Heart failure is a recognized, although uncommon, cause of massive liver cell necrosis, the clinical consequence of which are intermingled with those of cardiac insufficiency in most case. But, hepatic coma is rerely caused by hepatic congestion only. We report the three cases with heart failure resulted in massive liver cell necrosis and fulminant hepatic failure. The manifestations of fulminant hepatic failure were hepatic encephalopathy, jaundice, marked increase of prothrombin time and serum transaminase and there were no evidences of viral hepatitis and toxic hepatitis as a cause of liver failure.
Drug-Induced Liver Injury ; Estrogens, Conjugated (USP)* ; Heart Failure* ; Hepatic Encephalopathy ; Hepatitis ; Jaundice ; Liver ; Liver Failure ; Liver Failure, Acute* ; Necrosis ; Prothrombin Time

PURPOSE: To assess the safety and efficacy of intracorneal ring segment (Intacs ring) implantation in managing keratoconus. METHODS: This retrospective case series comprised of 11 keratoconic eyes (11 patients) had Intacs ring (Addition Technology, Inc, California, USA) implantation. The main outcome measures were best corrected visual acuity, refraction, keratometry, topography, and pachymetry. Patients were examined before Intacs ring implantation as well as one week, one, three, and six months postoperatively. RESULTS: The mean best corrected visual acuity improved from 0.60+/-0.33 logMAR preoperatively to 0.39+/-0.23 logMAR six months postoperatively (p>0.05) and the mean corneal thickness, from 432.82+/-41.17 micrometer preoperatively to 448.00+/-62.27 micrometer at six months (p>0.05). The mean cylinder improved from -5.36+/-2.70D preoperatively to -2.50+/-1.66D six months postoperatively (p<0.05) and the mean keratometry, from 47.99+/-2.38D to 42.83+/-1.72D at six months (p<0.05). In addition, the mean spherical equivalent improved from -6.64+/-3.49D preoperatively to -3.66+/-3.37D six months postoperatively (p<0.05). One eye had a risk of ring exposure, but the others had no significant complications. CONCLUSIONS: Intacs ring implantation appears to be effective in improving cylinder, spherical equivalent, and keratometry in patients with keratoconus.
California ; Eye ; Humans ; Keratoconus ; Outcome Assessment (Health Care) ; Retrospective Studies ; Visual Acuity

The central venous catheter(Quinton) was replaced in the right atrium for chemotherapy and blood sampling to a eight-year old girl with acute lymphoblastic leukemia. The catheter was flushed with heparin two times daily and the chemotherapeutic drug regimens by CCSG-105 protocol were vincristine, prednisone, L-asparaginase, daunomycin, methotrexate, cyclophosphamide, cytosine arabinoside, 6-mercaptopurine and adriamycin. On day 31 of catheterization, the lumen for blood sampling was blocked. From day 60 of catheterization, anorexia, nausea, vomiting, abdominal distension and tachypnea were developed. Echocardiogram, lung scan, pulmonary function test(PFT), arterial blood gas analysis (ABGA) were done. Two cemtimeters in diameter of thrombosis was found in the right atrium on echocardiogram. The lung scan showed slight decrease in uptake of Tc-99m on the whole lung fields. Restrictive ventratory impairment on PFT and decreased PaO2(48 mmHg) on ABGA were found. To lysis of thromboembolism, urokinase(4,400 IU/kg for initial 10 minutes and the 4,400 IU/kg for 12 hours) was injected intravenously and aspirin(30 mg/kg/d, po) was given. The thrombosis was disappeared from the atrium on echocardiogram and PaO2 was increased up to 97 mmHg temporary. The catheter was removed but total haziness on the right middle and lower lobes were developed after 5 days. The same dose of urokinase was injected just infront of the embolism through Pitfall catheter for 8 days intermittently as results of pulmonary angiography. Symptoms and PaO2 were alleviated and the lung was expanded with mild atelectasis on day 55 of the first fibrinolytic enzyme therapy. Although the frequent complications of central venous catheter are catheter occlusion and infection, we have to check the development of thromboembolism with echocardiogram periodically or in case of unexplained respiratory symptoms.
6-Mercaptopurine ; Angiography ; Anorexia ; Blood Gas Analysis ; Catheterization ; Catheters ; Central Venous Catheters* ; Cyclophosphamide ; Cytarabine ; Daunorubicin ; Doxorubicin ; Drug Therapy ; Embolism ; Enzyme Therapy ; Female ; Heart Atria ; Heparin ; Humans ; Lung ; Methotrexate ; Nausea ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Prednisone ; Pulmonary Atelectasis ; Tachypnea ; Thromboembolism* ; Thrombosis ; Urokinase-Type Plasminogen Activator ; Vincristine ; Vomiting

No abstract available.
Ultrasonics*

Atrial septal defect is one of the most common congenital heart diseases in adult, of which absolute causes is not confirmed, but explained by multifactorial inheritance. In Korea, there has been no case report of atrial septal defect in identical twins in spite of some reports of atrial septal defect in relatives and twins in other countries. We present a first case of atrial septal defect in identical twins whose mother had no infection or medication history during pregnancy.
Adult ; Heart Diseases ; Heart Septal Defects, Atrial* ; Humans ; Korea ; Mothers ; Multifactorial Inheritance ; Pregnancy ; Twins ; Twins, Monozygotic*

PURPOSE: To analyze the incidence and clinical course of epithelial ingrowth after laser in situ keratomileusis (LASIK) using a femtosecond laser. METHODS: We retrospectively evaluated the results of 1158 eyes of 581 patients who received LASIK with the flap created by a femtosecond laser from February 2006 to March 2009 at our institute. We investigated the incidence and clinical course of LASIK in which the flap was created by a femtosecond laser. RESULTS: Epithelial ingrowth was first detected one week after surgery in 12 (57%) of 21 eyes and within one month in 19 eyes (90%). Epithelial ingrowth was localized most commonly near the temporal and nasal flap edge in 12 eyes (57%). In two eyes (9.5%), an isolated ingrowth mass was located in the pupillary area. The development of more than 2.0 mm of epithelial ingrowth was observed in three eyes (0.25%). Among 28 eyes with loose epithelium or epithelial detachment during surgery, epithelial ingrowth was observed in six eyes (21.4%) compared with 15 (1.32%) of 1130 eyes without loose epithelium or epithelial detachment. Therefore, epithelial detachment during surgery was significantly associated with epithelial ingrowth (p = 0.00). CONCLUSIONS: In LASIK in which the flap is created by a femtosecond laser, damage to the epithelial layer increases the chances of epithelial ingrowth. Therefore, avoiding epithelial defects with a gentle maneuver is needed to reduce the chance of epithelial ingrowth during surgery.
Epithelium ; Eye ; Humans ; Incidence ; Keratomileusis, Laser In Situ ; Retrospective Studies

The refractive effects of incision parameters on surgically induced astigmatism in sutureless cataract surgery were studied retrospectively by automatic keratometeric evaluation. 215 eyes undergoing phacoemulsification and posterior chamber intraocular lens implantation were divided into five groups according to the incision length, direction and location : group 1 (14 eyes), 3.5mm superior scleral incision : group 2 937 eyes), 3.2mm temporal clear corneal incision : group 3 (24 eyes), 3.2mm temporal scleral incison : group 4 (24 eyes), 5.5mm superior scleral incision : group 5 (116 eyes), 5.5mm temporal scleral incision. All eyes were examined by keratometry preoperatively as well as at 1 days, at 1 and 2 weeks and at 1 and 2 months after surgery. Cravys vector analysis was performed to calculate the surgically induced astigmatism and keratometric readings were converted to polar values to estimate the mean postoperative keratometric astigmatism. After two postoperative months, mean induced atigmatism was -0.37+/-0.36D in Group 1, 0.27+/-0.44D in Group 2, 0+/-0.33D in Group 3, -0.74+/-0.46D in Group 4 and 0.22+/-0.63D in Group 5. There fore we constructed our own nomogram for managing astigmatism at cataract surgery.
Astigmatism* ; Cataract* ; Lens Implantation, Intraocular ; Nomograms ; Phacoemulsification ; Reading ; Retrospective Studies

Specific cutaneous infiltrates in chronic lymphocytic leukemia(CLL) presenting as tumor and large nodule on face, scalp and upper trunk and involvement of oral mucsa is extremly rare. In 7% of cases, leukemic infiltrates of the skin precede the diagnosis of Leuke. We report herein leukemic macrocheilia which occured 3 years before a diagnosis of CLL.
Diagnosis ; Leukemia ; Leukemia, Lymphocytic, Chronic, B-Cell* ; Scalp ; Skin

The incidence of atherosclerosis in Korea seems to be much increased due to diet change after national development. The pathogenesis of atherosclerosis is not clarified and there are many hypothesis but the most recent and reliable hypothesis is the ratio of HDL-cholesterol per total cholesterol. Under the basis of this hypothesis there have been much trials to administer the agents which has effect on lipid metabolism, so we tried pantethine on 30 patients who visited Han-Yang University Hospital Internal medicine Department, and the result as follows; 1) The mean age of study population was 50.1 years of age, mean body weight was 62kg, and mean height was 160.8cm. male was 17, and female 10. 2) The associated disease of study population was <19 with> cardiovascular disease, in 19, gastrointestinal disease 3, obesity in 1 and others in 4. 3) The undesirable effect of the drug was found on 3 patients; that is, constipation on 1 patient, dizziness on 1 patient, and skin eruption on 1 patient. 4) The mean serum lipids before and after pantethine administration(levels) are as following table. In conclusion, it seems that the effect of the drug which decreases the serum lipids is mild at initial but more increasing as the time goes by and constant, and we experience little side reaction except mild dizziness, constipation and skin eruption.
Atherosclerosis ; Body Weight ; Cardiovascular Diseases ; Cholesterol* ; Constipation ; Diet ; Dizziness ; Female ; Gastrointestinal Diseases ; Humans ; Incidence ; Internal Medicine ; Korea ; Lipid Metabolism ; Male ; Obesity ; Skin ; Triglycerides*

BACKGROUND: Confluent and reticulated papillomatosis(CRP) is a rare but clinically distinct dermatosis of which the etiology is unknown. The pathomechanisms have been discussed from four different viewpoints: 1) endocrine imbalance 2) abnormal host reaction to colonization by pityrosporum orbiculare 3) disorder of keratinization 4) variant of amyloidosis cutis. However recent reports have shown that defect in the keratinization has become the predominant pathomechanism of CRP. OBJECTIVE: Our purpose was to evaluate 25 cases of CRP clinically, histopathologically and electornimcroscopically, to reviewed the literature, and to commented on the pathogenesis. MEHTODS: The 25 patients were examined clinically and pathologic specimens were obtained from lesions for routine light microdcopy and electron microscopy. RESULTS: 1. There were difference between male(68%) ad female(32%) patients. 2. Age distribution, at first visit were variable, ranging from 13 to 35, with the mean age of 20 years-old.3. Duration of symptoms were variable, ranging from 1 month to 5 years with wean duration of 1.5 years. 4. In the seasonal influence 16 cases showed aggrevation of lesions in the summer. 5. The distribution of lesions were abdomen(18 cases), chest(16 cases), back(12 cases), shoulder(7 cases), and buttock(5 were) 6. Three patients had a concomitant disease such as Graves' disease(1 case) or iron-deficiency anemia(2 cases). 7. There were no familial occurrence in any cases. 8. There were no hyphaes or sppores in KOH mount in any cases. 9. The histopathological finding of the affected tissues were characterized as follow : All cases showed laminated hyperkeratosis, epidermal atrophy, acanthosis, and papillomatosis. 23 cases showed an increase of melanin pigment in the basal layer, minimal perivascular and/or perifollicular infiltration. 20 cases showed a decrease of the granular layer. 16 cases showed mild to moderate papillary edema, and dilated or congested upper dermal vessels. 10. In an electron microscopic studies the transitional cells between the stratum corneum and stratum granulosum contained less electron-dense tonofilament-keratohyaline aggregates with electron-lucent inclusions in their cytoplasm in a thick marginal band and degraded cell organelles. These cell layers were increased to 3 or 4 layers. The sratum corneum was thichened and showed a regular keratin pattern with intracellular and extracellular vacuoles. 11. 8 of the 10 patients treated with oral etretinate for 2 months showed some improvement. 7 of the 12 patients treated with topical scalicylic acid oint and selenium sulfide solution for 2 months showed some improvement. 1 patients with oral minocyclin for 2 months showed a marked improvement. 2 patients treated with oral ketoconazole did not show any improve-showed a marked improvement. CONCLUSION: In an electron microscopic study we found that transitional cell layers between stratum corneum and stratum granulosum were increased to 3 or 4 layers. Therefore we think that CRP may be a disease of defect in the keratinization. Although this abnormal keratinization is distinctive, it is uncertain whether it is primary or secondary.
Acitretin ; Age Distribution ; Amyloidosis ; Atrophy ; Colon ; Cytoplasm ; Edema ; Estrogens, Conjugated (USP) ; Etretinate ; Humans ; Hyphae ; Ketoconazole ; Malassezia ; Melanins ; Microscopy, Electron ; Organelles ; Papilloma ; Seasons ; Selenium ; Skin Diseases ; Vacuoles