is a better alternative. In the presence of a modest increase in serum osmolal gap (<30 mOsm/L), the starting dose of ethanol should be far less than the usual recommended dose. One can take advantage of the high vapor pressure of methanol in the treatment of methanol poisoning when hemodialysis is not readily available. Profuse sweating with increased water ingestion can be highly effective in reducing methanol levels. Impaired production of ammonia by the proximal tubule of the kidney plays a major role in the development of metabolic acidosis in pyroglutamic acidosis. Glycine, not oxalate, is the main final end product of ethylene glycol metabolism. Metabolism of ethylene glycol to oxalate, albeit important clinically, represents less than 1% of ethylene glycol disposal. Urine osmolal gap would be useful in the diagnosis of ethylene glycol poisoning, but not in methanol poisoning. Hemodialysis is important in the treatment of methanol poisoning and ethylene glycol poisoning with renal impairment, with or without fomepizole or ethanol treatment. Severe leucocytosis is a highly sensitive indicator of ethylene glycol poisoning. Uncoupling of oxidative phosphorylation by salicylate can explain most of the manifestations of salicylate poisoning.
Acidosis ; Alcohol Dehydrogenase ; Ammonia ; Eating ; Ethanol ; Ethylene Glycol ; Ethylenes ; Glycine ; Imidazoles ; Kidney ; Kinetics ; Methanol ; Nitro Compounds ; Oxidative Phosphorylation ; Pyrazoles ; Renal Dialysis ; Sweat ; Sweating ; Vapor Pressure ; Water

Prolonged imbalance between input and output of any element in a living organism is incompatible with life. The duration of imbalance varies, but eventually balance is achieved. This rule applies to any quantifiable element in a compartment of finite capacity. Transient discrepancies occur regularly, but given sufficient time, balance is always achieved, because permanent imbalance is impossible, and the mechanism for eventual restoration of balance is foolproof. The kidney is a central player for balance restoration of fluid and electrolytes, but the smartness of the kidney is not the reason for perfect balance. The kidney merely accelerates the process. The most crucial element of the control system is that discrepancy between intake and output inevitably leads to a change in total content of the element in the system, and uncorrected balance has a cumulative effect on the overall content of the element. In a living organism, the speed of restoration of balance depends on the permissible duration of imbalance without death or severe disability. The three main factors that influence the speed of balance restoration are: magnitude of flux, basal store, and capacity for additional storage. For most electrolytes, total capacity is such that a substantial discrepancy is not possible for more than a week or two. Most control mechanisms correct abnormality partially. The infinite gain control mechanism is unique in that abnormality is completely corrected upon completion of compensation.
Acid-Base Equilibrium ; Body Composition ; Compensation and Redress ; Electrolytes ; Kidney

This study was performed to investigate histopathologically the effect of amniotic membrane graft (AMG)on haze in deep stromal wound of cornea. The excimer laser phototherapeutic keratectomy (PTK)was used to create the wound model of 150 micrometerdepth, 6.0 mmdiameter area in 72 white rabbitsbilaterally.Each eye was randomized to three groups: control (topical antibiotic alone), contact lens application and AMG. Corneal haze,the number of anterior stromal keratocytes and thickness of the regenerated stroma were evaluated after treatments in corneal wound, and also the morphological changes of anterior stroma connected with corneal haze were analyzed. The score of corneal haze in AMG group was significantly lower than those in the others at postoperative 3 days, 2, 4, 6 and 8 weeks. The anterior stromal keratocytes in AMG group significantly remained more than those in the others at postoperative 3 days. The number of keratocytes and thickness of regenerated stromal tissue in wound area of AMG group were statistically lower as compared with those of the other groups at postoperative 4 weeks. The architecture of stromal lamella was most reg-ular in AMG group. Transmission electron microscopic observation demonstrated that the cells in anterior stroma were the active fibroblastic cells with prominent rough endoplasmic reticulum at postoperative 8 weeks. These findings indicate that corneal haze is closely connected with proliferation of corneal stroma , suggesting that AMG on deep corneal stromal wound reduces corneal haze by preventing proliferation of abnormal collagen and fibroblasts at the anterior stroma of the wound area.
Amnion* ; Collagen ; Cornea ; Corneal Stroma ; Endoplasmic Reticulum, Rough ; Fibroblasts ; Lasers, Excimer ; Transplants ; Wounds and Injuries

To evaluate the effect of amniotic membrane on corneal wound healing, using the VISX 193-nanometer excimer laser, the wound model of 150 micrometer depth, 6.0 mmdiameter area was created in 30 white rabbits (60 eyes). The treatment of corneal wound was categorized into three groups :topicalantibiotics alone (control), therapeutic contact lens application and amniotic membrane graft. The area of epithelial defect, proliferation of epithelial cells and inflammatory cell infiltration were evaluated during the entire observation period. Epithelial healing rates calculated by radius regression in control, contact lens and amniotic membrane groups were 42.5 micrometer/hr, 33.4 micrometer/hr and 53.4micrometer/hr respectively thus the effect of amniotic membrane was significantly outstanding (P<0.05). The epithelium was healed almost within 72 hours in eyes of amniotic membrane group but significantly delayed in contact lens group. The number of inflammatory cells in stroma were significantly lower in amniotic membrane group than others. The number of PCNA (proliferating cell nuclear antigen) immunoreactive cells has increased in amniotic membrane group than other groups and regionally at basal cell layer of limbus comparing to wound margin at first, third days after treatment. In view of the above findings, amniotic membrane on corneal wound accelerates the process of wound healing, with minimal complications.
Amnion* ; Cornea* ; Epithelial Cells ; Epithelium ; Lasers, Excimer ; Proliferating Cell Nuclear Antigen ; Rabbits ; Radius ; Transplants ; Wound Healing* ; Wounds and Injuries*

Background: and Purpose The Treat Stroke to Target (TST) was a randomized clinical trial involving French and Korean patients demonstrating that a lower low-density lipoprotein cholesterol (LDL-C, <70 mg/dL) target group (LT) experienced fewer cerebro-cardiovascular events than a higher target (90–110 mg/dL) group (HT). However, whether these results can be applied to Asian patients with different ischemic stroke subtypes remains unclear. Methods: Patients from 14 South Korean centers were analyzed separately. Patients with ischemic stroke or transient ischemic attack with evidence of atherosclerosis were randomized into LT and HT groups. The primary endpoint was a composite of ischemic stroke, myocardial infarction, coronary or cerebral revascularization, and cardiovascular death. Results: Among 712 enrolled patients, the mean LDL-C level was 71.0 mg/dL in 357 LT patients and 86.1 mg/dL in 355 HT patients. The primary endpoint occurred in 24 (6.7%) of LT and in 31 (8.7%) of HT group patients (adjusted hazard ratio [HR]=0.78; 95% confidence interval [CI]=0.45–1.33, P=0.353). Cardiovascular events alone occurred significantly less frequently in the LT than in the HT group (HR 0.26, 95% CI 0.09–0.80, P=0.019), whereas there were no significant differences in ischemic stroke events (HR 1.12, 95% CI 0.60–2.10, P=0.712). The benefit of LT was less apparent in patients with small vessel disease and intracranial atherosclerosis than in those with extracranial atherosclerosis. Conclusion In contrast to the French TST, the outcomes in Korean patients were neutral. Although LT was more effective in preventing cardiovascular diseases, it was not so in stroke prevention, probably attributed to the differences in stroke subtypes. Further studies are needed to elucidate the efficacy of statins and appropriate LDL-C targets in Asian patients with stroke.

Background: and Purpose The Treat Stroke to Target (TST) was a randomized clinical trial involving French and Korean patients demonstrating that a lower low-density lipoprotein cholesterol (LDL-C, <70 mg/dL) target group (LT) experienced fewer cerebro-cardiovascular events than a higher target (90–110 mg/dL) group (HT). However, whether these results can be applied to Asian patients with different ischemic stroke subtypes remains unclear. Methods: Patients from 14 South Korean centers were analyzed separately. Patients with ischemic stroke or transient ischemic attack with evidence of atherosclerosis were randomized into LT and HT groups. The primary endpoint was a composite of ischemic stroke, myocardial infarction, coronary or cerebral revascularization, and cardiovascular death. Results: Among 712 enrolled patients, the mean LDL-C level was 71.0 mg/dL in 357 LT patients and 86.1 mg/dL in 355 HT patients. The primary endpoint occurred in 24 (6.7%) of LT and in 31 (8.7%) of HT group patients (adjusted hazard ratio [HR]=0.78; 95% confidence interval [CI]=0.45–1.33, P=0.353). Cardiovascular events alone occurred significantly less frequently in the LT than in the HT group (HR 0.26, 95% CI 0.09–0.80, P=0.019), whereas there were no significant differences in ischemic stroke events (HR 1.12, 95% CI 0.60–2.10, P=0.712). The benefit of LT was less apparent in patients with small vessel disease and intracranial atherosclerosis than in those with extracranial atherosclerosis. Conclusion In contrast to the French TST, the outcomes in Korean patients were neutral. Although LT was more effective in preventing cardiovascular diseases, it was not so in stroke prevention, probably attributed to the differences in stroke subtypes. Further studies are needed to elucidate the efficacy of statins and appropriate LDL-C targets in Asian patients with stroke.

Background: and Purpose The Treat Stroke to Target (TST) was a randomized clinical trial involving French and Korean patients demonstrating that a lower low-density lipoprotein cholesterol (LDL-C, <70 mg/dL) target group (LT) experienced fewer cerebro-cardiovascular events than a higher target (90–110 mg/dL) group (HT). However, whether these results can be applied to Asian patients with different ischemic stroke subtypes remains unclear. Methods: Patients from 14 South Korean centers were analyzed separately. Patients with ischemic stroke or transient ischemic attack with evidence of atherosclerosis were randomized into LT and HT groups. The primary endpoint was a composite of ischemic stroke, myocardial infarction, coronary or cerebral revascularization, and cardiovascular death. Results: Among 712 enrolled patients, the mean LDL-C level was 71.0 mg/dL in 357 LT patients and 86.1 mg/dL in 355 HT patients. The primary endpoint occurred in 24 (6.7%) of LT and in 31 (8.7%) of HT group patients (adjusted hazard ratio [HR]=0.78; 95% confidence interval [CI]=0.45–1.33, P=0.353). Cardiovascular events alone occurred significantly less frequently in the LT than in the HT group (HR 0.26, 95% CI 0.09–0.80, P=0.019), whereas there were no significant differences in ischemic stroke events (HR 1.12, 95% CI 0.60–2.10, P=0.712). The benefit of LT was less apparent in patients with small vessel disease and intracranial atherosclerosis than in those with extracranial atherosclerosis. Conclusion In contrast to the French TST, the outcomes in Korean patients were neutral. Although LT was more effective in preventing cardiovascular diseases, it was not so in stroke prevention, probably attributed to the differences in stroke subtypes. Further studies are needed to elucidate the efficacy of statins and appropriate LDL-C targets in Asian patients with stroke.