Effect of Intraoperative Mitomycin C on the Surgical Outcomes of Ahmed Glaucoma Valve Implantation with Ciliary Sulcus Tube Placement

Purpose@#To evaluate the effect of intraoperative mitomycin C (MMC) on the surgical outcomes of ciliary sulcus (CS) Ahmed glaucoma valve (AGV) tube placement. @*Methods@#A retrospective review of medical records of 54 consecutive patients who underwent AGV implantation with tube placed in CS was performed. Consecutive cases operated without the use of intraoperative MMC from 2017 to 2019 were compared with consecutive cases operated with MMC from 2019 to 2021. Surgical failure was defined as intraocular pressure (IOP) exceeding 21 mmHg in two consecutive visits after postoperative 3 months or ≤30% IOP reduction, IOP ≤5 mmHg in two consecutive visits, or loss of light perception. Kaplan-Meier survival analysis and log-rank test were performed to compare the surgical failure rates. @*Results@#A total of 54 eyes of 54 patients were investigated. Mean follow-up period after AGV implantation was 1.4 ± 0.8 years. The MMC group showed significantly lower IOP during the 1st postoperative month (20.5 ± 8.6 mmHg vs. 15.8 ± 6.4 mmHg, p = 0.027), but the difference did not persist 6 months after the surgery (p = 0.805). The mean number of postoperative antiglaucoma medications was significantly lower in the MMC group in the 1st postoperative month (p = 0.047) but no difference was found at 6 months. No statistical difference was noted in the rates of postoperative complications. Kaplan-Meier survival analysis showed comparable survival rates between MMC group and no MMC group (p = 0.356). @*Conclusions@#The intraoperative use of MMC significantly lowered IOP in the 1st postoperative month but did not increase 6 months success rates in patients receiving AGV tube placement in CS.

Rapidly Progressive Ophthalmoplegia and Brainstem-Cerebellar Dysfunction in Rhombencephalitis Caused by Listeria monocytogenes / 대한평형의학회지

Listeria monocytogenes (L. monocytogenes) is a rare, but important bacterial pathogen causing central nervous system infection in the elderly, pregnant women, and immunocompromised patients. A 60-year-old man with diabetes presented with headache, fever and rapidly progressive ophthalmoplegia. Based on serological and MRI studies, he was diagnosed with rhombencephalitis due to L. monocytogenes. The patient recovered without complications with urgent initiation of empirical antibiotics and the pathogen-specific antibiotic treatment. L. monocytogenes should be considered as a cause of rhombencephalitis presenting as external ophthalmoplegia.

Medically Intractable Pseudotumor Cerebri Treated with Venous Sinus Stenting in a Child

No abstract available.

Metabolic Syndrome as a Risk Factor for Atrial Fibrillation in Patients with Acute Myocardial Infarction / 대한구급학회지

BACKGROUND: Atrial fibrillation (AF) has been linked to an increased risk for in-hospital and long-term mortality rates in patients with acute myocardial infarction (AMI). Obesity and metabolic syndrome (MS) are known to play an important role in cardiovascular morbidity and mortality. However, it is uncertain whether obesity and MS increase the risk of AF in patients with AMI. Therefore, we investigated independent risk factors for the occurrence of new-onset AF in patients with AMI who received optimal percutaneous coronary intervention (PCI). METHODS: We prospectively analyzed the association between MS and the incidence of cardiac arrhythmia in 146 patients with AMI who underwent PCI. Twenty-four-hour Holter monitoring was performed 3 days after AMI. We divided the patients into two different groups based on the development of AF and analysed their obesity based on body mass index (BMI) (kg/m2) and evaluated the existence of MS, as well as visceral obesity with fat computed tomography. RESULTS: Seventy-five patients (51.4%) were obese (BMI > or = 25) and 64 (44%) had MS. AF occurred in 33 (22.6%) patients. Age, MS, and visceral obesity were significantly associated with AF (p = 0.001, p = 0.003, and p = 0.03, respectively). There was no difference between obese and non-obese patients in the incidence of AF and VT. Multivariate analysis revealed that age and MS were independent risk factors of post-AMI AF. CONCLUSIONS: MS is an important and modifiable risk factor for new-onset AF especially in patients with AMI who underwent PCI.

Reliability study of 6-axis model surgery simulator for orthognathic surgery

The purpose of this study was to evaluate the reliability of 6-axis model surgery simulator (6AMSS) for orthognathic surgery. A rectangular parallelepiped plastic block was assembled to model-mounting plate of 6AMSS. Left-right (X), anterior-posterior (Y), up-down (Z) translation and pitching (empty set X), rolling (empty set Y) and yawing (empty set Z) rotation was planned and performed using 6AMSS. The actual translation and rotation were measured with dial gauge and precisional protractor, respectively. Comparison between the planned and actual movements of plastic block for each variable were made using paired t- test. Statistical analysis for X, Y, Z, empty set X, empty set Y and empty set Z movement have shown no significant differences between planned and actual movement (P > 0.05). This indicate that model surgery performed with the aid of the 6AMSS is accurate in 3D translation and rotation. The 6AMSS is practically useful for accurate fabrication of surgical splint for orthognathic surgery.

Three Cases of Non-Surgical Treatment of Stent Loss During Percutaneous Coronary Intervention

Percutaneous coronary intervention with stenting is widely used for ischemic heart disease. Because stent loss, which occurs rarely during the procedure, might have dire consequences, such as bleeding, stent embolism, acute myocardial infarction, emergency coronary artery bypass graft, and death, appropriate treatment is needed as soon as stent loss occurs. We report three cases of stent loss which were successfully treated with three different non-surgical methods.

Pentraxin 3 as a Novel Marker Predicting Congestive Heart Failure in Subjects With Acute Coronary Syndrome

BACKGROUND AND OBJECTIVES: Pentraxin 3 (PTX3) was shown to be elevated in the acute phase of acute myocardial infarction (AMI) and to have prognostic significance in AMI patients. The aim of this study was to estimate whether the value of PTX3 could be used as a prognostic biomarker, with the global registry of acute coronary events (GRACE) risk assessment tool, in patients with acute coronary syndrome (ACS). SUBJECTS AND METHODS: Between July 2007 and June 2008, 137 patient subjects (mean age : 61+/-12 years, M : F=108 : 29) with ACS who underwent coronary intervention, but did not have a prior percutaneous coronary intervention (PCI) and/or follow-up coronary angiogram, were enrolled. We estimated the all-cause mortality or death/MI, in-hospital and to 6 months, using the GRACE risk scores and compared these estimates with serum PTX3 concentrations. RESULTS: The serum PTX3 concentration showed a significant increase in ST segment elevation myocardial infarction (STEMI) greater than the unstable angina pectoris (UAP) group (2.4+/-2.1 ng/mL vs. 1.3+/-0.9 ng/mL, p= 0.017, respectively), but did not show a significant difference between non-ST segment elevation myocardial infarction (NSTEMI) and the UAP group (1.9+/-1.4 ng/mL vs. 1.3+/-0.9 ng/mL, p=0.083, respectively). The serum PTX3 concentration was closely related to death/MI in-hospital (r=0.242, p=0.015) and death/MI to 6 months (r=0.224, p=0.023), respectively. The serum PTX3 concentration was not related to all-cause mortality in-hospital (r=0.112, p=0.269) and to 6 months (r=0.132, p=0.191), respectively. Among the parameters determining the GRACE risk scores, the degree of Killip class in congestive heart failure (CHF) was independently associated with the supramedian PTX3 concentration [odds ratio: 2.229 (95% confidence interval: 1.038-4.787), p=0.040]. CONCLUSION: The serum PTX3 level provides important information for the risk stratification of CHF among the parameters determining the GRACE risk scores in subjects with ACS.

Evaluation of Cardiac Function by Transthoracic Echocardiography in Subjects with ST-Segment Elevation Myocardial Infarction Following Primary Percutaneous Coronary Intervention according to Valsartan Dose: The Valsartan One Center Trial

BACKGROUND: The aim of this study was to evaluate the mid-term changes in cardiac function by transthoracic echocardiogram (TTE) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) according to valsartan dose. METHODS: Between April 2006 and February 2009, 78 subjects (mean age: 57 +/- 12 years, M : F = 74 : 4) with STEMI who underwent primary PCI were enrolled. Fifty three patients received low dose valsartan (40 or 80 mg) and 25 patients received high dose valsartan (160 or 320 mg). Follow-up TTE was done approximately 2 years later. We evaluated the changes in left ventricular (LV) function between initial and final TTE after primary PCI and compared the changes between low and high dose valsartan group. RESULTS: The mean follow-up TTE duration was 24 +/- 8 months. Deceleration time (188.6 +/- 56.3 msec vs. 221.5 +/- 71.3 msec, p = 0.01), E/e' (12.24 +/- 5.2 vs. 10.1 +/- 4.9, p = 0.002), ejection fraction (52.7 +/- 8% vs. 55.2 +/- 8.4%, p < 0.01), and wall motion score index (1.45 +/- 0.30 vs. 1.33 +/- 0.32, p < 0.01) showed significant changes during the follow-up period. Wall motion improvement in injured myocardial segments was more frequently observed in the high-dose valsartan group compared to the low-dose group [18/25 (72%) vs. 24/53 (43.7%), p = 0.03]. There was no significant difference in the changes in cardiac dimensions and function between the low and high dose valsartan group. CONCLUSION: In patients with STEMI who undergoing primary PCI, high-dose valsartan treatment may be more helpful than low-dose in improving wall motion in the injured myocardium.

The Relationship Between Serum Pentraxin 3 and Central Obesity in ST-Segment Elevation Myocardial Infarction Patients

BACKGROUND AND OBJECTIVES: As shown in previous studies, pentraxin 3 (PTX3) can be a useful inflammatory marker for metabolic syndrome and central obesity. Serum PTX3 levels are also an independent factor associated with visceral fat area. The aim of this study was to assess the role of PTX3 as an inflammatory maker in patients with central obesity undergoing primary percutaneous coronary intervention (PCI) following an ST-segment elevation myocardial infarction (STEMI). SUBJECTS AND METHODS: From December 2007 to June 2008, 40 subjects (mean age: 61+/-11 years, M : F=34 : 6) with STEMI who underwent primary PCI were enrolled. We determined waist circumference, waist/hip ratio, body mass index (BMI), and visceral and total fat area via fat computed tomography (FAT-CT), and compared them with serum PTX3 concentrations. RESULTS: The serum PTX3 concentration was closely related to FAT-CT-estimated visceral fat area (r=0.41, p<0.01) and total fat area (r=0.38, p=0.01), respectively. The serum PTX3 concentration was not related to waist circumference (r=0.27, p=0.20), waist circumference/hip ratio (r=0.25, p=0.16), BMI (r=0.04, p=0.80) and lipid profiles, respectively. Among the parameters determining metabolic syndrome, an increasing visceral fat area had the strongest association with PTX3 concentrations. CONCLUSION: In patients with STEMI, PTX3 is associated with central obesity and it is significantly and independently correlated with visceral fat area. FAT-CT-estimated visceral fat area is the most reliable factor associated with serum PTX3 levels in patients with STEMI and central obesity.

A Clinical Review of Esophageal Atresia : One Surgeon's Experience

From 1979 to 2006, fifty eight patients with esophageal atresia were treated by one pediatric surgeon at Hanyang University Hospital. We analyzed the clinical findings and outcome of these 58 patients. There were 30 males and 28 females. Their mean birth weight was 2,960 +/- 400 g (1,170~4,020 g). The most common type of anomaly was Gross type C (49 patients; 84.5 %). There was no type B. Fifty-two patients underwent definitive surgery. Postoperative complications were as follows: anastomotic leakage in 17 patients (32.7 %), anastomotic site stricture in 15 (28.8 %), gastroesophageal reflux in 10 (19.2 %) and recurrent TEF in 1 (1.9 %). A total of 152 associated anomalies were detected from 48 patients (82.2 %). The cardiovascular system was the most commonly affected (30 patients with 46 anomalies). The VACTERL association was present in 14 patients (24.1 %). Operative mortality was 17.3 % including self-discharge patients after operation.

Two Cases of Venous Lake Treated with a Sclerosing Agent / 대한피부과학회지

Venous lakes are small, dark blue, slightly raised, soft lesions occurring on the exposed skin of an elderly person. The face, ears, lips, neck, forearms and backs of hands are common sites. Histopathologic findings show either one greatly dilated space or several interconnected dilated spaces filled with erythrocytes and lined by a single layer of flattened endothelial cells in the upper dermis. We report two cases of venous lake treated with sodium tetradecyl sulfate (STS) which is one of sclerosing agents. The lesions was almost disappeared and no side effects were observed. The two cases showed no recurrence.

The Effect of Lipo-PGE1 According to the Routes of Administration on the Survival of Transverse Rectus Abdominis Musculocutaneous Flap in Rats

The Transverse rectus abdominis musculocutaneous (TRAM) flap has been commonly used for autologous breast reconstruction. Despite these clinical usefulness, the TRAM flap is prone to partial flap or fat necrosis in especially pedicled flap. To improve flap survival, the surgical delay procedures and pharmacological treatments have been developed. In many studies for the pharmacological treatment, Lipo-PGE1 has demonstrated a marked ability to improve flap survival and it's effect has been proved similar to surgical delay procedure. The purpose of this study is to determine the most effective route of Lipo-PGE1 administration as a pharmacological treatment in TRAM flap of the rat. Fifty male Sprague-Dawley rats weighing 300-350 gm were divided into five groups, One week before flap elevation, Lipo- PGE1(2 microgram/kg) was injected three times in a week and than the left inferior epigastric vessel based TRAM flap (5.0x3.0 cm) elevated; group I: no procedure before flap elevation; group II: intraperitoneal injection; group III: intravenous injection; group IV: subcutaneous injection; group V: topical application. A flap was assessed at postoperative 7 days by comparison of flap survival rate, vessel counts(H-E stain), and vascular endothelial growth factor(VEGF) protein expressed by Western blot. The results demonstrated that the mean percentages of the flap survival area in group III were significantly higher than that of any other group(p<0.05). The vessel counts of all experimental groups were statistically higher than that of control group(p<0.05). Only in group III, the VEGF protein expression was increased significantly than control group and there are no difference in other experimental groups. In conclusion, the intravenous administration of the Lipo-PGE1 is the most effective on flap survival, and the VEGF induced by Lipo-PGE1 has some positive effects on new vessel formation and flap survival.

A Case of Acrokeratosis Verruciformis of Hopf / 대한피부과학회지

Acrokeratosis verruciformis of Hopf is a localized disorder of keratinization affecting the distal extremities. It develops during infancy or early childhood with no sexual predilection. The disease seems to be inherited in an autosomal dominant fashion. We describe a 55-year-old male with multiple, flat-topped papules on the left dorsum of the hand. The histologic findings showed marked hyperkeratosis, acanthosis, papillomatosis of the epidermis and circumscribed elevation of the epidermis which characteristically resembled "church spires". This case is unusual in that the patient had late onset of the lesions and no family history of the condition.

A Clinical Experience of Nasopalatine Duct Cyst with Bony Defect

The nasopalatine duct cyst, known as the incisive canal cyst, is the most common nonodontogenic cyst in the maxillofacial area. It is believed to arise from epithelial remnants of the embryonic nasopalatine duct. Nasopalatine duct cysts are most often detected in patients between forties and sixties. The trauma, bacterial infection, or mucous retention has been suggested as etiological factors. The cysts often present as asymptomatic swelling of the palate but can present with painful swelling or drainage. Radiologic findings include a well demarcated cystic structure in a round, ovoid or heart shape presenting with a well-defined bone defect in the anterior midline of the palate between and posterior to the central incisors. Most of them are less than 2cm in size. On MRI, the cyst is identified as a high-intensity, well-marginated lesion, which indicates that it contains proteinaceous material. We experienced a case of a 61-year-old female patient who had a 2.3*2.6*1.7cm sized nasopalatine duct cyst. The bony defect after a surgical extirpation was restored with hydroxyapatite. So we report a good results with some reviews of the literatures.

Three cases of mesenteric venous thrombosis treated by different modalities / 대한내과학회지

Mesenteric venous thrombosis is rare but can cause ischemia or infarction of small bowel. Mesenteric venous thrombosis is classified as either primary or secondary. Despite considerable advances in medical diagnosis and treatment, the diagnosis is often delayed and prognosis is still poor. We report three cases of mesenteric venous thrombosis treated by different modalities each other. The first case was superior mesenteric venous thrombosis secondary to acute acalculous cholecystitis and treated with anticoagulation. The second case was primary mesenteric venous thrombosis and treated by anticoagulation combined with percutaneous transhepatic thrombolysis. The third case was also primary mesenteric venous thrombosis, but, needed surgery with anticoagulation.

Comparative Study of Delayed Gastric Emptying between Manual and Stapled Anastomosis in Patients Undergoing Subtotal Gastrectomy with Billroth I Gastroduodenostomy for Early Gastric Cancer

PURPOSE: Many surgeons are using stapled anastomosis in Billroth I gastroduodenostomy after subtotal gastrectomy because of the shorter operation time and simpler handling. However, many patients complain delayed gastric emptying after using EEA stapler. The delayed gastric emptying was compared between manual and stapled anastomosis in Billroth I gastroduodenostomy for stomach cancer. METHODS: 92 patients who performed Billroth I gastroduodenostomy after subtotal gastrectomy due to early gastric cancer at the Hanyang University Guri Hospital between January 2001 to December 2003 were reviewed. Delayed gastric emptying was diagnosed by patients' symptoms and upper gastrointestinal roentgenogram. Manual anastomosis was using the Albert-Lambert suturing and stapled procedure with EEA stapler (auto suture(R)). RESULTS: Of the 92 patients, 22 were in the stapled anastomosis group (a mean age of 61.58 years, M:16, F:6) and 70 in the manually anastomosis group(a mean age of 61.12 years, M: 44, F: 26). The incidence of delayed Gastric emptying were significantly lower in the manual than the stapler group (P=0.035), but the operation times and the hospitas stay were significantly shorter in stapler group (P=0.001 and 0.07, respectively). CONCLUSION: The manual group had better outcomes with regard to gastric emptying despite of the many advantages of stapled anastomosis in the filedld of intraabdominal operations. Various stapled anastomosis instruments and methods have been tried, but further studies are necessary if stapled anastomosis is to be the perfect substitute for manual anastomosis.

A Case of Vitiligo Developed on the Sites of DNCB Application in a Patient with Alopecia Areata / 대한피부과학회지

We report a case of vitiligo developed on the sites of DNCB application for the treatment of alopecia areata in a 53-year-old woman. Histopathologic studies of the depigmented patches showed absence of melanin pigmentation at the basal layer of the epidermis and a negative reaction for the Fontana-Masson stain. The current theories explaining vitiligo development after topical sensitizer application are that topical sensitizers induce the vitiligo by a direct cytotoxic effect on the melanocytes, or by unmasking latent vitiligo as a result of the Koebner phenomenon due to contact dermatitis, but the exact mechanism is still unclear.

A Case of Nevus Comedonicus with Epidermolytic Hyperkeratosis / 대한피부과학회지

A 34-year-old female patient presented multiple 1-2mm sized dark brown coloured keratin plugs, within dilated follicles on the lower extremities from the birth. Histopathological findings showed a wide and deep invagination of the epidermis filled with keratin plugs which is a typical feature of nevus comedonicus, and the presence of epidermolytic hyperkeratosis on the epidermis and follicular wall. On another area, histopathological findings showed the presence of hyperkeratosis, acanthosis and epidermolytic hyperkeratosis of the epidermis; there are common changes of systematized epidermal nevus. We herein report a case of nevus comedonicus with epidermolytic hyperkeratosis.

A Case of Polypoid Basal Cell Carcinoma / 대한피부과학회지

A 59-year-old woman presented with a 20 years history of a mass on her scalp. The lesion had become larger and bled intermittently over the last year. On physical examination a polypoid tumor measuring 1.5x1.5cm was located on the scalp without palpable lymph nodes or signs of metastasis. Histologic examination of the lesion with hematoxylin and eosin staining showed a basal cell carcinoma with a adenoid differentiation. The tumor was excised, and the patient has had no recurrence or metastasis after two years. Polypoid basal cell carcinoma differs clinically from other variants of basal cell carcinoma in that it is polypoid and has a stalk that connects it to the skin surface. Histologically, it is also distinguished by restriction of the tumor aggregations to the polypoid mass.

A Case of Epithelioid Hemangioendothelioma / 대한피부과학회지

Epithelioid hemangioendothelioma is a rare tumor of vascular endothelium that is considered to be of borderline malignancy. Typical sites of involvement include soft tissue and less frequently, liver and lung. A 45-year-old woman had found a nodule on left second finger. There were no specific personal or family history. Physical examination revealed a 0.7x0.7cm sized skin-colored hard nodule on the dorsum of the distal interphalangeal joint of left second finger. There were no lymphadenopathy, hepatosplenomegaly, or bone tenderness. The patient underwent an excision of the lesion. On microscopic examination, a moderately well-circumscribed nodule composed of sheets and cords of epithelioid cells, many of which possessed intracytoplasmic lumina, was noted in the dermis. Erythrocytes were seen within some of the lumina. On immunohistochemical staining, the cells showed positive staining for factor VIII-related antigen and smooth muscle actin, and negative staining for CD31, CD34 and S-100.