Though topical administration of antifungal agents for fungal keratitis is effective, it results various toxic effect on cornea depending on the kinds of agents. So, the authors applied several kinds of antifungal agents on the cornea of rabbit and made a comparative study for corneal epithelial damage of which is related to each agents and instillation time using scanning electron microscope. Forty eyes from twenty rabbits were instilled with 0.15% amphotericin B, 5% natamycin, 1% clotrimazole, 0.2% fluconazole and BSS(as a control) in single drop in each eight eyes and then each two corneas resected and examined after 30 minutes, 1 hours, 3 hours and 6 hours. All antifungals showed toxic effects on the corneal epithelium. Significant loss, elongation or swelling in microvilli, especially at the cell periphery, were noted. The top layer of epithelial cells showed moth-eaten appearance or punched-out lesions, and localized destruction. The surface cells were shrunken with wrinkling of plasma membrane and bulging of nucleous. Part of surface cells lost intercellular attachment leaving retraction fibrils. Rarely first and second layer cells of the epithelium were destructed, exposing third layer cells. Dark cells and premature desquamating cells increased significantly with the lapse of time. In general, 5% natamycin and 1% clotrimazole showed relatively severe epithelial toxicity, on the other hand, 0.15% amphotericin B and 0.2% fluconazole shoed mild epithelial toxicity. Localized damages in the epithelial cells were developed in the early stage, and an extent and the depth of the damage in the cells increased in the course of time after instillation.
Administration, Topical ; Amphotericin B ; Antifungal Agents* ; Cell Membrane ; Clotrimazole ; Cornea ; Epithelial Cells ; Epithelium ; Epithelium, Corneal* ; Fluconazole ; Hand ; Keratitis ; Microscopy, Electron, Scanning ; Microvilli ; Natamycin ; Rabbits*

We have studied the overcorrection, undercorrection, astigmatic change and its incidence on time sequence after the excimer laser photorefractive keratectomy, and its relation with the degree of preoperative myopia, sex, and age. The study has been done with 429 eyes which we could assess for 6 months or more after excimer laser photorefractive keratectomy of myopia from July 1993 to march 1997. Overcorrection of more than -1D was common during the early postoperative periods and then gradually decreased with time. Overcorrection has been seen in 261 eyes(60.84%) after 1 month, but only 33 eyes(13.47%) after 1 year, and 13 eyes(11.02%) after 2 years. Undercorrection has been seen in 2 eyes(0.47%) after 1 month, but 25 eyes(10.20%) after 1 year, and 20 eyes(16.95%) after 2 years. Surgically induced astigmatism increased to 0.54+/-0.84D after 10 days and then decreased 0.19+/-0.75D after 12 months. Also, surgical induced astigmatism developed 1.13+/-1.10D in 247 eyes (57.58%) after 1 month, but decreased 0.89+/-0.45D in 107 eyes(43.67%) after 12 months. The occurrence of overcorrection and undercorrection was related to the severity of preoperative myopia(p<0.05), but with sex and age, it had no statistical correlation(p>0.05). The amount of postoperative astigmatism was related to preoperative astigmatism(p<0.05), but it had no statistical correlation with the degree of preoperative myopia, age, sex, and development and increase of surgically induced astigmatism(p>0.05).
Astigmatism ; Incidence ; Lasers, Excimer* ; Myopia* ; Photorefractive Keratectomy* ; Postoperative Period

We present here, a case of pemphigus erythematosus developed in a 31-year-old woman, who had been suffering from repeated episode, of remission and exacerbation with several erythematous, and somewhat oozing patche accompanying a mild pruritus or her face, upper part of the back and anterior chest. In serological studies, she had antinuclear antiboc@lies at. a titer of 1:160. Histopathological finding showed subcorneal bullae. Immunofluorescent study revealed IgG and C, deposition in the intercellular space of the epidermis and along the de rmoepidermal junction.
Adult ; Epidermis ; Extracellular Space ; Female ; Fluorescent Antibody Technique ; Humans ; Immunoglobulin G ; Pemphigus* ; Pruritus ; Thorax

To evaluate croneal haze related to amount of correction, age and sex following excimer laser photorefractive keratectomy(PRK) in myopic eyes, 39months follow-up study on 358 eyes was performed prospectively. The preoperative spherical equivalent refraction ranged from -1.0D to 11.25D(mean -6.18D). The subjective corneal haze grading showed a maximum with mean grading of 0.92 at 2 months and a gradual decrease to 0.14 at 24 months after PRK. The degree of haze was statistically greater with higher amount of correction(p<0.05). No difference was found related to age and sex(p>0.05). Clinically significant corneal haze and scarring was frequent in higher myopia group(p<0.05). Individual variation in corneal haze after PRK was found. However, high myopia is a risk factor of the corneal haze following PRK, and further study to decrease the corneal haze after PRK is necessary.
Cicatrix ; Follow-Up Studies ; Lasers, Excimer* ; Myopia* ; Photorefractive Keratectomy* ; Prospective Studies ; Risk Factors

The lacrimal gland ductal cyst is rare, and a closed cyst of the palpebral lobe of the lacrimal gland developing incidiously in the superotemporal cul-de-sac. The authors experienced a case of lacrimal gland ductal cyst, which was a relatively large-sized mass, protruding from the superior temporal conjunctival cul-de-sac. The patient showed temporal blepharoptosis with S-shape of lid margin, but she had no diplopia and limitation of extraocular muscles. The cystic lesion was excised completely through conjunctival approach and lateral canthotomy. Total resection is optimal technique to prevent recurrence. Histopathologically, the cyst contained serous contents in its cavity and its wall was lined by two layers of squamous epithelium, containing some lacrimal gland tissues. This cyst seems to be originated from the palpebral lobe of the lacrimal gland, considering its anatomical location and histopathological findings.
Blepharoptosis ; Diplopia ; Epithelium ; Humans ; Lacrimal Apparatus* ; Muscles ; Recurrence

With the epidemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2, the number of infected patients was rapidly increasing in Daegu, Korea. With a maximum of 741 new patients per day in the city as of February 29, 2020, hospital-bed shortage was a great challenge to the local healthcare system. We developed and applied a remote brief severity scoring system, administered by telephone for assigning priority for hospitalization and arranging for facility isolation (“therapeutic living centers”) for the patients starting on February 29, 2020. Fifteen centers were operated for the 3,033 admissions to the COVID-19 therapeutic living centers. Only 81 cases (2.67%) were transferred to hospitals after facility isolation. We think that this brief severity scoring system for COVID-19 worked safely to solve the hospital-bed shortage. Telephone scoring of the severity of disease and therapeutic living centers could be very useful in overcoming the shortage of hospital-beds that occurs during outbreaks of infectious diseases.

This research was performed to investigate the effects of NEP (Nutritional Education Practice) program developed by KHyDDI (Korea Hypertension Diabetes Daegu Initiative) for hypertension and diabetes patients. The subjects were 116 patients (hypertension 70, diabetes 46) who had completed basic education program at the education information center and four-session program was implemented for them. Nutrient intake was analyzed and compared before and after the program by 24-hr recall method and evaluate weight, waist circumference, body fat, blood pressure and eating habits in terms of nutrition knowledge, eating behavior, salty taste assessment. The improved results after the program were observed in weight, waist circumference, body fat ratio, blood pressure, slightly salty taste in salty taste assessment, nutrition knowledge, eating behavior, sodium, energy, carbohydrate and protein intake ratio to total energy (p < 0.001). Therefore, this program is effective in the improvement of weight, waist circumference and eating behavior, and the continued management would lead to the prevention of cardio-cerebrovascular diseases in the community.
Adipose Tissue ; Blood Pressure ; Eating ; Feeding Behavior ; Humans ; Hypertension ; Information Centers ; Nutrition Assessment ; Sodium ; Waist Circumference

The adrenal gland is the most commonly involved endocrine organ in patients infected with the human immunodeficiency virus (HIV). Adrenal function abnormality is more common in HIV patients than in the general population. It is important to recognize the condition of adrenal insufficiency, as this adrenal disorder may prove fatal if left untreated. Herein, we report a case of primary adrenal insufficiency in a 37-year-old male patient with acquired immunodeficiency syndrome. The patient complained of fever, general weakness, and fatigue. Impaired adrenal function was noted in the rapid ACTH stimulation test. After steroid supplementation, the patient's symptoms were improved. Therefore, HIV care physicians should ascertain adrenal dysfunction in HIV patients when they complain of fever and general weakness.
Acquired Immunodeficiency Syndrome ; Addison Disease ; Adrenal Glands ; Adrenal Insufficiency ; Adrenocorticotropic Hormone ; Adult ; Fatigue ; Fever ; HIV ; Humans ; Hydrocortisone ; Male

BACKGROUND: This study examined whether defects in insulin secretion contribute to the development and progression of type 2 diabetes mellitus (T2DM). METHDOS: Plasma insulin and glucose were measured after a glucose tolerance test to calculate the insulinogenic index (IGI) and the HOMA-IR Homeostasis model assessment of insulin resistance in subjects with normal glucose tolerance (NGT), prediabetes (preDM, n=49), and T2DM patients with disease duration <1 year (n=84), 1~5 years (n=45), or >5 years (n=37). Plasma proinsulin and adiponectin levels were also measured as a parameter of insulin secretion and resistance. RESULTS: The mean HOMA-IR increased and the adiponectin levels decreased relative to the deterioration of glucose tolerance in NGT and preDM subjects. However, differences in the HOMA-IR were not related to disease duration in T2DM subjects. The mean IGI was similar in NGT and preDM subjects, but there were significant deteriorations in IGI relative to the duration of diabetes. CONCLUSIONS: Defects in both insulin sensitivity and insulin secretion contribute to T2DM, but decreased insulin secretion may be more important in the development and progression of T2DM.
Diabetes Mellitus, Type 2/*physiopathology ; Disease Outbreaks ; Female ; *Glucose Tolerance Test ; Health Status Indicators ; Humans ; Insulin/*secretion ; *Insulin Resistance ; Male ; Middle Aged

BACKGROUND: Type B insulin resistance syndrome is a manifestation of autoantibodies to the insulin receptor that results in severe hyperglycemia and acanthosis nigricans. However, the mechanisms by which these autoantibodies induce hypoglycemia are largely unknown. In this paper, we report the case of patient with type B insulin resistance syndrome who presented with frequent severe fasting hypoglycemia and acanthosis nigricans. METHODS: To evaluate the mechanism of hypoglycemia, we measured the inhibition of insulin binding to erythrocytes and IM9 lymphocytes in a sample of the patient's dialyzed serum before and after immunosuppressive therapy. RESULTS: In the patient's pre-treatment serum IgG, the binding of 125I-insulin to erythrocytes was markedly inhibited in a dose-dependent manner until the cold insulin level reached 10-9 mol/L. We also observed dose-dependent inhibition of insulin binding to IM9 lymphocytes, which reached approximately 82% inhibition and persisted even when diluted 1:20. After treatment with glucocorticoids, insulin-erythrocyte binding activity returned to between 70% and 80% of normal, while the inhibition of insulin-lymphocyte binding was reduced by 17%. CONCLUSION: We treated a patient with type B insulin resistance syndrome showing recurrent fasting hypoglycemia with steroids and azathioprine. We characterized the patient's insulin receptor antibodies by measuring the inhibition of insulin binding.
Acanthosis Nigricans ; Antibodies ; Autoantibodies ; Azathioprine ; Cold Temperature ; Erythrocytes ; Glucocorticoids ; Humans ; Hyperglycemia ; Hypoglycemia ; Immunoglobulin G ; Insulin ; Insulin Resistance ; Lymphocytes ; Receptor, Insulin ; Steroids