PURPOSE: Diabetic macular edema is one of major causes leading to visual loss and it is difficult to be quantified. We investigated a volumetric quantification of retinal thickness change before and after focal laser photocoagulation with Heidelberg Retina Tomograph (HRT). METHODS: Ten patients who were diagnosed as diabetic retinopathy with clinically significant macular edema (CSME) in only one eye and treated with focal laser photocoagulation were studied. The opposite eyes which had no CSME were studied as control group. In the eyes which had CSME, the volume above reference plane (VARP) bounded by three consecutive circle centered at the fovea (diameter 1, 2, and 3 mm) were measured. The retinal thickness of control group was also measured with the same method. We performed focal laser photocoagulation for the eyes which had CSME and measured VARP at 1, 2, and 3 months after laser treatment. RESULTS: Three months after laser treatment, the VARP of treated eyes measured in each diameter was significantly decreased, however, there was no significant difference in control group. There was no significant difference in visual acuity change between before and 3 months after laser treatment. CONCLUSION: From the above results, we concluded that HRT could be used to quantify the change of diabetic macular edema before and after laser treatment.
Diabetic Retinopathy ; Humans ; Light Coagulation* ; Macular Edema* ; Retina ; Retinaldehyde ; Visual Acuity

We injected tissue plasminogen activator(TPA) and expansile gas into the vitreous of 17-year-old patient who presented with traumatic macular hole and subretinal hemorrhage. Most of the subretinal hemorrhage drained into the vitreous cavity through the macular hole. Two weeks after intravitreal injection, closure of macular hole accompanied by complete posterior vitreous detachment was observed. This case suggests that the tangential vitreous traction may play an important role in the development of traumatic macular hole as in the development of idiopathic macular hole. It is speculated that the induction of posterior vitreous detachment without vitrectomy can result in removal of this traction and closure of traumatic macular hole.
Adolescent ; Hemorrhage ; Humans ; Intravitreal Injections ; Plasminogen ; Retinal Perforations* ; Traction ; Vitrectomy ; Vitreous Detachment

BACKGROUND: The catheter ablation usin radiofrequency(RF) energy in patients with atrioventricular nodal reentrant tachycardia(AVNRT) and atrioventricular reentrant tachycardia(AVRT) ahs been proved as a safe and effective nonpharmacologic therapeutic modality. The purpose of our study was to evaluate the success rate and complications of the initial experience and to determine the extent of myocardial damage of RF catheter ablation. METHODS: Electrophysiologic study was performed with the standard technique. Twenty five patinents(M:F=16:9, mean age:42 years old) underwent RF catheter ablation in St. May's Hospital from April to December in 1994. The RF generator in this study was RFG-3D model and catheters were 6F or 7F steerable catheters with 4mm kistal tip. In order to evaluate the extent of myocardial damage the WBC count, LDH, CK, and CK-MB fraction were checked before and after RF catheter ablation and the Tc99m myocardial scintigraphy was performed within 72 hours of the porcedure. RESULTS: Six of twenty five patients had AVNRT, in which the success rate of selective ablation of the slow pathway was 83.8%. Nineteen patients with AVRT had one accessory pathway. The ablation success rate of 14 accessory pathways in left free wall location was 85.7%, and that of 3 in left posteroseptal location was 66.6%. Two right sided accessory pathways were not ablated successfully. The level of CK-MB fraction after ablation was within normal limit. Only one case revealed grade 2 of hot spot in Tc99m myocardial scintigraphy. CONCLUSION: The RF catheter ablation in patients with AVNRT and AVRT is a safe and effective nonpharmacologic therapeutic modality. But right sided accessory pathways are more difficult to ablate than left sided accessory pathways, requiring more experiences and better technique. The extent of myocardial damage after RF catheter ablation reveals relatively minimal by cardiac enzyme study and Tc99mmyocardial scintigraphy.
Catheter Ablation* ; Catheters ; Humans ; Myocardial Perfusion Imaging ; Radionuclide Imaging ; Tachycardia, Supraventricular*

BACKGROUND: To evaluate the effects of thoracic epidural anesthesia, with or without bilateral vagotomy, epinephrine-induced arrhythmias were studied in 31 rabbits anesthetized with 1 MAC enflurane. METHODS: Logdose protocol was used for the infusion of epinephrine; its arrhythmic dose being defined as the smallest infusion rate produced four or more continuous or intermittent arrhythmias within 15 seconds. RESULTS: The values (geometric mean) of arrhythmic doses and the plasma concentration of epinephrine during arrhythmia were as follows: 10.21 g.kg 1.min 1 and 83.16 ng/ml in epidural control group; 118.90 g.kg 1.min 1 and 677.76 ng/ml in epidural lidocaine group (p<0.05); 6.34 g.kg-1.min 1 and 96.42 ng/ml in intravenous lidocaine group; 8.65 g.kg 1.min-1 and 44.64 ng/ml in vagotomized-epidural control group; and 12.03 g.kg 1.min 1 and 95.35 ng/ml in vagotomized- epidural lidocaine group. CONCLUSIONS: The data suggest that thoracic epidural anesthesia raises the threshold for enflurane- epinephrine arrhythmias in rabbits and that this effect is eliminated by bilateral vagotomy.
Anesthesia, Epidural* ; Arrhythmias, Cardiac* ; Enflurane ; Epinephrine ; Lidocaine ; Plasma ; Rabbits* ; Vagotomy*

PURPOSE: We observed many cases which showed hypofluorescent spots in indocyanine green angiography (ICGA) at the late phase as well as white dot syndrome, so we analyzed for types and causes of these. METHODS: we analyzed the color photographs, fluorescein angiographs (FAG) and ICGA of the 21 patients (39 eyes) who have noted hypofluorescent spots at the late phase retrospectively. RESULTS: The hypofluorescent spots in ICGA could be classified into two types. The first is that which seen hypofluorescence from the early phase and clearly to the late phase and the second, relatively lighter dark spots which appeared after midphase and is seen in the late phase. But when we analyze these together with ophthalmologic findings and FAG, we found out that the lesion could not be found in the retina and FAG or that it is noted as hyperfluorescence or hypofluorescence in the early and late phase of FAG. So the causes were thought to be variable. CONCLUSIONS: We could find hypofluorescent spots in the late phase of ICGA in the lesions which were classified as white dot syndrome in the past as well as presented normal finding in the retina and FAG and they had variable morphologies and causes.
Angiography* ; Fluorescein ; Humans ; Indocyanine Green* ; Retina ; Retrospective Studies

PURPOSE: To evaluate the short-term results of photodynamic therapy with Verteporfin for the patients with choroidal neovascularization. METHODS: We performed photodynamic therapy with Verteporfin in 19 patients (19 eyes) who were diagnosed as subfoveal CNV. The range of age was from 27 to 81 years, and 57 years on average. Twelve patients were male and seven were female. The pretreatment visual acuity with ETDRS chart was from 20/200 to 20/32. On FAG, predominantly classic type were fourteen eyes, minimally classic were four eyes, and no classic was one eye. Visudyne(R) of 6 mg per body surface area was infused intravenously for 10 minutes, and then non-thermal diode laser of 689 nm wavelength was applied for 83 seconds with 600 Mw/Cm2 intensity. We followed up 1 month, 3 months after treatment, thereafter every 3 months. The follow up period was ranged from 3 months to 11 months, 4 months on average. We performed retreatment with the same method when any leakage was found on FAG which is performed every 3 month. RESULTS: Threes months after treatment, only one eye showed visual acuity decrease of more than 3 lines with ETDRS chart, and mean visual acuity change was increased by 0.94 lines. At the same time there was one eye which presented no leakage on FAG, seven eyes showed minimal leakage, ten eyes showed moderate leakage, and only one eye showed progression. Out of twelve eyes which could be followed up more than 6 months, only eye showed decreased visual acuity of more than 3 lines. On FAG, no leakage was not found, minimal leakage in nine eyes, moderate leakage in two eyes and one eye showed progression. CONCLUSION: The above results indicates that the short-term results of photodynamic therapy for subfoveal CNV from various causes were encouraging as a good treatment modality to reduce the risk of visual loss and further study with longer follow-up and large number of cases will be necessary to decide the effect of photodynamic therapy in Korea.
Body Surface Area ; Choroid* ; Choroidal Neovascularization* ; Female ; Follow-Up Studies ; Humans ; Korea ; Lasers, Semiconductor ; Male ; Photochemotherapy* ; Retreatment ; Visual Acuity

Diabetic nephropathy is a clinical syndrome characterized by persistent albuminuria, a relentless decline in GFR and raised arterial blood pressure, and usually diagnosed on clinical grounds without a renal biopsy. Their renal injuries are irreversible and they become eventually end-stage renal disease. Recently, it has been reported that proteinuria are also induced by other causes, and some of the renal diseases was treatable. The detection of non-diabetic renal disease in diabetic patients by renal biopsy has the prognostic and therapeutic importance. We report a case of type II diabetic mellitus with minimal change nephrotic syndrome, and no evidence of diabetic glomerulosclerosis.
Biopsy

BACKGROUND: Arterial stiffness is a strong indicator of cardiovascular risk. Increased visceral fat confers greater risks of metabolic syndrome and cardiovascular events. The aim of this study was to elucidate the relationships between arterial stiffness and regional distribution of abdominal adiposity (i.e. subcutaneous and visceral adipose tissue). METHODS: Thirty obese participants (M:F=17:13, mean age=53.6+/-12.0 years) underwent anthropometric measurements, laboratory procedures such as serum lipid levels and abdominal computed tomography scan. The aortofemoral pulse wave velocity was measured by foot to foot method using two continuous Doppler waves. RESULTS: Pulse wave velocity was positively associated with age, hip circumference (P<0.01), visceral to subcutaneous abdominal fat ratio and body weight (P<0.05), but independent of the total abdominal, visceral, and subcutanous fat. Although not positively associated, the mean pulse wave velocity tended to be higher in patients with history of hypertension or diabetes. CONCLUSIONS: The site of abdominal fat distribution contribute to the prediction of arterial stiffness and visceral adiposity is associated with increased risk of cardiovascular events.
Abdominal Fat ; Adiposity* ; Body Weight ; Foot ; Hip ; Humans ; Hypertension ; Intra-Abdominal Fat ; Methods ; Pulse Wave Analysis ; Vascular Stiffness*

PURPOSE: Recommended dietary allowance of vitamin C was determined on the basis of preventing the scurvy without considerations of the important function of the vitamin C as a first line antioxidant. So we measured the whole blood and plasma vitamin C concentrations of the contemporay healthy elementary school children in Chinju for the establishment of the optimal daily vitamin C requirment in the elementary school children. METHODS: Whole blood and plasma vitamin C concentrations were measured by the 2,4-dinitrophenylhydrazine method in 338 children from the 1st to the 6th grade of one elementary school in Chinju. RESULTS: Whole blood and plasma vitamin C concentrations were 1.36+/-0.34mg/dL and 1.07+/-0.33mg/dL respectively. There existed an close relationship between whole blood and plasma vitamin C concentrations (r=0.77, p=0.0001). Whole blood vitamin C concentration decreased as the age became older (r=-0.22 p=0.0001), but plasma vitamin C concentration did not change. There were no sex differences in the whole blood and plasma vitamin C concentrations except in the 3rd grade (p<0.05). Twenty-three of 338 elementary school children (6.8%) had the plasma vitamin C concentration less than 0.6mg/dL. CONCLUSIONS: We produced the blood and plasma vitamin C concentrations of the contemporay elementary school children in Chinju. These values were not satisfactory in consideration of the importance of the childhood health.
Ascorbic Acid* ; Child* ; Gyeongsangnam-do* ; Humans ; Plasma* ; Recommended Dietary Allowances ; Scurvy ; Sex Characteristics ; Vitamins*

BACKGROUND/AIMS: Low-dose metronomic chemotherapy involves the frequent administration of comparatively low doses of cytotoxic agents with no extended breaks, and it may be as efficient as and less toxic than the conventional maximum tolerated dose therapy. This study evaluated the feasibility and therapeutic efficacy of metronomic chemotherapy in patients with advanced hepatocellular carcinoma (HCC) with major portal vein thrombosis (PVT). METHODS: Thirty consecutive HCC patients with major PVT with or without extrahepatic metastasis were prospectively allocated to metronomic chemotherapy consisting of epirubicin being infused through the correct hepatic artery at a dose of 30 mg/body surface area (BSA) every 4 weeks, and cisplatin (15 mg/BSA) and 5-fluorouracil (50 mg/BSA) every week for 3 weeks, with intervening 1 week breaks. The treatment response was assessed using response evaluation criteria in solid tumors (RECIST). RESULTS: In total, 116 cycles of metronomic chemotherapy were administered to the 30 patients, with a median of 3 cycles given to individual patients (range, 1-15 cycles). Six patients (20.0%) achieved a partial response and six patients (20.0%) had stable disease. The median time to disease progression and overall survival were 63 days (range, 26-631 days) and 162 days (95% confidence interval; range, 62-262 days), respectively. Overall survival was significantly associated with baseline alpha-fetoprotein level (P=0.001) and tumor response (P=0.005). The baseline alpha-fetoprotein level was significantly associated with the disease control rate (P=0.007). Adverse events were tolerable and managed successfully with conservative treatment. CONCLUSIONS: Metronomic chemotherapy may be a safe and useful palliative treatment in HCC patients with major PVT.
Administration, Metronomic ; Adult ; Aged ; Antineoplastic Agents/administration & dosage ; Carcinoma, Hepatocellular/complications/*drug therapy/mortality ; Cisplatin/administration & dosage ; Epirubicin/administration & dosage ; Female ; Fluorouracil/administration & dosage ; Humans ; Kaplan-Meier Estimate ; Liver Neoplasms/complications/*drug therapy/mortality ; Male ; Middle Aged ; *Portal Vein ; Prognosis ; Tomography, X-Ray Computed ; Venous Thrombosis/complications/*diagnosis ; alpha-Fetoproteins/analysis