Purpose: To investigate the outcomes of re-fixation after the first intraocular lens (IOL) scleral fixation. Methods: We retrospectively reviewed the charts of patients who underwent second IOL scleral fixation and vitrectomy for dislocation of IOL after the first IOL scleral fixation. We compared the best-corrected visual acuity (BCVA) and spherical equivalent (SE) after 1 month of the first and second surgery, and noted the complications. Results: We included 21 eyes that underwent second IOL scleral fixation: 13 eyes (61.9%) with IOL exchange and eight (38.1%) with one-haptic fixation. Mean BCVAs (LogMAR) were 0.17 ± 0.25 and 0.11 ± 0.23 after the first and second surgery, respectively (p = 0.073); mean SEs were -0.94 ± 1.69 and -0.58 ± 1.46 diopters after the first and second surgery, respectively (p = 0.076). Postoperative complications occurred in eight eyes (38.1%), including temporarily increased intraocular pressure and suture knots exposure. However, none of the complications required re-operation. Conclusions The outcomes of primary and secondary IOL fixation were similar, and there were no serious complications of the second surgery.

Purpose: To investigate the outcomes of re-fixation after the first intraocular lens (IOL) scleral fixation. Methods: We retrospectively reviewed the charts of patients who underwent second IOL scleral fixation and vitrectomy for dislocation of IOL after the first IOL scleral fixation. We compared the best-corrected visual acuity (BCVA) and spherical equivalent (SE) after 1 month of the first and second surgery, and noted the complications. Results: We included 21 eyes that underwent second IOL scleral fixation: 13 eyes (61.9%) with IOL exchange and eight (38.1%) with one-haptic fixation. Mean BCVAs (LogMAR) were 0.17 ± 0.25 and 0.11 ± 0.23 after the first and second surgery, respectively (p = 0.073); mean SEs were -0.94 ± 1.69 and -0.58 ± 1.46 diopters after the first and second surgery, respectively (p = 0.076). Postoperative complications occurred in eight eyes (38.1%), including temporarily increased intraocular pressure and suture knots exposure. However, none of the complications required re-operation. Conclusions The outcomes of primary and secondary IOL fixation were similar, and there were no serious complications of the second surgery.

We experienced two cases of Boerhaave syndrome (spontaneous esophageal rupture). The first patient was a 62-year-old male who presented epigastric pain after several violent vomitings associated with alcohol ingestion. Diagnosis was done early and promptly in our emergency center and then definitive treatment was done only after 12hrs from onset of his symptom and he was discharged in relatively good condition 256ays after his admission. The second patient was a 44-year-old male who was transfered to our emergency center with chest pain, dyspnea and fever after vomitings associated with autobicycle accident. Diagnosis was delayed due to initial trauma oriented evaluation and incidious develpement of typical clinical findings and then he was managed conservatively but he died of multiple organ failure due to sepsis. We report these cases with literature review.
Adult ; Chest Pain ; Diagnosis ; Dyspnea ; Eating ; Emergencies ; Esophageal Perforation* ; Fever ; Humans ; Male ; Middle Aged ; Multiple Organ Failure ; Sepsis

Purpose: To evaluate the clinical characteristics of Korean patients diagnosed with retinitis pigmentosa. Methods: We retrospectively reviewed the medical records of patients diagnosed with retinitis pigmentosa from January 2014 to December 2019. We evaluated age, gender, the chief complaints, posterior subcapsular cataract status, abnormalities on optical coherence tomography, visual field test results, and electrooculograms. Results: A total of 492 eyes of 246 patients were included. The mean patient age was 48.0 ± 16.0 years and the chief complaints were decreased vision and night blindness. The mean logarithm of the minimal angle of resolution (logMAR) best‐corrected visual acuity (BCVA) was 0.31 ± 0.50. The BCVA was 0.5 or better in 368 eyes (74.8%). A total of 328 (71.0%) of 462 eyes that underwent visual field testing exhibited visual field defects within 10º. The mean Arden ratio was 1.28 ± 0.28 for the 242 eyes that underwent electro‐oculography. Optical coherence tomography revealed vitreomacular traction/an epiretinal membrane, cystoid macular edema, and retinal thinning in 135 (27.4%), 48 (9.8%), and 112 (22.8%) eyes, respectively. The ellipsoid zone was intact in 222 eyes (45.1%), disrupted in 220 (44.7%), and absent in 50 (10.2%). Conclusions Most patients with retinitis pigmentosa exhibited visual acuity of 0.5 or better, but also had central visual field defects. Various abnormalities were noted on optical coherence tomography of most patients.

BACKGROUND: The adequate intravascular ultrasound (IVUS) criteria for stent optimization have not been determined in long coronary stenting. We evaluated the predictors of angiographic restenosis and compared that according to stent lumen cross-sectional area (CSA) and stent length between short (stent length < 20 mm) and long (> or =20 mm) coronary stenting. METHODS: IVUS-guided coronary stenting was successfully performed in 285 consecutive patients with 304 native coronary lesions. Six-month follow-up angiogram was performed in 236 patients (82.8%) with 246 lesions (80.9%). Results were evaluated using conventional (clinical, angiographic, and IVUS) methodology. RESULTS: The overall angiographic restenosis rate was 22.8% (56/246)(short stent 17.6% vs long stent 32.2%, p=0.009). Using multivariate logistic regression analysis, the independent predictors of angiographic restenosis were the IVUS stent lumen CSA (odd ratio=1.51, 95% CI 1.18-1.92, p=0.001) and stent length (odd ratio=0.95, 95% CI 0.91-1.00, p=0.039). The angiographic restenosis rate was 54.8% in stent lumen CSA & 5.0 mm2 (short stent 37.5% vs long stent 73.3%, p=0.049), 27.4% between 5.0 and 7.0 mm2 (short stent 24.1% vs long stent 31.7%, p=0.409), 10.5% between 7.0 and 9.0 mm2 (short stent 10.0% vs long stent 12.5%, p=0.772), and 11.4% in stent lumen CSA > or =9.0 mm2 (short stent 10.4% vs long stent 13.3%, p=0.767)(p=0.001). CONCLUSIONS: Compared with short coronary stenting, long coronary stenting is effective treatment modality to cover long lesions with comparable long-term clinical outcomes in cases of stent lumen CSA > or =7.0 mm2. Regardless of the stent length, the most important factor determining the angiographic restenosis was the IVUS stent lumen CSA in relatively large coronary artery lesions.
Coronary Artery Disease ; Coronary Vessels* ; Follow-Up Studies ; Humans ; Logistic Models ; Stents* ; Ultrasonography*

BACKGROUND: The chronic stent recoil of Palmaz-Schatz stent was minimal. However, the chronic stent recoil of other types of stents has not been determined. We evaluated the chronic stent recoil of different design of stents. METHODS: Serial (after stent implantation and follow-up) intravascular ultrasound images using automatic transducer pullback devices were obtained in 70 native coronary artery lesions: slotted-tube design of Palmaz-Schatz stent 30 and NIR 10, sinusoidal ring design of GFX 20, and coil design of CrossFlex 10. Measurements of stent cross-sectional area (CSA) (4 image slices in Palmaz-Schatz stent and 7 image slices in GFX, NIR and CrossFlex) using computerized planimetry were performed. Stent CSA post-stenting and follow-up was compared to evaluate the chronic stent recoil of different designs of stent. The chronic stent recoil (%) was defined as (post-intervention-follow-up) stent CSAx100/post-intervention stent CSA. RESULTS: The changes of stent CSA between post-intervention and follow-up period were minimal in NIR stent, Palmaz-Schatz and GFX. However, there was significant reduction of stent CSA in CrossFlex stent. Compared with other types of stents, the changes of stent CSA were significantly larger in CrossFlex stent (p=0.001). The chronic stent recoil was significantly larger in CrossFlex stent than in other types of stents (4.0+/-6.0% vs 0.7+/-5.8% in GFX stent, 0.4+/-5.0% in Palmaz-Schatz and 0.3+/-3.0% in NIR, p=0.001, respectively). There were no significant differences of chronic stent recoil among GFX, NIR and Palmaz-Schatz stent. CONCLUSIONS: The chronic stent recoil was minimal in slotted-tube and sinusoidal ring designs of stent. However, there was significant chronic stent recoil in coil design of stent.
Coronary Artery Disease ; Coronary Vessels ; Follow-Up Studies ; Stents* ; Transducers ; Ultrasonography*

PURPOSE: Ginseng has been used throughout the Far East, including Korea and China, as a tonic and restorative agent to maintain physical vitality. The main pharmacoactive molecules of ginseng are ginsenosides. The present study was designed to investigate whether ginsenosides relax rabbit vaginal smooth muscle and whether this effect is modulated by nitric oxide(NO) and the cGMP pathway. MATERIALS AND METHODS: Strips of rabbit vagina were mounted in organ chambers to measure isometric tension. The strips were contracted with phenylephrine(5 X 10(-5) M), and the responses to acetylcholine, nitric oxide inhibitor, and ginsenosides were examined. The cGMP content of the strips was measured by radioimmunoassay after various doses of ginsenosides. RESULTS: Ginsenosides(100~500microgram/mL) relaxed vaginal smooth muscle in a dose-dependent manner(5~25%). Acetylcholine-induced relaxation was significantly increased in the presence of ginsenosides(100, 200microgram/mL)(p<0.05). The relaxation effect of ginsenosides was inhibited by L-NAME(10(-4) M), but the difference was not statistically significant(p>0.05). Ginsenosides(400microgram/mL for 7 min) increased the accumulation of cGMP. CONCLUSIONS: These data suggest that ginsenosides have a relaxing effect on rabbit vaginal smooth muscle. This effect is at least in part mediated by the NO-cGMP pathway.
Acetylcholine ; China ; Far East ; Ginsenosides* ; Korea ; Muscle, Smooth* ; Nitric Oxide ; Panax ; Radioimmunoassay ; Relaxation* ; Vagina

BACKGROUND: Although the net atrioventricular compliance can be obtained by invasive catheterization (Ccath) in mitral stenosis (MS), feasibility of noninvasive echocardiographic calculation of the compliance (Cecho) and its hemodynamic significance were not tested. METHODS: Using valve area by 2D planimetry (A2D) and deceleration slope (dv/dt) of transmitral velocity decay in continuous wave Doppler echocardiographic tracing, Cecho was defined as -A2D/(gamma dv/dt), which was compared with Ccath obtained directly during the catheterization in 30 MS patients with sinus rhythm. Exercise Doppler echocardiography with symptom-limited treadmill was performed in 66 patients with moderate to tight MS: mean mitral gradient (MG) and peak pressure gradient of tricuspid regurgitation (PGTR) at baseline and immediately after exercise were obtained using continuous wave Doppler echocardiographic tracing. Hemodynamic variables including Cecho, MG, PGTR and mitral valve area were analyzed to determine the association with patients' exercise tolerance. RESULTS: Cecho in 30 patients with tight MS (valve area 0.9+/-0.2 cm 2) was 4+/-1 ml/mmHg (2-7 mmHg), which showed a significant correlation with Ccath (r=0.48, p=0.01). Exercise time in 66 patients with moderate to tight MS showed significant negative correlation with resting MG, resting and postexercise PGTR, and positive correlation with Cecho: exercise time in those patients did not show any significant correlation with resting valve area. In multivariate analysis, Cecho and postexercise PGTR were independent factors determining exercise time in MS. CONCLUSIONS: The net atrioventricular compliance in MS can be calculated by noninvasive echocardiography, and it is an important hemodynamic factor determining exercise tolerance in MS.
Catheterization ; Catheters ; Compliance* ; Deceleration ; Echocardiography* ; Echocardiography, Doppler ; Exercise Tolerance ; Heart* ; Hemodynamics ; Humans ; Mitral Valve ; Mitral Valve Stenosis* ; Multivariate Analysis ; Tricuspid Valve Insufficiency

BACKGROUND AND OBJECTIVES: The GFX stent is a flexible, balloon-expansible stent made of sinusoidal element of stainless steel. The adjunct high-pressure balloon dilatations after stenting were usually recommended in routine stenting procedure. The aim of this study was 1) to evaluate the immediate and long-term clinical and angiographic outcomes and 2) to investigate the necessity of high-pressure balloon during GFX stenting. MATERIAL AND METHODS: One hundred seventy two consecutive patients underwent single 12 or 18 mm GFX stent implantation in 188 native coronary lesions. Two types of stenting technique were used: 1) stent size of a final stent-to-artery ratio of 1:1 (inflation pressure > 10 atm, usually 12-14 atm: high pressure group) and 2) stent size of 0.5 mm bigger than reference vessel (inflation pressure 10 atm, usually 9 atm: low pressure group). The adjunct high-pressure balloon dilatations were done only in cases of suboptimal results. RESULTS: The adjunct high-pressure balloon dilatation were required under angiographic guidance in 11 of 83 lesions (13%) in high pressure group and 7 of 105 lesions (7%) in low pressure group (p=0.203). Procedural success rate was 100%. There were no significant differences of in-hospital and long-term clinical events between 2 group. The overall angiographic restenosis rate was 17.7%: 18.4% in high pressure group and 17.1% in low pressure group (p=0.991). CONCLUSION: GFX stent is a safe and effective device with high procedural success rate and favorable late clinical outcome for treatment of native coronary artery disease. Further randomized trials may be needed to compare stenting techniques in GFX stent implantations.
Angioplasty ; Coronary Artery Disease ; Dilatation* ; Humans ; Stainless Steel ; Stents*

Background/Aims: This study aimed to investigate the patterns of preferred endoscopic procedure types and techniques for managing difficult common bile duct (CBD) stones in South Korea. Methods: The Committee of Policy and Quality Management of Korean Pancreatobiliary Association (KPBA) conducted a survey containing 19 questions. Both paper and online surveys were carried out; with the paper survey being conducted during the 2019 Annual Congress of KPBA and the online survey being conducted through Google Forms from April 2020 to February 2021. Results: The response rate was approximately 41.3% (86/208). Sixty-two (73.0%) worked at tertiary hospitals or academic medical centers, and 60 (69.7%) had more than 5 years of endoscopic retrograde cholangiopancreatography experience. The preferred size criteria for large CBD stones were 15 mm (40.6%), 20 mm (31.3%), and 30 mm (4.6%). For managing of large CBD stones, endoscopic papillary large balloon dilation after endoscopic sphincterotomy was the most preferred technique (74.4%). When performing procedures in those with bleeding diathesis, 64 (74.4%) respondents favored endoscopic papillary balloon dilation (EPBD) alone or EPBD with small endoscopic sphincterotomy. Fifty-five respondents (63.9%) preferred the doubleguidewire technique when faced with difficult bile duct cannulation in patients with periampullary diverticulum. In surgically altered anatomies, cap-fitted forward viewing endoscopy (76.7%) and percutaneous transhepatic cholangioscopy (48.8%) were the preferred techniques for Billroth-II anastomosis and total gastrectomy with Roux-en-Y anastomosis, respectively. Conclusions Most respondents showed unifying trends for the management of difficult CBD stones. The current practice patterns could be used as basic data for clinical quality improvements in the management of difficult CBD stones.