Recent Nonoperative Treatment of Elbow Pain / 이화의대지

Pain originating from the elbow can be due to issues affecting the joint itself or the structures surrounding it. These structures include the medial and lateral epicondyles, associated ligaments, the origins of wrist flexor and extensor muscles, the olecranon bursa, the distal biceps tendon, and the radial and ulnar nerves. Pain that appears to originate from a different location may actually be referred pain, potentially stemming from the neck (cervical radiculopathy) or the shoulder. Among complaints related to the elbow, lateral elbow pain is the most frequently reported. This pain could originate from the lateral epicondyle, the radiohumeral joint, or it could be referred pain from other areas. Medial elbow pain is the second most common complaint, often resulting from issues with the medial epicondyle or the ulnar nerve as it travels through the cubital tunnel. The biceps tendon is frequently the cause of anterior elbow pain. Patients who report swelling in the elbow are often experiencing olecranon bursitis. These conditions can often be effectively managed through conservative treatment. The aim of this article is to provide a structured approach to addressing patients with elbow pain, by detailing the common causes of such discomfort and exploring effective nonsurgical treatment options.

Myositis unrelated to the inoculation site after COVID-19 vaccination: a case report

We describe the case of a 49-year-old right hand-dominant woman with myositis of the biceps brachii muscle unrelated to the inoculation site following Pfizer-BioNTech COVID-19 vaccination on the deltoid muscle of the left shoulder. Coronavirus disease 2019 (COVID-19) pandemic has involved global spread, and different vaccines including inactivated, protein, vectored, and nucleic acid vaccines have been developed and administered. Common side effects of COVID-19 vaccines include general manifestations such as headache, fever, and fatigue, and various musculoskeletal symptoms. Here, we present a case of myositis occurring in the biceps brachii muscle unrelated to the inoculation site, which has not been reported previously, accompanied by a literature review.

Mid-Term Results after Anterior Cruciate Ligament Reconstruction Using Four-Strand Single Semitendinosus Tendon / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the mid-term results after anterior cruciate ligament (ACL) reconstruction using a single four-strand semitendinosus tendon. MATERIALS AND METHODS: We evaluated 81 patients (84 cases) who had undergone ACL reconstruction using an autologous single four-strand semitendinosus tendon. The patients consisted of 77 men and 4 women with a mean age of 28.8 years (15-59 years) years. Most injuries were sports related, and the largest number of cases occurred during a soccer game (38 cases). Combined injuries were meniscus injuries in 43 cases, cartilage injuries in 6 cases and medial collateral ligament injuries in 8 cases. Femoral fixation device was PINN-ACL CrossPin in 44 cases and extracortical suspension device in 40 cases. Suture tie around a screw post and an additional bioabsorbable screw were used for tibial fixation. The mean time from injury to surgery was 9+/-16 months (7 days-10 years) and the mean follow-up period was 72.0+/-8.3 months (53-95 months). Clinical evaluation was performed using Lachman test, pivot-shift test, KT-2000 arthrometer, Lysholm score, Tegner activity score, International Knee Documentation Committee (IKDC) score and return to pre-injury sports activity. Radiologic evaluation was performed using plain radiographs to evaluate joint space narrowing. RESULTS: All patients showed normal range of motion at the final follow-up. The Lachman test was positive in 4 cases, and pivot-shift test was positive in 3 cases. Lysholm score improved from 76.7 to 92.2, Tegner activity score improved from 5.1 to 6, IKDC score improved from 72.0 to 86.5, and mean anterior translation by KT-2000 improved from 7.4 mm to 2.3 mm, and 80.2micro of patients returned to pre-injury sports activity. No significant differences in joint space narrowing were observed in plain radiographs. CONCLUSION: In this study, good results were obtained after ACL reconstructions using the autologous four-strand single semitendinosus tendon with maintaining the joint stability at mid-term follow-up.

Factors Associated with Visual Outcomes of Postoperative Endophthalmitis Following Cataract Surgery

PURPOSE: The most serious complication related to cataract surgery is endophthalmitis. Although its incidence is decreasing, it remains the great threat to the outcome of visual acuity in patients who received cataract surgery. METHODS: Retrospective analysis was performed on 18 patients who were diagnosed with endophthalmitis. The following factors were investigated: method of cataract extraction, performance of anterior vitrectomy, presence of posterior capsule rupture, results of bacterial culture, existence of systemic disease, and the duration of time from initial cataract surgery to diagnosis of endophthalmitis and then to subsequent posterior vitrectomy. In addition, the differences in final visual acuity due to variations in these factors were analyzed. RESULTS: Patients who were diagnosed with endophthalmitis and had been commenced on systemic antibiotics within a week of the cataract operation, showed better outcomes in final visual acuity (P=0.043). CONCLUSION: Occurrence of endophthalmitis and subsequent usage of systemic antibiotics within a one-week time frame of cataract surgery, led to statistically significant improvement in final visual acuity compared to cases in which these events occurred one week later.

Factors Associated with Visual Outcomes of Postoperative Endophthalmitis Following Cataract Surgery

PURPOSE: The most serious complication related to cataract surgery is endophthalmitis. Although its incidence is decreasing, it remains the great threat to the outcome of visual acuity in patients who received cataract surgery. METHODS: Retrospective analysis was performed on 18 patients who were diagnosed with endophthalmitis. The following factors were investigated: method of cataract extraction, performance of anterior vitrectomy, presence of posterior capsule rupture, results of bacterial culture, existence of systemic disease, and the duration of time from initial cataract surgery to diagnosis of endophthalmitis and then to subsequent posterior vitrectomy. In addition, the differences in final visual acuity due to variations in these factors were analyzed. RESULTS: Patients who were diagnosed with endophthalmitis and had been commenced on systemic antibiotics within a week of the cataract operation, showed better outcomes in final visual acuity (P=0.043). CONCLUSION: Occurrence of endophthalmitis and subsequent usage of systemic antibiotics within a one-week time frame of cataract surgery, led to statistically significant improvement in final visual acuity compared to cases in which these events occurred one week later.

Interferon-alpha in the Treatment of Behcet's Disease

PURPOSE: To determine the therapeutic efficacy of interferon-alpha on patients with Behcet's disease who have been resistant to conventional therapies. METHODS: We treated 22 eyes of 13 patients with interferon-alpha for a mean of 20.5 months. They were given 3 million units interferon-alpha subcutaneously three times a week. Using slit lamp microscopy, fluorescent angiography, the authors compared visual acuity, frequency of relapse of uveitis and complications of interferon-alpha. RESULTS: The average ocular attack rate fell from 0.41 times a month to 0.19 times after interferon therapy. In addition, the degree of intraocular inflammation and especially retinal vasculitis decreased. There were no side effects significant enough to stop using interferon. CONCLUSIONS: Therapy with interferon-alpha seems to be an effective and safe regimen in Behcet's disease for refractory ocular attack and for the protection of vision.

Photodynamic Therapy of Choroidal Neovasculariation Associated with Large Serous Pigment Epithelial Detachment

PURPOSE: To evaluate the efficacy of photodynamic therapy of choroidal neovascularization (CNV) associated with large serous pigment epithelial detachment (PED) in eyes with age-related macular degeneration. METHODS: The records of nine eyes of nine patients were reviewed. Mean follow-up period was 11.4 months (range, 6 ~ 26 months). The photodynamic therapy was done using a spot size with a diameter larger than the greatest linear dimension of the CNV lesion revealed on indocyanine green angiography (ICGA). RESULTS: In 7 of 9 eyes, the PED persisted with progression of neovascular membrane, and retinal pigment epithelial tear occurred in 3 eyes. In one eye, visual improvement could be achieved with decreased extent of PED until the follow up period of 6 months. In remaining one eye, the caliber of new vessel decreased on ICGA accompanied by improvement of vision and PED after first photodynamic therapy. However, 3 months after second photodynamic therapy, CNV proliferated extensively with resultant visual loss. CONCLUSIONS: The results of our study suggest that photodynamic therapy provide no benefit in the treatment of CNV associated with large serous PED in age-related macular degeneration.

A Case of Ochrobactrum Anthropi Endophthalmitis after Cataract Surgery

PURPOSE: To report a case of Ochrobactrum anthropi endophthalmitis following cataract extraction and intraocular lens implantation. METHODS: A 57-year-old man was refered for evaluation and management of chronic uveitis on his left eye. He had undergone cataract surgery 1 year previously. His visual acuity of left eye was 20/100. The left eye had marked inflammation in anterior chamber and vitreous cavity. We performed pars plana vitrectomy with removal of the intraocular lens and intravitreal antibiotics injection (Amikacin 0.4 mg/0.1 ml). RESULTS: Microbiologic examination of the anterior chamber fluid, intraocular lens disclosed Ochrobactrum anthropi, a gram-negative bacillus. Twelve weeks after vitrectomy, his left corrected visual acuity was 20/25 and anterior segment showed no inflammatory cell.

Two Cases of Corneal Ring Infiltrates from Topical Anesthetic Abuse

PURPOSE: Topical anesthetic abuse resulting in sight-threatening keratitis may be seen as a masquerade syndrome in many cases because of ring infiltration of the cornea. The authors report two cases of keratopathy from topical anesthetic abuse that were originally suspected as infectious keratitis because of ring infiltration of the cornea METHODS: The medical records of two patients were retrospectively reviewed. The pathogenesis, diagnosis, and treatment of ring infiltrates were evaluated. RESULTS: The two patients presented a nonhealing epithelial defect, marked stromal edema, folds in Descemet's membrane, and typical stromal ring infiltrates of unknown etiology. The patients initially were treated empirically with antibacterial and antifungal agents in suspicion of infectious keratitis. These patients had sustained severe ocular pain, and chronically used topical anesthetics (0.5% proparacaine hydrochloride in one patient and 0.4% benoxinate hydrochloride in the other) for several weeks. All microbiology work-ups for the identification of infectious organisms including acanthamoeba were negative. After topical anesthetic was discontinued in two patients, amniotic membrane transplantation was performed on one patient. Corneas in two patients were re-epithelialized with mild scarring with topical antibiotic and steroid treatment.

Correlation of sFas Level with Uveitis Severity

PURPOSE: The aim of this study is to determine the soluble Fas (sFas) levels in both sera and aqueous humor in patients with uveitis and compare them to the uveitis severity. METHODS: We measured the sFas levels in both sera and aqueous humor (AH) of patients (n=40) with uveitis and non-uveitis controls (n=27). The patients with uveitis comprised 24 Behcet's disease, 6 panuveitis, 5 anterior uveitis, 2 lens induced uveitis, 1 Vogt-Koyanagi-Harada-disease, 1 sarcoidosis, and 1 retinal vasculitis. The severity of uveitis was determined by the Hogan's grading method (0~4 grade) at the time of sampling. RESULTS:The concentration of aqueous sFas in uveitis patients was significantly higher than that in nonuveitis controls, while there was no difference in the serum concentration of sFas between the two groups. In the paired samples of serum and AH, obtained simultaneously, the aqueous sFas levels were higher than serum Fas levels in patients with uveitis, whereas the non-uveitis controls displayed significantly lower sFas levels in AH than in the serum. The sFas levels in AH or serum were not different between Behcet's uveitis and non-Behcet's uveitis. However, in patients with Behcet's uveitis, circulating sFas strongly correlated with aqueous sFas, which was not so in those with non-Behcet's uveitis. Patients (n=29) with more active (grade> or =2) uveitis had significantly higher levels of aqueous sFas than those (n=11) with less active (grade<2) uveitis. After treatment with steroid and/or immunosuppressive agents, aqueous sFas levels were decreased in parallel with a reduction in the number of inflammatory cells in the anterior chamber. CONCLUSIONS: The levels of sFas were elevated in patients with uveitis and correlated well with uveitis severity.

The Comprehensive Glaucoma Diagnostic Model and Its Efficacy in Korean

To develop glaucoma diagnostic model for early detection of glaucoma and estimate its efficacy in Korea, we investigated the results of 98 ocular examinations of our patients at the department of ophthalmology, Kangnam St. Mary's hospital, the Catholic university of Korea, school of medicine from 1998 to 1999.Factors for glaucoma diagnostic model function were age of patients, sex, family history of glaucoma, history of hypertension, cardiovascular diseases and diabetes mellitus, refractive error, intraocular pressure, vertical cupdisc ratio and its asymmetry using ophthalmoscope, Heidelberg retina tomograph(HRT)and high frequency pattern VEP, ERG and visual field analysis. We calculated the diagnostic model function and its reliability compared to the results of visual field analysis using statistical package for social science(SPSS, version 7.5)program. The calculated glaucoma diagnostic model function was discriminant score=-8.0 8+0.25(age)+2.52(vertical C/D ratio)+0.11(C/D ratio asymmetry)-0.7(HRT classification)+0.003(intraocular pressure)+1.59(DM)-0.07(P100)+0.12(retino-cortical time)+0.04(sex). The sensitivity, specificity and diagnostic precision of the model function were 77.4%, 83.7%, 81.1%, respectively. With this comprehensive model using all known glaucoma factors, we could get better results about 15 to 20%than those of each individualmodel using the factors one by one. In conclusion, we think that the comprehensive glaucoma diagnostic model using all known risk factors may help us in early detection of glaucoma.

Comparison for the Measuring Methods of Intraocular Lens Power to Calculate for Eyes after LASIK

Calculating the intraoular lens (IOL)power for an eye that has previously had refractive surgery is a problem because of the difficulty of accurately measuring the corneal power using standard keratometers.To find more accurate method, we compared the accuracy of manual keratometer, calculation and contact lens method for intraocular lens power calculation for eyes after LASIK.The corneal power of 283 eyes were measured using manual keratometer (K (meas))and calculation method (K (calc))involving sphericalequivalent change after LASIK.Mean K (meas) (38.27 diopters[ D] )was significantly greater than mean K (calc) (36.64 D).Corneal power overestimation by manual keratometry correlated significantly with the spherical equivalent change after LASIK.The corneal power of 76 eyes were measured using hard contact lens method (K (rgp))in addition to above two methods.Mean K (meas) (38.53 D)was significantly greater than mean K (rgp) (37.78 D), which was significantly greater than mean K (calc) (36.91 D).The difference between K (meas)and K (rgp) did not correlate with the spherical equivalent change after LASIK.According to this study, if there is largely changed refraction after LASIK, it would be more ideal to use the calculation method.In case of small change after LASIK or PRK, it would be more recommendable to select lower one after comparing two values which come from calculation method and contact lens method.Even though we have theoretical conclusion to avoid error which induces hyperopia, it should be testified through clinical apply.

Comparison of Palpebral Fissure Height According to Horizontal

We compared palpebral fissure height according to horizontal fixation direction in normal subjects, strabismic patients[exotropia, esotropia, abducens nerve palsy], and patients with Duane's retraction syndrome. We respectively measured the palpebral fissure height of 39 normal subjects [78 eyes], 37 exotropia patients[74 eyes], 17 esotropia patients[34 eyes], 6 patients of abducens nerve palsy[6 eyes], and 8 patients with Duane's retraction syndrome[12 eye]. Measurements were obtained from standardized photographs in primary position, 30-degree adduction and abduction and maximum adduction and abduction of both eyes. The palpebral fissure height of normal subjects and exotropia patients was maximal in primary position and minimal in maximum adduction and abduction. On the other side, the palpebral fissure height of esotropia patients was maximal in 30 degree abduction. On the base of the height in primary position, the fissure height of normal subjects was 90%in maximum abduction and 89%in maximum adduction. But the fissure height of Duane's retraction syndrome was 103%in maximum abduction and 69%in maximum adduction. In normal group and exotropia, the fissure narrowed according to the degree of adduction and abduction, and in esotropia and abducens nerve palsy, the palpebral fissure of abducting eye was wider than that of primary position. In Duane's retraction syndrome the palpebral fissure of adducting eye markedly narrowed and the difference between the fissure height in maximum adduction and maximum abduction made diagnostic value in comparison to normal group.

A Case of Ocular Ischemic Syndrome Associated with Right Internal Carotid Artery Obstruction

Ocular ischemic syndrome(OIS) occurs secondary to severe carotid artery obstruction and includes various ocular signs and symptoms such as conreal edema, rubeosis iridis, neovascular glaucoma, hypoperfusion retinopathy, and choroidal perfusion disturbance. It is often missed or misdiagnosed in the early stage because of its very diverse and sometimes subtle initial presentations. Furthermore it is more difficult to differentiate the ocular ischemic syndrome from diabetic retinopathy or central retinal vein oclusion in early presentations. The early diagnosis is crucial for the care of this patient because OIS usually has a poor visual prognosis in the late stage and may be the presenting sign of serious cerebrovascular and ischemic heart disease. We have experienced a case of ocular ischemic syndrome in a 45 year old man with diabetic retinopathy and hypertensive retinopathy who presented with a neovascular glaucoma associated with ipsilateral internal carotid artery obstruction.

De Morsier`s Syndrome Expressed as Congenital Exotropia

De Morsier syndrome, or septo-optic dysplasia is a developmental anomaly characterized by unilateral or bilaterral optic nerve hypoplasia, agenesis of septum pellucidum, visual disturbance, and a variable spectrum of disturbed hypothalamic-pituitary function. We experienced a 7-month-old female with de Morsier syndrome whose presenting manifestation was congenital exotropia of right eye, and subsequent evaluation revealed optic nerve hypoplasia of right eye, absence of septum pellucidum, and hypothyroidism.

Central Retinal Artery Occlusion in Association with Thyroid Ophthalmopathy

Thyroid ophthalmolopathy causes bilateral proptosis, restricted ocular movements and optic neuropathy due to inflammatory cell infiltration into the soft tissue. We report a case of central retinal artery occlusion after thyroid ophthalmopathy by swelling of retrobulbar soft tussue and compression of optic nerve and brief review of related literature was presented.