Purpose: This study investigated the effects of high-dose steroid injections for ethambutol-induced optic neuropathy. Methods: A retrospective study examined 13 patients diagnosed with ethambutol-induced optic neuropathy at Wonju Severance Christian Hospital from December 2016 to November 2020. Methylprednisolone was injected at 1,000 mg/day for 3 days. The patients were evaluated before treatment; immediately after it; and at 1, 6, and 12 months. Visual acuity and visual fields were tested (Humphrey Field Analyzer, Carl Zeiss Meditec, Dublin, CA, USA) and the visual field index (VFI) and mean deviation (MD) were recorded. Results: We analyzed 26 eyes of 13 patients (6 males, 7 females; average age 68.7 years). Immediately after treatment, there was no significant improvement in visual acuity, but the VFI improved by 10% or more in 11 eyes and MD improved by 2 dB or more in 16 eyes. After the end of treatment, 13 of 26 eyes showed improved visual acuity of two lines or more in the Snellen table; VFI improved by more than 10% in 16 eyes and MD b y 2 dB or more in 20 eyes. The average differences in the final VFI and MD were 25.96 (standard deviation [SD] = 29.33) and 7.29 (SD = 7.09), respectively. Conclusions When patients with ethambutol-induced optic neuropathy were treated with high-dose steroid injections, 60% (16/26) showed visual field improvement immediately after treatment and 77% (20/26) ultimately showed improvement. This suggests that steroids have a therapeutic effect in patients with optic neuropathy caused by ethambutol. Further studies are needed.

Medicine in the twenty-first century will be different from the medicine of today. Recent changes in medical environment, such as changes in disease and mortality pattern and rapid increase in medical knowledge, require change and adaptation of medical education. The task of medical education is to help people entering medicine to prepare to meet their professional obligations in this new context. So we tried to join Problem-base learning(PBL), which challenges students to be more actively involved in defining what they learn and how they learn, and Computer-assisted learning(CAL), which uses multimedia and medical informatics as learning tools. Finally we developed Problem-oriented medical education program using the Internet. First, using simulated patient cases, we built clinical database with patients' history, physical examinations, and various laboratory findings. To provide PBL program through the Internet, we constructed client-server system using IJS(Internet Information Server) on Windows-NT settings, and made user-friendly dynamic interface with HTML, JAVA, JAVA Script and so on. PBL on the Web will make students learn effectively and actively, and offer vivid multimedia environment for medical education. We expect this PBL program to be used as an effective learning tool for residents or doctors as well as for medical students in the near future. The Internet
Education, Medical* ; Humans ; Indonesia ; Internet* ; Learning ; Medical Informatics ; Mortality ; Multimedia ; Physical Examination ; Students, Medical

Recent progress in medical informatics enables us to use medical information regardless of time or place, to make a diagnostic and therapeutic plan, according to increasing need about health of general population. There are many homepages on the web, which provides medical common senses, hospital information, and medical counselling on the web. Virtual Hospital, which offers comprehensive media information, has medical counselling program with various programs such as self-diagnosis, emergency information, drug information, Q and A, and so on. The aim of this study is to examine the content and purpose of medical counselling on the web. The subjects consisted of 150 counselings which were called 'Medical Counselling' in the Virtual Hospital for December 1996 through March 1997. Many questioners wanted to know treatment principles. to make a diagnosis, and to know specific medical knowledge, The most common questions are as follows; general and unspecified, digestive, skin, musculoskeletal problems. These findings suggests that medical counselling may be used to supplement the lack of direct medical interviews with doctors.
Counseling* ; Diagnosis ; Emergencies ; Internet* ; Medical Informatics ; Skin

Purpose: This study investigates the intraocular pressures and dry eye signs before and after botulinum toxin (botox) injections for patients with essential blepharospasm. Methods: From November 2021 to July 2022, a prospective study examined 78 eyes of 39 patients diagnosed with essential blepharospasm. Before injection and 1 and 3 months after injection, intraocular pressures (IOPs) were measured using a Goldmann applanation tonometer. The noninvasive breakup time (NIBUT), lipid layer thickness (LLT), tear meniscus height (TMH), and meibomian gland clearance were assessed with the aid of the IDRA platform (SBM Sistemi, Turin, Italy). Results: The average IOPs were 14.33 ± 3.47 (7-21), 13.45 ± 3.54 (9-21), and 13.28 ± 2.98 (7-20) mmHg before, and 1 and 3 months after, botox injection respectively (p = 0.002 , p = 0.004). Twenty-four eyes of 12 patients with dry eye symptoms evidenced a significant difference in the NIBUT 1 month after Botox injection, but no significant difference in any of the LLT, TMH, or meibomian gland areal loss percentage (p = 0.007, 0.201, 0.586, and 0.435 respectively). After 3 months, no dry eye parameter change, including the NIBUT, was significant (p = 0.202, 0.542, 0.240, and 0.721 respectively). Conclusions Botulinum toxin A injection temporarily relieved dry eye symptoms and reduced the IOP in patients with essential blepharospasm.

BACKGROUND: Epithelial-mesenchymal transition (EMT) is an important step in the invasion and progression of cancer and in the development of chemoresistance by cancer cells. METHODS: To address the clinical significance of the EMT pathway in lung adenocarcinoma and the association of the pathway with histological subtype, we examined 193 surgically resected lung adenocarcinoma samples for the expression of representative EMT-related proteins (E-cadherin, beta-catenin, and vimentin) by immunohistochemistry. Histological subtypes were classified according to the 2011 International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification. The results for EMT-related protein expression were analyzed for correlation with clinicopathological features and with survival. RESULTS: The loss of E-cadherin expression and aberrant beta-catenin expression were significantly associated with larger tumor size, pleural invasion, lymphatic/vascular invasion, and advanced pathological stage (p<0.05). The alteration of the E-cadherin/beta-catenin complex was least frequently observed in the lepidic-predominant group, but these associations were not statistically significant. In the multivariate analysis, altered E-cadherin/beta-catenin complex expression was found to be an independent poor prognostic factor (p=0.017; hazard ratio, 1.926; 95% confidence interval, 1.119 to 3.314). CONCLUSIONS: The alteration of the expression of the E-cadherin/beta-catenin complex was associated with aggressive tumor behavior in lung adenocarcinoma.
Adenocarcinoma ; beta Catenin ; Cadherins ; Epithelial-Mesenchymal Transition ; Immunohistochemistry ; Lung ; Lung Neoplasms ; Multivariate Analysis ; Proteins

A 74-year-old woman presented at our hospital with hemoptysis. Three months ago, she had endovascular stent-grafting done by a general surgeon for a saccular thoracic aneurysm that was found accidentally following an episode of fever and chills. Despite a lasting fever after the procedure, she was discharged without further treatment and follow-up. She was subsequently admitted to the hospital for evaluation and several exams were performed. Chest CT scans and an esophagoscopy identified an aorto-esophageal fistula at the level of the aorta that was covered by a previous stent-graft. After extensive administration of antibiotics, surgery was done - esophagectomy, cervical esophago-gastrostomy and replacement of the thoracic aorta. She was later discharged uneventfully.
Aged ; Aneurysm ; Aneurysm, Infected ; Anti-Bacterial Agents ; Aorta ; Aorta, Thoracic ; Chills ; Esophageal Fistula ; Esophagectomy ; Esophagoscopy ; Female ; Fever ; Fistula ; Follow-Up Studies ; Hemoptysis ; Humans ; Thorax

Sunitinib is a multi-target tyrosine kinase inhibitor used to treat gastrointestinal stromal tumors, renal cell carcinoma, and pancreatic neuroendocrine tumors. The most common adverse reactions are known to be nausea, fatigue, diarrhea, stomatitis, esophagitis, hypertension, skin toxicity (hand-foot syndrome), hypothyroidism, and reduction in the cardiac output of the left ventricle. Herein, we report the case of a 57 year-old female who visited our hospital complaining of epigastric pain. She had been taking sunitinib at 25 mg/day to treat a metastatic pancreatic neuroendocrine tumor. Upon computed tomography performed on admission, we observed that fluid had collected around the pancreas. Laboratory analysis revealed hypertriglyceridemia (triglycerides 993 mg/dL). Tyrosine kinase inhibitors are known to have limited effects on lipid metabolism. In this case, we suggest that hyperglycemia seems to have had a limited effect on lipid levels. We are rather of the view that hyperglycemia, a history of distal pancreatectomy, and hypothyrodisim, indirectly caused the observed hypertriglyceridemia.
Carcinoma, Renal Cell ; Cardiac Output ; Diarrhea ; Esophagitis ; Fatigue ; Female ; Gastrointestinal Stromal Tumors ; Heart Ventricles ; Humans ; Hyperglycemia ; Hypertension ; Hypertriglyceridemia* ; Hypothyroidism ; Lipid Metabolism ; Nausea ; Neuroendocrine Tumors* ; Pancreas ; Pancreatectomy ; Protein-Tyrosine Kinases ; Skin ; Stomatitis

Purpose: Intensive cytotoxic chemotherapy increases the risk of infection in patients with cancer by inducing bone marrow suppression and mucosal injury. Febrile neutropenia (FN) is the most important clinical adverse event in patients with cancer receiving cytotoxic chemotherapy. To prevent FN, standard precautions including hand and respiratory hygiene are generally recommended, but the exact effect of non-pharmacologic intervention has not been clearly proven in the clinical setting. We aimed to compare the incidence of FN between the pre-coronavirus disease 19 (COVID-19) era vs. the postCOVID-19 era. Methods: We retrospectively enrolled patients with breast cancer who received an adriamycin and cyclophosphamide (AC) regimen containing adjuvant chemotherapy at Jeju National University Hospital. We compared the incidence of FN between the pre- and post-COVID-19 period and analyzed characteristics of the event and other clinical risk factors. Results: In total, 149 patients were enrolled, including 94 who received AC chemotherapy in the pre-COVID-19 era and 55 who received it in the post-COVID-19 era. Sixteen patients (10.7%) experienced FN. Fourteen (14.9%) and 2 events (3.6%) occurred in pre-COVID-19 and post-COVID-19 eras, respectively. The post-COVID-19 era was the only risk factor for FN (P = 0.032). Conclusion We found an association between FN occurrence and the COVID-19 outbreak, providing indirect evidence of the importance of non-pharmacological measures to reduce FN risk in patients with breast cancer. Further research is required to confirm the standard precautions for FN prevention in patients with cancer.

Purpose: Intensive cytotoxic chemotherapy increases the risk of infection in patients with cancer by inducing bone marrow suppression and mucosal injury. Febrile neutropenia (FN) is the most important clinical adverse event in patients with cancer receiving cytotoxic chemotherapy. To prevent FN, standard precautions including hand and respiratory hygiene are generally recommended, but the exact effect of non-pharmacologic intervention has not been clearly proven in the clinical setting. We aimed to compare the incidence of FN between the pre-coronavirus disease 19 (COVID-19) era vs. the postCOVID-19 era. Methods: We retrospectively enrolled patients with breast cancer who received an adriamycin and cyclophosphamide (AC) regimen containing adjuvant chemotherapy at Jeju National University Hospital. We compared the incidence of FN between the pre- and post-COVID-19 period and analyzed characteristics of the event and other clinical risk factors. Results: In total, 149 patients were enrolled, including 94 who received AC chemotherapy in the pre-COVID-19 era and 55 who received it in the post-COVID-19 era. Sixteen patients (10.7%) experienced FN. Fourteen (14.9%) and 2 events (3.6%) occurred in pre-COVID-19 and post-COVID-19 eras, respectively. The post-COVID-19 era was the only risk factor for FN (P = 0.032). Conclusion We found an association between FN occurrence and the COVID-19 outbreak, providing indirect evidence of the importance of non-pharmacological measures to reduce FN risk in patients with breast cancer. Further research is required to confirm the standard precautions for FN prevention in patients with cancer.

Purpose: Intensive cytotoxic chemotherapy increases the risk of infection in patients with cancer by inducing bone marrow suppression and mucosal injury. Febrile neutropenia (FN) is the most important clinical adverse event in patients with cancer receiving cytotoxic chemotherapy. To prevent FN, standard precautions including hand and respiratory hygiene are generally recommended, but the exact effect of non-pharmacologic intervention has not been clearly proven in the clinical setting. We aimed to compare the incidence of FN between the pre-coronavirus disease 19 (COVID-19) era vs. the postCOVID-19 era. Methods: We retrospectively enrolled patients with breast cancer who received an adriamycin and cyclophosphamide (AC) regimen containing adjuvant chemotherapy at Jeju National University Hospital. We compared the incidence of FN between the pre- and post-COVID-19 period and analyzed characteristics of the event and other clinical risk factors. Results: In total, 149 patients were enrolled, including 94 who received AC chemotherapy in the pre-COVID-19 era and 55 who received it in the post-COVID-19 era. Sixteen patients (10.7%) experienced FN. Fourteen (14.9%) and 2 events (3.6%) occurred in pre-COVID-19 and post-COVID-19 eras, respectively. The post-COVID-19 era was the only risk factor for FN (P = 0.032). Conclusion We found an association between FN occurrence and the COVID-19 outbreak, providing indirect evidence of the importance of non-pharmacological measures to reduce FN risk in patients with breast cancer. Further research is required to confirm the standard precautions for FN prevention in patients with cancer.