BACKGROUND: Hyperuricemia is reported to be related to rapid progression of renal function in patients with chronic kidney disease (CKD). Allopurinol, a uric acid lowering agent, protects renal progression. However, it is not widely used in patients with CKD because of its serious adverse event. Febuxostat can be alternatively used for patients who are intolerable to allopurinol. We aimed to determine renoprotective effect and urate-lowering effect between the two drugs. METHODS: We performed a systematic review and meta-analysis of randomized controlled trials to assess the effects of febuxostat compared to allopurinol in patients with hyperuricemia. MEDLINE, Embase, and Cochrane Library databases were searched to identify research publications. RESULTS: Four relevant publications were selected from among 3,815 studies. No significant differences were found in the changes in serum creatinine from baseline between the febuxostat and allopurinol groups. Changes in estimated glomerular filtration rate (eGFR) were observed between the two groups at 1 month (mean difference 1.65 mL/min/1.73 m², 95% confidence interval [CI] 0.38, 2.91 mL/min/1.73 m²; heterogeneity χ² = 1.25, I² = 0%, P = 0.01); however, the changes in eGFR were not significantly different at 3 months. A significant difference did exist in the changes in albuminuria levels from baseline between the febuxostat and allopurinol groups (mean difference −80.47 mg/gCr, 95% CI −149.29, −11.64 mg/gCr; heterogeneity χ² = 0.81, I² = 0%, P = 0.02). A significant difference was also observed in the changes in serum uric acid from baseline between the febuxostat and allopurinol groups (mean difference −0.92 mg/dL, 95% CI −1.29, −0.56 mg/dL; heterogeneity χ² = 6.24, I² = 52%, P < 0.001). CONCLUSION: Febuxostat might be more renoprotective than allopurinol.
Albuminuria ; Allopurinol* ; Creatinine ; Febuxostat* ; Glomerular Filtration Rate ; Gout ; Humans ; Hyperuricemia* ; Population Characteristics ; Renal Insufficiency, Chronic ; Uric Acid

BACKGROUND: Diabetes self-management education and reinforcement are important for effective management of the disease. We investigated the effectiveness of interactive small-group education on glycemic, blood pressure, and lipid levels. METHODS: For this study, 207 type 2 diabetes patients with suboptimal glycemic control (HbA1c levels >6.5%) were enrolled. The conventional education group received an existing education program from April to November in 2006, and the interactive education group received a new small-group education program from December 2006 to July 2007. The two groups were comparatively analyzed for changes in blood sugar, glycated hemoglobin, lipid, and blood pressure at baseline, 3, 6, and 12 months and the proportion of patients achieving target goals at 12 months. RESULTS: After 12 months of follow-up, HbA1c levels in the interactive education group were significantly lower than in the conventional education group (6.7% vs. 6.4%, P<0.001). Fasting and 2 hour postprandial glucose concentrations, total cholesterol, and low density lipoprotein cholesterol were significantly lower in the interactive education group than in the conventional education group. The proportion of patients that achieved target goals was significantly higher in the interactive education group. CONCLUSION: The small-group educational method improved and re-established the existing group educational method. This finding suggests that the importance of education appears to be related to the method by which it is received rather than the education itself. Thus, the use of small-group educational methods to supplement existing educational methods established for diverse age levels should be considered in the future.
Achievement ; Blood Glucose ; Blood Pressure ; Cholesterol ; Cholesterol, LDL ; Diabetes Mellitus ; Fasting ; Follow-Up Studies ; Glucose ; Hemoglobins ; Humans ; Lipoproteins ; Reinforcement (Psychology) ; Self Care

PURPOSE: To evaluate the predictability of intraocular lens (IOL) power calculations using the IOLMaster and four different IOL power calculation formulas (Haigis, Hoffer Q, SRK II, and SRK/T) for cataract surgery in eyes with a short axial length (AL). METHODS: The present study was a retrospective comparative analysis which included 25 eyes with an AL shorter than 22.0 mm that underwent uneventful phacoemulsification with IOL implantation from July 2007 to December 2008 at Seoul National University Boramae Hospital. Preoperative AL and keratometric power were measured by the IOLMaster, and power of the implanted IOL was determined using Haigis, Hoffer Q, SRK II, and SRK/T formulas. Postoperative refractive errors two months after surgery were measured using automatic refracto-keratometry (Nidek) and were compared with the predicted postoperative power. The mean absolute error (MAE) was defined as the average of the absolute value of the difference between actual and predicted spherical equivalences of postoperative refractive error. RESULTS: The MAE was smallest with the Haigis formula (0.37 +/- 0.26 diopter [D]), followed by those of SRK/T (0.53 +/- 0.25 D), SRK II (0.56 +/- 0.20 D), and Hoffer Q (0.62 +/- 0.16 D) in 25 eyes with an AL shorter than 22.0 mm. The proportion with an absolute error (AE) of less than 1 D was greatest in the Haigis formula (96%), followed by those in the SRK II (88%), SRK-T (84%), and Hoffer Q (80%). CONCLUSIONS: The MAE was less than 0.7 D and the proportion of AE less than 1 D was more than 80% in all formulas. The IOL power calculation using the Haigis formula showed the best results for postoperative power prediction in short eyes.
Aged ; Aged, 80 and over ; Female ; Humans ; Lens Implantation, Intraocular ; *Lenses, Intraocular ; Male ; Middle Aged ; *Optics and Photonics ; Phacoemulsification ; Postoperative Period ; Refractive Errors/diagnosis/physiopathology ; Retrospective Studies

PURPOSE: To evaluate the changes in the clinical signs and symptoms of dry eye syndrome before and after cataract surgery according to the main incision location and the type of artificial tears. METHODS: Twenty-four eyes of 17 patients who underwent phacoemulsification and posterior chamber lens insertion from May 2009 to July 2009 were enrolled in the present study prospectively. The main incision location (temporal or superior incision) was determined according to the axis of astigmatism and the postoperative artificial tears (sodium hyaluronate with or without preservatives) were determined randomly. The tear film break-up time (TF-BUT), Schirmer test, esthesiometer, corneal surface grading with Oxford system and ocular surface disease index (OSDI) questionnaire before and 1, 2 and 6 months after surgery were evaluated. The corneal nerve was also analyzed using corneal confocal microscopy (Confoscan 4, Nidek, Italy) before, and 1 and 6 months after surgery. RESULTS: The TF-BUT was significantly longer (p = 0.010) and the OSDI score was significantly lower (p = 0.007) in the patient group with preservative-free sodium hyaluronate than the group with sodium hyaluronate containing preservatives at 6 months after cataract surgery. There were no statistically significant differences according to the main incision location in the sodium hyaluronate without preservatives group. CONCLUSIONS: Symptoms and several signs of dry eye syndrome triggered by cataract surgery decreased with preservative- free artificial tears compared to tears with preservatives.
Astigmatism ; Axis, Cervical Vertebra ; Cataract ; Dry Eye Syndromes ; Eye ; Humans ; Hyaluronic Acid ; Microscopy, Confocal ; Ophthalmic Solutions ; Phacoemulsification ; Prospective Studies ; Surveys and Questionnaires ; Tears

A ciliated hepatic foregut cyst (CHFC) is a rare cystic lesion consisting of a ciliated pseudostratified columnar epithelium, subepithelial connective tissue, a smooth muscle layer, and an outer fibrous capsule. A CHFC is usually unilocular and occurs at a higher frequency in males. A predilection exists at the medial segment located at the left lobe of the liver. We report the first case of a ciliated hepatic foregut cyst mimicking hepatic metastasis on a CT scan of a patient concurrently afflicted with gastric cancer.
Cilia ; Connective Tissue ; Epithelium ; Humans ; Liver ; Liver Diseases ; Male ; Muscle, Smooth ; Neoplasm Metastasis ; Stomach Neoplasms ; Tomography, X-Ray Computed

A pathologic splenic rupture is rare, occurring primarily in a spleen affected by infective, hematological, and neoplastic disease. To the best of our knowledge, no prior reports of a pathologic splenic rupture due to scrub typhus exist. Intrasplenic pseudoaneurysms and focal infarctions are visible on an initial CT scan. Moreover, the spontaneous splenic rupture occurred a week later. We report a case of nontraumatic-splenic rupture in a patient with scrub typhus.
Aneurysm, False ; Humans ; Infarction ; Rupture ; Scrub Typhus ; Spleen ; Splenic Rupture ; Typhus, Endemic Flea-Borne

A fibromatosis or desmoid tumor of the breast is an extremely rare benign tumor, which is often presented clinically and radiologically as a malignant tumor. Although benign, fibromatosis or desmoid tumors can grow aggressively in local infiltrating patterns. The recurrence is relatively common; hence a wide excision with a clear margin around the tumor is necessary. We report a case of a young female patient with a recurring fibromatosis of the breast after a local excision.
Breast ; Breast Neoplasms ; Female ; Fibroma ; Fibromatosis, Aggressive ; Humans ; Recurrence

A tailgut cyst is a rare congenital abnormality located in the retrorectal space and is usually manifested during childhood or adulthood. We report the MR, CT and ultrasound findings of a tailgut cyst in a 23-day-old neonate.
Congenital Abnormalities ; Humans ; Infant, Newborn ; Infant, Newborn, Diseases ; Sacrococcygeal Region

Esophageal squamous cell papillomatosis is a rare disorder that is usually found incidentally on an upper gastrointestinal endoscopy examination or autopsy. A 70-year-old woman presented with a two-month history of dysphagia and abdominal discomfort. A chest CT scan showed diffuse marked thickening of the esophageal wall along the entire length and multiple small enhancing polypoid projections in the distal esophagus. Diffuse circumferential FDG uptake in the entire esophagus was seen on [18F] FDG PET/CT. Squamous papillomatosis was diagnosed by an endoscopic biopsy. We report a case of extensive esophageal papillomatosis with imaging features on CT and [18F] FDG PET/CT, with a review of the clinical literature.
Aged ; Autopsy ; Biopsy ; Deglutition Disorders ; Endoscopy, Gastrointestinal ; Esophagus ; Female ; Fluorine Radioisotopes ; Humans ; Papilloma ; Positron-Emission Tomography ; Thorax ; Tomography, X-Ray Computed

Congenital absence of the portal vein is a rare anomaly in which diverse types of congenital portosystemic shunts are present. In this report, we describe this rare anomaly of a portosystemic shunt between the inferior mesenteric vein and left internal iliac vein, in a middle-aged man presenting with portosystemic encephalopathy.
Adult ; Hepatic Encephalopathy ; Humans ; Iliac Vein ; Mesenteric Veins ; Portal Vein ; Portasystemic Shunt, Surgical