No abstract available.
Humans*

PURPOSE: To determine the efficacy of photodynamic therapy (PDT) with verteporfin (Visudyne(R), Norvatis Ophthalmics AG, Hettingen, Switzerland), a benzoporphyrin derivative, in the treatment of corneal neo-vascularization (CN) in a rabbit eye model. METHODS: CN was induced by placing instrastromal sutures in the cornea. Two weeks after suturing, verteporfin was administrated intravenously and 1 hour later, the right eye (treated group) was exposed to a laser with a 689 nm wavelength, and the left eye was used as the control. The changes in CN were analyzed using biomicroscopy and optical microscopy in twelve rabbits. RESULTS: The mean percentages of the neovascular area in the control and treated groups were 96.4 +/- 1.9% and 90.3 +/- 3.5% (P=0.009) at three days after the PDT, 88.6 +/- 4.6% and 71.6 +/- 6.2% (P<0.001) at one week, and 76.8 +/- 4.4% and 43.6 +/- 15.1% (P<0.001) at two weeks, respectively. Optical microscopy showed significant differences between the control and treated group in terms of the area and number of CN (P<0.05). CONCLUSIONS: PDT with verteporfin is a safe and effective procedure for regressing CN. However, a further study will be necessary.
Animals* ; Cornea ; Corneal Neovascularization* ; Microscopy ; Photochemotherapy* ; Rabbits ; Sutures

PURPOSE: The purpose of this study is to prevent the graft-tunnel mismatching by N+7 method and to present the experience of the authors in anterior cruciate ligament reconstruction, using the patellar ten- don by N+7 method. MATERIALS AND METHODS: Authors analyzed 34 cases who had taken the anterior cruciate ligament reconstruction from April 1998 to July 1999, at Asan Medical Center, by N+7 method. By measuring the patellar tendon length(N), tibial guide was set an angle of N+7 degree. We analyzed the results by dividing the cases into 3 groups by the degree of extrusion of the bone plug from the tibial tunnel. RESULTS: Clinical results were acceptable in 79.4%(27 cases), protrusion in 8.8%(3 cases) and recession in 11.8%(4 cases). When the angle of tibial tunnel was less than 50 degrees, there wasn't a protruded case in 19 cases. Comparing with 15 cases of the angle which was larger than 50 degrees, there were three protruded cases. CONCLUSION: Clinical results of anterior cruciate ligament reconstruction using the patellar tendon, with N+7 method is superior to empirical methods which was performed by authors, previously at the point of positioning of ideal tibial tunnel and conveniency of the technique. Especially, if the graft tendon length is shorter than 43mm, N+7 method is preferable.
Anterior Cruciate Ligament Reconstruction* ; Anterior Cruciate Ligament* ; Chungcheongnam-do ; Knee ; Patellar Ligament ; Tendons ; Transplants*

PURPOSE: To determine whether analyte levels in serum laboratory tests and arterial blood gas analysis (ABGA) are helpful for differentiating between generalized seizures and syncope in the emergency department (ED). METHODS: Patients over 18 years old who presented to an ED of a tertiary care hospital with a transient loss of consciousness within 4 hours were selected to be in either the seizure (n=166) or syncope groups (n=168). After exclusion for criteria, we used ROC curves to determine AUC, optimal cut-off value, sensitivity, and specificity, depending on time (4 hour, 2 hour, 1 hour and 0.5 hour). We also did multivariate logistic regression. RESULTS: A total of 75 seizure group patients and 78 syncope group patients were studied. There were significant between group differences in total CO2 content, LDH, ammonia, pH, bicarbonate and lactate. AUC (area under the curve) values for blood tests were: 0.720 (tCO2), 0.686 (LDH), 0.737 (ammonia), 0.798 (pH), 0.710 (bicarbonate) and 0.770 (lactate). All AUC values were increased as the time from symptoms to ED arrival was shortened (except for LDH). On multivariate logistic regression analysis, pH (OR=9.587, 95% CI, 2.573-35.723. p=0.001) and ammonia (OR=3.932, 95% CI, 1.324-11.613, p=0.014) were statistically significant independent predictive factors. CONCLUSION: Serum laboratory testing and ABGA, especially serum ammonia and arterial pH, may be helpful for differentiating between generalized seizure and syncope in patients who experience a transient loss of consciousness and who come to the ED within 4 hours after the appearance of symptoms. But further evaluation is needed.
Ammonia ; Area Under Curve ; Bicarbonates ; Blood Gas Analysis ; Diagnosis, Differential ; Emergencies ; Hematologic Tests ; Humans ; Hydrogen-Ion Concentration ; Lactic Acid ; Logistic Models ; ROC Curve ; Seizures ; Sensitivity and Specificity ; Syncope ; Tertiary Healthcare ; Unconsciousness

Ischemic necrosis of the pituitary gland, known as Sheehan's syndrome, can develop after massive postpartum bleeding. This condition is rarely accompanied by diabetes insipidus. An empty sella is a constant feature of Sheehan's syndrome in the later phase, but very few observations of magnetic resonance imaging (MRI) features in the acute phase are available. We report a case of Sheehan's syndrome presenting with diabetes insipidus leading to severe hypernatremia, showing hemorrhagic postpartum pituitary apoplexy on acute MRI.
Diabetes Insipidus ; Diabetes Insipidus, Neurogenic ; Hemorrhage ; Hypernatremia ; Hypopituitarism ; Magnetic Resonance Imaging ; Necrosis ; Pituitary Apoplexy ; Pituitary Gland ; Postpartum Period

Objective: : Surgical site infection is the most detrimental complication following cranioplasty. In other surgical fields, intrawound vancomycin powder application has been introduced to prevent surgical site infection and is widely used based on results in multiple studies. This study evaluated the effect of intrawound vancomycin powder in cranioplasty compared with the conventional method without topical antibiotics. Methods: : This retrospective study included 580 patients with skull defects who underwent cranioplasty between August 1, 1998 and December 31, 2021. The conventional method was used in 475 (81.9%; conventional group) and vancomycin powder (1 g) was applied on the dura mater and bone flap in 105 patients (18.1%; vancomycin powder group). Surgical site infection was defined as infection of the incision, organ, or space that occurred after cranioplasty. Surgical site infection within 1-year surveillance period was compared between the conventional and vancomycin powder groups with logistic regression analysis. Penalized likelihood estimation method was used in logistic regression to deal with zero events. All local and systemic adverse events associated with topical vancomycin application were also evaluated. Results: : Surgical site infection occurred in 31 patients (5.3%) and all were observed in the conventional group. The median time between cranioplasty and detection of surgical site infection was 13 days (range, 4–333). Staphylococci were the most common organisms and identified in 25 (80.6%) of 31 cases with surgical site infections. The surgical site infection rate in the vancomycin powder group (0/105, 0.0%) was significantly lower than that in the conventional group (31/475, 6.5%; crude odds ratio [OR], 0.067; 95% confidence interval [CI], 0.006–0.762; adjusted OR, 0.068; 95% CI, 0.006–0.731; p=0.026). No adverse events associated with intrawound vancomycin powder were observed during the follow-up. Conclusion : Intrawound vancomycin powder effectively prevented surgical site infections following cranioplasty without local or systemic adverse events. Our results suggest that intrawound vancomycin powder is an effective and safe strategy for patients undergoing cranioplasty.

PURPOSE: There is a continuing debate about whether small bowel obstruction (SBO) is best managed operatively or nonoperatively. There is also no definite criteria for physician to decide to operate patient with SBO. This retrospective study was designed to determine the factors influencing the treatment modality of SBO. METHODS: A clinical analysis was applied to 95 patients with SBO who were admitted to the emergency department of Seoul National University Hospital from January, 2000 to December, 2001. The patients were divided into the operative and non-operative treatment groups according to the treatment modality. We compared parameters such as age, sex, the etiology of SBO, the history of previous SBO, the history of previous operation due to SBO, time period from onset of symptoms to admission, and symptoms and signs between two groups. RESULTS: Among 95 cases, the operative management was performed in 21 cases and the non-operative treatment in 74 cases. There was no significant difference in the distribution of age and sex between two groups. The most common etiology of SBO was adhesion due to previous operation. In the operative treatment group, 12 (57.1%) cases had the history of previous operation because of SBO, which showed a significant difference compared to the non-operative treatment group (p<0.001). The major symptoms and signs were abdominal pain, vomiting, abdominal tenderness, hyperperistalsis, leukocytosis, tachycardia, rebound tenderness and fever. Of these symptoms and signs, rebound tenderness was only more common in the operative group than in the non-operative group (p<0.001). CONCLUSION: At the time of admission to the emergency department, the rebound tenderness in patients with SBO is an important factor to consider the early operative intervention.
Abdominal Pain ; Emergency Service, Hospital ; Fever ; Humans ; Leukocytosis ; Retrospective Studies ; Risk Factors* ; Seoul ; Tachycardia ; Vomiting

PURPOSE: The purpose of this study was to examine the causes, clinical courses and outcomes in children with acute respiratory distress syndrome (ARDS), and evaluate the physiologic variables as prognostic factors in the patients. METHODS: Retrograde medical chart review was carried out in 24 patients who were diagnosed with ARDS at the pediatric intensive care unit (PICU) during 20-month period. RESULTS: The incidence of ARDS among all PICU admission was 3.7 percent and the mortality rate was 37.5 percent, which was 14.8 percent of overall deaths in PICU. The most common causes of ARDS were pneumonia and sepsis. We found significant differences between survivors and non- survivors in PaO2/FiO2 ratio (P/F ratio), alveolar arterial oxygen gradient and oxygenation index (OI) on the second day from the onset of ARDS. Therapies for ARDS such as high frequency oscillator ventilation (HFOV), recruitment maneuver and low dose corticosteroid improved the P/F ratio and OI, especially in survivors CONCLUSION: The mortality rate of children with ARDS was 37.5 percent; an important cause of death in PICU. HFOV, recruitment maneuver and low dose corticosteroid seemed to be effective in pediatric ARDS. The P/F ratio, alveolar arterial oxygen gradient and OI on the second day from the onset of ARDS may be useful as prognostic factors.
Cause of Death ; Child* ; Humans ; Incidence ; Intensive Care Units ; Mortality ; Oxygen ; Pneumonia ; Respiratory Distress Syndrome, Adult* ; Sepsis ; Survivors ; Ventilation

PURPOSE: We intend to provide more objective data for diagnosis of the patellofemoral pain syndrome by analyzing the positional changes of the patella radiologically. MATERIALS AND METHODS: In 42 normal knees and in 91 knees of patients with the patellofemoral pain syndrome, the following 6 parameters were analyzed using a 30 degree flexion lateral view and a Merchant axial view: 1) the Insall and Salvati method, 2) the Blackburne and Peel method, 3) the Saille method, 4) the depth of the trochlea, 5) the sulcus angle, 6) and the congruence angle. RESULTS: Using the Blackburne and Peel method of assessing the height of patella, the ratio was 0.86 in the control group, in contrast to 0.92 in the patellofemoral pain syndrome group (P<0.05). The average value of the congruence angle was 2.9 in the control group, while it was -9.2 in patellofemoral pain syndrome group (P<0.05). The other parameters showed no statistical significance. CONCLUSION: This indicates that the patella alta by the Blackburne and Peel method and the increase of congruence angle are useful in the diagnosis of the patellofemoral pain syndrome.
Diagnosis ; Humans ; Knee ; Patella ; Patellofemoral Pain Syndrome*

Eggerthella lenta (E. lenta) has been reported to cause bacteremia in patients with gastrointestinal tract disorders or malignancies and in immunocompromised patients. Cases of E. lenta have been increasing with the recent development of testing equipment. The mortality rate due to E. lenta bacteremia is high. The authors report a case of E. lenta bacteremia in an immunocompetent patient.