Purpose: We aimed to report on the clinical outcomes of scleral lens applications in Korean patients with various corneal disorders. Methods: This retrospective review was conducted for 62 eyes of 47 patients who had been fitted with scleral lenses for various corneal disorders. The patients were referred for inadequate spectacle-corrected visual acuity and rigid gas permeable (RGP) or soft contact lens intolerance. Uncorrected visual acuity, habitually corrected visual acuity, best lens-corrected visual acuity, topographic indices, keratometry indices, and lens parameters were evaluated. Results: Twenty-six eyes of 19 patients with keratoconus were enrolled. Other conditions included corneal scar (13 eyes of 12 patients), phlyctenules (three eyes), laceration (four eyes), chemical burn (one eye), keratitis (one eye), Peters’ anomaly (one eye), fibrous dysplasia (one eye), ocular graft-versus-host disease (two eyes of one patient), irregular astigmatism (18 eyes of 12 patients), and corneal transplant status (five eyes of four patients). The mean topographic values of the eyes include flat keratometric value (43.0 ± 6.1 diopters [D]), steep keratometric value (48.0 ± 7.4 D), and astigmatism (4.9 ± 3.6 D). Of the eyes fitted with scleral lenses, best lens-corrected visual acuity (0.10 ± 0.22 logarithm of the minimum angle of resolution [logMAR]) was significantly better than the habitually corrected visual acuity (0.59 ± 0.62 logMAR, p < 0.001). Conclusions Scleral contact lenses are a good alternative for patients with corneal abnormalities and those who are intolerable to RGP contact lenses, resulting in both successful visual outcomes and patient satisfaction, especially concerning keratoconus, corneal scar, and corneal transplant status.

PURPOSE: Acute acetaminophen intoxication is a common occurrence that can cause lethal complications. In most domestic emergency departments, clinicians tend to treat acetaminophen intoxication based on patients' history alone, simply due to the lack of a rapid acetaminophen laboratory test. We performed a 20-month study of intoxication patients to determine the correlation between the history of patients and serum laboratory tests for acetaminophen. METHODS: We took blood samples from 280 intoxication patients to evaluate whether laboratory findings detected traces of acetaminophen in the sample. Patients were then treated according to their history. Laboratory results came out after patients'discharge. Agreement between patients' history and laboratory results were analyzed. RESULTS: Among the 280 intoxicated patients enrolled, 38 patients had positive serum acetaminophen concentrations; 18 out of 38 patients did not represent a history suggesting acetaminophen intoxication. One patient without the history showed toxic serum acetaminophen concentration. Among the patients with the history, two patients with toxic serum acetaminophen concentration did not receive N-acetylcysteine (NAC) treatment due to their low reported doses, while other 2 patients without significant serum acetaminophen concentration did receive NAC treatment due to their high reported doses. CONCLUSION: This study showed a good overall agreement between history and laboratory test results. However, some cases showed inconsistencies between their history and laboratory test results. Therefore, in treating intoxication patients, a laboratory test of acetaminophen with rapid results should be available in most domestic emergency departments.
Acetaminophen* ; Acetylcysteine ; Diagnosis ; Emergency Service, Hospital ; Humans

PURPOSE: Data comparing the clinical benefits of medical treatment with those of percutaneous coronary intervention (PCI) in an elderly population with angina pectoris are limited. Therefore, we evaluated the efficacy of elective PCI versus optimal medical treatment (OMT) in elderly patients (between 75 and 84 years old) with angina pectoris. MATERIALS AND METHODS: One hundred seventy-seven patients with significant coronary artery stenosis were randomly assigned to either the PCI group (n=90) or the OMT group (n=87). The primary outcome was a composite of major adverse events in the 1-year follow-up period that included cardiovascular death, non-fatal myocardial infarction, coronary revascularization, and stroke. RESULTS: Major adverse events occurred in 5 patients (5.6%) of the PCI group and in 17 patents (19.5%) of the OMT group (p=0.015). There were no significant differences between the PCI group and the OMT group in cardiac death [hazard ratio (HR) for the PCI group 0.454; 95% confidence interval (CI) 0.041-5.019, p=0.520], myocardial infarction (HR 0.399; 95% CI 0.039-4.050, p=0.437), or stroke (HR 0.919; 95% CI 0.057-14.709, p=0.952). However, the PCI group showed a significant preventive effect of the composite of major adverse events (HR 0.288; 95% CI 0.106-0.785, p=0.015) and against the need for coronary revascularization (HR 0.157; 95% CI 0.035-0.703, p=0.016). CONCLUSION: Elective PCI reduced major adverse events and was found to be an effective treatment modality in elderly patients with angina pectoris and significant coronary artery stenosis, compared to OMT.
Aged ; Aged, 80 and over ; Angina Pectoris/mortality/*therapy ; Coronary Stenosis/therapy ; Female ; Humans ; Male ; Myocardial Infarction/prevention & control/*therapy ; *Percutaneous Coronary Intervention ; Proportional Hazards Models ; Prospective Studies ; Republic of Korea ; Stroke/epidemiology ; Treatment Outcome

PURPOSE: To investigate the effect of pretreatment with intravenous nicorandil on the incidence of contrast-induced nephropathy (CIN) in patients with renal dysfunction undergoing coronary angiography. MATERIALS AND METHODS: This randomized controlled multicenter study enrolled a total of 166 patients (nicorandil n=81; control n=85) with an estimated glomerular filtration rate <60 mL/min. Nicorandil 12 mg dissolved in 100 mL of 0.9% saline was administered intravenously for 30 minutes just prior to coronary angiography in the nicorandil group. The same volume of only saline was given to the control group. The primary end-point was the incidence of CIN, defined as >0.5 mg/dL increase or >25% rise in serum creatinine (SCr) concentration within 48 hours of contrast exposure compared to baseline. RESULTS: The final analysis included 149 patients (nicorandil n=73; control n=76). The baseline characteristics and the total volume of the used contrast (Iodixanol, 125.6+/-69.1 mL vs. 126.9+/-74.6 mL, p=0.916) were similar between the two groups. The incidence of CIN also did not differ between the nicorandil and control groups (6.8% vs. 6.6%, p=0.794). There was no difference between the two groups in the relative change in SCr from baseline to peak level within 48 hours after coronary angiography (-1.58+/-24.07% vs. 0.96+/-17.49%, p=0.464), although the nicorandil group showed less absolute change in SCr than the control group (-0.01+/-0.43 mg/mL vs. 0.02+/-0.31 mg/mL, p=0.005). CONCLUSION: Prophylactic intravenous infusion of nicorandil did not decrease the incidence of CIN in patients with renal dysfunction undergoing coronary angiography.
Administration, Intravenous ; Aged ; Contrast Media/*adverse effects ; Coronary Angiography/*adverse effects/methods ; Creatinine/blood ; Female ; Glomerular Filtration Rate ; Humans ; Incidence ; Kidney Diseases/*chemically induced/epidemiology/physiopathology/*prevention & control ; Male ; Middle Aged ; Nicorandil/*administration & dosage/therapeutic use

OBJECTIVE: Symptoms of posterior reversible encephalopathy syndrome (PRES) include headache, altered mental status, visual disturbances, and seizures. Typical radiological features include edema of the parieto-occipital lobes. The purpose of this study is to review the clinical and radiological findings in patients diagnosed with PRES. METHODS: All patients diagnosed with PRES between January 2006 and December 2012 were retrospectively included in this study. We reviewed demographic and clinical characteristics, and radiological findings. RESULTS: We identified 16 patients with PRES. The most common clinical presentation was seizure (n = 12, 75%). Clinical recovery occurred in all patients within days (mean, 5.7 +/- 4.6 days). Comorbid conditions included hypertension (n = 4, 25%), cytotoxic medications (n = 3, 18.8%), sepsis (n = 4, 25%), malignancy (n = 4, 25%), subarachnoid hemorrhage (n = 1, 6.3%), autoimmune disorders (n = 1, 6.3%) and eclampsia (n = 1, 6.3%). The most commonly involved location was the parieto-occipital lobe (n = 13, 81.3%). Atypical radiological findings included significant basal ganglia involvement in 4 episodes; brainstem in 3, cerebellum in 2, and thalamus in 3. Eleven patients (68.8%) underwent diffusion-weighted imaging and apparent diffusion coefficient mapping. Of those, 9 patients (81.8%) had hypo- or isointensity on diffusion-weighted imaging. On the apparent diffusion coefficient map, 10 patients (90.9%) had hyperintensity, and the other had normal values. CONCLUSION: We suggest that PRES may occur in patients with complex systemic conditions. The prognosis of PRES is usually benign. Physicians should be aware of certain atypical radiological findings to avoid a delayed diagnosis of PRES, as delayed diagnosis and treatment can result in permanent neurological sequlae.
Basal Ganglia ; Brain Stem ; Cerebellum ; Delayed Diagnosis ; Diffusion ; Eclampsia ; Edema ; Female ; Headache ; Humans ; Hypertension ; Pregnancy ; Prognosis ; Retrospective Studies ; Seizures ; Sepsis ; Subarachnoid Hemorrhage ; Thalamus

OBJECTIVE: Symptoms of posterior reversible encephalopathy syndrome (PRES) include headache, altered mental status, visual disturbances, and seizures. Typical radiological features include edema of the parieto-occipital lobes. The purpose of this study is to review the clinical and radiological findings in patients diagnosed with PRES. METHODS: All patients diagnosed with PRES between January 2006 and December 2012 were retrospectively included in this study. We reviewed demographic and clinical characteristics, and radiological findings. RESULTS: We identified 16 patients with PRES. The most common clinical presentation was seizure (n = 12, 75%). Clinical recovery occurred in all patients within days (mean, 5.7 +/- 4.6 days). Comorbid conditions included hypertension (n = 4, 25%), cytotoxic medications (n = 3, 18.8%), sepsis (n = 4, 25%), malignancy (n = 4, 25%), subarachnoid hemorrhage (n = 1, 6.3%), autoimmune disorders (n = 1, 6.3%) and eclampsia (n = 1, 6.3%). The most commonly involved location was the parieto-occipital lobe (n = 13, 81.3%). Atypical radiological findings included significant basal ganglia involvement in 4 episodes; brainstem in 3, cerebellum in 2, and thalamus in 3. Eleven patients (68.8%) underwent diffusion-weighted imaging and apparent diffusion coefficient mapping. Of those, 9 patients (81.8%) had hypo- or isointensity on diffusion-weighted imaging. On the apparent diffusion coefficient map, 10 patients (90.9%) had hyperintensity, and the other had normal values. CONCLUSION: We suggest that PRES may occur in patients with complex systemic conditions. The prognosis of PRES is usually benign. Physicians should be aware of certain atypical radiological findings to avoid a delayed diagnosis of PRES, as delayed diagnosis and treatment can result in permanent neurological sequlae.
Basal Ganglia ; Brain Stem ; Cerebellum ; Delayed Diagnosis ; Diffusion ; Eclampsia ; Edema ; Female ; Headache ; Humans ; Hypertension ; Pregnancy ; Prognosis ; Retrospective Studies ; Seizures ; Sepsis ; Subarachnoid Hemorrhage ; Thalamus

PURPOSE: According to current research, hypertonic saline has immunomodulatory effects. NF-kappaB is known as an important transcription factor involved in the production of inflammatory mediators during an inflammatory response. The purpose of this study was to determine the effect of hypertonic saline on both the NF-kappaB signaling pathway and on TNF-alphasynthesis in stimulated PMNs. METHODS: Isolated PMNs from healthy volunteers were subdivided into 3 groups by the incubation conditions: control (not stilmulated, isotonic condition), isotonic (stimulated, isotonic condition), hypertonic (stimulated, hypertonic condition). After nuclear proteins were isolated from the incubated PMNs, NF-kappaB was measured by Western blot. TNF-alpha was measured by ELISA from the culture media. RESULTS: The relative densities of nuclear NF-kappaB after 45 minute incubation were 0.28+/-0.14 (control group), 0.97+/- 0.16 (isotonic group), and 0.58+/-0.07(hypertonic group). Isotonic and hypertonic groups (fMLP stimulated groups) showed a significantly higher relative density than control groups. Among the study groups, the hypertonic groups had a smaller increased level compared to isotonic groups and were found to be statistically significant. The results from the 90 minute incubated groups were similar to that of the 45 minute incubated groups. The concentration of TNF- alphameasured from stimulated groups (isotonic group, hypertonic group) were significantly higher than control groups. Similar to the NF-kappaB result, the concentrations of TNF-alphain the hypertonic groups were significantly lower than isotonic groups. Longer incubation times were noted to display higher concentration in the stimulated groups. CONCLUSION: Stimulated PMNs incubated under hypertonic conditions showed a smaller increase in level of nuclear NF-kappaB and TNF-alphasynthesis compared to isotonic conditions. As a result, suppression of the NF-kappaB signaling pathway in stimulated PMNs is considered one of the mechanisms of hypertonic saline's immunomodulatory effect.
Blotting, Western ; Enzyme-Linked Immunosorbent Assay ; NF-kappa B ; Nuclear Proteins ; Saline Solution, Hypertonic ; Shock, Hemorrhagic ; Specific Gravity ; Transcription Factors ; Tumor Necrosis Factor-alpha

PURPOSE: The purpose of this study was to investigate the relationship of ECG change during CPR to outcomes in cardiac arrest patients. METHODS: A total of 170 patients who received cardiopulmonary resuscitation (CPR) in the emergency department from January 2005 to December 2006 were included for analysis. Medical records of study patients were reviewed, retrospectively. Age, sex, cause of arrest, location of arrest, arrest time, CPR time, initial ECG rhythme, changes in ECG during CPR, ROSC, 24 h survival, and number discharged alive were extracted from the medical records. Outcomes studied were ROSC rate and , survival rate at 24 h and at discharge. Student's t-test, the Chi-square test and one-way ANOVA were used for statistical analysis. RESULTS: The patients were divided into three groups according to the initial EKG rhythm. The groups showed no difference in ROSC rate, but the initial VF/VT group and the initial PEA group showed higher survival discharge rates than the initial asystole group (p=0.002). Patients whose rhythm changed from asystole to VF/VT showed significantly higher ROSC and 24 h survival rates but showed no difference in the survival to discharge rate. Patients whose rhythm changed from initial PEA to VF/VT showed no significance difference in ROSC rate, 24 h survival rate, or survival discharge rate. CONCLUSIONS: Although patients whose rhythm changed from initial asystole or PEA to shockable rhythm (VF/VT) showed no significant difference in survival discharge rate compared to those without change to shockable rhythm, in the long run, they may benefit from essential therapies to increase survival because of their higher ROSC rate and 24 h survival rate.
Cardiopulmonary Resuscitation ; Electrocardiography ; Emergencies ; Heart Arrest ; Humans ; Medical Records ; Peas ; Retrospective Studies ; Survival Rate

Bronchogenic cysts are usually located in the pulmonary parenchyma or mediastinum. When they are located in the mediastinum, they are usually near the bronchus or esophagus, but they are rarely at an intramural location of the esophagus. It is very difficult to differentiate between bronchogenic cyst and esophageal cyst before the operation. We report here on a patient for whom the preoperative diagnosis was supposed to be an esophageal cyst. The esophageal cyst was excised through the longitudinal division of the esophageal muscular layer without injury of the mucosa after right thoracotomy. The pathologic report revealed intramural bronchogenic cyst. We report here on a case of bronchogenic cyst that was located in the muscle layer of the lower esophagus.
Bronchi ; Bronchogenic Cyst* ; Diagnosis ; Esophageal Cyst ; Esophagus* ; Humans ; Mediastinum ; Mucous Membrane ; Thoracotomy

BACKGROUND: This study was to evaluate a nationwide nosocomial infection rate and antimicrobial resistance in intensive care units(ICUs) in Korea. METHODS: The study was carried out at 16 university-affiliated teaching hospitals from July through October 2004. We performed a prospective multicenter study to investigate nosocomial infection rates, device-associated infection rated, and causative pathogens and their antimicrobial resistance. RESULTS: The urinary tract was the most commonly involved site. Nosocomial infection rate was 12.48 in medical. ICU (MICU), 9.59 in medical surgical ICU (MSICU), 14.76 in surgical ICU (MSICU), and 11.60 in other lCU. Device-associated infection rates were as follow: 1) rates of urinary catheter-associated urinary tract infection were 4.26 in MICU, 3.17 in SICU, 4.88 in MSICU, and 5.87 in other ICU; 2) rates of central line-associated bloodstream infection were 3.24 in MICU, 1.56 in SlCU, 2.36 in MSICU, and 1.78 in other ICU; 3) rates of ventilator-associated pneumonia were 3.61 in MlCU, 13.05 in SICU, 1.68 in MSICU, and 4.84 in other lCU. Staphylococcus aureus was the most frequently identified microorganism in this study; 93% of S. aurues were resistant to methicillin; 17% of Pseudomonas aeruginosa isolated were resistant to imipenem; 11% of Enterococcus faecium and 18% of Enterococcus faecalis showed resistance to vancomycin. Over a half of Acinetobacter spp, Stenotrophomonas maltophilia, Klebsiella pneumoniae, and Escherichia coli showed resistant to fluoroquinolone. Conclusion: This study shows the seriousness of antimicrobial resistance and the importance of infection control in the lCU in Korea. This study should provide a theoretical strategy to enforce the infection control.
Acinetobacter ; Cross Infection* ; Enterococcus faecalis ; Enterococcus faecium ; Escherichia coli ; Hospitals, Teaching ; Hospitals, University* ; Imipenem ; Infection Control ; Intensive Care Units* ; Critical Care* ; Klebsiella pneumoniae ; Korea* ; Methicillin ; Pneumonia, Ventilator-Associated ; Prospective Studies ; Pseudomonas aeruginosa ; Staphylococcus aureus ; Stenotrophomonas maltophilia ; Urinary Tract ; Urinary Tract Infections ; Vancomycin