Cardiovascular Safety Pharmacology of Sibutramine

Sibutramine is an anorectic that has been banned since 2010 due to cardiovascular safety issues. However, counterfeit drugs or slimming products that include sibutramine are still available in the market. It has been reported that illegal sibutramine-contained pharmaceutical products induce cardiovascular crisis. However, the mechanism underlying sibutramine-induced cardiovascular adverse effect has not been fully evaluated yet. In this study, we performed cardiovascular safety pharmacology studies of sibutramine systemically using by hERG channel inhibition, action potential duration, and telemetry assays. Sibutramine inhibited hERG channel current of HEK293 cells with an IC50 of 3.92 muM in patch clamp assay and increased the heart rate and blood pressure (76 Deltabpm in heart rate and 51 DeltammHg in blood pressure) in beagle dogs at a dose of 30 mg/kg (per oral), while it shortened action potential duration (at 10 muM and 30 muM, resulted in 15% and 29% decreases in APD50, and 9% and 17% decreases in APD90, respectively) in the Purkinje fibers of rabbits and had no effects on the QTc interval in beagle dogs. These results suggest that sibutramine has a considerable adverse effect on the cardiovascular system and may contribute to accurate drug safety regulation.

Clear Cell Sarcoma of the Upper Thoracic Back Muscle

Clear cell sarcoma (CCS), also called malignant melanoma of soft parts, is a rare malignant soft tissue tumor and is often associated with tendons or aponeuroses. Most of CCS involve extremities, especially lower extremities, but a tumor occurring in the trunk is rare. We report an extremely rare case of CCS originated in the upper thoracic back muscle. To our knowledge, this case is the second report of CCS of the back muscle.

Lumbar Radiculopathy Caused by Intraspinal Synovial Cyst: A Case Report

A spinal synovial cyst is an uncommon lesion associated with degenerative spinal arthropathy. It can cause radicular symptoms and may masquerade clinically as other, more common entities. A 50-year-old female presented with an intraspinal synovial cyst at the L5-S1 level manifesting as lower back pain and right leg pain. The patient's clinical symptoms improved after surgical management. Intraspinal synovial cyst should be considered in the differential diagnosis of the patients presenting with acute radicular symptoms.

Nasal-type Natural Killer/T-cell Lymphoma of the Orbit

PURPOSE: To report two cases of nasal type Natural Killer (NK)/T-cell lymphoma of the orbit. METHODS: (Case 1) A 42-year-old woman presented with a 3-month history of painful proptosis and eyelid swelling in the right eye. Under the diagnosis of inflammatory pseudotumor, she was treated with intravenous and oral steroids. She visited our clinic with a 3-day history of proptosis with decreased visual acuity. Computed tomography (CT) revealed a large infiltrative mass in the right orbit. Incisional biopsy was performed in the right lower lid. (Case 2) A 42-year-old man was referred for consultation with a 1-month history of fever of unknown origin. Two months previously uveitis had developed in the right eye and had been treated with topical steroid. CT revealed an infiltrative soft-tissue like mass in the left orbit. Incisional biopsy was performed in the orbital area. RESULTS: Histopathologically, a diffuse infiltration of atypical lymphocytes was observed with angiocentric pattern in both patients. The infiltrating cells were positive on immunohistochemical stains for CD3 and CD56. The tumor cells were negative for CD20 and CD30. In situ hybridization demonstrated Epstein-Barr virus-encoded nuclear RNA. A diagnosis was made with NK/T-cell lymphoma of nasal type associated with Epstein-Barr virus infection. CONCLUSIONS: NK/T-cell lymphoma of the orbit is rare and has poor prognosis. It is important to distinguish a NK/T-cell lymphoma from the pseudotumor or uveitis unresponsive to steroid therapy.

Antiproliferative Effect and Safety of 5-Fluorouracil and Heparin in the Treatment of Proliferative Vitreoretinopathy

PURPOSE: Proliferative vitreoretinopathy (PVR) is a major cause of recurrence and failure after retinal reattachment surgery. We assessed the effect and safety of adjuvant combination therapy using 5-Fluorouracil (5-FU) and low molecular weight heparin (LMWH) for prevention of PVR after vitrectomy. METHODS: Infusion fluid supplemented with 200 micro gram/mln of 5-FU and 5 IU/ml of LMWH was used during vitrectomy for rhegmatogenous retinal detachment in 21 patients with PVR. Anatomical results, the occurrence of postoperative PVR, and best corrected visual acuity were assessed retrospectively after a minimum of 6-month follow-up. The occurrence of complication was investigated in 27 eyes including an additional 6 eyes without PVR. RESULTS: The primary success rate was 85.7% (18/21) and the incidence of postoperative PVR was 14.3% (3/21). There was hyphema or vitreous hemorrhage in 3 eyes (14.3%), and significant corneal edema in 1 eye (4.8%) immediately after operation. Those complications were resolved without surgical management. There was intraocular pressure elevation (47.6%), and progression of cataract (23.8%) after operation. Those were controlled with antiglaucoma medication or operation. CONCLUSIONS: The use of 5-FU and LMWH is relatively safe and is suggested to have an antiproliferative effect.

Three Cases of Macular Buckling for Retinal Detachment due to Macular Hole in Highly Myopic Eyes

PURPOSE: Retinal detachment due to macular holes in highly myopic eyes is now usually treated by intraocular gas tamponade with pars plana vitrectomy. However, reopening of the macular holes occurs frequently. In this study, we performed macular buckling for recurred retinal detachment caused by macular holes in highly myopic eyes that failed with vitrectomy and intraocular gas tamponade. We observed that these complex cases could be successfully repaired with this procedure. METHODS: Retinal detachment resulting from a macular holes was found to be present in 3 highly myopic eyes. Retinal reattachment was obtained in all eyes following pars plana vitrectomy and removal of the internal limiting membrane in the posterior pole and fluid-gas exchange. A few months later, the retinal redetachment occurred as a result of reopened macular hole. We performed macular buckling as reoperation. RESULTS: After the second surgery, the macular hole remained closed and the retina remained reattached in all 3 eyes. Retinal reattachment was maintained for longer than 3 months of follow-up periods, and the final visual acuity was improved. CONCLUSIONS: This small case series suggest that macular buckling is an effective procedure of reoperation for failed initial vitrectomy for retinal detachment with macular holes in highly myopic eyes.

IOL Calculations Following Photorefractive Keratectomy

Since excimet laser was introduced to refractive surgery more than 10 years ago, charact may have developed in some patients following photorefractive keratectomy (PRK). In those cases, there is a difficulty in calculating IOL power because of the mismeasurement of the corneal power(K) using manual keratometer, automated keratometer or corneal topography. Therefore, in case of a patient having cataract after PRK using the rigid contact lens and the calculated keratometry method. And then, we chose the flattest K measurement between the above methods, manual keratometer, automated keratometer and corneal topography. The desired spherical equivalent of the right eye after cataract surgery was decided to be -1.00D to reduce anisometropia, and that of the left eye, which had been operated on five months later, was emmetropic. the result was that the spherical equivalents after the operation were -0.88D for the right eye and -0.25D for the left eye, and the corrected visual acuity was 0.8 for the right and 0.9 for the left. It is considered that choosing the flattest K using the rigid contact lens method, the calculated keratometry method, manual keratometer, automated keratometer and corneal topography could be the best way to avoid postoperative hyperopia in calculating IOL power after PRK.

Malignant Transformation and Extracranial Metastasis of a Meningioma

Since its earliest description in the 18th century, meningioma has been considered a relatively indolent benign tumor which can be completely removed. Some grow very quickly, however, recur more frequently and with each recurrence, may change their biology to a more malignant form. A meningioma rarely metastasizes to the extracranium; the most frequent extracranial metastatic sites include the lung, musculoskeletal system and lymph node. The authors report a rare case of meningotheliomatous meningioma which occurred in the left parasagittal area and invaded the superior sagittal sinus; after surgery, it showed multiple recurrences and regrowth, and finally metastasized to the left thoracic cage. The authors also reviw the literature.

Remote Intracerebral Hematoma after Supratentorial Graniotomy

Four cases of intracerebral hemorrhage remote from the site of initial supratentorial craniotomy are presented. Traumatic cases are excluded in this report and all cases developed after uneventful elective craniotomy. Two patients had ruptured aneurysm and the other two had giant supratentorial tumors, one craniophayrngioma and one ependymoma. All patients were operated on supine position and no patient had preoperative hypertension. Two had hematoma in the sucortical white matter, one in the cerebellar hemisphere and the other one showed hematoma both in the cerebellar hemisphere and the supratentorial subcortical area. The size of hematoma ranged from 8-20cc in volume. No definite cause could be found except one in which the blood pressure was transiently elevated during induction of anesthesia. A possible cause might be the sudden changes of blood pressure during induction and recovery from anesthesia, overdrainage of CSF, continuous CSF drainage and sudden changes in intracranial dynamics by removal of a huge intracranial mass. One patient with intracerebellar hemorrhage needed emergency suboccipital craniectomy for removal of the hematoma. One patient shows no improvement due to aspiration pneumonia and subsequent lung abscess. Although rare, these conditions may occur after any craniotomy and surgeons should always be alert to the possibilities of such comlication, especially when intracranial pressure(ICP) was elevated.

Lumbo-Peritoneal Shunt: Review of a Series

The author reviewed a series of 48patients who underwent lumbo-peritoneal shunt operation at Taegu Catholic University Hospital during recent five years. Among them, 10 cases were excluded in this study because of their poor neurologic status which was not adequate to estimate the operative result. In our series, lumbo-peritoneal shunt was done in 34 cases of communicating hydrocephalus due to aneurysmal subarachnoid hemorrhage, head injury, spontaneous intracerebral hemorrhage with/without intraventicular hemorrhage and brain tumor, 2 cases of pseudomeningocele and 2 cases of normal pressure hydrocephalus. The results of this review demonstrate clinical improvement in 28 cases(73.7%), 10 cases(26.7%) of no clinical improvement. There were 9 complications including 8 shunt dysfunction and 1 infection. Among the 8 cases of shunt dysfunction, 5 cases showed postoperative early clinical improvement but revealed shunt dysfunction of delayed onset. In conclusion, lumbo-peritoneal shunt was considered as a good initial CSF diversion procedure in the treatment of communicating hydrocephalus and pseudomeningocele.

A Case of Moyamoya Disease with Intracranial Hemorrage in Pregnancy: Case Report

Intracranial Hemorrhage due to Moya-moya disease in the pregnancy women is rarely documented. We present a 31-years old woman who had intracranial hemorrhage at 34 weeks of gestation. She had stuporous state(Glouscow coma scale 2-3-5) with normal blood pressure at emergency room. Computed tomography revealed intraventricular hemorrhage and scanty intracerebral hemorrhage at left paraventricular area. External ventricular drainage enabled her symptoms to improve gradually. Additional MRI and angiography revealed finding of Moya-moya disease at left middle cerebral artery. Generally, intracranial hemorrhage during pregnancy, caused by aneurysmal rupture and AVM, is treated extensively regardless of pregnancy. In Moya-moya disease intracranial hemorrhage should be removed with a simple and safe procedure as soon as possible. And cesarean section should be considered in selected cases who has hypertension during labor.

Malignant Fibrous Histiocytoma of the Pericranium with Intracranial Extension: A Case Report

A case of malignant fibrous histiocytoma(MFH) arising from the pericranium which extend to the calvaria and the dura mater in a 32-year-old man is reported. This tumor presented as scalp induration and headache without any other neurologic abnormalities. Radical excision presented a surgical challenge because of the extensiveness of the lesion. In this case radical excision of pericranial and calvarial lesions were possible, however it is impossible to remove the lesion in the dura mater radically because of its extensiveness. Thus the radiation therapy was necessary after operation. Histologically, pericranial, calvarial and dura mater tumor tissues were same as that of the typical malignant fibrous histiocytoma of the soft tissue. The authors review the literatures of the MFH involving central nerve systems and discuss the management and the radiologic findings of this rare tumor.

Subdural Fluid Collection after Intracranial Aneurysmal Surgery

The clinical course of subdural fluid collection(SDGC) was studied in 32 cases of patients which underwent craniotomy for intracranial aneurysm and analysed regard to patients' age, sex, degree of initial subarachnid hemorrhage, the operating time of aneurysm, duration to appearance of SDFC from craniotomy, changes of clinical state, disappearance time, site, maximal thickness and changes of SDFC, management and prognosis. The results were summarized as followings. 1) SDFC was found in 33 of 85 patients(38.8%). 2) The older age group had higher incidence of SDFC than the younger age group. 3) The older age grop had thicker SDFC than the younger age group in the maximal thickness of SDFC, and that was statistically significant. 4) The early surgery group of aneurysm had lower incidence of SDFC compared with the delayed surgery group. 5) There were minimal changes of clinical states when SDFC was diagnosed by brain CT. 6) The frontal area was involved in all cases and bilateral involvement was noted in 15 cases(45.5%). 7) Surgical procedures were needed in 8 cases(24.2%) of SDFC, including 2 cases of chronic subdural hematoma. 8) Ventricular dilatation with spontaneous improvement of SDFC were noted in 8 cases(24.2%) and lumboperitoneal shunt for hydrocephalus was needed in only 2 cases of them.

A Case of Adult Brain Stem Tuberculoma:MR Imaging: Case Report

A 39 years old healthy male patient with intracranial brain stem tuberculoma manifested hydrocephalic symptoms due to obstruction of aqueduct of sylvius is presented. Surgical excision was undertaken for obtaining histologic diagnosis and resolving hydrocephalus, which made postoperative neurologic deficits. CT and Magnetic resonance(MR) imaging of intracranial tubercuroma were studied for approaching nonsurgical diagnosis of tuberculoma. MR imaging of tuberculoma shows low intensity on T2-weighted imaging with Magnevistring enhancement. The MR imaging feature of the tuberculoma were found to be distinct from those abscess, metastasis and glioma. Antituberculous chemotherapy is thought to be better than surgical approach in managing brain stem tuberculoma if radiologic diagnosis was obtained.

Three Cases o Pituitary Apoplexy

Three cases of pituitary apoplexy in patients with pituitary tumors are described. This uncommon condition is characterized by the sudden onset of headache, nausea, vomiting, visual impairement, diplopia, disturbance of consciousness and autonomic or hormonal dysfunction. The diagnosis is strengthened by a radiologically abnormal pituitary fossa & clinical symptoms and confirmed by the operative findings of hemorrhage necrotic tissue. Recently, CT enables the early diagnosis of pituitary apoplexy. Since CT can detect blood, it can document acute or chronic hemorrhage in pituitary adenoma. In addition, CT can discriminate between densities other than blood and can therefore be used to diagnosis those cases of pituitary apoplexy in which infarction & necrosis predominate. Finding of acute bleeding within tumor in enlarged sellar on plain CT establishes the diagnosis of pituitary apoplexy. Following three cases of pituitary apoplexy had special findings which was fluid level with faint rim enhancement of high density of dependent portion. Conculsively We agree that CT can help the early diagnosis and prompt surgical intervention of pituitary apoplexy.