Massive pulmonary hemorrhage in enterovirus 71-infected hand, foot, and mouth disease / 소아과

Hand, foot, and mouth disease (HFMD) is an acute, mostly self-limiting infection. Patients usually recover without any sequelae. However, a few cases are life threatening, especially those caused by enterovirus 71 (EV71). A 12-month-old boy was admitted to a primary hospital with high fever and vesicular lesions of the mouth, hands, and feet. After 3 days, he experienced 3 seizure episodes and was referred to our hospital. On admission, he was conscious and his chest radiograph was normal. However, 6 hours later, he suddenly lost consciousness and had developed a massive pulmonary hemorrhage that continued until his death. He experienced several more intermittent seizures, and diffuse infiltration of both lung fields was observed on chest radiography. Intravenous immunoglobulin, dexamethasone, cefotaxime, leukocyte-depleted red blood cells, fresh frozen plasma, inotropics, vitamin K, and endotracheal epinephrine were administered. The patient died 9 hours after intubation, within 3 days from fever onset. EV71 subgenotype C4a was isolated retrospectively from serum and nasopharyngeal swab by real-time reverse transcription-polymerase chain reaction. Here, we report a fatal case of EV71-associated HFMD with sudden-onset massive pulmonary hemorrhage and suspected encephalitis.

Massive pulmonary hemorrhage in enterovirus 71-infected hand, foot, and mouth disease / 소아과

Hand, foot, and mouth disease (HFMD) is an acute, mostly self-limiting infection. Patients usually recover without any sequelae. However, a few cases are life threatening, especially those caused by enterovirus 71 (EV71). A 12-month-old boy was admitted to a primary hospital with high fever and vesicular lesions of the mouth, hands, and feet. After 3 days, he experienced 3 seizure episodes and was referred to our hospital. On admission, he was conscious and his chest radiograph was normal. However, 6 hours later, he suddenly lost consciousness and had developed a massive pulmonary hemorrhage that continued until his death. He experienced several more intermittent seizures, and diffuse infiltration of both lung fields was observed on chest radiography. Intravenous immunoglobulin, dexamethasone, cefotaxime, leukocyte-depleted red blood cells, fresh frozen plasma, inotropics, vitamin K, and endotracheal epinephrine were administered. The patient died 9 hours after intubation, within 3 days from fever onset. EV71 subgenotype C4a was isolated retrospectively from serum and nasopharyngeal swab by real-time reverse transcription-polymerase chain reaction. Here, we report a fatal case of EV71-associated HFMD with sudden-onset massive pulmonary hemorrhage and suspected encephalitis.

Basal luteinizing hormone and follicular stimulating hormone: is it sufficient for the diagnosis of precocious puberty in girls?

PURPOSE: A gonadotropin-releasing hormone stimulation test (GnRHST) is the gold standard in diagnosing central precocious puberty (CPP). The aim of this study was to investigate the diagnostic accuracy of basal gonadotropin levels for girls with suspected precocious puberty and to evaluate the factors affecting positive results of the GnRHST. METHODS: Korean girls with early pubertal development who visited the clinic during 2010-2012 were included. Auxological and biochemical tests were evaluated and a standard GnRHST was performed. A peak luteinizing hormone (LH) level of > or =5 IU/L was considered a positive response during the GnRHST. RESULTS: A total of 336 girls were included. The positive responses were observed in 241 girls (71.7%), and negative responses were found in 95 girls (28.3%). In the logistic regression analysis, the coefficient of the basal LH and basal LH/follicular stimulating hormone (FSH) ratio was 4.23 (P<0.001) and 21.28 (P<0.001), respectively. Receiver operating characteristic analysis showed that the basal LH/FSH ratio is a better predictor of the pubertal result after the GnRHST than the basal LH (area under the curve was 0.745 and 0.740, respectively; P=0.027). Among 189 girls with a basal LH of <0.1 IU/L, 105 (55.6%) had positive responses. CONCLUSION: An elevated level of the basal LH and basal LH/FSH ratio was a significant predicting factor of positive responses during the GnRHST. However a GnRHST was still necessary for diagnostic confirmation of CPP because more than half of the girls with a basal LH level below the detection limit revealed to have CPP.

Clinical Evaluation of IOGEL 1103Lens Implantation

We studied the postoperative results of 38 patients (40 eyes) who received the implantation of IOGEL 1103 (Alcon, U.S.A.), a single piece intracapsular fixing hydrogel lens. Scleral pocket incision was done tangentially 2mm posterior to the surgical limbus and 4mm in length. The diameter of continuous curvilinear capsulorhexis (GCC) was about 5mm and intercapsular phacoemulsification was carried out. No suture or single 10-0 nylon suture was used for the closure. Uncorrected visual acuity of 20/40 or better was observed in 70% of all cases at 1 week postoperatively and in 90% at 2 months postoperatively Mean keratometric astigmatism analized by vector analysis was 0.65 diopter (D) at 1 week postoperatively and -0.13D at 8 weeks postoperatively and the changes from preoperative astigmatism was 0.31D at 1 week postoperatively, and 0.43D at 8 weeks postoperatively. Intraocular lens (IOL) was damaged during insertion into the capsular bag in 7.5%. Fibrinoid membrane on IOL surface formed in 5% and cystoid macular edema was shown in 2.5%. Severe shrinkage of anterior capsule (less than 3 mm in diameter) was shown in 22.5% at 8 weeks postoperatively. Early postoperative results revealed that IOGEL 1103 is relatively stable in the capsular bag and induces good visual recovery with less astigmatism. However, a method to prevent the postoperative shrinkage of anterior capsule and a proper shape of hydrogel lens should be investigated in the future.

Effect of Incision Length on Visual Recovery and Astigmatism in No-Suture Cataract Surgery

To evaluate the effect of incision length on visual recovery and astigmatism in sutureless cataract surgery, three different lengths of incision were applied to 69 eyes. Soft intraocular lens (IOL) was inserted through 4mm incision in group 1 (16 eyes), ovoid polymethylmethacrylate (PMMA)IOL was inserted through 5mm incision in group 2 (31 eyes), and 7mm optic sized PMMA IOL was inserted through 7mm incision in group 3 (22 eyes). Average uncorrected visual acuity was 0.69, 0.52 and 0.57 at one week and 0.79, 0.68 and 0.66 at eight weeks in the group 1, group 2, and group 3 respectively. There was no statistically significant difference among the three groups (p>0.05). Keratometric astigmatism was 0.26 diopter (D), - O.1OD and -O.12D in the group 1, group 2, and group 3 respectively. There was no statistically significnt difference among the three groups (p>0.05). Keratometric astigmatism was 0.26 diopter (D), -O.1OD and O.12D in the group 1, group 2, and group 3 respectively at one week postoperatively. The change of mean keratometric astigmatism from 1 to 8 weeks postoperatively was 0.73D in group 1 ,0.60D in group 2 and 0.79D in group 3 and there was no statistically significant difference among the three groups (p>0.05). As postoperative problems, microleakage of aqueous humor at incision site and cystoid macular edema were shown in 6% of the group 1. Microhyphema was shown in 6% of group 1, 6% of group 2 and 18% of group 3 at one day postoperatively. Early clinical observations indicate that sutureless cataract surgery shows early visual recovery and minimizes surgically induced astigmatism without serious complications, regardless of length of incision.

Evaluation of 82 Cases of Oval Optic Intraocular Lens Implanted in the Bag

The postoperative results of 77 paients:(82 eyes) who had undergone phacoemulsification with implantation of oval optic poly methylmethacrylate (PMMA) introoular intraowlar lens (IOL) (5 X 6mm) were evaluated retrospectively. Scleral pocket incision was done tangentially at the point 2mm. apart from the surgical limbus and 5mm in length. No suture in the group 1 (30 eyes), single horizontal suture in the group 2 (31 eyes) and single X suture in the group 3 (21 eyes) were used for the closure method. Average uncorrected visual acuity at postoperative one week was 0.5 or better in each group and there was no statistically significant difference among three groups (p>0.05). The change in mean keratometric astigmatism from postoperative one to eight weeks turned out to be less than 1 diopter (D) in each group and there was no statistically significant difference among three groups (p>0.05). When the diameter of continuous cirular capsulorhexis (CCC) was greater than 5mm or the position of CCC was decentered, it was found that optic was partially escaped form the bag due to adhesion between the remained anterior and posterior capsular structure. It could be suggested that oval optic PMMA IOL showes early visual recovery with less astigmatism regardless of the suture method and in order to place the optic of IOL properly in the bag postoperatively, the diameter of CCC should be less than 5mm and the position of CCC should be centered.

Clinical Observation on Implantation of Posterior Chamber Intraocular Lens for Complicated Cataract in Leprose Patient

Twenty cases who had underwent extracapsular cataract extraction with pupilloplasty followed by implantation of posterior chamber intraocular lens (PCL) were followed up more than 3 months from May 1989 to April 1991. Postoperative uncorrected visual acuity was improved in all cases. Corrected visual acuity was 20/40 or better in 13 cases (65% of all cases) and refractive state was myotic (-1.1D in average) at 2 months after operation. Postoperative astigmatism was -1.3D in average at 2 months after operation, which became -0.8D in average at 1 year after operation. Postoperatively vitreous prolapse occured in 1 case and increased intraocular pressure due to posterior synechiae was observed in 1 case. After-catract developed in 1 case. We obtained good clinical results after ECCE and PCL implantation in leprosy patients for whom wearing the contact lens and glasses were impractical due to hand and finger deformities.