Inje University Research Articles

Early spatial changes in the posterior corneal surface after laser in situ keratomileusis

Purpose To evaluate the forward shift of the posterior corneal surface after myopic laser in situ keratomileusis (LASIK) relative to the residual stromal bed thickness and the ablation percentage of the total corneal thickness. Setting Department of Ophthalmology, Ilsan Paik Hospital, Inje University, Ilsan, Korea. Methods Three hundred sixty-three eyes of 182 consecutive patients who had LASIK were examined retrospectively. The range of the refractive errors was −1.5 to −12.0 diopters. Corneal topography using Orbscan ® II (Bausch & Lomb) and pachymetry were obtained preoperatively and 1 week and 1, 2, and 3 months postoperatively. The patients were divided into 4 groups based on the residual stromal bed thickness: Group 1, 145 eyes with less than 250 μm; Group 2, 129 eyes with 250 to 300 μm; Group 3, 76 eyes with 300 to 350 μm; and Group 4, 13 eyes with more than 350 μm. They were also grouped by the ablation percentage per total corneal thickness: Group A, 16 eyes with less than 10%; Group B, 166 eyes with 10% to 20%; Group C, 146 eyes with 20% to 30%; and Group D, 35 eyes with more than 30%. Results The increase in the forward shift of the posterior corneal surface postoperatively correlated with the residual corneal bed thickness and the ablation ratio per total corneal thickness. There were no statistically significant changes in the postsurgical forward shift of the posterior corneal surface if the residual corneal thickness remained greater than 350 μm or the ablation percentage was less than 10%. Conclusions Increased forward shift of the posterior corneal surface is common after myopic LASIK and correlates with the residual corneal thickness and the ablation percentage per total corneal thickness. An excessively thin residual corneal bed or a large ablation percentage may increase the risk of iatrogenic complications.

Effect of a capsular tension ring on intraocular lens decentration and tilting after cataract surgery

Purpose: To evaluate the effect of a capsular tension ring (CTR) on the tilting and decentration of intraocular lenses (IOLs) after cataract surgery.Setting: Department of Ophthalmology, Ilsan Paik Hospital, Inje University, Kyunggyi-do, Korea.Methods: Cataract surgery was performed in both eyes of 20 patients ranging in age from 57 to 75 years. The 40 eyes were divided into 2 groups based on whether a CTR (Lucid Korea) was implanted. Each patient received a CTR in 1 eye only. All IOLs (AcrySof® MA60BM, Alcon) were implanted in the capsular bag after a continuous curvilinear capsulorhexis smaller than the IOL optic was created and phacoemulsification performed. The extent of IOL tilting and decentration was measured with the EAS-1000 anterior eye segment analysis system 7, 30, and 60 days after surgery.Results: The extent of IOL decentration was statistically significantly less in eyes with both an IOL and CTR than in those with an IOL only. The mean decentration in the CTR-IOL group was 0.38 mm ± 0.16 (SD) at 7 days, 0.43 ± 0.15 mm at 30 days, and 0.42 ± 0.17 mm at 60 days. The mean values in the IOL-only group were 0.49 ± 0.11 mm, 0.53 ± 0.14 mm, and 0.57 ± 0.16 mm, respectively. The amount of IOL tilting was also significantly less in the CTR-IOL group. The mean tilting in the CTR-IOL group was 2.22 ± 0.46 degrees at 7 days, 2.36 ± 0.50 degrees at 30 days, and 2.47 ± 0.40 degrees at 60 days. The mean values in the IOL-only group were 3.14 ± 0.65 degrees, 2.91 ± 0.67 degrees, and 3.06 ± 0.56 degrees, respectively.Conclusion: These results indicate that the CTR reduces undesirable postsurgical IOL movement for at least 60 days.

Evaluation of Exposure to 2,2‐Dichloro‐1,1,1‐Trifluoroethane (HCFC‐123) in Air‐conditioner Manufacturing Workers and their Health Effects in South Korea

Evaluation of exposure to 2,2‐Dichloro‐1,1,1‐trifluoroethane (HCFC‐123) in air‐conditioner manufacturing workers and their health effects in South Korea: Yong Chul Shin, et al. Department of Occupational Health and Safety, Inje University—Hepatic dysfunction in workers exposed to HCFC‐123 has recently been reported, but information on the level of exposure to the material and the related hepatotoxicity in workers handling the material is very limited. This study evaluated the exposure status in some Korean workers handling the chemical and whether they have liver dysfunction. We investigated all four factories manufacturing large‐sized industrial air‐conditioners operating in South Korea in 1998. The range and geometric mean of the estimated 8‐hour TWA concentrations at two factories were 2.2 ppm (0.89‐4.2 ppm) and 32.5 ppm (4.9‐113.9 ppm), respectively. It was estimated that the HCFC‐123 concentrations at the other two factories were lower than those at the former two. Liver function was within the normal range in all the exposed workers. The present study did not show any health effect of HCFC‐123 on workers. Worker exposure in this study was intermittent and lower than in studies which reported cases of liver dysfunction, so that the level and pattern of exposure to HCFC‐123 would be very important as a cause of liver dysfunction. Our study showed that liver dysfunction did not occur at an exposure concentration less than 32.5 ppm as an 8‐hour TWA of HCFC‐123.

Accuracy and predictability of the compensatory function of Orbscan II in intraocular pressure measurements after laser in situ keratomileusis

Purpose: To evaluate the usefulness of the compensatory function of Orbscan II (Orbtek, Bausch & Lomb) for measuring postoperative intraoperative pressure (IOP) in laser in situ keratomileusis (LASIK) patients. Setting: Department of Ophthalmology, Ilsan Paik Hospital, Inje University, Ilsan, Korea. Methods: Two hundred ten patients had LASIK using the Hansatome® microkeratome (Bausch & Lomb) and the MEL 70 G-scan laser (Aesclepion-Meditec) and were examined retrospectively. The patients included in the study were divided into 2 groups: Group 1, 123 eyes with less than –6.0 diopters (D) of myopia; Group 2, 60 eyes with more than –6.0 D of myopia. The IOP was measured preoperatively and 2 and 4 weeks after LASIK using a noncontact tonometer (NCT CT-60, Topcon). The results were corrected with the Orbscan II program. Results: The mean IOPs in Group 1 were 16.35 mm Hg ± 2.90 (SD) preoperatively, 10.80 ± 2.21 mm Hg at 2 weeks, and 10.63 ± 2.28 mm Hg at 4 weeks. After compensation with Orbscan II, the 2-week and 4-week values were 16.81 ± 3.14 mm Hg and 16.68 ± 3.22 mm Hg, respectively. The mean IOPs in Group 2 were 17.63 ± 2.93 mm Hg, 10.07 ± 1.55 mm Hg, and 10.43 ± 1.84 mm Hg, respectively; after compensation, they were 18.40 ± 4.09 mm Hg and 18.05 ± 4.09 mm Hg, respectively. After compensation with Orbscan II, there were no statistically significant differences between the preoperative and postoperative IOPs. Conclusions: Orbscan II may help predict actual IOP values after LASIK and avoid the misinterpretation of high IOPs as normal IOPs.

POPULATION DYNAMICS AND THE TOXICITY OF BLUE‐GREEN ALGAE IN THE NAKTONG RIVER, KOREA

Lee, J. A.1, Choi, A. R.1, Park, J. H.1 & Chung, I. K2 1Department of Environmental Science, Inje University, Kimhae 621‐749, Korea; 2Departement of Marine Science, Pusan National University, Pusan 609‐735, KoreaSeasonal and spatial variations of phytoplankton community were monitored at 16 sites along the Naktong River. Blue‐green algae appeared from May through November with dominant genera of Microcystis, Anabaena, Oscillatoria and Gomphosphaeria. Frequency and biomass of the genera became greater at lower reaches. The Microcystis were observed from May to October up to 85,750cells/ml. Six species of Microcystis were identified with morphological characteristics and M. aeruginosa was most dominant. There were significant relationships between biomass of Microcystis and NO‐3, TP and pH in water column. However, NH4+, PO4‐3 and N/P were not critical in successions to the Microcystis dominated community. Microcystis blooms were notable at water temperature higher than 25°C. Microcystis density in sediment was 3 orders of magnitude higher than water column. Anabaena density ranged up to 11,220cells/ml. Four species of Anabaena were identified and A. flos‐aquae was most dominant. Anabaena biomass was not related to temperature, NO3‐, TN, PO4‐3, TP and N/P of water column and the frequency of trichome with akinete and/or heterocyte were not related to these parameters. Microcystins were detected from May to November with yearly fluctuations. Microcystin‐RR was most dominant. Total 84.2% of algal materials with Microcystis exhibited toxicity of microcystin with maximum of 3,292μg/g dry wt. Total 12.5% of water column with Microcystis exhibited dissolved microcystin up to 3.3μg/l. Microcystin concentrations were positively related to Microcystis biomass and pH of water column. Anatoxin‐a was determined by FD‐HPLC analysis with NBD‐F and all concentrations were below the detection limit of 0.1μg/l.

A Randomized Comparison of Cilostazol Versus Ticlopidine Therapy After Elective Coronary Stent Implantaion

Background:Percutaneous transluminal coronary angioplasty (PTCA) is a widely acceptable treatment for ischemic heart disease. However, restenosis after successful PTCA, which develops in 20-30% of all patients, remains a serious late complication. This study was performed to compare the efficacy of cilostazol with that of ticlopidine for the prevention of stent restenosis. Materials and Methods:Fifty three patients who had undergone coronary stent implantation were divided into group A (n=25) receiving 100 mg aspirin and 200 mg cilostazol and group B (n=28) receiving 100 mg aspirin and 500 mg ticlopidine, between Sep 1998 and Feb 1999 at Pusan Paik Hospital, Inje University. Clinical and laboratory evaluations were preformed at regular intervals. Results:There were no differences in baseline characteristics between the two groups. Coronary artery restenosis was observed in 5 (20.8%) patients of group A and 8 (26%) of group B, a difference which was not statistically significant (p=NS). The minimal luminal diameter was 2.10±0.89 mm in group A and 1.93±0.65 mm in group B (p=NS). Two patients in group A complained of headaches, while 6 (21. 4%) patients of group B developed side effects including thrombocytopenia in 2 patients, and skin rash in 2 patients (Edwhat of the remaining 2 patients with side effects in group B?). No instances of cardiac death occurred during the follow-up period. Conclusion:The findings of this study suggest that aspirin plus cilostazol may be a safer as well as an qually antithrombotic regimen, compared to that of aspirin plus ticolpidine, for recovery after elective coronary stent implantation.(Korean Circulation J 2001;31(8):780-787)

Compartment Syndrome Complicating Avulsion Fractures of the Tibial Tubercle

Avulsion of the tibial tubercle is an uncommon physeal injury. Complications from this fracture have rarely been reported and seldom affect the long-term outcome. Three adolescent boys who sustained avulsion fracture of the tibial tubercle, were complicated by compartment syndrome and treated at Inje University Sang-Gye Paik Hospital from September 1989 to February 1995. Injury to the soft tissue surrounding the tibial tubercle avulsion may be more extensive than is usually appreciated. The anatomy of the proximal tibia

The Effect on Workers' Knowledge, Attitudes and Behavior of a Group Health Care Program for Small‐Sized Plants in Pusan, Korea

The Effect on Workers' Knowledge, Attitudes and Behavior of a Group Health Care Program for Small Sized Plants in Pusan, Korea: Hae‐Sook Sohn, et al. Department of Preventive Medicine, Medical College, Inje University—To investigate the effect of a group health care program by observing differences in knowledge, attitudes and behavior (K, A and B) regarding occupational health services, a cross sectional survey of 201 workers served under a Group Health Care Program (GHCP) was carried out from November, 1995 to January, 1996. The K, A and B of workers were assessed by questionnaires about occupational health services. Subjects were divided to two groups according to the duration they had been served with group health care (Group I: <1 year, Group II: > = 3 years). K, A and B were compared in the two groups. All measures of K, A and B related to occupational health services, except satisfaction with the GHCP, were higher in Group II than in Group I. Group II was significantly higher in K, A and B (P<0.01) about personal protective equipment. This study confirmed that workers' K, A and B were positively influenced by the GHCP. The fact that the percentages of workers wearing personal protective equipment (PPE) and of proper use of PPE in Group II were significantly higher indicates that GHCP may be effective in the prevention of some aspects of occupation‐related diseases.

Electrophysiologic Characteristics of Successfully Ablated Midseptal Accessory Pathway

Seung Hwan Lee, M.D. Cardiology Division, Department of Internal Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea Jong Cheol Ryu, M.D. Department of Internal Medicine, College of Medicine, Inje University, Pusan, Korea Geon-Young Kim, M.D., Shinki Ahn, M.D., Moon Hyoung Lee, M.D., Sung Soon Kim, M.D., F.A.C.C. Cardiology Division, Yonsei Cardiovascular Center, Yonsei University, Seoul, Korea

Clinical and Electrophysiologic Characteristics of the Patients with Wolff-Parkinson-White Syndrome

Shin-Ki Ahn, M.D., Moon-Hyoung Lee, M.D., Yang-Soo Jang, M.D., Dong-Jin Oh, M.D., In Suck Choi, M.D., Jong Won Ha, M.D., Se Joong Rim, M.D., Byung-Ok Kim, M.D., Nam-Sik Chung, M.D., Won Heum Shim, M.D., Seung Yun Cho, M.D., Sung Soon Kim, M.D. Cardiology Division, Yonsei Cardiovascular Center, Yonsei University, Seoul, Korea Department of Internal Medicine, Kang Dong Sacred Heart Hospital, Hallym University, Seoul, Korea Department of Internal Medicine, Jung-ang Gil Hospital, Inchon, Korea Sanggye Paik Hospital, Department of Internal Medicine, College of Medicine, Inje University, Seoul, Korea

Congenital Bronchoesophageal Fistula of Adult in Korea

Background : Congenital bronchoesophageal fistula(BEF) presented in adult life is a rare disorder and has characteristic clinical findings such as paroxysmal cough after water ingestion and recurrent respiratory infections. It usually manifested recurrent pneumonia and chronic cough with purulent phlegmon which was mis-or under-diagnosed as chronic bronchitis, bronchiectasis or lung abscess so forth. Methods : We reviewed retrospectively 13 cases of congenital BEF in adult of Paik Hospital, College of Medicine, Inje University including 22 cases of congenital BEF previously reported in literature of Korea from 1979 through 1995. Results : The mean age at diagnosis was . There was no difference in sex ratio(Male : Female 18 : 17). The most common symptom was cough(91.4%), followed by chronic sputum(74.3), hemoptysis(25.7), and paroxysmal nocturnal cough at specific position(20%). Twenty one of 31 patients who were able to review have the most specific sign, Ono's sign presented as paroxysmal cough after liquid ingestion. By classification of Braimbridge-Keith, Fourteen(45.1%) of 31 patients were group I (associated with esophageal diverticulum), 15(48.4%) were group II (simple fistula), and group Ill and IV was one case in each. The opening of fistula confined to right lower lobe in 26(76.5%), left lower lobe in 6(17.6%), and left main bronchus in 2(5.9%) cases. Conclusion : Congenital bronchoesophageal fistula is uncommon disorder which has characteristic histories and specific symptoms such as chronic and recurrent lower respiratory infections, and paroxysmal cough after liquid ingestion. Medical attention and careful history should be done in patients who have localized recurrent lower respiratory infections in right lower lobe.

Long-term therapy of hypertension.

Hypertension is a major chronic disorder which calls for a long-term treatment. The success or failure of the treatment of chronic diseases depends largely on the compliance of patients. So, the success of the treatment of hypertension will be influenced by good compliance, ideal antihypertensive agents and the improvement of the system which can lower medical expenses. The long-term use of antihypertensive agents causes adverse effects and tolerances. Some kind of antihypertensive agents have an effect on the metabolic aspects, particularly like the worsening of the serum lipids and lowering of the glucose tolerance. Recently, the availability of the ambulatory blood pressure monitoring is being emphasized in the diagnosis of hypertension, the timing of initiation or withdrawal of antihypertensive agents and evaluation of the efficacy of the drugs. On the other hand, the frequency and the predicting parameters of the complication, which occurs during the treatment, should be considered in relation with other risk factors and special consideration is needed for the selection of the antihypertensive agent when the concurrent disorder is present. We1,2) have urged the interest of physicians on the several problems as above which were accompanied by the long-term therapy with antihypertensive agents, and would like to report the result of analysis of the data, which has been gathered in the hypertension clinic of Seoul Paik Hospital, Inje University for 15 years, in order to recollect these problems and draw out the resolutions. Long-Term Therapy and Compliance The core of the effective long-term therapy with antihypertensive agents is to improve the compliance of patients. The high compliance results from the interaction among patients, doctors and social conditions. Nessman et al. recommended the following as methods which could improve compliance. The first one was utilization of the educational materials. The second, education of health care officials. The third, home visiting. The fourth, home care. The fifth, measurement of blood pressure at home. The measurement of compliance can be done by several methods. In our clinic, it has mainly been measured in terms of the scores of visiting the clinic. In other clinics, it has been measured in terms of the scores of taking medicine3). But the modification of the life style should be considered in measuring compliance. (Table 1) Table 1. Measurement of Compliance

Nine cases of strongyloidiasis in Korea

Nine cases of human infection with Strongyloides stercoralis are reported among patients admitted to the Seoul Paik and Sang-Kye Paik Hospitals, Inje University, from April 1990 to January 1992. The patients, 7 males and 2 females aged between 50 and 70, either had the history of long term use of steroids for management of arthritis, or were complicated with other chronic diseases such as hypertension, liver diseases, psychotic disorders, and gastrointestinal problems. All of the nine patients revealed rhabditoid larvae of S. stercoralis in fecal examination. A 57-year-old woman who complained of arthritis and abdominal discomfort, was treated with albendazole and mebendazole, and on the 4th and 5th treatment day 220 parasitic adult females were collected from the diarrheal stool. The patient had a long history of administration of steroids for treatment of arthritis, and seems to have suffered from hyperinfection syndrome due to autoinfection with S. stercoralis. This is the 3rd report on the recovery of parasitic adult females of S. stercoralis in Korea.

The Experience and Evaluation of Problem-Based Learning in Inje University College of Medicine

The Experience and Evaluation of Problem-Based Learning in Inje University College of Medicine

A case of tracheobronchopathia osteoplastica.

Tracheobronchopathia osteoplastica(TPO) is a rare disorder characterized by submucosal cartilaginous or bony projections into the tracheobronchial lumen with sparing of the posterior membranous portion of tracheobronchial tree. The etiology of TPO is still unknown. A 44-year-old male was admitted to Seoul Paik Hospital Inje University due to left chest pain for 10 days. On the past history he had sufferred from symptoms of bronchitis for several months. He showed radiologically massive pleural effusion in left lung field. Pleural biopsy revealed chronic pleuritis with hemorrhage. Bronchoscopic findings showed multiple intraluminal portruding nodule from just below the vocal cord to carina and both main bronchi. Pathology of bronchoscopic biopsy showed abnormal proliferation of atypical bony and carilagious nodules in the tracheal submucosa. We experianced a case of tracheobronchopathia osteoplastica involving the trachea and main bronchus in 44-year old male, associated with massive pleural effusion. This report is a case of TPO with review of literature.