Treatment Results of Treatment-naïve Neovascular Age-related Macular Degeneration in Patients Over 85 Years of Age

Purpose@#To investigate the characteristics and treatment results of patients aged ≥ 85 years who were diagnosed with treatment-naïve neovascular age-related macular degeneration (nAMD). @*Methods@#The medical records of patients diagnosed with treatment-naïve nAMD who were ≥ 85 years old at the time of diagnosis with at least 12 months follow-up were retrospectively reviewed. The number of intravitreal injections of anti-vascular endothelial growth factor (VEGF) and agents used during the entire period were investigated. Best-corrected visual acuity and optical coherence tomography results before and after treatment were analyzed. Visual acuity of the fellow eye was also collected. @*Results@#A total of 40 eyes of 40 patients with mean age of 87.5 ± 2.4 were included in the study. The mean logarithm of the minimal angle of resolution visual acuity was 0.85 ± 0.57, and the mean of the fellow eye was 0.93 ± 0.99. Compared to before the treatment, there was no significant difference after intravitreal injection in terms of visual acuity. Central retinal thickness showed significant reduction at all time points after treatment. @*Conclusions@#In patients aged ≥ 85 years at the time of diagnosis, intravitreal injections of anti-VEGF prevented deterioration of visual acuity and showed successful anatomical outcomes. Especially, many had poor visual acuity in the fellow eye, suggesting the importance of maintaining visual acuity. Therefore, active treatment is necessary in the elderly.

Modified Rectangular Loop Suture for Refractory Pupillary Optic Capture of Scleral Fixated Intraocular Lens

Purpose@#To report a modified rectangular loop suture technique for patients with refractory pupillary optic capture after intraocular lens scleral fixation. @*Methods@#A modified rectangular loop suture was performed in four patients with persistent pupillary capture despite medication and laser iridotomy. A loop suture pattern was designed in the two quadrants without the scleral fixation knot. A 2 mm loop suture point was marked 2 mm away from the corneal limbus. The suture point was similarly marked in the opposite quadrants. Small conjunctival incisions were made at a marked point and a non-absorbable 10-0 prolene long needle was passed. The needle was inserted at the 1 o’clock position through the conjunctival incision and passed between the intraocular lens and the iris plane. Then it was withdrawn using a 26-gauge (G) syringe from the 8 o’clock position in the opposite quadrant. Similarly, the needle was passed from the 7 o’clock position under the conjunctiva, and pulled out of the sclera at the 2 o’clock position. It was then passed to the 1 o’clock position under the conjunctiva and a knot was made and buried. The operation was completed without closure of the conjunctival incision. @*Results@#In all four eyes, pupillary optic capture was corrected and remained stable without recurrence for an average of 7.25 months. @*Conclusions@#The modified rectangular loop suture may be useful for refractory pupillary capture cases. The procedure is relatively simple and minimizes scleral exposure to the conjunctival suture. It is expected that this may reduce patient discomfort.

Clinical Features of Strabismus in Patients with Unilateral Pediatric Cataract

PURPOSE: The incidence rate and clinical features of strabismus and factors affecting onset of strabismus were evaluated in patients with unilateral pediatric cataract. METHODS: A total of 42 patients who underwent lens removal for treatment of unilateral cataract between January 1996 and January 2011 were evaluated. Patients were divided into 3 groups (Ortho/Ortho, Ortho/Strabismus, and Strabismus/Strabismus) according to preoperative and postoperative ocular alignment. Age at surgery, visual acuity, amblyopia, and spherical equivalent were compared among the 3 groups. RESULTS: Of the total patients, 7 had strabismus preoperatively and 5 developed postoperative strabismus. Thus, a total of 12 patients had postoperative strabismus. Preoperatively, 5 patients had exotriopa and 2 patients had esotropia. Postoperatively, 9 patients had exotropia and 3 patients had esotropia. Exotropia was more common than esotropia. In comparison of the 3 groups, postoperative visual acuity was significantly low, and differences in visual acuity between normal eye and cataract eye were significantly larger in the Ortho/Strabismus group. There were no significant differences among the 3 groups in age at surgery, amblyopia, or spherical equivalent. CONCLUSIONS: In the patients with unilateral pediatric cataract, exotropia was the most common type. Because there is a high possibility of postoperative strabismus in patients who had lower postoperative visual acuity, careful observation is needed in these patients.

Comparison of Sensory and Motor Functions in Patients with Constant and Intermittent Infantile Exotropia

PURPOSE: The aim of this study was to compare sensory and motor functions in patients with constant and intermittent primary infantile exotropia. METHODS: From March 2010 to November 2015, 58 patients with primary infantile exotropia were divided into a constant group (21 patients) and an intermittent group (37 patients) according to frequency of exodeviation at the first visit. Sex, family history of strabismus, age at diagnosis, spherical equivalent, and presence of amblyopia were compared. Angle of deviation, ocular motor function, and stereopsis were measured. RESULTS: Females were more prevalent (p = 0.027) and the spherical equivalent of the right eye was more myopic (-0.99 D) (p = 0.023) in the constant infantile exotropia group. However, there was no significant difference in family history of strabismus, age at diagnosis, amblyopia, latent nystagmus, or stereopsis between the two groups. There were no significant differences between the two groups in angle of deviation at near or distance (p = 0.598, p = 0.518). Dissociated vertical deviation was accompanied in 2 patients in the constant group and 3 in the intermittent group. Inferior oblique overaction was accompanied in 8 patients in the constant group and 16 in the intermittent group, while vertical deviation was accompanied in 1 patient in the constant group and 3 in the intermittent group. However, there were no significant differences between the groups for any of these findings. CONCLUSIONS: Constancy of exodeviation is insufficient to diagnose primary infantile exotropia. Compared to those in whom exodeviation was intermittent, the patients with constant infantile exotropia showed similar clinical features. Therefore, close observation is recommended in patients with intermittent and constant infantile exotropia.

Complete Oculomotor Nerve Palsy Complicated by Inflammation of the Cavernous Sinus in Herpes Zoster Ophthalmicus

PURPOSE: To report a case of complete oculomotor nerve palsy with pupil involvement complicated by inflammation of the cavernous sinus. Complete resolution was obtained after 12 days of antiviral and steroid treatments. CASE SUMMARY: A 60-year-old male presented with edema and vesicles of the right upper eyelid. The patient had myalgia, cough, fever and headache 1 week earlier and was treated with conservative therapy. The patient received an antiviral agent (famciclovir 250 mg) twice a day and steroid agent (methylprednisolon 4 mg) once a day at the dermatology department for 1 week. The eyelid edema and vesicles improved. However, ptosis, ocular movement limitation, mydriasis of the right eye and diplopia occurred. Brain magnetic resonance imaging revealed hyperintensity in the right cavernous sinus with enhancement, implicating inflammation. The patient was diagnosed with right complete oculomotor nerve palsy with pupil involvement. An antiviral agent (famciclovir 250 mg) three times a day and a steroid agent (prednisolone 40 mg) once a day were prescribed. From the next day, ptosis and ocular movement limitation improved and 12 days later, completely resolved. CONCLUSIONS: Ocular movement limitation and mydriasis can be accompanied by herpes zoster ophthalmicus without uveitis and cerebral aneurysm. Administering active antiviral and steroid treatment to obtain rapid resolution is important.

A Case of the Third, Fourth, and Sixth Nerve Palsy in a Patient with Cerebral Aspergillosis

PURPOSE: To report a case of cerebral aspergillosis with third, fourth, and sixth nerve palsy. CASE SUMMARY: A 66-year-old female presented with ocular pain, diplopia, ptosis, and limited ocular movement of the right eye. The patient had experienced rhinorrhea and headache in the right temporal area 3 weeks prior and was treated with oral antibiotics for 1 week. Marginal reflex distance 1 was -4 mm in the right eye and +4 mm in the left eye. Upward, downward, medial, and lateral gaze limitation (-4/-4/-3.5/-2.5) was evaluated. Magnetic resonance imaging (MRI) revealed a mass originating from the nasopharynx and passing through the petrous apex, foramen lacerum, carvernous sinus, sphenoid sinus, orbital apex, and inferior orbital fissure. The mass had high signals on T2-weighted imaging. After 5 days, the mass was removed by endoscopic surgery and aspergillus was detected histopathologically. The patient was given intravenous voriconazole for 11 days and oral voriconazole for 11 weeks. Ptosis and ocular movement limitation began to improve after 6 weeks postoperatively. After 4 months, ocular movement was not limited and there was no recurrence during the 1 year follow-up period. CONCLUSIONS: The present case showed that orbital aspergillosis can invade the intracranial area and third, fourth, and sixth nerve palsy can develop without exophthalmos. Thus, when ocular movement disorders, ptosis and symptoms of sinusitis are present in orbital aspergillosis patients, use of appropriate diagnostic tools such as MRI and active treatment are important.

Expanding Hematoma of the Abdominal Wall Caused by Spontaneous Rupture of a Deep Circumflex Iliac Artery:Report of A Case Treated by Coil Embolization

Abdominal wall hematoma is a rare but well-known disease, usually caused by trauma or, on rare occasions, occurring spontaneously. Hematomas of the rectus sheath and the anterolateral abdominal wall are commonly associated with injury to the inferior epigastric artery and the deep circumflex iliac artery, respectively. The diagnosis of spontaneously developed abdominal wall hematoma is sometimes delayed, due its clinical manifestations being similar to those of other causes of the acute abdomen. CT and angiography can be helpful in the diagnosis of the hematoma and the injured vessel. Herein, we report on a rare case of a spontaneously developed anterolateral abdominal wall hematoma treated with microcoil embolization of the left deep circumflex iliac artery.

Intravascular Papillary Endothelial Hyperplasia (Masson's Hemangioma) of the Liver: A New Hepatic Lesion

Intravascular papillary endothelial hyperplasia (Masson's hemangioma) is a disease characterized by exuberant endothelial proliferation within the lumen of medium-sized veins. In 1923, Masson regarded this disease as a neoplasm inducing endothelial proliferation, however, now it is considered to be a reactive vascular proliferation following traumatic vascular stasis. The lesion has a propensity to occur in the head, neck, fingers, and trunk. Occurrence within the abdominal cavity is known to be very rare, and especially in the liver, there has been no reported case up to date. The authors have experienced intravascular papillary endothelial hyperplasia of the liver in a 69-yr-old woman, and report the case with a review of the literature.

Management patterns of upper gastrointestinal symptoms

BACKGROUND: Upper gastrointestinal symptoms is the one of the most frequent symptom in primary medicine, those manifestations are various and can not find the cause in many cases. In Korea the management patterns for upper gastrointestinal symptoms are using drug store, oriental medicine, folk methods, diet therapy in addition to medical service. We have investigated the behavioral patterns for the control of upper gastrointestinal symptoms. METHODS: The authors surveyed the patients who had visited Dong guk university Kyung ju hospital with upper gastrointestinal symptoms from April 1 to June 30 in 2000. RESULTS: 269 questionnaires were collected and among them 247 completed ones were analysed. 112 subjects were used medical service only(45.3%), 135 subjects were used alternative methods also(54.7%). Among the 135 subjects who used alternative methods, 60 visited to drug store(44.4%), 36 took oriental medicine(26.7%), 18 used folk herbal remedy(26.7%), 5 used diet therapy(3.7%), 16 used folk manual therapy(11.9%), most commonly. Women more commonly used alternative methods(P<0.01). By occupation, housewives more commonly used alternative methods and specialists less commonly used alternative methods. There were no significant difference between two groups in other general characteristics, most severe symptom, cost, satisfaction. CONCLUSION: We find the behavioral patterns for relieving upper gastrointestinal symptoms are using alternative methods(drug store, oriental medicine, folk herbal remedy, folk manual therapy, diet therapy) in addition to using medical service. Women and housewives more commonly used alternative methods, and specialist less commonly used alternative methods.

CT and MR Findings of Neonatal Dermoid ("Hairy Polyp")Developed at Eustachian Tube: A Case Report

Nasopharyngeal dermoid is a rare disease which in neonates leads to respiratory failure. We report the CT and MR imaging findings of a case of neonatal dermoid which developed in the Eustachian tube. The neonate involved was referred to our hospital because of respiratory difficulties and cyanosis.

Reccurent Unilateral Lung Collapse in an Asthmatic Child

Abnomalities in the production and transport of airway secretions play an important role in the pathophysiology of asthma. Segmental atelectasis as a complication of asthma, is relatively common in children. On the other hand, massive atelectasis such as the collapse of one lung is a very rare occurence. We report a seven-year-old male asthmatic patient with right lung collapse caused by mucoid impaction. Fourteen months before admission, the patient experiened bronchopneumonia with left unilateral lung collapse due to mucus plugging and recovered by bronchoscopic removal. The clinical findings, chest X-ray and chest CT suggested the collapse of the right lung was caused by mucus plugging. Fiberoptic bronchoscopy revealed the obstruction of the right main bronchus due to thick mucoid impaction. The histologic finding of mucoid material removed by brochoscopy showed only eosinophil clusters. In addition to fibroptic broncoscopic removal of mucoid secretions, hydration, chest physiotherapy, brochodilators and steroids, the patient received tracheostomy because of difficulty in sputum expectoration, poor improvement of clinical symptoms and chest X-ray findings, with rapid improvements. This case showed that early aspiration of bronchial mucoid secretions by bronchoscopy and tracheostomy was very critical, without waiting for a further deterioration of respiratory function.

Treatment of Intravenous Immune-Globulin Resistant Kawasaki Disease with Corticosteroids

PURPOSE: To evaluate the efficacy of steroid therapy on prevention of development and progression of coronary artery aneurysm in intravenous immune globulin (IVIG)-resistant Kawasaki disease, we treated three children with high dose of intravenous methylprednisolone followed by low dose oral prednisolone. METHODS: We selected three children with Kawasaki disease who did not repond or who initially responded but soon developed recrudescent fever after retreatment of IVIG (total 4gm/kg). These three patients were treated with high dose methylprednisolone (10mg/kg) intravenously and followed by low dose prednisolone (1mg/kg) orally for 7 days. Echocardiographic evalutions were performed within 8 days of admission (before steroid therapy), at discharge and 1 month after discharge. RESULTS: All three patients showed rapid normalization of clinical symptoms and did not developed significant coronry artery abnormalities. No adverse reaction was observed. CONCLUSIONS: Steroid therapy (mini pulse methylprednisolone and prednisolone therapy) is valuable for patients with Kawasaki disease resistant to intravenous immune globulin therapy.

A Case of Acute Viral Myositis

Diffuse myalgia is common in transient systemic viral infections but overt myositis, with weakness and signs of muscle inflammation, rarely accompanies viral infection in chidren. We describe a 8-year-old boy with severe myalgia and tenderness in both lower extremities, whose unusual skeletal muscle uptake on Technetium-methylene diphosphate bone scan helped to diagnosis of myositis. Clinical course, muscle-derived enzyme studies(AST, ALT, LD, CK), electromyogram findings, histopathologic findings obtained from left gastrocnemius muscle biopsy and serologic studies for enteroviral antibodies (enterovirus type 71 and Coxsackie B4 neutralization antibody titer 1:128 respectively) were all compatible with acute viral myositis.

A Clinical Study of Tsutsugamushi Disease in Children

No abstract available.

The Status of Central Nervous System Tumors in Daegu City and Kyungbook Province

The authors analized statistically 403 cases of C.N.S. tumors confirmed by pathology in the boundary of Daegu city and Kyungbook province from January 1984 to December 1986. The results were as follows: 1) The each cases of male and female were 220(54.6%) and 183(45.4%). 2) Intracranial tumors were 288 cases(71.5%), spinal tumors 75(18.6%), and others 40(9.9%). 3) Numbers of C.N.S. tumors were 8.7/100,000 population in city and 6.3/100,000 in country. 4) Among the intracranial tumors, glioma(30.9%) was the most common and followed by meningioma(16.3%) and metastatic tumor(8.7%). Among the spinal tumors, metastatic tumors was 34.6%, neurofibroma 30.7%, and meningioma 5.3%. 5) The majority of intracranial tumors were found in supratentorial region(76.3%), in which area frequency of tumor incidence were as follows; glioma, meningioma, metastatic tumor. Among the infratentorial area(22.6%), the sequence of tumor incidence were glioma, medulloblastoma, and neurilemmoma, 6) Tumors predominantly in male were oligodendroglioma(2:1), metastatic tumor(1.8:1), and medulloblastoma(1.7:1), and in female were meningioma(1:2), neurilemmoma(1:1.7), and pituitary tumor(1:1.5). 7) Peak age incidence of glioma, meningioma, and neurilemmoma were from 40 to 60 years, pituitary tumor and oligodendroglioma were 30 to 50 years, craniopharyngioma and ependymoma were around 10 years old, and metastatic tumor was 50 to 70 years old. 8) In the spinal tumors, the most favorable site of longitudinal axis was thoracic area(62.7%) and transverse location was epidural space(45.3%). 9) The most common site of metastatic tumor were came from lung(29.1%) in brain metastasis and prostate(19.2%) in spine.

An Experiments Study for Usage of Urokinase in Treatment of Intracerebral Hematoma

Thrombolysis using urokinase solution is one of the effective methods in treatment of intracerebral hematoma. The present study was undertaken in order to 1) determine the most effective concentration of urokinase solution, 2) determine the most suitable time interval of irrigation of urokinase solution through the measurement of hemoglobin and FDP(Fibrin / Fibrinogen Degradation Product) of drained solution, 3) estimate the size of unresolved hematoma without taking brain CT. The results are summarized as follows : 1) The most effective and economic concentration of urokinase solution was 1000 u/ml. 2) The most preferable time interval of irrigation of urokinase solution was about one hour. 3) It was possible to estimate the size of unresolving hematoma by means of measurement of hemoglobin and hematocrit of patient, hemoglobin and volume of the thrombolysed solution, so that it was unnecessary to take brain CT for measurement of remaining hematoma.

A Case of Epidermoid Cyst in the Fourth Ventricle

Epidermoid cyst is a congenital tumor and it's incidence is relatively rare in all intracranial tumors. Preference site is the basal surface of the brain, particularly the cerebellopontine angle and parasellar region. We report a epidermoid cyst in the fourth ventricle of 37 years old femals with signs of cerebellar dysfunctions. The literature on the incidence, diagnosis, surgical technoque and complications are reviewed.

Epidural Morphine for Control of Pain after Lumbar Laminectomy

Epidural morphine has been used successfully for the relief of acute or chronic pain by direct injection or catheter method. We report the use of morphine for postoperative pain control in 18 herniated lumbar disc patients. These patients were compaired with 25 others who were not received epidural morphine. Without using of epidural catheter, single small dose morphine(3~5mg) in 1.5ml normal saline was administered under the direct infution into the epidural space just before closure of the lumbar operative wound. Epidural morphine group required only 2 times of parenteral narcotics injections within the first 24 hours after lumbar laminectomy, whereas nonmorphine group required 48 injections. The average narcotics injection frequencies were statistically significant(p<0.01). Hypotension were occured in three cases and pruritus in two cases. But more investication and study were needed for hypotension which was true side effect or not. Respiratory depression was not occured.