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

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

No abstract available.
Ultrasonics*

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

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*

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

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

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

No abstract available.
Ultrasonography, Prenatal*

To examine the stability in the bag in foldable silicone IOL implantation and determine its effect on visual acuity. This study comprised 66 eyes that had phacoemulsification with three-piece foldable silicone intraocular lens(IOL) implantation that were prospectively evaluated about 2 months after surgery. The examination included the status of the haptic and optic placement, extent of posterior capsular capsular opacification(PCO), and the best corrected visual acuity. Sixty-five eyes had an in-in haptic placement, one eye had in-out placement, and there was no eye in out-out placement. Capsular capture occurred in 13 eyes(19.70%). The extent of POC in eyes with capsular capture was greater than in those withot capture. But the best corrected visual acuity in eyes with capsular capture made no difference to those without capture. In addition, eyes with in-out and out-out haptic placement had worse PCO than the eyes with in-in placement. There was a high incidence of capsular capture after silicone IOL implantation. This complication, along with the undesirable placement of the haptics, led tod PCO and was anticipated visual inpairment in long term follow-up. Therefore proper amount of continuous curvilinear capsulorhesix opening and complete placement of lens in the bag ahould be necessary.
Follow-Up Studies ; Incidence ; Lenses, Intraocular* ; Phacoemulsification ; Prospective Studies ; Silicones* ; Visual Acuity