Ascending Colon Variceal Bleeding in Cirrhotic Patient with Emergent Endoscopic Variceal Obturation with N-butyl-2-cyanoacrylate / 대한소화기학회지

Ectopic varices are rare among patients with portal hypertension, especially in the ascending colon. It is difficult to evaluate massive lower gastrointestinal bleeding in patients with liver cirrhosis by colonoscopy due to hemodynamic instability and poor bowel preparation. In Korea, there has only been one case report about ascending colon variceal bleeding, in which hemostasis was performed by venous coil embolization. We report another rare case of ascending colon variceal bleeding in a patient with alcoholic cirrhosis, who was successfully treated via two sessions of N-butyl-2-cyanoacrylate injection through colonoscopy. This case suggests that the careful endoscopic approach and hemostasis with glue injection might be an option for treating massive bleeding in the lower gastrointestinal varix.

Deep Vein Thrombosis Due to Compression of Huge Hepatic Cyst Successfully Treated by Inferior Vena Cava Filter and Cyst Drainage / 대한소화기학회지

An 88-year-old woman complained of right quadrant abdominal pain and severe edema in both legs. She had a history of pulmonary embolism one month ago. Abdomen CT showed a huge hepatic cyst compressing the intrahepatic portion of the inferior vena cava (IVC). The venogram CT showed multifocal thrombosis in the iliocaval and both lower extremity veins. Percutaneous hepatic cyst drainage was carried out. Fluid analysis presented leukocytosis, which suggested an infected hepatic cyst. To prevent secondary pulmonary thromboembolism, an IVC filter was inserted before catheter drainage for the hepatic cyst. One week later, abdominal pain was relieved. Then, sclerotherapy for the remnant hepatic cyst was performed by ethanol. Follow-up CT showed an increased amount of thrombosis in the iliocaval and left calf vein, but the IVC filter prevented another thromboembolic event successfully. The patient started dabigatran, a new oral anticoagulant, and compression stockings were applied to both legs. After one month, no visible thrombosis in the pelvis or either extremity was detected in abdominal CT. This case suggests that a huge hepatic cyst, especially with infection, should be considered as a possible cause of deep vein thrombosis if no other risk factors for thromboembolism exist.

Symptomatic Hypermagnesemia in Normal Kidney Function with a Colonic Cleansing Agent / 대한내과학회지

Most reported cases of hypermagnesemia are related to laxative abuse and impaired renal function, while hypermagnesemia is uncommon without iatrogenic magnesium administration and decreased renal function. Magnesium-containing bowel-cleansing agents are widely used before colonoscopy, usually without complications. However, we experienced a case of symptomatic hypermagnesemia with normal renal function after using a bowel-cleansing agent. A 74-year-old man with normal renal function complained of lethargy and motor weakness after taking a bowel-cleansing agent containing 14 grams of magnesium before a colonoscopy for hematochezia. His magnesium level was 12 mg/dL. Fluid stasis in the gut due to colonic obstruction might have caused the hypermagnesemia. He was treated successfully with a bowel enema and intravenous calcium. We should be cautious when prescribing drugs for colonoscopy if colonic obstruction is suspected.

The Statistical Observation of Ocular Injury in the Military

PURPOSE: We investigated the clinical characteristics of ocular trauma in the military for prevention and treatment application. METHODS: We retrospectively surveyed epidemiologic characteristics by investigating the medical records of 790 patients who were hospitalized in the Armed Forces Capital Hospital from January 1, 2001 to December 31, 2010 and investigated the prognostic factors that influenced visual outcome. RESULTS: Among the 790 patients with ocular trauma, 22.9% of the patients had an open injury and 77.1% had a closed injury. The most common cause of injury was sports-related ocular trauma (39%) and fatigue duty-related trauma (23.4%). The following 8 risk factors were considered poor prognostic factors: open injury, involved posterior segment, operation, initial visual acuity of 0.1 or less, corneal laceration, hyphema, RD, and intraocular foreign body. There was a significant correlation between the probability of poor visual outcome and the number of risk factors (correlation coefficient = -0.468, p < 0.0001). CONCLUSIONS: In the present study, the cause, characteristics and prognostic factor of military personnel's ocular injury were determined. The results can be useful in the prevention and management of ocular injury in the military.

Comparison and Repeatability of Anterior Segment Parameters Obtained by Galilei and Slit-lamp Optical Coherence Tomography

PURPOSE: To evaluate the repeatability and comparability of anterior chamber depth (ACD) and central corneal thickness (CCT) measurements obtained by Galilei dual Scheimpflug analyzer (Ziemer, Port, Switzerland) and slit-lamp optical coherence tomography (SL-OCT; Heidelberg Engineering, Dossenheim, Germany). METHODS: ACD and CCT were measured by Galilei and SL-OCT in 68 eyes of 68 healthy young subjects. Each measurement was performed 3 times by a single examiner, and the repeatability of 3 consecutive measurements was analyzed. ACD and CCT measurements were compared between the 2 devices. RESULTS: Both Galilei and SL-OCT showed high repeatability (ICCs > or = 0.994) for ACD and CCT measurements. The mean ACD and CCT measured by Galilei were greater than SL-OCT measurements by 0.11 +/- 0.09 mm and 14.01 +/- 7.38 microm, respectively. The 95% limit of agreement values for ACD and CCT measurements were 0.36 mm, 27.66 microm, respectively, and were highly correlated (correlation coefficients > or = 0.89, p < 0.001). CONCLUSIONS: Although the repeatability of each device was high, ACD and CCT obtained by Galilei and SL-OCT were significantly different. These differences should be considered when interpreting ACD and CCT measurements obtained by the 2 devices.

A Case of Acute Fibrin Pupillary Block Diagnosed by Ultrasonic Biomicroscopy

PURPOSE: To report a case of fibrin pupillary block diagnosed by ultrasonic biomicroscopy (UBM) and treated by argon-neodymium:YAG (Nd:YAG) laser in a patient with uveitis. CASE SUMMARY: A 56-year-old man visited the hospital for decreasing visual acuity and a sudden onset of pain in the right eye. Best corrected visual acuity was 0.02 in the right eye and 1.0 in the left eye. Intraocular pressure (IOP) was 48 mm Hg in the right eye and 18 mm Hg in the left eye. Slit-lamp examination revealed diffuse corneal stromal edema with Descemet's folds and uniform shallowing of the anterior chamber, with 360 degrees of peripheral iridocorneal touch in the right eye. A fibrin membrane was present across the pupil. UBM showed a fibrin membrane across the pupil, uniform shallowing of the anterior chamber, and peripheral angle closure. The lens was displaced posteriorly. A sequential Nd:YAG laser membranectomy was performed that same day, with immediate deepening of the anterior chamber and normalization of the IOP. CONCLUSIONS: UBM can play an invaluable role in the diagnosis of fibrin pupillary block by showing the presence of a fibrin pupillary membrane, accumulation of aqueous in the posterior chamber, and a clear separation between the iris and the lens. Nd:YAG laser membranectomy can be performed effectively in a fibrin pupillary block.

Comparison Between Retinal Nerve Fiber Layer Change and Visual Field Change in Normal Tension Glaucoma

PURPOSE: To evaluate longitudinal changes in retinal nerve fiber layer thickness (RNFL) and visual field in patients with normal tension glaucoma (NTG). METHODS: Thirty eyes of 30 NTG patients and 30 eyes of 30 normal control subjects were enrolled in the present study. RNFL thickness was measured using optical coherence tomography (OCT), and visual field tests were performed using a Humphrey visual field analyzer at baseline and 23.3 +/- 15.3 months later. Changes in RNFL thickness at each clock-hour segment and visual field sensitivities were analyzed. The rates of change in RNFL thickness were also calculated. RESULTS: Significant differences in RNFL thickness were observed between NTG patients and normal control subjects at the 5, 6, 7 and 12 o'clock positions at baseline (p < 0.001). At follow-up, the RNFL thickness change was not significant for normal control subjects, although it was significant for NTG patients at the 4, 5, 6, 7, 11 and 12 o'clock positions (p < 0.001). Visual field parameters did not change significantly in the normal control subjects or NTG patients. The reduction rates of RNFL thickness were 0.38 microm/month for the NTG patients and 0.11 microm/month for the normal control group, displaying a 3.5-fold faster reduction rate for NTG patients. CONCLUSIONS: The NTG group showed greater reductions in RNFL thickness in the upper and lower sectors over time; however, the visual field parameters did not change significantly. The results suggest that progression of glaucoma can be detected in an earlier stage using OCT than can be detected using a visual field test.

A Retrospective Study of Sintered Porous-Surfaced Dental Implants in Restoring the Posterior Maxilla

PURPOSE: The purpose of this retrospective report was to analyze long-term survival rate of sintered porous-surfaced dental implant (Endopore(R) Dental Implant system, Innova Corporation, Toronto, ON, Canada). METHODS: 61 partially edentulous patients were received a total of 127 Endopore dental implants in the maxilla. Of the 127 implants, 24 implants were restored with individual (ie, non-splinted) crowns, while 103 implants were splinted to other implants. Medical records and radiographs were evaluated and analyzed by the cumulative survival rate, location of implants, implants length and diameter, crown/implant ratio and whether the implant was splinted. Chi squire test was used statistically. RESULT: Of the 127 implants, 8 implants (6.3%) were removed and and cumulative survival rate was 93.7%. CONCLUSION: Endopore implants showed satisfactory results after up to 8 years function periods in the edentulous posterior maxilla.

Functional recovery of mandibular high condylar fracture patient with immediate provisional implant: case report

Treatment methods of mandibular condylar fracture were conservative and surgical method. Surgical method of mandibular high condylar fracture was very difficult because approach and internal fixation of small size fracture fragment were difficult. So there is a tendency to select conservative method over surgical method for guiding a stable occlusion and avoiding TMJ disorder and growth disturbance, minimizing pain and deviation during function. But, in case of mandibular high condylar fracture patient who has no biting teeth on posterior teeth area, guiding a stable occlusion and conservative functional treatment were very difficult. In this case, patient was 62years old male. He had fracture of mandibular symphysis, right mandibular body, left mandibular high condyle. We treated the patient for mandibular symphysis and right mandibular body fracture area with surgical method. But left mandibular high condylar fracture area was difficult to treat with surgical method. So we selected a conservative functional method on left mandibular high condylar fracture area. We intended recovery of vertical dimension and stable occlusion with implantation of immediate provisional implant on maxillar and mandibular posterior teeth area, and temporary crown. And then patient did mandibular functional movement and his mandibular function was recoverd.

Clinicostastical study of inpatients of abscess in fascial spaces for the last 5 years

One of the most difficult problems to damage in dentistry is an odontogenic infection. These infections may range from low-grade, well-localized infections that require only minimal treatment to a severe, life-threatenig fascial space infection. Although the overwhelming majority of odontogenic infections are easily managed by minor surgical procedures and supportive medical therapy that includes antibiotic administration, the practitioner must constantly bear in mind that these infections may become severe in a very short time. We made an investigation was targeting on 78 male and 47 female patients (125 patients in total) who had been hospitalized because of the fascial space abscess on the oral and maxillofacial area and gained a complete recovery in Daegu Catholic University Hospital, Oral and Maxillofacial Surgery from January 1999 to December 2003. By tracing their charts, we could grasp the characteristics such as age, gender, the time of breakout and specific areas of the attacks, making a conclusive study of the statistical analysis and finally, we could reach conclusions. Now, we report the conclusion from the investigation with the literature. The proportion of males and females was approximately 3 to 2, and in age group, patients under 10 years old marked the highest, 22.4%. The patients between the age of 10 and 40 were only 14.4%, yet those who were between 40 and 80 marked 53.6% in contrast. In the monthly distribution, the order was Dec.(13.6%)-Sep.(12%)-Jan.(10.4%) and in seasonal distribution, it was winter(30.4%)-fall(28%)- summer(24.4%)- spring(19.2%). Considering the medical history, D.M. was the highest which was 30.3%, hypertension marked 24.4%, and the patients with both D.M. and hypertension were 9.0%. The major cause of infection of oral and maxillofacial areas was odontogenic infection, which marked about 96%, and especially the cases related to dental caries occurred most frequently, which was 51.2%. In the number of relaxed fascial space, single fascial space was 81.6%, and in the degree of relaxation of fascial space, the buccal space abscess marked 40.8%, following submandibular space abscess, which was 30.4%.