Acute posterior multifocal placoid pigment epitheliopathy usually occurs in young or middle-aged adults and is usually bilateral. This syndrome is characterized by the acute onset of multiple, flat, yellow-white lesion of the posterior pole at the level of the retinal pigment epithelium and by the rapid loss of vision. These lesions resolve spontaneously, leaving extensive degeneration of pigment epithelium within a few weeks and visual acuity spontaneously improves in most cases. In the acute stage, fluorescein angiographic appearance of condition is characterized by placoid lesions blocking transmission of choroidal fluorescence in the initial phase, which are gradually stained and fluorescence faintly in the late phase. Older lesions represent residual defects in the pigment epithelium and appear as transmission defect without late staining or leakage of dye. Authors experienced and treated a case of acute posterior multifocal placoid pigment epitheliopathy in 19-years old male patient, and had a good visual improvement.
Adult ; Choroid ; Epithelium ; Fluorescein ; Fluorescence ; Humans ; Male ; Retinal Pigment Epithelium ; Visual Acuity ; Young Adult

We surveyed the causes of blindness among the 6692 eye patients of 3 hospitals(Seoul, Chunan, Kumi) in 1984. Blindness is defined as visual acuity of 0.1(20/200) or less in better eye with best correction. The representation of the diagnosis of the ocular diseases is based on the examination of the ophthalmologists. The estimated number of blindness is 259(6.74%)in Seoul, 106(8.92%) in Chunan, 70(4.21%) in Kumi with total of 435(6.5%) among the 6692 eye patients. The leading causes of blindness for individual districts are cataract(28.19%), retinal and vitreous diseases(20.46%), trauma (15.06%), diseases of optic nerve(10.81%), corneal diseases(8.10%) in Seoul; cataract(35.81%), corneal diseases(18.87%), global diseases(13.21%), trauma(10.38%), retinal and vitreous diseases(6.60%) in Chunan; and cataract(34.29%), corneal diseases(14.21%), trauma (12.86%), global diseases(8.57%), retinal and vitreous diseases(8.50%) in Kumi. Rates of the blind eyes for the age groups are; 1.2%(under the age of 5), 4.1%(6~9), 10.3%(10~19), 30.8%(20~39), 23.5%(40~59), and 30.1%(above 60). Important causes of blindness in each age group are trauma(43.48%), optic nerve diseases(13.04%), and global diseases(13.04%) for below the age of 10, trauma(28.89%), retinal diseases(17.78%), and optic nerve diseases(13.33%) in 10~19 age group, corneal diseases(19.40%). cataract(18.66%), and retinal diseases(16.42%) in 20~39 age group, cataract(28.43%), retinal diseases(18.63%), and corneal diseases(10.78%) in 40~59 age group and cataract(59.54%), retinal diseases(9.92%), and glaucoma(8.40%) for above 60. There are no significant differences between male and female, right eyes and left eyes in the causes of the blind eyes, and also we make some comparisons with different statistics of domestic and foreign countries.
Blindness* ; Chungcheongnam-do ; Diagnosis ; Female ; Gyeongsangbuk-do ; Humans ; Male ; Optic Nerve ; Retinaldehyde ; Seoul ; Visual Acuity

Introduction: Current prognostic markers have improved survival prediction, however, it has not advanced treatment strategies. Gene expression profiling may identify biological markers suitable as therapeutic targets. Leukaemia stem cell is associated with adverse outcome, however, its biological characteristics are still being investigated. We observed higher in vitro cell viability in acute myeloid leukaemia (AML) samples with poor prognosis, which may be stem cell related. Objective: The objective of this study was to profile highly expressed genes in an AML sample of poor prognosis/high viability and compare with a sample of good prognosis/low viability. Method: Subtractive hybridization was performed on two AML samples with high blast counts (>80%), a poor prognosis, PP (disease free survival, DFS<12 months) and a good prognosis, GP (DFS>12 months) sample. The PP sample had higher CD34+ counts (73% vs 46%) and higher cell viability than the GP sample. cDNA libraries were subsequently cloned and sequenced. Results: cDNA subtracted from the PP samples was identified as genes active during fetal/embryonic development (LCOR, CNOT1, ORMDL1), HOX- related genes (HOXA3, PBX3, SF3B1), hematopoiesis (SELL, IL-3RA) and aerobic glycolysis/hypoxia (PGK1, HIGD1A) -associated genes. Majority of GP clones isolated contained genes involved in oxidative phosphorylation, OXPHOS (COXs, ATPs, MTND4 and MTRNR2), protein synthesis (including ribosomal proteins, initiating and elongation factors), chromatin remodeling (H2AFZ, PTMA), cell motility (MALAT1, CALM2, TMSB4X), and mitochondria (HSPA9, MPO) genes. Conclusion: Thus, the PP sample exhibited stem cell-like features while the GP sample showed cells at a high level of cell activity. These genes are potential prognostic markers and targets for therapy.
Leukemia, Myeloid, Acute

PURPOSE: Methicillin-resistant Staphylococcus aureus (MRSA) is a major nosocomial pathogen in the intensive care units (ICUs). The purpose of this case-control study is to identify risk factors for acquisition of MRSA during ICU stays in patients with and without MRSA. METHOD: The study was conducted in a 16 beds-neurosurgical intensive care unit of a 2200-bed tertiary care university hospital in Seoul, Korea. Medical record and Critical Classification Scoring System were reviewed retrospectively in patients who were admitted more than 3 days from August 1, 2003 to May 30, 2004. Cases and controls were matched for age and gender. The obtained specimens were nasal swab and sputum. RESULT: There were 950 patients' admissions during the period. Among them, MRSA was isolated from twenty-three patients who were considered as hospital acquired. Artificial airway (p=.045), frequency of suction (p=.002), nasogastric tube (p=.004), wound drain (p=.045), and vancomycin (p=.019) were risk factors for MRSA acquisition in univariate analysis. Frequency of suction (p=.012, OR 3.5) was revealed as the only risk factor in multivariate conditional logistic regression. CONCLUSION: Our findings give support to recent studies that suggest that frequent physical contact may increase the nosocomial acquisition of MRSA in a neurosurgical ICU.
Case-Control Studies* ; Classification ; Humans ; Intensive Care Units ; Critical Care* ; Korea ; Logistic Models ; Medical Records ; Methicillin Resistance* ; Methicillin-Resistant Staphylococcus aureus* ; Retrospective Studies ; Risk Factors* ; Seoul ; Sputum ; Suction ; Tertiary Healthcare ; Vancomycin ; Wounds and Injuries

Clinical findings, electrocardiographic voltage and left ventricular function were evaluated in 104 patients with percardial effusion. Patients were classified into three groups by the amounts of pericardial effusion measured by two-dimensional echocardiography. 49 patients had small pericardial effusion, 31 moderate effusion and 24 large effusion. In 47 patients the effusions were clinically unsuspected prior to echocardiographic examination. Pericardial friction rub was noted in 14 patients, two-thirds of whom had moderate to large effusions. There was no relationship between the size of effusion and the presence of friction rub. Total QRS amplitudes were lower in patients with moderate to large effusions than those in control group. Maximum diastolic endocardial velocity(DEVM) and E-F slope of the anterior mitral leaflet were decreased significantly in patients with moderate to large effusions as compared with those with small effusions. As a result, authors concluded that reduction in the QRS voltages in serial ECGs may suggest the presence and the amount of pericardial effusion and also DEVM and E-F slope of the anterior mitral leaflet can be sensitive measures of left ventricular relaxation in patients with pericardial effusion.
Echocardiography* ; Electrocardiography* ; Friction ; Humans ; Pericardial Effusion* ; Relaxation ; Ventricular Function, Left*

Left ventricular hypertrophy(LVH) is one of common cardiovascular complications in hypertensive patients and it is well known that hypertensive cardiac disease accompained by LVH is still common cause of congestive heart failure in spite of treatment of hypertension. The authors assessed the prevalence of anatomical and functional abnormalities of left ventricle by EKG, chest X-ray and echocardiography in 45 essential hypertensive patients and also in 20 normal controls. Average values of left ventricular posterior wall thickness(LVPWd), interventricular septal thickness(IVSd), left ventricular mass(LVM), and left ventricular mass index(LVM/BSA) by echocardiography in hypertensive groups with LVH by EKG or chest X-ray were significantly higher than those of hypertensive groups without LVH by EKG or chest X-ray(P<0.005). Among 27 hypertensive patients with LVH by EKG and chest X-ray increased LVPWd was found in 24 patients(18%) and increased LVH in 26 patients(19%). Increased LVPWd and LVM were found in 3 patients(23%) among 13 hypertensives without LVH by EKG and chest X-ray. Hypertensive patients with increased LVH showed LVH by EKG and chest X-ray more frequently than those with increased LVPWd. Also, hypertensive patients without increased LVM showed MVH by EKG and chest X-ray less frequently than those without increased LVPWd. Therefore, echocardiography appears to be superior to routine chest X-ray and EKG for defecting LVH in hypertensive patients, especially without LVH by these tests. In conclusion, even though estimation of LVM by echocardiography seems to be a better method than single measurement of LVPWd, it seems thant estimation of LVM together with LVPWd will be more valuable in diagnosis of LVH in hypertensive patients.
Diagnosis ; Echocardiography* ; Electrocardiography ; Heart Diseases ; Heart Failure ; Heart Ventricles ; Humans ; Hypertension* ; Hypertrophy, Left Ventricular* ; Prevalence ; Thorax

Postoperative respirative depression is a major factor limiting the use and safety of intraoperative narcotics. The need for an effective and safe narcotic antagonist to reverse this side effect without complication persists more than three decades of research. While narcotic induced respiratory depression can be reversed by appropriate, specific narcotic antagonist, it has not been possible to nulify the frespiratory depressant effects of narcotic without simultaneously nullifying the analgesic effects. Doxspram hydrochloride, respiratory stimulant, has been found to be significantly potent and selectively respirogenic. The present study undertakes to determine whether doxapram is ablereverse the respiratory depressnat effect of mrphine without mullifying the analgesic effects. In this study, 20 patients in 29 ASA class l patients given intravenous morphine, 0.5mg/kg, for elective surgery, produce postoperative respiratory depression. Inadequate spontaneous respiration at the end of anesthesia were treated with doxapram. The results were as follows: 1) Doxapram (mean 21.6mg) was able to reverse the respiratory depressant effect of morphine without nullifying the analgesic effect. 2) There was no hemodynamic alteration during reversal.
Anesthesia ; Depression ; Doxapram* ; Hemodynamics ; Humans ; Morphine* ; Narcotics ; Respiration ; Respiratory Insufficiency*

The anesthesiologist is sometime presented with the problem of coagulation defects through the perioperative period. The possible causes of inappropriate hemostasis in this situation are numerous, and multiple mechanism may be simultaneously involved. Coagulation and fibrinolysis variables were measured in 15 patients who had undergone prolonged major surgery or received massive transfusion before and until 10 days after operation. Hemostactic surveys included platelet count, fibrinogen, prothrombin time, activated partial thromboplastin time, antithrombin lll, and fibrin degraduation products. No patients had major hemorrhage, thrombosis, or disseminated intravascular coagulation, but laboratory findings suggest that a hypercoagulable state existed even 10 days postoperatively. The results were as follows: 1) Platelet counts decreased just after operation, but significantly increased to 154% of the control value 7 days after operation and 204% 10 days postoperatively. 2) Prothrombin time was significantly prolonged just after operation compared to the control value, but returned to normal in 4 days postoperatively. 3) Fibrinogen decreased just after operation, but significantly increased to 165% of the control value 4 days after operation, 178% 7days after operation and 191% 10 days postoperatively. 4) Activated partial thromboplastin time was not changed through the entire period. 5) Antithrombin lll was not changed through the entire period. 6) Fibrin degradation product was within normal ranges before operation, but in 11 cases it exceeded normal range from 1 to 10 days postoperatively.
Disseminated Intravascular Coagulation ; Fibrin ; Fibrinogen ; Fibrinolysis* ; Hemorrhage ; Hemostasis ; Humans ; Partial Thromboplastin Time ; Perioperative Period ; Platelet Count ; Prothrombin Time ; Reference Values ; Thrombosis

Dextran is a macromolecular polymer of dextrose. Dextran is used as a plasma expander with reduction in blood viscosity and disruption of red cell aggregates. It also inhibits platelet aggregation and prothrombin activation. It has been reported that a hemostatic defect characterized by a prolonged bleeding time in subject receiving large amount of dextran. The present study was undertaken to observe the effect of dextran on bleeding time and platelet aggregation by increasing volume. In this study, bleeding time was checked and sampling was done at before infusion, after 5 ml/kg, 10 ml/kg and 15 ml/kg infusion of dextran in 15 patients with spinal or regional anesthesia. The results were as follows: 1) There was prolonged bleeding time by increasing volume of dextran 40, but within nonnal limit. 2) There was no platelet aggregation with 15ml/kg of dextran.
Anesthesia, Conduction ; Bleeding Time ; Blood Platelets* ; Blood Viscosity ; Dextrans* ; Glucose ; Humans ; Plasma ; Platelet Aggregation ; Polymers ; Prothrombin

There are many predisposing factors for acute pulmonary edema, namely, left ventricular failure due to cardiac disease or fluid overloading, hypoalbuminemia, pulmonary capillary endothelial damage from bacterial toxins or irritant gases, rare central nervous system injuries pulmonary hyersensitivity reactions, etc. Acute pulmonary edema following operations is a rare complication especially in a patient whose preoperative cardiopulmonary status was within normal limits. We present a case of unilateral pulmonary edema immediately following operation in a 46 year old male patient who had a modified pull-through operation due to tongue cancer and who had no evidence of preoperative cardiopulmonary disorders. The edema was relieved after 9 hours with intensive care of pulmonary edema such as IPPB with Omorphine, diuretics, corticosteroid, asemi-sitting position and frequent tracheal suction.
Bacterial Toxins ; Capillaries ; Causality ; Central Nervous System ; Diuretics ; Edema ; Heart Diseases ; Humans ; Hypoalbuminemia ; Critical Care ; Intermittent Positive-Pressure Breathing ; Male ; Middle Aged ; Noble Gases ; Pulmonary Edema* ; Suction ; Tongue Neoplasms