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Descemet's Membrane Detachment Associated with Inadvertent Viscoelastic Injection in Viscocanalostomy.

Chan Yun KIM ; Gong Jae SEONG ; Hyoung Jun KOH ; Eung Kweon KIM ; Young Jae HONG

Yonsei Medical Journal.2002;43(2):279-281. doi:10.3349/ymj.2002.43.2.279

We report a case of Descemet's membrane detachment, a rare complication of viscocanalostomy. During the operation, the injection cannula was directed slightly oblique to the Schlemm's canal rather than parallel to it. Localized corneal whitening developed adjacent to the injection site during viscoelastic injection. One week postoperatively, corneal edema decreased and Descemet's membrane detachment was noted. Nine months after surgery, the cornea was clear while the Descemet's membrane detachment remained. And IOP was 19 mmHg without any medications. We think that improper cannula positioning during viscoelastic injection may cause Descemet's membrane detachment, a rare complication of viscocanalostomy.
Aged ; Case Report ; Corneal Diseases/*etiology ; *Descemet's Membrane ; Human ; Hyaluronic Acid/administration & dosage ; Injections/adverse effects ; Intraoperative Complications ; Male ; Ocular Hypertension/*surgery

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Successful Treatment of Pure Red Cell Aplasia with Plasmapheresis in a Patient with Systemic Lupus Erythematosus.

Bo Geum CHOI ; Wan Hee YOO

Yonsei Medical Journal.2002;43(2):274-278. doi:10.3349/ymj.2002.43.2.274

Pure red cell aplasia (PRCA) is a rare cause of anemia associated with systemic lupus erythematosus (SLE), and fewer than 20 cases have been reported. The development of PRCA may be mediated by an autoimmune mechanism which is supported by the presence of antibodies that impair various stages and mechanisms of erythropoiesis, by the association with immunological disorders or lymphoma, and by a favorable response to immunosuppressive drugs, antilymphocyte globulin, thymectomy, and splenectomy. However, these therapies have not been successful in all patients with PRCA. We report our experience with a 31-year-old female patient with SLE who developed PRCA that did not respond to immunosuppressive therapies. However, complete normalization of erythropoiesis was achieved after the removal of the autoantibodies by plasmapheresis, and the patient has now maintained a normal hemoglobin level for more than eight months. We suggest that plasmapheresis might be tried in the treatment of PRCA cases before other more aggressive therapies are commenced.
Adult ; Bone Marrow/pathology ; Case Report ; Erythropoiesis ; Female ; Human ; Lupus Erythematosus, Systemic/*complications ; *Plasmapheresis ; Red-Cell Aplasia, Pure/*complications/pathology/physiopathology/*therapy

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Incidentally Found Pharyngoesophageal Diverticulum on Ultrasonography.

Jinna KIM ; Young Jin KIM ; Eun Kyung KIM ; Cheong Soo PARK

Yonsei Medical Journal.2002;43(2):271-273. doi:10.3349/ymj.2002.43.2.271

The pharyngoesophageal diverticulum in the lower part of the neck can be detected using neck ultrasonography. We present a case of pharyngoesophageal diverticulum mimicking a thyroid nodule, which was found incidentally by ultrasonography, and discuss its peculiar findings, which might be useful to diagnose pharyngoesophageal diverticulum and to prevent invasive procedures such as needle aspiration biopsy.
Aged ; Barium/diagnostic use ; Case Report ; Diagnosis, Differential ; Esophagus/radiography ; Human ; Male ; Thyroid Nodule/diagnosis/ultrasonography ; Zenker Diverticulum/diagnosis/*ultrasonography

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Successful Cyclophosphamide Therapy in Recurrent Eosinophilic Colitis Associated with Hypereosinophilic Syndrome.

Ju Hee LEE ; Jin Woo LEE ; Cheol Soon JANG ; Eun Sang KWON ; Hyo Young MIN ; Seok JEONG ; Kye Sook KWON ; Don Haeng LEE ; Hyeon Geun CHO ; Pum Soo KIM ; Hyung Gil KIM ; Yong Woon SHIN ; Young Soo KIM

Yonsei Medical Journal.2002;43(2):267-270. doi:10.3349/ymj.2002.43.2.267

Eosinophilic colitis is a relatively rare complication of hypereosinophilic syndrome which is characterized by abdominal pain and bloody diarrhea and is usually treated with steroids and hydroxyurea. However, no standard regimen exists in cases of intractable disease despite several treatment attempts with Interferon- alpha, cyclosporin, etoposide, and vincristine, etc. We here report a case of a 43-year-old woman with recurrent eosinophilic colitis as a complication of hypereosinophilic syndrome who was successfully treated with cyclophosphamide.
Adult ; Case Report ; Colitis/*complications/*drug therapy/pathology ; Cyclophosphamide/*therapeutic use ; Eosinophilia/*complications/*drug therapy/pathology ; Female ; Human ; Hypereosinophilic Syndrome/*complications ; Recurrence

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Proteus Syndrome: A Natural Clinical Course of Proteus Syndrome.

John A LINTON ; Byeong Kwon SEO ; Choong San OH

Yonsei Medical Journal.2002;43(2):259-266. doi:10.3349/ymj.2002.43.2.259

A 16-year-old Korean male patient presented with macrodactyly, hemihypertrophy of the face and extremities, plantar cerebriform hyperplasia, a subcutaneous mass of the left chest, macrocephaly and verrucous epidermal nevi. These findings are consistent with Proteus Syndrome. The clinical features, etiology, management, natural course and differential diagnosis of this case are discussed.
Adolescent ; Case Report ; Disease Progression ; Human ; Male ; Proteus Syndrome/diagnosis/etiology/*physiopathology/therapy

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Fetal Reduction in Multifetal Pregnancy: Ethical Dilemmas.

Ivica TADIN ; Damir ROJE ; Ivo BANOVIC ; Deni KARELOVIC ; Marko MIMICA

Yonsei Medical Journal.2002;43(2):252-258. doi:10.3349/ymj.2002.43.2.252

As a result of the increased use of drugs that enhance fertility, and the advent of in vitro fertilization and embryo transfer over the last 2 decades, the incidence of multifetal pregnancies has increased exponentially. In parallel with this increase methods of care for women carrying multiple fetuses have become more complex and well developed. Importantly, it has become obvious that in the case of such pregnancies the rates of mortality and morbidity of both fetuses and mothers, particularly in cases where four or more fetuses are involved, are extremely high. Improvements in the techniques of assisted fertilization should result in fewer yatrogenic multifetal pregnancies and a commensurate decrease in related risks. Fetal reduction seems to be an acceptable method of improving maternal and fetal outcome in high order multiple pregnancies despite the many unresolved medical and ethical dilemmas.
*Ethics, Medical ; Female ; Human ; Pregnancy ; *Pregnancy Reduction, Multifetal/adverse effects/methods ; *Pregnancy, Multiple

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Local Delivery of Nitric Oxide from an Eluting Stent to Inhibit Neointimal Thickening in a Porcine Coronary Injury Model.

Jung Han YOON ; Chiung Jen WU ; James HOMME ; Ronald J TUCH ; Rodney G WOLFF ; Eric J TOPOL ; A Michael LINCOFF

Yonsei Medical Journal.2002;43(2):242-251. doi:10.3349/ymj.2002.43.2.242

To assess the effect of a NO-eluting stent on reducing neointimal thickening in a porcine coronary artery stent injury model, sodium nitroprusside (SNP), a NO donor, was incorporated into polyurethane (PU) polymer and coated onto metallic coil stents, and two types of stents with thin and thick barrier coatings were characterized. In vivo biological activity of the NO-eluting stents was assessed by measurement of coronary arterial cGMP levels in 32 pigs/64 arteries at days 1, 2, 7 and 14. Morphometric analyses were performed in 16 pigs to determine the effect of NO-eluting stents on neointimal hyperplasia 28 days following arterial injury. The SNP-coated stents released NO in a controlled manner for up to 4 weeks in the in vitro experiments and an increase in local tissue cGMP levels was demonstrated for up to 14 days. The neointimal area at 28 days was not diminished, however, by NO eluded from either stents of thin or thick barriers (control bare stent - 0.66 mm2, control PU stent - 0.68 mm2, SNP-PU thin coating stent - 0.78 mm2, SNP-PU thick coating stent - 0.85 mm2; all p=NS). In conclusion, the SNP-coated polymer stent exerted a local biological effect on the arterial wall, with sustained elevation of cGMP level. Although local delivery of NO from this device did not reduce neointimal hyperplasia in this porcine model, this polymer-coated stent might be a promising tool for administration of other agents that may modify the reparative tissue responses leading to restenosis.
Animal ; Coated Materials, Biocompatible ; Coronary Vessels/*injuries ; Nitric Oxide/*administration & dosage/pharmacology ; *Stents ; Swine ; Tunica Intima/*drug effects ; Wounds and Injuries/*pathology

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Comparative Study of Concentration of Isoflavones and Lignans in Plasma and Prostatic Tissues of Normal Control and Benign Prostatic Hyperplasia.

Sung Joon HONG ; Sun Il KIM ; Soo Mee KWON ; Jong Ran LEE ; Bong Chul CHUNG

Yonsei Medical Journal.2002;43(2):236-241. doi:10.3349/ymj.2002.43.2.236

Objective: Isoflavones and lignans are phytoestrogens that have recently gained interest as dietary factors related to prostatic diseases. However, no data on the concentrations in prostate tissue in humans is available. Therefore, the concentrations of isoflavones and lignans in plasma and prostatic tissues according to the prostate volume were compared to determine their possible effect on the benign prostatic growth. Methods: Fasting plasma and prostatic tissue specimens were acquired from 25 men over 50 years of age with similar normal dietary habits and no previous history of drug intake that could affect the isoflavones and lignans levels. The tissue was acquired either during a transurethral resection of the prostate in 15 patients with benign prostatic hyperplasia (BPH) with prostate volume over 40 ml or during a radical cystoprostatectomy in 10 patients with bladder cancer with a prostate volume < 25 ml, who were used as the controls. Quantitative analysis of the isoflavones, specifically equol, daidzein and genistein and lignans, particularly enterodiol and enterolactone, was performed by gas chromatography-mass spectrometry. Results: The mean prostatic concentrations of enterodiol, enterolactone, equol and daidzein in the BPH and the control groups were similar. However, the mean prostatic concentration of genistein was significantly lower in the BPH group than in the control group (65.43 +/- 17.05 vs 86.96 +/- 37.75 ng/ ml, respectively, p=0.032). The plasma concentration of isoflavones and lignans in the two groups were comparable. Conclusion: Isoflavones, but not lignans, have some influence the benign prostatic growth, and the prostatic concentration of genistein possibly has the closest association among them. More studies to further clarify the roles and mechanisms of isoflavone action on BPH including pharmacokinetic studies are recommended.
Blood/*metabolism ; Comparative Study ; Human ; Isoflavones/*metabolism ; Lignans/*metabolism ; Male ; Middle Age ; Osmolar Concentration ; Prostate/*metabolism ; Prostatic Hyperplasia/*metabolism ; Reference Values

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H2O2 Enhances Ca2+ Release from Osteoblast Internal Stores.

Soon Ho NAM ; Sang Yong JUNG ; Chang Moo YOO ; Ei Hwan AHN ; Chang Kook SUH

Yonsei Medical Journal.2002;43(2):229-235. doi:10.3349/ymj.2002.43.2.229

The physiological activity of osteoblasts is known to be closely related to increased intracellular Ca2+ activity ([Ca2+]i) in osteoblasts. The cellular regulation of [Ca2+]i in osteoblasts is mediated by Ca2+ movements associated with Ca2+ release from intracellular Ca2+ stores, and transmembrane Ca2+ influx via Na+-Ca2+ exchanger, and Ca2+ ATPase. Reactive oxygen species, such as H2O2, play an important role in the regulation of cellular functions, and act as signaling molecules or toxins in cells. In this study, we investigated the effects of H2O2 on cellular Ca2+ regulation in osteoblasts by measuring intracellular Ca2+ activities using cellular calcium imaging techniques. Osteoblasts were isolated from the femurs and tibias of neonatal rats, and cultured for 7 days. The cultured osteoblasts were loaded with a Ca2+-sensitive fluorescent dye, Fura-2, and fluorescence images were monitored using a cooled CCD camera, and subsequently analyzed using image analyzing software. The results obtained are as follows: (1) The osteoblasts with lower basal Ca2+ activities yielded a transient Ca2+ increase, a Ca2+ spike, while osteoblasts with higher basal Ca2+ activities showed a continuous increase in [Ca2+]i leading to cell death. (2) Ca2+ spikes, generated after removing Na+ from superfusing solutions, were blocked by H2O2 and this was followed by a sustained increase in Ca2+ activity. (3) ATP- induced Ca2+ spikes were inhibited by pretreating with H2O2 and this was followed by a continuous increase of [Ca2+]i. When cells were pretreated with the exogenous nitric oxide (NO) donor S-Nitroso-N-acetylpenicilance (SNAP, 50 microM), treatments of ATP (1 mM) induced a Ca2+ spike-like increase, but [Ca2+]i did not return to the basal level. (4) The expression of inositol- 1,4,5-triphosphate receptor (IP3R) was enhanced by H2O2. Our results suggest that H2O2 modulates intracellular Ca2+ activity in osteoblasts by increasing Ca2+ release from the intracellular Ca2+ stores.
Animal ; Calcium/*metabolism ; Cells, Cultured ; Hydrogen Peroxide/*pharmacology ; Osteoblasts/*drug effects/*metabolism ; Oxidants/*pharmacology ; Rats

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The Nerve-dependency of Merkel Cell Proliferation in Cultured Human Fetal Glabrous Skin.

Dong Kun KIM ; Karen A HOLBROOK

Yonsei Medical Journal.2001;42(3):311-315. doi:10.3349/ymj.2001.42.3.311

Merkel cells are thought to function as slowly adapting mechanoreceptors and are known as targets for sensory nerves. However, the nerve-dependency of Merkel cells remains controversial. In this respect, some investigators have found interregional differences between hairy and glabrous skin and others have shown intraregional differences within denervated rat touch domes. Differences between species have also been reported. This study was performed to determine whether Merkel cells proliferate in vitro in the absence of the systemic factors, blood vessels and the intact nerves in human skin. Suspension organ culture was performed using fetal digits to investigate their in vitro proliferation. Merkel cells and cutaneous nerves were identified using antibodies to cytokeratin 20 and protein gene product 9.5 (PGP 9.5), respectively. Fetal digits of 56-82 day gestational age were cultured in serum free medium in a high O2 (45%) environment. Tissues were harvested before starting culture (D0) and 1,4,7,14, 28d after culture. Merkel cells were observed in the volar pads and dorsal nail matrices at D0. After 28d of suspension organ culture, digits looked healthy structurally and the number of Merkel cells had increased. However, PGP 9.5-immunoreactive nerves were markedly diminished after 1 day of culture and almost disappeared after 4 days. Merkel cell proliferation in vitro suggested that Merkel cell development is probably nerve-independent in human fetal glabrous skin.
Cell Division ; Female ; Human ; Intermediate Filament Proteins/analysis ; Merkel Cells/*physiology ; Organ Culture ; Pregnancy ; Skin/cytology/*embryology/*innervation ; Thiolester Hydrolases/analysis

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