Purpose: To report a case of a successful secondary Descemet membrane endothelial keratoplasty in failed penetrating keratoplasty. Case summary: A 46-year-old male with keratoconus in both of his eyes underwent penetrating keratoplasty in his right eye 30 years ago and in his left eye 14 years ago. From one and a half year ago, the patient’s visual acuity decreased in his left eye due to graft failure. For treatment, secondary Descemet membrane endothelial keratoplasty was performed. Partial detachment of Descemet membrane was observed at 13 days after the operation, and an additional air injection was performed. At 8 months after the operation, the patient’s uncorrected visual acuity improved to 0.5 and the cornea maintained its clearance without rejection. Conclusions Secondary Descemet membrane endothelial keratoplasty was successfully performed in a patient with failed penetrating keratoplasty.

Purpose: To report a case of a successful secondary Descemet membrane endothelial keratoplasty in failed penetrating keratoplasty. Case summary: A 46-year-old male with keratoconus in both of his eyes underwent penetrating keratoplasty in his right eye 30 years ago and in his left eye 14 years ago. From one and a half year ago, the patient’s visual acuity decreased in his left eye due to graft failure. For treatment, secondary Descemet membrane endothelial keratoplasty was performed. Partial detachment of Descemet membrane was observed at 13 days after the operation, and an additional air injection was performed. At 8 months after the operation, the patient’s uncorrected visual acuity improved to 0.5 and the cornea maintained its clearance without rejection. Conclusions Secondary Descemet membrane endothelial keratoplasty was successfully performed in a patient with failed penetrating keratoplasty.

This study evaluated the significance of aortic calcification index (ACI), an estimate of abdominal aortic calcification by plain abdominal computed tomography (CT), in terms of left ventricular (LV) diastolic dysfunction, mortality, and nonfatal cardiovascular (CV) events in chronic hemodialysis patients. Hemodialysis patients who took both an abdominal CT and echocardiography were divided into a low-ACI group (n = 64) and a high-ACI group (n = 64). The high-ACI group was significantly older, had a longer dialysis vintage and higher comorbidity indices, and more patients had a previous history of CV disease than the low-ACI group. The ACI was negatively correlated with LV end-diastolic volume or LV stroke volume, and was positively correlated with the ratio of peak early transmitral flow velocity to peak early diastolic mitral annular velocity (E/E' ratio), a marker of LV diastolic function. The E/E' ratio was independently associated with the ACI. The event-free survival rates for mortality and nonfatal CV events were significantly lower in the high-ACI group compared with those in the low-ACI group, and the ACI was an independent predictor for all-cause deaths and nonfatal CV events. In conclusion, ACI is significantly associated with diastolic dysfunction and predicts all-cause mortality and nonfatal CV events in hemodialysis patients.
Adult ; Age Factors ; Aged ; Aged, 80 and over ; Aorta, Abdominal ; Blood Flow Velocity ; Blood Pressure ; Calcinosis/*etiology ; Cardiovascular Diseases/*complications ; Disease-Free Survival ; Echocardiography ; Female ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Kidney Failure, Chronic/*complications/mortality ; Male ; Middle Aged ; Predictive Value of Tests ; Prognosis ; Regression Analysis ; Renal Dialysis ; Risk Factors ; Tomography, X-Ray Computed ; Ventricular Dysfunction, Left/complications/*physiopathology

The purpose of this study was to evaluate the reliability of 6-axis model surgery simulator (6AMSS) for orthognathic surgery. A rectangular parallelepiped plastic block was assembled to model-mounting plate of 6AMSS. Left-right (X), anterior-posterior (Y), up-down (Z) translation and pitching (empty set X), rolling (empty set Y) and yawing (empty set Z) rotation was planned and performed using 6AMSS. The actual translation and rotation were measured with dial gauge and precisional protractor, respectively. Comparison between the planned and actual movements of plastic block for each variable were made using paired t- test. Statistical analysis for X, Y, Z, empty set X, empty set Y and empty set Z movement have shown no significant differences between planned and actual movement (P > 0.05). This indicate that model surgery performed with the aid of the 6AMSS is accurate in 3D translation and rotation. The 6AMSS is practically useful for accurate fabrication of surgical splint for orthognathic surgery.
Orthognathic Surgery ; Plastics ; Splints

PURPOSE: Most technical difficulties in intracranial stenting are derived from the vascular resistance caused by the severe tortuousness of intracranial arteries. The purpose of this study was to develop a practical method for measuring vascular tortuousness so that it would be possible to predict technical difficulties requiring further technical support. MATERIALS AND METHODS: We developed a best-fit circle metrics which made measurement of vascular tortuousness feasible, which was called "curve index (CI)". We compared the curve index in 56 consecutive patients who underwent M1 stenting for symptomatic severe stenosis. The difference in the CI between the successful and the aborted groups was statistically compared by using the Mann-Whitney U test. ROC curve analysis was performed to evaluate the diagnostic performance of the best-fit circle metrics. RESULTS: There was no statistically significant difference between the successful and the aborted cases in the CIs of each curve segment. However, the sum of all CIs of the aborted group was significantly larger (3.49) than that of the successful group (2.53) (p=0.013). On ROC curve analysis, the area under the curve was 0.806. When we took the cut-off value to be 3, the sensitivity was 75% and the specificity 85%. CONCLUSION: We developed a practical method for measuring the CI of vessel curves in order to estimate the tortuousness of the internal carotid artery. A CI less than 3, therefore, indicates a favorable vascular curvature for the intracranial stenting procedure. A vessel having a higher curve index was more likely to be aborted.
Arteries ; Carotid Artery, Internal* ; Constriction, Pathologic ; Humans ; ROC Curve ; Sensitivity and Specificity ; Stents ; Vascular Resistance

PURPOSE: To evaluate radiological findings of non-calcified ductal carcinoma in situ (DCIS) and to correlate those with histological features. MATERIALS AND METHODS: From July 2002 to March 2006, 22 patients with histologically-proven non-calcified DCIS were included. Mammography was obtained in 19 patients, ultrasound in 18 patients, and both examinations in 15 patients. Radiological findings were evaluated according to the Breast Imaging Reporting and Data System by American College of Radiology. Histological tumor subtype and Van Nuys classification of DCIS were assessed. RESULTS: Histological subtypes consisted of mixed type in 11 patients (50%), comedo in 4 (18%), cribriform in 4 (18%), papillary type in 2 (9%), and solid in one (5%). According to Van Nuys classification, group 3 DCIS was observed in 13 (59%) patients. In the 19 patients who underwent mammography, 13 patients presented with abnormal findings: focal asymmetry in 7 patients (37%), masses in 4 (21%), skin thickening in one (5%), and architectural distortion in one (5%). In the 18 patients who had received breast ultrasound, a mass was present in 15 (83%) patients and ductal changes in 3 patients (17%). Sixty percent of patients with masses on ultrasound had group 3 DCIS and 100% of patients with ductal change had group 1 DCIS (p=0.017). CONCLUSION: Diagnosis of non-calcified DCIS by mammography is not an easy task due to the lack of typical malignant calcifications or masses. High resolution ultrasound can be useful for detecting non-calcified DCIS, and ultrasound findings are correlated with histological features.
Adult ; Aged ; Aged, 80 and over ; Breast Neoplasms/metabolism/pathology/*radiography/*ultrasonography ; Calcinosis/metabolism/pathology ; Carcinoma, Intraductal, ; Female ; Humans ; Mammography ; Middle Aged

Anaplastic thyroid cancer is the most aggressive form of cancer found in humans. Usually it is easily diagnosed; however at times other diseases are mistaken for anaplastic thyroid cancer. We present a case of primary lung adenocarcinoma presenting with features that appeared as anaplastic thyroid cancer. The 43-year-old female patient was diagnosed with anaplastic thyroid cancer at a local clinic just before presenting to our hospital. At the clinic she had a neck node excisional biopsy and was informed of the diagnosis of anaplastic cancer. On admission to our hospital, very large bilateral thyroid masses, and lymphadenopathy involving multiple cervical lymph nodes was observed; therefore, we started chemoradiotherapy. The patient showed dramatic improvement and we began to think of other potential etiologies. A FDG-PET study showed increased uptake at the left lower lung area corresponding to a pneumonic consolidation; a TBLB was performed, and reported as poorly differentiated adenocarcinoma. We referred the patient to the oncology department. The patient died after two cycles of systemic chemotherapy.
Adenocarcinoma ; Adult ; Biopsy ; Chemoradiotherapy ; Diagnosis ; Drug Therapy ; Female ; Humans ; Lung Neoplasms* ; Lung* ; Lymph Nodes ; Lymphatic Diseases ; Neck ; Thyroid Gland* ; Thyroid Neoplasms*

Purpose: The present study aims to determine the clinical outcome of kidney transplantation and to provide data of long-term graft and patient survival. Methods: Between 1969 and 2005, 1,500 kidney transplants were performed at the Kangnam st. Mary's hospital. We analyzed the clinical characteristics and outcomes of kidney transplant recipients retrospectively. Results: The mean follow-up period was 112 months. Chronic glomerulonephritis was the leading cause of primary renal diseases, but the proportion of has increased from 1 % before 1985 to 6% afterwards. First renal transplantation was 94.5% (n=1418), and retransplantation was 5.4% (n=82). Type of donor source was mostly living-related, with the recent decrease in the number of living- unrelated donors. Currently, 72l patients are alive with functioning grafts, 297 cases had graft failure, 277 cases died, 205 cases were transferred or lost during follow-up. Main cause of graft failure was chronic allograft nephropathy (n=316). Overall, 1-, 5-, 10-, and 20-year graft survival were 92%, 81%, 66%, and 29% respectively. 1-, 5-, 10-, and 20-year patient survival were 93%, 88%, 81%, and 69% respectively. Conclusion: This review of 36-years experience in a single center showed that the graft survival has improved compared to the initial transplantation era.
Allografts ; Follow-Up Studies ; Glomerulonephritis ; Graft Survival ; Humans ; Kidney Transplantation ; Kidney* ; Korea* ; Retrospective Studies ; Risk Factors ; Tissue Donors ; Transplantation ; Transplants ; Unrelated Donors

PURPOSE: Recent studies have indicated that the p53 tumor suppressor gene and vascular endothelial growth factor (VEGF) play an important role in the angiogenic process of tumors. In this study, the correlation of the expressions of p53 and VEGF and the clinical features in gastric cancer were investigated. METHODS: The expressions of p53 and VEGF in gastric cancer were determined using immunohistochemistry on 98 randomly selected gastric cancer patients that had received curative resection. RESULTS: The expression of p53 and VEGF were observed in 51% and 50% of tumors, respectively. A significant correlation was found between p53 expression and the tumor histological type (P=0.045). The higher the TNM stage, the higher the observed level of p53 expression. The p53 and VEGF expression stati coincided in 70.4% of tumors, with a significant correlation found between the p53 and VEGF stati. Significantly worse survival rates were found in p53-positive and VEGF-positive patients than in those that were p53-negative and VEGF-negative. CONCLUSION: The present results indicated that p53 and VEGF expressions are useful in predicting the prognosis of patients with gastric cancer.
Genes, Tumor Suppressor ; Humans ; Immunohistochemistry ; Prognosis ; Stomach Neoplasms* ; Survival Rate ; Vascular Endothelial Growth Factor A*

PURPOSE: To differentiate tuberculous enteritis and Crohn's disease with barium study using Bayes theory. MATERIALS AND METHODS: The study group consisted of 34 patients with tuberculous enteritis (age range 16-86 years, mean age 43.3 years, M:F=19:15) and 36 patients with Crohn's disease (age range 19-78 years, mean age 35.2 years, M:F=18:18). These diagnoses were confirmed by therapeutic tests (tuberculous enteritis: 15, Crohn's disease:16) or histopathological examinations (tuberculous enteritis: 19, Crohn's disease: 20) conducted from January 1993 to May 2003. Three radiologists (two abdominal specialists and one trainee) analyzed each radiological finding of tuberculous enteritis and Crohn's disease by means of a barium enema and/or small bowel series. We used Fisher's exact test to verify the statistical significance of each radiological finding and p-values less than 0.05 were considered to be significant. We calculated the likelihood ratio (LR) of tuberculous enteritis versus Crohn's disease for each finding by employing Bayes theory. RESULTS: The radiological findings associated with a high likelihood ratio for tuberculous enteritis were the involvement of the cecum (LR=2.65) and ascending colon (LR=1.99), rigid narrowing (LR=1.94), shortening of the bowel (LR=1.99), haustral loss (LR=1.97) and sacculation (LR=3.88). The radiological findings associated with a high LR for Crohn's disease (low LR for tuberculous enteritis) were age between 20 and 29 years (LR=0.53), the involvement of the jejunum (LR=0.12), terminal ileum (LR=0.19), sigmoid colon (LR=0.30) or rectum (LR=0.17), and the presence of skip lesions (LR=0.19) or strictures (LR=0.21). With these LRs, the probability of the subject having tuberculous enteritis versus Crohn's disease could be calculated using Bayes theory. CONCLUSION: The analysis of a barium study using Bayes theory could provide an objective, easy and fast method of differentiating tuberculous enteritis and Crohn's disease.
Barium* ; Bays* ; Cecum ; Colon, Ascending ; Colon, Sigmoid ; Constriction, Pathologic ; Crohn Disease* ; Diagnosis ; Enema ; Enteritis* ; Humans ; Ileum ; Intestine, Small ; Jejunum ; Rectum ; Specialization ; Tuberculosis, Gastrointestinal