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

The recurrence of viral hepatitis B or C after liver transplantation is almost universal but their clinical courses and outcomes are vary widely. We investigated four cases of rapidly progressive and fatal recurrent viral hepatitis following liver transplantation, which were rapidly progressive and fatal. Case 1 was a 58-year-old male, who developed recurrent viral hepatitisC. Case 2, 3, and 4 were a 59-year-old female, a 42-year-old male, and a 50-year-old male, respectively, who developed recurrent viral hepatitis B. In cases 1 and 2, the histopathological features of the first liver biopsies were prominent ballooning degeneration of the hepatocytes but later biopsies revealed significant lobular activity. Case 3 began with a marked fatty change and mild lobular and porto-periportal activity and progressed to severe lobular activity and septal fibrosis. In case 4, the first liver biopsy revealed minimal lobular activity but the second biopsy revealed severe lobular activity.
Adult ; Biopsy ; Female ; Fibrosis ; Hepatitis B ; Hepatitis* ; Hepatocytes ; Humans ; Liver Transplantation* ; Liver* ; Male ; Middle Aged ; Recurrence

BACKGROUND: The optimal screening tools for hepat ocellular carcinoma are regular tests of alpha fetoprotein (aFP)and liver ultrasonography every 6 months in high risk group. To implement successful long-term project for reducing cancer-mortality,it is essential to know the reasons f or non-compliance among the high risk group. METHODS: A telephone survey was done a mong the hepatitis B surface antigen positive patient group who had not receiveda follow-up test of aFP and liver ultrasonography. This group was selected among the patients who had received health examinations from January,2002 to December,2002 at a university hospital center for health promotion, and the reasons for non-compliance were inquired. RESULTS: There were no stati stical di fferences i n educational level,economic status,age,and sex between the patient group who had taken appropriate follow-up tests and the group who had not. But there were statistically significant differences in the admission history and t ransf usi on hi st ory bet ween t he t wo groups. The reasons for non-compliance were as follows:1. ignorance to the significance of follow-up examination (41.7%),2.lack of time (27.8%),3.no specific signs of cancer (22.2%),4.high costs (5.6%),and 5.fear of discovering serious disease. CONCLUSION: It is important to have patients educated on the significance of screening and early diagnosis of hepatocellular carcinoma.
alpha-Fetoproteins ; Carcinoma, Hepatocellular* ; Compliance ; Early Diagnosis ; Follow-Up Studies ; Health Promotion ; Hepatitis B Surface Antigens* ; Hepatitis B* ; Hepatitis* ; Humans ; Liver ; Mass Screening* ; Telephone ; Ultrasonography

A 39-year-old hairdresser developed sodium bromate poisoning after drinking a cup of hair neutralizer in a suicide attempt. This is the first case of visual loss afteringestion of sodium bromate. Only few cases are as a cause of acute renal failure reported in medical literature. She presented 1 day later with anuria, required hemodialysis. Sensorineural hearing loss, often a characteristic finding, was developed.
Acute Kidney Injury* ; Adult ; Anuria ; Deafness* ; Drinking ; Hair ; Hearing Loss, Sensorineural ; Humans ; Poisoning* ; Renal Dialysis ; Sodium* ; Suicide

OBJECTIVE: To evaluate the changes of gait patterns during crossing obstacles of different heights in hemiplegic stroke patients and to compare gait characteristics with those of healthy control subjects. METHOD: Subjects were 13 hemiplegic stroke patients and 9 age-matched healthy adults. Subjects stepped over obstacles with each height of 3, 8 and 13 cm. The three- dimensional gait analysis was performed. Temporospatial, kinematic and kinetic parameters were measured in both lead and trail limb. The pre- and post-obstacle distance, pre- and post-obstacle swing time and toe clearance were also measured. RESULTS: With increase in height of obstacles, ratio of single limb support time, angle of hip, knee flexion in swing phase and hip extensor moment increased in both lead and trail limbs. In the lead limb, post-obstacle distance and toe clearance also increased (p<0.05). Compared with control groups, the angle of knee flexion, hip extensor and hip flexor moment and pre- and post-obstacle distance decreased significantly in the lead limb of hemiplegic patients (p<0.05). In the trail limb of hemiplegic patients, the angle of hip flexion, hip flexor moment and post-obstacle distance decreased (p<0.05). CONCLUSION: Understanding strategies for adequate control and coordination of the swing limb during crossing obstacles may be the basis for the safe training of obstacle crossing in hemiplegic stroke patients.
Adult ; Extremities ; Gait ; Hip ; Humans ; Knee ; Stroke ; Toes

BACKGROUND/AIMS: The aim of this study was to evaluate the efficacy of lamivudine in patients with HBeAg-negative and HBV DNA-positive chronic liver disease. METHODS: Twenty-four chronic liver disease patients were enrolled whose serology had common characteristics of HBeAg (-), and anti-HBe (+) but HBV DNA (+). All had elevated alanine aminotransferase (ALT) levels. 150mg of lamivudine was given orally once daily for more than 6 months. The goal of this treatment was the elimination of HBV DNA in serum and normalization of ALT level. Once HBV DNA disappearance and ALT normalization were observed, lamivudine was continued for two additional months. HBeAg, anti-HBe, HBV DNA and ALT were followed up every 1-2 month during, and after, treatment. RESULTS: Median duration of treatment was seven months. HBV DNA became undetectable after a median one month of treatment and ALT activity was normalized in all 24 patients within six months. Among the sixteen patients who were followed for more than 12 months after cessation of treatment, six relapsed. The cumulative relapse rate at 12 months was 37.5%. CONCLUSION: Lamivudine suppresses HBV replication effectively and normalizes serum ALT in patients with HBeAg-negative and HBV DNA-positive chronic liver disease. The relapse rate after cessation of treatment seems to be relatively low.
Alanine Transaminase ; DNA ; Hepatitis B e Antigens ; Hepatitis B virus ; Humans ; Lamivudine* ; Liver Diseases* ; Liver* ; Recurrence ; Withholding Treatment

PURPOSE: Acute renal failure (ARF) is one of the common complications after liver transplantation (LT) and could be fatal unless promptly treated. Identification of risk factors is needed to prevent ARF and to attenuate the unfavorable outcomes of ARF after LT. The aim of this study was to analyze risk factors for development of postoperative ARF (between day 0 and day 30 after LT). METHODS: Total 72 LTs were performed between 1996 and 2005. Sixty six patients' records, excluding 6 patients with preoperative serum creatinine level more than 2.5 mg/dl, were reviewed retrospectively for preoperative, intraoperative, and postoperative variables to compare patients presenting ARF with the remaining patients. RESULTS: Postoperative ARF occurred in 36 transplants (54.5%) after LT. Preoperative serum sodium, bilirubin and BUN, creatinine level were higher in ARF group. ARF group had more child-pugh class C, and more episodes of preoperative hepatic encephalopathy. During intraoperative period, anhepatic time was longer and total doses of intraoperative furosemide was larger in ARF group. Also, postoperative blood immunosuppressant level was higher, and postoperative episodes of bleeding and hypotension were more common in ARF group. In multivariate analysis, preoperative child-pugh class C (P=0.041), preoperative serum creatinine level (> or =1.0 mg/dL, P=0.032), and postoperative episodes of hypotension and bleeding (P=0.045, P=0.03 respectively) were identified as risk factors for postoperative ARF. CONCLUSION: This study showed that preoperative renal and liver function, and postoperative hemodynamic condition were independent risk factors for development of ARF after LT.
Acute Kidney Injury* ; Bilirubin ; Creatinine ; Furosemide ; Hemodynamics ; Hemorrhage ; Hepatic Encephalopathy ; Humans ; Hypotension ; Intraoperative Period ; Liver Transplantation* ; Liver* ; Multivariate Analysis ; Retrospective Studies ; Risk Factors* ; Sodium

OBJECTIVE: To evaluate the level of depression, anxiety and quality of life in primary caregivers for the severe stroke patients. METHOD: We studied a sample of 44 severe stroke patients and their primary caregivers. Functional status of the severe stroke patients was evaluated by Modified Barthel Index (MBI). We collected the data through interviewing the caregivers and using the Beck Depression Inventory (BDI), State- Trait Anxiety Inventory (STAI), Ego-strength scale, Short Form Health Survey-36 (SF-36) and Family APGAR (Adaptation, Partnership, Growth, Affection and Resolve) score. RESULTS: The average level of depression in caregivers was low. The mean socres of STAI were 41.5 for state anxiety and 44.3 for trait anxiety, respectively. Ego-strength scale was significantly inversely related to BDI score and trait anxiety inventory score, but positively related to SF-36 score. The most influencing factor for the SF-36 score was the BDI score. CONCLUSION: Primary caregivers for the home-bound severe stroke patients demonstrated a lower level of quality of life, especially mental health, general health and vitality component. Community based rehabilitation should more focus on the evaluation and support for caregiver's psychologic status and their quality of life.
Anxiety ; Caregivers* ; Depression ; Humans ; Mental Health ; Quality of Life* ; Rehabilitation ; Stroke*

We here report two cases of combined liver-kidney transplantation in patients with both end stage renal disease and hepatitis B related liver cirrhosis. The first case was a 55-year-old man with hepatitis B related liver cirrhosis and chronic renal failure, who received cadaveric liver and kidney transplantation. Immunosuppressants were cyclosporine, prednisolone, and mycophenolate mofetil. Clinical course was uneventful except for hemolytic anemia due to alloimmunization that occurs after ABO-mismatched solid organ transplantation. Hemoglobin level became stable after plasmapheresis. His renal and hepatic function is maintained up to the present time. The second case was a 42-year-old man with nephrotic syndrome and liver cirrhosis. The patient underwent living related-combined liver-kidney transplantation. Donors were his son and brother. Blood type of the patient and donors were identical and the result of HLA crossmatch was negative. On the 14th postoperative day, stenosis at anastomotic site of hepatic artery was detected. After balloon angioplasty hepatic function was normalized. At 8 months after the transplantation, the patient is stable without adverse events.
Adult ; Anemia, Hemolytic ; Angioplasty, Balloon ; Cadaver ; Constriction, Pathologic ; Cyclosporine ; Hepatic Artery ; Hepatitis B* ; Hepatitis* ; Humans ; Immunosuppressive Agents ; Kidney Failure, Chronic ; Kidney Transplantation ; Liver Cirrhosis* ; Liver* ; Middle Aged ; Nephrotic Syndrome ; Organ Transplantation ; Plasmapheresis ; Prednisolone ; Siblings ; Tissue Donors ; Transplants

PURPOSE: End stage renal disease caused by diabetic nephropathy is increasing throughout the world. In earlier years, the results of kidney transplantation in diabetics were not as good as those in non-diabetics and the presence of diabetes has been considered as contraindication at many centers. But the survival rate of diabetic patients treated with transplantation has improved in recent years. In this study we compared the results of kidney transplantation in diabetic patients group with those of non-diabetic patients group. METHODS: We reviewed our experience in a single center with 1,386 kidney transplantation patients in non-diabetic patients, compared with 31 kidney transplantation patients in diabetic patients. The clinical characteristics such as age, sex, duration of diabetes mellitus, serum albumin, blood urea nitrogen, hemoglobin, glycated hemoglobin, creatinine clearance, and morbidity were retrieved from medical charts. RESULTS: For diabetic transplantation patients one- and five year patient survival were 92.3% and 84%; for non-diabetic transplantation patients one- and five year patient survival were 98.7% and 93.4%. It showed statistically significant differences in patient survival between two groups. We analyzed graft survival in two ways. When all deaths were not censored, the graft survival rate of diabetic transplantation patients was significantly lower than that of non-diabetic transplantation patients: 80.6% vs 85.8% at 5 years and 27.3% vs 68.6% at 10 years (P=0.04). But the graft survival rate did not differ significantly between the diabetic and non-diabetic patients when deaths were censored: 95% vs 91.7% at 5years and 63.3% vs 79.5% at 10 years (P=0.96) In the analysis of risk factors affecting patient mortality, presence of DM and graft loss were associated with mortality and its odds ratios were 8.94 and 6.33 respectively. CONCLUSION: The overall patient survival and graft survival were significantly worse in the diabetic transplantation patient group than the non-diabetic transplantation patient group. But graft survival was not different between two groups when death was censored. This means that graft survival in diabetic transplantation group is not different actually with non- diabetic transplantation group when comorbidities are fully evaluated and treated before transplantation.
Blood Urea Nitrogen ; Comorbidity ; Creatinine ; Diabetes Mellitus ; Diabetic Nephropathies ; Graft Survival ; Hemoglobin A, Glycosylated ; Humans ; Kidney Failure, Chronic ; Kidney Transplantation* ; Kidney* ; Mortality ; Odds Ratio ; Risk Factors ; Serum Albumin ; Survival Rate ; Transplants