PURPOSE: To evaluate the differences between IOLMaster(R) and A-scans in changes in axial length after vitrectomy in patients with macular disease. METHODS: Using IOLMaster(R) and A-scans, we measured preoperative and postoperative axial length in 12 eyes with epiretinal membranes (ERM) and in 8 eyes with macular holes (MH). The relationship between the absolute error in axial length after vitrectomy and both methods was assessed using Mann-Whitney U test. The correlation to central macular thickness was evaluated by Spearman's correlation coefficient. RESULTS: In eyes with ERM and MH, preoperative and postoperative axial lengths obtained with both methods had no significant difference (p>0.05). The absolute error in axial length after vitrectomy was not significant using IOLMaster(R) (ERM: 0.07+/-0.05 mm, MH: 0.04+/-0.02 mm, p>0.05) but was significant using A-scan (ERM: 0.20+/-0.11 mm, MH: 0.30+/-0.07 mm, p<0.05). The correlation between the change of axial length after vitrectomy and the central macular thickness was poor (IOLMaster(R): ERM; correlation coefficient = -0.182, p>0.05, MH; correlation coefficient = -0.054, p>0.05, A-scan: ERM; correlation coefficient = -0.210, p>0.05, MH; correlation coefficient = -0.156, p>0.05). CONCLUSIONS: The IOLMaster(R) is more useful than the A-scan when measuring axial length without refractive errors after vitrectomy in eyes with macular disease.
Epiretinal Membrane ; Eye ; Humans ; Refractive Errors ; Retinal Perforations ; Vitrectomy

PURPOSE: To evaluate the differences between IOLMaster(R) and A-scans in changes in axial length after vitrectomy in patients with macular disease. METHODS: Using IOLMaster(R) and A-scans, we measured preoperative and postoperative axial length in 12 eyes with epiretinal membranes (ERM) and in 8 eyes with macular holes (MH). The relationship between the absolute error in axial length after vitrectomy and both methods was assessed using Mann-Whitney U test. The correlation to central macular thickness was evaluated by Spearman's correlation coefficient. RESULTS: In eyes with ERM and MH, preoperative and postoperative axial lengths obtained with both methods had no significant difference (p>0.05). The absolute error in axial length after vitrectomy was not significant using IOLMaster(R) (ERM: 0.07+/-0.05 mm, MH: 0.04+/-0.02 mm, p>0.05) but was significant using A-scan (ERM: 0.20+/-0.11 mm, MH: 0.30+/-0.07 mm, p<0.05). The correlation between the change of axial length after vitrectomy and the central macular thickness was poor (IOLMaster(R): ERM; correlation coefficient = -0.182, p>0.05, MH; correlation coefficient = -0.054, p>0.05, A-scan: ERM; correlation coefficient = -0.210, p>0.05, MH; correlation coefficient = -0.156, p>0.05). CONCLUSIONS: The IOLMaster(R) is more useful than the A-scan when measuring axial length without refractive errors after vitrectomy in eyes with macular disease.
Epiretinal Membrane ; Eye ; Humans ; Refractive Errors ; Retinal Perforations ; Vitrectomy

PURPOSE: we clinically measured the temperature rise in real time and analyzed the difference of albino rabbit and pigmented rabbit in use of the specially designed thermometer. METHODS: Specially designed thermometer was attached into the subretinal pigment epithealial and choroidal space through the suprachoroidal space in three pigment and three albino rabbits, with diode laser of 810 nm wave length, 3 mm spot size. We examined the retinal temperature according to laser irradiance power at each ten seconds during sixty seconds and the laser power setting was 200 mW, 300 mW, 400 mW in pigmeted rabbit and 300 mW, 600 mW, 800 mW in albino rabbit. We analyzed the results based on the measurements at least three times per each irradiance power. RESULTS: In albino rabbit, the maximal range of retinal temperature change was 1.2 degrees C and 1.7 degrees C in 300 mW and 600 mW, 14.1 degrees C in 800 mW power of 810 nm diode laser irradiance. In pigmented rabbit, the maximal range of retinal temperature change was 12.1 degrees C in 200 mW of laser irradiance power, 16.2 degrees C in 300 mW, 24.3 degrees C in 400 mW during sixty seconds in 810 nm diode laser. CONCLUSIONS: We investigated the ratinal temperature at transpupillary thermotherapy in 810 nm wavelength diode laser on rabbits. The difference of retinal temperature change was in accordance with the amount of chorioretinal melanin pigment. Therefore if the laser power setting used in caucasians would be attempted in orientals, it is the point to be considered during transpupillary thermotherapy.
Choroid ; Hyperthermia, Induced* ; Lasers, Semiconductor ; Melanins ; Rabbits* ; Retinaldehyde* ; Thermometers

Generally, the left kidney from a living donor is more commonly preferred but the right kidney is occasionally donated because of multiple left renal arteries or repeated transplantation. The right donor nephrectomy is usually more difficult compared to the left because the right renal vein is often multiple and short, which complicates dissection of the vascular pedicle. From Jan. 1989 to Sep. 1992, 112 consecutive cases of right donor nephrectomies out of a total of 771 cases were retrospectively reviewed with the preoperative renal angiography and the intraoperative assessment of the right renal vascular pedicle. The indications for right donor nephrectomy include 1) multiple or proximal bifurcating renal arteries of the left kidney (89.3%), 2) repeated transplantation in the recipient (9%). In 26.8% of the cases, there were more than two right renal veins. In the right donor nephrectomy, it is often necessary to perform vena cava cuff resection because of short and frequently occurring multiple right renal veins. For the dissection of the inferior vena cava (IVC), the aberrantly occurring right gonadal vein, the adrenal vein draining above the junction of the renal vein and IVC, and the lumbar vein below the junction should always be looked for and must be ligated if any are found.
Adult ; Blood Vessels/anatomy & histology ; Female ; Human ; Intraoperative Period ; Kidney/*blood supply ; Male ; Nephrectomy/*methods ; Retrospective Studies ; *Tissue Donors

BACKGROUND: In cardiac arrest, the survival rate increases with the provision of bystander cardiopulmonary resuscitation (CPR), of which the initial response and treatment are critical. Telephone CPR is among the effective methods that might increase the provision of bystander CPR. This study aimed to describe and examine the improvement of neurological outcomes in individuals with out-of-hospital acute cardiac arrest by implementing the nationwide, standardized telephone CPR program. METHODS: Data from the emergency medical service-based cardiac arrest registry that were collected between 2009 and 2014 were used. The effectiveness of the intervention in the interrupted time-series study was determined via a segmented regression analysis, which showed the risk ratio and risk difference in good neurological outcomes before and after the intervention. RESULTS: Of 164,221 patients, 148,403 were analyzed. However, patients with unknown sex and limited data on treatment outcomes were excluded. Approximately 64.3% patients were men, with an average age of 63.7 years. The number of bystander CPR increased by 3.3 times (95% confidence interval [CI], 3.1–3.5) after the intervention, whereas the rate of good neurological outcomes increased by 2.6 times (95% CI, 2.3–2.9 [1.6%]; 1.4–1.7). The excess number was identified based on the differences between the observed and predicted trends. In total, 2,127 cases of out-of-hospital cardiac arrest (OHCA) after the intervention period received additional bystander CPR, and 339 cases of OHCA had good neurological outcomes. CONCLUSION: The nationwide implementation of the standardized telephone CPR program increased the number of bystander CPR and improved good neurological outcomes.
Cardiopulmonary Resuscitation* ; Emergencies ; Heart Arrest ; Humans ; Male ; Odds Ratio ; Out-of-Hospital Cardiac Arrest* ; Survival Rate ; Telephone*

Supernumerary derivative (22) syndrome is a rare genomic syndrome. It is characterized by severe mental retardation, microcephaly, failure to thrive, preauricular tag or sinus, ear abnormalities, cleft and/or high-arched palate, micrognathia, kidney abnormalities, congenital heart defects, and genital abnormalities in males. In 99% of the cases, one of the parents is a balanced carrier of a translocation between chromosome 11 and chromosome 22. To date, there have been about 100 case reports of supernumerary derivative (22) syndrome. In most of the cases, supernumerary derivative (22) syndrome was the result of 3:1 meiotic segregation in the maternal 11;22 translocation carrier. We now report a case of 47,XX, + der(22)t(11;22)(q23;q11.2) resulting from 3:1 meiotic segregation of the paternal translocation carrier.
Chromosomes, Human, Pair 11 ; Chromosomes, Human, Pair 22 ; Congenital Abnormalities ; Ear ; Failure to Thrive ; Heart ; Humans ; Intellectual Disability ; Kidney ; Male ; Microcephaly ; Palate ; Parents ; Trisomy

PURPOSE: To evaluate the side effects, pattern of failure, and survival rate according to the sequence of postoperative adjuvant radiotherapy and chemotherapy, patients with stages II and lll rectal cancer who had undergone curative resection were randomized to early radiotherapy group (arm I) or 'late radiotherapy group (arm II)', then we intend to determine the most effective sequence of the radiotherapy and chemotherapy. MATERIALS AND METHODS: From January 1996 to March 1999, 3 13 patients with curatively resected stages II and III rectal cancer have been randomized to early' or late radiation therapy group and recei ved combined chemotherapy (5-FU 375 mg/m/day, leucovorin 20 mg/m, IV bolus daily D1-5, 8 cycles) and radiation therapy (whole pelvis with 45 Gy/25 fractions/5 weeks). Arm I received radiation therapy from day 1 with first cycle of chemotherapy and arm II received radiation therapy from day 57 with third cycle of chemotherapy after completion of first two cycles. Preliminary analysis was performed with 228 patients registered up to Jun 1998. Two out of the 228 patients were excluded because of double primary cancer. Median follow-up period was 23 months. RESULTS: Local recurrence occurred in 11 patients (9.7%) for arm I and 9 patients (8%) for arm II. There was no significant difference between both groups (p=0.64). However, distant metastasis was found in 22 patients (19.5%) for arm I and 35 patients (31.0%) for arm II and which showed statistically significant difference between the two groups (p=0.046). And neither 3-year disease-free survival (70.2% vs 59.2%, p=0.2) nor overall survival (89.4% vs 88.0%, p=0.47) showed significant differences. The incidence of leukopenia during radiation therapy and chemotherapy was 78.3% and 79.9% respectively but leukopenia more than RTOG grade 3 was only 2.1% and 6.0% respectively. The incidence of diarrhea more than 10 times per day was significantly higher in the patients for arm I than for arm II (71.2% vs 4 1.6%, p=0.02) but this complication was controlled with supportive cares. CONCLUSION: Regardless of the sequence of postoperative adjuvant radiation therapy and chemotherapy a fter curative resection for rectal cancer, local recurrence rate was low with combined chemoradiotherapy. But distant metastasis rate was lower in early radiation therapy group than in late radiation therapy group and the reason is unclear. Most patients completed these treatments without severe complication, so these were thought to be safe treatments but the treatment compliance should be improved.
Arm ; Chemoradiotherapy ; Chemotherapy, Adjuvant* ; Compliance ; Diarrhea ; Disease-Free Survival ; Drug Therapy ; Follow-Up Studies ; Humans ; Incidence ; Leucovorin ; Leukopenia ; Neoplasm Metastasis ; Pelvis ; Prospective Studies* ; Radiotherapy* ; Radiotherapy, Adjuvant ; Rectal Neoplasms* ; Recurrence ; Survival Rate

PURPOSE: Microperimetry with the scanning laser ophthalmoscope (SLO) allows precise point-to-point correlation between visual functions and retinal pathology. The aim of this study was to evaluate the retinal sensitivity in patients with diabetic retinopathy. METHODS: We divided 15 eyes into 3 study based on the severity of the diabetic retinopathy and 5 healthy eyes as a control. Twenty eyes of 20 patients were prospectively examined with static manual microperimetry using the SLO (Scanning laser microscope 101, Rodenstock, Munich, Germany) to compare the retinal sensitivity according to the severity of retinal pathology. RESULTS: We observed a generalized decrease in retinal sensitivity in diabetic retinopathy patients. There was a significant decrease in retinal sensitivity over 5degrees in non-proliferative diabetic retinopathy and proliferative diabetic retinopathy (p<0.05). CONCLUSIONS: Results indicate that the higher the degree of diabetic retinopathy, retinal sensitivity decreased. A decreased in retinal sensitivity was also observed with retinal hemorrhage, exudate and neovascularization. It may help in making management decisions in diabetic patients by offering sensitive parameters in addition to the visual acuity.
Diabetic Retinopathy ; Exudates and Transudates ; Humans ; Ophthalmoscopes ; Pathology ; Prospective Studies ; Retinal Hemorrhage ; Retinaldehyde* ; Visual Acuity

PURPOSE: We report a case of central retinal artery occlusion after two intravitreal injections of triamcinolone acetonide for diabetic macular edema due to non-proliferative diabetic retinopathy. METHODS: A forty-six year old man with a ten-year history of DM visited our clinic because of diminished vision in his right eye (0.02). He received intravitreal triamcinolone acetonide for diabetic macular edema due to NPDR. After injection, he showed recovery of visual acuity (0.9) and decrease of macular edema. After two months, he received a second intravitreal triamcinolone acetonide injection because his visual acuity had diminished during the two-month period. Fifteen days after the second injection, visual acuity of his right eye suddenly diminished to no light perception. At this time, we performed fundus photograph, fluorescein angiography, and optical coherence tomography. RESULTS: From the fundus exam, we diagnosed the patient with CRAO and prescribed an antithrombotic agent. Five month after the occlusion, visual acuity of the right eye improved 0.3, but generalized sclerosis of retinal vessels was present. Eight months after the occlusion, however he developed neovascular glaucoma and visual acuity of the right eye fell to the light perception negative range. CONCLUSIONS: We experienced a case of central retinal artery occlusion after intravitreal triamcinolone acetonide injection. Therefore, possible vascular complications should be considered following this type of injection.
Diabetic Retinopathy* ; Fluorescein Angiography ; Glaucoma, Neovascular ; Humans ; Intravitreal Injections ; Macular Edema* ; Retinal Artery Occlusion* ; Retinal Artery* ; Retinal Vessels ; Sclerosis ; Tomography, Optical Coherence ; Triamcinolone Acetonide* ; Triamcinolone* ; Vision, Low ; Visual Acuity

PURPOSE: The purpose of this study is to evaluate the efficacy of hypofractionated radiation therapy (RT) in the treatment of unresectable hepatocellular carcinoma (HCC) after failure of transarterial chemoembolization (TACE) or in cases of refractory HCC, and to investigate biliary complications after hypofractionated RT. MATERIALS AND METHODS: We retrospectively enrolled patients with unresectable, TACE-unresponsive, or refractory HCC treated with hypofractionated RT between July 2006 and December 2012. The perihilar region was defined as the 1-cm area surrounding the right, left, and the common hepatic duct, including the gallbladder and the cystic duct. Significant elevation of total bilirubin was defined as an increase of more than 3.0 mg/dL, and more than two times that of the previous level after completion of RT. RESULTS: Fifty patients received hypofractionated RT and 27 (54%) had a tumor located within the perihilar region. The median follow-up period was 24.7 months (range, 4.3 to 95.5 months). None of the patients developed classic radiation disease symptoms, but four patients (8%) showed significant elevation of total bilirubin within 1 year after RT. During follow-up, 12 patients (24%) developed radiologic biliary abnormalities, but only two patients had toxicities requiring intervention. Estimated local progression-free survival, progression-free survival, and overall survival of the patients at 3-year post-hypofractionated RT were 89.7%, 11.2%, and 57.4%, respectively. CONCLUSION: Biliary complications associated with a higher dose exposure of hypofractionated RT were minimal, even in the perihilar region. Hypofractionated RT provided excellent local control and may be a valuable option for treatment of unresectable cases of TACE-unresponsive or refractory HCC.
Bilirubin ; Carcinoma, Hepatocellular* ; Cystic Duct ; Disease-Free Survival ; Dose Fractionation ; Follow-Up Studies ; Gallbladder ; Hepatic Duct, Common ; Humans ; Radiotherapy ; Retrospective Studies