Orbital Apex Syndrome Caused by Co-infection of Actinomyces with Invasive Fungal Sinusitis

Purpose@#We report a case of orbital apex syndrome caused by co-infection of Actinomyces and Aspergillus invasive fungal sinusitis.Case summary: An 87-year-old female visited our clinic for decreased visual acuity which began 2 weeks prior to her visit. She had a history of angina and uncontrolled diabetes. Her best-corrected visual acuity (BCVA) of the left eye was 0.2, the intraocular pressure was in the normal range, and mild ptosis with impaired abduction was noted. Gadolinium-enhanced brain magnetic resonance imaging showed left maxillary sinusitis and an enhanced lesion invading the pterygopalatine fossa. Functional endoscopic sinus surgery was performed by an otorhinolaryngologist. Pathology revealed co-infection with Aspergillus and Actinomyces. Her left BCVA was negative light perception despite surgery and impaired abduction progressed to total ophthalmoplegia. @*Conclusions@#We report a case of orbital apex syndrome caused by invasive fungal sinusitis with a rare co-infection of Actinomyces and Aspergillus.

Conjunctival Fibroma after Excision of a Recurrent Pterygium

Purpose@#To report a case of conjunctival fibroma after excision of a recurrent pterygium.Case summary: A 44-year-old male was referred with pterygium recurrence. The patient had undergone pterygium surgery on his left eye 7 years prior. Examination of the conjunctiva revealed fibrovascular proliferative tissue that had grown onto the cornea at the medial limbus in his left eye. The patient underwent pterygium excision, amniotic membrane transplantation, and intraoperative 0.02% mitomycin C soaking. Pterygium was confirmed histologically. Two years after surgery, a 5 × 3 mm semi-translucent, white conjunctival mass at the medial limbus was found in the left eye. The best-corrected visual acuity was 1.0 in both eyes and the intraocular pressure was within normal limits. Suspecting recurrent pterygium, the patient underwent excision of the conjunctival mass, conjunctival autograft, and 0.02% mitomycin C soaking during surgery. Under histologic examination, paucicellular substantia propria with abundant collagen and scattered fibroblasts was observed; the mass was diagnosed as conjunctival fibroma. No sign of recurrence was evident 2 years postoperatively. @*Conclusions@#Although conjunctival mass after pterygium excision is likely to be recurrent pterygium in most cases, there is the rare possibility of conjunctival fibroma; thus, histologic examination should be performed for differential diagnosis.

Age-related Clinical Analysis of Bacterial Keratitis in Daejeon and Chungcheong Provinces: a Multicenter Study

Purpose@#The purpose of this study was to investigate the age-related clinical features, risk factors, and prognoses of bacterial keratitis in Daejeon and Chungcheong provinces and the patterns and trends of fluoroquinolone antibiotic susceptibility. @*Methods@#Medical records of 433 patients (433 eyes) who visited one of the five university hospitals in Daejeon and Chungcheong provinces and were diagnosed as culture-positive bacterial keratitis between January 2000 to December 2018 were reviewed retrospectively. The patients were divided into younger and older groups based on an age of 60 years. Predisposing factors, prognostic factors, treatment method, causative organisms, and susceptibility to fluoroquinolone were analyzed. @*Results@#Two hundred seventy three males (63.0%) and 160 females (37.0%) were included. The most common risk factors in the younger group were contact lens wear (27.5%) and trauma and foreign body (27.0%). The most common risk factors in the older group were trauma and foreign body (30.5%). Staphylococcus species was the most common causative Gram-positive bacteria, regardless of age, and Pseudomonas species was the most common among Gram-negative bacteria. The older group tended to have more severe keratitis required more surgical treatment and had a worse visual outcome than the younger group (p 0.05). @*Conclusions@#Bacterial keratitis in Daejeon and Chungcheong provinces indicated more severe clinical aspects and worse prognoses in older patients showing similar results from previous studies. Caution regarding trauma and foreign bodies and managing previous ocular disease is necessary for all age groups. Education regarding adequate contact lens care and hygiene is required for younger (<60 years) patients.

Conjunctival Fibroma after Excision of a Recurrent Pterygium

Purpose@#To report a case of conjunctival fibroma after excision of a recurrent pterygium.Case summary: A 44-year-old male was referred with pterygium recurrence. The patient had undergone pterygium surgery on his left eye 7 years prior. Examination of the conjunctiva revealed fibrovascular proliferative tissue that had grown onto the cornea at the medial limbus in his left eye. The patient underwent pterygium excision, amniotic membrane transplantation, and intraoperative 0.02% mitomycin C soaking. Pterygium was confirmed histologically. Two years after surgery, a 5 × 3 mm semi-translucent, white conjunctival mass at the medial limbus was found in the left eye. The best-corrected visual acuity was 1.0 in both eyes and the intraocular pressure was within normal limits. Suspecting recurrent pterygium, the patient underwent excision of the conjunctival mass, conjunctival autograft, and 0.02% mitomycin C soaking during surgery. Under histologic examination, paucicellular substantia propria with abundant collagen and scattered fibroblasts was observed; the mass was diagnosed as conjunctival fibroma. No sign of recurrence was evident 2 years postoperatively. @*Conclusions@#Although conjunctival mass after pterygium excision is likely to be recurrent pterygium in most cases, there is the rare possibility of conjunctival fibroma; thus, histologic examination should be performed for differential diagnosis.

Age-related Clinical Analysis of Bacterial Keratitis in Daejeon and Chungcheong Provinces: a Multicenter Study

Purpose@#The purpose of this study was to investigate the age-related clinical features, risk factors, and prognoses of bacterial keratitis in Daejeon and Chungcheong provinces and the patterns and trends of fluoroquinolone antibiotic susceptibility. @*Methods@#Medical records of 433 patients (433 eyes) who visited one of the five university hospitals in Daejeon and Chungcheong provinces and were diagnosed as culture-positive bacterial keratitis between January 2000 to December 2018 were reviewed retrospectively. The patients were divided into younger and older groups based on an age of 60 years. Predisposing factors, prognostic factors, treatment method, causative organisms, and susceptibility to fluoroquinolone were analyzed. @*Results@#Two hundred seventy three males (63.0%) and 160 females (37.0%) were included. The most common risk factors in the younger group were contact lens wear (27.5%) and trauma and foreign body (27.0%). The most common risk factors in the older group were trauma and foreign body (30.5%). Staphylococcus species was the most common causative Gram-positive bacteria, regardless of age, and Pseudomonas species was the most common among Gram-negative bacteria. The older group tended to have more severe keratitis required more surgical treatment and had a worse visual outcome than the younger group (p 0.05). @*Conclusions@#Bacterial keratitis in Daejeon and Chungcheong provinces indicated more severe clinical aspects and worse prognoses in older patients showing similar results from previous studies. Caution regarding trauma and foreign bodies and managing previous ocular disease is necessary for all age groups. Education regarding adequate contact lens care and hygiene is required for younger (<60 years) patients.

Surgical Treatment of Sensory Cyclic Esotropia

No abstract available.

Risk Factor Analysis of Diabetic Retinopathy Diagnosed with Non-mydriatic Fundus Camera: KNHANES V

PURPOSE: To clarify the relationship between various factors (sociodemographic factors, health behavioral risk factors and health status, and diabetic factors) related to diabetic retinopathy and to suggest improvements regarding the associated medical examination. METHODS: The subjects were 1,444 diabetic patients diagnosed in the 5th Korean National Health and Nutrition Examination Survey (KNHANES), aged 19 years or older, who underwent non-mydriatic fundus photography. The criteria for diagnosing diabetes were a fasting glucose level ≥ 126 mg/dL and a previous diagnosis of diabetes or currently undergoing treatment. The diagnosis of diabetic retinopathy followed the modified Airlie House classification. Univariate and multivariate analyses of diabetic retinopathy were performed. RESULTS: Among the 1,444 patients who were diagnosed with diabetes, 277 had diabetic retinopathy; the prevalence rate was 19.18%. The higher the body mass index, the lower the risk of diabetic retinopathy by 0.924 times (p = 0.001; 95% confidence interval [CI], 0.883–0.966). The longer the duration of diabetes, the greater the risk of diabetic retinopathy; the prevalence period group of more than 11 years had a 26.025-fold higher risk than the newly diagnosed group (p < 0.001; 95% CI, 10.840–62.482). The risk of diabetic retinopathy increased with the hemoglobin A1c (HbA1c) level; the risk was 5.973-fold higher in the group with HbA1c above 11.0% (p < 0.001; 95% CI, 2.984–11.956) compared with the group with HbA1c < 6.0%. The risk of diabetic retinopathy was 2.050-fold greater with insulin injections (p = 0.003; 95% CI, 1.284–3.275). CONCLUSIONS: The risk of diabetic retinopathy was higher in patients with a longer duration of diabetes, a high HbA1c level, and in those using insulin. These findings highlight the need for early education and ophthalmologic examinations for at-risk patients.

Clinical Analysis of Recurrent Inguinal Hernias

PURPOSE: Recurrent inguinal hernia repairs provide a considerable technical challenge and greater risk of further recurrence. The purpose of this study was to establish a preventive method and management plan for recurrent inguinal hernia. METHODS: The medical records of adult having undergone an inguinal hernia operation at the Dankook university hospital, between June 1994 and December 2004, were analyzed. The patients' characteristics, types of hernia and operation methods were recorded. In the recurrent cases, the numbers and names of previous operation, types of recurrent hernia, and times to reoperation were analyzed. RESULTS: Of the 470 inguinal hernia cases, 35 were operated on for a recurrent hernia. With the recurrent hernias, the operation times were longer and the use of general anesthesia was more frequent. Of the recurrent hernia types, direct hernias were the most frequent. More than half the recurrent hernias were operated on 5 years after the primary hernia repairs. The recurrent hernia was treated with or without a mesh in 33 (94.3%) and 2 cases (5.7%), respectively. In the previous operations, mesh had or had not been used in 30 (85.7%) and 5 cases (14.3%), respectively. CONCLUSION: In the recurrent hernia group, the most frequent type of previous repair was an operation without a mesh. A direct hernia was the most frequent type of recurrence. The recurrent hernias were mostly repaired using a mesh.

Long Gap Esophageal Atresia Successfully Treated by Esophageal Lengthening Using External Traction Sutures

The repair of esophageal atresia with a long gap still continues to pose difficulties for the surgeon. There is general agreement that the child's own esophagus is best, but it is also believed that a primary repair is not always possible. Foker JE et al. (1997) developed a technique of esophageal lengthening using external traction sutures. We experienced one case of esophageal atresia with a 4.5cm gap (4 vertebral spaces) which was repaired using the external traction suture technique.

Small Bowel Perforation by a Fish Bone in Intestinal Obstruction: A Case Report

Intestinal perforation by an ingested foreign body is uncommon, and less than 1% lead to intestinal perforation. The diagnosis of fish-bone-induced intestinal perforation is difficult because of the rare history of foreign body ingestion, various clinical presentations, and the radiolucent character of fish bone. Usually, the correct diagnosis is established after an operation. We experienced a rare case of small bowel perforation induced by a fish bone accompanying an intestinal obstruction due to previous operation. Foreignbody-induced perforation is relatively rare, but it should be considered in the case of an acute abdomen.

Comparison of Respiratory Symptom between Urban and Rural Residents / 예방의학회지

This paper was carried out for comparison of respiratory symptoms between urban and rural residents that is somewhat related to air pollution. And as urban residents, 470 persons of Daegu (Taegu) and 364 of Pohang were selected and 472 rural residents were also, in Eus ng-Gun, those who were responded to questionnaire distributed from April 10, 1984 to April 30 through students of middle or high school. The subjects were families of the student. The questionnaire was appropriately modified the item B of Cornell Medical Index by author. Looking into the rate of complaints about each part, generally, the rate in urban is higher than that in rural. Particularly it is higher to 'feeling a choking lump or swelling of throat', 'the sputum' and 'the asthma' in the city (p<0.05). On the contrary, women in the farm village, to 'caught a severe cold' as compared with the city. In men under nineteen years of age, it is higher than the farm village to 'feeling a choking lump or swelling of throat' of Pohang (p<0.05). But in men forties, it is higher than the city that farm people are 'soaking sweat at night' and 'foreign body sensation on throat'. Students hardly differ between the two ares, while the group having occupation in Pohang felt more in 'feeling a choking lump or swelling of throat' than the farm residents. As the result, I consider that the rural residents were much affected by physical fatigue and pesticides, and the urban, by some problems of industrial fuel, traffic gas and various dusts.