Spontaneous Intracranial and Spinal Subdural Hematoma: A Case Report / 대한신경손상학회지

Spinal subdural hematoma (SDH) is rarely reported, and their simultaneous occurrence with intracranial SDH is even more rare. A 67-year-old male patient with a history of posterolateral fusion to treat an L2 burst fracture came to our outpatient clinic due to an inability to walk by himself over the previous 3 weeks. A neurological examination revealed that the patient was alert with occasional confusion and slight motor weakness in the lower extremities. Brain and lumbar spine magnetic resonance imaging (MRI) was then performed. A brain MRI revealed a large subacute SDH along the right cerebral convexity and falx cerebri with midline shifting, and a spine MRI revealed a right side-predominant subacute SDH extending from L4 to S1. For treatment, burr hole trephination of the intracranial SDH and fluoroscopy-guided lumbar puncture of the spinal SDH were performed and resulted in a favorable outcome. This is a report of a rare case of spontaneous intracranial and lumbar spine SDH. We include a review of the current literature and a discussion of the pathogenesis of this condition in this report.

Scleral Allograft with Autologous Buccal Mucosal Transplantation for Tube Erosion Ocurred after Ahmed Glaucoma Valve Implant Surgery: Three Cases

After Drainage implant surgery, erosion of conjunctiva or cornea over tube can occur about 5%in late postoperative period. Scleral allograft for exposed tube should be used to prevent secondary infection. We report three glaucoma patients treated graft with autologous buccal mucosal transplantation for recurrent tube exposure. First case was a 68-year-old male patient with neovascular glaucoma due to central retinal vein occlusion. Second case was a 37-year-old female patient with pseudophakic glaucoma. Third case was a 70-year-old male patient with diabetic neovascular glaucoma. Ahmed glaucoma valve implant surgeries were done for three patients. For tube exposure, we used autologous buccal mucosal transplantation. There was no recurrent erosion and intraocular pressure was maintained well more than 6 months of follow-up. In cases for tube exposure, we introduce that autologous buccal mucosal transplantation can be used to treat tube exposure.

A Case of Retinal Hemorrhage after Climbing the Himalaya Mountains

High altitude exposure may produce multiple symptoms of mountain sickness. A 27-year-old man presented with metamorphopsia in his left eye which occurred following climbing the Himalaya Mountains. His best corrected visual acuity was right eye, 0.9 and left eye, 0.3. Ophthalmoscopy disclosed retinal hemorrhages in both eyes and a subfoveal hemorrhage in left eye. Fluorescein angiography showed blockage of fluorescence caused by retinal hemorrhages. Indocyanin green angiography showed no hot spot. One month later, best corrected visual acuity of his left eye was 0.4 and the degree of metamorphopsia decreased. Thus we report the case of mountain sickness who showed retinal hemorrhage and subfoveal hemorrhage with a review of available literatures.

The Quantitative Analysis of Effectiveness of Radiation Therapy on Choroidal Ne ovascular Membra n e s

The natural course of visual acuity of choroidal neovascularization (CNV) membrane is known to be poor.When fovea is involved, only a subset of patients is eligible for laser photocoagulation or alternative treatment odalities.Radiation therapy has been investigated for applying to such cases, however there have been controversies among reports on the effec-tiveness of radiation therapy.Hence we intended to evaluate the effective-ness of radiation therapy quantitatively.Twenty-one eyes with subfoveal CNV were treated with 4 MV X-ray (total dose of 20 Gy).After the follow-up period of 6months or longer, the visual acuity remained stable or improved from the initial visual acuity in 15 of 21 eyes (71.4%). Based on indocyanine green (ICG)video angiography, the CNVs decreased in their size in 16 of 21 eyes (76.2%)and this difference was statistically significant. These results suggest that radiation can induce regression of subfoveal CNV and maintain central vision in a significant number of patients and we believe that larger, longer study is necessary.

Trabeculectomy with Mitomycin C(MMC)

Mitomycin C has an inhibitory effect on the proliferation of fibroblasts and it is used as an adjunct to trabeculectomy. To clarify the effects of mitomycin C on trabeculectomy, we ana lysed 95 eyes that received trabeculectomy with mitomycin C and 90 eyes that received trabeculectomy without mitomycin C. There were no significant differences in sex, age, type of glaucoma and preoperative intraocular pressure (IOP) between two groups (p>0.05 respectively). The mean rops at 6 months after surgery and the success rate were not significantly different between two groups (p>0.05). But considering the mean IOP of successful cases, the mitomycin C used group showed the lower postoperative IOP(p<0.05). The rate of complete seccess which had no antiglaucoma medications and 5-fluorouracil administration during the postoperative period was higher in the mitomycin C used group (p<0.05). Postoperative complications, espicially hypotony, were more common in the mitomycin C used patients. Hypotony was more frequent in the patients who received brief exposure of mitomycin C. Most of the hypotony patients had primary open angle glaucoma and lower preoperative IOP. According to the results of our study, mitomycin C should be used in the high risk group patients who are young and have secondary glaucoma or history of failure of filtering procedures, and also in the patients with difficulty of postoperative medical treatment and requiring lower IOP.

The Prevalence of Glanucoma in Korean Adults

Early detection of glaucoma by mass screening is the most practical approach for prevention of blindness. An epidemIOlogical study gives the most essential information on prevalence an distribution of the disease in relation to diverse background factors. But, before now, an epidemiological study for glaucoma has not been carried out in Korea. Our glaucoma survey was conducted in the health examination center of Yongdong Severance hospital during 1990 and 1991. The total numbers of subjects examined was 4424 persons aged 30 years or older. A mainstay of the screening consisted of applanation tonometry and fundus photography with a non-mydriatic camera, followed by automated perimetry as a recall examination. Overall prevalences of glaucoma obtained were primary open angle glaucoma 0.23% (10 patients), low tension glaucoma 2.04% (108 patients), and ocular hypertension 0.23% (10 patients). The mean lOP obtained with applanation tonometry was 14.04 +/- 2.99 mmHg for men and 14,07 +/- 2.67 mmHg for women. In additon, our data have pointed out that the lOP in different ages tends to be constant, whereas prevalences of glaucoma and low tension glaucoma increase with aging.

The Factors Affect on the Success Rate of the Trabeculectomy

To find the factors that affect on the success rate of the trabeculectomy, we investigated 208 eyes of 158 patients with various types of glaucoma which had undergone trabeculectomy. The patients were followed up at least 3 month postoperatively. The criteria of success was maintenance of postoperative IOP below 21 mmHg. The total success rate was 89.4%. In young patients, the success rate was lower than that of older ones. The success rate of open angle glaucoma, acute angle closure glaucoma and chronic angle closure glaucoma were higher than that of congenital glaucoma and secondary glaucoma. Recently performed operation demonstrated higher success rate. The type of conjunctival flap, scleral flap and use of 5-fluorouracil were independent factors that affect on the success rate.

Seventy cases of endoscopic surgery in gynecologic patients / 대한산부인과학회잡지

No abstract available.