A Case of Acquired Lacrimal Fistula Caused by Silicone Tube Remnant

PURPOSE: To report a case of acquired lacrimal fistula caused by silicone tube remnant. CASE SUMMARY: A 56-years-old female who suffered from purulent discharge in inner skin of the right lower eyelid visited our clinic. Lacrimal fistula was found in the skin at the medial side of the right lower eyelid. The patient reported that she had a silicone tube intubation operation 3 years prior due to a nasolacrimal obstruction of right eye. On syringing test, saline solution and purulent discharge were drained from the fistula skin opening and there was no nasolacrimal obstruction. After admission, antibiotic treatment and potadine soaking dressing were performed to facilitate spontaneous closing of the lacrimal fistula. However, the lacrimal fistula relapsed and lacrimal fistulectomy and bicanalicular silicone tube intubation were performed. During surgery, silicone tube remnant material not totally extubated at the lacrimal sac was found which we removed. Postoperatively, systemic antibiotic therapy was administered and the chronic inflammation improved. CONCLUSIONS: We report a case of lacrimal fistula caused by silicone tube remnant in the lacrimal sac. Acquired lacrimal fistula caused by a silicone tube remnant can be treated by fistulectomy and silicone tube remnant removal.

A Case of Acquired Lacrimal Fistula Caused by Silicone Tube Remnant

PURPOSE: To report a case of acquired lacrimal fistula caused by silicone tube remnant. CASE SUMMARY: A 56-years-old female who suffered from purulent discharge in inner skin of the right lower eyelid visited our clinic. Lacrimal fistula was found in the skin at the medial side of the right lower eyelid. The patient reported that she had a silicone tube intubation operation 3 years prior due to a nasolacrimal obstruction of right eye. On syringing test, saline solution and purulent discharge were drained from the fistula skin opening and there was no nasolacrimal obstruction. After admission, antibiotic treatment and potadine soaking dressing were performed to facilitate spontaneous closing of the lacrimal fistula. However, the lacrimal fistula relapsed and lacrimal fistulectomy and bicanalicular silicone tube intubation were performed. During surgery, silicone tube remnant material not totally extubated at the lacrimal sac was found which we removed. Postoperatively, systemic antibiotic therapy was administered and the chronic inflammation improved. CONCLUSIONS: We report a case of lacrimal fistula caused by silicone tube remnant in the lacrimal sac. Acquired lacrimal fistula caused by a silicone tube remnant can be treated by fistulectomy and silicone tube remnant removal.

A Case of a Congenital Lacrimal Outflow Dysgenesis with Supernumerary Lacrimal Puncta

PURPOSE: To report a case of congenital lacrimal outflow dysgenesis with supernumerary lacrimal puncta. CASE SUMMARY: A 45-years-old woman presented with chronic bilateral epiphora with no specific medical history. Slit-lamp examination revealed bilateral upper and lower double puncta. The accessory puncta were situated along the lid margin, medial to the normal one and had a typical slit configuration. Additionally, there was a lower canalicular system block that appeared unresponsive to simple probing. Bilateral endoscopic conjunctivodacryocystorhinostomy with Jones tube was performed. Chronic bilateral epiphora was relieved after bilateral endoscopic conjunctivodacryocystorhinostomy with Jones tube. CONCLUSIONS: A case of congenital lacrimal outflow dysgenesis with supernumerary lacrimal puncta was observed, which has not been previously reported in Korea. Surgical repair of the congenital lacrimal outflow dysgenesis with supernumerary lacrimal puncta should be considered to achieve a functional recovery of the lacrimal drainage system.

Various Treatments Using Invaluable Donor Cornea

PURPOSE: To report cases of transplanting a donor's 2 corneas to 5 patients suffering from several corneal diseases. CASE SUMMARY: Two corneas were donated from a 66-year-old donor, who suffered from brain damage due to asphyxia, one hour after being pronounced dead by doctors. Two penetrating keratoplasties and 3 partial lamellar keratoplasties were performed for patients with corneal opacity, corneal ulcer and corneal perforation. After the procedure all grafts were stable. CONCLUSIONS: Under the present circumstances of decreasing donations of corneas after death and the increasing demand for keratoplasty in Korea, the mutual cooperation among hospitals to treat more than one patient using one donated cornea is a method the authors believe can alleviate this situation.

Protective Effects of Epigallocatechin Gallate after UV Irradiation in Cultured Human Retinal Pigment Epithelial Cells

PURPOSE: To evaluate the protective effects of Epigallocatechin gallate (EGCG) against UV irradiation in cultured human retinal pigment epithelial (RPE) cells. METHODS: UV irradiation was produced by a UV lamp for 30 seconds with an irradiance of 3.3 mW/cm2. After 5 minutes and 1 hour, we administered different concentrations of EGCG (0, 5, 10, 15, 25, 50, 100 uM). The cell count was determined under a microscope using a counting chamber and the cell activity was evaluated by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay. RESULTS: The cell count of cultured human RPE cells after UV irradiation was markedly increased in the EGCG administration group, compared with the non-administrated group. The cell activity of the cultured human RPE cells after UV irradiation was markedly increased in the EGCG administration group and was increased in a dose-dependent way as determined by the MTT assay. CONCLUSIONS: The administration of EGCG increased the cell count and the cell activity after UV irradiation in cultured human retinal pigment epithelial cells; this suggests that EGCG provided protection against UV damage in cultured human retinal pigmented epithelial cells.

A Case of a Solid and Papillary Epithelial Neoplasm of the Pancreas with Local Invasion into the Duodenum / 대한소화기내시경학회지

A solid and papillary epithelial neoplasm of the pancreas is a very rare and low-grade type of malignancy, although an increasing number of cases have been reported in recent years. Patients with a solid and papillary epithelial neoplasm of the pancreas have a good prognosis and may be cured if the disease is diagnosed before metastasis and diffuse local invasion. A 23-year-old female who had a 4-year history of recurrent abdominal pain, was admitted due to lower abdominal pain. Incidentally a calcified, 6 4 cm sized ovoid mass was found in the right upper quadrant, from a simple abdominal X-ray. An ERCP, abdominal sonography, and CT were performed, as well as a pylorus preserving pancreatoduodenectomy. Gross pathologic examination revealed a well encapsulated mass with cystic degeneration and hemorrhagic necrosis. Microscopically, the tumor had papillary fronds with a fibrovascular connective tissue core. There was focal infiltration of tumor cells into the duodenal wall and heterotropic pancreatic tissue in the submucosa. Immunohistochemistry revealed positivity for neuron-specific enolase. The patient maintained a healthy status for one year since the operation.

A Clinical Analysis of an Esophageal Hiatal Hernia and Reflux Esophagitis - The relationship with weight, alcohol, smoking, coffee, H. pylori infection / 대한소화기내시경학회지

BACKGROUND AND AIMS: The importance of esophageal hiatal hernias in the pathogenesis of gastroesophageal reflux disease has been debated. It has been reported that a variety of factors are associated with hiatal hernias and esophagitis. The purpose of this study was to determine the correlation between hiatal hernia, reflux esophagitis and weight, alcohol, smoking, coffee and H. pylori infection. METHODS: 660 consecutive patients who had undergone an esophagogastroduodenoscopy due to upper gastrointestinal symptoms were reviewed. A diagnosis of hital hernia was made when the distance between the diaphragmatic crus and the tubular esophagus exceeded 1.5 cm, and the presence of a hernia sac at the U turn of the scope. RESULTS: Among the 660 cases, 71 cases (10.8%) of hiatal hernia and 30 cases (4.5%) of reflux esophagitis were noted. The male-to-female ratio was 1.6:1 and 4.3:1, respectively. The most common age group involved the fifth decade and sixth decade. Reflux esophagitis was found in 13 (18.3%) of 71 patients with hiatal hernias. Hiatal hernias were found in 36 (17.9%) of 201 patients who were overweight (BMI>23) and in 43 (23%) of 187 patients who were smokers. Reflux esophagitis was found in 23 (11.9%) of 194 patients who were alcohol drinkers and in 21 (11.2%) of 187 patients who were smokers. H. pylori infection was present in 36 (50.7%) of 71 patients with hiatal hernias, and 17 (56.2%) of 30 patients with reflux esophagitis. CONCLUSIONS: The rate of the hiatal hernia was significantly higher in patients who were overweight and smokers. The rate of reflux esophagitis was significantly higher in patients who were alcohol drinkers and smokers. But in multivariate analysis, none were risk factors associated with hiatal hernias or reflux esophagitis.

Anthropometric Measurement of Newborn in Women with Gestational Diabetes Mellitus

PURPOSE: To find the anthropometric characteristics of newborn in women with gestational diabetes mellitus(GDM), and the relationship between the birth weight and anthropometric measurements of newborn, maternal body habitus and glycemic control in GDM group. METHODS: Maternal weight, height, and obstetric history of 82 women with GDM and 93 women with normal glucose tolerance were recorded at the time of screening test and delivery. Within 2 days after birth, the birth weight and anthropometric measurements were obtained, and maternal glycohemoglobin concentrations were measured and umbilical cord blood samples for C-peptide were collected in GDM group at delivery. RESULTS: There were no differences in the birth weight and frequency of LGA newborn between GDM and control group, although the primary C-section of GDM group was significantly higher compared with the control group. The abdominal circumference(AC) and triceps, subscapular, and thigh skinfold thickness(SFT) of newborn in GDM group were significantly increased compared with the control group. Maternal glycohemoglobin concentration was correlated with birth weight, but not with AC and three SFTs in GDM group. Umbilical cord blood C-peptide level had a correlation with birth weight and three SFTs in GDM group. Newborn's AC had a correlation with maternal weight and weight gain in GDM group, but not in control group. CONCLUSION: Although the birth weight and frequency of LGA did not differ, AC and triceps, subscapular, and thigh SFT were increased in GDM group. These increases of anthropometric measurements were observed in AGA newborn, and were greater in LGA newborn.

Relationship of Ultrasonographic Findings and Neurologic Outcomes in Infants with Birth Weight of Less than 2,000gm

PURPOSE: In premature, neurologic sequelae is most important long-term complication. So we investigated the relationship between brain ultrasonographic findings and neurologic outcome. METHODS: Infants weighting less than 2,000gm who were discharged from the Neonatal Intensive Care Unit of Seoul National University Children's Hospital from Jan 1, 1989 to Dec. 31 1992, were investigated. All ultrasound images were examined for evidence ICH/IVH, periventricular echogenicity, and cystic PVL. Infants were assessed neurodevelopmentally in the neonatal period and at least until 12 months corrected for gestation age. RESULTS: 1) Total 291 infants were discharged, but expired, against medical advice discharged, and lost follow-up infants were exculded, 187 infants were investigated for the realtionship between brain ultrasonographic findings and neurologic outcomes. 2) The proportion of infants with neurologic sequelae (cerebral palsy) according to birth weight was as follow: 4 cases (50%) of less than 1,000gm; 13 cases (24.5%) of between 1,001gm and 1,500gm; 11 cases (5.6%) of between 1,501gm and 2,000gm, 3) The proportion of infants with neurologic sequelae according to intraventricular hemorhage (IVH) was as follows : no IVH, 1 cases (1.4%) of 69 case; IVH gradeI, 9 cases (16.1%) of 56 cases; IVH grade II, 9 cases (17%) of 53 cases; grade III, 5 cases (55.6%) of 9 cases. 4) The proportion of infants with neurologic sequelae according to the degree of periventricular echogenisity (PVE) was as follows : normal PVE, none of 53 cases; transient increased PVE, 1 case (2.5%) of 40 cases; persistent increased PVE, 6 cases (8.3%) of 72 cases; cystic periventricular leukomalacia (PVL), 17 cases (77%) of 22 cases. 5) Mantel-Haenszel chi-square analysis for the relationship between IVH and PVE showed significant correlation (p0.05). 7) The severity and nature of neurologic sequelae correlated with the locations and the severity of cystic PVL. CONCLUSIONS: These data suggest that low birth weight and PVL are risk factors of neurologic sequelae, and location and extent of PVL correlate with severity and type of neurologic sequelae. So early detection and follow-up examination of PVL by brain ultrasonography are needed for early detection of neurologic sequelae and minimization of handicaps.

Relationship of Ultrasonographic Findings and Neurologic Outcomes in Infants with Birth Weight of Less than 2,000gm

PURPOSE: In premature, neurologic sequelae is most important long-term complication. So we investigated the relationship between brain ultrasonographic findings and neurologic outcome. METHODS: Infants weighting less than 2,000gm who were discharged from the Neonatal Intensive Care Unit of Seoul National University Children's Hospital from Jan 1, 1989 to Dec. 31 1992, were investigated. All ultrasound images were examined for evidence ICH/IVH, periventricular echogenicity, and cystic PVL. Infants were assessed neurodevelopmentally in the neonatal period and at least until 12 months corrected for gestation age. RESULTS: 1) Total 291 infants were discharged, but expired, against medical advice discharged, and lost follow-up infants were exculded, 187 infants were investigated for the realtionship between brain ultrasonographic findings and neurologic outcomes. 2) The proportion of infants with neurologic sequelae (cerebral palsy) according to birth weight was as follow: 4 cases (50%) of less than 1,000gm; 13 cases (24.5%) of between 1,001gm and 1,500gm; 11 cases (5.6%) of between 1,501gm and 2,000gm, 3) The proportion of infants with neurologic sequelae according to intraventricular hemorhage (IVH) was as follows : no IVH, 1 cases (1.4%) of 69 case; IVH gradeI, 9 cases (16.1%) of 56 cases; IVH grade II, 9 cases (17%) of 53 cases; grade III, 5 cases (55.6%) of 9 cases. 4) The proportion of infants with neurologic sequelae according to the degree of periventricular echogenisity (PVE) was as follows : normal PVE, none of 53 cases; transient increased PVE, 1 case (2.5%) of 40 cases; persistent increased PVE, 6 cases (8.3%) of 72 cases; cystic periventricular leukomalacia (PVL), 17 cases (77%) of 22 cases. 5) Mantel-Haenszel chi-square analysis for the relationship between IVH and PVE showed significant correlation (p0.05). 7) The severity and nature of neurologic sequelae correlated with the locations and the severity of cystic PVL. CONCLUSIONS: These data suggest that low birth weight and PVL are risk factors of neurologic sequelae, and location and extent of PVL correlate with severity and type of neurologic sequelae. So early detection and follow-up examination of PVL by brain ultrasonography are needed for early detection of neurologic sequelae and minimization of handicaps.

The Perinatal Complications in Infants of Mothers with Gestational Diabetes Mellitus

PURPOSE: This study was performed to examine the impact of gestational diabetes mellitus (GDM) on perinatal outcomes, especially macrosomia and metabolic complications in Korean women. Subjects and METHODS: We studied perinatal outcomes of 65 women with GDM who delivered a singleton infant and were not complicated by medical disease that might effect the fetal growth, 65 women with normal glucose tolerance were selected to match subject with GDM matched to age, height, and prepregnancy weight. RESULTS: 1) Mean birth weight in infants of mothers with GDM was significantly heavier than that in infants of control mothers, even though the delivery was almost one week earlier (3524 vs. 3364gm). 2) Although length and head circumference of infants were not different between 2 groups, chest circumference and Ponderal index were significantly higher in infants of mothers with GDM. 3) The frequencies of LGA infants and macrosomia were higher in GDM group, but frequency of prematurity was not different between 2 groups. 4) The proportion of disproportionate growth among macrosomic infants was significantly higher in GDM group. 5) In infants of mothers with GDM, the frequencies of LGA infants were not significantly different between 2 groups which were separated according to the fasting glucose level measured at the time of diagnosis. 6) In infants of mothers with GDM, the frequencies of hypoglycemia, polycythemia, hypocalcemia and hyperbilirubinemia were 21.5%, 18.5%, 3.1% and 33.8% respectively. When infants of mothers with GDM were divided to 2 groups (LGA, AGA), the frequencies of polycythemia and hyperbilirubinemia in LGA infants were higher than those in AGA infants (30.8 vs. 10.3% and 50.5 vs. 23.1%, respectively). 6) There was a significant positive correlation between Ponderal index and chest circumference/head circumference ratio (r=0.37, p<0.01). CONCLUSIONS: Inspite of tight metabolic control of mothers with GDM, perinatal complications, such as macrosomia, hypoglycemia, hyperbilirubinemia were frequent in infants of mothers with GDM. In case of infants of mothers with GDM, perinatal complication should be treated earlier or prevented by careful physical examination and intensive management.