Diabetic Ketoacidosis Associated with Emphysematous Gastritis: A Case Report

Diabetic ketoacidosis is a serious and demanding medical emergency for the field of endocrinology, and the identification and correction of the precipitating factors is equally important. Many patients of diabetic ketoacidosis show gastrointestinal symptoms as an initial presentation, and coincidental gastrointestinal diseases can be neglected or misdiagnosed. Emphysematous gastritis is a rare and lethal disease in which gas bubbles form in the stomach wall. The predisposing factors include ingestion of corrosive substances, alcohol abuse, diabetes, and immunosuppressive therapy. Thus, it may be difficult to detect emphysematous gastritis early, especially when it is developed in conjunction with diabetic ketoacidosis. We report a case of diabetic ketoacidosis associated with emphysematous gastritis in a young male without medical history.

A Case of Retinal Detachment Surgery in Albinism Patient

PURPOSE: To report a case of retinal detachment surgery in a patient with oculocutaneous albinism. CASE SUMMARY: A 44-year-old man visited our clinic complaining of decreased visual acuity in his left eye. His best corrected visual acuity was hand movement in his left eye, and rhegmatogenous retinal detachment involving the macula at the superior temporal site was found. We performed pars plana vitrectomy and attempted to reattach the retina using endolaser photocoagulation; however, the laser burn was not made, and we failed to reattach the retina. At that point, we carried out cryopexy around the retinal tear, and injected silicone oil into the vitreous cavity. Ten months after surgery, his best corrected visual acuity was 0.06, and there was no recurrent retinal detachment or proliferative vitreoretinopathy. CONCLUSIONS: In patients with albinism with melanin deficiency, cryopexy is more useful than laser photocoagulation for retinal detachment surgery.

The Effect of Phacoemulsification with a Liquefaction Device on Cornea Endothelium

PURPOSE: To access the effect of phacoemulsification using the AquaLase(R) (Alcon Laboratories, TX, U.S.A.) on corneal endothelial cell. METHODS: This study comprised 47 eyes of 43 patients having phacoemulsification with the AquaLase(R). Various corneal endothelial cell parameters, including corneal endothelial cell density, corneal thickness and morphologic change, were evaluated up to 2 months postoperatively. RESULTS: Preoperative mean corneal endothelial cell density was 2818+/-282 cell/mm2. Postoperative mean corneal endothelial cell density was 2682+/-390 cell/mm2 at 1 day, 2701+/-263 cell/mm2 at 1 month and 2721+/-396 cell/mm2 at 2 month. Corneal endothelial cell loss was 4.74%, 4.00% and 3.55% at postoperative 1 day, 1 month and 2 months respectively. There was no statistically significant difference between preoperative and postoperative corneal endothelial cell density (p>0.05). The corneal endothelial cell loss was not increased even though the phacoemulsification time with the AquaLase(R) was increased (p>0.05). Preoperative mean corneal thickness was 559.4+/-37.4 micrometer. Postoperative mean corneal thickness was 586.9+/-35.1 micrometer at 1 day, 573.3+/-30.1 micrometer at 1 month and 554.9+/-26.7 micrometer at 2 month. There was a significant increase in corneal thickness at postoperative 1 day (p=0.001). However, there was no statistically significant difference of corneal thickness between preoperative and postoperative 1 month and 2 month (p>0.05). CONCLUSIONS: The phacoemulsification with the AquaLase(R) dose not cause the significant corneal endothelial cell density and corneal thickness change postoperatively.

The Effect of Phacoemulsification with Oscillation Device on the Cornea and Lens Opcatiy

PURPOSE: To access the effect of phacoemulsification, using Neosonix(R) (Alcon Laboratories, TX, USA), on the cornea and lens opacity. METHODS: This study involved 42 eyes of 37 patients who underwent phacoemulsification using the Neosonix from December 2005 through March 2006. We measured the density and the thickness of lenses using a Scheimpflug camera and evaluated the correlation between the density and the phaco time. To evaluate the effects of Neosonix(R) on the corneal endothelium, we measured various corneal endothelial cell parameters, including corneal endothelial cell density, corneal thickness, and morphologic changes up to two months postoperatively. RESULTS: The preoperative mean values of lens density for the anterior cortex, nucleus, and posterior cortex were 105.86+/-34.99 CCT, 82.17+/-35.14 CCT, and 77.88+/-52.98 CCT, respectively. The mean phacoemulsification time was 48.67+/-29.79 seconds and increased significantly, according to the increase of the densities of the lens nucleus and cortex (p0.05). CONCLUSIONS: The phacoemulsification time using oscillation device significantly increased as the density of the lens cortex and nucleus increased, and there was no statistically significant difference between the preoperative and postoperative values of corneal endothelial cell density.

Endovascular Treatment of Basilar Bifurcation Aneurysm with Open Access of Vertebral Artery

Microsurgical clipping is considered the treatment of choice for ruptured intracranial aneurysms. However, ruptured posterior circulation aneurysms remain technically difficult to expose or clip and outcomes in these cases are poorer than those seen in cases of anterior circulation aneurysms. Therefore, endovascular treatment becomes another treatment option in cases of ruptured posterior circulation aneurysms. But, the vertebral artery may not be selected due to luminal narrowing, which are atherosclerotic stenosis clinically, congenital anomalies, or acquired kinking, and structural problem of angle between aorta, subclavian artery and vertebral artery. In these cases, other approaches can be used through, for example, subclavian, axillary, or brachial artery approach. But sometimes such prcedures may be also inappropriate. One other approach is direct percutaneous vertebral artery approach. Though this one also doesn't overcome many clinical and anatomical problems. The authors present two cases of ruptured basilar tip aneurysms which was treated with endovascular Guglielmi detachable coil embolization with open surgery and catheterization, because the one had anatomical problem, and the other had structural problem.