The Clinical Outcome of Endoscopic Transnasal Conjunctivodacryocystorhinostomy Using MEDPOR(R) Coated Tear Drain

PURPOSE: Tube displacement, consisting of protrusion, spontaneous loss, and intrusion, is the most common cause of failure in conjunctivodacryocystorhinostomy with Jones tube. Recently, MEDPOR(R) Coated Tear Drain was designed to minimize these complications. We evaluate the surgical outcome of conjunctivodacryocystorhinostomy with MEDPOR(R) Coated Tear Drain. METHODS: Primary conjunctivodacryocystorhinostomy or revision surgery using MEDPOR(R) Coated Tear Drain was done on 23 eyes of 23 patients and the development of displacement was monitored. Thirteen patients suffered from habitual displacement of Jones tube and underwent revision surgery, while the remaining 10 underwent primary conjunctivodacryocystorhinostomy. RESULTS: During 12-month follow-up after surgery, tube intrusion was noted in one among the 23 patients. Protrusion or spontaneous loss of tube did not develop. CONCLUSIONS: The use of MEDPOR(R) Coated Tear Drain may be very effective not only for revision surgery in patients who have suffered from habitual displacement of Jones tube but also on primary conjunctivodacryocystorhinostomy.

Surgical Results of Modified Dacryocystorhinostomy

PURPOSE: To evaluate the surgical results of endoscopic modified dacryocystorhinostomy (DCR). METHODS: The authors operated on patients with upper punctal and canalicular obstruction associated with nasolacrimal duct obstruction and performed endoscopic modified DCR. One end of a lacrimal tube was passed into the nasal cavity through an excision site of the caruncle and internal ostium and the other end of the tube was inserted into the nasal cavity through a patent punctum and the newly created intranasal ostium. The two ends were tied together in the nasal cavity in modified DCR. RESULTS: The primary success rate of modified DCR was 71.0%. Of the four failed cases, one underwent CDCR using Jones tube. CONCLUSIONS: The author's modified DCR may be a suitable alternative method to CDCR or DCR using monocanalicular silicone tube to relieve epiphora in patients with NLD obstruction associated with upper punctal and canalicular obstruction.

Clinical Effect of Limited Myectomy for the Treatment of Essential Blepharospasm

PURPOSE: Limited protractor myectomy was employed through lid crease incision alone and the effect and complications of this surgery were evaluated and compared with those of the conventional method in essential blepharospasm. METHODS: Seven patients who were not responsive to botulinum toxin injection for essential blepharospasm and who were worried about large scars after protractor myectomy underwent limited myectomy through lid crease incision in the upper lid and lateral myectomy in the lower lid. The corrugator and procerus muscles were left in place. RESULTS: Blepharospasm was improved in five of the seven patients after limited myectomy and by botulinum injection in one of the remaining two patients for whom limited myectomy was not successful. Severe lymphedema seen after protractor myectomy through suprabrow incision was not encountered. Long-term lymphedema, skin necrosis, eyebrow loss, and exposure keratitis were reduced and operative time was shorter than that of conventional methods. CONCLUSIONS: Limited myectomy through lid crease incision in essential blepharospasm has less postoperative complications and shorter operative time than conventional surgery.

The Surgical Results of Transcanalicular LASER-assisted Dacryocystorhinostomy

PURPOSE: The purpose of this study is to evaluate the effectiveness of transcanalicular laser-assisted dacryocystorhinostomy(DCR) comparing with previous endonasal DCR. METHODS: The patients were divided into two groups; One is transcanalicular laser-assisted DCR, the other is endonasal DCR. 35 patients with NLD obstruction underwent transcanalicular laser-assisted DCR. The bony ostium was created using a transmitting Nd: YAG fiberoptics catheter laser through the canaliculus. On the other hand, 45 patients with NLD obstruction underwent endonasal DCR. The authors compared success rate, postoperative complication and operative time between two groups. RESULTS: The success rate of transcanalicular laser-assisted DCR group and endonasal DCR group were 88.6% (31/35) and 88.9% (40/45), respectively. There was no significant difference between two groups in success rate (p>0.99). Postoperative granuloma formation was seen in 29% (transcanalicular group) and 58% (endonasal group), respectively. The operative time for transcanalicular and endonasal DCR was needed for 28.3min, 47.7min, respectively. There were statistically significant differences in less granuloma formation and shorter operative time in transcanalicular group than in endonasal group (p<0.01). CONCLUSIONS: When patients with NLD obstruction have a thin bony portion of the lacrimal fossa, transcanalicular laser-assisted DCR with shorter operative time and less postoperative complications may be chosen as the beneficial procedure rather than endonasal DCR.

The Effect of Perlane(R) Injection on Superior Sulcus Deformity

PURPOSE: This study evauated the effect of Perlane(R) injection into the subcutaneous tissue on six patients with superior sulcus deformity. METHODS: From August 2001 to September 2003, Perlane(R) was injected on the six eye lids of six patients with superior sulcus deformity caused by orbital varix, blow-out fracture, or anophthalmos. RESULTS: Superior sulcus deformity of all six patients was completely corrected with Perlane(R), bilateral symmetry was achieved for all six. Ocular pain and superior sulcus deformity disappeared after Perlane(R) injection in two patients with orbital varices. Ptosis developed temporarily in one patient at two weeks after injection, was resolved spontaneously at 8 months. The average duration of correction was 12 months. CONCLUSIONS: Although Perlane(R) is not a permanent material, the Perlane(R) injection is an effective and easy way to correct superior sulcus deformity especially for those who do not want to undergo surgery or have the deformity undercorrected. A larger series of patients and longer follow-up might be necessary to obtain further information on Perlane(R) injection for patients with superior sulcus deformity caused by various etiologies.

Confocal Microscopic Findings Associated with LASIK Flap with Foreign Corneal Epithelial Cells

PURPOSE: To evaluate the inflammatory response following the insertion of corneal epithelium into rabbit corneal stroma using confocal microscope. METHODS: Newzealand white rabbits were underwent corneal flap procedure using Microkeratome (Hansatome, Chiron, USA) and corneal epithelium was inserted. We divided the rabbits into three groups: Group A: flap only, Group B: flap with central epithelium insertion, Group C: flap with peripheral epithelium insertion. We examined the rabbit corneas at the time point of 4, 24, 72hours, 7days, and 1 month after surgery using confocal microscope and CD 11b immunohistochemical stain. RESULTS: At the early stage, the inflammatory cells were more frequently observed in the group C than in the group A and B, and at postoperative 72hours only in the group C. In stromal and total corneal thickness, there was a tendency of increase to the postoperative 24 hours and decrease in all groups, but the group C was more stronger tendency than other groups (P0.05). In immunohistochemical staining (CD11b), polynucleated cells and mast cells were more visible in group B and C than in group A. CONCLUSIONS: The postoperative inflammatory reaction of the LASIK flap may be related with corneal epithelial cells, and we think that more attention should be needed with the management of microkeratome.

The effect of double silicone tube intubation on surgical outcome of endonasal dacryocystorhinostomy

PURPOSE: This study is to evaluate the effectiveness on patency rates of two silicone tube intubation comparing with one silicone tube intubation in endonasal dacryorhinostomy. METHODS: The 99 patients' charts were reviewed on patency rate and the cause of failure in patients with nasolacrimal duct obstruction, who had undergone endonasal DCR with two sets of silicone tube intubation. Another 100 patients who underwent endoscopic DCR with single silicone tube intubation, were enrolled in this study as the control group to compare the patency rates and the causes of failure between the two groups. RESULTS: Double silicone tube intubation group showed much higher lacrimal patency rates (89.9%) than that (84.0%) of single silicone intubation group. It seems to be due to less membrane formation (4%) at the site of internal ostium by sufficient bougination in two silicone tube intubation group compared with one silicone tube intubation group (16%). Two silicone tube intubation in endonasal DCR was more effective in preserving the lacrimal patency and avoidance of membranous obstruction at newly created nasal ostium (P=0.03). There were no significant differences in the size of nasal cavity, sex and age distributions, and postoperative cares between the two groups. CONCLUSIONS: Two silicone tube intubation can be considered to be a method of improving success rate in endonasal DCR.

Standard Performance Measurements of GE AdvanceTM Positron Emission Tomography / 대한핵의학회잡지

PURPOSE: The purpose of this study was to establish optimal imaging acquisition conditions for the GE Advance(TM) PET imaging system by performing the acceptance tests designed by National Electrical Manufacturers Association (NEMA) protocol and General Electric Medical Systems (GEMS) test procedures. MATERIALS AND METHODS: Performance tests were carried out with 18FDG radioactivity source and phantoms by using a standard acquisition mode. Transaxial resolution and scatter fraction tests were performed with a line source and axial resolution with a point source, respectively. A cylindrical phantom made of polymethylmethacrylate (PMMA) was used to measure sensitivity, count rate losses and randoms, uniformity correction, and attenuation inserts were added to measure remaining tests. The test results were acquired in a diagnostic acquisition mode and analyzed mainly on high sensitivity mode. RESULTS: Transaxial resolution and axial resolution were measured as average of 4.65 mm and 3.98 mm at 0 cm, and 6.02 mm and 6.71 mm at 20 cm on high sensitivity mode, respectively. Average scatter fraction was 9.87%, and sensitivity was 225.8 kcps/micronCi/cc of trues. Activity at 50% deadtime was 4.6 Ci/cc, and the error of count rate correction at that activity was from 1.49% to 3.83%. Average nonuniformity for total slice was 8.37%. The accuracy of scatter correction was -0.95%. The accuracies of attenuation correction were 5.68% for air, 0.04% for water and -6.51% for polytetrafluoroethylene (PTFE). CONCLUSION: The results satisfied most acceptance criteria, indicating that the GE AdvanceTM PET system can be optimally used for clinical applications.

Clinical and Angiographic Characteristics and Long-term Follow-up in Patients with Variant Angina Who Presented as Acute Myocardial Infarction

BACKGROUNG AND OBJECTIVES: There were numerous reports for clinical characteristics and prognosis of patients with variant angina (VA) but little information is available for patients with VA who presented as acute myocardial infarction (AMI). The purpose of this study is to determine the clinical and angiographic predictors for initial development of AMI in patients with VA and prognosis of patients with VA who presented as AMI. MATERIALS AND METHODS: The study group comprised 166 patients with VA:forty one (25%) of whom presented as AMI (Group A;Male 32, mean age 50 years) and 125 presented as typical VA or unstable angina (Group B;Male 73, mean age 54 years). The diagnosis of VA was made by spontaneous spasm and ergonovine or acetylcholine (only Group B) provocation. RESULTS: 1)Male gender (78% vs. 58%, p<0.05), smoking (74% vs. 53%, p<0.05), and disease duration (18+/-5 vs. 7+/-1 month, p<0.0001), and ST-segment elevation during chest pain (71% vs. 23%, p<0.05) were significantly higher in group A than in Group B. 2)Prevalence of fixed stenosis of 50% or greater was higher in Group A than in group B (12% vs. 2%, p<0.05) and the percent stenosis after nitroglycerin injection was also greater in group A than in group B (43+/-5% vs. 28+/-2, p<0.01), but the disease activity such as frequency of resting angina, spontaneous spasm, and multivessel spasm were not different between two groups. 3)During clinical follow-up at a mean duration of 2.7 years, three patient (2%) in group B died of a cardiac cause. Non-fatal MI occurred 1 (2%) and 3 patients (2%) in group A and B, respectively. CONCLUSIONS: Our data show that male gender, smoking, duration of disease, ST-segment elevation during chest pain, and a fixed stenosis of 50% or greater are predictors for initial development of AMI in patients with VA. The prognosis in group A is excellent and this may be associated with less severe atherosclerotic disease and a high rate of medication with calcium channel blocker or nitrate compared with those in previous studies.

A Case of Simultaneous Bilateral Emphysematous Pyelonephritis and Cystitis / 대한내과학회지

Since the first clinical observation by Kelly and MacCallum, gas-forming infection of the urinary tract has been extensively studied. It is characterized by gas production within the urinary tract. The gas may often pass outside the urinary tract. Patients with this disorder invariably have uncontrolled diabetes mellitus and pos sibly associated obstructive uropathy. It is usually caused by aerobic bacteria, most commonly Escherichia coli. In the literature, the majority of cases were emphy sematous pyelonephritis alone or emphysematous cystitis separately. Bilateral renal involvement associated with emphysematous cystitis is very rarely seen and no case was reported yet in Korea. We report a case of bilateral emphysematous pye lonephritis and emphysematous cystitis which occured in 48-year-old diabetic patient simultaneously. It was caused by E. coli. The patient was cured by medical management alone.

Edge Dissection after Intracoronary Stenting: Predictor, Angiographic and Clinical Follow-up after Additional Procedures

BACKGROUND AND OBJECTIVES: This study was performed to determine the predictive factors for edge dissection (ED) and clinical significance of ED after coronary stenting. MATERIALS AND METHODS: The study group comprised 215 patients (243 lesions, mean age 59 years, 157 male) in whom coronary stents were implanted between June, 1994 and June, 1998. By angiography, EDs were categorized into minor (a very focal segment 5mm with prominent adventitial staining and >50% of lumen compromize), and acute closure. RESULTS: 1.ED occurred in 30 (12.3%, minor 15, major 12) out of 243 lesions. Twelve of 30 EDs were located at the distal margin of the stent and occurred during high pressure. 2.Development of ED after stenting significantly correlated with severity of stenosis at the stent margin (> or =30%, 19/30 vs. 33/213, p=0.0001), degree of angulation (>45 0 , 16/30 vs. 48/213, p=0.0001), and calcification in the lesion (2/30 vs. 4/213, p=0.02). 3.There was no significant difference in clinical success rate between two groups (27/30 vs. 175/185, NS). 4.CRR in major and acute closure EDs (n=12) were significantly higher in patients treated with repeated angioplasty than in patients treated with additional stents (5/6 vs. 1/8, p=0.02). CONCLUSIONS: EDs after coronary stenting are relatively common and lesion's characteristics such as severity of stenosis (> or =30%) at the stent margin, angulation (>45 0 ), and calcification of the lesion are predictive factors for EDs. EDs are not associated with early adverse clinical events. However, CRR was significantly higher in patients treated by repeated angioplasty in major and acute closure EDs.

A Case of Acute Hemolytic Anemia and Methemoglobinemia Induced by Massive Dapsone Intoxication / 대한혈액학회지

Dapsone toxicity is evidenced by varying clinical pictures ranging from deep cyanosis in an otherwise alert normal appearing individual to restlessness, dyspnea, extensive hemolytic anemia, methemoglobinemia, sulfhemoglobinemia and serious central nervous system dysfunction. We experienced a case of acute massive dapsone intoxication in 34 years old man due to voluntary ingestion of 25g of this drug as a suicide attempt. A severe methemoglobinemia developed, accompanied by nausea, vomiting, intense cyanosis, headache, and dyspnea. Subsequently moderate hemolytic anemia observed. The patient recovered completely after intensive treatment with methylene blue, activated charcoal hemoperfusion, oral charcoal ingestion, steroid, and conservative treatment. Methylene blue was given by continuous intravenous infusion in order to avoid overdosage. We herein report a case of the acute hemolytic anemia and severe methemoglobinemia induced by massive dapsone intoxication with a review of the literature.

A Case of Rifampicin-induced Thrombocytopenic Purpura / 대한혈액학회지

A 30 year-old women who had had moderately advanced pulmonary tuberculosis and taken antituberculosis regimens including rifampicin was admitted with the symptoms of petechiae on the trunk and extremities and gum bleeding. The thrombocytopenic purpura appeared 20 days after the treatment with rifampicin, and which was rapidly improved with discontinuation of the drug. The diagnosis was confirmed by relapse of thrombocytopenia after retreatment with rifampicin. The paper presents a patient with thrombocytopenia induced by rifampicin and a brief review of pertinent literature.

A Case of Undifferenciated Large Cell Carcinoma of Lung Associated with Neurofibromatosis / 대한내과학회지

Neurofibromatosis also referred to as von Recklinghausen`s disease, is an autosomal dominant disease, which is characterized by cutaneous neurofibromas, cafe-au-lait spot, and axillary freckles. Although neruofibromatosis is a congenital disorder, the pulmonary manifestation become evident in adulthood. Approximately 15percent of patients with cutaneous lesions have intrathoracic neurofibromas. In some patients with neurofibromatosis, the lungs are the seat of interstitial fibrosis, leiomyoma, and bullous lesion, meningocele or less commonly lung cancer. The association of neurofibromatosis and lung cancer is rare, A 47-year-old man, who was a heavy smoker, was admitted to our hospital because of hemoptysis. Since cafe-au-lait sopts, diffuse pigmentation and multiple neurofibromatosis were observed on the skin, he was considered to have von Recklinghausen`s disease. Chest X-ray film showd extensive hazy density affecting all of his lung field, and minimal peribronchial infiltratin in his left lower lung field. Chest CT showed that near total consolidative lesions were present of right middle lobe. Also, some patchy infiltration were present in his right lower lobe and some of left lower lobe. Histoathological examination of the percutaneous lung biopsy specimen demonstrated that he had undifferentiated large cell carcinoma. The Authors have experienced a case of neurofibromatosis combined with undifferntiated large cell carcinoma. A brief review of related literature was conducted.

A Case of Hydranencephaly Combined with Twin Pregnancy

Hydranencehaly is an abnormality consisting of complete or almost absence of the cerebral hemispheres, which are replaced by a large fluid-filled cavity. The midbrain and brain stem are relatively intact, and rudiments of frontal, temporal and occipital cortex may be present. We diagnosed it through the evaluation of clinical features, prenatal US (intrauterine pregnancy, 37 wks) and brain CT. Authors have experienced a case of hydranencephaly combined with twin pregnancy and reported with a brief literature review.

Clinical Approach of Ultrasonography in the Diagnosis of Intussusception in Infant and Children

Thirty consecutive patient seen in a pediatric out patient and emergency department, in whom the diagnosis of intussusception was considered, had an ultrasound examination of the abdomen before the barium enema. The peak age was 5~12 month (range 4~34 month). Intussusception was detected by ultrasonography in all 25 cases proved by barium enema (sensitivity 100%). Normal findings on ultrasonography correlated with a negative barium enema results in 5 of 5 cases (negative predictive value=100%). No intussusception was missed by ultrasonography. To determine which patient would most benefit from ultrasonography, we divided patients into either a high risk group (100% intussusception) or a low risk group (37.5% intussusception) on the basis of clinical symptoms. We conclude that ultrasonography can be used as a rapid sensitive screening procedure in the diagnosis or exclusion of childhood intussusception. Probability of surgical reduction was associated with size of of total thickness and external rim thickness.

Two Cases of Toxic Shock Syndrome(TSS) in Infants

Much has been learned of the pathogenesis and pathophysiology of the toxic shock syndrome (TSS) since the initial description in 1978 by Dr. James K, Todd. The clinical illness is defined by the criteria listed in the case definition formulated for epidemiologic studies. With the advent of widespread recognition of TSS, there have been numerous published reports describing the clinical and laboratory findings, primarily in menstruating females. And there have been also reported about six cases in Korea. Moreover, TSS is uncommon in the prepubertal age group and no case report in infant in Korea. We experienced two cases of TSS in infants aged 11/2 yrs and 9 months associated with respiratory infection-pneumonia, pyopneumothorax and localized skin abscess that were confused with Kawasaki disease (KD). The diagnosis was made on the basis of clinical features and laboratory findings, and the cases met the Centers of Disease Control case definition of TSS. And thus we report these cases and review related literatures.