A Boy with Chronic Active EBV Infection Presented as Mosquito Bite Hypersensitivity Progressed to Fatal Hemophagocytic Lymphohistiocytosis due to NK Cell Neoplasm / 임상소아혈액종양

Chronic active Epstein-Barr virus (CAEBV) infection is characterized by recurrent infectious mononucleosis (IM)-like symptoms and an unusual pattern of anti-EBV antibodies. We report a boy with CAEBV who progressed to aggressive hemophagocytic lymphohistiocytosis (HLH) with NK cell neoplasm. A 19-year-old adolescent boy was admitted with fever and a history of recurrent IM-like symptoms following mosquito bites since the age of 6 years. His condition was diagnosed as CAEBV with atypical lymphocytosis and an unusual pattern of anti-EBV antibodies. His symptoms subsided during treatment with steroids and cyclosporine, although the EBV genome load kept increasing for several years. He was re-admitted after follow-up loss for 8 years, and his clinical and laboratory findings confirmed HLH and high titer of the EBV genome. Bone marrow analysis with flow cytometry showed hemophagocytosis with compatible NK cell neoplasm. He rapidly progressed to pulmonary infection and expired soon after. We conclude that hematopoietic stem cell transplantation may be a potential therapeutic modality for treating CAEBV before serious EBV manifestations.

Analysis of Positional Relationships of Various Centers in Cataract Surgery

PURPOSE: To analyze the positional relationships of various centers in patients undergoing femtosecond laser-assisted cataract surgery (FLACS). METHODS: The locations of the pupil center (PC), limbal center (LC) and lens center were analyzed in each patient using optical coherence tomography during FLACS in 35 eyes of 35 patients. Using the preoperative corneal aberrometry device, angle kappa and the location of the visual axis (VA) were calculated. After acquiring the relative horizontal and vertical coordinates of each center, the distance and location among each center were compared. The relative location and distance of each center were statistically evaluated. RESULTS: The distance from the PC to the lens center was 0.147 ± 0.103 mm, that from the LC to the lens center was 0.205 ± 0.104 mm, and that from the VA to the lens center was 0.296 ± 0.198 mm. The distance from the PC to the VA was 0.283 ± 0.161 mm, that from the LC to the VA was 0.362 ± 0.153 mm, and that from the lens center to the VA was 0.296 ± 0.198 mm. Among the various centers, the PC was the closest to the lens center, whereas the LC and VA were the farthest. Based on the location of the lens center, the PC, LC, and VA exhibited differences in the X and Y coordinate positions (vertical p = 0.004, horizontal p < 0.001). Among them, the LC was significantly inferior and temporal compared to the PC (vertical p = 0.026, horizontal p = 0.023). Based on the location of the VA, the respective locations of the PC, LC and lens center in two dimensions did not significantly differ (vertical p = 0.310, horizontal p = 0.926). CONCLUSIONS: This study demonstrated the positional and locational relationships between the centers regarding FLACS. The locations of the PC, LC, and VA were different from the lens center with the PC being the closest. Surgeons should be aware of these positional relationships, especially in FLACS.

The Influence of Preoperative Meibomian Gland Disease on Dryness after Cataract Surgery

PURPOSE: The aim of this study is to analyze the influence of preoperative meibomian gland disease (MGD) on the postoperative dry eye disease after cataract surgery. METHODS: 100 eyes of 85 patients who had undergone cataract surgery were enrolled. Patients were stratified into three groups by the severity of meibomian gland disease (MGD Grade I, MGD Grade II and MGD Grade III). In each group, we recorded the indexes of dry eye such as Ocular surface disease index, tear breakup time, Schirmer's test and Corneal staining at preoperatively and postoperative week 1, 2, 5, 9. We compared the indexes, preoperatively and postoperatively between three groups. RESULTS: In comparison of the preoperative indexes between groups, the more severe meibomian gland disease the patients have, the higher Ocular surface disease index and the shorter tear breakup time were observed (p < 0.05). In comparison the preoperative with the postoperative indexes, Ocular surface disease index was higher and tear breakup time was shorter at every postoperative moment in MGD Grade (Gr) II and Gr III. In comparison between MGD groups, MGD Gr III showed higher ocular surface disease index than MGD Gr I and Gr II at every follow up point, and shorter tear breakup time than MGD Gr I and Gr II at preoperative and postoperative week 1 and 9 (p < 0.05). CONCLUSIONS: The severity of meibomian gland disease which exist preoperatively can affect the aggravation of dry eye disease after cataract surgery. Therefore, the treatment of meibomian gland disease before cataract surgery can be a therapeutic option to prevent aggravation of dry eye after cataract surgery.

Corneal Endothelial Cell Loss after Tube Shunt Surgery in Fuch's Heterochromic Iridocyclitis

PURPOSE: To report a case of corneal failure after implantation of the Ahmed glaucoma valve occurring in a patient diagnosed with Fuchs' heterochromic iridocyclitis. CASE SUMMARY: A 53-year-old male who complained of ocular pain and suddenly decreased visual acuity in his right eye visited our clinic. His visual acuity was 0.15 and intraocular pressure (IOP) was 55 mm Hg. The slit-lamp examination revealed edematous cornea, fine round or stellate keratic precipitates connected with fine filaments on the endothelium and depigmentation of the iris. The corneal endothelial cell density was 2,958 cells/mm2. There was no specific finding in his left eye. The IOP did not improve with medical treatment, therefore, an Ahmed glaucoma valve was implanted in his right eye. At every follow-up exam the tube was well positioned and the IOP was maintained between 8 and 13 mm Hg. Eight months postoperatively, the patient complained of decreased visual acuity and the cell density was decreased to 1,408 cells/mm2. Posterior subcapsular cataract opacity was observed as well as progression of depigmentation and distortion of the iris. Seventeen months after the surgery, the cell density was 700 cells/mm2. On follow-up examination, his visual acuity was decreased to FC10 cm with the cataract progressing, therefore cataract surgery was performed. One month postoperatively, his vision improved to 0.1. However, the visual acuity deteriorated due to progression of the corneal edema and penetrating keratoplasty was performed. CONCLUSIONS: Aggravation of the corneal complication after Ahmed glaucoma valve implantation should be considered in patients with Fuchs' heterochromic iridocyclitis-induced glaucoma.

The Effects of Plasma Endotoxin Level on Survival Time of Terminally Ill Cancer Patients / 한국호스피스완화의료학회지

PURPOSE: Since most terminally ill cancer patients die of multiple organ failure, plasma endotoxin concentration levels may be used to predict the life expectancy. This study was performed to evaluate the clinical significance of endotoxin level in plasma as a prognostic factor for survival in patients with terminal cancer. METHODS: This study was conducted with 56 terminally ill cancer patients, above 20 years old, from April 2009 through October 2009. Demographic characteristics, Karnofsky performance status, and survival time were evaluated. We analyzed blood levels of white blood cell hemoglobin, hematocrit, aspartate aminotransferase, alanine aminotransferase, c-reactive protein, total bilirubin and endotoxin in each patient. RESULTS: We considered following variable for univariate analysis: plasma endotoxin level, sex, age, WBC, hemoglobin, hematocrit, AST, ALT, total bilirubin, CRP and severity of pain. Univariate analysis did not show a significant association between plasma endotoxin level and survival time. However, in a multivariate analysis with factors that were found to be significantly associated with survival sex, WBC count and total bilirubin level in univariate analysis, high levels of plasma endotoxin and short survival time were significantly related. CONCLUSION: Plasma endotoxin level could be used as a prognostic factor to predict the life expectancy of terminally ill cancer patients.

A Case of Melanocytoma Originating from the Iris

PURPOSE: To report a case of melanocytoma originating from the iris observed for the first time in Korea. CASE SUMMARY: A 53-year-old female with an unexpected iris mass was referred to our clinic. A round, 2.5 mm x 3.5 mm-sized iris mass was found on slit lamp examination in the 12 o'clock area of the patient's left eye. The mass was densely pigmented and had a smooth surface. Gonioscopy showed the mass had reached the peripheral cornea frontward and the lens backward. An excisional biopsy was performed for diagnosis. After the operation, a gonioscopic examination showed an intact ciliary body behind the surgical margin of the iris. A melancytoma of the iris was observed on subsequent histopathological examination. The patient has remained symptom-free with no iris mass recurrence since the operation. CONCLUSIONS: A few cases of iris melanocytomas have been reported worldwide but not in Korea. We confirmed a case of melanocytoma originating from the iris for the first time in Korea.

Is human papillomavirus genotype an influencing factor on radiotherapy outcome? Ambiguity caused by an association of HPV 18 genotype and adenocarcinoma histology / 부인종양

OBJECTIVE: To evaluate whether human papillomavirus (HPV) genotype is associated with poor prognosis of uterine cervical cancer treated primarily with radiotherapy. METHODS: HPV genotyping was performed in 181 radiotherapy patients using SPF10 polymerase chain reaction and HPV reverse hybridization line probe assay. Univariate and multivariate Cox regression analysis was performed to explore the prognostic factors. Bivariate analysis was performed to investigate any association between HPV genotype and the rest of the prognostic factors. RESULTS: HPV type 18 was associated with poor disease-free survival on univariate analysis but the statistical significance was abolished when multivariate analysis was applied. Bivariate analysis was performed to examine the possible confounding factors influencing the effect of HPV 18 on prognosis. As a result, adeno/adenosquamous carcinoma histology reduced the prognostic importance of HPV 18 by 66% (2.4 to 1.6), and was the only factor which reduced the hazard ratio of HPV 18. When compared to non-18 squamous cell carcinoma, type 18 increased the risk of recurrence up to 4-fold in adeno/adenosquamous/HPV 18 and 3.7 in adeno/adenosquamous/non-18, and to 2-fold in squamous carcinoma/HPV 18, respectively. CONCLUSION: Our data suggest that the prognostic significance of HPV 18 genotype is substantial on radiotherapy outcome, but can be underestimated because of the close association of the HPV 18 and adenocarcinoma/adenosquamous carcinoma histology. Both HPV 18 and histologic type should be regarded as strong prognostic factors in considering the treatment outcome of the uterine cervical cancer.

The Correlation between Postural Control and Attention during Performance of Dual Task in Stroke Patients

OBJECTIVE: To compare differences in postural changes during dual-task performance (DTP) between stroke patients and healthy controls, and to investigate the relationship between postural control and attention during DTP in stroke patients. METHOD: Twenty-nine subacute stroke patients who were able to stand independently and ten age-matched, healthy controls were enrolled in the study. The postural control of subjects was evaluated in all of the following four conditions using posturography: a simple standing state with eyes open (EO), a DTP with EO, a simple standing state with eyes closed (EC) and a DTP with EC. The dual-task was performed by standing while inversely repeating a given four-digit number. The parameters were stability index (SI) and weight distribution index (WDI) in posturography. Both visual and auditory inattention of the stroke patients were measured using the computer neuropsychologic test. RESULTS: In stroke patients, SI and WDI increased significantly during DTP (p<0.05) both their EO and EC status. The change of SI during DTP was positively correlated with the visual and auditory inattention in stroke patients (p<0.01) with their EO status. No significant correlations were noticed in WDI. CONCLUSION: Postural changes during DTP increased more in stroke patients than in healthy controls. Postural control showed a significant correlation with visual and auditory attention during the DTP in stroke patients. We therefore expect that dual-task training using postural control and attention will be an attractive treatment method for increasing postural stability in stroke patients.

The Knowledge and Attitude of Medical Students towards the Organ Donation / 대한이식학회지

PURPOSE: This research was intended to study on the knowledge and attitude of the medical students towards the organ donation in brain death, who will be in charge of organ donation and transplantation as health specialists in the future. METHODS: The data had been collected from 723 medical students who have finished clinical practice courses in 41 medical schools in Korea. RESULTS: 1) There were significant differences in the knowledge and attitude to the organ donation in brain death in gender and the location of university hospital. Another difference was caused by the ways to gain the information of it. In the case of attitude, there were notable differences according to the ways to obtain information of the organ donation and whether one accepts organ donation. 2) In the analysis of the knowledge of general features, the important factors were confirmed statistically by the location of university hospital and the way to get the information for organ donation. And in the attitude, the medical knowledge and the progress of brain death were more meaningful among other factors statistically. 3) The correlation between the knowledge and attitude of respondents about organ donation in brain death was not valuable statistically (r=0.055, P=0.142), on the other hand, in the medical knowledge (r=0.135, P=0.001) and the knowledge about progress of brain death (r=-0.075, P=0.043), were valuable statistically. CONCLUSION: For the strategy, they should be added to the medical college curriculum and clinical practice program about organ donation. In addition, medical students would recognize the importance, progress and the role of organ donation in brain death through this program. Eventually, they would have positive attitude about the organ donation and contribute to expand it.