PURPOSE: To evaluate the efficacy of intravitreal injections of triamcinolone acetonide (TA) at the end of pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR). METHODS: We analyzed 50 patients (52 eyes) who underwent PPV for treatment of PDR and received an intravitreal injection of 4 mg TA at the end of surgery. The study group (Group 1) was compared with a control group (Group 2, 46 patients, 51 eyes) (matched with the study group for preoperative parameters) who underwent PPV without intravitreal injection of TA. RESULTS: In Group 1, the grade of anterior chamber cells at postoperative days 1 and 7 was significantly lower than that of Group 2. There was slight mean IOP elevation in Group 1 at postoperative weeks 2, 3, 4, and 8, but it was not statistically significant. Forty-four eyes (84.6%) from Group 1 showed better visual acuity at the last follow-up than at the preoperative visit (Group 1). Thirty-two eyes (62.8%) from Group 2 showed better visual acuity at the last follow-up than at the preoperative visit. The degree of visual improvement was 0.75 logMAR in Group 1 and 0.59 logMAR in Group 2. Vitreous hemorrhage occurred in 9 eyes (17.3%) from Group 1 and in 19 eyes (37.3%) from Group 2. However, the differences in the occurrence of neovascularization in iris and neovascular glaucoma between two groups were not statistically significant. CONCLUSIONS: Intravitreal TA injection at the end of PPV seems to be effective in improving visual acuity and decreasing early postoperative inflammation and the frequency of vitreous hemorrhage.
Anterior Chamber ; Diabetic Retinopathy* ; Follow-Up Studies ; Glaucoma, Neovascular ; Humans ; Inflammation ; Intravitreal Injections ; Iris ; Triamcinolone Acetonide* ; Triamcinolone* ; Visual Acuity ; Vitrectomy* ; Vitreous Hemorrhage

BACKGROUND: Although neuromuscular blockade can influence the bispectral index (BIS) during anesthesia, there have been contradictory reports regarding its effects. The purpose of this study was to investigate whether a muscle relaxant affected the level of BIS during propofol anesthesia. METHODS: Forty-eight healthy patients undergoing elective surgery under general anesthesia were enrolled in this prospective, randomized, double-blind study. All patients received an effect-site targeted concentration of propofol via a TCI system that was titrated until loss of consciousness occurred. The patients then received either an injection of vecuronium (relaxant group, n = 24) or normal saline as a placebo (placebo group, n = 24) at 3 minutes after loss of consciousness. The BIS and electromyogram (EMG) activity were recorded from anesthetic induction to 4 minutes after injection of the vecuronium or placebo. RESULTS: The BIS significantly decreased after injection in both groups (P < 0.05), however, the decrease in the BIS was larger in the relaxant group than in the placebo group (P < 0.05). The decrease of EMG activity was not significantly different between the two groups after administration of vecuronium or placebo. CONCLUSIONS: During propofol induction of anesthesia, a muscle relaxant decreased BIS significantly without decreasing the EMG activity.
Anesthesia ; Anesthesia, General ; Double-Blind Method ; Humans ; Muscles ; Neuromuscular Blockade ; Propofol ; Prospective Studies ; Unconsciousness ; Vecuronium Bromide

PURPOSE: To evaluate the levels of vascular endothelial growth factor (VEGF) in the vitreous of patients with proliferative diabetic retinopathy (PDR) and to find any correlation between clinical and fundus findings, grade of PDR, post-operative complications and surgical outcomes. METHODS: Using ELISA, the vitreous concentration of VEGF was measured in 74 patients with PDR who had undergone vitrectomy and in 13 control patients. RESULTS: The pre-operative levels of VEGFin the vitreous of the PDR patients was significantly increased compared with those of the control and with the post-operative levels. The pre-operative VEGF concentration in the vitreous of the PDR patients was correlated with the duration of diabetes and the severity of proteinuria, but not with the type of diabetes, level of HbA1c, hypertension and BUN/creatinine levels. The severity of PDR was also correlated with pre-operative VEGF levels, especially in NVD, NVE and NVI, but was not correlated with vitreous hemorrhage and fibrous proliferation elsewhere. There was negative correlation with the severity of retinal detachments. The vitreous levels of VEGF in PDR were significantly lower in those who had received previous laser photocoagulation than in those who did not. The VEGF levels were also significantly elevated in patients who developed NVI or NVG in the post-operative period. The changes of visual acuity after vitrectomy in the PDR patients were not correlated with vitreous levels of VEGF. CONCLUSIONS: These results show that VEGF is related to intraocular angiogenesis, progression of PDR and post-operative complications such as NVI or NVG, and that panretinal photocoagulation could prevent the progression of PDR.
Diabetic Retinopathy* ; Enzyme-Linked Immunosorbent Assay ; Humans ; Hypertension ; Light Coagulation ; Proteinuria ; Retinal Detachment ; Vascular Endothelial Growth Factor A* ; Visual Acuity ; Vitrectomy* ; Vitreous Hemorrhage

BACKGROUND AND OBJECTIVES: Until recently, blowout fractures (BOFs) of the medial orbital walls were treated using external approach. With recent advances in endoscopy, many cases of BOFs of the medial orbital walls are now treated endonasaly using an endoscope. This article describes endonasal endoscopic reduction (EER) of BOFs of the medial orbital walls and reports the clinical results. MATERIALS AND METHODS: Twelve patients with BOFs of the medial orbital walls underwent EER. Their records were reviewed for surgical indications, operative techniques, operative results, and postoperative complications. RESULTS: Surgical indications were persistent diplopia, limitation of eye movement, and significant enophthalmos. Ten patients showed complete resolution of symptoms after the operation. One patient underwent medial wall reconstruction with transorbital approach after failure of EER, and is now free of symptoms. Another patient with both zygomatic fracture and BOF of the orbital floor remained enophthalmic after EER. There were no other significant complications postoperatively. CONCLUSION: The results indicate that EER is a safe and effective method of treating BOFs of the medial orbital walls.
Diplopia ; Endoscopes ; Endoscopy ; Enophthalmos ; Eye Movements ; Humans ; Orbit* ; Postoperative Complications ; Zygomatic Fractures

BACKGROUND AND OBJECTIVES: In blowout fracture (BOF) of the medial orbital wall, the presence of significant enophthalmos indicates a need for surgery. In early post-traumatic period, it is usually difficult to measure the degree of enophthalmos due to orbital edema. So, in order to decide on the correct treatment method, it will be useful if we can predict the degree of enophthalmos according to the extent of fracture observed in computed tomography (CT). We studied the relationship between the extent of fracture measured in CT scans and the degree of enophthalmos in BOF of the medial orbital wall. MATERIALS AND METHODS: Nine patients with isolated BOF of the medial orbital wall confirmed by CT scans were studied. The severity of enophthalmos was measured by exophthalmometry. The area of fracture site and the volume of herniated orbital tissue were measured in CT scans. The statistical significance was analyzed using linear regression method. RESULTS: The degree of enophthalmos increased as the area of fracture site or the volume of herniated orbital tissue increased. The area of the fracture site and the volume of the herniated orbital tissue that caused enophthalmos of 2 mm were 1.9 cm2 and 0.9 ml, respectively. CONCLUSION: In BOF of the medial orbital wall, surgical intervention may be recommended to prevent significant enophthalmos when the area of fracture site is 1.9 cm2 or more, or the volume of herniated orbital tissue is 0.9 ml or more.
Edema ; Enophthalmos* ; Humans ; Linear Models ; Orbit* ; Tomography, X-Ray Computed

Endomyocardial biopsy often fails to show myocardial inflammation for patients with clinically suspected myocarditis. The serum isoforms of troponin T (cTnT) level is a very sensitive marker of myocardial injury and it is elevated even in the absence of myocardial inflammation. We investigated the correlations for myocardial injury, virus titers and inflammation in acute viral infection. Using the murine coxsackievirus group B3 (CVB3) myocarditis model, the histopathologic findings and virus titers in mouse hearts were compared with the serum cTnT levels measured by ELISA at various time points. Viable virus titers in the hearts peaked at 3 days after infection (8.22+/-0.13 log10 PFU/100 mg of heart); they decreased at day 7 and no viable virus was detected from day 14. Myocardial inflammation was minimal at day 3, peaked at day 7 and markedly decreased at day 14. The individual serum TnT levels were significantly increased at day 3 (7.37+/-1.46 ng/ml), persisted to day 7 (0.73+/-0.08 ng/ml), and normalized at day 14. Serum cTnT levels were correlatable with virus titers in the heart (r=0.744, P <0.01), but the serum cTnT levels were not correlated with the degrees of inflammation. Using the less myocarditic strain of CVB3, similar relationships were observed between the changes for the serum cTnT levels and the heart virus titers. During the course of viral infection, myocardial injury precedes the pathologic evidence of inflammation, and the elevated cTnT levels provide evidence of myocardial injury even in the absence of any histologic findings of myocarditis.
Acute Disease ; Animals ; Coxsackievirus Infections/*pathology ; Enterovirus B, Human/isolation & purification/pathogenicity/*physiology ; Female ; Heart/*virology ; Hela Cells ; Humans ; Inflammation/*immunology ; Mice ; Mice, Inbred BALB C ; Myocardial Infarction/immunology/*pathology ; Myocarditis/immunology/pathology/*virology ; *Myocardium/immunology/pathology ; Research Support, Non-U.S. Gov't ; Troponin T/blood ; Virus Replication

Acute pulmonary embolism is usually caused by deep vein thrombosis of the lower extremities. However, vegetations of the tricuspid valve (TV) can cause embolic occlusion of the pulmonary vasculature and hence pulmonary embolism. We experienced a case of acute pulmonary embolism caused by subacute infective endocarditis of the TV. The computerized tomographic scans showed huge vegetations on the patient's TV and obstruction of the bilateral pulmonary arteries. He was successfully treated with intravenous antibiotics and TV replacement.
Anti-Bacterial Agents ; Endocarditis ; Lower Extremity ; Pulmonary Artery ; Pulmonary Embolism ; Tricuspid Valve ; Venous Thrombosis

Prosthetic valve thrombosis(PVT) may be a life-threatening complication requiring prompt intervention. This is a case report of thrombolytic therapy for thrombosis of prosthetic mitral valve. A 47 year-old male admitted to the emergency room for abrupt onset of dyspnea. He had undergone mitral valve replacement(On-X valve, 29mm) for mitral stenosis 8 months ago. The patient's international normalized ratio(INR) on admission was 1.09. The mechanical clicks were muffled and rales were heard in both lung fields. A transesophageal echocardiography(TEE) revealed prosthetic valve thrombosis with increased transvalvular pressure gradient(34 mmHg). The patient's condition needed to intubation for mechanical ventilation due to hemodynamic compromise, however his wife and relatives refused the surgical intervention due to financial problems. The patient was transferred to the cardiac care unit and we decided to perform thrombolytic therapy. A bolus of 1,500,000 IU of urokinase was given, followed by a drip of 1,500,000 IU for 1 hour. The patient did not improved hemodynamically; therefore, we gave 100 mg of tissue plasminogen activator(t-PA) for over 2 hours. During that time mechanical clicks were audible and hemodynamics of the patient improved progressively. A TEE showed disappearance of thrombus and decreased pressure gradient(1.7 mmHg) after 6 hours of thrombolytic therapy. The patient was recovered without any neurologic sequale and was discharged with administration of warfarin.
Dyspnea ; Emergency Service, Hospital ; Hemodynamics ; Humans ; Intubation ; Lung ; Male ; Middle Aged ; Mitral Valve Stenosis ; Mitral Valve* ; Plasminogen ; Respiration, Artificial ; Respiratory Sounds ; Spouses ; Thrombolytic Therapy* ; Thrombosis* ; Urokinase-Type Plasminogen Activator ; Warfarin

Prosthetic valve thrombosis(PVT) may be a life-threatening complication requiring prompt intervention. This is a case report of thrombolytic therapy for thrombosis of prosthetic mitral valve. A 47 year-old male admitted to the emergency room for abrupt onset of dyspnea. He had undergone mitral valve replacement(On-X valve, 29mm) for mitral stenosis 8 months ago. The patient's international normalized ratio(INR) on admission was 1.09. The mechanical clicks were muffled and rales were heard in both lung fields. A transesophageal echocardiography(TEE) revealed prosthetic valve thrombosis with increased transvalvular pressure gradient(34 mmHg). The patient's condition needed to intubation for mechanical ventilation due to hemodynamic compromise, however his wife and relatives refused the surgical intervention due to financial problems. The patient was transferred to the cardiac care unit and we decided to perform thrombolytic therapy. A bolus of 1,500,000 IU of urokinase was given, followed by a drip of 1,500,000 IU for 1 hour. The patient did not improved hemodynamically; therefore, we gave 100 mg of tissue plasminogen activator(t-PA) for over 2 hours. During that time mechanical clicks were audible and hemodynamics of the patient improved progressively. A TEE showed disappearance of thrombus and decreased pressure gradient(1.7 mmHg) after 6 hours of thrombolytic therapy. The patient was recovered without any neurologic sequale and was discharged with administration of warfarin.
Dyspnea ; Emergency Service, Hospital ; Hemodynamics ; Humans ; Intubation ; Lung ; Male ; Middle Aged ; Mitral Valve Stenosis ; Mitral Valve* ; Plasminogen ; Respiration, Artificial ; Respiratory Sounds ; Spouses ; Thrombolytic Therapy* ; Thrombosis* ; Urokinase-Type Plasminogen Activator ; Warfarin

PURPOSE: Authors applied multiple punctures and steroid injection as a modified treatment of ganglion cyst and report objective and subjective outcomes. MATERIALS AND METHODS: We prospectively evaluated 40 patients with ganglion cysts of hands and wrists who underwent multiple punctures and steroid injection. Symptom improvement, recurrence rate and complications were evaluated after minimum follow-up period of 12 months. RESULTS: Pain and discomfort improved in 31 patients (78%), however, recurrence was observed in 32 patients (80%). The factors associated with low recurrence rate included ganglions located at the hand or palm, with small diameter, and with short period of symptoms. CONCLUSION: Multiple punctures and steroid injection resulted in relatively high recurrence rate of mass itself in the treatment of ganglion cyst. However, from the view point of symptom improvement, this procedure could be considered as a simple modified treatment before surgical excision.
Follow-Up Studies ; Ganglion Cysts ; Hand ; Humans ; Prospective Studies ; Punctures ; Recurrence ; Wrist