Exploring Generalization Capacity of Artificial Neural Network for Myelin Water Imaging

Purpose@#To understand the effects of datasets with various parameters on pretrained network performance, the generalization capacity of the artificial neural network for myelin water imaging (ANN-MWI) is explored by testing datasets with various scan protocols (i.e., resolution and refocusing RF pulse shape) and types of disorders (i.e., neuromyelitis optica and edema). @*Materials and Methods@#ANN-MWI was trained to generate a T2 distribution, from which the myelin water fraction value was measured. The training and test datasets were acquired from healthy controls and multiple sclerosis patients using a multiecho gradient and spin-echo sequence with the same scan protocols. To test the generalization capacity of ANN-MWI, datasets with different settings were utilized.The datasets were acquired or generated with different resolutions, refocusing pulse shape, and types of disorders. For all datasets, the evaluation was performed in a white matter mask by calculating the normalized root-mean-squared error (NRMSE) between the results from the conventional method and ANN-MWI. Additionally, for the patient datasets, the NRMSE was calculated in each lesion mask. @*Results@#The results of ANN-MWI showed high reliability in generating myelin water fraction maps from the datasets with different resolutions. However, the increased errors were reported for the datasets with different refocusing pulse shapes and disorder types. Specifically, the region of lesions in edema patients reported high NRMSEs. These increased errors indicate the dependency of ANN-MWI on refocusing pulse flip angles and T 2 characteristics. @*Conclusion@#This study proposes information about the generalization accuracy of a trained network when applying deep learning to processing myelin water imaging.

Exploring Generalization Capacity of Artificial Neural Network for Myelin Water Imaging

Purpose@#To understand the effects of datasets with various parameters on pretrained network performance, the generalization capacity of the artificial neural network for myelin water imaging (ANN-MWI) is explored by testing datasets with various scan protocols (i.e., resolution and refocusing RF pulse shape) and types of disorders (i.e., neuromyelitis optica and edema). @*Materials and Methods@#ANN-MWI was trained to generate a T2 distribution, from which the myelin water fraction value was measured. The training and test datasets were acquired from healthy controls and multiple sclerosis patients using a multiecho gradient and spin-echo sequence with the same scan protocols. To test the generalization capacity of ANN-MWI, datasets with different settings were utilized.The datasets were acquired or generated with different resolutions, refocusing pulse shape, and types of disorders. For all datasets, the evaluation was performed in a white matter mask by calculating the normalized root-mean-squared error (NRMSE) between the results from the conventional method and ANN-MWI. Additionally, for the patient datasets, the NRMSE was calculated in each lesion mask. @*Results@#The results of ANN-MWI showed high reliability in generating myelin water fraction maps from the datasets with different resolutions. However, the increased errors were reported for the datasets with different refocusing pulse shapes and disorder types. Specifically, the region of lesions in edema patients reported high NRMSEs. These increased errors indicate the dependency of ANN-MWI on refocusing pulse flip angles and T 2 characteristics. @*Conclusion@#This study proposes information about the generalization accuracy of a trained network when applying deep learning to processing myelin water imaging.

Immunological measurement of aspartate/alanine aminotransferase in predicting liver fibrosis and inflammation

Background/Aims@#Enzymatic analysis of aspartate/alanine aminotransferase (AST/ALT) does not exactly represent the progression of liver fibrosis or inflammation. Immunoassay for AST (cytoplasmic [c] AST/mitochondrial [m] AST) and ALT (ALT1/ALT2) has been suggested as one alternatives for enzymatic analysis. The objective of this study was to evaluate the efficacy of immunoassay in predicting liver fibrosis and inflammation. @*Methods@#A total of 219 patients with chronic hepatitis B (CHB) who underwent hepatic venous pressure gradient (HVPG) and liver biopsy before antiviral therapy were recruited. Serum samples were prepared from blood during HVPG. Results of biochemical parameters including enzymatic AST/ALT and immunological assays of cAST, mAST, ALT1, and ALT2 through sandwich enzyme-linked immunosorbent assay (ELISA) immunoassay with fluorescence labeled monoclonal antibodies were compared with the results of METAVIR stage of live fibrosis and the Knodell grade of inflammation. @*Results@#METAVIR fibrosis stages were as follows: F0, six (3%); F1, 52 (24%); F2, 88 (40%); F3, 45 (20%); and F4, 28 patients (13%). Mean levels of AST and ALT were 121 ± 157 and 210 ± 279 IU/L, respectively. Mean HVPG score of all patients was 4.7 ± 2.5 mmHg. According to the stage of liver fibrosis, HVPG score (p < 0.001, r = 0.439) and ALT1 level (p < 0.001, r = 0.283) were significantly increased in all samples from patients with CHB. ALT (p < 0.001, r = 0.310), ALT1 (p < 0.001, r = 0.369), and AST (p < 0.001, r = 0.374) levels were positively correlated with Knodell grade of inflammation. @*Conclusions@#ALT1 measurement by utilizing sandwich ELISA immunoassay can be useful method for predicting inf lammation grade and fibrosis stage in patients with CHB.

Association between Relative Handgrip Strength and C-Reactive Protein in Adults / 대한스포츠의학회지

Purpose@#The purpose of this study was to investigate whether obesity indicators are mediated in the association between muscle strength and inflammation levels, and further confirm the association between muscle strength level by sex and age and inflammatory levels. @*Methods@#In this study, 3,234 adults living in rural areas were surveyed from 2007 to 2015 and the data was finally analyzed on 2,149 adults. To identify that obesity indicators are mediated in relation to the association between relative grip strength and C-reactive protein (CRP) level, odds ratio (OR) and 95% confidence interval (CI) were calculated using logistic regression analysis (p＜ 0.05). @*Results@#As confounding variables were adjusted, the odds ratio for high inflammatory conditions was lower at a high (OR, 0.58; 95% CI, 0.40–0.85) or medium (OR, 0.64; 95% CI, 0.46–0.90) level of relative grip strength than a low level of relative grip strength. However, there were no significant results if the body fat percentage was added for the confounding variable. When the association between relative grip strength and inflammatory conditions was divided by sex, for women, the odds ratio about high inflammatory conditions was gradually decreased as the relative grip level increased (medium level: OR, 0.55; 95% CI, 0.35–0.87; high level: OR, 0.49; 95% CI, 0.30–0.82). The association of relative grip strength with inflammatory conditions was shown differently in age groups. @*Conclusion@#In conclusion, improvement of muscle strength is a factor that can lower the level of inflammation, and it is important to lower the level of inflammation that can cause cardiovascular disease through resistance exercise differentiated by age and sex.

Pigmented Mass in the Anterior Chamber Suspected of Granuloma Caused by a Metallic Foreign Body

PURPOSE: To report on a patient with a brown pigmented mass in the anterior chamber suspected of a granuloma caused by a metallic foreign body and to review the relevant literature. CASE SUMMARY: A 63-year-old man presented with blurring in his right eye, which had initially began several years prior. Concentric corneoscleral brown pigmentation about 2 mm in diameter was found in the superonasal limbal area. A rectangular parallelepiped mass was observed in the superonasal anterior chamber, which was an even brown color with a small white portion, smooth-surfaced, and non-vascularized. The pupil was oval and dragged superonasally, possibly due to mild compression of the iris caused by the mass. In pre-enhanced orbital computed tomography, a round high signal intensity with a diameter of 3.0 mm was found in the superonasal anterior segment. Though excisional biopsy using the lamellar scleral flap was considered for exact diagnosis, this was not performed considering the clinical features are more indicative of granuloma than iris melanoma. Neither changes in the size of the mass nor the shape of the pupil were observed during the follow up period until 19 months after the first visit. CONCLUSIONS: When a pigmented mass in the anterior chamber is detected, benign and malignant iris tumors and granulomas should be considered for a differential diagnosis. The patient's exact past medical history and clinical features differentiating malignant and benign masses are important for proper diagnosis due to the difficulty in obtaining tissue diagnoses in some cases.

Corrigendum: Circulating Aneuploid Cells Detected in the Blood of Patients with Infectious Lung Diseases

There was an error in the article. Chung-Hee Sonn (Ph.D.) should have been listed as a co-corresponding author but Jhingook Kim was listed as the sole corresponding author of the article. Therefore, we ask to correct that both Chung-Hee Sonn and Jhingook Kim are co-corresponding authors.

Sociodemographic Factors Related to Lower Urinary Tract Symptoms in Men: A Korean Community Health Survey / 대한배뇨장애요실금학회지

PURPOSE: This study estimated the prevalence of lower urinary tract symptoms (LUTS) in Korean men and the conditions for being diagnosed with or treated for LUTS/benign prostatic hyperplasia (BPH). METHODS: We analyzed cross-sectional data collected from 69,851 Korean men who were 40 years of age or older and had participated in the Korean Community Health Survey performed in 2011. Interviewers performed face-to-face surveys that included sociodemographic questions, the International Prostate Symptom Score (IPSS), and questions regarding whether the subjects had been diagnosed with or treated for LUTS/BPH. We estimated the prevalence of LUTS and assessed whether the subjects had been diagnosed with or treated for LUTS/BPH. RESULTS: Moderate to severe LUTS, storage symptoms, and voiding symptoms increased with age. The IPSS quality of life score was 1.5±0.004 in the mild LUTS group (n=57,701), 3.3±0.01 in the moderate LUTS group (n=9,203), and 4.3±0.02 in the severe LUTS group (n=2,947) (P<0.0001). The prevalence of moderate to severe LUTS in those who had not been diagnosed with LUTS/BPH was 64.5% (7,847 of 12,150), and the prevalence of moderate to severe LUTS in those who had been diagnosed with LUTS/BPH but had not been treated was 23.5% (2,853 of 12,150). CONCLUSIONS: The severity of LUTS in Korean men increased with age, and the IPSS quality of life score increased with the severity of LUTS. Many Korean men with moderate to severe LUTS had not been diagnosed or treated for LUTS/BPH. Socioeconomic conditions played an important role in health-seeking behavior among patients with LUTS/BPH.

Circulating Aneuploid Cells Detected in the Blood of Patients with Infectious Lung Diseases

The identification of circulating tumor cells (CTCs) is clinically important for diagnosing cancer. We have previously developed a size-based filtration platform followed by epithelial cell adhesion molecule immunofluorescence staining for detecting CTCs. To characterize CTCs independently of cell surface protein expression, we incorporated a chromosomal fluorescence in situ hybridization (FISH) assay to detect abnormal copy numbers of chromosomes in cells collected from peripheral blood samples by the size-based filtration platform. Aneuploid cells were detected in the peripheral blood of patients with lung cancer. Unexpectedly, aneuploid cells were also detected in the control group, which consisted of peripheral blood samples from patients with benign lung diseases, such as empyema necessitatis and non-tuberculous mycobacterial lung disease. These findings suggest that chromosomal abnormalities are observed not only in tumor cells, but also in benign infectious diseases. Thus, our findings present new considerations and bring into light the possibility of false positives when using FISH for cancer diagnosis.

The association between blood cadmium level, frequency and amount of gejang (marinated crab) intake

BACKGROUND: Gejang (marinated crab) is a favorite traditional food and a main source of crab intake among Koreans. The present study aimed to identify the possibility of cadmium inflow to the body through gejang; accordingly, the relationship between gejang intake frequency and amount, and blood cadmium concentrations was investigated. METHODS: Using data from the first Korea National Health and Nutrition Examination Survey in the sixth period in 2013, means and standard errors of blood cadmium concentrations in relation to gejang intake frequency and amount, as well as the monthly intake of gejang, were obtained from 1381 participants for whom data regarding blood cadmium concentration measurements was available. RESULTS: After adjustment for confounding factors, a gejang intake frequency of four or fewer times per week and a monthly intake of 200 cm3 or less had no significant effect on blood cadmium concentrations. However, participants with gejang intake of at least five times per week had a weighted mean cadmium concentration of 2.12 μg/L (p < 0.001), and participants who had a gejang monthly intake of more than 200 cm3 had a weighted mean cadmium concentration of 1.76 μg/L (p < 0.001). CONCLUSION: These results suggest that to minimize the effect of gejang consumption on blood cadmium level, gejang intake should be limited to four or less times per week and 200 cm3 or less per month. Weekly intake of at least five times and monthly intake of more than 200 cm3 may increase blood cadmium levels.

Analysis of Treatment Results after Thyroid Lobectomy with Prophylactic Ipsilateral Central Neck Lymph Node Dissection for Low-Risk Papillary Thyroid Carcinoma: A Single Institute Experience / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Surgical options for low-risk papillary thyroid carcinoma (PTC) have been in debate. The purpose of this study was to analyze the treatment results of lobectomy and prophylactic ipsilateral central lymph node dissection (cND) for low-risk PTC. SUBJECTS AND METHOD: We retrospectively analyzed 906 patients who were diagnosed as PTC pre- or post-operatively and underwent lobectomy and/or prophylactic ipsilateral cND from 2001 to 2010. Studied variables were clinicopathologic data, complications, sites of recurrence, overall survival, and recurrence free survival rates. RESULTS: Fifty two (5.7%) patients showed recurrence during follow-up. Of the 52 recurrent cases, 32 (61.5%) cases recurred in a remnant thyroid only, 11 (21.2%) cases in a lymph node (LN) only, and 9 (17.3%) cases in a remnant thyroid and the LN. One (0.1%) patient showed permanent vocal cord palsy. Overall survival rate at 10 years was 99.6%. Overall recurrence free survival rates at 5 and 10 years were 97.1% and 81.0%, respectively. Risk factors for recurrences were old age (>45), contralateral nodule(s) at initial surgery, large tumor, no prophylactic cND, and pathological LN metastasis. CONCLUSION: Lobectomy with prophylactic ipsilateral cND may be a good option for low risk PTC patients due to excellent overall survival rates, recurrence rates, and minimal complication rates.

Clinical Features and Outcomes of Papillary Thyroid Carcinoma in Patients Aged under 20 / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Thyroid carcinoma rarely occurs in children and adolescents, whose clinical features are diverse, and treatment outcomes are still controversial. The aim of this study was to evaluate the clinical features and the treatment outcomes of papillary thyroid carcinoma (PTC) patients younger than 20 years old. SUBJECTS AND METHOD: This is a retrospective study for patients younger than 20 years old, who were diagnosed as PTC from January 1992 to February 2009. Clinical features, size, pathologic type, extrathyroidal extension, recurrence, multiplicity, extent of surgery, and lymph node metastasis were retrospectively evaluated. RESULTS: Forty patients, of 6 malse and 34 females, were enrolled, with their mean age being 16 years old. The initial operations were total thyroidectomy for 9 patients, unilateral lobectomy for 15 patients, and total thyroidectomy and lateral neck dissection for 16 patients. Cervical lymph node metastases were diagnosed in 25 patients. Extrathyroidal extensions were observed in 30 patients. Postoperative radioactive iodine therapy was performed in 35 patients. During the follow-up period, 8 patients had recurred. All patients were alive at the last follow-up. CONCLUSION: PTC in children and adolescents aged under 20 is a rare disease and tends to present as an advanced disease with low mortality compared to adult PTC. Recurrence had no effect on survival. Aggressive treatment with total thyroidectomy, central neck dissection, and radioiodine therapy may prevent recurrence.

A Case of Parathyroid Carcinoma Presenting as Brown Tumors / 대한이비인후과학회지

Carcinoma of the parathyroid gland has been reported as a rare disease occurring in 0.5 to 4% of patients with the primary hyperparathyroidism. Brown tumor is characterized as the terminal stage of remodeling processes during the primary or secondary hyperparathyroidism. Brown tumor induced by the primary hyperparathyroidism can commonly occur in the ribs, clavicle, and pelvic bone. We experienced a case of a 29-year old female patient, who had parathyroid carcinoma leading to primary hyperparathyroidism, followed by multiple Brown tumor. We present this case of parathyroid carcinoma with Brown tumors with a brief review of literature.

A Case of Pancreatitis Associated with Hyperfunctioning Intrathyroidal Parathyroid Adenoma / 대한이비인후과학회지

Both intrathyroidal parathyroid adenoma and acute pancreatitis from hyperparathyroidism are rare disorders. We report a case of acute pancreatitis from hyperfunctioning intrathyroidal parathyroid adenoma in a 40-year-old man with severe abdominal pain. Serum chemistry values show-ed high amylase, lipase, calcium and intact parathyroid hormone level, and abdominal CT revealed acute pancreatitis. A 7 mm lesion was detected inside the left upper pole of thyroid on neck ultrasonography and confirmed to be a parathyroid lesion based on fine needle aspiration cytology. After exploratory parathyroidectomy, symptoms subsided. In patients who present with acute pancreatitis, hyperparathyroidism should also be considered if risk factors such as alcohol ingestion, gallstone, previous endoscopic retrograde cholangiopancreatography, and abdominal trauma do not exist. Exploratory parathyroidectomy should be performed in a case of acute pancreatitis from primary hyperparathyroidism.

Psychosocial, Physical, and Autonomic Correlates of Depression in Korean Adults: Results from a County-Based Depression Screening Study

OBJECTIVE: We aimed to investigate the prevalence and psychosocial and neurophysiological correlates of depression in a large county-based cohort of Korean adults. METHODS: We recruited 2355 adults from a rural county-based health promotion program. The following psychometric scales were used: the Center for Epidemiologic Studies Depression scale (CES-D) was used to assess depression, the General Health Questionnaire (GHQ) was used to evaluate stress, and the Medical Outcome Study Social Support Survey (MOS-SSS) was used to determine perceived social support. Heart rate variability (HRV) was used to assess neurophysiological properties. The psychosocial and neurophysiological variables of adults with depression (CES-D score > or =25) and without depression (CES-D score <25) were statistically compared. A logistic regression model was constructed to identify factors independently associated with depression. RESULTS: We estimated that 17.7% of the subjects had depression, which was associated with old age, being female, being single, less religious affiliation, high education, low body mass index (BMI), low levels of aerobic exercise, low social support, and a low HRV triangular index. The explanatory factors of depression included high education, less religious affiliation, low levels of current aerobic exercise, low BMI, and low social support. CONCLUSION: Given the relatively high prevalence of overall depression, subsyndromal depression should also be regarded as an important issue in screening. The independent factors associated with depression suggest that practical psychosocial intervention, including brief psychotherapy, aerobic exercise, and other self-help methods should be considered. In addition, the HRV results suggest that further depression screening accompanied by neurophysiological features would require fine methodological modifications with proactive efforts to prevent depressive symptoms.

Osteoporosis Risk Prediction for Bone Mineral Density Assessment of Postmenopausal Women Using Machine Learning

PURPOSE: A number of clinical decision tools for osteoporosis risk assessment have been developed to select postmenopausal women for the measurement of bone mineral density. We developed and validated machine learning models with the aim of more accurately identifying the risk of osteoporosis in postmenopausal women compared to the ability of conventional clinical decision tools. MATERIALS AND METHODS: We collected medical records from Korean postmenopausal women based on the Korea National Health and Nutrition Examination Surveys. The training data set was used to construct models based on popular machine learning algorithms such as support vector machines (SVM), random forests, artificial neural networks (ANN), and logistic regression (LR) based on simple surveys. The machine learning models were compared to four conventional clinical decision tools: osteoporosis self-assessment tool (OST), osteoporosis risk assessment instrument (ORAI), simple calculated osteoporosis risk estimation (SCORE), and osteoporosis index of risk (OSIRIS). RESULTS: SVM had significantly better area under the curve (AUC) of the receiver operating characteristic than ANN, LR, OST, ORAI, SCORE, and OSIRIS for the training set. SVM predicted osteoporosis risk with an AUC of 0.827, accuracy of 76.7%, sensitivity of 77.8%, and specificity of 76.0% at total hip, femoral neck, or lumbar spine for the testing set. The significant factors selected by SVM were age, height, weight, body mass index, duration of menopause, duration of breast feeding, estrogen therapy, hyperlipidemia, hypertension, osteoarthritis, and diabetes mellitus. CONCLUSION: Considering various predictors associated with low bone density, the machine learning methods may be effective tools for identifying postmenopausal women at high risk for osteoporosis.

Clinical Characteristics of Diffuse Sclerosing Variant of Papillary Thyroid Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Diffuse sclerosing variant (DSV) is a rare variant of papillary thyroid carcinoma (PTC) and has been adopted as a histologic variant. Due to the limited number of cases and the heterogeneity of the tumor's clinical behavior, there is no consensus for DSV's optimal treatment and post-operative follow-up. The purpose of this study is to evaluate the clinical manifestation, recurrence and prognosis of 10 patients with DSV. SUBJECTS AND METHOD: We retrospectively reviewed ten consecutive patients in whom DSV was first observed between 2000 and 2012. All patients are presently under active follow-up at Korea Cancer Center Hospital. Patients underwent a total thyroidectomy with central compartment and laterocervical lymph node dissection only when this involvement was documented by pre-surgery ultrasound examination with fine needle aspiration biopsy. RESULTS: The mean observation interval was 41.6 months. The ratio of male to female was 1 : 9, and the age of incidence was 34.2+/-11.4. The average size of mass was measured 2.9+/-1.9 cm. Upon the diagnosis, eight cases had central and lateral neck lymph nodal metastasis, which was confirmed during the operation. There was no distant metastasis, but one case was confirmed with lung metastasis during the follow-up period. There was no mortality during the follow-up periods in all ten cases. CONCLUSION: DSV of PTC has high risk characteristics of large tumor size, extrathyroidal extension, and multiple lymph nodes metastasis. We may expect comparable outcome with classical PTC by proper surgical treatment and postoperative radioactiveiodine ablation.

A Case of Lead Poisoning due to a Mixture of Talisman Ash

BACKGROUND: Lead is a metal that has no biological function useful for the human body. In Korea, non-occupational exposure to lead has mostly occurred through taking oriental medicine. However, in this paper we report a case of lead poisoning caused by ingesting talisman material. CASE PRESENTATION: A 16-year-old male patient complained of severe abdominal pain after taking cinnabar, a talisman material. He was diagnosed with lead poisoning accompanied by acute hepatitis. We confirmed that the cinnabar the patient took contained about 10% elemental lead. After symptom management, the patients' symptoms, liver function test results, and blood lead concentration level improved. CONCLUSION: Lead poisoning can be accompanied by hepatitis, although rarely. As we have confirmed that cinnabar as a talisman material is harmful to the human body, measures to prevent its misuse are needed.

Immunogenicity and Protective Effectiveness of Japanese Encephalitis Vaccine: A Prospective Multicenter Cohort Study / 소아감염

PURPOSE: This study aimed to study the antibody response of Japanese encephalitis vaccination in children using different kinds of vaccines (inactivated vaccine, live attenuated vaccine or interchanged) and evaluate the effectiveness of the vaccines to provide the basis of efficient immunization schedule of Japanese encephalitis. METHODS: Measurement of the neutralization antibody (NTAb) titers following Japanese encephalitis vaccination using different vaccines for 170 children, 2-6 year of age, who visited six university hospitals and are confirmed by immunization records. RESULTS: Among 170 children who were given primary immunization on Japanese encephalitis, 103 children were given inactivated vaccine, 64 children were given live attenuated vaccine and 3 children were given interchangeably. NTAb titers were more than 1:10 in all children of three groups. The geographic mean antibody titer was 322 in inactivated vaccine group and 266 in live attenuated vaccine group. However, there was no significant difference between two groups. In both groups, the NTAb titer showed the peak at 1-4 months after the third immunization and declined. The NTAb titers of three children who were given two kinds of vaccines alternately were 1:135, 1:632, and 1:2511, respectively. CONCLUSION: According to the results of this study in children younger than 6 years old, there is no significant difference in effectiveness between inactivated and live attenuated vaccines. However, further studies for the changes of antibody titers for a longer period of time on larger population are required.

A Case of Choroidal Metastasis from Renal Cell Carcinoma

PURPOSE: To report a rare case of choroidal metastasis from renal cell carcinoma. CASE SUMMARY: A 61-year-old man visited our clinic with the chief complaint of decreased vision in the right eye. Three years earlier, he underwent right nephrectomy due to renal cell carcinoma. Best corrected visual acuity was 0.2 in the right eye and 1.0 in the left eye. Fundoscopic examination of the right eye revealed a yellowish, dome-shaped elevated choroidal mass with serous retinal detachment, measuring 5.0 x 4.0 disc diameter and located lateral to the macular area. Systemic evaluations showed multiple lung and brain metastases. A diagnosis of choroidal metastasis from renal cell carcinoma was made for the right eye, and the patient received local treatments with oral sorafenib therapy, composed of subtenon triamcinolone injection and intravitreal ranibizumab injection. Tumor progression continued, and visual acuity declined to hand motion. Enucleation was recommended, but the patient refused and is on a regular follow-up after transpupillary thermotherapy. CONCLUSIONS: Ocular manifestation may be the initial presenting sign of a recurrent tumor, and an extensive systemic evaluation for metastatic malignancy should be performed. The present example showed a rare case of choroidal metastasis from renal cell carcinoma.

Treatment of Compressive Optic Neuropathy by Recurred Maxillary Cancer Using Stereotactic Radiosurgery: A Case Report

PURPOSE: To report a case of a female patient treated with stereotactic radiosurgery for compressive optic neuropathy by recurred maxillary cancer. CASE SUMMARY: A 51-year-old woman with a history of maxillary cancer presented with decreased visual acuity and visual field and color vision defects in the right eye. The CT scan revealed a wide spread mass along the ethmoid sinus, orbit, optic canal, and skull base. Under the impression of compressive optic neuropathy, stereotactic radiosurgery was performed. A cumulative dose of 39 Gy in 3 daily fractions of 13 Gy was administered to the mass. After 10 days, visual acuity, color vision, and visual field improved and were maintained after a 2 month follow-up. CONCLUSIONS: Stereotactic radiosurgery could be another treatment option for patients with compressive optic neuropathy caused by a malignant tumor.