Omphalomesenteric Fistula Presenting with Meconium Discharge from the Umbilicus / 이화의대지

The omphalomesenteric duct is an embryologic connection between the midgut and yolk sac, which typically disappears at 5th to 7th week of gestation. Failure of the obliteration process can lead to omphalomesenteric duct remnants. We report a case of a neonate with a patent omphalomesenteric duct fistula opening to the umbilicus presenting with meconium sprouting from the umbilical stump. Segmental resection of the ileum and end to end anastomosis were conducted. The patient was discharged on the 8th postoperative day without any complications, and no abnormalities were observed at the outpatient clinic follow-up up to 5 months after surgery. Here we describe the case and a review of the literature.

Omphalomesenteric Fistula Presenting with Meconium Discharge from the Umbilicus / 이화의대지

The omphalomesenteric duct is an embryologic connection between the midgut and yolk sac, which typically disappears at 5th to 7th week of gestation. Failure of the obliteration process can lead to omphalomesenteric duct remnants. We report a case of a neonate with a patent omphalomesenteric duct fistula opening to the umbilicus presenting with meconium sprouting from the umbilical stump. Segmental resection of the ileum and end to end anastomosis were conducted. The patient was discharged on the 8th postoperative day without any complications, and no abnormalities were observed at the outpatient clinic follow-up up to 5 months after surgery. Here we describe the case and a review of the literature.

Clinical and Demographic Characteristics of Blepharoptosis in Korea: A 24-year Experience including 2,328 Patients

PURPOSE: To describe the demographics, relative incidence of subtypes, and clinical characteristics of blepharoptosis in Korean patients. METHODS: This is a retrospective, observational case series consisting of 2,328 patients who underwent ptosis surgery from 1991 to 2014 at a tertiary referral hospital in Korea. The patients were classified according to the type of ptosis and the evaluation of clinical characteristics including levator muscle function (LF) and degree of ptosis. RESULTS: Of the 2,328 patients, 1,815 (78%) had congenital ptosis and 513 (22%) had acquired ptosis. Simple congenital ptosis is the most common type overall (73.7%), and aponeurotic ptosis is the most common acquired type. More than three-quarters of eyes with congenital ptosis were affected in a moderate (34.4%) to severe degree (41.3%), and most of these eyes had fair (33.7%) to poor LF (60.1%). Among eyes with acquired ptosis, approximately three-quarters were affected in a mild (33.3%) to moderate degree (41.0%), with 63.3% of these eyes having good LF. The most widely used surgical technique was frontalis suspension (55.1%), followed by levator resection (29.0%) and aponeurosis repair (14.8%). At 3 years after the first surgery, 15.7% of patients with congenital ptosis and 10.4% of patients with acquired ptosis underwent reoperation. CONCLUSIONS: Although the prevalence has decreased from previous years, the proportion of cases with congenital ptosis was higher in this study than has been shown in research conducted in the West. The majority of eyes with congenital ptosis was affected to a severe degree and had poor LF, while those with acquired ptosis were affected to a moderate degree and had good LF. More cases with acquired ptosis presented with fair to poor LF, and frontalis suspension surgery was performed more commonly compared to previous studies. The reoperation rate was higher in congenital ptosis compared to acquired ptosis.

Effects of Triamcinolone-soaked Packing for Endonasal Revision in Patients with Failed Endoscopic Dacryocystorhinostomy

PURPOSE: To evaluate the efficacy of endonasal revision using triamcinolone-soaked nasal packing in patients exhibiting recurrence of epiphora after endoscopic dacryocystorhinostomy. CASE SUMMARY: Four patients (4 eyes) who presented with the chief complaint of recurrence of epiphora after endoscopic dacryocystorhinostomy underwent endonasal revision under local anesthesia. On nasal endoscopy, granulation tissue and membranous tissue around the osseous foramen was removed during endonasal revision. According to the operator's judgement, the osseous foramen was additionally expanded. Following insertion of a silicone tube, triamcinolone-soaked nasal packing was used for intra-nasal packing. The silicone tube was removed after follow-up of more than 12 weeks. Immediately after removing the silicone tube, there was free passage of saline on lacrimal syringing as well as complete resolution of epiphora. At over 6 months of follow-up after tube removal, there was no recurrence of epiphora in any of the 4 patients. CONCLUSIONS: Triamcinolone-soaked nasal packing may be considered in patients with failed endoscopic dacryocystorhinostomy.

Clinical Characteristics of Idiopathic Orbital Inflammation Accompanied with Paranasal Sinusitis

PURPOSE: To investigate the clinical characteristics of idiopathic orbital inflammatory disease (IOI) with paranasal sinusitis. METHODS: This study is a retrospective, comparative case series of patients who were diagnosed with IOI between January 2009 and December 2016. This study included patients with available medical and radiologic data at diagnosis and who participated in follow-up for more than 12 months after treatment. The patients were divided into two groups according to accompaniment of paranasal sinusitis and were compared. RESULTS: Among 101 patients with IOI, 13 (12.9%) were identified to have paranasal sinusitis. The incidence of pain was higher in patients with sinusitis (69.2%) than in patients without sinusitis (25.0%, p = 0.003). More patients with paranasal sinusitis experienced recurrence after systemic steroid therapy (69.2%) than in the other group (34.1%, p = 0.033). Additional immunosuppressants and/or radiation therapy were needed only in 9.1% patients without sinusitis but in 38.5% patients with sinusitis (p = 0.039). CONCLUSIONS: IOI patients with sinusitis showed a significantly higher recurrence rate. More careful follow-up of patients during steroid tapering and treatment of sinusitis might be helpful to prevent recurrence of IOI.

Case Reports of Lacrimal Sac Tumors Discovered in Patients with Persistent Epiphora Following Dacryocystorhinostomy

No abstract available.

Successful Treatment of Orbital Lymphangioma with Intralesional Bleomycin and Application of Continuous Negative Pressure

No abstract available.

Development of Thyroid-Associated Ophthalmopathy in Patients Who Underwent Total Thyroidectomy

PURPOSE: To report clinical characteristics of thyroid-associated ophthalmopathy (TAO) in patients who previously underwent total thyroidectomy for thyroid cancer or a benign mass of the thyroid. MATERIALS AND METHODS: Of the patients who were diagnosed with TAO from March 2008 to March 2012, we performed a retrospective chart review on those who had undergone total thyroidectomy for thyroid cancer or a benign mass of the thyroid before the occurrence of ophthalmopathy. RESULTS: Of the 206 patients diagnosed with TAO, seven (3.4%) met the inclusion criteria. The mean age of the subjects was 47.4 years, and all were female. Six patients were diagnosed with papillary thyroid cancer, and one was diagnosed with a benign mass. The duration between total thyroidectomy and onset of TAO ranged from 3-120 months (median 48 months). Ophthalmic manifestations varied among cases. Except for the patient who was diagnosed with a benign mass, all patients showed hyperthyroid status and were under Synthroid hormone treatment at the time of TAO development. Five of these six patients had positive levels of thyroid-stimulating hormone (TSH) receptor autoantibodies. CONCLUSION: TAO rarely develops after total thyroidectomy, and the mechanism of TAO occurrence is unclear. However, most patients showed abnormalities in thyroid function and TSH receptor autoantibodies.

A Case of Surgical Management for Orbital Organizing Hematoma from Orbital Varix

PURPOSE: Orbital varices, which can lead to proptosis or globe displacement, are caused by Valsalva's maneuver or bending forward. Most of the orbital varices are treated conservatively, but surgical treatment is necessary for severe cosmetic or functional problems. We report a case of orbital organizing hematoma accompanied by an orbital varix which was successfully removed surgically without complications such as intraoperative bleeding. CASE SUMMARY: A 78-year-old female presented with the complaint of 4 mm proptosis and hyperglobus of left eye. Orbit magnetic resonance imaging (MRI) showed a well demarcated extraconal mass in the inferior orbit which appeared to be an orbital varix. Initially, we decided to monitor the patient without surgery because proptosis was reduced to 1 mm within a week. However, after 5 months, the symptoms suddenly worsened, specifically, 4 mm of proptosis with severe hyperglobus and pain. MRI showed a 29.7 x 21.2 x 23.7 mm mass compressing the globe upward. Six weeks of conservative care did not improve the symptoms and we eventually performed an anterior orbitotomy through the inferior conjunctiva. There was a minor bleeding during the surgery. Based on the histological test, the mass was determined to be an organizing hematoma covered by a membrane. At 8 months postoperatively, symptoms had not recurred. CONCLUSIONS: Orbital varices are usually treated conservatively since its surgical removal is known to have risks. Nonetheless, if an MRI shows an orbital organizing hematoma, it can be surgically debulked successfully without complications when a chronic hemorrhage from orbital varix causes serious proptosis and globe deviation.

Development and Effect of a Metabolic Syndrome Prevention Program for University Students using Mobile Application

PURPOSE: The purpose of the study was to develop and evaluate the effect of a metabolic syndrome prevention program using mobile application for university students. METHODS: A pretest-posttest design with content analysis as a triangulation method was used. The participants were 49 university students. Data were analyzed using descriptive statistics, chi2-test, t-test and Fisher's exact test with the SPSS WIN 18.0 program. RESULTS: The application consisted of six main menus as follows: 'basic education', 'nutrition education', 'exercise education', 'meal diary', 'exercise checkup', and 'tips'. The experimental group had higher recognition about metabolic syndrome prevention than the control group (F=7.919, p=.007). Understanding of metabolic syndrome among participants was mostly related to chronic diseases such as obesity, hypertension and diabetes in relation to the importance of eating habits and exercising. CONCLUSION: The results indicate that metabolic syndrome prevention education using mobile application is necessary and would be useful for university students.

Retinal Nerve Fiber Layer Defect Associated with Astrocytic Hamartoma in a Patient with Tuberous Sclerosis

PURPOSE: To report the progression of an astrocytic hamartoma of the right optic nerve head as well as the retina, and the progression of retinal nerve fiber defect associated with astrocytic hamartoma in a patient with tuberous sclerosis. CASE SUMMARY: A 6-year-old boy with tuberous sclerosis and an astrocytic hamartoma of the right optic nerve head, which was found at the time of ophthalmologie examinations, was referred from the pediatric neurologist for evaluation of the vigabatrin-associated visual field changes. Fundus examination revealed 1/2 disc diameter (DD)-sized astrocytic hamartoma located at the margin of the superior part of the optic nerve. The retina of the left eye was normal. Eighteen months after the first visit, enlarged optic disc hamartoma of the right eye and newly onset retinal astrocytic hamartoma located approximately 1.5 DD inferior to the fovea of the left eye were found. Three years later, an increase in the size of the astrocytic hamartoma of the right optic nerve and development of retinal nerve fiber defects were observed. CONCLUSIONS: Astrocytic hamartoma in patients with tuberous sclerosis is usually stable without progression. However, in our patient, astrocytic hamartoma showed progression, and development of retinal nerve fiber defects occurred. Regular follow-up is necessary for astrocytic hamartoma in patients with tuberous sclerosis.

Two Cases of Metronidazole-Induced Neurotoxicity Lacking of Clinico-Radiological Correlation

Metronidazole is an antimicrobial agent widely used for the treatment of trichomoniasis, giardiasis, amebiasis, and anaerobic bacterial infections. It has been reported that metronidazole-induced neurotoxicity is associated with responsible lesions on brain MRI. We report 2 patients with metronidazole-induced neurotoxicity, who had no responsible lesions on brain MRI for their neurological deficits. The pathogenic mechanisms are discussed.