Acute Traumatic Lymphedema without Tissue Injury Detected by Lymphoscintigraphy

Lymphedema is an important disease that causes regional swelling. Although it is not life threatening, it significantly affects the physical and psychological status of the patient. Additionally, lymphedema treatment may be difficult, when its diagnosis is delayed. However, it is not possible to conclude a diagnosis of lymphedema, when the clinical history is uncertain. As observed in the current case, lymphedema caused by minor trauma without any fracture or internal wounds, was detected using a lymphoscintigraphy. Hence, even minor trauma can cause lymphedema and a lymphoscintigraphy can provide critical information for the diagnosis of lymphedema. For this reason, a lymphoscintigraphy test is considered in situations where patients there is differential diagnosis of lymphedema.

Risk of Bladder Cancer among Patients with Diabetes Treated with a 15 mg Pioglitazone Dose in Korea: A Multi-Center Retrospective Cohort Study

It has not yet been determined whether chronic exposure to relatively low doses of pioglitazone increases risk of bladder cancer. We aimed to assess the risk of bladder cancer associated with pioglitazone in Korean patients. This was a retrospective cohort study of diabetic patients who had > or = 2 clinic visits between November 2005 and June 2011 at one of four tertiary referral hospitals in Korea. A prevalent case-control analysis nested within the cohort was conducted to further adjust confounders. A total of 101,953 control patients and 11,240 pioglitazone-treated patients were included, in which there were 237 and 30 cases of incidental bladder cancer (64.9 and 54.9 per 100,000 person-years; age, sex-adjusted HR 1.135, 95% confidence interval [CI] 0.769-1.677), respectively. In the prevalent case-control analysis nested within the cohort, use of pioglitazone for a duration of > 6 months, but not ever use of pioglitazone, was associated with an increased rate of bladder cancer as compared to never use of pioglitazone. In conclusion, we failed to exclude the possible association between use of pioglitazone for a duration of > 6 months and bladder cancer.

Herbal Medication Aggravates Cataract Formation: A Case Report

We report a case of complicated cataract aggravated after taking herbal medication for atopic dermatitis. An 11-yr-old boy was referred for the evaluation of decreased visual acuity in both eyes for 2 months. Past history showed that he had been diagnosed with atopic dermatitis when he was 1 yr old. He had been treated only with herbal medication for a period of 8 months prior to visiting our clinic. He had his visual acuity checked in a local ophthalmic clinic one year before, and the visual acuity was 20/20 in both eyes at that time. When attending our clinic the ophthalmologic examination showed that his best corrected visual acuity was 20/200 in both eyes. Lenses of both eyes had severe posterior subcapsular and posterior capsular opacity. Phacoemulsification, posterior chamber intraocular lens implantation, and posterior continuous curvilinear capsulectomy were performed in both eyes. After 3 months postoperatively, the best corrected visual acuity was recovered to 20/20 in both eyes without any complication. Our case suggests that there may be a risk of aggravation of cataract or development of cataract after treatment with some unidentified herbal medication in a patient with atopic dermatitis.

Multifocal Electroretinograms in Amblyopic Patients

PURPOSE: To evaluate the results of amblyopia on multifocal electroretinogram (mfERG). METHODS: The mfERG procedure was performed on nineteen monocular amblyopic patients (age ranged from 7 to 42 years) using the VERIS(TM) (EDI, San Mateo, CA) system. The central 30 degrees of ocular fundus were stimulated by an array of 103 hexagonal elements for four minutes. The responses of six concentric rings (rings 1 to 6) radiating from the foveal center were averaged, and the latencies and amplitudes of N1, P1 and N2 were compared with the findings of the normal contralateral eyes. The mfERG procedure was recorded again after improvement of vision in one patient (No. 4) who underwent occlusion treatment for one month. RESULTS: There were no significant differences of N1, P1 and N2 latencies between normal contralateral and amblyopic eyes (P>0.05). However, P1 amplitudes of the amblyopic eyes were reduced significantly compared with those of the normal contralateral eyes on rings 1 and 2 (P<0.05). N1 and N2 amplitudes of the amblyopic eyes were also reduced, but not significantly. After the successful occlusion treatment of patient No. 4, the responses of the amblyopic eye were improved but not the level of the contralateral normal eye. CONCLUSIONS: These results suggest that amblyopia may cause some changes in mfERG responses, especially in terms of amplitudes of the central retina. Further investigation is needed to determine whether these results are due to the physiologic change(s) of the amblyopia itself or to fixation instability during the test.

Effect of Refractive Error on the Multifocal Electroretinogram

PURPOSE: To evaluate the influence of refractive blur on the results of mfERG. METHODS: mfERG was performed on 10 healthy volunteers with a refractive error within +/- 1 diopter. The central 30 degrees of the ocular fundus were stimulated by an array of 103 hexagonal elements, for four minutes, using VERISTM. To change the refractive status, 6-cm diameter corrective lens, of -6, -4, -2, plano, +2, +4, and +6 diopters, were placed in front of the eyes, and the examination distance adjusted to compensate retinal image size changes due to corrective lens. The mfERG responses were grouped by 6 concentric rings, and then averaged. For each ring, the latencies and amplitudes of the N1, P1 and N2 were analyzed. The 6 rings were divided into the central (ring 1, 2) and peripheral (ring 3~6) retina, and the latencies and amplitudes of the N1, P1 and N2 were then also analyzed. RESULTS: Refractive blur can affect the results of the mfERG. Latency delay was more common at the peripheral than central retina, but had no statistically significant correlations with the refractive power increase. CONCLUSIONS: When the viewing distance was adjusted to create a constant retinal image size, the influence of refractive blur may cause some changes in the mfERG results. Therefore, when evaluating the results of an mfERG, the effects of the refractive error should be borne in mind.

FAG, ICG and OCT Findings in Multiple Evanescent White Dot Syndrome

PURPOSE: We evaluated one patient with multiple evanescent white dot syndrome (MEWDS), using fundus fluorescein angiography (FAG), indocyanine green angiography (ICGA), optical coherence tomography (OCT) on acute phase of the disease, at 2 weeks after onset and at 10weeks. METHODS: Each diagnostic images were compared with patient's clinical course .OCT measurements of serial retinal thickness were done to assess the change in retinal thickness over the disease process. RESULTS: White dots on fundoscopic examination showed hypofluorescent on ICGA and imaged hyperreflective on OCT without presence of neither subretinal fluid nor neuroretinal increase in thickness. These ICGA and OCT findings suggest that lesions of perfusion defect on ICGA may be caused by interstitial precipitations of inflammatory cells in choriocapillaries and the underlying mechanism is not due to vasculitis with edema or serous exudation. CONCLUSIONS: ICGA and OCT allowed more precise anatomic evaluation than FAG in diagnosis and correlated well with clinical symptoms.

Multifocal Electroretinograms in Patients with Branch Retinal Vein Occlusion

PURPOSE: To evaluate the damage to the inner retina in patients with branch retinal vein occlusion (BRVO), we recorded multifocal electroretinograms (mfERG) and analyzed the waveform changes of the first and the second order kernel responses. METHODS: Eight eyes of patients with unilateral BRVO were included. Fourteen eyes of 14 normal subjects were also tested as controls. VERIS system was used to record mfERG. The first and the second order kernel responses of each quadrant were averaged. Averaged responses were compared with those of the contralateral eyes and normal control eyes. RESULTS: The amplitudes of averaged tracing decreased in the N1, P1, and N2 of the first order kernel responses in the affected quadrant in comparison with those of contralateral and normal control eyes (P<0.05). Prolongation of latency was noted in N1, P1 and N2 in the affected quadrant. In the second order kernel responses of the affected quadrant, no responses were found in four patients. The delay in latency and the decrease in amplitude were more marked in the second order kernel responses than in the first order kernel responses (P<0.01). CONCLUSIONS: The first order mfERG components decreased in amplitude and increased in latency, with N2 being the most severely affected. And the second order mfERG components were more decreased in the affected area in patients with BRVO. These results suggested that the second order kernel responses may reflect the condition of the inner retina better than the first order kernel responses.

Multifocal Electrophysiologic Findings in MEWDS: Multiple Evanescent White Dot Syndrome

PURPOSE: To evaluate the relationship between the lesions of the MEWDS, retinal dysfunction and the cause of decreased visual acuity. METHODS: A patient with a medical history, retinal finding, and the fluorescein angiographic findings consistent with the diagnosis of MEWDS is described. Full field ERG and mfERG were performed and the results was analyzed to find the relationship the visual acuity and the fluorescein angiographic findings. RESULTS: mfERG of the involved eye shows diffuse depression of the amplitude accentuated by focal areas of steep depression thought to correspond to white spot and full field ERG shows generalized depressed signal. The mfERG abnormalities seen at the presentation resolved with the resolution of visual symptoms after 1 month. CONCLUSIONS: The major symptoms of the patient is due to the decreased retinal function and the mfERG is seem to be the useful and safe tool for evaluation of the retinal function and the relationship between the symptoms and the white dots.

Asymmetric Bilateral Lateral Recti Recession in Intermittent Exotropia

It is reported that the recurrence rate in intermittent exotropia is 20-50%. In this study, we evaluated whether the recurrence is reduced with asymmetric recession of bilateral lateral recti(LROU) in intermittent exotropia.Twenty-nine patients underwent the asymmetric LROU recession for intermittent exotropia with follow-up of 6-54 months. The amount of recession of lateral rectus muscle in deviating eye was 2mm more than in the fixating eye. Immediate postoperative overcorrection, the rate of orthophotia, and the occurrence of consecutive esotropia(ET) were analysed.The mean amount of immediate postoperative esodeviation was 16.5+/-7.4PD(0-34PD); four patients showed 0-4PD, 18 patients 11-20PD, and 7 patients showed considerable amount of ET as high as 21-30PD. Consecutive EToccurred in 6.8% of patients despite large amounts of postoeprative ET. The outcome of orthophoria was favorable, in 93.1% of patients in follow up of 6 months, 85.1% in 12 months and 78.5% in 24 months.This study suggests that asymmetric LROU recession is an effective procedure for the correction of intermittent exotropia.

Comparison of Wound Healing and Inflammation Depending on the ablation Methods in Rabbits

In excimer laser ablation, the methods of epithelial removal include mechanical, chemical(alcohol), and laser ablation. To investigate the effects of the de-epithelialization methods, we removed corneal epithelia of 60 rabbits with above three methods and examined corneal epithelial healing time, stromal PMN cells, and immunohistochemical expression of c-fos with time interval. Corneal epithelia healed in 48 hours in the alcohol and laser ablation groups, but in 72 hours in the mechanical ablation group. The count of the stromal PMN cells was maximal in 12 hours in all three groups, and the inflammaion was prolonged in the alcohol ablation group(p<0.05). The c-fos was expressed after 6 hours, 12 hours and 24 hours in all 3 groups and after 48 hours only in the mechanical ablation group. This study suggests that mechanical ablation may produce a larger damage to cornea than laser and chemical ablations and the expression of c-fos in corneal epithelium may be significant findings related to epithelial wound healing.

The Adequate Concentration of Subconjunctivally Injected Mitomycin c for the Prevention of Postoperative Adhesion in Strabisrnus

It. has been reported that, subconjunctival mitornycin c is strongiy effective in the reduction of postoperative fibrosis and adhesion. However we have to be cautious in using it clinically because of severe complications, scleral necrosis, endophthalmitis, etc. To find out the adequate concentration of mitomycin C, the authors performed 3mm recession of the superior rectus muscle (SR) in the left sys of 24 rabbits which were divided into 4 groups. Each group was composed of 6 rabbits. The 0.1%of 0.9% normal saline, 0.005% 0.01%, and 0.02% mitomycin c were injected subcounctivally through the site of SR recession in each group, respectively. The severity of the adhesion between SR and its surrounding tissues and the reduction of fibroblast. proliferation were evaluated histopathologically with the light microscope one month after surgery. The 0.01% and 0.02%mitomycin C-injected groups demonstrated considerable inhibition of postoperative adhesion and fibroblastic proliferation (p0. 15), This study reveals that the concentration of mitomycin c between 0.01% and 0.02% may prevent postoperative adhesions effectively after strabisrnus surgery. Further studies are needed to demonstrate the lowest concentration of mitoniycin c to prevent postoperative adhesion effectively without any com.plicat.ions in clinical use.

Autologous blood transfusion in oral and maxllofacial surgery

No abstract available.

Autologous blood transfusion in oral and maxllofacial surgery

No abstract available.