The purpose of our study is to evaluate the visual, refractive and IOP results following combined small incision phacoemulsification, foldable lens implantation, and fornix based trabeculectomy with Mitomycin-C. Seventy-six eyes of 64 patients with cataract and glaucoma had undergone the combined procedure. Minimal follow-up period was 6 months(mean 12.8+/-4.8 months). All the eyes that were free of preexisting macular disease and endstage glaucomatous optic nerve damage demonstated significant improvement in visual acuity. Postoperative astigmatisn was negligible(-0.41diopters). The average IOP reduction was 7.7mmHg. Functioning filtrating bleb persisted in 76.3% of the eyes. Complications with this method were not significant compared with other studies reporting the combined procedure. The small incison phacotrabeculectomy with mitomycin-C technique that we describe appears to be effective in early restoration of visual acuity and reduction of IOP without significant complications.
Blister ; Cataract ; Follow-Up Studies ; Glaucoma ; Humans ; Mitomycin* ; Optic Nerve ; Phacoemulsification* ; Trabeculectomy* ; Visual Acuity

For studies on the developmental stages of migrating erythroid cells and the development of sinusoid, transmission and scanning electron microscopic observations were undertaken on rat fetal liver in 13, 15, 17, 19, 21 days of gestation. The results obtained were as follows. 1. The hepatic sinusoidal endothelium were mainly non-fenestrated cell and fenestrated cell with diaphragm before 17 days of gestation, but fenestrated cells without diaphragm began to appear after 17 days of gestation. Two types of fenestrae were observed, free and clustered fenestrae, but both types were not involved in migration of erythroid cells. 2. Endothelial cell was continuous with neighboring cells by intercellular junctions between lateral cytoplasmic processes with zonula adherens, and between perinuclear cytoplasms with macula adherens. 3. After 13 days of gestation, Kupffer cells showed as matured cell morphology of irregular shape with long cytoplasmic processes into hepatic cord and perisinusoidal space. 4. Migrating erythroid cells in rat fetal liver sinusoid were mainly consisted of immature erythroblasts from proerythroblast to acidophilic erythroblast. The migration occurred through the migrating pores formed on the various sites of the endothelial cytoplasm into the hepatic sinusoidal lumen with no relation to the maturation stages of erythroblast and endothelial cell. In summary, the migration of erythroid cells in the sinusoid of rat fetal liver occurred through the invasion and migration pores transiently formed at various sites of endothelial cytoplasm, and migrating erythroid cells were mainly nucleated immature types.
Adherens Junctions ; Animals ; Cytoplasm ; Diaphragm ; Emigration and Immigration ; Endothelial Cells ; Endothelium ; Erythroblasts ; Erythroid Cells* ; Intercellular Junctions ; Kupffer Cells ; Liver* ; Pregnancy ; Rats*

BACKGROUND: Akathisia is defined as inner feeling or restlessness and can be associated with restless movement. It is a frequent and disabling complication of neuroleptics and was reportedly common in postencephalitic parkinsonism. Akathisia has been reported and appears to be common in Parkinson's disease(PD). OBJECTIVE: To determine the frequency and clinical features of akathisia and dexamine the relationship between presence of akathisia and various clinical parameters of PD, Method: we evaluated 137 PD patients from movement disorder clinics in Samsung Medical Center and Seoul National University Hospital, using a modified akathisia questionnare. We compared two groups between those with akathisia and those without akathisia. We analysed the pattern, location and chronology of akathisia, and the correlation between akathisia and clinical parameters of PD. RESULTS: 1. Of the 137 patients (76 women, 61 men), 43(22 women, 21 men) (31.4%) had akathisia. 2. Patients with akathisia had more advanced disease than those without akathisia as determined by Hoehn and Yahr stage (p<0.05). 3. Patients with akathisia were more often akinetic-rigid than tremor predominent (p<0.05). 4. Patients with akathisia were more frequently treated with levodopa than those without akathisia (p<0.05). 5. There was no difference between two groups for age, sex or disease duration(p<0.05). 6. Of the 43 patients with akathisia, 35 patients had motor restlessness and 27 patients had associated sensory complaints. 7. The whole body or legs were most frequently affected. 8. Akathisic symptoms occurred irregularly and mainly in the afternoon. 9. Nineteen patients had difficulty in their jobs due to akathisia. Conclusion: Akathisia is a common problem in PD especially in severe akinetic-rigid form. It can be the main cause of disability in PD. Recognition and proper management are needed.
Antipsychotic Agents ; Female ; Humans ; Leg ; Levodopa ; Movement Disorders ; Parkinson Disease* ; Parkinson Disease, Postencephalitic ; Psychomotor Agitation* ; Seoul ; Tremor

Apolipoprotein E-epsilon4(APOE4) is recently known as a susceptibility gene or risk factor associated with late-onset Alzheimer's disease (AD). Association between APOE4 and probable AD was determined in Korean population. Twenty patients met the NINCDS-ADRDA probable AD criteria (M:F=7:13, Mean age: 70.1 yr)were compared with 146 controls without dementia (M:F=83:63, Mean age:63.6 yr). APOE genotype was determined by polymerase chain reaction and allele specific hybridization technique. APOE4 allele frequency (0.33 vs. 0.11, p<.01) and proportion of carriers with APOE4(60% vs. 19%, p<.01) were significantly increased in patient group. APOE4 genotype is also associated with late-onset sporadic AD in Korean, and APOE genotyping may be useful for differential diagnosis of AD for patients with dementia.
Alleles ; Alzheimer Disease* ; Apolipoprotein E4 ; Apolipoproteins E ; Apolipoproteins* ; Dementia ; Diagnosis, Differential ; Gene Frequency ; Genotype* ; Humans ; Korea* ; Polymerase Chain Reaction ; Risk Factors

Hypoglycemia sometimes manifests as focal neurologic deficits simulating cerebrovascular disease. Symptoms are usually resolved by glucose infusion, but persistent hemiplegia is rarely reported. A 68-year-old diabetic woman on oral hypoglycemic agent(OHA) was admitted with right hemiplegia and global aphasia. Blood glucose level was 29 mg/dl on admission. No evidence of cerebral infarct or underlying brain disease could be found on initial brain CT and follow up MRI. Focal stenosis or occlusion was also absent on MR angiography. Hemiplegia and aphasia were not improved despite adequate therapy. Hypoglycemic hemiplegia should be suspected in all diabetic patients using insulin or OHA with stroke-like episode, and we suggest that prolonged hypoglycemia may be related to persistence of neurologic deficits.
Aged ; Angiography ; Aphasia ; Blood Glucose ; Brain ; Brain Diseases ; Constriction, Pathologic ; Female ; Follow-Up Studies ; Glucose ; Hemiplegia* ; Humans ; Hypoglycemia ; Insulin ; Magnetic Resonance Imaging ; Neurologic Manifestations

Hemimasticatory spasm is a rare disorder that often accompanies facial hemiatrophy and is characterized by spasm in one or more of the jaw-closing muslces supplied by the fifth cranial nerve. We report a clinical and electrophysiological observation of a patient of hemimasticatory spasm, who presented involuntary spasm on masseter muscle and hemiatrophy of the face on the right side for 7 years.
Facial Hemiatrophy ; Humans ; Masseter Muscle ; Spasm* ; Trigeminal Nerve

OBJECTIVES: Disparities in healthcare among minority groups can result in disparate treatments for similar severities of symptoms, unequal access to medical care, and a wide deviation in health outcomes. Such racial disparities may be reduced via use of an Electronic Medical Record (EMR) system. However, there has been little research investigating the impact of EMR systems on the disparities in health outcomes among minority groups. METHODS: This study examined the impact of EMR systems on the following four outcomes of black patients: length of stay, inpatient mortality rate, 30-day mortality rate, and 30-day readmission rate, using patient and hospital data from the Medicare Provider Analysis and Review and the Healthcare Information and Management Systems Society between 2000 and 2007. The difference-in-difference research method was employed with a generalized linear model to examine the association of EMR adoption on health outcomes for minority patients while controlling for patient and hospital characteristics. RESULTS: We examined the association between EMR adoption and the outcomes of minority patients, specifically black patients. However, after controlling for patient and hospital characteristics we could not find any significant changes in the four health outcomes of minority patients before and after EMR implementation. CONCLUSIONS: EMR systems have been reported to support better coordinated care, thus encouraging appropriate treatment for minority patients by removing potential sources of bias from providers. Also, EMR systems may improve the quality of care provided to patients via increased responsiveness to care processes that are required to be more time-sensitive and through improved communication. However, we did not find any significant benefit for minority groups after EMR adoption.
Bias (Epidemiology) ; Delivery of Health Care ; Electronic Health Records ; Humans ; Inpatients ; Length of Stay ; Linear Models ; Medicare ; Minority Groups ; Minority Health* ; Mortality

OBJECTIVES: Disparities in healthcare among minority groups can result in disparate treatments for similar severities of symptoms, unequal access to medical care, and a wide deviation in health outcomes. Such racial disparities may be reduced via use of an Electronic Medical Record (EMR) system. However, there has been little research investigating the impact of EMR systems on the disparities in health outcomes among minority groups. METHODS: This study examined the impact of EMR systems on the following four outcomes of black patients: length of stay, inpatient mortality rate, 30-day mortality rate, and 30-day readmission rate, using patient and hospital data from the Medicare Provider Analysis and Review and the Healthcare Information and Management Systems Society between 2000 and 2007. The difference-in-difference research method was employed with a generalized linear model to examine the association of EMR adoption on health outcomes for minority patients while controlling for patient and hospital characteristics. RESULTS: We examined the association between EMR adoption and the outcomes of minority patients, specifically black patients. However, after controlling for patient and hospital characteristics we could not find any significant changes in the four health outcomes of minority patients before and after EMR implementation. CONCLUSIONS: EMR systems have been reported to support better coordinated care, thus encouraging appropriate treatment for minority patients by removing potential sources of bias from providers. Also, EMR systems may improve the quality of care provided to patients via increased responsiveness to care processes that are required to be more time-sensitive and through improved communication. However, we did not find any significant benefit for minority groups after EMR adoption.
Bias (Epidemiology) ; Delivery of Health Care ; Electronic Health Records ; Humans ; Inpatients ; Length of Stay ; Linear Models ; Medicare ; Minority Groups ; Minority Health* ; Mortality

INTRODUCTIONThis study aims to determine the attitudes of Asian elderly patients towards invasive life support measures, the degree of patient-surrogate concordance in end-of-life decision making, the extent to which patients desire autonomy over end-of-life medical decisions, the reasons behind patients' and surrogates' decisions, and the main factors influencing patients' and surrogates' decision-making processes. We hypothesize that there is significant patient-surrogate discordance in end-of-life decision making in our community.

MATERIALS AND METHODSThe patient and surrogate were presented with a hypothetical scenario in which the patient experienced gradual functional decline in the community before being admitted for life-threatening pneumonia. It was explained that the outcome was likely to be poor even with intensive care and each patient-surrogate pair was subsequently interviewed separately on their opinions of extraordinary life support using a standardised questionnaire. Both parties were blinded to each other's replies.

RESULTSIn total, 30 patients and their surrogate decision-makers were interviewed. Twenty-eight (93.3%) patients and 20 (66.7%) surrogates rejected intensive care. Patient-surrogate concurrence was found in 20 pairs (66.7%). Twenty-four (80.0%) patients desired autonomy over their decision. The patients' and surrogates' top reasons for rejecting intensive treatment were treatment-related discomfort, poor prognosis and financial cost. Surrogates' top reasons for selecting intensive treatment were the hope of recovery, the need to complete final tasks and the sanctity of life.

CONCLUSIONThe majority of patients desire autonomy over critical care issues. Relying on the surrogates' decisions to initiate treatment may result in treatment against patients' wishes in up to one-third of critically ill elderly patients.

Advance Directive Adherence ; Aged ; Aged, 80 and over ; Attitude ; Critical Care ; psychology ; Critical Illness ; psychology ; therapy ; Decision Making ; Dissent and Disputes ; Female ; Humans ; Male ; Personal Autonomy

INTRODUCTIONEfavirenz is an inducer of drug metabolism enzymes. We studied the effect of efavirenz and ritonavir-boosted darunavir on serum unconjugated and conjugated bilirubin, as probes for UGT1A1 and bile transporters.

MATERIALS AND METHODSHealthy volunteers were enrolled in a clinical trial. There were 3 periods: Period 1, 10 days of darunavir 900 mg with ritonavir 100 mg once daily; Period 2, 14 days of efavirenz 600 mg with darunavir/ritonavir once daily; and Period 3, 14 days of efavirenz 600 mg once daily. Serum bilirubin (conjugated and unconjugated) concentrations were obtained at baseline, at the end of each phase and at exit.

RESULTSWe recruited 7 males and 5 females. One subject developed grade 3 hepatitis on efavirenz and was excluded. Mean serum unconjugated bilirubin concentrations were 6.09 μmol/L (95% confidence interval [CI], 4.99 to 7.19) at baseline, 5.82 (95% CI, 4.88 to 6.76) after darunavir/ritonavir, 4.00 (95% CI, 2.92 to 5.08) after darunavir/ritonavir with efavirenz, 3.55 (95% CI, 2.58 to 4.51) after efavirenz alone and 5.27 (95% CI, 3.10 to 7.44) at exit (P <0.01 for the efavirenz phases). Mean serum conjugated bilirubin concentrations were 3.55 μmol/L (95% CI, 2.73 to 4.36) at baseline, 3.73 (95% CI, 2.77 to 4.68) after darunavir/ritonavir, 2.91 (95% CI, 2.04 to 3.78) after darunavir/ritonavir with efavirenz, 2.64 (95% CI, 1.95 to 3.33) after efavirenz alone and 3.55 (95% CI, 2.19 to 4.90) at exit (P <0.05 for the efavirenz phases).

CONCLUSIONEfavirenz decreased unconjugated bilirubin by 42%, suggesting UGT1A1 induction. Efavirenz also decreased conjugated bilirubin by 26%, suggesting induction of bile efflux transporters. Ritonavir-boosted darunavir had no effect on bilirubin concentrations. These results indicate that efavirenz may reduce concentrations of drugs or endogenous substances metabolized by UGT1A1 or excreted by bile efflux transporters.

Adult ; Aged ; Anti-HIV Agents ; therapeutic use ; Benzoxazines ; pharmacology ; Biological Transport ; Confidence Intervals ; Darunavir ; Dose-Response Relationship, Drug ; Drug Interactions ; Enzyme Induction ; drug effects ; Female ; Glucuronosyltransferase ; biosynthesis ; blood ; HIV Infections ; drug therapy ; HIV Protease Inhibitors ; Humans ; Incidental Findings ; Male ; Membrane Transport Proteins ; drug effects ; metabolism ; Middle Aged ; Ritonavir ; pharmacology ; Sulfonamides ; pharmacology ; Young Adult