Spinal epidural hematoma in a gastric cancer patient after epidural catheterization: A case report

Spinal epidural hematoma is a rare event that is usually thought to require immediate surgical therapy. A variety of predisposing factors have been demonstrated for this malady and hemostatic abnormalities are rather frequent in cancer patients. In this report, we present a case of an old man who was diagnosed with early gastric cancer. He had normal coagulation function. After performing hemodynamically stable surgery, an epidural catheter was inserted. The patient underwent reoperation due to postoperative wound bleeding on postoperative day 1. In the evening of the 2nd postoperative day, emergency magnetic resonance imaging (MRI) revealed an epidural hematoma extending from T5 to T8. The patient's coagulation function became even worse. We thought that acute DIC had developed on the patient. Approximately 2 months later, he finally showed spontaneous clinical improvement.

Spinal epidural hematoma in a gastric cancer patient after epidural catheterization: A case report

Spinal epidural hematoma is a rare event that is usually thought to require immediate surgical therapy. A variety of predisposing factors have been demonstrated for this malady and hemostatic abnormalities are rather frequent in cancer patients. In this report, we present a case of an old man who was diagnosed with early gastric cancer. He had normal coagulation function. After performing hemodynamically stable surgery, an epidural catheter was inserted. The patient underwent reoperation due to postoperative wound bleeding on postoperative day 1. In the evening of the 2nd postoperative day, emergency magnetic resonance imaging (MRI) revealed an epidural hematoma extending from T5 to T8. The patient's coagulation function became even worse. We thought that acute DIC had developed on the patient. Approximately 2 months later, he finally showed spontaneous clinical improvement.

A Case of Surgically Treated Serous Macular Detachment Associated With Optic Disc Pit

PURPOSE: To report the clinical results of a planned vitrectomy, laser photocoagulation and gas tamponade for the treatment of serous macular detachment associated with optic disc pit. However, laser photocoagulation was performed on a postoperative outpatient basis for subretinal fluid. CASE SUMMARY: A 13-year-old women presented with central visual disturbance in the left eye. Her best-corrected visual acuity (BCVA) was 0.16. On ophthalmic examination, the patient was diagnosed with optic disc pit combined with serous macular detachment. After 3 months, the serous macular detachment increased and visual acuity decreased to 0.1. Pars plana vitrectomy combined with complete posterior vitreous detachment was performed. After intravitreal injection of perfluorodecalin, internal drainage of the subretinal fluid using the back flush needle around the optic disc pit was performed, but the fluid was not drained. The planned intraoperative photocoagulation was not performed due to a large serous macular detachment. Gas tamponade was performed and a facedown position was maintained for 1 week followed by laser photocoagulation. The subretinal fluid was completely absorbed and visual acuity was improved. In addition, recurrence was not observed throughout the follow-up period.

Anesthetic management of the ex utero intrapartum treatment (EXIT) procedure: A case report / 대한마취과학회지

The ex utero intrapartum treatment (EXIT) procedure is a very rare technique performed in cases of fetal congenital malformations. The EXIT procedure increases the rate of survival at delivery by maintaining the uteroplacental circulation until the airway of the fetus is secured. To maintain the uteroplacental circulation, a higher dose of inhalational anesthetics and/or intravenous nitroglycerin can be used as compared to conventional Cesarean section. The aim of this report is to share our anesthetic experience during the EXIT procedure with members of the Korean society of anesthesiology for the first time, and to highlight the maternal implications of the use of inhalational anesthetics and nitroglycerin during Cesarean section for the EXIT procedure.

Combination Treatment for Choroidal Neovascularization Associated With Large Retinal Pigment Epithelial Detachment

PURPOSE: To evaluate the efficacy of the combination therapy of intravitreal bevacizumab injection and photodynamic therapy in neovascular age-related macular degeneration associated with large retinal pigment epithelial detachment. METHODS: A total of 13 eyes were reviewed, with 9 eyes diagnosed with definite choroidal neovascularization (CNV) and 4 eyes diagnosed with CNV or polypoidal choroidal vasculopathy (PCV) becausethe exact type could not be determined. Photodynamic therapy was performed within 1 week after bevacizumab injection according to indocyanine green angiography (ICGA). Additional bevacizumab injections were performed within a 4 to 6 week interval. Additional photodynamic therapy was performed within 4 months. RESULTS: The visual acuity on final examination had improved in 3 eyes (23.1%), was maintained in 7 eyes (53.8%), and decreased in 3 eyes (23.1%). The change of the PED before and after treatment showed regression in 5 eyes (38.5%), recurrence after regression in 2 eyes (15.4%), persistence in 4 eyes (30.8%), and retinal pigment epithelial tear in 2 eyes (15.4%). The maintained or improved visual acuity rate was 66.7% (6/9) and 100% (4/4) in the CNV and CNV or PCV group, respectively. CONCLUSIONS: The combination therapy in neovascular age-related macular degenerationassociated with large retinal pigment epithelial detachment is a viable alternative treatment in the stabilization and improvement of vision. However, further studies with long-term follow up and controlled studies with anti-vascular endothelial growth factor antibody monotherapy are required.

Result Analysis According to Surgical Amout after Unilateral Lateral Rectus Recession in Patients with Exodeviation under 25PD

PURPOSE: Study by result analysis the proper recession amount according to the deviation angle after unilateral lateral rectus recession in exodeviation. METHODS: A retrospective analysis data from 139 patients who underwent unilateral lateral rectus recession with 15~24PD exodeviation and monitored for 12 months or longer was performed. The analyzed patients were divided into 7.5 mm, 8 mm, 8.5 mm, 9 mm, 9.5 mm groups according to the surgical amount of recession and 15~18PD, 19~20PD, 21~24PD groups according to the deviation angle. The strabismus surgery and results analyses were based on distance deviation. Alignment within 4PD of esodeviation and 10PD of exodeviation was considered a surgical success. RESULTS: The success rates were 53.8% for the 15~18PD group and 40% for the 19~20PD group in the 7.5 mm recession group, 77.7% for the 15~18PD group and 66.7% for the 19~20PD group and 63.6% for the 21~24PD group in the 8 mm recession group, 100% for the 15~18PD group and 81.2% for the 19~20PD group and 72.7% for the 21~24PD group in the 8.5 mm recession group, 83.3% for the 15~18PD group and 85.7% for the 19~20PD group and 83.3% for the 21~24PD group in the 9 mm recession group, 100% for the 19~20PD group and 76.9% for the 21~24PD group in the 9.5 mm recession group at 1 year postoperative. The rates of -1 abduction limitation were respectively 3.1%, 12% and 21.4% in the 8.5 mm, 9 mm and 9.5 mm recession groups and the rate of -2 abduction limitation was 14.3% in the 9.5 mm recession group at 1 year postoperative. CONCLUSIONS: Considering the success state and abduction limitaions, the proper surgical amount of recession is 8.5 mm in the 15~18PD group and 9 mm in the 19~20PD and 21~24PD groups.

Distribution and Change of Total Astigmatism, Corneal Astigmatism and Residual Astigmatism with Age in Patient with Emmetropia

PURPOSE: We evaluated the distribution and change of total, corneal and residual astigmatism with age in patients with emmetropia. METHODS: We examined the visual acuity, refraction, and corneal curvature in 263 persons aged from 3 to 83 years (mean, 38 years), with a spherical equivalent refraction of under +/-0.75 diopter (D). We analysed the distribution and change of the astigmatism. RESULTS: Total astigmatism was changed from with-the-rule (WTR) to against-the-rule (ATR) with aging based on WTR of 0.31 +/- 0.48 D in the 3-10 year-old group, ATR of 0.02 +/-0.52 D in the 31-40 year-old group and ATR of 0.65 +/- 0.66 D in the 71-83 year-old group. Corneal astigmatism showed a similar pattern to that of total astigmatism with WTR of 1.03 +/- 0.47 D, WTR of 0.37 +/- 0.78 D, ATR of 0.05 +/- 0.59 D and ATR of 0.31 +/- 0.64 D in the 3-10, 31-40, 61-70 and 71-83 year-old groups, respectively. Residual astigmatism showed ATR astigmatism in all age groups such as ATR of 0.71 +/- 0.48 D, ATR of 0.60 +/- 0.44 D and ATR of 0.35 +/- 0.71 D in the 3-10, 41-50 and 71-83 year-old groups, respectively. CONCLUSIONS: Total and corneal astigmatism showed the change from WTR to ATR, and residual astigmatism showed the pattern of decreasing ATR with aging in patients with emmetropia. The change of total astigmatism with aging seems to be influenced by that of corneal astigmatism rather than by that of residual astigmatism.

A Case of Decompensated Esotropia after LASEK

PURPOSE: To report a 38-year-old woman who showed esotropia and diplopia after LASEK surgery. METHODS: A 38-year-old mildly myopic woman, who didn't ordinarily need glasses or contact lenses, visited our clinic complaining of sudden onset of esotropia and diplopia following LASEK. Although she had had rarely intermittent esotropia in the past, her orthophoria had been maintained usually. The refractive error, -2.00 Dsph=-0.75 Dcyl x 172 A in the right eye and -2.50 Dsph=-0.75 Dcyl x 27 A in the left eye before LASEK. was improved to -0.50 Dsph -0.25 Dcyl x 48 A in the right eye and -0.25 Dsph in the left eye after LASEK. However, she showed acute esotropia of 40 prism diopters (PD) at near and 30 PD at distance and diplopia. The Worth 4 dot test and Bagolini striated lens test indicated left suppression. In the Titmus stereo test, she exhibited loss of stereoacuity. RESULTS: Her esotropia persisted for two months after first visiting our clinic, so we performed surgery of unilateral lateral rectus muscle resection and medial rectus muscle recession. After strabismus surgery, she showed orthophoria and the diplopia disappeared, while fusion and stereoacuity were regained. CONCLUSIONS: The clinical course of this patient suggested that recovery of accommodative need convert esophoria to esotropia. Therefore we recommend meticulous preoperative evaluation of strabismus in all candidates for refractive surgery.

A Case of Combined Pregnancy after IVF-ET / 대한주산의학회잡지

No abstract available.