A Case of Epidural Abscess Occurred after Liver Abscess Complicated by Transarterial Chemoembolization in a Patient with Metastatic Cancer to Liver / 대한소화기학회지

Transarterial chemoembolization (TACE) is one of the most effective therapies for unresectable hepatocelluar carcinoma or metastatic hypervascular tumors. Abscess occurring in the other organs beside the liver after TACE is a complication that often occurs, sometimes potentially fatal. We report a case of spinal epidural abscess occurred after liver abscess complicated by TACE in a patient with metastatic neuroendocrine tumors to the liver. A 67-year-old female underwent TACE first for the metastatic lesions to liver, with a history of pancreatoduodenectomy for the primary pancreatic neuroendocrine tumor. Four days after TACE, sudden high fever occurred, and liver abscess was found on abdominal CT. Two days later, back pain and radiating pain to the right leg occurred, and lumbar spine MRI showed spinal epidural abscess. After intravenous antibiotics for 8 weeks and partial laminectomy, the patient recovered and was discharged without complications.

Esophageal Pyogenic Granuloma: Endosonographic Findings and Endoscopic Treatments

Pyogenic granuloma is a benign inflammatory vascular lesion, mainly found in the skin and oral mucosa. A few cases of pyogenic granuloma in the gastrointestinal tract have been reported, and the esophagus was the main site in these cases. These patients were diagnosed with pyogenic granuloma after they underwent upper endoscopy and biopsy. Endoscopic resection is a favorable treatment option for esophageal pyogenic granuloma. Recently, we observed characteristic endosonographic findings in two cases with esophageal pyogenic granuloma, which were then treated successfully by endoscopic resection.

A Case of F-18 FDG PET-CT Detection of Sporadic Medullary Thyroid Carcinoma and Cervical Lymph Node Metastasis of Ovarican Cancer / 고신대학교의과대학학술지

Medullary thyroid carcinoma (MTC) is derived from the parafollicular or C-cells. As surgical resection is the only curative therapy for MTC, the early diagnosis is important for the patient's survival. F18-Fluorodeoxyglucose positron emission tomography-computed tomography (F-18 FDG PET CT) is a noninvasive imaging method which can be used to diagnose malignant thyroid tumors including recurrent or residual MTC. However, due to the limitations of this technique, it is difficult to differentiate benign from malignant thyroid tumors. We herein present a 47-year-old woman with ovarian cancer history who was found to have thyroid incidentaloma with metastatic cervical lymph node through F-18 FDG PET CT. Thyroid incidentaloma of the patient was examined by fine needle aspiration and the result of this diagnostic procedure showed suspicious MTC. The patient was subsequently diagnosed as having sporadic medullary thyroid carcinoma and metastatic cervical lymph node due to ovarian cancer.

25-Hydroxyvitamin D Status Based on Estimated Glomerular Filtration Rate in Patients with Chronic Kidney Disease / 대한내과학회지

BACKGROUND/AIMS: Accumulating data suggest that vitamin D deficiency is prevalent in patients with chronic kidney disease (CKD). However, comprehensive data are lacking for Koreans. The aim of this study was to survey vitamin D deficiency among patients with CKD in Korea and to identify the relationships among various factors. METHODS: We conducted a retrospective cohort study of 444 patients who were divided into four subgroups by estimated glomerular filtration rate (eGFR) for comparisons of mean 25-hydroxyvitamin D [25(OH)D] level and other parameters. In addition, non-dialyzed patients were categorized into four groups based on 25(OH)D levels ( or =30 ng/mL), and risk factors for severe vitamin D deficiency ( or = 60 mL/min/1.73 m2, 43% (34/79) showed severe 25(OH)D deficiency, and the mean 25(OH)D level was 11.7 +/- 5.3 ng/mL. In CKD3 group, 53.2% (41/77) showed severe 25(OH)D deficiency, with a mean level of 11.3 +/- 7.2 ng/mL. In CKD4 group, 53.3% (49/92) had severe 25(OH)D deficiency, with a mean level of 11.0 +/- 6.2 ng/mL. Approximately 71% (139/196) of patients in CKD5 group showed severe deficiency, and the mean level was 9.2 +/- 5.9 ng/mL. Severe 25(OH)D deficiency was affected by winter season, renal function, diabetes, and low-density lipoprotein cholesterol. The serum parathyroid hormone level was inversely correlated with the 25(OH)D level, such that 25(OH)D <20 ng/mL were associated with a steep increase in parathyroid hormone. CONCLUSIONS: Vitamin D deficiency is highly prevalent in the Korean population. Few patients met a sufficient 25(OH)D concentration, even in the early stages of CKD. Our data suggest that 25(OH)D level of 20 ng/mL is a threshold for a rapid increase in parathyroid hormone levels.

A Case of Adrenal Cystic Pheochromocytoma with Contralateral Adrenocortical Adenoma Causing Subclinical Cushing's Syndrome

Bilateral adrenal neoplasms are associated with metastatic cancer, pheochromocytoma and lymphoma. The coexistence of a unilateral functioning adrenocortical adenoma with contralateral pheochromocytoma is extremely rare. A 52-year-old woman complained of fatigue, headache, palpitation, and progressive weight gain. Hormonal assessment demonstrated high 24 hours urine epinephrine, norepinephrine, and free cortisol. A dexamethasone suppression test (overnight 1 mg, low dose 2 mg) showed insuppressible cortisol. Computerized tomographic scanning revealed a bilateral adrenal tumor. To preserve adrenal function, right adrenalectomy along with left adrenal tumorectomy was performed. Histological finding of the right adrenal tumor was pheochromocytoma and the left adrenal tumor was adrenocortical adenoma. This patient was the first case of a functional adrenocortical adenoma with contralateral cystic pheochromocytoma in Korea. We report the case with a review of the literature.

A Case of Ocular Adnexal Benign Reactive Lymphoid Hyperplasia Recurred as Systemic Malignant Lymphoma

PURPOSE: We report a case of recurred systemic malignant lymphoma developed after the treatment for ocular adnexal benign reactive lymphoid hyperplasia. CASE SUMMARY: A 71-year-old female visited our hospital for right upper eyelid swelling and proptosis that had been progressing slowly for 4 years. Orbital computed tomography (CT) showed enlargement of the bellies of lateral and superior rectus muscles in the right orbit, but other abnormal findings were not detected in the systemic evaluation. Through incisional biopsy, benign reactive lymphoid hyperplasia was diagnosed on histopathologic examination. Upper eyelid swelling and proptosis resolved after radiation therapy. Fifty-one months after the treatment of benign reactive lymphoid hyperplasia, the patient visited our hospital again for a painful mass that had developed in the left neck. On neck CT, it showed enlargement of the left cervical lymph node and asymmetrical thickening of the left oropharyngeal wall. Systemic MALT lymphoma was confirmed, and radiation therapy was performed. According to neck CT, four months after radiation therapy, the enlargement and thickening resolved. CONCLUSIONS: Because there is a possibility of systemic malignant lymphoma after benign reactive lymphoid hyperplasia, continuous follow-up and repeated systemic evaluation should be required after treatment of ocular adnexal benign reactive lymphoid hyperplasia.

Risk Factors Leading to Enucleation or Evisceration in Endophthalmitis

PURPOSE: To evaluate the risk factors associated with enucleation or evisceration in endophthalmitis patients. METHODS: The medical records of endophthalmitis cases from January 1995 to July 2006 were reviewed retrospectively. The cases were divided into 2 groups, the enucleation/evisceration group (36 eyes of 36 patients) who underwent enucleation or evisceration and the intraocular procedures group (61 eyes of 60 patients) who received intravitreal antibiotics injection and/or vitrectomy. We analyzed these cases with respect to age, sex, initial visual acuity, causes of endophthalmitis, systemic disease, and causative organisms. RESULTS: Older age (p=0.002), women (17/32, p=0.027), no light perception at presentation (33/37, p<0.001), endophthalmitis associated with corneal ulcer (25/25, p<0.001), and diabetes mellitus (14/20, p=0.001) were significantly associated with enucleation or evisceration. CONCLUSIONS: Older age, poor initial visual acuity, endophthalmitis associated with corneal ulcer, and diabetes mellitus were strongly associated with enucleation or evisceration. If any of these factors are present, more intensive treatments are warranted to prevent loss of the eye.

Optical Coherence Tomography Findings in Three Cases of Albinism

PURPOSE: To report optical coherence tomography (OCT) findings in albinism. METHODS: Full ocular examinations, including OCT, were performed in one patient with ocular albinism and two patients with oculocutaneous albinism. RESULTS: OCT scans were unable to detect the foveal depression in these patients. A widespread thickening of the retina occurred throughout the entire fovea, which showed no difference from the surrounding macula. OCT scans also demonstrated probable scleral layer below the retinal pigment epithelial (RPE) layer. CONCLUSIONS: OCT scans of albinism patients confirmed foveal hypoplasia and increased transmission of incident light in the RPE layer.

Difference in 24-Hour Ambulatory Blood Pressure in Normal Tension Glaucoma and Primary Open-Angle Glaucoma

PURPOSE: To evaluate the variation of 24-hours blood pressure in patients with normal tension glaucoma (NTG) and primary open-angle glaucoma (POAG). METHODS: Thirty patients with NTG, 30 patients with POAG, and 30 normal controls were enrolled in this study. Each subjects underwent 24-hours ambulatory blood pressure monitoring. The variation of each parameter and difference among NTG, POAG, and control groups were compared. RESULTS: The lowest diastolic blood pressure (DBP) and the lowest mean arterial blood pressure (MAP) were significantly lower in the NTG group(51.9+/-11.3 mmHg and 66.9+/-13.1 mmHg) than in the POAG group(60.0+/-11.4 mmHg and 77.8+/-16.8 mmHg, p=0.048 and 0.024) and the control group(60.1+/-10.5 mmHg and 77.4+/-13.3 mmHg, p=0.047 and 0.031) during nighttime. More patients showed a lowest MAP less than 60 mmHg in the NTG group(8 patients, 27%) than in the POAG group(2 patients, 7%) and the control group(2 subjects, 7%, p=0.038 each). In addition, a decrease of more than 15% in DBP was more frequent in NTG group(17 patients, 57%) than in the POAG group(9 patients, 30%) and the control group(9 subjects, 30%, p=0.037 each). CONCLUSIONS: Nocturnal reduction in blood pressure may play an important role in the pathogenesis of NTG in some patients. Therefore, nighttime blood pressure should be considered as an important reference factor in diagnosis and treatment of NTG.

A Case of Intravitreal Voriconazole for the Treatment of Drug-resistant Penicillium Endophthalmitis

PURPOSE: To report a case of a drug-resistant Penicillium endophthalmitis that was treated with intravitreal voriconazole injection. CASE SUMMARY: A 73-year-old male who developed endophthalmitis after cataract surgery was treated with intravitreal vancomycin and ceftazidime injection after aqueous and vitreous cultures were done. The condition were not improve after intravitreal injection, and the culture showed Penicillium species. Fungal endophthalmitis was diagnosed and pars plana vitrectomy, intraocular lens removal, and intravitreal amphotericin B injection were performed. However, a progressive worsening of the ocular condition was observed, and the patient was transferred to our hospital. At initial visit, the best corrected visual activity was hand movement. The hypopyon and thick exudative membrane filled the anterior chamber. Pars plana vitrectomy and intravitreal voriconazole injection were performed under the diagnosis of drug-resistant Penicillium endophthalmitis. The condition improved after the operation, and there was no recurrence of endophthalmitis until four months after vitrectomy. CONCLUSIONS: Voriconazole is useful in the treatment of drug-resistant fungal endophthalmitis.

Transient Unilateral Visual Loss and Ophthalmoplegia Following Spine Surgery in Prone Position

PURPOSE: To report a case of transient ophthalmoplegia and visual loss caused by ophthalmic artery occlusion induced after surgery in prone position. METHODS: A 32-year-old woman was referred to the department of ophthalmology for unilateral visual loss and ophthalmoplegia after cervical spine surgery performed in prone position. Full ocular examinations, including fluorescein angiography (FAG) and electroretinography (ERG) were performed. RESULTS: On the initial visit, her right visual acuity was light perception and the left visual acuity was 1.0. Ophthalmoplegia and an afferent pupillary defect was present in the right eye. A fundus examination revealed no abnormal findings. On the 4th day, the retina in posterior pole was opacified and late phase of FAG showed fluorescein leakage from the retinal and choroidal vessels. On the 8th day, the best corrected visual acuity of the right eye was improved to 0.7 and ERG showed decreased amplitudes of both a and b waves. On the 12 th day, ocular motility was fully recovered. On the 61 st day, visual acuity of the right eye was 0.7 and ERG showed that the amplitude had improved from the initial examination.

Superior oblique lengthening procedure with silicone expander in rabbits

Using a rabbit model, we assessed the postoperative status and histopathologic findings of superior oblique tenotomy with silicone expander procedure. In the control group we marked and cut the superior oblique, and in the experimental group we inserted a silicone 240 retinal band 4 mm in length along the edges of incision. At the postoperative weeks 1,3,5 and 7, we randomly chose five rabbits and made a histopathologic examination after hematoxylin-eosin and Masson's trichrome stain. The distance between the incised edges was various in the control group, but constant in the experimental group. With time inflammation decreased and fibrosis of the superior oblique increased. Foreign body reaction occurred around the suture material in both groups., but not around the silicone expander. At 5 weeks atrophy of the superior oblique was observed in both groups.From the above results, we concluded that the superior oblique lengthening procedure using silicone expander is a useful surgical method for weakening the superior oblique muscle.