Antimetabolites, 5-fluorouracil(5-FU) and mitomycin-C(MMC), are used to promote the success rate of the glaucoma filtration surgery(GFS). The authors observed and compared the duration of bleb formation and complications by slit-lamp biomicroscopy, and the inhibition of fibroblast proliferation and of fibrosis by light microscopy following GFS in 4 group rabbits. One hundred and twenty rabbits comprised in this study were divided into four groups; the first control group(I) was the balanced salt solution soaked group(BSS) during GFS, the second(II) was the 5-FU subconjunctival injected group(5-FU SC) after GFS, the third(III) was the 5-FU soaked group(5-FU) during GFS, and the fourth(IV) was the MMC soaked group(MMC) during GFS. For the maintenance of bleb formation, MMC, 5-FU SC, 5-FU and BSS group showed 0%, 26.7%, 16.7%, 100% at the 1 month after GFS, and 0%, 0%, 0%, 73.3% at the 2 months after GFS, respectively, which suggested that MMC group lasted longest. The inhibition of fibrosis and fibroblast proliferation became higher in the order of MMC, 5-FU, 5-FU SC, BSS group at 2 weeks after the surgery. At 3 months after GFS, there was no conspicuous statistic difference(P>0.05) between 5-FU SC and 5-FU group, but some differences(P<0.001) in the rest groups. From these results, we concluded that antimetabolites such as 5-FU and MMC could be used effectively in cases of poor prognosis of GFS. However, the dosage and application method of antimetabolites should be considered very carefully and further research will be necessary to find out the optimal dosage with minimum toxicity.
Antimetabolites ; Blister ; Fibroblasts ; Fibrosis ; Filtering Surgery* ; Filtration* ; Fluorouracil* ; Glaucoma* ; Microscopy ; Mitomycin* ; Prognosis ; Rabbits*

A retrospective study of 135 injured cervical spine patients who admitted to Soonchunhyang University Hospital between Jan 1, 1989 and May 31, 1994 was conducted. The major results were as follows: 1) The incidence was highest in fourth decade and average age was 39 years old. The ratio of male to female was 3.5:1. 2) Traffic accident(67%) was the most common cause of cervical spine injury, and passenger car accident(55%) was the most frequent cause among them. 3) In 111 patients, 141 cases of radiographic abnormalities were found and vertebral body fracture(57%) was the most common lesion among them. SCIWORA(spinal cord injury without radiographic abnormality) patients were seven. High cervical spine(C1-2) injury was 36 cases (26%) and lower cervical spine(C3-7) injury was 105 cases(74%). The most common involved level of injured vertebrae was C2(23%) followed by C5(22%), C6(20%). The anterior dislocation of body was more common than the posterior one, and C5-6 dislocation was the most common among them. The compressive flexion(40%) and distractive flexion(29%) injuries were more common among types of the lower cervical injuries. 4) The associated injuries were head injury, long bone fracture, chest injury, visceral injury and mutiple contusion & laceration, and head injury was the most common among them. 5) According to Franekel's grade, the rates of neurologic improvement were 23%, 47% and 14% in total cases, operated and non-operated patients respectively. There was statistical significance in the difference between the improvement of Frankel's grade of operated and those of non-operated patients(p<0.02). 6) In 101 patients(75%) conservative treatment was performed. Of 34 patients(25%) were operated, 23 patients were performed anterior approach and 11 were done posterior approach. 7) The common complications were respiratory disorder, bed sore, and urinary tract infection, in order of frequency and the rate of complication was 33%. 8) Mortality rate during hospitalization was 5%, and the common causes were pneumonia and septicemia.
Adult ; Contusions ; Craniocerebral Trauma ; Dislocations ; Female ; Fractures, Bone ; Hospitalization ; Humans ; Incidence ; Lacerations ; Male ; Mortality ; Pneumonia ; Pressure Ulcer ; Retrospective Studies ; Sepsis ; Spine* ; Thoracic Injuries ; Urinary Tract Infections

We evaluated the clinical results of phacoemulsification and posterior chamber lens implantation in posttrabeculectomy eyes. 26 eyes operated during Jan. 1990 to Dec.1995 were evaluated retrospectively with preoperative and postoperative visual acuity, intraocular pressure(IOP) and antiglaucomatous agent usage.The cataract operations were done by clear corneal incisions avoiding the filtering bleb sites. The average interval between trabeculectomy and cataract surgery was 25 months. From a total of 26 eyes 11 had the diagnosis of primary open angle glaucoma(POAG) and 12 eyes chronic angle closure glaucoma(CACG). The preoperative visual acuity was 0.3 or less in 53.8%, and the postoperative visual acuity was 0.4 or better in 57.7%. The preoperative and postoperative IOPs were 14.4+/-4.3mmHg and 15.3+/-4.6mmHg respectively, showing a slight increase. Filtering bleb failure was observed in one eye in which trabeculectomy was formed twice. Antiglaucomatous agent usage decreased to 8 cases from an initial 10 cases. The preoperative IOP of the 8 cases was 17.3+/-5.1mmHg, while it was 13.1+/-3.3mmHg in the 18 cases in which the IOP was controlled without treatment. There was a significant difference between the two(P=0.03). There was a significant relationship between preoperative and postoperative antiglaucomatous agent usage(P=0.01). Taken individually, POAG showed a greater incidence of postoperative antiglaucomatous agent usage than CACG, but was insignificant(P=0.56).
Blister ; Cataract ; Diagnosis ; Incidence ; Phacoemulsification ; Retrospective Studies ; Trabeculectomy ; Visual Acuity

Colon interposition is a surgical procedure used for maintenance of luminal conduit after esophagectomy. Although epithelial neoplasia, such as adenoma and adenocarcinoma, may develop in the interposed colon, there are only few case reports on the condition. Due to the rarity of this condition, there is no definite consensus on recommending screening endoscopy for the early detection of neoplasia in the interposed colons. Here, we report a case of intramucosal adenocarcinoma in an interposed colon. Initial endoscopic resection for this tumor failed to accomplish complete resection. A subsequent endoscopic resection was performed 1 month later and complete resection was achieved. Based on our experience and recommendation on screening endoscopy for gastric cancer in Korea, we suggest that regular screening esophagogastroduodenoscopies should be performed following esophagectomy to detect early neoplasia in the stomach and interposed colon and avoid adverse results induced by delayed detection.
Adenocarcinoma ; Adenoma ; Colon ; Consensus ; Endoscopy ; Endoscopy, Digestive System ; Esophagectomy ; Korea ; Mass Screening ; Phenobarbital ; Stomach ; Stomach Neoplasms

BACKGROUND AND OBJECTIVES: Interleukin-21 receptor (IL-21R) gene polymorphism is related with the development of systemic vasculitis. In this study, we investigated the polymorphisms of IL-21R gene in patients with Kawasaki disease (KD). SUBJECTS AND METHODS: We genotyped the promoter region of IL-21R gene (-2500 bp to +1 bp) in 100 patients with KD and 100 healthy controls. All study subjects were Korean. We designed five pairs of primers and performed polymerase chain reaction (PCR) and direct sequencing. We analyzed whole promoter sequences of 200 individuals with comparison to reference sequences of IL-21R gene (NG_012222.1/NC_000016.9). RESULTS: We found five single nucleotide polymorphisms (SNPs) of which minor allele frequency (MAF) >0.01 in the promoter region of IL-21R gene. Those are -1681 G>T (chromosome site 27411802), -379 G>A (27413104), -332 G>C (27413151, rs2214537), -237 A>T (27413246), and -53 G>A (27413430). There is no significant difference in MAF of each SNP between patients with KD and healthy controls except -237 A>T. Twenty five patients with KD had more than 1 SNP in contrast to only seven healthy controls had. The patients with KD have significantly more IL-21R gene polymorphisms than controls (odds ratio: 3.0, 95% confidence interval: 1.6-5.6, p=0.0005). There was no significant correlation between IL-21R gene polymorphisms and the serum level of IL-21. The serum level of total IgE was not significantly correlated with the presence of IL-21R gene polymorphisms. CONCLUSION: Our data suggest that the genetic susceptibility profile for KD may include IL-21R gene.
Gene Frequency ; Genetic Predisposition to Disease ; Humans ; Immunoglobulin E ; Interleukins ; Mucocutaneous Lymph Node Syndrome ; Polymerase Chain Reaction ; Polymorphism, Genetic ; Polymorphism, Single Nucleotide ; Promoter Regions, Genetic ; Receptors, Interleukin-21 ; Systemic Vasculitis

It has been hypothesized that jobs that have both high psychological demands and low decision latitude ('job strain") can lead to musculoskeletal disorder. The objective of this study was to test whether job strain was correlated with the presence of work-related musculoskeletal disorder, especially myofascial pain syndrome (MPS). Information on demographic factors, confounders such as household load and taking care of children or not, and scores for decision latitude, job demand, and social support was obtained by self-administered questionnaire, which had been developed in Korean language, by adopting NIOSH instrument and Extended Karasek Model (16 items). All subjects were also examined by rehabilitation medicine specialists for musculoskeletal disorders. Subjects (n=370) could be categorized into 4 groups, these were, housewives(n=89), shipyard CAD workers(n=89), general female workers(n=79; nurses, insurance counselors, public officials, clerks, etc), and telephone directory assistance operators(n=113). Results from univariate analyses indicated that all demographic factors, all confounders, scores for decision latitude and social support were not associated with the risk of musculoskeletal disorder. However, score for job demand was higher in musculoskeletal disorder cases than others. In subgroup analysis, this association was convinced again, in telephone directory assistance operators. Job strain model showed that the group of telephone directory assistance operators was high-strain group, and OR of musculoskeletal disorder was 2.446 (95% C.I. : 1.174, 5.096), when comparing this with the low strain group. In conclusion, job strain is a risk factor for work-related musculoskeletal disorder.
Child ; Counseling ; Demography ; Family Characteristics ; Female ; Humans ; Insurance ; Myofascial Pain Syndromes ; National Institute for Occupational Safety and Health (U.S.) ; Questionnaires ; Rehabilitation ; Risk Factors ; Specialization ; Telephone

The author reviewed 294 cases of surgically treated cerebral aneurysms during the period from January, 1987 to December, 1992. The results were as follow: The sex ratio between male and female was 1:1.53 and the mean age was 51.3 years. 2) At admission, 220 patients were in relatively good neurologic condition and functional recovery was obtained in 229 patients(78%). 3) The most common site was anterior communicating artery and the number of posterior circulation aneurysms was 12(4%). 4) The incidence of multiple aneurysms was 4% and clinical vasospasm was observed in 19% of the patients. 5) Operative mortality was 8.8% and the prognostic factors were related with age, sex, history of hypertension, amount of SAH, size and site of aneurysm, preoperative neurologic state, clinical vasospasm, and timing of operation.
Aneurysm ; Arteries ; Female ; Humans ; Hypertension ; Incidence ; Intracranial Aneurysm* ; Male ; Mortality ; Sex Ratio

Echocardiographic parameters can predict cardiovascular events in several clinical settings. However, which echocardiographic parameter is most predictive of each cardiovascular or non-cardiovascular event in patients starting hemodialysis remains unresolved. Echocardiography was used in 189 patients at the time of starting hemodialysis. We established primary outcomes as follows: cardiovascular events (ischemic heart disease, cerebrovascular disease, peripheral artery disease, and acute heart failure), fatal non-cardiovascular events, all-cause mortality, and all combined events. The most predictable echocardiographic parameter was determined in the Cox hazard ratio model with a backward selection after the adjustment of multiple covariates. Among several echocardiographic parameters, the E/e' ratio and the left ventricular end-diastolic volume (LVEDV) were the strongest predictors of cardiovascular and non-cardiovascular events, respectively. After the adjustment of clinical and biochemical covariates, the predictability of E/e' remained consistent, but LVEDV did not. When clinical events were further analyzed, the significant echocardiographic parameters were as follows: s' for ischemic heart disease and peripheral artery disease, LVEDV and E/e' for acute heart failure, and E/e' for all-cause mortality and all combined events. However, no echocardiographic parameter independently predicted cerebrovascular disease or non-cardiovascular events. In conclusion, E/e', s', and LVEDV have independent predictive values for several cardiovascular and mortality events.
*Echocardiography ; Female ; Heart Failure/*diagnosis/mortality ; Humans ; Kidney Failure, Chronic/mortality/*therapy ; Male ; Middle Aged ; Predictive Value of Tests ; Prognosis ; *Renal Dialysis ; Risk Factors ; Ventricular Function, Left/*physiology

Acute bilateral renal cortical necrosis is relatively unusual cause of acute renal failure (ARF). We report a rare case of acute bilateral renal cortical necrosis associated with diclofenac sodium. A 57-year-old man visited to our hospital with progressive oligoanuria for three days. Four days earlier, after diclofenac sodium 150 mg was injected intramuscularly at local hospital, he experienced anaphylactic shock. Our laboratory findings revealed the existence of fibrin split, thrombocytopenia, coagulopathy, and microangiopathic hemolytic anemia (MAHA). These findings were compatible with disseminated intravascular coagulation (DIC). The radiocontrast enhancement CT scan showed a bilateral lack of enhancement of the renal cortex after contrast infusion, enhancement of renal medulla, and the absence of renal excretion of the contrast dye. Renal biopsy showed a cortical necrosis with congested acellular glomuruli and necrotic tubules. Empiric treatment including hemodialysis was commenced. Although his renal function was not completely recovered, he is now being followed up at this hospital without dialysis.
Acute Kidney Injury ; Anaphylaxis ; Anemia, Hemolytic ; Biopsy ; Dialysis ; Diclofenac* ; Disseminated Intravascular Coagulation ; Estrogens, Conjugated (USP) ; Fibrin ; Humans ; Kidney Cortex Necrosis* ; Middle Aged ; Necrosis ; Renal Dialysis ; Thrombocytopenia ; Tomography, X-Ray Computed

Transient receptor potential vanilloid subtype 1 (TRPV1) on astrocytes prevents ongoing degeneration of nigrostriatal dopamine (DA) neurons in MPP⁺-lesioned rats via ciliary neurotrophic factor (CNTF). The present study determined whether such a beneficial effect of astrocytic TRPV1 could be achieved after completion of injury of DA neurons, rather than ongoing injury, which seems more relevant to therapeutics. To test this, the MPP⁺-lesioned rat model utilized here exhibited approximately 70~80% degeneration of nigrostriatal DA neurons that was completed at 2 weeks post medial forebrain bundle injection of MPP⁺. TRPV1 agonist, capsaicin (CAP), was intraperitoneally administered. CNTF receptor alpha neutralizing antibody (CNTFRαNAb) was nigral injected to evaluate the role of CNTF endogenously produced by astrocyte through TRPV1 activation on DA neurons. Delayed treatment of CAP produced a significant reduction in amphetamine-induced rotational asymmetry. Accompanying this behavioral recovery, CAP treatment increased CNTF levels and tyrosine hydroxylase (TH) activity in the substantia nigra pars compacta (SNpc), and levels of DA and its metabolites in the striatum compared to controls. Interestingly, behavioral recovery and increases in biochemical indices were not reflected in trophic changes of the DA system. Instead, behavioral recovery was temporal and dependent on the continuous presence of CAP treatment. The results suggest that delayed treatment of CAP increases nigral TH enzyme activity and striatal levels of DA and its metabolites by CNTF endogenously derived from CAP-activated astrocytes through TRPV1, leading to functional recovery. Consequently, these findings may be useful in the treatment of DA imbalances associated with Parkinson's disease.
Animals ; Antibodies, Neutralizing ; Astrocytes ; Capsaicin ; Ciliary Neurotrophic Factor ; Dopamine ; Dopaminergic Neurons ; Medial Forebrain Bundle ; Models, Animal ; Neurons ; Parkinson Disease ; Pars Compacta ; Rats ; Receptor, Ciliary Neurotrophic Factor ; Tyrosine 3-Monooxygenase