Management of Adult Blunt Renal Injury: A 10-Year Retrospective Review at a Single Institution

Purpose@#Renal injury occurs in up to 5% of trauma cases and the kidney is the third most wounded abdominal organ. The study objective was to analyze clinical characteristics of patients with blunt renal trauma and review the treatment of high-grade blunt renal injuries. @*Methods@#The medical charts of trauma patients who visited Haeundae Paik Hospital between March 2010 and February 2020 were retrospectively analyzed. Data on demographics, injury patterns, clinical presentation, management, and outcomes were analyzed. @*Results@#A total of 68 patients with renal trauma were included in this study. The most common renal injury was Grade III (n = 27, 39.7%). Falling was the predominant mechanism of injury (n = 33, 48.5%), and 23.5% (n = 16) of patients sustained isolated renal trauma. Organ damage related to kidney injury included chest injury (57.4%, n = 39) and abdominal or pelvic content injury (48.5%, n = 33). The overall mortality rate was 2.9% (n = 2). There were 45 cases of high-grade renal trauma (AAST Kidney injury scale Grade Ш-V). There was no statistical difference in the outcomes of high-grade (n = 44, 97.8%) and low-grade (n = 23, 100%) renal trauma patients who received nonoperative treatment (p = 0.511). Variables did not differ significantly, except for the injury severity score which was statistically significantly different between low-grade and high-grade renal trauma patients (p = 0.001). @*Conclusion@#Most patients with traumatic renal injury, even those with high-grade injury, can be managed by nonoperative treatment, and have a good prognosis.

Efficacy of Prophylactic Cranial Irradiation According to the Risk of Extracranial Recurrence in Limited-Stage Small Cell Lung Cancer / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#We aimed to evaluate the effectiveness of prophylactic cranial irradiation (PCI) for “early brain metastasis”, which occurs before extracranial recurrence (ECR), and “late brain metastasis”, which occurs after ECR, in limited-stage small cell lung cancer (LS-SCLC). @*Materials and Methods@#We retrospectively analyzed 271 LS-SCLC patients who underwent definitive chemoradiation. All patients were initially staged with brain magnetic resonance imaging and positron emission tomography. Intracranial recurrence (ICR), ECR, progression-free rate (PFR), and overall survival (OS) were analyzed as clinical endpoints. The competing risk of the first recurrence with ICR (ICRfirst) was evaluated. Significantly associated variables in multivariate analysis of ECR were considered as ECR risk factors. Patients were stratified according to the number of ECR risk factors. @*Results@#The application of PCI was associated with higher PFR (p=0.008) and OS (p=0.045). However, PCI was not associated with any of the clinical endpoints in multivariate analysis. The competing risk of ICRfirst was significantly decreased with the application of PCI (hazard ratio, 0.476; 95% confidence interval, 0.243 to 0.931; p=0.030). Stage III disease, sequential, and stable disease after thoracic radiation were selected as ECR risk factors. For patients without these risk factors, the application of PCI was significantly associated with increased OS (p=0.048) and a decreased risk of ICRfirst (p=0.026). @*Conclusion@#PCI may play a role in preventing early brain metastasis rather than late brain metastasis after ECR, suggesting that only patients with a low risk of ECR may currently benefit from PCI.

Induction Chemotherapy as a Prognostication Index and Guidance for Treatment of Locally Advanced Head and Neck Squamous Cell Carcinoma: The Concept of Chemo-Selection (KCSG HN13-01) / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#Certain patient subgroups who do not respond to induction chemotherapy (IC) show inherent chemoresistance in locally advanced head and neck squamous cell carcinoma (LA-HNSCC). This study aimed to assess the prognostic value of IC, and role of IC in guiding the selection of a definitive locoregional therapy. @*Materials and Methods@#Out of the 445 patients in multi-institutional LA-HNSCC cohort, 158 (36%) receiving IC were enrolled. The study outcome was to assess overall survival (OS) through IC responsiveness and its role to select subsequent treatments. @*Results@#Among 135 patients who completed subsequent treatment following IC, 74% responded to IC (complete response in 17% and partial response in 58%). IC-non-responders showed 4.5 times higher risk of mortality than IC-responders (hazard ratio, 4.52; 95% confidence interval, 2.32 to 8.81; p < 0.001). Among IC-responders, 84% subsequently received definitive concurrent chemoradiotherapy (CCRT) and OS was not differed by surgery or CCRT (p=0.960). Regarding IC-non-responders, 54% received CCRT and 46% underwent surgery, and OS was poor in CCRT (24-month survival rate of 38%) or surgery (24-month survival rate of 63%). @*Conclusion@#Response to IC is a favorable prognostic factor. For IC-responders, either surgery or CCRT achieved similar survival probabilities. For IC-non-responder, multidisciplinary approach was warranted reflecting patients’ preference, morbidity, and prognosis.

Division of a single free flap in multiple digit reconstruction

Background@#Single free flaps are a commonly used reconstructive method for multiple soft tissue defects in digits. We analyzed the flap size, division timing, and degree of necrosis in cases with various types of flap division. @*Methods@#We conducted a retrospective review of the medical charts of patients who had undergone single free flap reconstruction for multiple soft tissue defects across their digits from 2011 to 2020. The flap types included were the lateral arm free flap, venous forearm free flap, thenar free flap, hypothenar free flap, anterolateral thigh free flap, medial plantar free flap, and second toe pulp free flap. Flap size, anastomosed vessels, division timing, and occurrence of flap necrosis were retrospectively investigated and then analyzed using the t-test. @*Results@#In total, 75 patients were included in the analysis. The success rate of the free flaps was 97.3%. All flaps were successfully divided after at least 17 days, with a mean of 47.17 days (range, 17–243 days) for large flaps and 42.81 days (range, 20–130 days) for the medium and small flaps (P=0.596). The mean area of flap necrosis was 2.38% in the large flaps and 2.58% in the medium and small flaps (P=0.935). Severe necrosis of the divided flap developed in two patients who had undergone flap division at week 6 and week 34. @*Conclusions@#In cases where blood flow to the flap has been stable for more than 3 weeks, flap division can be safely attempted regardless of the flap size.

Fingertip reconstruction with a subcutaneous flap and composite graft composed of nail bed and volar pulp skin

Background@#Fingertip injuries are very common; however, the reconstruction of volar pulp defects with nail bed defects is challenging in the absence of the amputated segment. We reconstructed fingertip amputations with nail bed defects using a new surgical approach: a subcutaneous flap and composite graft. @*Methods@#We treated 10 fingertip amputation patients without an amputated segment, with exposed distal phalangeal bone and full-thickness nail bed defects between February 2018 and December 2020. All patients underwent two-stage surgery: in the first stage, a subcutaneous flap was performed to cover the exposed distal phalanx, and in the second stage, a composite graft, consisting of nail bed, hyponychium, and volar pulp skin, was applied over the subcutaneous flap. @*Results@#All flaps survived and all composite grafts were successful. The wounds healed without any significant complications, including the donor site. The average follow-up duration was 11.2 months (range, 3–27 months). The new nail and the shape of the volar pulp were evaluated during follow-up. All patients were satisfied with their natural fingertip shapes and the new nails did not have any serious deformities. @*Conclusions@#A subcutaneous flap in combination with a composite graft fitting the shape of the defect could be another option for fingertip injuries without amputated segments.

Apurinic/apyrimidinic endonuclease 1 is associated with poor prognosis after curative resection followed by adjuvant chemotherapy in patients with stage III colon cancer

Purpose@#Apurinic/apyrimidinic endonuclease 1 (APE1) is a key enzyme involved in the base excision repair pathway. It also has redox activity and maintains various transcription factors in an active reduced state. APE1 may be associated with chemoresistance. In the present study, we first investigated the expression level of APE1 protein and its correlation with oncologic outcomes of oxaliplatin-based chemotherapy in patients with stage III colon cancer. Further, we investigated the effects of human APE1 siRNA on the sensitivity of oxaliplatin in SNU-C2A colon cancer cells. @*Methods@#Tissue specimens from tumor and normal colon of 33 patients with stage III colon cancer were obtained from 2006 to 2009. The patients received at least eight cycles of oxaliplatin-based chemotherapy. APE1 expression was analyzed by immunohistochemistry and Western blotting using a cultured SNU-C2A cell line. Cell viability and apoptosis were determined by Cell Counting Kit-8 and caspase-3 cleavage using Western blotting. @*Results@#All the colon cancer tissues showed APE1 staining in the nucleus, whereas all the normal colon tissues were negative for APE1 staining in the cytoplasm. The group with a higher expression of APE1 demonstrated poorer prognosis than the group with low expression (P=0.026 for overall survival and P=0.021 for disease-free survival). Treatment with oxaliplatin resulted in a dose-dependent increase in APE1 expression in SNU-C2A cells. APE1 siRNA significantly enhanced oxaliplatin-induced growth inhibition, and also increased oxaliplatin-induced apoptosis in SNU-C2A cells. @*Conclusion@#APE1 could be considered a prognostic factor in colon cancer patients treated with oxaliplatin-based chemotherapy.

Characteristics and treatment patterns in older patients with locally advanced head and neck cancer (KCSG HN13-01)

Background/Aims@#Treatment decisions for locally advanced head and neck squamous cell carcinoma (LA-HNSCC) are complicated, and multi-modal treatments are usually indicated. However, it is challenging for older patients to complete treatments. Thus, we investigated disease characteristics, real-world treatment, and outcomes in older LA-HNSCC patients. @*Methods@#Older patients (aged ≥ 70 years) were selected from a large nationwide cohort that included 445 patients with stage III–IVB LA-HNSCC from January 2005 to December 2015. Their data were retrospectively analyzed and compared with those of younger patients. @*Results@#Older patients accounted for 18.7% (83/445) of all patients with median age was 73 years (range, 70 to 89). Proportions of primary tumors in the hypopharynx and larynx were higher in older patients and older patients had a more advanced T stage and worse performance status. Regarding treatment strategies of older patients, 44.5% of patients received concurrent chemoradiotherapy (CCRT), 41.0% underwent surgery, and 14.5% did not complete the planned treatment. Induction chemotherapy (IC) was administered to 27.7% (23/83) of older patients; the preferred regimen for IC was fluorouracil and cisplatin (47.9%). For CCRT, weekly cisplatin was prescribed 3.3 times more often than 3-weekly cisplatin (62.2% vs. 18.9%). Older patients had a 60% higher risk of death than younger patients (hazard ratio, 1.6; p = 0.035). Oral cavity cancer patients had the worst survival probability. @*Conclusions@#Older LA-HNSCC patients had aggressive tumor characteristics and received less intensive treatment, resulting in poor survival. Further research focusing on the older population is necessary.

Omission of neoadjuvant radiotherapy for clinical T2/N1 and T3N0/1 middle and low rectal cancers with safe circumferential resection margins

Purpose@#For moderately advanced rectal cancers with safe circumferential margins, the oncologic benefit of neoadjuvant radiotherapy must be reconsidered because of the possibility of overtreatment, resulting in complications from radiotoxicity. To evaluate the oncologic safety of the omission of neoadjuvant radiotherapy for moderately advanced rectal cancers, we evaluated and compared the prognoses of patients who underwent radical resection with and without neoadjuvant radiotherapy for T2/N1 and T3N0/1 middle and low rectal cancers with safe circumferential resection margins. @*Methods@#We retrospectively enrolled 66 patients who underwent radical resection for clinical (c) T2N1 and T3N0/1 middle and low rectal cancers between 2008 and 2014. Patients with distant metastasis; cT4, cN2, or positive lateral pelvic lymph nodes; positive circumferential resection margin; signet-ring cell carcinoma; cT1/2N0; or those who had received adjuvant radiotherapy were excluded. The clinical and pathological characteristics and 5-year oncologic outcomes of the noradiotherapy (n = 34) and radiotherapy (n = 32) groups were compared. @*Results@#The rates of abdominoperineal resection and ileostomies and the proportion of patients who received adjuvant chemotherapy were significantly higher in the radiotherapy group. There were no significant differences in tumor location, clinical stage, surgery type, pathologic N stage, anastomotic leakage, or long-term oncologic outcomes including 5-year disease-free survival, overall survival, and local recurrence and distant metastasis rates between both groups. @*Conclusion@#The oncologic benefit of neoadjuvant radiotherapy for cT2/N1 and T3N0/1 middle and low rectal cancers with safe circumferential resection margins is considered unclear, and it can be omitted to prevent radiotoxicity and facilitate prompt essential treatment.

Apoptosis induced by water extracts of Nypa fruticans wurmb via a mitochondria-dependent pathway in human FaDu hypopharyngeal squamous carcinoma cells

Nypa fruticans Wurmb (NFW) contains a large amount of phenolic acid and flavonoids, and is popular as a superfood in Myanmar. NFW has various biological activities, such as anti-inflammatory, anti-oxidant, and neuroprotective properties; however, the anti-cancer effect of NFW have not been reported. In this study, we investigated the anticancer activity of water extracts of NFW (WeNFW) and the underlying mechanism in human FaDu hypopharyngeal squamous carcinoma cells. The WeNFW inhibited FaDu cell growth in a dose-dependent manner without affecting normal cells (L929), as determined by an MTT assay and Live and Dead assay. In addition, the concentrations of WeNFW without cytotoxicity (0.025, 0.05, and 0.1 mg/mL) inhibited wound healing and colony formation. Furthermore, WeNFW significantly induced apoptosis through the proteolytic cleavage of caspase-3 and -9, poly (ADP-ribose) polymerase, and downregulation of Bcl-2 and upregulation of Bax in FaDu cells, as determined by DAPI staining, FACS analysis, and western blot analysis. Taken together, these results suggest that WeNFW exhibits potent anti-cancer effects by suppressing the growth of oral cancer cells, wound healing and colony formation activity. Via mitrochondrial-dependent apoptotic pathways in human FaDu hypopharyngeal squamous carcinoma cells. Therefore, WeNFW can provide a natural chemotherapeutic drug for oral cancer in humans.

Strategy for salvaging infected breast implants: lessons from the recovery of seven consecutive patients

Background@#In recent years, implant-based breast reconstruction has been performed because of its simplicity, short operation time, and rapid recovery of patients. Several studies have reported treatment methods for implant surgery-related infection, which is a serious complication. The aim of this study was to introduce our strategy for salvaging infected implants and to evaluate its effectiveness. @*Methods@#The authors performed a retrospective study of 145 cases from 132 patients who underwent implant-based breast reconstruction from January 2012 to December 2018. Empirical antibiotics were immediately administered to patients with suspected infections. The patients then underwent salvage treatment including appropriate antibiotics, ultrasonography-guided aspiration, debridement, antibiotic lavage, and implant exchange through a multidisciplinary approach. Patient demographics, operative data, duration until drain removal, adjuvant treatment, and complications were analyzed. @*Results@#The total infection rate was 5.5% (8/145). A longer indwelling catheter period and adjuvant treatment were significantly associated with infection. The salvage treatment showed a success rate of 87.5% (7/8). Seven patients who received early aggressive salvage treatment recovered from infection. One patient with methicillin-resistant Staphylococcus aureus, who received salvage treatment 11 days after symptom onset, did not respond to drainage and antibiotic treatment. That patient subsequently underwent explantation. @*Conclusions@#In implant-based breast reconstruction, prevention of infection is of the utmost importance. However, if an infection is suspected, proactive empirical antibiotic therapy and collaboration with the necessary departments are required. Through a multidisciplinary approach and proactive early management, swift and appropriate salvage should be performed.

Syphilis Presenting as a Unilateral Incipient Papillitis

Purpose@#To report a case of unilateral incipient syphilitic papillitis.Case summary: A 53-year-old female visited for a routine ocular examination. Best-corrected visual acuities were 20/20 in both eyes and there was no abnormality in the anterior segment, pupillary response, ocular motility examination, color vision test, and there were no inflammatory cells in the anterior chamber and vitreous cavity of both eyes. However, optic disc edema and corresponding retinal nerve fiber layer (RNFL) thickening in her left eye were observed in a fundoscopic examination and by optical coherence tomography. In orbital magnetic resonance imaging, there was no abnormal enhancement of the optic nerve or optic nerve sheath in both eyes. Serological tests were positive for fluorescent treponemal antibody absorbance (FTA-ABS) immunoglobulin M (IgM) and IgG, the treponema pallidum hemagglutination test, venereal disease research laboratory (VDRL) testing, and a rapid plasma reagin test, but there was no abnormal finding in cerebrospinal fluid analyses including the VDRL and FTA-ABS tests. With the diagnosis of unilateral incipient syphilitic papillitis in her left eye, she was treated with intravenous penicillin for 14 days and high dose systemic steroids for 3 days with complete resolution of the optic disc edema and RNFL thickening. @*Conclusions@#Syphilis can present as a unilateral incipient papillitis. Therefore, in case with unilateral papillitis, serological test for syphilis, appropriate antibiotics and steroid treatment should be considered.

Adenoma miss rate of polypectomy-referring hospitals is high in Korea

Background/Aims@#We evaluated the miss rates of polyps, adenomas, and advanced neoplasia of polypectomy-referring hospitals and risk factors for missed adenomas. @*Methods@#We compared medical records and electronic images of initial colonoscopies from polypectomy-referring hospitals with those of corresponding therapeutic colonoscopies from Seoul St. Mary’s Hospital obtained from May 2014 to February 2016. @*Results@#A total of 147 patients (56.6 ± 12.1 years, 37 females) were included. The mean number of polyps and adenomas detected on initial colonoscopy was 2.4 ± 1.7 and 1.7 ± 1.4, respectively. The mean number of additionally detected polyps and adenomas per patient during therapeutic colonoscopy was 1.4 ± 1.8 and 1.0 ± 1.5, respectively. Pooled miss rate for polyps, adenomas, and advanced neoplasia was 36%, 37%, and 11%, respectively. Pooled miss rate for adenomas was significantly higher for right-sided, non-pedunculated, and small (< 1 cm) adenomas (p = 0.031, p = 0.000, and p = 0.000, respectively). The miss rate of polyps, adenomas, and advanced neoplasia per patient was 60%, 49%, and 7%, respectively. Multivariate analysis revealed age and number of adenoma on initial colonoscopy were significantly related with risk for adenoma-missing (p = 0.005 and p = 0.023, respectively). @*Conclusions@#Among patients referred for polypectomy, adenoma is missed in one of two patients and advanced neoplasm is missed in one of 13. Patients with advanced age or multiple adenoma on initial colonoscopy have a higher possibility of missed adenoma. Total colon exploration should be performed carefully during therapeutic colonoscopy.

Arterial or venous free flaps for volar tissue defects of the proximal interphalangeal joint: A comparison of surgical outcomes

Background@#For volar soft tissue defects of the proximal interphalangeal (PIP) joint, free flaps are technically challenging, but have more esthetic and functional advantages than local or distant flaps. In this study, we compared the long-term surgical outcomes of arterial (hypothenar, thenar, or second toe plantar) and venous free flaps for volar defects of the PIP joint. @*Methods@#This was a single-center retrospective review of free flap coverage of volar defects between the distal interphalangeal and metacarpophalangeal joint from July 2010 to August 2019. Patients with severe crush injuries (degloving, tendon or bone defects, or comminuted/intra-articular fractures), thumb injuries, multiple-joint and finger injuries, dorsal soft tissue defects, and defects >6 cm in length were excluded from the study, as were those lost to follow-up within 6 months. Thirteen patients received arterial (hypothenar, thenar, or second toe plantar) free flaps and 12 received venous free flaps. Patients’ age, follow-up period, PIP joint active range of motion (ROM), extension lag, grip-strength ratio of the injured to the uninjured hand, and Quick Disabilities of Arm, Shoulder & Hand (QuickDASH) score were compared between the groups. @*Results@#Arterial free flaps showed significantly higher PIP joint active ROM (P=0.043) and lower extension lag (P=0.035) than venous free flaps. The differences in flexion, grip strength, and QuickDASH scores were not statistically significant. @*Conclusions@#The surgical outcomes of arterial free flaps were superior to those of venous free flaps for volar defects of the PIP joint.

Partial second toe pulp free flaps in early childhood

Background@#The introduction of the partial second toe pulp free flap has enabled superior aesthetic and functional results for fingertip reconstruction in adults. Children undergoing fingertip amputation for various reasons have limited options for reconstruction. Conventional treatment could shorten the finger, leading to poor cosmesis and function. We report 18 years of our experiences with fingertip reconstruction using partial second toe pulp free flaps in patients in early childhood. @*Methods@#Medical charts of children who had undergone fingertip reconstruction using partial second toe pulp free flaps from 2001 to 2018 were retrospectively reviewed. The surgical procedures were identical to those for adults, except for the usage of 11-0 nylon sutures. Patients’ demographic data, vessel size, flap dimensions, length of the distal phalanx, and functional outcomes over the course of long-term follow-up were documented. The statistical analysis was performed with the Student t-test, the Mann-Whitney U test, and Pearson correlation analysis. @*Results@#Eighteen toe pulp flaps in 17 patients (mean age, 3.0 years) were identified. All the flaps survived without any major complications. In long-term follow-up, the flap-covered distal phalanges showed growth in line with regular development. There was no donor-site morbidity, and all children adapted to daily life without any problems. In two-point discrimination tests, the fingertip sensation recovered to almost the same level as that in the contralateral finger. @*Conclusions@#Partial second toe pulp free flaps are an excellent option for fingertip reconstruction in young children, as well as in adults.

Extended Estlander flap for repairing a large upper lip defect involving the oral commissure

Various methods for reconstructing partial upper lip defects have been reported, some of which, such as the Abbe and Estlander flaps, involve using the lower lip. However, determining the appropriate reconstruction method for large upper lip and oral commissure defects is particularly difficult because of the need to preserve the function and sensory ability of the lips and oral sphincter while achieving a satisfactory appearance. We describe our successful experience of using an extended Estlander flap to reconstruct a large defect caused by the excision of basal cell carcinoma on the upper lip and oral commissure.

Clinical impact of sarcopenia in patients with colon cancer undergoing laparoscopic surgery

Purpose@#Previous studies have reported that progressive muscle loss, known as sarcopenia, has a negative impact on colon cancer treatment. However, the majority of studies have analyzed on patients undergoing open resection, and the association of sarcopenia with clinical outcomes is not clear for patients with colon cancer undergoing laparoscopic surgery. Thus, the aim of this study was to evaluate the impact of sarcopenia on clinical outcomes after laparoscopic surgery for colon cancer. @*Methods@#A total of 423 patients who underwent laparoscopic surgery for colon cancer between November 2010 and October 2014 were included. Body composition was assessed by measuring muscle and fat areas at the third lumbar vertebra (L3) on preoperative computed tomography. The L3 skeletal muscle area was used to calculate the skeletal muscle index and to assess for sarcopenia. @*Results@#Sarcopenia was identified in 54 patients (12.8%). The median time to first flatus (3 days), median time to tolerable soft diet (4 days), and median length of hospital stay (7 days) were not significantly different between patients with and without sarcopenia. However, sarcopenia was an independent risk factor for postoperative complications in the logistic regression multivariate analysis (p = 0.015). Sarcopenia was not associated with overall or disease-free survival. @*Conclusion@#Sarcopenia was not negatively associated with functional recovery, hospital stay, and oncologic outcomes in patients with colon cancer who underwent laparoscopic surgery. However, sarcopenia was associated with postoperative complications after laparoscopic surgery for colon cancer.

Measuring Defocus Curves of Monofocal, Multifocal and Extended Depth-of-focus Intraocular Lenses Using Optical Bench Test

PURPOSE: To determine the through-focus optical bench test performance of monofocal, bifocal, and extended depth-of-focus intraocular lenses (IOLs), and to measure their defocus curves.METHODS: A model eye was placed on an optical bench to test three different IOLs (TECNIS ZXR00, ZMB00, and ZCB00; Abbott Medical Optics, Santa Ana, CA, USA). The focus was changed by inserting trial lenses from +1.00 diopters to −4.00 diopters, in increments of +0.25 diopters. The 1951 United States Air Force Resolution chart was used to determine the quality of the images. The degree of similarity with reference images was given by the cross-correlation coefficient, and defocus curves were drawn and compared.RESULTS: Bifocal IOLs showed lower image quality with the addition of minus diopter trial lenses, but showed good image quality at near distance. Bifocal IOLs also showed a ‘double peak’ in their defocus curve. Monofocal IOLs showed a lower image quality and cross-correlation coefficient with addition of lower-diopter trial lenses. The extended depth of focus IOLs showed a single peak in their defocus curve, but had a wider range of diopters and better image quality than monofocal IOLs.CONCLUSIONS: Bifocal IOLs showed a double peak defocus curve, and extended depth of focus IOLs showed a wider diopter range and better image quality than monofocal IOLs.

Non-glaucomatous Retinal Nerve Fiber Layer Defect Associated with Paravascular Inner Retinal Defect

PURPOSE: To report a case of non-glaucomatous retinal nerve fiber layer (RNFL) defect associated with paravascular inner retinal defect (PIRD) in a patient with idiopathic epiretinal membrane (ERM).CASE SUMMARY: A 70-year-old male who was diagnosed with ERM in his right eye and pseudoexfoliative glaucoma in his left eye visited our clinic. His intraocular pressure was 14 mmHg in both eyes while using topical hypotensive medications in both eyes. His right eye showed no glaucomatous change of the optic disc head, and also no glaucomatous visual field defect on standard automated perimetry. Red-free fundus photography and swept-source optical coherence tomography showed an ERM and wedge-shaped RNFL defect starting from the PIRD, not the optic disc head. He was diagnosed with non-glaucomatous RNFL defect in the right eye and was told to stop using topical hypotensive medication for the right eye. After 2 years of discontinuing the medication, the IOP was within the normal range, the RNFL defect showed no progression, and the visual field remained stationary.CONCLUSIONS: A non-glaucomatous RNFL defect can develop in association with PIRD in patients with idiopathic ERM. Examinations for PIRD as well as evaluation of the optic disc head are therefore necessary in patients with ERM and RNFL defect.

Acute Lymphoblastic Leukemia in a Patient Treated with Letrozole and Palbociclib / 한국유방암학회지

Palbociclib, in conjunction with endocrine therapy, has been approved for the treatment of patients with advanced breast cancer. The common hematological toxicities associated with palbociclib are leukopenia and neutropenia. However, hematological malignancies have not been reported for palbociclib treatment. Here, for the first time, we present a case of acute lymphoblastic leukemia that was diagnosed in a patient undergoing treatment with letrozole and palbociclib for metastatic breast cancer. This case emphasizes the need for long term follow up of patients treated with palbociclib.

Three types of ossifying fibroma: A report of 4 cases with an analysis of CBCT features

Ossifying fibroma is a slow-growing benign neoplasm that occurs most often in the jaws, especially the mandible. The tumor is composed of bone that develops within fibrous connective tissue. Some ossifying fibromas consist of cementum-like calcifications, while others contain only bony material; however, a mixture of these calcification types is commonly seen in a single lesion. Of the craniofacial bones, the mandible is the most commonly involved site, with the lesion typically inferior to the premolars and molars. Ossifying fibroma of the jaw shows a female predominance. Some reports of ossifying fibroma have been published in the literature; however, this report continues the research on this topic by detailing 3 types of ossifying fibroma findings on panoramic radiographs and cone-beam computed tomographic images of 4 patients. The radiographs of the presented cases could help clinicians understand the variations in the radiographic appearance of this lesion.