Differentiation between Glioblastoma and Solitary Metastasis: Morphologic Assessment by Conventional Brain MR Imaging and Diffusion-Weighted Imaging

Purpose@#Differentiating between glioblastoma and solitary metastasis is very important for the planning of further workup and treatment. We assessed the ability of various morphological parameters using conventional MRI and diffusion-based techniques to distinguish between glioblastomas and solitary metastases in tumoral and peritumoral regions. @*Materials and Methods@#We included 38 patients with solitary brain tumors (21 glioblastomas, 17 solitary metastases). To find out if there were differences in the morphologic parameters of enhancing tumors, we analyzed their shape, margins, and enhancement patterns on postcontrast T1-weighted images. During analyses of peritumoral regions, we assessed the extent of peritumoral non-enhancing lesion on T2- and postcontrast T1-weighted images. We also aimed to detect peritumoral neoplastic cell infiltration by visual assessment of T2-weighted and diffusionbased images, including DWI, ADC maps, and exponential DWI, and evaluated which sequence depicted peritumoral neoplastic cell infiltration most clearly. @*Results@#The shapes, margins, and enhancement patterns of tumors all significantly differentiated glioblastomas from metastases. Glioblastomas had an irregular shape, ill-defined margins, and a heterogeneous enhancement pattern; on the other hand, metastases had an ovoid or round shape, well-defined margins, and homogeneous enhancement. Metastases had significantly more extensive peritumoral T2 high signal intensity than glioblastomas had. In visual assessment of peritumoral neoplastic cell infiltration using T2-weighted and diffusion-based images, all sequences differed significantly between the two groups. Exponential DWI had the highest sensitivity for the diagnosis of both glioblastoma (100%) and metastasis (70.6%). A combination of exponential DWI and ADC maps was optimal for the depiction of peritumoral neoplastic cell infiltration in glioblastoma. @*Conclusion@#In the differentiation of glioblastoma from solitary metastatic lesions, visual morphologic assessment of tumoral and peritumoral regions using conventional MRI and diffusion-based techniques can also offer diagnostic information.

Differentiation between Glioblastoma and Solitary Metastasis: Morphologic Assessment by Conventional Brain MR Imaging and Diffusion-Weighted Imaging

Purpose@#Differentiating between glioblastoma and solitary metastasis is very important for the planning of further workup and treatment. We assessed the ability of various morphological parameters using conventional MRI and diffusion-based techniques to distinguish between glioblastomas and solitary metastases in tumoral and peritumoral regions. @*Materials and Methods@#We included 38 patients with solitary brain tumors (21 glioblastomas, 17 solitary metastases). To find out if there were differences in the morphologic parameters of enhancing tumors, we analyzed their shape, margins, and enhancement patterns on postcontrast T1-weighted images. During analyses of peritumoral regions, we assessed the extent of peritumoral non-enhancing lesion on T2- and postcontrast T1-weighted images. We also aimed to detect peritumoral neoplastic cell infiltration by visual assessment of T2-weighted and diffusionbased images, including DWI, ADC maps, and exponential DWI, and evaluated which sequence depicted peritumoral neoplastic cell infiltration most clearly. @*Results@#The shapes, margins, and enhancement patterns of tumors all significantly differentiated glioblastomas from metastases. Glioblastomas had an irregular shape, ill-defined margins, and a heterogeneous enhancement pattern; on the other hand, metastases had an ovoid or round shape, well-defined margins, and homogeneous enhancement. Metastases had significantly more extensive peritumoral T2 high signal intensity than glioblastomas had. In visual assessment of peritumoral neoplastic cell infiltration using T2-weighted and diffusion-based images, all sequences differed significantly between the two groups. Exponential DWI had the highest sensitivity for the diagnosis of both glioblastoma (100%) and metastasis (70.6%). A combination of exponential DWI and ADC maps was optimal for the depiction of peritumoral neoplastic cell infiltration in glioblastoma. @*Conclusion@#In the differentiation of glioblastoma from solitary metastatic lesions, visual morphologic assessment of tumoral and peritumoral regions using conventional MRI and diffusion-based techniques can also offer diagnostic information.

Multilayered Engineered Tissue Sheets for Vascularized Tissue Regeneration

A major hurdle in engineering thick and laminated tissues such as skin is how to vascularize the tissue. This study introduces a promising strategy for generatingmulti-layering engineered tissue sheets consisting of fibroblasts and endothelial cells co-seeded on highly micro-fibrous, biodegradable polycaprolactone membrane. Analysis of the conditions for induction of the vessels in vivo showed that addition of endothelial cell sheets into the laminated structure increases the number of incorporated cells and promotes primitive endothelial vessel growth. In vivo analysis of 11-layered constructs showed that seeding a high number of endothelial cells resulted in better cell survival and vascularization 4 weeks after implantation.Within one week after implantation in vivo, red blood cells were detected in the middle section of three-layered engineered tissue sheets composed of polycaprolactone/ collagen membranes. Our engineered tissue sheets have several advantages, such as easy handling for cell seeding, manipulation by stacking each layer, a flexible number of cells for next-step applications and versatile tissue regeneration, and automated thick tissue generation with proper vascularization.

Paradigm Consideration for Studies of Women's Mental Health: Focused on Domestic Nursing Academic Journals / 정신간호학회지

PURPOSE: This integrative review was done to explore trends in mental health nursing research on women in terms of a research paradigm, life-cycles of the women, and mental health concepts. METHODS: n this study an examination was done of the literature on mental health of women described in nursing research published in major Korean nursing journal databases from 2000 to 2012. The Journal of Child Health Nursing was excluded. The MeSH search terms included 'nursing' and 'woman' and 282 articles were included in the final review. RESULTS: Postpositivism was the most predominantly used paradigm. Middle aged women were studied more often and older and reproductive aged women were less likely to be studied compared to their percentage of the total population. Researchers focused most on depression, followed by sleep disorders and anxiety disorders. CONCLUSION: The study results indicate a need for rmfjtunursing researchers to utilize various research paradigms when conducting nursing research and demonstrate paradigm utility. Researchers should also pay more attention to older and reproductive aged women, and to anxiety disorders.

Long-Term Results of LASIK for Presbyopia Correction in Myopic Patients Using Aspheric Micro-Monovision

PURPOSE: To evaluate the efficacy, safety, and satisfaction of patients who underwent LASIK for presbyopia correction in myopic patients using aspheric micro-monovision. METHODS: LASIK for presbyopic correction using aspheric micro-monovision was performed in 18 patients between December 2010 and December 2011. Distance, intermediate, and near visual acuity, refractive change, and patient's satisfaction were evaluated for at least 12 months after the surgery. RESULTS: Among dominant eyes, 100% achieved uncorrected distance and intermediate visual acuity of 0.8 or better and 100% of the eyes achieved 0.8 or better binocularly. In the non-dominant eyes, 83% achieved uncorrected near visual acuity of J3 or better, and 94% of the eyes achieved J3 or better binocularly. Postoperatively, the mean manifest refraction spherical equivalent (MRSE) of the dominant eyes were -0.09 +/- 0.35D, -0.17 +/- 0.42D, and -0.17 +/- 0.47D at 1, 6 and 12 months, respectively. The MRSE of the non-dominant eyes were -0.94 +/- 0.53D, -1.03 +/- 0.56D, and -1.02 +/- 0.50D at postoperative 1, 6, and 12 months, respectively, without significant regression. After surgery, the patient's overall satisfaction score was good (4.2 out of 5). CONCLUSIONS: The aspheric micro-monovision protocol showed good distance, intermediate, and near visual outcomes, and was a well-tolerated, stable, and effective procedure for treating patients with myopic presbyopia.

Anticholinesterase Treatment for Patients With Paralytic Strabismus Following a Viper Bite

PURPOSE: To describe the therapeutic effect of anticholinesterase treatment for patients with paralytic strabismus and blepharoptosis following a viper bite METHODS: A prospective non-comparative interventional case series study was designed including 6 patients with ophthalmic complications such as paralytic strabismus and blepharoptosis following a viper bite. Anticholinesterase (pyridostigmine) 60 mg was administered to patients 3 times a day in additional to conservative treatment including antivenom, antibiotics and tetanus toxoid. Patients underwent a measurement of deviation, diplopia test and MRD 1. Subjective evaluation of the diplopia symptoms was performed daily after treatment. RESULTS: Subjective diplopia was relieved in 2 out of the 6 patients on the first day and in the other 4 patients on the second day. The angle of deviation decreased approximately 37% on the first day and ocular position became orthophoric on the third day in all patients. The blepharoptosis was completely resolved in 4 patients on the first day. No complication following anticholinesterase treatment was noticed. CONCLUSIONS: Treatment using anticholinesterase for patients suffering from diplopia and blepharoptosis following a viper bite is an effective and safe treatment.

Canaliculitis After Dacryocystorhinostomy with Silicone Tubes

PURPOSE: To investigate the incidence and clinical course of canaliculitis after dacryocystorhinostomy (DCR) with silicone tubes. METHODS: A retrospective analysis was performed on 521 eyes in 484 patients who had undergone DCR with silicone tubes between October 1994 and May 2006. RESULTS: Canaliculitis occurred in 11 eyes (2.1%). The mean age of the 10 patients involved in this study was 62.1 years (47~71 years) with a mean follow-up period of 11.1 months (6~36 months). The mean onset of canaliculitis was 3.2 months (1~5 months) after the surgery. All cases of canaliculitis were resolved with antibiotic treatment after silicone tube removal, and the surgical outcomes were successful in all patients. CONCLUSIONS: The incidence of canaliculitis after DCR with silicone tubes was rare. In such cases, the final surgical outcome was successful after appropriate treatment.

Two Cases of Giant Cell Angiofibroma in the Orbit

PURPOSE: To report two cases of giant cell angiofibroma in the orbit. CASE SUMMARY: (Case 1) A 17-year-old girl was referred for evaluation of the left upper eyelid swelling which had developed 6 months ago. On initial examination, a 1.5 cm sized ovoid and nontender mass was palpated in the medial aspect of the left orbit. CT scan and MR imaging of the orbit showed a non-calcified, well-circumscribed homogenous soft tissue mass, which was uniformly enhanced and did not invade the adjacent tissue. Excisional biopsy of the orbital mass was performed. (Case 2) A 30-year-old man presented with left proptosis which had developed 2 months ago and hemorrhage into the upper and lower eyelid which had developed 1 week ago. CT scan and MR imaging showed an heterogeneously enhancing mass, not involving the adjacent tissue in the superior retrobulbar space. Excisional biopsy through a lateral orbitotomy was performed. Histologic evaluation revealed proliferation of spindle cells with pseudovascular spaces and multinucleated giant cells.Immunohistochemical staining for CD34 and vimentin was positive and staining for CD31, smooth muscle actin was negative. A diagnosis of giant cell angiofibroma was made. CONCLUSIONS: The possibility of giant cell angiofibroma should be considered in the differential diagnosis for an orbital mass without a hemorrhage or with a hemorrhage in the eyelid in adult patients.

The Results of Periocular Injections of Triamcinolone for Thyroid Orbitopathy

PURPOSE: The aim of this study is to evaluate the effects and complications of periocular injections of triamcinolone acetonide in patients with thyroid orbitopathy who could not tolerate systemic corticosteroid therapy. METHODS: Six patients with a mean age of 48.7 years showed symptoms of severe acute thyroid orbitopathy. They received four doses of 20 mg of triamcinolone acetonide via periocular injection into the inferotemporal orbital quadrant every 2 weeks. The response to treatment and the presence of adverse effects were evaluated retrospectively. RESULTS: Three of six patients (50%) showed significant improvement in soft tissue swelling in both eyes. Only one patient (17%) showed improvement of proptosis. No patients showed improvement in diplopia and ocular motility. The mean thickness of the extraocular muscles measured by CT scan remained unchanged. Compressive optic neuropathy developed in one patient and resolved after intravenous high-dose steroid treatment. Two patients received radiation therapy for resistant inflammatory symptoms. One patient underwent extraocular muscle surgery. In one patient, there was no adverse effect at the injection site, except for a foreign body granuloma. CONCLUSIONS: Periocular triamcinolone injection could be effective for patients with thyroid orbitopathy in the acute inflammatory phase in reducing soft tissue swelling. The procedure showed no significant effect on exophthalmos or ocular motility.

Surgical Outcome and Postoperative Complications of Vitrectomy for Diabetic Retinopathy

PURPOSE: The surgical outcome of diabetic vitrectomy, prognostic factors influential to development of postoperative complications and possible risk factors of postoperative neovascular glaucoma which is main cause of blindness were evaluated. METHODS: The medical records of 56 eyes in 51 patients who underwent vitrectomy for proliferative diabetic retinopathy were reviewed. RESULTS: Anatomical success was achieved in 50 eyes (89%) and vision better than 5/200 in 39 eyes (70%) of 56 eyes that had undergone vitrectomy due to diabetic retinopahty. Statistically significant improvement of vision was obtained among the patients who had preoperative visual acuity of 5/200 or better (p<0.05). Postoperative complication such as neovascular glaucoma proved to be detrimental to visual outcome. The causes of poor visual outcome included neovascular glaucoma, optic atrophy, cataract, macular edema, subretinal hemorrhage, macular subretinal fibrosis, and vitreous hemorrhage. Neovascular glaucoma occurred in 5 eyes among the total 56 eyes (9%). There was no statistically different result in the incidence of neovascular glaucoma according to preoperative panretinal photocoagulation, intraoperative cataract extraction, postoperative retinal detachment, intraocular gas or oil injection, duration of diabetes, control of blood sugar and presence of diabetic nephropathy. CONCLUSIONS: The visual prognosis of diabetic vitrectomy is related with preoperative visual acuity. As neovasular glaucoma is detrimental to visual outcome, it is important to find postoperative neovascularizaton on iris as soon as possible and effective treatment is also important.

Intravenous Thrombus Formation in Branch Retina Vein Occlusion

PURPOSE: It is very rare to observe the thrombus formation next to the ateriovenous crossing(AV crossing) in branch retinal vein occlusion(BRVO). We investigated two cases with the thrombus in BRVO. MATERIALS AND METHODS: Two of 347 cases with BRVO to perform the fluorescein angiography(FAG) were observed to form the intravascular thrombus next to the AV crossing. RESULTS: The vascular wall in the area of thrombus was hyperfluorescent in FAG. The fluorescence was visible in the early arteriovenous phase and it increased in the mid-phase of the angiogram. Investigatons for systemic hypertension and hyperlipidemia in two cases were positive. The vascular wall in the area of thrombus in one case revealed as hyperfluorescence exaggeratedly in length by forward and backward movement of the thrombus during performing FAG. And the leakage of fluorescein from the venule next to the AV crossing was not observed. In the other case, the vascular wall in the area of thrombus revealed the small hyperfluorescent spot and the leakage of fluorescein. CONCLUSIONS: The pathogenesis of thrombus formation in the retinal vein resulting in retinal vein occlusion is not well understood. Although poststenotic turbulence of blood flow after an AV crossing or a preexisting vessel wall alteration combined with alterations of blood fluidity may induce thrombus formation, it was uncertain in our cases whether or not the thrombus formation was associated with hyperlipidemia, systemic hypertension, and hypercoaguable states.

Cholesterol Crystals in Aqueous Humor of the Eye with Phacolytic Glaucoma

Iridescent cholesterol crystals in the anterior chamber are unusual finding. Although the clinical picture of phacolytic glaucoma is well recognized, the nature of the iridescent or hyperrefringent crystals is not well understood. A 70 years old womon presented with the acute onset of monocular pain and redness. The examination revealed a high intraocular pressure (42 mmHg), conjunctival hyperemia, and diffuse corneal edema. The heavy flare and pseudohypopyon were seen in the anterior chamber associated with iridescent or hyperrefringent particles. The anterior chamber aspirate obtained at operation was subsequently examined by wet field microscopy. Wet field microscopy showed that macrophages identified histologically in the aspirate corresponded to regular round cells about two to three times the size of an leukocyte. And, notched rectangular platelike crystals were typical morphologically of cholesterol, varied in size, and contacted each other. We found cholesterol crystals in aqueous humor of the eye with phacolytic glaucoma.