Purpose: To investigate the usefulness of atropine (Isopto atropine 1% eye drops®; Alcon, Fort Worth, TX, USA) for cycloplegic refraction in patients with partially accommodative esotropia. Methods: We retrospectively analyzed the medical records of patients with partially accommodative esotropia who underwent cycloplegic refraction using both cyclopentolate and atropine at Pusan National University Hospital between November 2017 and December 2020. Patients who replaced their glasses after cycloplegic refraction with atropine were included in group 1 and all other patients were included in group 2. Clinical features and the angle of ocular deviation were compared between the two groups. Results: This study included 23 patients with a mean age of 58.2 ± 22.3 months and mean interval between the two examinations of 5.2 ± 4.1 months. Spherical equivalent was larger after cycloplegic refraction using atropine compared to cyclopentolate (+3.04 ± 1.70 and +2.31 ± 1.75 diopters, respectively; p = 0.001). Groups 1 and 2 included 19 (83%) and 4 (17%) patients, respectively. Clinical characteristics did not significantly differ between the two groups. In group 1, the angle of ocular deviation at near fixation significantly decreased from 28.7 ± 14.0 to 20.7 ± 11.6 prism diopters (p = 0.002) after correction of the refractive error. Conclusions Cycloplegic refraction with atropine may be useful for detecting latent hyperopia and managing strabismus in patients with partially accommodative esotropia.

OBJECTIVE: To evaluate the prevalence of incidentally found unruptured intracranial aneurysms (UIAs) on the brain MR angiography (MRA) from a community-based general hospital. MATERIALS AND METHODS: This was a prospectively collected retrospective study, carried out from January 2004 to December 2004. The subjects included 3049 persons from a community-based hospital in whom MRA was performed according to a standardized protocol in an outpatient setting. Age- and sex-specific prevalence of UIAs was calculated. The results by MRA were compared with intra-arterial digital subtraction angiography (DSA) findings. RESULTS: Unruptured intracranial aneurysms were found in 137 (5%) of the 3049 patients (M:F = 43:94; mean age, 60.2 years). The prevalence of UIAs was 5% (n = 94) in women and 4% (n = 43) in men, respectively (p = 0.2046) and showed no age-related increase. The most common site of aneurysm was at the distal internal carotid artery (n = 64, 39%), followed by the middle cerebral artery (n = 40, 24%). In total, 99% of aneurysms measured less than 12 mm, and 93% of aneurysms measured less than 7 mm. Direct comparisons between MRA and DSA were available in 70 patients with 83 UIAs; the results revealed two false positive and two false negative results. CONCLUSION: This community-hospital based study suggested a higher prevalence of UIAs observed by MRA than previously reported. These findings should be anticipated in the design and use of neuroimaging in clinical practice.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Aneurysm, Ruptured/diagnosis ; Angiography, Digital Subtraction ; Cerebral Angiography ; Female ; Humans ; Incidental Findings ; Intracranial Aneurysm/*diagnosis/radiography ; *Magnetic Resonance Angiography ; Male ; Middle Aged ; Young Adult

BACKGROUNDING AND AIM: Recent reports have suggested that preoperative biliary drainage increases the perioperative morbidity and mortality rates of pancreaticoduodenectomy. We reviewed retrospectively 150 patients who underwent pancreaticoduodenectomy to examine the relationship between preoperative biliarydrainage and the morbidity and mortality associated with pancreaticoduodenectomy. METHODS: Peri-operative morbidity and mortality were evaluated in 150 consecutive patients who underwent pancreaticoduodenectomy at Pusan National University Hospital for 10 years. Univariate and multivariate logistic regression analysis were done to evaluate the relationship between preoperative biliary decompression and the following end points: any complication, any major complication, infectious complications, intraabdominal abscess, pancreaticojejunal anastomotic leak, wound infection, and postoperative death. RESULTS: Preoperative prosthetic biliary drainage was performed in 86 patients (57.3%) (stent group), 17 patients (11.3%) underwent surgical biliary bypass performed during prereferral laparotomy, and the remaining 47 patients(31.3%) (no-stent group) did not undergo any form of preoperative biliary decompression. The overall surgical death rate was 1.3% (two patients); the number of deaths was too small for multivariate analysis. By multivariate logistic regression, no differences were found between the stent and no-stent groups in the incidence of all complications, major complications, infectious complications, intraabdominal abscess, or pancreaticojejunal anastomotic leak. Wound infections were more common in the stent group than the no-stent group. CONCLUSIONS: Preoperative biliary decompression increases the risk for postoperative wound infections after pancreaticoduodenectomy. However, there was no increase in the risk of major postoperative complications or death associated with preoperative stent placement. Patients with extrahepatic biliary obstruction do not necessarily require immediate laparotomy to undergo pancreaticoduodenectomy with acceptable morbidity and mortality rates; such patients can be treated by endoscopic biliary drainage without concern for increased major complications and death associated with subsequent pancreaticoduodenectomy.
Abscess ; Anastomotic Leak ; Busan ; Decompression ; Drainage ; Humans ; Incidence ; Laparotomy ; Logistic Models ; Mortality ; Multivariate Analysis ; Pancreaticoduodenectomy* ; Postoperative Complications ; Retrospective Studies ; Stents ; Surgical Wound Infection ; Wound Infection

Purpose: To report a case of traumatic optic neuropathy aggravated by orbital emphysema after an orbital fracture.Case summary: A 19-year-old man with no specific medical history was referred for a right orbital fracture caused by blunt trauma to the supraorbital rim of the right eye. Computed tomography (CT) showed a right orbital fracture involving the inferomedial wall and inferomedial strut. The corrected visual acuity was 0.4 in the right eye (RE) and 1.0 in the left and the intraocular pressure was 15 and 18 mmHg, respectively. Restriction on downgaze, abduction, and an indefinite relative afferent pupillary defect (RAPD) were observed in the RE. Fundus exam was non-specific other than commotio retinae on the temporal side of the macula in the RE. After 12 hours post trauma, the visual acuity of the RE had decreased to light perception. Definite RAPD was observed with optic disc swelling on the fundus photo and optical coherence tomography. Orbital CT showed air shadows, which were not seen on the initial evaluation, adjacent to the optic disc. We diagnosed traumatic optic neuropathy aggravated by orbital emphysema. High-dose intravenous steroid was given for 3 days. Despite a lateral canthotomy and cantholysis to decompress the right orbit, visual acuity did not improve above counting fingers. Conclusions Increased intraorbital pressure and congestion caused by orbital emphysema may exacerbate traumatic optic neuropathy. Therefore, close observation is required.

BACKGROUND: Currently, the incidence of hepatitis A is on the increase in Korea. Although there is emphasis on contact precautions, the nosocomial outbreak of hepatitis A virus (HAV) in healthcare personnel has increased within endemic areas because these workers inevitably come in close contact with patients and work under suboptimal hygiene conditions. In this study, we evaluated the necessity of immunization against HAV for healthcare personnel. METHODS: We investigated the seropositivity of serum immunoglobulin G (IgG) anti-HAV antibody (Ab) in 672 healthcare personnel on the basis of their age-group, sex, and occupation in Soon Chun Hyang University Hospital and Soon Chun Hyang University Bucheon Hospital. RESULTS: The subjects were divided into 6 groups on the basis of their ages to identify differences among the various age groups in the number of cases with HAV Ab seropositivity. Significant intergroup differences were noted in this respect: 21-25 years, 2/152 (1.3%); 26-30 years, 33/245 (13.5%); 31-35 years, 70/148 (47.3%); 36-40 years, 52/79 (65.8%); >40 years, 44/48 (91.7%). CONCLUSION: The number of seropositive cases was low among young healthy personnel: low seropositivity is an emerging risk for vulnerable population. With the increase in the incidence of hepatitis A, healthcare personnel have become a risk population for hepatitis A, as are community residents. Therefore, for healthcare personnel working in hospitals, immunization against HAV should be recommended for personnel younger than 30 years, and serological testing for older personnel.
Delivery of Health Care ; Hepatitis ; Hepatitis A ; Hepatitis A Antibodies ; Hepatitis A Vaccines ; Hepatitis A virus ; Humans ; Hygiene ; Immunization ; Immunoglobulin G ; Incidence ; Korea ; Occupations ; Serologic Tests ; Vulnerable Populations

PURPOSE: to investigate the effect of amniotic membrane transplantation (AMT) on corneal epithelial healing. METHODS: A 4-mm epithelial debridement was made in central rabbit cornea. Then, human amniotic membrane was transplanted (AMT group) or a contact lens was applied (contact lens group). The contralateral eyes were unwounded as controls. After surgery 5-bromo-2'-deoxyuridine (BrdU) was injected via ear vein. Each corneal tissue including the limbus was obtained on postoperative 12, 24 and 48 hours. Proliferating cell nuclear antigen (PCNA) in limbal and peripheral corneal epithelium and keratinocyte growth factor (KGF) in limbal stroma were immunolocalized by immunohistochemical method. Incorporation of BrdU in limbal and peripheral corneal epithelium was visualized by indirect immunofluorescent method. RESULTS: AMT group significantly accelerated the expression of PCNA and BrdU at limbal and peripheral corneal epithelial cells. The expression of PCNA and BrdU showed a peak at 24hr in both groups and increased in limbal epithelial cells more than peripheral corneal epithelial cell in AMT group. The expression of KGF on limbal keratocyte increased in AMT group more than contact lens group and coincided wiht the expression pattern of PCNA and BrdU. The number of keratocyte in significantly decreased in contanct lens group compared wiht AMT group. CONCLUSION: AMT enhanced corneal epithelial wound healing in vivo by stimulating limbal epithelial proliferation which is indirectly mediated in part by upregulating the expression of KGF, which is a potent epithelial mitogen secreted by limbal keratocytes.
Amnion* ; Bromodeoxyuridine ; Cornea ; Debridement ; Ear ; Epithelial Cells* ; Epithelium, Corneal ; Fibroblast Growth Factor 7 ; Humans ; Proliferating Cell Nuclear Antigen ; Veins ; Wound Healing

A 51-year old woman was admitted to our hospital because of Exertional dyspnea, Palpitation, Headache, upper-limb hypertension, and lower-limb claudication. A loud systolic bruit was audible along Lt. carotid artery. Upper limb hypertension was responsed to drug moderately (included ACEI, alpha, beta-blocker, Ca++-channel blocker), but claudication of lower limb was aggravated, also on exertion, Blood Pressure of upper-limb was elevated to 180 mmHg. So, chest CT and Aortogram was performed, we confirmed long segmental stenosis from thorasic Aorta to the renal a. bifurcation level. Finally, We performed after axillo-femoral bypass surgery. After surgery, upper limb hypertension and lower limb claudication was improved.
Aorta ; Blood Pressure ; Carotid Arteries ; Constriction, Pathologic ; Dyspnea ; Female ; Headache ; Humans ; Hypertension ; Lower Extremity ; Middle Aged ; Takayasu Arteritis ; Tomography, X-Ray Computed ; Upper Extremity

BACKGROUND: The intrapleural instillation of tetracycline for pleural sclerosis had been most commonly used in patients with symptomatic malignant pleural effusion or recurrent pneumothorax for a long time. Unfortunately, at a time of expanding use of this agent, the production of injectable tetracycline hydrochloride used for pleurodesis was discontinued by its sole manufacturer in mid-1991 because the manufacturer was unable to meet US Food and Drug Administration purity standards. So we performed a preliminary study of doxycycline, as a alternative pleural sclerosant on rabbit pleura and compared its efficacy with that of tetracycline. METHOD: Eighteen New Zealand white rabbits weighing 2 to 3kg(mean 2.6kg) were divided into three groups. In each groups, one tetracycline(20 mg/ml/kg) and two doxycycline solutions(7 mg/ml/kg and 20 mg/ml/kg) instillated into the right pleural space through an 18-gauge angiocath with care to prevent pneumothorax. All rabbits were sacrificed after 28 days. RESULTS: 1) In the group of tetracycline 20 mg/ml/kg(six rabbits), five rabbits showed partial pleural symphysis with several fibrous bands, and one rabbit died on 22th day. 2) In the group of doxycycline 7 mg/ml/kg(six rabbits), three rabbits showed partial pleural symphysis and the other three rabbits showed complete pleural symphysis without necrosis of underlying parenchymal lung tissue. 3) In the group of doxycycline 20 mg/ml/kg(six rabbits), two rabbits showed complete pleural symphysis without lung necrosis, another two rabbits showed complete pleural symphysis with lung necrosis, and the other two rabbits died on 4th and 13th day, respectively. CONCLUSION: We concluded that doxycycline is a highly effective sclerosing agent having stronger pleurodesis effect with that of tetracycline by dose base and its optimal dosage was considered as 7 mg/ml/kg with minimal complications.
Doxycycline* ; Humans ; Lung ; Necrosis ; Pleura ; Pleural Effusion, Malignant ; Pleurodesis* ; Pneumothorax ; Rabbits ; Sclerosis ; Tetracycline ; United States Food and Drug Administration

STUDY DESIGN: A retrospective study. OBJECTIVES: To evaluate the safety and usefulness of implant removal based on fusion by radiological change analyses and non-fused segment motion angle after open reduction, multi-segment fixation, and single segment fusion. SUMMARY OF LITERATURE REVIEW: There have been reports that discuss possible fracture of fixator, loss of reduction, or failure of fixation in certain cases of single segment fixation consistent with thoracolumbar fracture. MATERIALS AND METHODS: We analyzed 83 patients who had undergone treatment by fixation of the top 2 segments and the bottom segment. The posterolateral fusions were performed for the top segment for thoracolumbar fractures. The mean follow-up was 21.3 months. Wedge and local kyphotic angles, anterior, and posterior heights of the vertebral body were measured on plain radiograph. The range of motion of each segment was recorded by flexion-extension lateral radiographs at 6 month after the removal of implants. RESULTS: Radiologic assessments performed on 83 patients demonstrated preoperative mean wedge angle, kyphotic angle, mean anterior body height of 20.1degrees, 18.5degrees and 62.0%, respectively, and, postoperatively, these were corrected by 9.0degrees, 9.3degrees and 24.6%, respectively. In the 44 cases that had the implants removed, the correction losses were 0.4degrees(P=0.258) and 3.7degrees(P=0.000), 0.5%(P=0.756), and at the last follow-up, compared to measurements prior to the removal. There was no statistical significance in wedge angle or anterior body height. The range of motion measured on the non-fused segment was 3.9degrees on average at 6-months after the hardware removal. CONCLUSIONS: The multi-segments fixation and single-segment fusion for the thoracolumbar fracture can preserve correction and the motion of non-fusion segment. Although the implant removal after union can sustain motion, further studies regarding degenerative change of the non-fused segment are necessary.
Body Height ; Follow-Up Studies ; Humans ; Range of Motion, Articular ; Retrospective Studies

Both genetic and environmental factors play important roles in the pathogenesis of Parkinson Disease (PD). The contribution of many environmental factors including dietary factor remains unproven. The purpose the study was to investigate the dietary habits, nutrient intake and dietary quality of Korean PD patients according to the duration of disease. PD patients were recruited from K and S university hospitals from May 2005 to January 2006. This study was carried out after approval by the Institute Review Board (IRB). British Brain Bank criteria was used to diagnose PD. The subjects were classified into 2 groups based on the duration of PD: < 25 months and > or = 25 months groups. General characteristics, anthropometric measurements, food habits and dietary intakes were investigated. The results of this study were as follows: 1) The mean age of < 25 months group (66.9 +/-8.0 yr) was significantly higher than that of > or = 25 months group (62.2 +/- 8.8 yr) (p < 0.05). No significant differences were found for academic background, occupation, living status and social activity, however, numbers of diseases, exercise and family history of PD were significantly different. 2) Anthropometric measurements were not different between the two groups. 3) The frequency of taking snacks was significantly higher in <25 months group and the amounts of alcohol consumption were significantly higher in > or = 25 months group. 4) Daily intakes of most nutrients were very low compared with DRI. 5) The MAR score was significantly lower in < 25 months group (p < 0.05;) however, the scores of DVS, DDS and DQI were not significantly different. As a conclusion an overall nutrient intake and dietary quality of the Parkinson's Disease patients need to be improved regardless of duration of the disease and a well-balanced diet should be emphasized.
Alcohol Drinking ; Brain ; Diet ; Food Habits ; Hospitals, University ; Humans ; Nutritional Status ; Occupations ; Parkinson Disease ; Snacks