A Case of Peripheral Ulcerative Keratitis as Primary Herpes Simplex Infection in a Child

PURPOSE: To report a case of peripheral ulcerative keratitis in a case of primary herpes simplex infection. CASE SUMMARY: A 7-year-old male complaining of pain, redness, and decreased vision in the left eye 5 days in duration visited our clinic. The patient had also vesicular lesions over the edematous left upper eyelid. Slit-lamp examination revealed peripheral ulcerative keratitis with stromal infiltration involving the superior peripheral cornea. Corneal sensation in the left eye was decreased. The patient was advised to use topical and oral antiviral agents and a topical steroid. After 5 days of follow-up, the corneal lesions were decreased and vesicles were absent. Six months later, only minor opacities remained in the cornea. CONCLUSIONS: We report the first case report in Korea of peripheral ulcerative keratitis with blepharoconjunctivitis presented as primary herpes simplex infection which responded to antiviral and steroid treatment in a young male.

The Stereoscopic Acuity in Patients with Unilateral or Bilateral Visual Field Defects

PURPOSE: To evaluate the stereoscopic acuity in patients with unilateral or bilateral visual field defects. METHODS: Stereoscopic acuity was measured using the Titmus stereo test for 36 subjects with visual field defects (VFD). VFD was assessed by sum of MD (mean deviation, MDsum) and PSD (pattern standard deviation, PSDsum) of both eyes in Humphrey visual field test and presence of central VFD (within 30degrees isopter) in Goldman visual field test. 25 glaucoma subjects and 11 optic neuritis subjects were included. Patients with strabismus or ocular motility disorders which could affect stereoscopic acuity were excluded. RESULTS: The mean of MDsum was -20.10 +/- 12.31 dB (-45.13~-10.64 dB) and PSDsum was 13.10 +/- 8.76 dB (9.62-25.47 dB). The mean stereoscopic acuity was 710 +/- 922 arc sec (40-3000 arc sec) with Titmus stereo test. The associations between stereoscopic acuity and PSDsum (r = 0.400, p = 0.016), presence of central VFD within 30 degrees (r = 0.428, p = 0.03) were statistically significant. There was positive trend between stereoscopic acuity and duration of VFD, but with no statistical significance. CONCLUSIONS: Decreased stereoscopic acuity was associated with PSDsum and VFD in the central 30 degrees. We should consider this decrease of stereoscopic acuity as well when evaluating visual function of the patients with VFD.

The Stereoscopic Acuity in Patients with Unilateral or Bilateral Visual Field Defects

PURPOSE: To evaluate the stereoscopic acuity in patients with unilateral or bilateral visual field defects. METHODS: Stereoscopic acuity was measured using the Titmus stereo test for 36 subjects with visual field defects (VFD). VFD was assessed by sum of MD (mean deviation, MDsum) and PSD (pattern standard deviation, PSDsum) of both eyes in Humphrey visual field test and presence of central VFD (within 30degrees isopter) in Goldman visual field test. 25 glaucoma subjects and 11 optic neuritis subjects were included. Patients with strabismus or ocular motility disorders which could affect stereoscopic acuity were excluded. RESULTS: The mean of MDsum was -20.10 +/- 12.31 dB (-45.13~-10.64 dB) and PSDsum was 13.10 +/- 8.76 dB (9.62-25.47 dB). The mean stereoscopic acuity was 710 +/- 922 arc sec (40-3000 arc sec) with Titmus stereo test. The associations between stereoscopic acuity and PSDsum (r = 0.400, p = 0.016), presence of central VFD within 30 degrees (r = 0.428, p = 0.03) were statistically significant. There was positive trend between stereoscopic acuity and duration of VFD, but with no statistical significance. CONCLUSIONS: Decreased stereoscopic acuity was associated with PSDsum and VFD in the central 30 degrees. We should consider this decrease of stereoscopic acuity as well when evaluating visual function of the patients with VFD.

Bilateral Candida albicans Endophthalmitis after Robot-Assisted Laparoscopic Radical Prostatectomy in a Patient with Prostate Adenocarcinoma

PURPOSE: To report a case of bilateral Candida albicans endophthalmitis after robot-assisted laparoscopic radical prostatectomy (RALP) in a patient with prostate adenocarcinoma. CASE SUMMARY: A 61-year-old male patient had RALP for prostate adenocarcinoma. Four days after the surgery, the patient had a fever and pancytopenia. Two weeks after the surgery, the patient complained of decreased visual acuity in both eyes. Best-corrected visual acuity (BCVA) was counting fingers at 60 cm in the right eye and 20/63 in the left eye. The fundus examination showed vitreous opacity and yellow circumscribed chorioretinal lesions in both eyes. The blood and urine cultures were negative. An intravitreal voriconazole injection (100 microg/0.1 ml) was given in both eyes. However, the vitritis worsened, and BCVA decreased to counting fingers at 30 cm in the right eye and 60 cm in the left eye. Thus, combined phacoemulsification and 23-gauge microincisional vitrectomy surgery with a silicone oil injection was performed in both eyes at 1-week intervals. The vitrectomy sample culture was positive for Candida albicans in both eyes. Four months after the vitrectomy, BCVA was 20/100 in both eyes without subretinal lesions. CONCLUSIONS: Clinicians should be aware that bilateral Candida albicans endophthalmitis could be complicated by RALP in a patient with prostate adenocarcinoma or with other risk factors.

Hydrodynamic Relationship between Color Doppler Ultrasonography Findings and the Number of Internal Spermatic Veins in Varicoceles

PURPOSE: The improvement of testicular volume, testosterone levels and sperm concentration was suggested to be significantly associated with the number of internal spermatic veins (ISVs) ligated during varicocelectomy. Herein, we investigated preoperative color Doppler ultrasonography (CDU) findings as potential preoperative predictors of the number of ISVs requiring ligation during microsurgical subinguinal varicocelectomy. MATERIALS AND METHODS: In a prospective evaluation of 40 patients, maximal vein size and maximal reflux velocity were measured, while the total cross-sectional area of the affected testicular veins during a Valsalva maneuver was calculated using CDU by a single uroradiologist. Microsurgical subinguinal varicocelectomies were performed by one urologist. RESULTS: Among the semen parameters, semen morphology showed significant improvement (p=0.033), which was much clearer in the patients with a higher number of ISVs ligated than a lower number of ISVs ligated. Among the various preoperative variables, maximal reflux velocity and total cross-sectional area on CDU were related to the number of ISVs ligated (r=-0.442, p=0.004; r=0.594, p=0.000, respectively). Furthermore, univariate and multivariate linear regression analyses showed that maximal reflux velocity and total cross-sectional area on CDU were independent predictive factors of the number of ISVs ligated. CONCLUSION: Maximal reflux velocity and total cross-sectional area on CDU were related to the number of ISVs ligated. This means that the maximal reflux velocity and total cross-sectional area measured by preoperative CDU can predict the number of ISVs requiring ligation during microsurgical subinguinal varicocelectomy, which might be related to significant improvement of semen parameters after varicocelectomy.

Vardenafil Enhances Oxytocin Expression in the Paraventricular Nucleus without Sexual Stimulation / 대한배뇨장애요실금학회지

PURPOSE: Oxytocin is associated with the ability to form normal social attachments. c-Fos is an immediate early gene whose expression is used as a marker for stimulus-induced changes in neurons. The effect of phosphodiesterase-5 (PDE-5) inhibitors on oxytocin activation in the brain without sexual stimuli has not yet been reported. In the present study, we investigated the effects of vardenafil on oxytocin and c-Fos expression in the paraventricular nucleus (PVN) of conscious rats. METHODS: Male Sprague-Dawley rats weighing 300+/-10 g were divided into 6 groups (n=5 in each group): the control group, the 1-day-0.5 mg/kg, the 1-day-1 mg/kg, the 1-day-2 mg/kg, the 3-day-1 mg/kg, and the 7-day-1 mg/kg vardenafil administration group. The experiment was conducted without sexual stimulation. Vardenafil was orally administered. The animals in the control group received an equivalent amount of distilled water orally. The expression of oxytocin and c-Fos in the PVN was detected by immunohistochemistry. RESULTS: Oxytocin expression in the PVN was increased by 1 day administration of 2 mg/kg vardenafil, and this effect of vardenafil appeared in a duration-dependent manner. c-Fos in the oxytocin neurons of the PVN was increased by 1 day administration of 2 mg/kg vardenafil, and this effect of vardenafil also appeared in a duration-dependent manner. These results showed that vardenafil augments the expression of oxytocin with activation of oxytocin neurons in the PVN. CONCLUSIONS: In this study, we showed that the PDE-5 inhibitor, vardenafil directly enhances oxytocin expression and also activates oxytocin neurons in the PVN, which indicates that vardenafil may exert positive effects on affiliation behavior and social interaction.

The Establishment of Dendritic Cell-Tumor Fusion Vaccines for Hormone Refractory Prostate Cancer Cell

PURPOSE: Dendritic cell (DC)-based tumor vaccine is an attractive modality for the treatment of hormone-refractory prostate cancer (HRPC) because it has some efficacy and few side effects in patients with poor general conditions. The aim of this study was to establish which is the most effective DC vaccine for the treatment of HRPC. We compared DC vaccine sensitized with tumor lysate and a fusion vaccine of DCs and tumor cells. MATERIALS AND METHODS: The DU145 cancer cell line was purchased from the American Type Culture Collection. DCs were cultured from peripheral blood monocytes. Peripheral blood monocytes were cultured in RPMI 1640 medium supplemented with interleukin-4 (IL-4), granulocyte-macrophage colony-stimulating factor, and 10% fetal calf serum. Tumor necrosis factor-alpha was added on day 7 to support maturation. Functional activity was measured in three groups: the DC single-culture group, the DC culture group with DC vaccine sensitized with tumor lysates, and the DC culture group prepared with tumor fusion vaccine made from irradiated tumor cells and monocyte-derived DCs by the polyethylene glycol method. RESULTS: By FACS analysis, the rate of DC-tumor fusion vaccine was 20.3+/-3%. The IL-12 level produced by the DC-tumor fusion vaccine was significantly higher than that of DCs pulsed with tumor lysate (p<0.05). Also, the generation of interferon-gamma by tumor-specific T cells in the DC-tumor fusion vaccine group was superior to that of DCs pulsed with tumor lysate (p<0.05). In addition, the T cells of the tumor lysate-pulsed DCs and tumor fusion vaccine had 1.6 and 2.5 times the functional activity, respectively, of the DC single-culture group in killing tumor cells in the cytotoxicity assay. CONCLUSIONS: The DC-tumor fusion vaccine seems to be more effective than DC single-culture or DC-tumor lysate vaccine in the treatment of HRPC.

Postpartum Emphysematous Cystitis after Casarean Section

Emphysematous cystitis is a rare infectious condition of the urinary bladder. Underlying diabetes mellitus is present in over half of reported cases with women being affected twice as often as men. It also occurs in alcoholism, undernutrition, radiating and immunosuppressive treatments. We present a case of postpartum emphysematous cystitis after Casarean section (C-sec) in a young female without underlying disease.