PURPOSE: To evaluate the change of corneal endothelial cell following acute angle closure glaucoma attack, the central endothelial cell between the affected and the fellow eye was compared. METHODS: Twelve patients with uniocular acute angle closure glaucoma were enrolled. After acute attacks were resolved with medical treatment, 12 affected and 12 fellow eyes received laser peripheral iridotomy. The central endothelial cell counts of the affected and the fellow eyes were measured with specular microscope. RESULTS: While the mean central endothelial cell count of the affected eye was 1758.67+/-794.33 cells/mm2, that of the fellow eye was 2727.17+/-355.20 cells/mm2. The average difference of endothelial cell count between the affected and the fellow eye was 968.5 cells/mm2. It showed a mean decrease in cell density of 35.51% (p=0.000). There was a clear correlation between the duration of elevated pressure and the number of central corneal endothelial cells lost (p=0.014). CONCLUSIONS: Even if the intraocular pressure was well controlled after acute angle closure glaucoma attack, the endothelial cell count of cornea can be decreased. Therefore, if acute angle closure glaucoma attack occurs, intraocular pressure should be reduced immediately. If the eye attacked by acute angle closure glaucoma is to have intraocular surgery, there clearly needs to be care not to injure the endothelium and measure the endothelial cell count preoperatively.
Cell Count ; Cornea ; Endothelial Cells* ; Endothelium ; Glaucoma, Angle-Closure* ; Humans ; Intraocular Pressure

No abstract available.
Down Syndrome* ; Humans ; Twins, Monozygotic*

PURPOSE: We presented our initial clinical experiences with transumbilical laparoendoscopic single-site (LESS) ureterolithotomy for large, impacted ureteral stones. MATERIALS AND METHODS: Between March 2009 and November 2009, seven LESS ureterolithotomies were performed at our institute. During the operation, we made a single 2 cm incision at the umbilicus and a homemade port by using a small wound retractor (Alexis(R), Applied Medical, Rancho Santa Margarita, USA), a surgical glove, and conventional trocars. The operation was performed in the same manner as conventional laparoscopic surgery. The mean maximal stone diameter was 21.9 mm (range, 16.0-27.0 mm). There were six cases of upper ureteral stones and one case of a mid-ureteral stone. Perioperative and postoperative parameters were evaluated. RESULTS: The mean operative time was 197.1 min (range, 150-270 min). No transfusions were required. The mean postoperative hospital stay was 3.3 days (range, 2-6 days). The mean pain intensity on a visual analogue scale (VAS) on postoperative day 2 was 26 mm (range, 0-80 mm), and the mean cosmetic VAS at 6 weeks after the operation was 0 mm. The mean time for patients to return to their baseline activities was 4.0 days (range, 3-7 days). In six cases, all stones were completely removed on the basis of postoperative radiologic evaluation. There were no cases of major complications, including internal organ injury, urinary leakage, or urinary tract infection. CONCLUSIONS: Transumbilical LESS ureterolithotomy can be considered as an alternative treatment option with minimal invasiveness and good effectiveness for large, impacted ureteral stones.
Cosmetics ; Gloves, Surgical ; Humans ; Laparoscopy ; Length of Stay ; Operative Time ; Surgical Instruments ; Surgical Procedures, Minimally Invasive ; Umbilicus ; Ureter ; Ureterolithiasis ; Urinary Tract Infections

PURPOSE: The purpose of this study is to illustrate MR patterns of signal intensity of proximal femur in normal subjects according to the age distribution. METHOD AND MATERIAL: Tl-weighted MR images of the proximal femur in 125 subjects, aged 13 days to 25 years, were retrospectively analyzed. Age distribution was classified to 4 groups;below 4 months, 5 months to 4 years, 5 years to 14 years, and 15 years to 25 years. RESULTS: By the age of 4 months, the non-ossified femoral epiphysis was seen as intermediate-signal-intensity cartilage. At 5 months-4 years, the ossified fernoral capital epiphysis was seen within intermediate-signal-intensity cartilage and appeared as decreased or increased signal-intensity red or yellow marrow surrounded by a rim of low-signal-intensity cortical bone. At 5-14 years, the ossified femoral capital and greater trochanteric epiphysis were seen within the intermediate-signal-intensity cartilage and appeared as decreased or increased signal-intensity red or yellow marrow. At 15-25 years, the proximal metaphyseal marrow showed increased signal intensity. Four patterns of the metaphyseal marrow were recognized by Ricci et al. The frequency of pattern la progressively decreased with age. Pattern 2 and 3 were visible in the 15-25 years age group. CONCLUSION: An understanding of the spectrum of normal age-related change of the proximal femoral cartilage and marrow patterns serves as the foundation for interpretation of proximal femur pathologies.
Age Distribution ; Bone Marrow ; Cartilage ; Epiphyses ; Femur* ; Humans ; Magnetic Resonance Imaging* ; Pathology ; Retrospective Studies

Most intracranial schwannomas originate from the cranial nerve especially CN V, VIII. However, schwannomas from low-cranial nerve are rarely reported. We report a case of large foramen magnum schwannoma in a 26 year-old-man presenting swallowing difficulty, nausea and vomiting. Magnetic resonance image revealed a cystic multilobulated huge mass from midclivus to atlas which compressed brain stem. The mass was removed by far-lateral transcondylar approach and confirmed with schwannoma which originated from hypoglossal nerve.
Brain Stem ; Cranial Nerves ; Deglutition ; Foramen Magnum* ; Hypoglossal Nerve ; Nausea ; Neurilemmoma* ; Vomiting

PURPOSE: To evaluate the short-term effect of intravitreal aflibercept (Eylea(R); Regeneron Pharmaceuticals Inc., Tarrytown, NY, USA and Bayer, Basel, Switzerland) on the visual outcomes and retinal anatomic changes of patients with polypoidal choroidal vasculopathy (PCV). METHODS: Intravitreal Eylea(R) was injected into 16 eyes of 16 patients with PCV in this retrospective case study. After therapy, the patients were followed up for over 3 months. Changes in best-corrected visual acuity (BCVA) and central foveal thickness (CFT) using optical coherence tomography (OCT) and abnormal vasculature on indocyanine green angiography (ICGA) were evaluated. RESULTS: The mean log MAR BCVA was 0.75 +/- 0.60 at baseline, 0.74 +/- 0.60 and 0.71 +/- 0.63 at 1 and 2 months, respectively (p > 0.05) and 0.57 +/- 0.53 at 3 months (p < 0.05) after treatment. The mean CFT was 379 +/- 130 microm at baseline, 281 +/- 92 microm, 247 +/- 54 microm, and 231 +/- 51 microm at 1, 2, and 3 months, respectively, after treatment (p < 0.05). Complete resolution was 43%, 55%, and 50% at 1, 2, and 3 months, respectively in pigment epithelial detachment (PED), 67%, 83%, and 92% at 1, 2, and 3 months, respectively in subretinal fluid (SRF) and 33%, 60%, and 60% at 1, 2, and 3 months, respectively in intraretinal fluid (IRF) using OCT. The polypoidal lesions in ICGA decreased in 12 of 14 eyes (86%). CONCLUSIONS: Intravitreal injection of Eylea(R) with PCV reduced CFT due to decreased retinal PED, SRF, IRF and occluded effectively the polypoidal lesion leaking. Compared with baseline, mean BCVA at the 3-month follow-up was significantly improved.
Angiography ; Choroid* ; Follow-Up Studies ; Humans ; Indocyanine Green ; Intravitreal Injections ; Retinaldehyde ; Retrospective Studies ; Subretinal Fluid ; Tomography, Optical Coherence ; Visual Acuity

BACKGROUND/AIMS: Endoscopic hemoclip application is an effective and safe method of endoscopic hemostasis. We conducted a multicenter retrospective study on hemoclip and hemoclip combination therapy based on prospective cohort database in terms of hemostatic efficacy not in clinical trial but in real clinical practice. METHODS: Data on endoscopic hemostasis for non-variceal upper gastrointestinal bleeding (NVUGIB) were prospectively collected from February 2011 to December 2013. Among 1,584 patients with NVUGIB, 186 patients treated with hemoclip were enrolled in this study. Subjects were divided into three groups: Group 1 (n=62), hemoclipping only; group 2 (n=88), hemoclipping plus epinephrine injection; and group 3 (n=36), hemocliping and epinephrine injection plus other endoscopic hemostatic modalities. Primary outcomes included rebleeding, other therapeutic management, hospitalization period, fasting period and mortality. Secondary outcomes were bleeding associated mortality and overall mortality. RESULTS: Active bleeding and peptic ulcer bleeding were more common in group 3 than in group 1 and in group 2 (p<0.001). However, primary outcomes (rebleeding, other management, morbidity, hospitalization period, fasting period and mortality) and secondary outcomes (bleeding associated mortality and total mortality) were not different among groups. CONCLUSIONS: Combination therapy of epinephrine injection and other modalities with hemoclips did not show advantage over hemoclipping alone in this prospective cohort study. However, there is a tendency to perform combination therapy in active bleeding which resulted in equivalent hemostatic success rate, and this reflects the role of combination therapy in clinical practice.
Adult ; Aged ; Angiography ; Cohort Studies ; Combined Modality Therapy ; Databases, Factual ; Epinephrine/therapeutic use ; Female ; Gastrointestinal Hemorrhage/etiology/*therapy ; *Hemostasis, Endoscopic ; Humans ; Male ; Middle Aged ; Prospective Studies ; Proton Pump Inhibitors/therapeutic use ; Retrospective Studies ; Stomach Ulcer/complications/drug therapy/pathology ; Surgical Instruments ; Treatment Outcome

Choroid plexus cysts (CPCs) are the most commom neuroepithelial cysts, occuring in more than 50% of some autopsy series. They are typically small and asymptomatic and are discovered incidentally in older patients, usually in the trigone of the lateral ventricle. Symptomatic CPCs (usually exceptionally large, 2-8 cm) are rare. The authors report a case of large symptomatic choroid plexus cyst, located in the trigone of the right lateral ventricle in a 26-yr-old man who presented with headache and vomiting. The patient underwent endoscopic removal through a burr hole placed 3 cm from the midline and just behind the hair line. The histological examination of the cyst wall was consistent with choroid epithelium. Despite of postoperative intraventricular hemorrhage and catheter infection, he discharged home without neurologic deficits. The endoscopic fenestration rather than excision should be considered as the first surgical procedure because the goal of treatment is shrinkage of the cyst until normal cerebrospinal fluid flow is restored.
Adult ; Brain Diseases/diagnosis/pathology/*surgery ; *Choroid Plexus ; Cysts/diagnosis/pathology/*surgery ; Endoscopy ; Humans ; Male

BACKGROUND/AIMS: The diagnostic proton pump inhibitor test (PPI test) is a method used in diagnosing gastroesophageal reflux disease (GERD). This study aimed to determine the appropriate dose of lansoprazole for use in the diagnostic test for GERD. METHODS: This study was a randomized, controlled, multicenter trial in the Daegu-Gyeongbuk area. Patients with typical reflux symptoms such as regurgitation and heartburn for at least three months were enrolled in this study. Patients were divided into two groups, the erosive reflux disease (ERD) group and the non-erosive reflux disease (NERD) group, and randomized to 14 days of treatment with lansoprazole at a dose of 15 mg, 30 mg or 60 mg once daily. The PPI test was considered positive if the patient's symptoms improved by more than 50%. RESULTS: A total of 218 patients were enrolled, and analysis was performed on the 188 patients who completed the study. The PPI test was positive in 93.2% of the ERD group and 87.2% of the NERD group. A positive PPI test was observed in 91.7%, 89.4%, and 87.2% of the 15 mg, 30 mg, and 60 mg groups, respectively. Significant symptom score changes were observed starting on day 8 for the 15 mg, 30 mg, and 60 mg groups. CONCLUSIONS: In this multicenter, randomized study of Korean patients, the standard dose of lansoprazole was as effective as a high dose of lansoprazole in relieving the symptoms of GERD, regardless of the presence of ERD, by day 14 of treatment.
2-Pyridinylmethylsulfinylbenzimidazoles ; Diagnostic Tests, Routine ; Gastroesophageal Reflux ; Heartburn ; Humans ; Proton Pumps

BACKGROUND/AIMS: The tolerance of the liver to ischemia during intermittent hepatic pedicle clamping was compared with that during continuous hepatic pedicle clamping, and intermittent hepatic pedicle clamping was thought to more tolerable to ischemia/reperfusion injury. The mechanisms underlying this were unknown. We examined the relationship between ischemia/reperfusion injury and the production of oxygen-derived free radicals using spin resonance spectrometry. METHODS: Adult male Sprague-Dawley rats were subjected to either continuous or intermittent hepatic pedicle clamping. Alpha-(4-pyridyl 1-oxide)-N-tert-butylnitrone was administered to rats as a spin trap agent. Continuous clamping (15, 30, or 60 minutes) or intermittent clamping(four cycles of 15-minutes ischemia and 5 or 15 minutes of reperfusion) of hepatic pedicle was carried out. After reperfusion, blood samples were obtained and measuring liver enzyme to evaluate hepatic injury. Hepatic tissue blood flow was measured using a color Doppler blood flowmeter. RESULTS: When there was a longer period of hepatic pedicle occlusion, increased oxygen-derived free radical generation was detected after reperfusion. There was no significant increase in oxygen-derived free radical production or liver enzymes leakage when the duration of ischemia was 15 minutes. Oxygen-derived free radical generation and liver enzyme leakage were significantly less in intermittent pedicle clamping than in continuous clamping for 60 minutes. CONCLUSION: According this results, there is a oxygen-derived free radicals and liver damage in less in intermittent pedicle clamping than continuous clamping although many oxygen-derived free radicals are produced.
Adult ; Animals ; Constriction* ; Flowmeters ; Free Radicals ; Humans ; Ischemia ; Liver* ; Male ; Rats* ; Rats, Sprague-Dawley ; Reperfusion ; Spectrum Analysis