It is well known that histologic grade and tumor stage are important prognostic factors, and that the monoclonal antibody to proliferating cell nuclear antigen(PCNA) can recognize S-phase cells. The PCNA index of 53 transitional cell carcinomas(TCCs) of the urinary bladder was studied to evaluate its prognostic validity. The PCNA indices of TCCs ranged from 38 to 92, whih were quite different from that of normal transitional epithelium(9.4). The PCNA indices were significantly higher in tumors of the higher histologic grade and/or tumor stage(correlation coefficient 0.64 and 0.43; P=0.00). The PCNA index was particularly valuable in discriminating the superficial TCCs from the deeply invasive TCCs(67.1+/-15.46 and 79.9+/-9.70; P=0.000). Among TCCs of the same tumor stage, the histologic grade affected the PCNA index. However, TCCs of the same histologic grade revealed similar PCNA indices regardless of tumor stage. These results indicate that the PCNA index is an objective and reliable prognostic factor in TCCs, which is superior to the conventional histologic grade.

PURPOSE: Malignant glaucoma is a rare complication of anterior segment surgery. The authors present a case of a malignant glaucoma-like phenomenon during cataract surgery in a primary open-angle glaucoma (POAG) patient. CASE SUMMARY: A 74-year-old man with POAG underwent a cataract surgery in his left eye. After phacoemulsificiation, sodium hyaluronate was used to form the capsular bag for intraocular lens implantation. Following this procedure, the capsular bag space and anterior chamber became shallow. Intraocular pressure (IOP) elevated, and the shallowing of the anterior chamber and capsular bag space continued to a dangerous level. The surgical procedure was stopped and postponed for two days. After two days, IOL was successfully implanted in the posterior bag. CONCLUSIONS: Although the preoperative ophthalmologic examination failed to reveal a zonular problem, there was a possibility for a small area of zonular defect. A malignant glaucoma-like phenomenon was suspected to have occurred due to leakage of sodium hyaluronate or balanced salt solution into the vitreous through a small area of zonular dialysis. If a similar condition, occurs delayed surgery for IOL implantation would be more effective than vitrectomy or laser treatment.
Aged ; Anterior Chamber ; Cataract ; Dialysis ; Eye ; Glaucoma ; Glaucoma, Open-Angle ; Humans ; Hyaluronic Acid ; Intraocular Pressure ; Lens Implantation, Intraocular ; Vitrectomy

We evaluate central endothelial cell loss(ECL) following phacoemulsification through a temporal sclera tunnel incision and temporal clear corneal incision. Seventy two eyes that had phacoemulsification surgery were divided into two groups. In group 1(n=41), a foldable silicone intraocular lens(IOL). was implanted through a 3.2mm sutureless clear corneal incision. In group 2(n-31), a 5.5mm sutureless scleral tunnel incision. Cell density of the corneal endothelium in all eyes was recorded preoperatively and 2 months postoperatively. and the percentage of endothelial cell loss was determinded. Percentage of endothelial cell loss were 8.37+/-7.5% in group 1, 6.61+/-7.1% in group 2. Phacoemulsification with 5.5mm scleral tunnel incisions produced slightlyless ECL than Phacoemulsification with 3.2mm clear corneal incisions. No statistically significant difference was observed among these two groups.
Cataract ; Cell Count ; Endothelial Cells ; Endothelium, Corneal ; Phacoemulsification ; Sclera ; Silicones

BACKGROUND: Many investigators have advocated neural and especially regional sympathetic blockade for acute herpe. zoster pain. Some believe that nerve blocks not only relieve acute pain but also, if given early in the course of clinical disease, prevent progression to postherpetic neuralgia. OBJECTIVE: The purpose of this study was to evaluate the preventive effect of sympathetic blockade on herpes zoster METHODS: Fifteen patients with herpes zoster were treated with sympathetic blocks according to the severity of pain. RESULTS: The total score of pain degree decreased from 3.4 to 1.1 with sympathetic blocks in 15 patients in 2 months. Sympathetic blocks prevented or relieved postherpetic neuralgia in more than 90% of patients treated within 2 weeks of the onset of the acute phase of the disease and in more than 85% of patients over 60. CONCLUSION: Sympathetic blocks are effective in preventing postherpetic neuralgia if applied soon after the onset of the acute phase of herpes zoster.
Acute Pain ; Herpes Zoster ; Humans ; Nerve Block ; Neuralgia, Postherpetic* ; Research Personnel

BACKGROUND: Night shift work induces physiological and psychological stress by altering sleep and biological rhythms and is associated with hypertension, diabetes, obesity, and cardiovascular diseases. Few studies have been conducted on the control of hypertension and diabetes. This study aimed to examine the effect of night shift work on the control rate of hypertension and diabetes. METHODS: Subjects comprised workers aged 20–65 years who underwent specific health examination at a single facility in seven different affiliated examination centers from 1 January to 31 December 2016. Workers were categorised into day workers and night shift workers. Demographic and medical history were taken, and physical examination was done. Blood pressure (BP) and fasting glucose were measured. The control rate of each disease was evaluated based on treatment goals presented in the treatment guidelines of the Korean Society of Hypertension and the Korean Diabetes Association (systolic BP < 140 mmHg and diastolic BP < 90 mmHg; fasting glucose ≤ 130 mg/dL). RESULTS: Among 631,418 subjects, 11.2% (70,450) were night shift workers. Of whom 6.1% (4,319) were taking antihypertensive medication and 2.5% (1,775) were taking diabetes medication. Among patients taking antihypertensive medications, the proportion of those whose BP was controlled to suit treatment goals was 81.7% (26,635) of day workers and 77.4% (3,343) of night shift workers, which was significantly different (p < 0.001). Among patients taking diabetes medications, the proportion of those whose blood glucose was controlled to suit treatment goals was 37.4% (4,489) of day workers and 36.5% (647) of night shift workers, but the difference was not significant. The control rates for patients taking antihypertensive medications (odds ratio [OR]: 0.74, 95% confidence interval [CI]: 0.68–0.80) were lower among night shift workers than day workers with adjustment for age, sex, smoking history, alcohol consumption, exercise, and obesity. However, there were no differences in control rates for patients taking diabetes medications (OR: 0.99, 95% CI: 0.87–1.10) between day workers and night shift workers. CONCLUSIONS: Night shift work can have an effect on the uncontrolled BP in workers taking antihypertensive medications. Therefore, additional efforts for disease control are necessary for night shift workers with hypertension.
Alcohol Drinking ; Blood Glucose ; Blood Pressure ; Cardiovascular Diseases ; Diabetes Mellitus ; Fasting ; Glucose ; Humans ; Hypertension ; Obesity ; Periodicity ; Physical Examination ; Smoke ; Smoking ; Stress, Psychological ; Treatment Outcome

Leber's hereditary optic neuropathy(LHON) is an optic nerve disease that causes blindness and is associated with maternally inherited mitochondrial DNA(mt DNA) mutations. The most common mitochondrial DNA mutation among LHON patients is a point mutation at the nucleotide 11778 in the subunit 4 of complex I. In one 45-year old male LHON patient with bilateral optic neuropathy, we investigated the presence of a point mutation of mitochondrial DNA and identified a single guanine to adenine transition mutation in the mitochondrial DNA at nucleotide point 11778.
Adenine ; Blindness ; DNA, Mitochondrial* ; Guanine ; Humans ; Male ; Middle Aged ; Optic Atrophy, Hereditary, Leber ; Optic Nerve Diseases ; Point Mutation*

BACKGROUND: The plasma effect-site equilibrium rate constant (k(e0)) of propofol has been reported in various pharmacodynamic studies; however, it is not desirable to apply k(e0) for the link with pharmacokinetic models that were separately investigated. Thus, we titrated k(e0) for the pharmacokinetic model, which is known as the multiple covariates adjusted model of propofol. METHODS: Ninety female patients scheduled for gynecologic surgery were randomly assigned to three groups targeting different plasma concentrations of 5.4, 8.1, and 10.8 microgram/ml. Target-controlled infusions (TCI) were provided by a computer-assisted continuous infusion system. Time to loss of responsiveness (LOR) was measured by a blind investigator; effect-site concentrations (C(e)) for LOR were then calculated with simulation of TCI using different k(e0)s. We determined the k(e0) minimizing total discrepancy (TD) between the inputted and calculated k(e0) from the t(1/2)k(e0)s for a given probability of LOR of the C(e), and also obtained the k(e0) for the minimal TD between the median Ce, which were compared to the known k(e0). RESULTS: k(e0)s from these two methods were 0.3692 and 0.3788/min. C(e)s for LOR with these k(e0)s were significantly different from those with Schnider's k(e0). CONCLUSIONS: We proposed a method for titration of the k(e0) of propofol. The k(e0)s of propofol was lower than Schnider's k(e0). An adequate k(e0) for the specific pharmacokinetic model and a certain population would be useful for prediction of an accurate C(e), and could be used for calculation of accurate dosing during targeting of the effect site.
Aluminum Hydroxide ; Anesthesia ; Carbonates ; Female ; Gynecologic Surgical Procedures ; Humans ; Plasma ; Propofol

BACKGROUND: This study evaluates the effectiveness of the target-controlled infusion (TCI) of remifentanil through stepwise increases in the effect-site concentration (Ceff) in preventing coughs. METHODS: In a preliminary study, we randomly selected 140 patients to receive remifentanil through two-step increases in Ceff (1.0 ng/ml to 4.0 ng/ml: Group R1-4; 2.0 ng/ml to 4.0 ng/ml: Group R2-4). Based on the results of the preliminary study, we employed another sample of 140 patients and implemented a three-step increase in TCI (1.0 ng/ml to 2.0 ng/ml to 4.0 ng/ml: Group R1-2-4). We then compared this treatment with direct targeting based on 4.0 ng/ml TCI (Group R4). We recorded the episodes of coughs, rating them as mild (1-2), moderate (3-4), or severe (5 or more). RESULTS: In Group R1-4, one patient (1.5%) coughed during the first step, and five (7.3%) coughed during the second step. In Group R2-4, nine (13.2%) coughed during the first step, but none coughed during the next step. Only one patient had a mild cough during the three-step increase in TCI, that is, patients in Group R1-2-4 were significantly less likely to cough than those in Group R4 (P < 0.001). CONCLUSIONS: Stepwise increases in the TCI of remifentanil reduced the incidence of remifentanil-induced coughing, and the three-step increase in TCI nearly eliminated remifentanil-induced coughing.
Cough ; Humans ; Incidence ; Opioid-Related Disorders ; Piperidines ; Resin Cements

BACKGROUND: Intravenous fentanyl has been used for acute postoperative pain management, but has not always provided reliable adequate analgesia, including patient-controlled analgesia (PCA). The purpose of this study was to investigate the efficacy of time-scheduled decremental infusion of fentanyl for postoperative analgesia. METHODS: Ninety-nine patients, aged 20-65 years, undergoing laparoscopic-assisted hysterectomy using total intravenous anesthesia (TIVA) were randomly assigned into one of the three groups. Their background infusions of fentanyl diluent (2 ml/hr of diluent was equivalent with 0.5 microg/kg/hr of fentanyl) with PCA were maintained at the fixed-rate of 2 ml/hr until the postoperative 24 hr (FX2-2-2), or at the decremental rates of 6.0, 4.0, 2.0 ml/hr (D6-4-2) and 8.0, 4.0, 2.0 ml/hr (D8-4-2). The visual analogue score (VAS), incidence of inadequate analgesia, frequency of PCA intervention, and side effects were evaluated. RESULTS: VAS was significantly higher in FX2-2-2 than in D6-4-2 and D8-4-2 until postoperative 3 hr (P < 0.05). After postoperative 4 hr, VAS was significantly higher in FX2-2-2 than D8-4-2 (P < 0.05). The incidence of inadequate analgesia of FX2-2-2 was significantly greater than D6-4-2 (P = 0.038) and D8-4-2 (P < 0.001) until postoperative 1 hr. None of the patients had ventilatory depression, and postoperative nausea and vomiting were not significant among the groups. CONCLUSIONS: The time-scheduled decremental background infusion regimens of fentanyl, based on the pharmacokinetic model, could provide more effective postoperative pain management after TIVA, and the side effects and the risk for morbidity were not different from the fixed-rate infusion regimen.
Analgesia ; Analgesia, Patient-Controlled* ; Anesthesia, Intravenous* ; Fentanyl* ; Humans ; Hysterectomy ; Incidence ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Postoperative Nausea and Vomiting ; Respiratory Insufficiency

Bronchogenic cyst is an uncommon congenital anomaly that arises from maldevelopment of the primitive foregut, and is usually found in the lung and mediastinum. Cutaneous or subcutaneous bronchogenic cysts are rare, and occur especially in the shoulder region. We report here on a 40-year-old woman with a soft, nontender, cystic mass on the upper posterior aspect of the right acromioclavicular joint; this had been recognized about 20 years before. She underwent incision and drainage of the lesion at a local clinic about 1 year ago, but the wound was not healed. MRI showed an irregular-shaped dark signal intensity lesion that measured 2 x 1.5 cm in the subcutaneous fat layer. Microscopically, the cyst was lined by pseudostratified ciliated columnar epithelium that displayed squamous metaplasia. The cyst wall revealed frequent smooth muscle bundles, occasional seromucous glands and multifocal lymphocytic infiltration. This is the first reported case of subcutaneous bronchogenic cyst of the shoulder in a Korean adult.
Acromioclavicular Joint ; Adipose Tissue ; Adult ; Bronchogenic Cyst* ; Drainage ; Epithelium ; Female ; Humans ; Lung ; Magnetic Resonance Imaging ; Mediastinum ; Metaplasia ; Muscle, Smooth ; Shoulder* ; Subcutaneous Fat ; Wounds and Injuries