Direct Contact with Platelets Induces Podoplanin Expression and Invasion in Human Oral Squamous Cell Carcinoma Cells

Oral squamous cell carcinoma (OSCC) is mostly diagnosed at an advanced stage, with local and/or distal metastasis. Thus, locoregional and/or local control of the primary tumor is crucial for a better prognosis in patients with OSCC. Platelets have long been considered major players in cancer metastasis. Traditional antiplatelet agents, such as aspirin, are thought to be potential chemotherapeutics, but they need to be used with caution because of the increased bleeding risk. Podoplanin (PDPN)-expressing cancer cells can activate platelets and promote OSCC metastasis. However, the reciprocal effect of platelets on PDPN expression in OSCC has not been investigated. In this study, we found that direct contact with platelets upregulated PDPN and integrin β1 at the protein level and promoted invasiveness of human OSCC Ca9.22 cells that express low levels of PDPN. In another human OSCC HSC3 cell line that express PDPN at an abundant level, silencing of the PDPN gene reduced cell invasiveness. Analysis of the public database further supported the co-expression of PDPN and integrin β1 and their increased expression in metastatic tissues compared to normal and tumor tissues of the oral cavity. Taken together, these data suggest that PDPN is a potential target to regulate platelet-tumor interaction and metastasis for OSCC treatment, which can overcome the limitations of traditional antiplatelet drugs.

Clinical Significance of Tear Film Osmolarity in Patients with Mild Dry Eye Syndrome

Purpose@#To seek Pearson correlations of tear film osmolarity measured by the I-PEN® (I-MED Pharma Inc., Dollard-des-Ormeaux, Canada) with Schirmer test result, tear break-up time, and Ocular Surface Disease Index score in patients with mild dry eye syndrome. @*Methods@#Patients with mild dry eye syndrome were divided into two groups according to Ocular Staining Score: group 1 (50 patients; 67 eyes) and group 2 (59 patients; 91 eyes), 90 patients and 158 eyes in total. The above mentioned correlations were derived. @*Results@#No significant correlations were observed between tear film osmolarity and Schirmer test result (r < -0.01, p = 0.97), tear break-up time (r = 0.05, p = 0.54), or Ocular Surface Disease Index score (r = 0.03, p = 0.76). When the two groups were compared, the Ocular Surface Disease Index score significantly differed between groups (p < 0.01), whereas the Schirmer test result (p = 0.31), tear break-up time (p = 0.11), and tear film osmolarity (p = 0.12) did not. @*Conclusions@#No significant correlations were found between tear film osmolarity and other dry eye indicators in patients with mild dry eye syndrome. The diagnostic utility of tear film osmolarity in patients with moderate dry eye syndrome is should be evaluated.

Clinical Significance of Tear Film Osmolarity in Patients with Mild Dry Eye Syndrome

Purpose@#To seek Pearson correlations of tear film osmolarity measured by the I-PEN® (I-MED Pharma Inc., Dollard-des-Ormeaux, Canada) with Schirmer test result, tear break-up time, and Ocular Surface Disease Index score in patients with mild dry eye syndrome. @*Methods@#Patients with mild dry eye syndrome were divided into two groups according to Ocular Staining Score: group 1 (50 patients; 67 eyes) and group 2 (59 patients; 91 eyes), 90 patients and 158 eyes in total. The above mentioned correlations were derived. @*Results@#No significant correlations were observed between tear film osmolarity and Schirmer test result (r < -0.01, p = 0.97), tear break-up time (r = 0.05, p = 0.54), or Ocular Surface Disease Index score (r = 0.03, p = 0.76). When the two groups were compared, the Ocular Surface Disease Index score significantly differed between groups (p < 0.01), whereas the Schirmer test result (p = 0.31), tear break-up time (p = 0.11), and tear film osmolarity (p = 0.12) did not. @*Conclusions@#No significant correlations were found between tear film osmolarity and other dry eye indicators in patients with mild dry eye syndrome. The diagnostic utility of tear film osmolarity in patients with moderate dry eye syndrome is should be evaluated.

Intraocular Lens Power Calculation Using Shammas-PL Formula after Laser In-situ Keratomileusis

Purpose@#To calculate the intraocular lens (IOL) power using the Shammas-PL formula after laser in-situ keratomileusis (LASIK). @*Methods@#Forty-one eyes of 29 patients that had undergone cataract surgery from September 2018 to September 2019 after LASIK were enrolled in this study. A preoperative AL-Scan® (Nidek Co., Gamagori, Japan) was used to measure the axial length, anterior chamber depth, and corneal curvature. An IOL power calculation was performed using the Shammas-PL (post LASIK) formula. Mean absolute error (MAE) and mean arithmetic error (MARE) were calculated using preoperative manifest refraction and postoperative manifest refraction. @*Results@#Of the 41 eyes, 15 eyes (36.6%) were relatively hyperopic-shifted after surgery compared to the predicted refractive error before surgery, 25 eyes (61%) showed a relative myopic shift, and one eye (2.4%) showed no change with respect to the previous refractive predicted error. Refractive errors before cataract surgery were not related to myopic, emmetropic, or hyperopic shifting after surgery (p > 0.05). @*Conclusions@#When cataract surgery using the Shammas-PL formula was performed after LASIK, myopic shifting was more common than hyperopic shifting. The MAE was greater in myopic-shifted cases than that of hyperopic-shifted cases. Thus, it is better to determine IOL power toward the hyperopic side than the target refractive prediction.

Central Toxic Keratopathy after Femtosecond Laser in-situ Keratomileusis

Purpose@#To report a case of central toxic keratopathy after femtosecond laser in-situ keratomileusis (LASIK).Case summary: A 26-year-old male developed diffuse lamellar keratitis bilaterally on day 2 after femtosecond LASIK. He was applying topical steroid frequently, while also using topical antibiotics. On day 6 after LASIK, slit-lamp biomicroscopy showed a thick central corneal opacity on the right eye so a flap irrigation was performed. He was then treated with systemic methylprednisolone. A corneal epithelial crack and stromal striae were noted by slit-lamp biomicroscopy on postoperative day 10. Four weeks after LASIK, the refractive error was +4.25 Dsph = -1.25 Dcyl Axis 80°. He was treated with topical steroid, topical antibiotics, and oral doxycycline until eight weeks after LASIK. Eight weeks after LASIK, the patient was observed without treatment. The central corneal thickness recovered from 488 μm at eight weeks to 540 μm, and the refractive error was +1.25 Dsph = -0.75 Dcyl Axis 85° at postoperative 72 weeks. The central corneal opacity also recovered. @*Conclusions@#Because femtosecond LASIK may result in a combination of diffuse lamellar keratitis and central toxic keratopathy, the clinical characteristics and natural course of both diseases should be understood and timely treatment should be available.

Comparison of Perioperative Contrast Sensitivity between Laser in situ Keratomileusis and Small-incision Lenticule Extraction

Purpose@#To compare contrast sensitivity before and after surgery in patients who underwent laser in situ keratomileusis (LASIK)and small-incision lenticule extraction (SMILE). @*Methods@#From February 2019 to April 2019, 20 patients who underwent LASIK, and 21 who underwent SMILE, were comparedbefore, one day, one week, and one month after surgery. @*Results@#On postoperative day (POD) 1, contrast sensitivity was better in the LASIK group than in the SMILE group under all conditionsfor 1.6, 1, and 0.64 cycles per degree (cpd). One week after surgery, the contrast sensitivity of the LASIK group was betterthan that of the SMILE group under photopic conditions with glare for 1.6, 1, and 0.64 cpd, under photopic conditions withoutglare for 1 and 0.64 cpd, and under all scotopic conditions for 2.5, 1.6, and 0.64 cpd (p< 0.05). There was no significant differencebetween the two groups, except under the scotopic conditions without glare for 0.64 cpd at one month after surgery. In theLASIK group, the contrast sensitivity was best at one week after surgery. The SMILE group showed the poorest contrast sensitivityon POD 1, but this gradually improved. @*Conclusions@#The LASIK group had better contrast sensitivity on one day and one week after surgery than the SMILE group, butthere was no significant difference at one month after surgery. In the LASIK group, the contrast sensitivity was best at one weekafter surgery. In the SMILE group, the contrast sensitivity was worst on POD 1.

Refractive Power Outcomes with an Intraocular Lens with 0.25-diopter Intervals

Purpose@#The Eyelike K-flex Aspheric® (Koryoeyetech, Seoul, Korea) is manufactured in 0.25-diopter (D) intervals, which allows the target refractive error after surgery to be achieved. We here evaluate the refractive power outcomes. @*Methods@#We retrospectively studied 95 eyes of 72 patients who underwent cataract surgery with implantation of the Eyelike K-flex Aspheric®. Refractive error was measured at 1 and 2 months postoperatively (33 eyes of 27 patients) and compared to that of patients fitted with 0.50-D-interval lenses (62 eyes of 49 patients). @*Results@#At 1 month postoperatively, the mean absolute error between the spherical equivalent and planned value was 0.33 ± 0.28 and 0.41 ± 0.39 D in the 0.25- and 0.50 D-interval lens groups, respectively (p = 0.318). At 2 months postoperatively, the respective values were 0.21 ± 0.15 and 0.34 ± 0.29 D (p = 0.009). @*Conclusions@#The Eyelike K-flex Aspheric® shows excellent refractive predictability; use of 0.25-D-interval intraocular lenses close to the target refractive power allows the desired spherical equivalent to be achieved.

Accuracy of Intraocular Lens Power Calculations Based on Total and Standard Keratometry

Purpose@#To compare the accuracy of standard and total keratometry data obtained using the Barrett Universal II and Barrett Toric Calculator. @*Methods@#In total, 111 eyes of 111 patients who visited our hospital for cataract surgery from February 2019 to September 2019 were included in this study. Total keratometry and standard keratometry data were obtained using the Barrett Universal II and the Barrett Toric Calculator; mean absolute errors were derived by using preoperative IOL Master 700® (Carl Zeiss Meditech AG, Jena, Germany) data and 2-month postoperative manifest refraction data. The mean absolute errors of the two methods were compared in terms of a posterior corneal astigmatism greater than 0.3 diopter (D) in patients fitted with Toric intraocular lenses. @*Results@#Using the Barrett Universal II formula, the mean absolute error spherical equivalent difference between total keratometry and standard keratometry was 0.021 ± 0.102 D (p = 0.65) when the Barrett Toric Calculator was used. The mean absolute error differences between the two methods were 0.015 ± 0.121 D for the spherical equivalent (p = 0.80) and 0.005 ± 0.870 D for the cylinder measurement (p = 0.94). In terms of a posterior corneal astigmatism greater than 0.3 D, the mean absolute error spherical equivalent and cylinder measurement differences were -0.020 ± 0.107 D (p = 0.70) and -0.023 ± 0.055 D (p = 0.50) in patients fitted with Toric intraocular lenses. @*Conclusions@#The total keratometry method, which directly measures posterior corneal curvature, yields data comparable to those of the standard keratometry method. When the posterior corneal astigmatism was greater than 0.3 D, we found no significant difference between the total keratometry and standard keratometry data of patients fitted with Toric intraocular lenses.

Refractive Power Outcomes with an Intraocular Lens with 0.25-diopter Intervals

Purpose@#The Eyelike K-flex Aspheric® (Koryoeyetech, Seoul, Korea) is manufactured in 0.25-diopter (D) intervals, which allows the target refractive error after surgery to be achieved. We here evaluate the refractive power outcomes. @*Methods@#We retrospectively studied 95 eyes of 72 patients who underwent cataract surgery with implantation of the Eyelike K-flex Aspheric®. Refractive error was measured at 1 and 2 months postoperatively (33 eyes of 27 patients) and compared to that of patients fitted with 0.50-D-interval lenses (62 eyes of 49 patients). @*Results@#At 1 month postoperatively, the mean absolute error between the spherical equivalent and planned value was 0.33 ± 0.28 and 0.41 ± 0.39 D in the 0.25- and 0.50 D-interval lens groups, respectively (p = 0.318). At 2 months postoperatively, the respective values were 0.21 ± 0.15 and 0.34 ± 0.29 D (p = 0.009). @*Conclusions@#The Eyelike K-flex Aspheric® shows excellent refractive predictability; use of 0.25-D-interval intraocular lenses close to the target refractive power allows the desired spherical equivalent to be achieved.

Accuracy of Intraocular Lens Power Calculations Based on Total and Standard Keratometry

Purpose@#To compare the accuracy of standard and total keratometry data obtained using the Barrett Universal II and Barrett Toric Calculator. @*Methods@#In total, 111 eyes of 111 patients who visited our hospital for cataract surgery from February 2019 to September 2019 were included in this study. Total keratometry and standard keratometry data were obtained using the Barrett Universal II and the Barrett Toric Calculator; mean absolute errors were derived by using preoperative IOL Master 700® (Carl Zeiss Meditech AG, Jena, Germany) data and 2-month postoperative manifest refraction data. The mean absolute errors of the two methods were compared in terms of a posterior corneal astigmatism greater than 0.3 diopter (D) in patients fitted with Toric intraocular lenses. @*Results@#Using the Barrett Universal II formula, the mean absolute error spherical equivalent difference between total keratometry and standard keratometry was 0.021 ± 0.102 D (p = 0.65) when the Barrett Toric Calculator was used. The mean absolute error differences between the two methods were 0.015 ± 0.121 D for the spherical equivalent (p = 0.80) and 0.005 ± 0.870 D for the cylinder measurement (p = 0.94). In terms of a posterior corneal astigmatism greater than 0.3 D, the mean absolute error spherical equivalent and cylinder measurement differences were -0.020 ± 0.107 D (p = 0.70) and -0.023 ± 0.055 D (p = 0.50) in patients fitted with Toric intraocular lenses. @*Conclusions@#The total keratometry method, which directly measures posterior corneal curvature, yields data comparable to those of the standard keratometry method. When the posterior corneal astigmatism was greater than 0.3 D, we found no significant difference between the total keratometry and standard keratometry data of patients fitted with Toric intraocular lenses.

The Usefulness of a Wearable Device in Daily Physical Activity Monitoring for the Hospitalized Patients Undergoing Lumbar Surgery

OBJECTIVE: Functional outcomes have traditionally been evaluated and compared using subjective surveys, such as visual analog scores (VAS), the Oswestry disability index (ODI), and Short Form-36 (SF-36), to assess symptoms and quality of life. However, these surveys are limited by their subjective natures and inherent bias caused by differences in patient perceptions of symptoms. The Fitbit Charge® (Fitbit Inc., San Francisco, CA, USA) provides accurate and objective measures of physical activity. The use of this device in patients after laminectomy would provide objective physical measures that define ambulatory function, activity level, and degree of recovery. Therefore, the present study was conducted to identify relationships between the number of steps taken by patients per day and VAS pain scores, prognoses, and postoperative functional outcomes. METHODS: We prospectively investigated 22 consecutive patients that underwent laminectomy for spinal stenosis or a herniated lumbar disc between June 2015 and April 2016 by the same surgeon. When patients were admitted for surgery and first visited after surgery, preoperative and postoperative functional scores were recorded using VAS scores, ODI scores, and SF-36. The VAS scores and physical activities were recorded daily from postoperative day (POD) 1 to POD 7. The relationship between daily VAS scores and daily physical activities were investigated by simple correlation analysis and the relationship between mean number of steps taken and ODI scores after surgery was subjected to simple regression analysis. In addition, Wilcoxon’s signed-rank test was used to investigate the significance of pre-to-postoperative differences in VAS, ODI, and SF-36 scores. RESULTS: Pre-to-postoperative VAS (p<0.001), ODI (p<0.001), SF-36 mental composite scores (p=0.009), and SF-36 physical composite scores (p<0.001) scores were found to be significantly different. Numbers of steps taken from POD 1 to POD 7 were negatively correlated with daily VAS scores (r=-0.981, p<0.001). In addition, the mean number of steps from POD 3 to POD 7 and the decrease in ODI conducted one month after surgery were statistically significant (p=0.029). CONCLUSION: Wearable devices are not only being used increasingly by consumers as lifestyle devices, but are also progressively being used in the medical area. This is the first study to demonstrate the usefulness of a wearable device for checking patient physical activity and predicting pain and prognosis after laminectomy. Based on our experience, the wearable device used to provide measures of physical activity in the present study has the potential to provide objective information on pain severity and prognosis.

The Usefulness of a Wearable Device in Daily Physical Activity Monitoring for the Hospitalized Patients Undergoing Lumbar Surgery

OBJECTIVE: Functional outcomes have traditionally been evaluated and compared using subjective surveys, such as visual analog scores (VAS), the Oswestry disability index (ODI), and Short Form-36 (SF-36), to assess symptoms and quality of life. However, these surveys are limited by their subjective natures and inherent bias caused by differences in patient perceptions of symptoms. The Fitbit Charge® (Fitbit Inc., San Francisco, CA, USA) provides accurate and objective measures of physical activity. The use of this device in patients after laminectomy would provide objective physical measures that define ambulatory function, activity level, and degree of recovery. Therefore, the present study was conducted to identify relationships between the number of steps taken by patients per day and VAS pain scores, prognoses, and postoperative functional outcomes.METHODS: We prospectively investigated 22 consecutive patients that underwent laminectomy for spinal stenosis or a herniated lumbar disc between June 2015 and April 2016 by the same surgeon. When patients were admitted for surgery and first visited after surgery, preoperative and postoperative functional scores were recorded using VAS scores, ODI scores, and SF-36. The VAS scores and physical activities were recorded daily from postoperative day (POD) 1 to POD 7. The relationship between daily VAS scores and daily physical activities were investigated by simple correlation analysis and the relationship between mean number of steps taken and ODI scores after surgery was subjected to simple regression analysis. In addition, Wilcoxon’s signed-rank test was used to investigate the significance of pre-to-postoperative differences in VAS, ODI, and SF-36 scores.RESULTS: Pre-to-postoperative VAS (p<0.001), ODI (p<0.001), SF-36 mental composite scores (p=0.009), and SF-36 physical composite scores (p<0.001) scores were found to be significantly different. Numbers of steps taken from POD 1 to POD 7 were negatively correlated with daily VAS scores (r=-0.981, p<0.001). In addition, the mean number of steps from POD 3 to POD 7 and the decrease in ODI conducted one month after surgery were statistically significant (p=0.029).CONCLUSION: Wearable devices are not only being used increasingly by consumers as lifestyle devices, but are also progressively being used in the medical area. This is the first study to demonstrate the usefulness of a wearable device for checking patient physical activity and predicting pain and prognosis after laminectomy. Based on our experience, the wearable device used to provide measures of physical activity in the present study has the potential to provide objective information on pain severity and prognosis.

Anterior Segment Changes after Laser Iridotomy for the Treatment and Prevention of Angle-closure Glaucoma

PURPOSE: To evaluate the changes and characteristics of the anterior segment of the eye after laser peripheral iridotomy (LPI) conducted on patients with acute angle closure crisis (AACC) for both therapeutic purposes and prophylactic purposes in the fellow eye. METHODS: Anterior segments were examined by topography, laser interferometry, anterior segment optical coherence tomography, anterior chamber depth (ACD), anterior chamber volume (ACV), anterior chamber angle (ACA), angle opening distance (AOD), central corneal thickness (CCT), and axial length as compared to prior procedures in 20 eyes with glaucoma (treatment group) and 20 contralateral eyes (prophylactic group) in 20 patients diagnosed with AACC. RESULTS: Before laser treatment, there were no significant differences in pre-LPI ACV, ACA, AOD and axial length, although differences in the CCT and ACD existed between the groups. Compared to prior laser treatment at 1 and 3 months after laser treatment, the ACV, ACA, AOD 500, and AOD 750 increased in both groups. When both groups were compared 1 month after their laser treatments, the AOD 750 was increased in the treatment group. There were no significant differences between two groups 3 months post LPI. CONCLUSIONS: Other than changes in the ACD and CCT, no significant differences were observed in the anterior segment characteristics in AACC affected and contralateral eyes prior to LPI. After LPI, the treatment group showed greater changes in their anterior segments; however, the open angle was maintained at 1 month post treatment.

Findings of Eye Screening Examinations with Wide-Field Digital Imaging System in Healthy Newborns

PURPOSE: To present the results of eye screening examinations using RetCam in healthy newborns. METHODS: Eye screening examinations were performed using the RetCam wide-field digital imaging system (Clarity Medical System, Pleasanton, CA, USA), as requested by parents, on healthy newborns within a week after birth in an obstetrics and gynecology hospital between June 2012 and September 2014. During the examination, photographs were taken showing red reflex and the fundus. The reading was conducted by a pediatric ophthalmologist. RESULTS: The examinations included a total of 10,023 newborn babies, and abnormalities were discovered in 2,916 patients (29.09%). The most commonly found abnormality was retinal hemorrhage, which was discovered in 2,796 babies (27.89%) and 471 patients showed a large amount of bleeding or macular hemorrhage. In 71 patients (0.7%), ophthalmologic examination was recommended after newborns presented with one of the following conditions: congenital cataracts, retinoblastoma, persistent hyperplastic primary vitreous, vitreous hemorrhaging, persistent pupillary membrane, choroidal nevus or albinism. Due to unclear photographs, 85 eyes of 49 patients (0.48%) could not be read. CONCLUSIONS: Ophthalmologic screening using RetCam is a safe, simple and useful technique for discovering ophthalmologic abnormalities. Additionally, when abnormalities are suspected, the role of a pediatric ophthalmologist is increasingly important in helping patients receive appropriate ophthalmologic treatment. Furthermore, retinal hemorrhage, which occurred in the majority of all observed abnormalities, requires further investigation to examine the possibilities of amblyopia in cases with a large amount of bleeding or macula involvement.

Spontaneous Regression of Recurred Hepatocellular Carcinoma with Multiple Lung Metastases

Hepatocellular carcinoma (HCC) is the most common form of liver malignancy. Spontaneous regression of HCC is extremely rare phenomenon and mechanism of regression remains ob-scure. 75-year-old woman previously diagnosed with hepatitis C virus-related liver cirrhosis was found to have single mass in liver with elevation of alpha-fetoprotein level to 10,320 ng/mL. Transarterial chemoembolization (TACE) was performed. 27 months after TACE recurred HCC with multiple lung nodules were confirmed. The patient refused any therapeutic modality. The patient underwent follow-up without any anti-cancer treatment. 8 months after recur-rence follow up computed tomography scan revealed spontaneous regression of HCC and completely disappeared lung nodules. The patient is currently doing well and without any evidence of recurrence. The causes of spontaneous regression of HCC are not well understood. Proposed mechanisms are ischemic injury, biological factors, herbal medicine, immunological variations. Further studies are necessary to improve our understanding of this rare phenom-enon.

Clinical Factors for Consideration in Patients with Gastric Hyperplastic Polyps Treated by Endoscopic Polypectomy

BACKGROUND/AIMS: Hyperplastic polyps are the most common type of gastric polyps that constitute 30~93% of all benign epithelial gastric polyps. The overall prevalence of dysplasia in patients with hyperplastic polyps is believed to be 2 cm). We aimed to identify the clinical features of hyperplastic polyps that undergo neoplastic transformation. MATERIALS AND METHODS: Between March 2011 and June 2013, 315 hyperplastic polyps that were removed by endoscopic polypectomy from 217 patients were analyzed retrospectively. RESULTS: Neoplastic transformations were found in 5 cases (1.6%), including 3 cases of adenoma (1.0%) and 2 cases of adenocarcinoma (0.6%). Polypectomy-associated complications were noted in only 2 cases (0.6%), which were bleeding in both cases. Neoplastic transformation was significantly associated with the absence of hyperemia on endoscopy (non-neoplastic transformation group, n=26 [8.4%] vs. neoplastic transformation group, n=3 [60%]; P=0.006). However, no other significant differences was found between these groups in terms of age, sex, presence of Helicobacter pylori, size, location, number of detected polyps in each patient, and endoscopic appearances such as nodular changes or erosions and shape. CONCLUSIONS: No clinical factors were associated with the neoplastic transformation of hyperplastic polyps. In addition, neoplastic transformations were almost impossible to identify using endoscopy. Therefore, endoscopic polypectomy could be considered for the accurate diagnosis and definitive treatment of gastric hyperplastic polyps <1 cm in size.

A Case of MALT Lymphoma with Left Inferior Rectus Muscle Invasion

PURPOSE: To report an unusual case of mucosa-associated lymphoid tissue (MALT) lymphoma localized to the left inferior rectus muscle. CASE SUMMARY: A 52-year-old male presented with double vision 6 months in duration, which was exacerbated in the down-gaze. On initial examination, 6 and 30 prism diopters (PDs) of left hypertropia were observed in primary gaze and down gaze, respectively. Prominently limited infraduction was also observed in his left eye. Computed tomography (CT) revealed contrast enhancing mass on the left inferior rectus muscle. He was diagnosed with suspicious orbital pseudotumor and treated with systemic steroid for 2 months. Double vision and limited infraduction was improved and the mass size was decreased on CT. After 21 months, the patient revisited the clinic with the same symptoms. In the down-gaze, 35 PDs of hypertropia were observed in his left eye along with limited infraduction. CT revealed an enlarged mass and left superior rectus muscle recession along with an incisional biopsy of the left inferior rectus muscle were performed. Infiltration by small lymphoid cells was detected with hematoxylin-eosin and immunohistochemical stainings. Subsequently, the patient was diagnosed with MALT lymphoma localized to the left inferior rectus muscle. CONCLUSIONS: This is the first description of MALT lymphoma with inferior rectus muscle invasion in a Korean patient. In a patient with strabismus and limited duction, the possibility of extraocular muscle tumor including lymphoma should be considered. Homogenously contrast-enhanced mass on orbit CT can help in to make a diagnosing extraocular muscle lymphoma.

Successful Treatment of a Gastric Plasmacytoma Using a Combination of Endoscopic Submucosal Dissection and Oral Thalidomide

We report a rare case of a gastric plasmacytoma treated with endoscopic resection and oral thalidomide therapy. A 70-year-old man was admitted to our hospital with indigestion. He had no specific medical history and unremarkable laboratory results. Gastroendoscopic findings revealed a focal, erythematous, flat elevated lesion in the anterior wall of the stomach antrum. A biopsy revealed atypical lymphocytes. Endoscopic submucosal dissection (ESD) with an insulation-tipped knife was performed 45 days after diagnosis. Radiological and hematological evaluations, including a bone marrow biopsy, were performed and showed no involvement of other organs. The patient was diagnosed with extramedullary gastric plasmacytoma. Follow-up gastroendoscopy was performed three times during a 2-year period and showed nonspecific ESD scarring. The patient's condition was found to be stable.

The Prevalence, Genotype and Antimicrobial Susceptibility of High- and Low-Level Mupirocin Resistant Methicillin-Resistant Staphylococcus aureus

BACKGROUND: Mupirocin has been used for the treatment of skin infections and eradication of nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA). The increased use of this antibiotic has been accompanied by outbreaks of MRSA that are resistant to mupirocin. OBJECTIVE: This study aims to determine the prevalence, genotype and antimicrobial susceptibility of mupirocin-resistant MRSA from 4 Korean hospitals. METHODS: A total 193 MRSA clinical isolates were collected from four university hospitals. Antimicrobial susceptibility tests, including mupirocin, and pulsed-field gel electrophoresis (PFGE) pattern analysis were performed. RESULTS: Overall, 27 of the 193 (14.1%) MRSA isolates were resistant to mupirocin. All of the (A) hospital isolates showed high-level (HL) mupirocin resistance and the low-level (LL) mupirocin resistant strains were from three other hospitals. The PFGE patterns of 16 mupirocin-resistant isolates were divided into 5 clusters (1-5), and the nine HL mupirocin-resistant isolates belonged to cluster 1. Both the HL and LL mupirocin-resistant MRSA isolates were susceptible to vancomycin and rifampin, but they were resistant to ciprofloxacin, clindamycin and tetracycline. The erythromycin and fusidic acid resistance rates were different between the HL and LL resistant isolates. CONCLUSION: HL mupirocin-resistant isolates that could transfer this resistance to other bacteria were detected and these isolates were clonally related. The emergence of mupirocin resistant isolates emphasizes the importance of using antibiotics judiciously and carefully monitoring the prevalence of mupirocin resistance.

A Case of Barium Appendicitis after a Small Bowel Series / 대한소화기내시경학회지

Barium appendicitis is a rare complication that occurs due to barium retention in the appendix after a barium study. It is believed that retained barium in the appendix forms a barium-coated fecalith and causes barium appendicitis. A 19-year-old man visited the hospital due to melena. He underwent an endoscopy and a colonoscopy but no bleeding focus was discovered. Next, a small bowel series was performed to confirm the absence of small bowel bleeding. Two weeks later, he felt right lower quadrant pain in his abdomen and developed a fever. A blood test revealed an elevated white blood cell count. A plain abdominal radiograph indicated retained barium in the appendix. A computed tomography scan revealed a dilated barium filled appendix. Thus, the pain was thought to caused by barium retention in the appendix that precipitated acute appendicitis. He underwent an appendectomy and healed well without complications.