A 13-year-old boy with strangulation of the floating gallbladder by the lesser omentum

The selection of imaging modality is important in emergency departments because symptoms in children are usually unclear. In children with abdominal pain, differential diagnosis ranges from common diseases to rare entities requiring surgical therapy. Unremarkable findings on routine investigation, such as laboratory tests and plain radiographs, cannot rule out the surgical entities. Close observation and, if needed, further imaging tests are necessary in emergency departments or even in wards for children with recurrent or worsening abdominal pain. We report a rare case of a 13-year-old boy with strangulation of the floating gallbladder by the lesser omentum. This article features the imaging findings of the rare surgical entity.

Factors Associated with Pain Following Intravitreal Injections

PURPOSE: To investigate factors associated with pain intensity following intravitreal injection and factors that might be associated with changes in pain intensity in patients who received repeated injections. METHODS: A total of 172 eyes (147 patients) were prospectively enrolled. Patients rated their pain from 0 to 10 using a visual analogue scale. Multiple linear regression analysis was used to evaluate factors associated with pain score. Sixty-eight patients evaluated their degree of pain more than once and were divided into three groups according to changes in pain during repeated injections. Clinical factors were compared among the three groups. RESULTS: Pain scores of women (women, 3.1 ± 1.5 vs. men, 2.4 ± 1.2; p = 0.003), those who received dexamethasone implant injection (dexamethasone implant, 3.5 ± 1.1 vs. anti-vascular endothelial growth factor, 2.7 ± 1.4; p = 0.028), and those who did not undergo anterior chamber paracentesis (ACP) (ACP, 2.6 ± 1.3 vs. no ACP, 3.0 ± 1.6; p = 0.047) were significantly higher than those of the other groups. On multiple linear regression analysis, only female sex and ACP were significantly associated with degree of pain. The waiting time during the second injection was significantly associated with change in degree of pain in patients who received repeated injections. CONCLUSIONS: Women were more prone to perceive pain, and the ACP procedure reduced pain during intravitreal injections. Most patients who received repeated injections felt that pain was similar or decreased compared to that experienced during the previous injection. However, increased waiting time might have been associated with increased discomfort for patients who received repeated injections.

Intravitreal Ranibizumab Injection in Adult-onset Coats' Disease: A Case Report

PURPOSE: To report a case of adult-onset Coats' disease which showed decreased retinal edema and improved visual acuity following intravitreal ranibizumab injection. CASE SUMMARY: A 21-year-old woman visited our hospital for decreased visual acuity in left eye from 3 months ago. Her best corrected visual acuity was 1.0 in the right eye, and 0.4 in the left eye. The intraocular pressure was 19 mmHg in the right eye and 16 mmHg in the left eye. At anterior segment examination, no abnormal findings were found. On fundus examination, subretinal exudates, superior retinal edema at posterior pole, and telangiectasia along superortemporal vascular arcade were observed in the left eye. Upon diagnosis as Coats' disease, intravitreal ranibizumab was performed, and laser photocoagulation was done around the retinal telangiectasia and nonperfusion area. Then, the second and third intravitreal ranibizumab injections were performed by a month, and her best visual acuity was improved to 0.8 and optical coherence tomography revealed decreased retinal edema. CONCLUSIONS: We report a case of adult-onset Coats' disease. Intravitreal ranibizumab injection is effective in rapid visual improvement and decrease of retinal edema as combination therapy with laser photocoagulation which was a generalized treatment of choice in Coats' disease.

A Case of Acute Appendicitis due to Appendicular Tuberculosis

The most common presentation of abdominal tuberculosis is an ileocecal disease, but isolated appendicular involvement is rarely seen. It is difficult to make diagnosis of intestinal tuberculosis because it may mimic many other intestinal diseases. The symptoms are nonspecific such as fever, fatigue and weight loss. A 35-yr-old woman with no remarkable past medical history was admitted due to intermittent abdominal pain of 3 mo duration. The patient underwent laparoscopy-assisted partial ileocecectomy including diseased appendix. Tuberculous appendicitis was finally diagnosed with all considerations of possible pathological results. We report a case of acute appendicitis due to tuberculous involvement with a review of the literature.