Adjunctive use of Mitomycin C (MMC)in trabeculectomy has greatly improved the success rate. Trabeculectomy with MMC, however, has resulted in a cystic and thin-walled filtering bleb, which may be more susceptible to infection. Late onset bleb-related endophthalmitis developed in a glaucoma patient at 40 months after MMC trabeculectomy. Filtering bleb in this patient had been avascular, thin-walled and cystic prior to the occurrence of endophthalmitis. Patient complained of decreased visual acuity with ocular discomfort and conjunctival injection and showed a mucopurulent infiltrate within the bleb, hypopyon and vitritis. Visual acuity was hand motion. An intensive treatment included anterior chamber irrigation, lensectomy,par plana vitrectomy, intravitreal and subconjunctival antibiotics (vancomycin,gentamycin) injection and topical and systemic corticosteroid (dexamethasone) and antibiotics,which led to a resolution.
Anterior Chamber ; Anti-Bacterial Agents ; Blister ; Endophthalmitis* ; Glaucoma ; Hand ; Humans ; Mitomycin* ; Trabeculectomy* ; Visual Acuity ; Vitrectomy

We report a case of eosinophilic fasciitis occurring in a 48-year-old man who showed tender, edemstous, indurated, and tight skin on the left forearm and elbow joint. Laboratory findings showed peripheral blood eosinophilia and hypergammaglobulinemia. Other laboratory tests were negative or within normal limits including ANA and anti-DNA. Histopathological findings revealed sclerosis of dermis and thickening of fat and fascia with intense infiltrations of lymphocytes, histiocytes and eosinophils. He was treated successfully with oral prednisolone for 2 weeks.
Dermis ; Elbow Joint ; Eosinophilia ; Eosinophils* ; Fascia ; Fasciitis* ; Forearm ; Histiocytes ; Humans ; Hypergammaglobulinemia ; Lymphocytes ; Middle Aged ; Prednisolone ; Sclerosis ; Skin

We observed the change of intraocular pressure(IOP)and the complications after contact transscleral cyclophotocoagulation with Neodymium:YAG (Nd:YAG)laser for the refractory glaucoma patients. Refractory glaucoma in twenty eyes was treated with contact transscleral continuous-wave Nd:YAG laser cyclophotocoagulation with a sapphire-tipped probe. Using 7W of power for 0.7 seconds with 32 applications and intraocular pressure(IOP) was measured at 1 day, 1 week, 1 month, 2 months, 3 months, 4 months, 5 months and 6 months, postoperatively. The intraocular pressure(IOP)decreasing rate was 62% and the success rate was 60%at 6 months postoperatively. It is suggested that contact transscleral cyclophotocoagulation with Nd:YAG laser is useful in lowering IOP in refractory glaucoma patients.
Glaucoma* ; Humans

No abstract available.
Closing Volume* ; Humans ; Posture* ; Pulmonary Ventilation*

There are many clinical reports on implant exposure as a complication of hydroxyapatite orbital implantation, but relatively small number of reports have concerned full range of complications that can occur with hydroxyapatite orbital implants. The authors analyzed all the complications associated with the 110 hydroxyapatite orbital implants performed by one surgeon at the department of ophthalmology, Presbyterian Medical Center between January 1993 and June 1998, and discussed the management and progression of them. There were 8 kinds, 40 cases of soft tissue problems, 3 kinds, 20 cases of eyelid problems, and 7 kinds, 27 cases with prosthesis and pegging.Most of them were improved with conservative management and surgical treatments were required in 2 cases with conjunctival wound disruption, 5 cases with implant exposure, 3 cases with overgrowth of subconjunctival granulation tissue, 3 cases with ptosis, 1 case with eyelid laxity, 2 cases with peg extraction, and 4 cases with poor peg position. Surgeons and patients who want to use hydroxyapatite as an orbital implant would be more satisfied with thorough knowledge on many possible complications and their etiology, proper prevention and management.
Durapatite* ; Eyelids ; Granulation Tissue ; Humans ; Ophthalmology ; Orbit* ; Orbital Implants* ; Prostheses and Implants ; Protestantism ; Wounds and Injuries

BACKGROUND: The mortality from acute respiratory distress syndrome(ARDS) in the late stage, which is characterized by progressive pulmonary fibroproliferation, is >or=80%. Although previous prospective trials failed to show a survival benefit of steroid therapy in early ARDS, recently, a few of reports have described the survival benefit of the long-term use of steroid in patients with late ARDS. In this study, we analyzed the effect of steroid therapy on patietns with late ARDS. In this study, we analyzed the effect of steroid therapy on patients with late ARDS retrospectively in a single. Medral intensive care unit. METHODS: Over a 3-year period, the medical records of 48 ARDS patients who had veen on mechanical ventilation more than 8 days were reviewed. 14 patients were treated by the long-term use of methylprednisolone and another 34 patients served as a control. Both groups were comparable regarding clinical and physiologic data lung injury score(LIS), multiple organ failure score, APACHE III and SAPS II score. Because steroid was instituted after 8 days of advanced mechanical ventilatory support in average, we arbitrarily defined the 8th day of ARDS as first day of the study. RESULTS: Initially, the group had similar PF(PaO2/FiO2)ratio, LIS, APA CHE III and SAPS II score. By 7th day after the start of steroid therapy, there were significant improvements in PF ratio, LIS, APACHE III and SAPS II score. The mortality in the steroid treated group was significantly lower(42.9% vs 73.5%, p<0.05). CONCLUSIONS: Although the data of this study was retrospective and was not randomized, in order to improve the patients's outcomes, steroid therapy should be considered in late ARDS patients. However, prospective trials are needed to define the indication and the effect of steroid therapy in late ARDS.
APACHE ; Humans ; Intensive Care Units ; Lung Injury ; Medical Records ; Methylprednisolone ; Mortality ; Multiple Organ Failure ; Prospective Studies ; Respiration, Artificial ; Retrospective Studies

BACKGROUND: Anti-mitochondrial antibodies (AMA) are a hallmark of primary biliary cirrhosis (PBC); however, low titers of AMA are also detected in some patients without PBC. We evaluated the clinical value of commercial rat kidney/stomach sections and an additional biochip coated with mitochondrial antigen M2 (pyruvate dehydrogenase complex). METHODS: A total of 124 patients who had been tested for AMA were evaluated. Results of AMA, antibodies to M2, and antinuclear antibody were reviewed retrospectively and searched for clinical and laboratory data to diagnose PBC. AMA and M2 antibody were assayed by an indirect immunofluorescence assay using EUROPLUS kit (Euroimmun, Luebeck, Germany). RESULTS: In 10 of the 124 patients, a diagnosis of PBC was established by AMA, liver function test or liver biopsy. The sensitivity and specificity of rat kidney/stomach section, M2 antibody, and coarse cytoplasmic fluorescent pattern of HEp-2 cell were 80.0, 75.0, 88.9% and 97.4, 98.2, 97.3%, respectively; however, these differences were not statistically significant. Six patients with coarse cytoplasmic pattern of HEp-2 cell at 1: 320 dilution were positive for both rat kidney/stomach sec-tion and M2 antibody. Two of five patients with coarse cytoplasmic pattern at below 1: 80 dilution were diagnosed as PBC, yet all of them were negative for M2 antibody. CONCLUSIONS: M2 biochip test would be convenient to test simultaneously with rat kidney/stomach section and it provided results similar to those of the preexisting serological tests for PBC.
Animals ; Antibodies ; Antibodies, Antinuclear ; Biopsy ; Cytoplasm ; Diagnosis ; Fluorescent Antibody Technique, Indirect ; Humans ; Liver ; Liver Cirrhosis, Biliary ; Liver Function Tests ; Oxidoreductases ; Rats ; Retrospective Studies ; Sensitivity and Specificity ; Serologic Tests

Fabry disease is a X-linked lysosomal storage disorder caused by deficiency of alpha-galactosidase A. This abnormality in enzyme results intracellular accumulation of globotriaosylceramide and leads to severe painful neuropathy with progressive renal, cardiovascular, and cerebrovascular dysfunction and early death. We report a 35 year-old man who had been suffered from acroparesthesia aggravated by body temperature elevation and with asymptomatic renal function impairment, which were proven to be due to Fabry disease. We performed gene analysis by PCR direct sequencing and confirmed missense mutation of GLA gene. Recently enzyme replacement of alpha-galactosidase was introduced and we think that the importance of early diagnosis and treatment should be emphasized.
Adult ; alpha-Galactosidase* ; Body Temperature ; DNA Mutational Analysis ; Early Diagnosis ; Fabry Disease* ; Humans ; Mutation, Missense ; Polymerase Chain Reaction ; Proteinuria

A glycogen storage disease(GSD) type I is a metabolic disease caused by a deficiency in one of the components of the glucose-6-phosphatase(G-6-Pase) system. This disorder results in hypoglycemia, hepatomegaly, lactic acidemia, hyperlipidemia, and hyperuricemia. Common long(-)term complications include growth retardation, gout, hepatic adenomas, osteoporosis and renal disease. However the cardiovascular system is rarely involved, and only six cases of pulmonary hypertension associated with GSD I have been reported in the literature. We experienced a case of pulmonary hypertension with type I GSD. A 31-year-old man, who had discovered type I GSD and received portocaval shunt operation 22 years ago, was admitted to the hospital with the chief complaint of dyspnea. Echocardiographic examination and cardiac catheterization revealed severe pulmonary hypertension. Nitric oxide and oral prostacycline derivative(beraprost) were tried without acute favorable response. After one year with beraprost, dyspnea, exercise capacity and hemodynamic parameters were improved. We report this case with a review of the literature.
Adenoma ; Adult ; Cardiac Catheterization ; Cardiac Catheters ; Cardiovascular System ; Dyspnea ; Echocardiography ; Epoprostenol ; Glycogen Storage Disease* ; Glycogen* ; Gout ; Hemodynamics ; Hepatomegaly ; Humans ; Hyperlipidemias ; Hypertension, Pulmonary* ; Hyperuricemia ; Hypoglycemia ; Metabolic Diseases ; Nitric Oxide ; Osteoporosis

BACKGROUND: The occurrence of lung complications after allogenic bone marrow transplantation(BMT) has been reported as 40-60 percent. The risk factors for lung complications are whole body irradiation, high dose chemotherapy, graft versus host disease, old age and CMV infection. The prevalence of graft versus host disease is less in Korea than in Western countries, but frequency of CMV infection is higher. Therefore, the pattern of lung complications may be different in Korea from those in Western countries. METHODS: A retrospective cohort study was performed on one hundred consecutive adult patients who underwent allogenic bone marrow transplantation from December, 1993 to May, 1999 at Asan Medical Center. Lung complications were divided into two groups by the time of development, within 30days (pre-engraftment) and beyond 30 days (post-engraftment), and then subdivided into infectious and non-infectious complication. Infectious complications were defined as having the organism in blood, BAL fluid, pleural fluid or sputum, or compatible clinical findings in patients, which improved with antibiotics or an anti-fungal therapy. RESULT: 1) Eighty three episodes of lung complications had occurred in 54 patients. 2) Within thirty days after BMT, non-infectious complications were more common than infetions, but this pattern was reversed after 30days. After one year post-BMT, there was no infectious complication except in cases of recurrence of underlying disease or development of chronic GVHD. 3) Among the non-infectious complication, pleural effusion (27 episodes) was most common, followed by pulmonary edema(8 episodes), bronchiolitis obliterans(2 episodes), diffuse alveolar hemorrhage(1 episode) and bronchiloitis obliterans with organizing pneumonia(1 episode), 4) The infectious complications were pneumonia(bacterial:9 episodes, viral:4 episodes, fungal:5 episodes, pneumocystis carinii:1 episode), pulmonary tubercoulosis(3 episodes) and tuberculous pleurisy(3 episodes). 5) Lung complications were more frequent in CMV positive patients and in patients with delayed recovery of neutrophil count. 6) The mortality was higher in the patients with lung complications. CONCLUSION: Lung complications developed in 54% after allogenic BMT and were associated with higher mortality.
Adult ; Anti-Bacterial Agents ; Bone Marrow Transplantation* ; Bone Marrow* ; Bronchiolitis ; Chungcheongnam-do ; Cohort Studies ; Drug Therapy ; Graft vs Host Disease ; Humans ; Korea ; Lung* ; Mortality ; Neutrophils ; Pleural Effusion ; Pneumocystis ; Prevalence ; Recurrence ; Retrospective Studies ; Risk Factors ; Sputum ; Whole-Body Irradiation