A Case of Extramedullary Progression Despite of Serologic Improvement in a Patient Treated with Thalidomide for Multiple Myeloma / 대한혈액학회지

Thalidomide is an anti-angiogenic agent widely used in patients with multiple myeloma. The response to therapy is commonly monitored using serum and/or urine M protein, as these are known to reflect the tumor burden. Although extramedullary plasmacytomas are tissues with high neovascularization, it has been suggested in some reports that the response to thalidomide in these patients may be inferior, despite changes in the serum M protein level. Herein, we report the case of a patient who newly developed hepatosplenic extramedullary plasmacytoma, despite reduction in the serum M protein level following thalidomide treatment.

Effect of Cyclophosphamide as the Treatment of Recurrent Membranoproliferative Glomerulonephritis after Renal Transplantation / 대한이식학회지

The treatment of recurrent type 1 membranproliferative glomerulonephritis (MPGN) after renal transplantation is undetermined yet. We report a case with a recurrent type 1 MPGN with ascites after renal transplantation that had a favorable outcome. A woman aged 50 was diagnosed recurrent type 1 MPGN in 2002. Afterwards she took cyclosporine, prednisolone and mycophenolate mofetil. Since August 2003, Her urine output was reduced and she suffered from abdominal distention. Serum creatinine was elevated to 2.5 mg/dL and physical examination and abdominal CT scan showed large amount of ascites. So, we substituted cyclophosphamide for mycophenolate mofetil. She was 55 kg before the substitution of cyclophosphamide but 12 months later, she weighed 44 kg and her creatinine decreased to 1.5 mg/dL. Therefore, it seems a good idea to use cyclophosphamide for the treatment of recurrent glomerulonephritis with ascites after renal transplantation.

Triamcinolone Regurgitation into Anterior Chamber after Intravitreal Triamcinolone Injection

PURPOSE: To report triamcinolone regurgitation into the anterior chamber after intravitreal triamcinolone injection for macular edema. METHODS: A total of 402 eyes (432 cases) received intravitreal injection of triamcinolone acetonide for macular edema from November 2002 to December 2004. A retrospective review included the medical records of all patients who showed regurgitation into the anterior chamber after intravitreal triamcinolone injection. The clinical outcome and any complications were analyzed. RESULTS: Regurgitation was observed in 9 of 402 eyes (11 of 432 cases, 2.55%) after intravitreal triamcinolone acetonide injection. All were phakic eyes. Pseudohypopyon was observed during the follow-up period but resolved gradually without any significant complications. Intravitreal injection of triamcinolone acetonide results in increased visual acuity (p<0.01) and decreased macular thickness (p<0.01) after 2 weeks of injection. CONCLUSIONS: Triamcinolone particles that regurgitated into the anterior chamber gradually resolved without any significant complications. These can, however, mask symptoms of endophthalmitis and delay accurate diagnosis, so careful follow-up examination is imperaive.

A clinical consideration about clinical manifestations of the Bromate poisoning / 대한내과학회지

Bromate which is an oxidant exists as a form of potassium bromate (KBrO3) and sodium bromate (NaBrO3) and has been primarily used as a permanent neutralizer in a household. In 1985, that has been reported for clinical course of bromate poisoing. After 1985, many variable clinical manifestation of the bromate poisoning were reported in Korea. In 2003, three patients of the bromate poisoing admited in Sanggye Paik hospital,Inje university school of medicine, Korea. In this work, the bromate poisoning was investigated based on 3 cases experienced previously 8 cases reported in Korea and compared with the case report of foreign country.

Atrophic Tracts of Retinal Pigment Epithelium in Central serous Chorioretinopathy and Its Angiographic Findings

Atrophic tracts of the retinal pigment epithelium are angiographic images of the posteior pole, esp, inferior hemispheric retina. It is likely that serous detachment of the neuroepithelium constituting the central serous chorioretinopathy (CSC) of the posterior pole prolongs itself downwards, leaving a localized atrophy as a mark on the pigmented epithelium. In this study, they are presented in 8 cases (10 eyes) afected jointly by the CSC. All of the patients were male. The average age at the time of follow-up examination was 44.5 years. One of 10 eyes was noted to have clinically discernible, dependent peripheral retinal detachment. Retinal pigment epithelial atrophic tracts in this study were classified by 3 patterns in the FAG. One pattern presents as an irregular atrophic tract, which almost is located at the watershed zone near the temporal margin of the optic disc. Another pattern presents as the atrophic tract with a vertical line, which coursed vertically from the posterior pole into the inferior fundus. The other pattern composes of the two previous patterns. The atrophic tract of the RPE in the FAG showed hyperfluorescence. The lesions within the atrophic tracts of the RPE showed several depigmented spots and a pronounced window defect in the FAG. In the ICG angiography, the atrophic tracts of the tetinal pigment epithelium showed hypofluorescence distinctly during late phase of the ICG angiography.

Effect of Premedication and Honan Balloon prior to Cataract Surgery on Intraocular Pressure measured by Tono-pen

With with use of Tono-pen, we investigated the degree of reduction in intraocular pressure of the Honan intraocular pressure reducer(HIPR) with preoperative use of dichlorphenamide and mannitol or without. Seventy five patients scheduled for cataract surgery were divided into 4 groups by preoperative medication. Intraocular pressure was measured before preoperative medication and in process of time after external compression with the Honan intraocular pressure reducer(HIPR) following retrobulbar injection. There was no additive effect on the reduction of intraocular pressure with the preoperative use of dichlorphenamide and mannitol. A rapid initial reduction in intraocular presure over the first 5 minutes of compression was followed by a more gradual reduction from 5 to 20 minutes. We concluded that the compression of up to 20 minutes duration without the preoperative use of dichlorphenamide and mannitol is adequate.

Advantages of Indocyanine Green angiography over fluorescein angiography in Diagnosis of Choroidal neovascularization in Age-related Macular degeneration

Choroidal neovascularization(CNV) secondary to age-related macular degeneration(AMD) occurs in the majority of patients with exudative maculopathy. Using an Indocyanine-green (ICG) angiography system, the authors obtained 24 ICG angiograms with CNV in AMD, and compared them with fluorescein angiograms. CNV was classic in 3 eyes(12.5%) and occult in 21 eyes(87.5%) on fluorescein angiography. The location of the CNV was extrafoveal in 12 eyes(50%), juxtafoveal in 6 eyes(25%) and subfoveal in 6 eyes(25%). Occult CNV was diagnosed in 21 eyes. Of these eyes, 8(38%) had solitary or multifocal hot spot by ICG angiography. Plaques were seen in 13(62%) of these eyes. Occult CNV with pigment epithelial detachment was diagnosed in 7 eyes. In 5 eyes, we were able to detect a well-defined CNV underlying a subretinal hemorrhage. Sixty-seven percentage of eyes with occult CNV could be reclassified as having well-delinated CNV by virtue of the additional findings provided by ICG angiography. But thirty-three percentage of eyes with occult CNV remained ill defined on the ICG angiography. ICG angiography is especially useful in delineating occult neovascularization, neovascularization with overlying subretinal hemorrhage or serosanguineous fluid, and neovasularization associated with pigment epithelial detachments. The results of this study suggest that ICG angiography is a safe test and an important test in evaluation, classification, and laser treatment of patients with occult CNV secondary to AMD.

ICG-enhanced digital angiography and photocoagulation of choroidal neovascularization in age-related macular degeneration

Choroidal neovascular membranes are often poorly defined on fluorescein angiography because of fluorescein leakage or blockage of hyperfluorescence by overlying hemorrhage, lipid, turbid fluid, or pigment. Indocyanine green (ICG) is a highly protein-bound dye in the near infrared portion of the spectrum. Therefore, ICG remained in and around the neovascular membrane and enhanced the visualization of certain membranes poorly defined with fluorescein. ICG penetrated through the overlying turbid tissue, and improved the visualization of the underlying choroidal neovascular membrane. Using an infrared angiography system, the authors obtained 21 ICG-angiograms with suspected choroidal neovascularization, and compared them to fluorescein angiograms. In 5 of the 21 eyes, occult choroidal neovascularization was well delineated on the ICG angiograms. In 2 eyes, we were able to detect a well-defined choroidal neovascular membrane underlying a subretinal hemorrhage. In 12 of the 21 eyes with choroidal neovascular membrane, we performed argon-green laser photocoagulation applying the overlay technique of the ICG angiogram to red-free photo or the early fluorescein angiogram, and evaluated the effect of full coverage laser treatment.