A Fibroma of Tendon Sheath Causing Carpal Tunnel Syndrome:A Case Report of an Atypical Clinical Presentation

Fibroma of the tendon sheath is a benign slow-growing fibrous tumor. Although rare, cases occurring in the upper extremities usually involve the fingers. It appears as a well-defined, roundor oval-shaped mass originating from the flexor tendon. Abundant fibrous stroma makes fibromas appear as a low intensity mass in all MRI sequences. Most of the fibromas manifest as painless soft tissue masses. Herein, we report a case of fibroma of the tendon sheath with an unusual clinical presentation, triggering carpal tunnel syndrome during wrist movement.

Community-Based Pre-HospitalElectrocardiogram TransmissionProgram for Reducing Systemic TimeDelay in Acute ST-Segment ElevationMyocardial Infarction

Background and Objectives@#In acute ST-segment elevation myocardial infarction (STEMI),on-site transmission of electrocardiogram (ECG) has been shown to reduce systemic timedelay to reperfusion and improve outcomes. However, it has not been adopted in communitybasedemergency transport system in Korea. @*Methods@#Busan Regional Cardio-cerebrovascular Center and Busan Metropolitan City Fireand Safety Headquarters (BMFSH) jointly developed and conducted a pre-hospital ECGtransmission program. Seven tertiary hospitals and 22 safety stations of BMFSH participated.Systemic time delay to reperfusion of STEMI patients in the program was compared with thatof 95 patients transported by 119 emergency medical system (EMS) before the program wasimplemented. @*Results@#During the study period, 289 ECG transmissions were made by 119 EMS personnel,executed within 5 minutes in 88.1% of cases. Of these, 42 ECGs were interpreted as STsegmentelevation. Final diagnosis of STEMI was made in 20 patients who underwent primarypercutaneous coronary intervention. With the program, systemic time delay to reperfusion wassignificantly reduced (median [interquartile range; IQR], 76.0 [62.2–98.7] vs. 90.0 [75.0–112.0],p<0.01). Significant reduction of door-to-balloon time was also observed (median [IQR], 45.0[34.0–69.5] vs. 58.0 [51.0–68.0], p=0.03). The proportion of patients with systemic time delayshorter than 90 minutes rose (51.6% vs. 75.0%, p=0.08) with pre-hospital ECG transmission. @*Conclusions@#We developed and implemented a community-based pre-hospital ECG transmission program for expeditious triage of STEMI patients. Significant reductions ofsystemic time delay and door-to-balloon time were observed. The expanded use of prehospitalECG transmission should be encouraged to realize the full potential of this program.

Intraindividual Comparison of Visual Outcomes between Blue Light-filtering and Ultraviolet Light-filtering Intraocular Lens

PURPOSE: To compare the clinical results of short-term visual acuity and quality of vision after implantation of a yellow-tinted blue light-filtering intraocular lens (IOL) (Acrysof IQ® SN60WF) and an clear ultraviolet (UV) light filtering IOL (enVista™ MX60) in the same patient. METHODS: 44 patients with bilateral cataract received an SN60WF in one eye and an MX60 in the other eye. All eyes were evaluated for refraction power and uncorrected visual acuity (UCVA) at preoperative and 1, 3 months postoperatively. At postoperative 3 months, corrected visual acuity, quality of vision (OQAS II®), contrast sensitivity (CGT 2000®) and visual field (Humphrey Field Analyzer®), and subjective patients' response to the degree of brightness were evaluated. Furthermore, glistening degree, intraocular stability, and posterior capsular opacification were examined. RESULTS: There were no significant differences in average refractive power or UCVA at 1 and 3 months (p > 0.05) between the two groups. At 3 months after cataract surgery, the quality of vision according to OQAS II®, the contrast sensitivity according to CGT 2000® with the glare either on or off, and visual field; showed no difference between the two groups (p > 0.05). Both IOLs had no glistening and posterior capsular opacity. The patients' response to the degree of brightness shows that MX60 (48.3%) has a higher degree of satisfaction. CONCLUSIONS: Yellow-tinted blue light-filtering IOL and clear UV light-filtering IOL had no difference in short-term visual acuity and quality of vision. Subjective brightness perception, however, was better with clear UV light-filtering IOL.

Choroidal Thickness Variation According to Refractive Error Measured by Spectral Domain-optical Coherence Tomography in Korean Children

PURPOSE: To assess choroidal thickness (CT) variation according to refractive errors using enhanced-depth imaging optical coherence tomography. METHODS: Eighty-nine eyes (in 89 children) <±6 diopter were categorized into three groups: hyperopia, emmetropia, and myopia, according to refractive error, and underwent choroidal scans using enhanced-depth imaging-optical coherence tomography. CT was measured at the fovea and at 1 mm and 3 mm nasal (N1 and N3), temporal (T1 and T3), superior (S1 and S3), and inferior (I1 and I3) from the fovea. RESULTS: Mean foveal CTs were 346.86 µm, 301.97 µm, and 267.46 µm in the hyperopia, emmetropia, and myopia groups, respectively (p < 0.05). CTs at N3 and T3 were 214.59 µm and 318.68 µm, 163.92 µm and 320.79 µm, and 153.93 µm and 295.61 µm in the hyperopia, emmetropia, and myopia groups, respectively (p < 0.05). All CTs in the hyperopia group were thicker than those of other groups (p < 0.05). Fovea was thickest and was significantly thicker than at N3 and I3 in hyperopia (p < 0.05). T3 thickness in the emmetropia and myopia groups was greater than thickness at other areas, particularly the nasal and inferior choroids (p < 0.05). CT was positively correlated with spherical equivalent (p = 0.029). CONCLUSIONS: In Korean children, CTs were greater in the hyperopia group than in the emmetropia and myopia groups. The temporal choroid was thicker than the nasal choroid, regardless of the refractive error. The thickest location in the hyperopia group was the fovea; however, the temporal choroid was thickest in the emmetropia and myopia groups.

The Effect of Subconjunctival Bevacizumab Injection before Conjunctival Autograft for Pterygium

PURPOSE: To evaluate the effect of subconjunctival bevacizumab injection before conjunctival autograft for pterygium. METHODS: Twenty-five eyes (25 patients) with pterygium received a subconjunctival injection of 2.5 mg (0.1 mL) bevacizumab 1-2 weeks prior to conjunctival autograft surgery. The control group (25 eyes of 25 patients) received the same operation. Two weeks, 1 month and every month after the surgery, the vascularization of surgical site, the recurrence rate and the effect of wound healing were analyzed. RESULTS: The bevacizumab group showed a decreased conjunctival vascularity grade compared with the control group based on light microscopy. The bevacizumab group also showed lower vascular epithelial growth factor (VEGF) compared with the control group using immunohistochemical analysis and western blot. There was no recurrence in both groups, but, persistent autograft edema was observed at 8 weeks postoperatively in the bevacizumab group. CONCLUSIONS: Although preoperative injection of bevacizumab effectively reduced vascularity and VEGF concentration of pterygium tissue, prolonged autograft edema was observed. Based on these results, bevacizumab inhibits lymphangiogenesis as well as angiogenesis. Therefore, delayed wound healing should be considered when subconjunctival bevacizumab injection is administered before pterygium surgery.

Clinical Features of Moyamoya Disease in Children

PURPOSE: Moyamoya disease, is a chronic progressive cerebrovascular occlusive disorder that can lead to permanent neurologic deficit. The aim of this study is to analyze clinical features, radiologic findings, and prognosis of Moyamoya disease comparing with previous studies. METHODS: We retrospectively reviewed on the clinical data of 26 patients and they were analyzed in terms of age, sex, clinical features, radiologic findings, treatment and prognosis. RESULTS: The male to female ratio was 1:1.6 and the mean age was 9.3 years(male 6.1 years and female 10.9 years). There was a higher occurrence rate in 11-15 year-old group, compared to the previous studies. The most common symptoms at onset were hemiparesis and hemiplegia. Brain infarction, hemorrhage and seizure were found in five, three and two patients on brain imaging respectively. Eight patients(44%) showed reduced perfusion without structural abnormalities on brain perfusion CT. The internal carotid artery was the most common site of occlusion on conventional angiography. Indirect encephalo-duro-arterio-synangiosis was performed in 76.9% of the patients. One patient(3.85%) died and twelve patients(46.15%) showed neurologic sequelae at the time of discharge. Sequelae included hemiplegia, gaze disturbance, facial palsy, and seizures. CONCLUSION: Compared with previous studies, the age at onset was higher in our patients, with a peak incidence after the age of 10. Lower rate of severe neurologic sequelae, such as hemiparesis and hemiplegia was observed in this study. Because this study was limited by the small number of patients included, further investigations such as multi-center prospective analysis is needed.

A Case of Jejunostomy for Cerebral Palsy with Recurrent Aspiration Pneumonia / 소아알레르기및호흡기학회지

Cerebral palsy (CP) usually arises in the prenatal period, interferes with normal development of the brain and presents as a disorder of motor dysfunction. It is a common cause of severe neurologic disability in children with incidence of 2 per 1000 live births in Canada. Presently, with the persistent increase in premature births and improved care in the perinatal period, the incidence of CP is strikingly augmented. According to neurologically impaired motor ability, they commonly have feeding difficulties, like swallowing, leading to frequent aspiration pneumonia and gastroesophageal reflux. Therefore, improvement of feeding techniques should be an urgent requirement to correct the risk of poor growth. We report a case of CP due to kernicterus who have recurrent pneumonia and growth failure, experience a jejunostomy to overcome the feeding problems.

A Case of Alveolar Soft Part Sarcoma in a Child / 대한소아혈액종양학회지

Alveolar soft part sarcoma (ASPS) is a rare soft tissue tumor that accounts for 5% of pediatric non-rhabdomyosarcoma soft tissue sarcomas. The disease presents as a indolent asymptomatic mass and affects primarily younger patients. The clinical course is often indolent and late metastases can develop even after prolonged disease-free intervals. Radiotherapy and chemotherapy play a very limited role in the treatment. We report a pediatric case of ASPS with a brief review of the literature.

Development of VX-II Carcinoma Model in Rabbit Uterus: Evaluation with MR Imaging and Histopathology

PURPOSE: To develop a VX-II carcinoma model in the rabbit uterus and to describe the MR imaging findings of an experimentally induced VX-II uterine carcinoma along with the histopathologic findings. MATERIALS AND METHODS: 13 New Zealand rabbits were included in this study. Two pieces of tissue suspension (1 mm3x2) of VX-II carcinoma were loaded in an 18 gauge disposable needle and the tissue embedded in the wall of each horn of the rabbits' uterus. We obtained the MR images at 2 weeks in group A (n=5), or at 2 and 4 weeks in group B (n=8). T2-weighted images were obtained using an extremity coil. On MR imaging, we measured the signal intensity of the tumor and the uterine wall. We also measured the size and shape of the tumor and we compared this with the histopathologic results. RESULTS: On MR images obtained 2 weeks after inoculation, all the rabbit uteruses (group A and B, n=13) show a thick tubular wall, and the uteruses demonstrated a high signal intensity on T2-weighted images. The thickened uterine walls were measured as 3-10 mm (mean: 6.5 mm). Peritoneal nodules were observed in 3/13 rabbits (23%), the nodules measured 1.5-1.8x3.0 cm; uterine masses were observed in 3/13 rabbits (23%), and they measured 0.6-1.5x1.3-1.5 cm. On MR images obtained 4 weeks after the inoculations (group B, n=8), rabbit uteruses that had VX-II carcinoma show thick tubular wall in all cases (n=8, 100%) and round uterine masses (n=6, 75%). The thickened uterine walls measured 5-14 mm (mean 7.6 mm) and uterine masses measured 1.3-3.0x1.5-6.0 cm. All the rabbit uteruses having VX-II carcinoma showed high signal-to-noise ratios along the thickened uterine walls or masses on T2WI. On the histopathologic exam after sacrificing the rabbit, a few viable tumor cells were found because of necrosis in the inner portion of the uterine tumors, and abundant viable tumor cells were found at the periphery of the uterine tumors. CONCLUSION:We can develop an animal model with uterine tumor in rabbit uterus using VX-II carcinoma. Experimentally induced VX-II carcinomas in rabbit uterus demonstrated central necrosis, and MR imagings of experimentally induced uterine VX-II carcinomas were well correlated with the histopathology.

Changing Trends in Surgical Approaches of the Hysterectomy: 3408 cases Vaginal Hysterectomy-The University of Hallym Hospital's Experience in Korea / 대한산부인과학회잡지

OBJECTIVE: The purpose of our study evaluate to assess the feasibility and safety of performing vaginal hysterectomy on our experience. METHODS: Between 1990 year and 1997 year, 3408 women underwent vaginal hysterectomy without laparoscopic assistance at Hallym University Hospital in Korea. All hysterectomies(abdominal & vaginal) were reviewed and these were compared with all hysterectomy cases from most recent year available for complete analysis. RESULT: 1. In 1990 yrs~1997 yrs, vaginal hysterectomies compromised 51%(vaginal hysterectomy [below VH]: 268 / total abdominal hysterectomy [below TAH]: 258; 1990), 55%(VH: 254/TAH: 212; 1991), 60%(VH: 346/TAH: 227; 1992), 64%(VH: 341/TAH: 190; 1993), 72%(VH: 434/TAH: 168; 1994), 75%(VH: 489/TAH: 156; 1995), 76.%(VH: 632/TAH: 196; 1996), 78%(VH: 657/TAH: 190;1997), a high increased rate of vaginal hysterectomy significantly. 2. The average age of patients was 41.9+/- 8.18(26~84) years old and 25 nullipara and 274 primiparas and 3109 multiparas. The mean parity was 2.74+/-0.36. 3. The common surgical indications were uterine myoma(53.9%), prolapse of uteri(23.3%), CIN II-III or microinvasive cervical cancer(6.5%), others(16.3%) 4. The average time of operation(hysterectomy and colporrhaphy) was 78.3+/- 14.2 min(40~230). 5. The average weight of uterus was 166.5+/- 111.4 gm(60~1130 gm), 34.0% was done morcellation. 6. 5.7% of operated women had previous abdominal operaton (without tubal ligation). 7. The common associated procedures were posterior colporrhaphy(47.4%), anteroposterior colporrhaphy(45.6%), adnexectomy(4.9%), other(2.1%). 8. The mean blood loss was 280+/- 104.4 ml and 12.4% of operated women were need of transfusion. 9. The minor complication rate was 10.6% e.g. urinary retention(5.3%-179cases), abdominal bleeding (including conversion TAH) (0.3%-9cases), pelvic hematoma(0.3%-11cases), post operation fever(2.8%-94cases), mortality cases none. 10. The mean hospital days were 7 days(4~20) CONCLUSION: In our experience the following conclusions have been reached that vaginal hysterectomy is usually well tolerated by most women, a safe operation with few complications and without notable blood loss and without the need of expensive laparoscopic equipment. The incidence of vaginal hysterectomy is characterized by pronounced fluctuations suggested that no valid general guidelines have yet been established for the indication via vagina of surgical treatment. The incidence of vaginal hysterectomy correlates with the experience of individual surgeon strongly. Vaginal hysterectomy remains the method of choice for removal of the uterus in the absence of absolute contraindication.

A Study of Interleukin -8 in the Peritoneal Fluid of Patients with Endometriosis / 대한산부인과학회잡지

No abstract available.