PURPOSE: To evaluate therapeutic effects and usefulness of a combination treatment of intravitreal injection of triamcinolone acetonide (IVTA) and panretinal photocoagulation (PRP) in patients with clinically significant macular edema secondary to proliferative diabetic retinopathy (PDR). METHODS: Visual acuity test, fundoscopy, fluorescein angiography, and optical coherence tomography (OCT) were taken in 20 patients (20 eyes) of macular edema and PDR. A combination of intravitreal injection of triamcinolone acetonide and PRP was performed in 10 patients (10 eyes) and a combination of focal or grid laser photocoaqulation and PRP in the remaining 10 eyes. The postoperative outcomes were compared between the two combination treatments by best corrected visual acuity (BCVA), tonometry, fluorescein angiography, and OCT at 2 weeks, 1, 2, and 3 months. RESULTS: Average BCVA (log MAR) significantly improved from preoperative 0.56+/-0.20 to 0.43+/-0.08 at 1 month (P=0.042) and it was maintained until 3 months after a combination of IVTA and PRP in 10 eyes (P=0.007). The thickness of fovea decreased from average 433.3+/-114.9 micrometer to average 279.5+/-34.1 micrometer at 2 weeks after combined treatment of IVTA and PRP (P=0.005), which was significantly maintained until 3 months, but there was a transient visual disturbance and no significant difference in thickness of the fovea before and after treatment in the groups with PRP and focal or grid laser photocoagulation. CONCLUSIONS: A combination of IVTA and PRP might be an effective treatment modality in the treatment of macular edema and PDR and prevent the subsequent PRP-induced macular edema result in visual dysfunction. In combination with PRP, IVTA might be more effective than focal or grid laser photocoagulation and PRP for reducing diabetic macular edema and preventing aggravation of macular edema without transient visual disturbance in patients requiring immediate PRP.
Vitreous Body ; Triamcinolone Acetonide/*administration & dosage/therapeutic use ; Treatment Outcome ; Middle Aged ; Macular Edema, Cystoid/*drug therapy/etiology/*surgery ; *Laser Coagulation ; Injections ; Humans ; Glucocorticoids/*administration & dosage/therapeutic use ; Diabetic Retinopathy/*complications ; Aged

The treatment planning and dosimetry of small fields for stereotactic radiosurgery with 10 MV x-ray isocentrically mounted linear accelerator is presented. Special consideration in this study was given to the variation of absorbed dose with field size, the central axis percent depth doses and the combined moving beam dose distributon. The collimator scatter correction factors of small fields (1x1~3x3 cm2) were measured with ion chamber at a target chamber distance of 300cm where the projected fields were larger than the polystyrene buildup caps and it was calibrated with the tissue equivalent solid state detectors of small size (TLD, PLD, ESR and semiconductors). The central axis percent depth doses for 1x1 and 3x3 cm2 fields could be derived with the same acuracy by interpolating between measured values for larger fields and calcu1ated zero area data, and it was also calibrated with semiconductor detectors. The agreement between experimental and calculated data was found to be under +/-2% within the fields. The three dimensional dose planning of stereotactic focusing irradiation on small size tumor regions was performed with dose planning computer system (Therac 2300) and was verified with film dosimetry. The more the number of strips and the wider the angle of arc rotation, the larger were the dose delivered on tumor and the less the dose to surrounding the normal tissues. The circular cone, we designed, improves the alignment, minimizes the penumbra of the beam and formats ball shape of treatment area without stellate patterns. These dosimetric techniques can provide adequate physics background for stereotactic radiosurgery with small radiation fields and 10 MV x-ray beam.
Axis, Cervical Vertebra ; Computer Systems ; Film Dosimetry ; Particle Accelerators ; Polystyrenes ; Radiosurgery* ; Semiconductors

Detection of cerebrospinal fluid leakage or exact localization of leakage site after spinal surgery is difficult on conventional imaging studies. We report two patients with surgery-related spinal CSF leakage detected on magnetic resonance (MR) myelography. They presented with severe headache after spinal surgeries, lumbar discectomy and excision of spinal meningioma, respectively. The sites of spinal CSF leakage in the patients were detected accurately on MR myelography, and the patients recovered from the postoperative CSF leakage after being treated with an epidural blood patch or reoperation. MR myelography may be effective in demonstrating the exact site of surgery-related spinal CSF leakage.
Blood Patch, Epidural ; Diskectomy ; Headache ; Humans ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets ; Meningioma ; Myelography ; Reoperation

The loss of neuronal cells in the central nervous system may occur in many neurodegenerative diseases. Alzheimer's disease is a common senile disease in people over 65 years, and it causes impairment characterized by the decline of mental function, including memory loss and cognitive impairment, and affects the quality of life of patients. However, the current therapeutic strategies against AD are only to relieve symptoms, but not to cure it. Because there are only a few therapeutic strategies against Alzheimer's disease, we need to understand the pathogenesis of this disease. Cell therapy may be a powerful tool for the treatment of Alzheimer's disease. This review will discuss the characteristics of Alzheimer's disease and various available therapeutic strategies.
Alzheimer Disease* ; Cell- and Tissue-Based Therapy ; Central Nervous System ; Humans ; Memory Disorders ; Neurodegenerative Diseases ; Neurons ; Quality of Life ; Stem Cells* ; Transplantation

The objective of this study was to assess the effect of lidocaine jelly application to chest tubes on the intensity and duration of overall pain, chest tube site pain and the required analgesics for postoperative pain relief in coronary artery bypass graft (CABG) patients. For patients in group L, we applied sterile 2% lidocaine jelly on the chest tubes just before insertion, and for patients in group C, we applied normal saline. Overall visual analogue scale (VAS), maximal pain area with their VAS were documented postoperatively, and the frequency that button of patient-controlled analgesia was pressed (FPB) and total fentanyl consumption were assessed. The number of patients who complained that tube site was the most painful site was significantly higher in group C than in group L (85% vs. 30% at extubation, P<0.001). The overall VAS score was significantly higher in group C than in group L (39.14+/-12.49 vs. 27.74+/-13.76 at extubation, P=0.006). After all of the tubes were removed, the VAS score decreased more in group C (5.74+/-4.77, P<0.001) than in group L (3.05+/-2.48, P<0.001). FPB and total fentanyl consumption were significantly higher in group C than in group L (73.00, 59.00-78.00 vs. 34.00, 31.00-39.25, P<0.001; 2,214.65+/-37.01 vs. 1,720.19+/-361.63, P<0.001, respectively). Lidocaine jelly application is a very simple way to reduce postoperative pain by reducing chest tube site pain after CABG. (Clinical Trials Registry No. ACTRN 12611001215910)
Adolescent ; Adult ; Aged ; Analgesia, Patient-Controlled ; Anesthetics, Local/*therapeutic use ; Cardiac Catheters/adverse effects ; Chest Tubes/*adverse effects ; Coronary Artery Bypass ; Drainage ; Female ; Fentanyl/therapeutic use ; Humans ; Lidocaine/*therapeutic use ; Male ; Middle Aged ; Pain Management/*methods ; Pain Measurement ; Pain, Postoperative/*drug therapy ; Random Allocation ; Young Adult

Background/Aims: Coenzyme Q10 (CoQ10) has antioxidant effects and is commercially available and marketed extensively. However, due to its low bioavailability, its effects are still controversial. We developed a water-soluble CoQ10-based micelle formulation (CoQ10-W) and tested it in an experimental model of tacrolimus (TAC)-induced diabetes mellitus (DM). Methods: We developed CoQ10-W from a glycyrrhizic-carnitine mixed layer CoQ10 micelle preparation based on acyltransferases. TAC-induced DM rats were treated with either lipid-soluble CoQ10 (CoQ10-L) or CoQ10-W for 4 weeks. Their plasma and pancreatic CoQ10 concentrations were measured using liquid chromatography- tandem mass spectrometry. The therapeutic efficacies of CoQ10-W and CoQ10-L on TAC-induced DM were compared using functional and morphological parameters and their effects on cell viability and reactive oxygen species (ROS) production were also evaluated in cultured rat insulinoma cells. Results: The plasma CoQ10 level was significantly increased in the CoQ10-W group compared to that in the CoQ10-L group. Intraperitoneal glucose tolerance tests and glucose-stimulated insulin secretion revealed that CoQ10-W controlled hyperglycemia and restored insulin secretion significantly better than CoQ10-L. The TAC-mediated decrease in pancreatic islet size was significantly attenuated by CoQ10-W but not by CoQ10-L. TAC-induced oxidative stress and apoptosis were significantly more reduced by CoQ10-W than CoQ10-L. Electron microscopy revealed that CoQ10-W restored TAC-induced attenuation in the number of insulin granules and the average mitochondrial area, unlike CoQ10-L. In vitro studies showed that CoQ10-L and CoQ10-W both improved cell viability and reduced ROS production in TAC-treated islet cells to a similar extent. Conclusions CoQ10-W has better therapeutic efficacy than CoQ10-L in TAC-induced DM.

BACKGROUND: Tissue expansion is an effective and valuable technique for the reconstruction of large skin lesions and scars. This study aimed to evaluate the applicability and safety of a newly designed skin expanding bioreactor system for maximizing the graft area and minimizing the donor site area. METHODS: A computer-controlled biaxial skin bioreactor system was used to expand skin in two directions while the culture media was changed daily. The aim was to achieve an expansion speed that enabled the skin to reach twice its original area in two weeks or less. Skin expansion and subsequent grafting were performed for 10 patients, and each patient was followed for 6 months postoperatively for clinical evaluation. Scar evaluation was performed through visual assessment and by using photos. RESULTS: The average skin expansion rate was 10.54%+/-6.25%; take rate, 88.89%+/-11.39%; and contraction rate, 4.2%+/-2.28% after 6 months. Evaluation of the donor and recipient sites by medical specialists resulted in an average score of 3.5 (out of a potential maximum of 5) at 3 months, and 3.9 at 6 months. The average score for patient satisfaction of the donor site was 6.2 (out of a potential maximum of 10), and an average score of 5.2 was noted for the recipient site. Histological examination performed before and after the skin expansion revealed an increase in porosity of the dermal layer. CONCLUSIONS: This study confirmed the safety and applicability of the in vitro skin bioreactor, and further studies are needed to develop methods for increasing the skin expansion rate.
Bioreactors* ; Cicatrix ; Culture Media ; Humans ; Patient Satisfaction ; Porosity ; Skin Transplantation ; Skin* ; Specialization ; Tissue Donors ; Tissue Expansion ; Transplants

No abstract available.
Erythrocytes*

A Modified irradiation technique utilizing a linear accelerator for radiation surgery within the brain was performed in 4 patients. Three of them had brain tumors and one small arteriovenous malformation in midbrain. A Hitchcock stereotactic apparatus and a 10 MeV linear accelerator have been adapted and special computer programs for dosimetry were obtained and studied experimentally with a phantom model. Stereotactic radiosurgery is a valuable tool in the treatment of inoperable, deep seated intracranial lesions, the major advantage being high efficacy and smoothness of the procedure, as well as short hospitalization times.
Arteriovenous Malformations ; Brain ; Brain Neoplasms ; Hospitalization ; Humans ; Mesencephalon ; Particle Accelerators* ; Radiosurgery*

A retrospective analysis has been made of 40 patients with pineal region tumors and CNS germ cell tumors who were treated at Yonsei University Hospital, Department of Radiation Oncology between 1971 and 1985. A tissue diagnosis was obtained before radiotherapy in 19 patients and 21 patients were irradiated without histological diagnosis. Among 19 biopsy-proven cases, 14 were germinomas, 2 were teratomas, and the others were two pineocytomas and one pineoblastoma. In the earlier period, every attempt was made to obtain a tissue pathology by either stereotaxic biopsy or open craniotomy before irradiation. However, in recent years, with the advent of CT scan, a trial radiotherapy with a modest dose of 20 Gy in 2 weeks was attempted in cases of highly suspected germinomas by CT scan findings. Further management after trial radiation depended on the radiation response shown on the follow-up CT scan and tumor marker study. Radiation fields varied from a small local field to whole brain or entire neuroaxis irradiation. Most patients received 40-50 Gy to the primary tumor site and 20-30 Gy to the neuroaxis. Twenty-nine of the total 40 patients are alive without of disease 22-144 months after treatment and the overall 5-year recurrence-free survival rate was 74.4%, Univariate analysis of prognostic factors at presentation showed that tumor type was highly correlated with outcome. Two of fourteen biopsy-proven germinomas and none of nine presumed germinomas by trial radiation recurred. On the other hand, five of six patients who showed poor response to trial radiation died of uncontrolled disease and only one patient with elevated AFP in serum and CSF was salvaged by chemotherapy. On the basis of the results of this study, application of trial radiation therapy without tissue biopsy is well justified as a treatment modality in a suspected germinoma by CT scan finding. Aggressive combined modality approaches with surgery, radiotherapy and chemotherapy need to be investigated to improve results in radioresistant tumors.
Biopsy ; Brain ; Craniotomy ; Diagnosis ; Drug Therapy ; Follow-Up Studies ; Germ Cells* ; Germinoma ; Hand ; Humans ; Neoplasms, Germ Cell and Embryonal* ; Pathology ; Pinealoma ; Radiation Oncology ; Radiotherapy ; Retrospective Studies ; Survival Rate ; Teratoma ; Tomography, X-Ray Computed