The Usefulness of Ice Test for Diagnosis of Myasthenia Gravis in Patients with Ptosis

PURPOSE: To compare the results of the ice test with other diagnostic tests for the diagnosis of myasthenia gravis in patients with ptosis. METHODS: The patients included in this study presented with suspicious myasthenic blepharoptosis and visited the Department of Ophthalmology, Guro Hospital, Korea University between March 2003 and February 2004 for diagnosis. All patients received "myasthenic ptosis workup" including the ice test, edrophonium test, RNS EMG, and anti-acetylcholine receptor antibody (anti-AchR) titer test. The tests were compared for specificity, sensitivity, ease of performance, economic benefits and observed complications. RESULTS: The patients included six men and nine women with an average age of 36.9+/-2.4 yrs. Positive test results were obtained as follows: Ice test 80%, edrophonium test 66.7%, RNS EMG 53.3%, and anti-AchR titer test 86.7%. Adverse effects of edrophonium test were encountered in two patients who had nausea, vomiting, and dizziness. CONCLUSIONS: The authors found that the ice test was simpler, faster, more economic, and safer than the others for diagnosing blepharoptosis caused by myasthenia gravis. Considering its relative high sensitivity and specificity, the ice test should be the first screening test given to patients with suspicious myasthenic ptosis.

The Usefulness of Ice Test for Diagnosis of Myasthenia Gravis in Patients with Ptosis

PURPOSE: To compare the results of the ice test with other diagnostic tests for the diagnosis of myasthenia gravis in patients with ptosis. METHODS: The patients included in this study presented with suspicious myasthenic blepharoptosis and visited the Department of Ophthalmology, Guro Hospital, Korea University between March 2003 and February 2004 for diagnosis. All patients received "myasthenic ptosis workup" including the ice test, edrophonium test, RNS EMG, and anti-acetylcholine receptor antibody (anti-AchR) titer test. The tests were compared for specificity, sensitivity, ease of performance, economic benefits and observed complications. RESULTS: The patients included six men and nine women with an average age of 36.9+/-2.4 yrs. Positive test results were obtained as follows: Ice test 80%, edrophonium test 66.7%, RNS EMG 53.3%, and anti-AchR titer test 86.7%. Adverse effects of edrophonium test were encountered in two patients who had nausea, vomiting, and dizziness. CONCLUSIONS: The authors found that the ice test was simpler, faster, more economic, and safer than the others for diagnosing blepharoptosis caused by myasthenia gravis. Considering its relative high sensitivity and specificity, the ice test should be the first screening test given to patients with suspicious myasthenic ptosis.

Treatment of Exotropia Caused by Lost Medial Rectus Muscle

PURPOSE: We report three patients with large angle exotropia had lost medial rectus muscle (MR) and who attained good alignment postoperatively. METHODS: Patient 1 was a 51-year-old female with a history of strabismus surgery done at 10 years of age. Exotropia of 80 prism diopter (PD) gradually developed with limitation of adduction in the right eye. Patient 2 was a 52-year-old male with fixed exotropia of 95 PD in his left eye, which became blind after a severe contusion injury. The third patient was a 46-year-old male who had MR of the right eye cut during endoscopic sinus surgery. Severe limitation of adduction followed with exotropia of 50 PD. We could not find MR in any of the three patients and noted severe adhesion between eyeball and Tenon's capsule. Ocular movement was severely limited horizontally and even vertically. RESULTS: Postoperatively Patient 1 showed orthophoria in follow-up of 2 years. Patient 2 had 16PD of exotropia in follow-up of 13 months, which was cosmetically acceptable. Patient 3 obtained orthophoria after surgery and developed 10 degrees of left head turning to avoid diplopia. CONCLUSIONS: When a patient shows longstanding large angle exotropia with limitation of adduction, we may consider the MR loss. A reasonable treatment may be to align the eyes cosmetically in primary position by weakening the abducting power and suturing the anterior part of nasal Tenon's capsule to the MR insertion site after adhesiolysis.

A Case of Visual Field Defect from Intracranial Optic Nerve Compression by Normal Caliber Internal Carotid Artery

PURPOSE: Compression of the optic nerve by a dolichoectatic internal carotid artery is known to cause of visual field defects. We experienced a case of optic nerve compression by a normal-appearing internal carotid artery. METHODS: A 22-year-old man presented with left eye visual field defect without obvious cause and magnetic resonance imaging revealed compression of the left optic nerve by ipsilateral internal carotid artery. RESULTS: At eight-month follow-up, there was no improvement in visual field defect or optic disc change. CONCLUSIONS: In an unexplained optic neuropathy, T1-weighted MRI is needed to evaluate the relationship between the optic nerve and internal carotid artery.

The Usefulness of Ultrasound-Guided Core Needle Biopsy for Non-Palpable Breast Lesion

PURPOSE: To determine the usefulness of ultrasound-guided core biopsy for the diagnosis of non-palpable beast lesions. MATERIALS AND METHODS: Between April 1996 and December 2000, 932 lesions in 901 patients were the object of ultrasound-guided core biopsy. Of these, 440 non-palpable lesions ranging in size from 0.3 to 3.0 (average, 0.9)cm, and found in 428 patients (all women aged, on average, 43.9 years), were included in this study. The pathologic results of core biopsy were compared with the available surgical data, and clinical and radiologic follow-up data were also reviewed. A 16-gauge needle was used in 197 lesions, and a 14-gauge neadle in the other 243. RESULTS: At core biopsy, 53 lesions were diagnosed as invasive carcinoma, and 45 of these were excised. Forthfour were confirmed as invasive carcinoma, and in one case there was no residual tumor. Seven lesions, diagnosed as ductal carcinoma in situ at core biopsy, were surgically removed, and the final diagnosis was ductal carcinoma in four cases and invasive carcinoma in two. Two of four cases initially diagnosed as atypical ductal hyperplasia were finally diagnosed as invasive carcinoma after surgery. Six lesions diagnosed at core biopsy asbenign were later found to be malignant (false-negative rate, 8.3%). Radiologic imaging suggested that all six lesions-for two of which, a 14-gauge needle was used, and for four, a 16-gauge needle-were malignant. The false-negative rate was 5.1% and 12%, respectively, whithout statistical significance (p=0.26). CONCLUSION: Ultrasound-guided core needle biopsy for non-palpable breast lesions is useful and can replace surgical excision. To avoid false-negative assessment, however, strict radiologic-histopathologic correlation is required.

Repair of Telecanthus with Titanium Miniplate in Blepharophimosis Syndrome

Telecanthus in congenital blepharophimosis has traditionally been repaired with conventional methods such as medial canthal tendon tucking and transnasal wiring.We report 2 cases of patients with telecanthus who underwent repair with titanium miniplate. After the anterior limb of medial canthal tendon was dissected, its insertion site was drilled and a titanium miniplate was fixed with screws.The dissected medial canthal tendon was fixed with 4-0 mersilene to a miniplate hole.After the surgery, we obtained a mean decrease of 11 mmin intermedial canthal distance and no complications except scar in incision site. We believe that this procedure has advantages such as short operation time, precise placement of the medial canthal tendon.For these reasons, it seems to be an excellent alternative to transnasal wiring, but considers this operation because of scar in incision site.

Cases with Endometrial Polyp and Endocervical Polyp Associated With Tamoxifen Use / 대한산부인과학회잡지

Tamoxifen is a nonsteroidal triphenylethylene delivative that has been widely used in the treatment of breast cancer. tamoxifen is indicated for the adjuvant treatment of breast cancer in women following total mastectomy or segmental mastectomy, breast irradiation and chemotherapy. tamoxifen has been shown to have significant benificial effect in the treatment of breast cancer patient as hormonal therapy. However ,there is mounting evidence that tamoxifen may affect other hormon sensitive organs, including the uterus and ovaries. An increased risk of endometrial polyps, endometrial hyperplasia and adenocarcinoma has been reported in tamoxifen treated women. We have met cases of endometrial polyp and endocervical polyp which were associated with tamoxifen use, after modified radical mastectomy for infilterating ductal carcinoma of breast . So we report these cases with the brief review of literatures.

Surgical Treatment of Thyroid-related Upper Eyelid Retraction

Lid retraction is one of the most common problems in Grave's disease. Many techniques for correction of the upper eyelid retraction have been described.The authors performed surgeries for correction of upper lid retraction by means of transconjunctival and transcutaneous recession of the aponeurosis of the levator muscle and Muller's muscle. From March 1997 to June 1999, 8 patients underwent for unilateral upper lid retraction through transcutaneous approaches and 6 patients through transconjunctival approaches.Transcutaneous and transcon-junctival approaches were effective when the recession was 1.54 mm, and 2.43 mm, respectively for every millimeter of correction for retraction desired.Two approaches were safe and efficacious and could be used for all degrees of eyelid retraction, but transcutaneous approach was thought to be more appropriate for severe eyelid retraction and blephraplasty simultaneously than transconjunctival approach.

The Anti-angiogenic Effect of Recombinant Tissue Inhibitor of Metalloproteinase Type 2 (TIMP-2) in N-heptanol Induced Neovascularization of Rat Cornea

Corneal neovascularization is a challenging problem in ophthalmologic practice. We evaluated the anti-angiogenic effect of recombinant tissue inhibitor of metalloproteinase type 2 (rTIMP-2) which is an endogenous inhibitor of matrix metalloproteinases. Sprague-Dawley rats of 6 weeks of age were used in this study. N-heptanol was applied to the eyes of the rats to induce chemical injury and eventual neovascularization. The rats were divided into 4 groups, 5 rats for each. We instilled only the phosphate buffered solution once a day for 10 days to the eyes of rats in the control group. Rats in group 1 received subconjunctival injection of 0.05 mgof rTIMP-2, those in group 2 received intraperitoneal injection of 0.05 mg of rTIMP-2, and those in group 3 received intraperitoneal injection of 0.1 mg of rTIMP-2 once a day for 10 days respectively. After 4 weeks, photographs of corneas were taken with a built-in camera of the slit lamp, and the eyes were enucleated. We made histologic specimens of the corneas and examined them with a light microscope. The severity of the neovascularization was quantified with angiogenesis scoring system. The group 1, 2 and 3 showed significant suppression of angiogenesis compared with the control respectively, but there was no statistically significant difference among their angiogenesis scores. Under the light microscope, the corneas of control group showed much more severe infiltration of inflammatory cells and higher density of new vessels compared with group 1, 2 and 3. We hypothesize that TIMP-2 suppressed the angiogenesis in chemical injury of cornea and TIMP-2 might benefit those patients with corneal neo-vascularization, although careful further studies are required in humans.

The Expression of NADPH-diaphorase in Corneal Neovascularization of streptozotocin Induced Diabetic Rat

We evaluated the effect of nitric oxide on the corneal neovascularization in diabetic rats. The NADPH-diaphorase histochemistry was used to investigate the relationship between the nitric oxide synthase activity and the corneal neovascularzation of disbetic rats. Sprague-Dawley rats of 6 weeks of age were use in this study. Streptozotocin(65mm/kg, Sigma, USA) was injected intraperitoneally to induce diabetes. N-heptanol was applied to the right eyes of the diabetic rats to induce neovascularization and the left eyes were remained uninjured. After four weeks, 5 eyes of the non-diabetic rats, 5 eyes of the diabetic rats, and 5 eyes of the neovascularized diavetic rats were enucleated. The enucleated eyes were stained with NADPH-diaphorase histochemistry method and examined under the light microscope. Neovascularized corneas showed intense expression of NADPH-diaphorase at the whole layer of epithelium, the superficial stroma, and the walls of new vessels. Corneas of the nondiabetic rats and uninjured those of diabetic rats showed only mild expression of NADPH-diaphorase, and there were no significant difference of expression between them. According to these results, we think that the increased expression of nitric oxide synthase or nitric oxide may be related to the corneal neovascularization in diabetic rats.

Nonoperative Management of Blunt Abdominal Trauma with Hemoperitoneum

Because of the two merits of nonoperative management of blunt abdominal trauma, 1) avoidance of operative morbidity and 2) better treatment of associated injuries, the use of nonoperative management has been extended, but the indications for such treatment have not been sufficiently found. One hundred two(102) cases admitted due to hemoperitoneum, 44 involving surgery and 58 conservative managment, were analyzed for age, sex, cause of injury, injured organ, injury grade, transfusion amount, and shock on admission. The major causes of injury in the nonoperative and the operative groups are as follows : 23 cases of auto-pedestrian accidents and 15 cases of in-car accidents in the nonoperative group and 19 cases of auto-pedestrian accidents in the operative group. In terms of the injured organ, liver trauma was the most frequent, and spleen trauma was next. The difference in the transfusion amount between the two groups was statistically significant; 8.1 units in the nonoperative group and 13 units in the operative group. In conclusion, 1) nonoperative management can be considered as a first choice in children with blunt abdominal trauma and stable vital signs; 2) patients with hemodynamically stable liver injury with AAST OIS grade 4 and isolated splenic injury AAST OIS grade 4 are candidates for nonoperative management; and 3) nonoperative management through emergency care without transfusion can be considered in cases with stable vital signs.