PURPOSE: To present the result of a new technique for compressing the flap with amniotic membrane patch to manage epithelial ingrowth following a lacerated or microperforated flap near the visual axis during laser in situ keratomileusis (LASIK) surgery. METHODS: Four patients having epithelial ingrowth involving the visual axis were treated as follows: Under a surgical microscope, 3~5 landmark sutures were located at the margin of the flap and the flap was lifted carefully. After removing epithelial cells, preplaced corneal sutures were tied to fix the flap and a prepared amniotic membrane patch was tightly sutured to the sclera to compress the entire cornea. The amniotic membrane overlay was maintained for about a week and then removed. RESULTS: All four eyes achieved a best corrected visual acuity of 20/25 or better and no eyes have shown signs of recurrence within 3 months. CONCLUSIONS: Amniotic membrane patch can be a useful way to secure the flap in the treatment of epithelial ingrowth threatening the visual axis, especially when direct sutures are deemed difficult.
Amnion* ; Axis, Cervical Vertebra ; Cornea ; Epithelial Cells ; Humans ; Keratomileusis, Laser In Situ ; Recurrence ; Sclera ; Sutures ; Visual Acuity

PURPOSE: To present the result of a new technique for compressing the flap with amniotic membrane patch to manage epithelial ingrowth following a lacerated or microperforated flap near the visual axis during laser in situ keratomileusis (LASIK) surgery. METHODS: Four patients having epithelial ingrowth involving the visual axis were treated as follows: Under a surgical microscope, 3~5 landmark sutures were located at the margin of the flap and the flap was lifted carefully. After removing epithelial cells, preplaced corneal sutures were tied to fix the flap and a prepared amniotic membrane patch was tightly sutured to the sclera to compress the entire cornea. The amniotic membrane overlay was maintained for about a week and then removed. RESULTS: All four eyes achieved a best corrected visual acuity of 20/25 or better and no eyes have shown signs of recurrence within 3 months. CONCLUSIONS: Amniotic membrane patch can be a useful way to secure the flap in the treatment of epithelial ingrowth threatening the visual axis, especially when direct sutures are deemed difficult.
Amnion* ; Axis, Cervical Vertebra ; Cornea ; Epithelial Cells ; Humans ; Keratomileusis, Laser In Situ ; Recurrence ; Sclera ; Sutures ; Visual Acuity

PURPOSE: To improve the understanding of infectous keratitis after LASIK by analyzing our clinical experiences. METHODS: We retrospectively reviewed the records of 12 eyes of 9 subjects who developed infectious keratitis after LASIK, and compared them in terms of onset of symptoms, microbiologic profile, medical and surgical interventions, and final visual acuities. RESULTS: Among them, one eye was found to have culture-proven bacterial infection, five eyes with non tuberculous mycobacterial infection, one eye with Nocardial infection, one eye with fungal keratitis and four eyes of two subjects with unisolated microorganisms. Bacterial infections included unisolated cases presenting 2 days after LASIK, mycobacteria presented at an average of 14.4 days after LASIK, Nocardia presented 4 months after LASIK (7 days after trauma), and fungus presented 3 days after LASIK. Bacterial infections were diagnosed immediately after onset of symptoms, and resolved 30 days after treatment. Mycobacterial infections were diagnosed 14 days (6-55 days) after onset and resolved after 6.2 months of treatment, which included flap amputation in 4 of 5 eyes. Fungal infections were diagnosed 30 days after onset, and resolved after 2.5 months of treatment. Norcardial infections were diagnosed 17 days after onset, and resolved after 3 months. Final visual acuities were over 0.5 in 4 of 5 cases of bacteria, in 3 of 5 cases of mycobacteria, in the 1 case of Nocardia and light perception in fungal keratitis. CONCLUSIONS: Bacterial infections tended to present within two days, whereas mycobacteria presented about 14 days after LASIK. Mycobacterial infections required the longest duration of treatment, however the visual outcome was the worst in fungal keratitis.
Amputation ; Bacteria ; Bacterial Infections ; Fungi ; Keratitis* ; Keratomileusis, Laser In Situ* ; Nocardia ; Retrospective Studies ; Visual Acuity

PURPOSE: To improve the understanding of infectous keratitis after LASIK by analyzing our clinical experiences. METHODS: We retrospectively reviewed the records of 12 eyes of 9 subjects who developed infectious keratitis after LASIK, and compared them in terms of onset of symptoms, microbiologic profile, medical and surgical interventions, and final visual acuities. RESULTS: Among them, one eye was found to have culture-proven bacterial infection, five eyes with non tuberculous mycobacterial infection, one eye with Nocardial infection, one eye with fungal keratitis and four eyes of two subjects with unisolated microorganisms. Bacterial infections included unisolated cases presenting 2 days after LASIK, mycobacteria presented at an average of 14.4 days after LASIK, Nocardia presented 4 months after LASIK (7 days after trauma), and fungus presented 3 days after LASIK. Bacterial infections were diagnosed immediately after onset of symptoms, and resolved 30 days after treatment. Mycobacterial infections were diagnosed 14 days (6-55 days) after onset and resolved after 6.2 months of treatment, which included flap amputation in 4 of 5 eyes. Fungal infections were diagnosed 30 days after onset, and resolved after 2.5 months of treatment. Norcardial infections were diagnosed 17 days after onset, and resolved after 3 months. Final visual acuities were over 0.5 in 4 of 5 cases of bacteria, in 3 of 5 cases of mycobacteria, in the 1 case of Nocardia and light perception in fungal keratitis. CONCLUSIONS: Bacterial infections tended to present within two days, whereas mycobacteria presented about 14 days after LASIK. Mycobacterial infections required the longest duration of treatment, however the visual outcome was the worst in fungal keratitis.
Amputation ; Bacteria ; Bacterial Infections ; Fungi ; Keratitis* ; Keratomileusis, Laser In Situ* ; Nocardia ; Retrospective Studies ; Visual Acuity

No abstract available.
Alagille Syndrome* ; Cholestasis ; Xanthomatosis*

PURPOSE: We evaluated the occurrence of renal scarring in children with unilateral vesicoureteral reflux (VUR), and the relationships between renal scar formation and risk factors such as VUR, duration of fever, acute-phase reactant, age, and sex. METHODS: We retrospectively analyzed the data of 35 children newly diagnosed with unilateral vesicoureteral reflux after urinary tract infection (UTI) in Wallace Memorial Baptist Hospital between January 1996 and December 2004. Ultrasonography, Erythrocyte sedimentation rate (ESR), and C- reactive protein (CRP) were performed initially. Voiding cystourethrography (VCUG) was performed 1 to 3 weeks after treatment with UTI. (99m) Tc-dimercaptosuccinic acid (DMSA) scan was performed 4 to 6 months after treatment. RESULTS: Scintigraphic renal damage was present in 29 percent of the refluxing and in 3 percent of the nonrefluxing kidneys (P< 0.05). The severity of VUR was significantly correlated with renal scar formation (P< 0.05). The duration of fever before treatmen (5.0+/-1.3 vs 2.6+/-1.3) and prolonged fever of over 5 days were significantly different between renal scar group and non-renal scar group (P< 0.05). ESR (56.3+/-23.8 vs 27.9+/-18.1 mm/hr, P< 0.05) and CRP (12.8+/-7.3 vs 3.9+/-3.8 mg/dL, P< 0.05) at the diagnosis of UTI in the renal scar group were higher, compared to those of the non-renal scar group. There were no significant differences in age and sex between the two groups. CONCLUSION: The presence and grade of VUR, the duration of fever before treatment, prolonged fever over 5 days, ESR, and CRP were risk factors for renal scarring, irrespective of age and sex. Diagnosis and management of VUR, in children with UTI, is important to prevent renal scars.
Blood Sedimentation ; Child* ; Cicatrix* ; Diagnosis ; Fever ; Humans ; Kidney ; Protestantism ; Retrospective Studies ; Risk Factors ; Ultrasonography ; Urinary Tract Infections ; Vesico-Ureteral Reflux*

OBJECTIVES: This study investigated the patterns of psychotropic medications prescribed to patients admitted to an open psychiatric ward. METHODS: We reviewed 4282 medical records of patients who were discharged from an open psychiatric ward from May 2003 through April 2014. Data were collected on each patient's age, sex, length of hospital stay, number of past admissions, discharge diagnosis, and kinds and dosages of psychotropic medications at discharge. RESULTS: Among the 1384 male and 2898 female patients, 3.56 psychotropic medications were prescribed on average, with the number increasing across years, from 3.30 in 2003-2008 to 3.76 in 2009-2014. Prescription rates of antipsychotics, anxiolytics, and hypnotics significantly increased in patients with depressive disorders, bipolar disorders, anxiety disorders, delirium, dementia, and amnestic and other cognitive disorders. Only lithium prescription rates decreased significantly. Prescriptions for two or more anxiolytics and antipsychotics increased during the survey years, while antidepressant polypharmacy rates decreased. CONCLUSIONS: Recently, there has been a significant increase in the number of psychotropic medications prescribed, including antipsychotics, anxiolytics, and hypnotics. Caution should be exercised when prescribing medications to avoid cost increases and the risk of side effects, with uncertain gains in the quality of care.
Anti-Anxiety Agents ; Antipsychotic Agents ; Anxiety Disorders ; Bipolar Disorder ; Delirium ; Dementia ; Depressive Disorder ; Diagnosis ; Female ; Gyeonggi-do* ; Humans ; Hypnotics and Sedatives ; Length of Stay ; Lithium ; Male ; Medical Records ; Polypharmacy ; Prescriptions*

Pancreas acinar cell carcinoma (ACC) accounts for only 1-2% of pancreatic exocrine malignant tumor. The symptoms of patients with ACC are usually non-specific, for example the anorexia and weight loss. Patients may develop Schmid's triad including subcutaneous fat necrosis, polyarthritis, and eosinophilia. We reported a case of ACC which was manifested by subcutaneous nodule as initial clinical symptom. To our knowledge, this is the first reported case of ACC presenting as subcutaneous fat necrosis in Korea.
Carcinoma, Acinar Cell/*diagnosis/surgery/ultrasonography ; Fat Necrosis/pathology ; Humans ; Keratins/metabolism ; Male ; Middle Aged ; Pancreatic Neoplasms/*diagnosis/surgery/ultrasonography ; Subcutaneous Fat/*pathology ; Synaptophysin/metabolism ; Tomography, X-Ray Computed

OBJECTIVE: It is well known that treatment with quetiapine can easily cause somnolence and daytime sleepiness in patients with bipolar disorder. Such sedation may be the discomfort to the drug in terms of patient's perspectives and results in drug noncompliance. This study was aimed to investigate the effect of 6-week quetiapine monotherapy on subjective aspects of sleep in patients with acute bipolar disorder. METHODS: In a Korean multi-center, open-label, 6-week study, patients with a DSM-IV diagnosis of bipolar I disorder (manic or mixed episodes) were included to treatment with quetiapine. The dose of quetiapine initially started at 200 mg/day and rapid titrated up to 800 mg/day within day 7 according to the clinical judgements. Clinical improvement was evaluated using Young Mania Rating Scale (YMRS) and Clinical Global Impression-Bipolar version (CGI-BP). Extrapyramidal side effects were measured by Simpson-Angus Rating Scale (SARS) and Barnes Akathisia Rating Scale (BARS). The overall subjectively reported adverse events were gathered during the study period. Subjective sleep questionnaire modified from Leeds Sleep Evaluation Questionnaire (LSEQ) was used to assess the subjective measures of sleep, which included the aspects covering the ease of getting to sleep (GTS), quality of sleep (QOS) and hangover behavior next day (HOV). All assessments were done at baseline and days 7, 14, 21 and 42 after treatment with quetiapine. Analyses were focused to compare the differences between pre-drug baseline and post-treatment with quetiapine. RESULTS: Total 78 (male=30, female=48) patients were included and most of them were inpatients (N=59, 74.7%). Fifty-nine (75.9%) patients were completed the study. Mean changes of YMRS from baseline were significant at days 7, 14, 21 and 42. There were no significant differences from baseline in SARS and BARS at any assessment points. The common subjectively reported adverse events were somnolence, dizziness and dry mouth. While mean changes of 5 items measuring nighttime sleep (GTS and QOS) from baseline were significantly improved at days 7, 14, 21 and 42, those of HOV were not differed between baseline and post-treatment assessments. CONCLUSION: Data showed that quetiapine monotherapy had favorable effect on acute manic symptoms and well tolerated. Also this result suggests that quetiapine monotherapy may improve the self-perceived quality of sleep without any daytime impairment following sleep in acute manic patients.
Bipolar Disorder ; Diagnosis ; Diagnostic and Statistical Manual of Mental Disorders ; Dizziness ; Humans ; Inpatients ; Mouth ; Psychomotor Agitation ; Surveys and Questionnaires ; Quetiapine Fumarate

OBJECTIVES: Electrocardiogram (ECG) data are important for the study of cardiovascular disease and adverse drug reactions. Although the development of analytical techniques such as machine learning has improved our ability to extract useful information from ECGs, there is a lack of easily available ECG data for research purposes. We previously published an article on a database of ECG parameters and related clinical data (ECG-ViEW), which we have now updated with additional 12-lead waveform information. METHODS: All ECGs stored in portable document format (PDF) were collected from a tertiary teaching hospital in Korea over a 23-year study period. We developed software which can extract all ECG parameters and waveform information from the ECG reports in PDF format and stored it in a database (meta data) and a text file (raw waveform). RESULTS: Our database includes all parameters (ventricular rate, PR interval, QRS duration, QT/QTc interval, P-R-T axes, and interpretations) and 12-lead waveforms (for leads I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, and V6) from 1,039,550 ECGs (from 447,445 patients). Demographics, drug exposure data, diagnosis history, and laboratory test results (serum calcium, magnesium, and potassium levels) were also extracted from electronic medical records and linked to the ECG information. CONCLUSIONS: Electrocardiogram information that includes 12 lead waveforms was extracted and transformed into a form that can be analyzed. The description and programming codes in this case report could be a reference for other researchers to build ECG databases using their own local ECG repository.
Calcium ; Cardiovascular Diseases ; Demography ; Diagnosis ; Drug-Related Side Effects and Adverse Reactions ; Electrocardiography* ; Electronic Health Records ; Hospitals, Teaching ; Korea ; Machine Learning ; Magnesium ; Potassium