A Report of Two Case of Ocular Toxicity Resulting from Direct or Indirect Bee Venom

PURPOSE: To report a patient stung by a bee, who was diagnosed with sterile endopthalmitis and another patient diagnosed with optic neuritis, with decreasing visual acuity, after refined bee venom injection around the orbital tissue. CASE SUMMARY: A 82-year-old female visited our hospital for decreased visual acuity in the right eye and ocular pain due to a bee sting. The bee sting penetrated the sclera into the vitreous. In the anterior segment, severe cornea edema and anterior chamber cells were seen. Using ultrasonography, inflammation was seen around the intravitreal area. After 3 months, intravitreal inflammation regressed but the patient's visual acuity was light perception negative, and corneal opacity, neovascularization, and phthisis bulbi were detected. A 55-year-old male visited our hospital for ocular pain in the right eye and decreasing visual acuity after refined bee venom injection around the orbital tissue. The best-corrected visual acuity in the right eye was 15/100, there was moderate injection on the conjunctiva. A relative afferent pupillary defect, abnormal color vision test results, and a defect in the visual field test were observed. There was no pain during external ocular movement, and other general blood tests, and a brain MRI were normal. Based on these symptoms, methylprednisolone megatherapy was started for treatment of optic neuritis. After treatment, visual acuity of the right eye was 9/10 and all other clinical optic neuritis symptoms regressed. CONCLUSIONS: Based on these two cases, ocular toxicity from bee venom could result from both direct and indirect courses. Treatment using refined bee venom might be harmful, and caution is recommended in its use.

Two Cases of Methemoglobinemia Induced by the Exposure to Nitrobenzene and Aniline

OBJECTIVE: To report two cases of methemoglobinemia induced by inhaled nitrobenzene and dermally absorbed aniline. METHODS: We have evaluated a 37-year-old male worker exposed to nitrobenzene by inhalation while conducting maintenance job of mononitrobenzene pump and a 25-year-old male worker exposed dermally to aniline while unloading. RESULTS: The first case is a 37-year-old male exposed to nitrobenzene. His blood methemoglobin concentration level was initially 19.8%, and chest X-ray was normal. After oxygen therapy, the blood methemoglobin concentration level decreased to 2.1%, and the symptoms were alleviated. The second case is a 25-year-old male exposed dermally to aniline. His chest X-ray was normal, but blood methemoglobin concentration level reached maximally 46.8%. He was treated with methylene blue due to relatively high blood methemoglobin level. Gradually after the treatment, his methemoglobin concentration level was normalized to 0.8% and simultaneously symptoms were resolved. CONCLUSIONS: After the thorough exposure investigations and medical evaluations, we have concluded that these cases were methemoglobinemia induced by occupational exposure to nitrobenzene and aniline. We suggest that businesses which handle methemoglobinemia-causing substances control the engineering process strictly, implement periodic screening, and establish emergency patient management system.

A Suspicious Case of Chloroform Induced Acute Toxic Hepatitis in Laboratory Worker / 대한산업의학회지

OBJECTIVES: To report upon a case of toxic hepatitis in a worker exposed to chloroform. METHODS: A 28-year-old female who had worked as chemical analysis engineer in a laboratory using chloroform was hospitalized due to nausea, vomiting and generalized weakness. The authors evaluated her using blood tests, abdominal CT scan and her occupational history. RESULTS: The blood tests revealed acute toxic hepatitis. Other causes of hepatitis such as viral, drug induced or alcoholic hepatitis could be excluded. But autoimmune hepatitis couldn't be totally ruled out(ANA (++), IgG(serum) 1780 mg/dL). After admission, her symptoms improved and her liver enzyme levels(AST and ALT) were markedly reduced. She returned to her workplace after discharge. Afterwards, however, her liver enzyme levels increased again one week after returning to her workplace. Subsequent to a job change, her liver enzyme levels reduced and normalized after eight weeks. The airbone laboratory chloroform ranged from 3.155 to 9.037 ppm. CONCLUSIONS: The authors presume that this patient's liver injury was related to an interaction of chloroform toxicity and a predisposition to autoimmune hepatitis. The rapid improvement of the clinical symptoms and the progressive normalization of the liver function tests once the chloroform exposure eliminated supports the diagnosis.

Evaluation of Glaucomatous Damage in the Fellow Eyes of Patients With Unilateral Retinal Vein Occlusion

PURPOSE: To investigate the visual field (VF) and retinal nerve fiber layer (RNFL) status of the fellow eyes in patients with unilateral retinal vein occlusion (RVO). METHODS: Fifty patients with unilateral RVO and 35 normal control subjects wereconsecutively recruited. Humphrey VF parameters and RNFL status using scanning laser polarimetry with variable corneal compensation (GDx-VCC) were compared between the fellow eyes of the patients with unilateral RVO and control eyes. We also assessed the risk factors for the development of glaucomatous damage in the fellow eyes of unilateral RVO patients. RESULTS: Twelve fellow eyes out of 50 patients with unilateral RVO showed glaucomatous VF and RNFL changes assessed by GDx-VCC. VF indices and RNFL thickness parameters in the study group were significantly lower than those in the control group (p<0.05). Increased age and vertical cup-to-disc ratio were significantly associated with severity of VF and RNFL damage in the fellow eye of unilateral RVO patients (p<0.05). CONCLUSIONS: The fellow eyes in patients with unilateral RVO showed significantly worse VF indices and lower RNFL thickness than normal control eyes. The glaucomatous change should be carefully monitored in the fellow eyes of unilateral RVO patients.

Comparison Between Dynamic Contour Tonometry and Goldmann Applanation Tonometry

PURPOSE: To compare the intraocular pressures (IOPs) measured by dynamic contour tonometry (DCT) and Goldmann applanation tonometry (GAT), and to investigate the association of IOPs on eyes of varying central corneal thickness (CCT). METHODS: In this prospective study, 451 eyes of 233 subjects were enrolled. IOPs were measured by GAT and DCT. CCT was measured three times and the average was calculated. Each eye was classified into one of three groups according to CCT: low CCT (group A, CCT550 micrometer, n=142). In each group, we investigated the association of CCT with IOP measurement by GAT and DCT. RESULTS: The IOPs measured by GAT and DCT were significantly associated for all eyes (R=0.853, p<0.001, Pearson correlation). CCT was related with both IOP measurement by GAT and DCT with statistical significance (mixed effect model, p<0.001). However, subgroup analysis showed that CCT affected IOP measured by GAT for groups B and C, whereas it affected IOP measured by DCT only for group C. CONCLUSIONS: IOP measured by DCT was not affected by CCT in eyes with low to normal CCT, whereas this measurement was affected in eyes of high CCT range. CCT may have less effect on IOP measurements using DCT than those obtained by GAT, within a specified range of CCT.

The Relationship Between Parameters Measured by Optical Coherence Tomography and Visual Field Indices

PURPOSE: To evaluate the diagnostic ability of optic disc topographic parameters and the retinal nerve fiber layer (RNFL) thickness parameter measured by optical coherence tomography (OCT) and to determine the association of these structural parameters with visual field indices. METHODS: Fifty-six glaucomatous eyes and 65 healthy control eyes were enrolled in this retrospective cross-sectional study. Each subject had a 24-2 full threshold test on a Humphrey visual field analyzer and an optical coherence tomographic evaluation. The parameters from the fast RNFL thickness algorithm and the fast optic disc algorithm were analyzed by an ROC curve, and we sought to determine the association of these parameters with visual field indices by linear and logarithmic regression. RESULTS: The area under the receiver operating characteristic curve (AUROC) value of the fast optic disc algorithm parameters ranged from 0.78 to 0.79 and that of the fast RNFL thickness algorithm parameters ranged from 0.74 to 0.81. The associations between the parameters from the fast optic disc algorithm and from the fast RNFL thickness algorithm with visual field indices were statistically significant (P<0.001). CONCLUSIONS: The fast optic disc algorithm and the fast RNFL algorithm revealed comparable diagnostic ability in discriminating glaucoma and significant associations with visual field indices.

Arthroscopic Management for Septic Arthritis of the Hip Joint in Adults: A Report of Four Cases / 대한정형외과학회잡지

Treatment of pyogenic arthritis in hip joints in adults usually required debridement through early arthrotomy. However, domestically arthroscopic management is not widely performed. Recent development of operation techniques and equipments helped to improve the value of arthroscopic approach and its diagnostic value and therapeutic usefulness. We report the clinical results from the 4 cases of pyogenic arthitis of hip joint in adults treating with arthroscopic irrigation and debridement.

Relationship between Scanning Laser Polarimetry with Enhanced Corneal Compensation and with Variable Corneal Compensation

PURPOSE: To evaluate the structure-function relationships between retinal sensitivity measured by Humphrey visual field analyzer (HVFA) and the retinal nerve fiber layer (RNFL) thickness measured by scanning laser polarimetry (SLP) with variable corneal compensation (VCC) and enhanced corneal compensation (ECC) in glaucomatous and healthy eyes. METHODS: Fifty-three eyes with an atypical birefringence pattern (ABP) based on SLP-VCC (28 glaucomatous eyes and 25 normal healthy eyes) were enrolled in this cross-sectional study. RNFL thickness was measured by both VCC and ECC techniques, and the visual field was examined by HVFA with 24-2 full-threshold program. The relationships between RNFL measurements in superior and inferior sectors and corresponding retinal mean sensitivity were sought globally and regionally with linear regression analysis in each group. Coefficients of the determination were calculated and compared between VCC and ECC techniques. RESULTS: In eyes with ABP, R2 values for the association between SLP parameters and retinal sensitivity were 0.06-0.16 with VCC, whereas they were 0.21-0.48 with ECC. The association of RNFL thickness with retinal sensitivity was significantly better with ECC than with VCC in 5 out of 8 regression models between SLP parameters and HVF parameters (P<0.05). CONCLUSIONS: The strength of the structure-function association was higher with ECC than with VCC in eyes with ABP, which suggests that the ECC algorithm is a better approach for evaluating the structure-function relationship in eyes with ABP.

Effect of irradiation on the Porphyromonas gingivalis / 대한구강악안면방사선학회지

PURPOSE: The aim of this study was to observe a direct effect of irradiation on the periodontopathic Porphyromonas gingivalis (P. gingivalis). MATERIALS AND METHODS: P. gingivalis 2561 was exposed to irradiation with a single absorbed dose of 10, 20, 30, and 40 Gy. Changes in viability and antibiotic sensitivity, morphology, transcription, and protein profile of the bacteriumafter irradiation were examined by pour plating method, disc diffusion method, transmission electron microscopy, RT-PCR, and immunoblot, respectively. RESULTS: Viability of irradiated P. gingivalis drastically reduced as irradiation dose was increased. Irradiated P. gingivalis was found to have become more sensitive to antibiotics as radiation dose was increased. With observation under the transmission electron microscope, the number of morphologically abnormal cells was increased with increasing of irradiation dose. In RT-PCR, decrease in the expression of fimA and sod was observed in irradiated P. gingivalis. In immunoblot, change of profile in irradiated P. gingivalis was found in a number of proteins including 43-kDa fimbrillin. CONCLUSION: These results suggest that irradiation may affect the cell integrity of P. gingivalis, which is manifested by the change in cell morphology and antibiotic sensitivity, affecting viability of the bacterium.

Diagnostic Ability of Scanning Laser Polarimetry with Enhanced Corneal Compensation in the Eye with Typical and Atypical Retadation Pattern

PURPOSE: To investigate the relationship between the SLP-VCC parameters and the SLP-ECC parameters in the eyes with typical retardation pattern (TRP) and atypical retardation pattern (ARP), and the sensitivities and specificities of the SLP-VCC parameters and the SLP-ECC parameters in the eye with TRP and ARP. METHODS: In this prospective study, 72 eyes with TRP images (30 glaucomatous and 42 normal eyes) and 53 eyes with ARP images (28 glaucomatous and 25 normal eyes) were recruited. For each group, we analyzed relationship between each parameters of GDx-VCC and GDx-ECC and the diagnostic ability of GDx-ECC by using the ROC curve. RESULTS: In the eyes with TRP, TSNIT average was significantly lower by GDx-ECC than GDx-VCC in the control group. Inferior average was significantly higher by GDx-ECC than GDx-VCC in both glaucomatous and normal group. TSNIT standard deviation was significantly higher by GDx-ECC than GDx-VCC in both groups. NFI was significantly lower by GDx-ECC than GDx-VCC in both groups. TSS (typical scan score) was significantly higher by GDx-ECC than GDx-VCC in both groups. In the eyes with ARP, TSNIT average was significantly lower by GDx-ECC than GDx-VCC in both groups. Superior and Inferior average was not different between GDx-ECC and GDx-VCC. TSNIT standard deviation was significantly higher by GDx-ECC than GDx-VCC in both groups. NFI was not different between groups. TSS was significantly higher by GDx-ECC than GDx-VCC in both groups. Comparison of ROC curve for the SLP parameters revealed no difference between VCC and ECC. TSNIT standard deviation, however, showed relatively high value in GDx-ECC compared with GDx-VCC. CONCLUSIONS: GDx-ECC has comparable diagnostic ability in discriminating glaucomatous and normal eyes with GDx-VCC and TSNIT standard deviation by the GDx-ECC algorithm could be a useful parameter in discriminating glaucomatous and normal eyes.

A Case of Early Gastric Adenocarcinoma Mimiking a Submucosal Tumor / 대한소화기내시경학회지

Early gastric adenocarcinoma with the endoscopic features resembling a submucosal tumor is extremely rare and is characterized by erythema, central depression and erosion on the surface of the lesion, which can be distinguished from submucosal tumor. When a tumor is completely covered with normal mucosa, it is extremely difficult to obtain endoscopic biopsy specimens from the underlying lesion. EUS alone is not necessarily diagnostic. Various techniques have been advocated to overcome this problem, including US-guided biopsy, partial removal by an endoscopic snare excision, endoscopic mucosal resection as well as EUS with FNA. We encountered a case of an early gastric adenocarcinoma with well differentiation, presenting as a submucosal tumor. The early gastric adenocarcinoma was evaluated by endoscopy and EUS, and was confirmed by a surgical resection. We report this case with a review of the relevant literature.

Corneal Topographic Study Using Orbscan II between Keratoconus and Keratoconus Suspect

PURPOSE: To compare corneal topographic changes using Orbscn II between keratoconus and keratoconus- suspected eyes. METHODS: Thirty-seven keratoconus eyes, 17 keratoconus-suspected eyes and 37 normal eyes were evaluated by using Orbscan II corneal topography. We compared central phachymetry, anterior elevation from best-fit sphere (BFS), posterior elevation from BFS, most protruded corneal thickness, central corneal thickness, anterior chamber depth, corneal diameter, and pupil size. RESULTS: Central pachymetry, anterior and posterior elevation from BFS, central corneal thickness, and anterior chamber depth were statistically significantly different between keratoconus and control eyes. Anterior elevation from BFS showed a significant difference between keratoconus-suspected and control eyes. There were statistically significant differences in central pachymetry, posterior elevation from BFS, central corneal thickness and most protruded corneal thickness between keratoconus and keratoconus-suspected eyes. Corneal diameter and pupil size showed no differences among the 3 groups. CONCLUSIONS: Suspected keratoconus eyes have a higher value of anterior elevation from BFS on Orbscan II topography as compared with control eyes. Central pachymetry, posterior elevation from BFS, central corneal thickness and most protruded corneal thickness may be helpful in distinguishing between keratoconus and keratoconus-suspected eyes.

Analysis of familial tendency in skeletal class III malocclusion

The purpose of this study was to examine the familial tendency of the patients with mandibular prognathism in three generations and to define the relationship between the familial tendency and the skeletal class III morphology. The probands of this study were 103 orthognathic surgery patients with skeletal Class III malocclusions who had undergone (48 men, 55 women) mandibular set-back surgery. A questionnaire was given to patients who sought surgical treatment for excessive mandibular length, and all answers were confirmed in interviews. Lateral cephalograms were analyzed in cranial base parameters, mandibular positional parameters and mandibular skeletal parameters. In the examined families, 58.3% had at least one member other than the proband who had mandibular prognathism. The affected ratio of total relatives was 4.5%, and the value was higher in first-degree (13.4%) than second-degree (5.9%) and third-degree relatives (1.7%). The affected ratio was 51.9% in the offsprings who had at least one affected father or mother. The comparison of the groups according to the familial tendency showed no significant craniofacial skeletal measurments. In conclusion, skeletal class III malocclusion showed high familial tendency, suggesting a significant genetic influence in the etiology. However, the patient's familial tendency did not show the special craniofacial patterns compare to the subjects without familial tendency.

A Case of a Traumatic Eyeball Rupture in Terrien's Marginal Degeneration and It's Surgical Repair

PURPOSE: To report a primary surgical repair of a severe corneal laceration, a lens prolapse and a traumatic aniridia by blunt trauma in Terrien's marginal degeneration. METHODS: A 46-year-old female visited our hospital for corneal laceration due to a blunt trauma of the right eye. A primary corneal suture was done and 8 days later, amniotic membrane transplantation was performed. RESULTS: The perforated eyeball regained its integrity with a stabilized cornea. Also, the anterior chamber was reformed and visual acuity improved. CONCLUSIONS: In the first case of Terrien's marginal degeneration in the right eye, which had a 360-degree iridodialysis(aniridia) with aphakia due to blunt traumatic separation of the iris root from the ciliary body. We achived a good operative result with primary corneal suture and amniotic membrane transplantation.

Clinical Investigation of Therapeutic Effect and Extrusion Rate of Punctal Plug for Dry Eye Syndrome

PURPOSE: To investigte the extrusion rate of punctal plugs and to evaluate their long-term effectiveness related to punctal occlusion. METHODS: The subjects were 120 eyes of 60 patients with tear-deficient dry eye who underwent punctal occlusion using a silicone punctal plug from May 2003 to Jun 2004. They were followed up for 382.3+/-164.3 days. We studied the extrusion rate and the period of extrusion for each plug and examined the differences between the objective and subjective indicators of dry eye syndrome before and after plug insertion and between extruded and non-extruded punctal plugs. RESULTS: In this study, 25.8% of all plugs were extruded during the follow-up period. The majority of plugs (41.9%) were extruded within 100 days after plug insertion. As objective indicators, results of Schirmer test and BUT were significantly increased after plug insertion. As subjective indicators, the patients' clinical symptoms significantly improved. Patient use of artificial tear drops significantly decreased and was discontinued by 70.8% after plug insertion. There were however no significant differences between the extrusion group and the non-extrusion group in each case. CONCLUSIONS: Punctal plug occlusion therapy for tear-deficient dry eye is effective, but the extrusion rate is relatively high. Regardless of punctal plug extrusion, patients experienced a symptomatic improvement. Serious consideration of this fact may greatly aid in making therapeutic adaptations and maintaining a good relationship.

Arthroscopic Treatment of Osseous Abnormalities as a Cause of Femoroacetabular Impingement : Preliminary Clinical Results / 대한정형외과학회잡지

PURPOSE: To report the preliminary clinical results for arthroscopic treatment of osseous abnormalities as a cause of femoroacetabular impingement (FAI). MATERIALS AND METHODS: We evaluated 26 patients diagnosed with FAI who were treated by arthroscopic debridement of the labrum, spur resection, and bump resection from March 2004 to March 2005. Osseous abnormalities of FAI were evaluated for the presence or absence of asphericity, pistol grip deformity, coxa vara, coxa valga, retroversion of the acetabulum, and protrusion of acetabulum were present or not. We evaluated the clinical manifestations based on patient satisfaction, sequential JOA pain scores and ranges of motion of the hips. RESULTS: 24 patients were satisfied postoperatively. The average JOA pain score preoperatively and postoperatively at 2 weeks, 6 weeks, 3 months, and 6 months, were 0.85, 0.71, 1.50, 1.71, and 1.86, respectively. At 2 weeks preoperatively, the clinical symptoms were aggravated and 6 months postoperatively, the clinical symptoms were improved. 11 patients could not take a cross-legged position preoperatively: but 10 of the 11 patients could take a cross-legged position postoperatively. CONCLUSION: Preliminary clinical results for arthroscopic treatment of osseous abnormalities were satisfactory. We need to perform a follow-up study of the clinical results about the early detection of which findings and decompression of which osseous abnormalities will prevent or delay the progression of osteoarthritis through mid and long-term follow up.

Heterotrophic Ossification after Total Knee Arthroplasty: A Case Report / 대한정형외과학회잡지

Heterotrophic ossification (HO) is a reactive disease that is defined as the formation of mature lamellar bone in the soft tissue but it is rarely associated with loss of motion and stiffness. The reported incidence of HO after total knee arthroplasty (TKA) ranges from 1% to 42%. We experienced a case of HO adversely affecting the ambulation of the patient as a result of the severe ankylosis of the knee after TKA. We report this case with a review of the relevant literature.

Pigmented Villonodular Synovitis of the Ankle Joint / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical manifestations and results of treatment, we have analyzed five cases of Pigmented villonodular synovitis (PVNS) involving the ankle joint, a very rare disease in which the intraarticular joint has active inflammation with hypertrophy of the synovium. MATERIALS AND METHODS: From January 2002 to July 2004, five patients who presented with a mass in the ankle joint had histopathologically confirmed PVNS, retrospectively identified after surgery. Four male patients and one female patient were included in the study. All five patients had preoperative ankle joint swelling and a mass without a history of trauma; all had standard x-rays and three of the five patients had Magnetic resonance imaging (MRI). RESULTS: As a result of the testing there were two localized and three diffuse types identified. For one diffuse type, arthroscopy assisted intraarticular synovectomy was carried out before invasive synovectomy. Mass excision and broad synovectomy were carried out in all cases, and histological evaluations were performed after surgery. For two cases that had incomplete synovectomy, due to adhesions surrounding soft tissue and severe bony invasion, the surgical region was simultaneously treated with postoperative radiation therapy. After an average postoperative follow-up period of 13 months, the pain, swelling and edema resolved and there were no signs of recurrence. CONCLUSION: Mass excision and broad synovectomy provided both accurate diagnosis and successful treatment of PVNS of the ankle joint. In cases where incomplete synovectomy is performed due to anatomical difficulties or bony invasion, combination with postoperative radiation therapy may help reduce the recurrence rate.

Clinical Analysis of Recurrent Inguinal Hernias

PURPOSE: Recurrent inguinal hernia repairs provide a considerable technical challenge and greater risk of further recurrence. The purpose of this study was to establish a preventive method and management plan for recurrent inguinal hernia. METHODS: The medical records of adult having undergone an inguinal hernia operation at the Dankook university hospital, between June 1994 and December 2004, were analyzed. The patients' characteristics, types of hernia and operation methods were recorded. In the recurrent cases, the numbers and names of previous operation, types of recurrent hernia, and times to reoperation were analyzed. RESULTS: Of the 470 inguinal hernia cases, 35 were operated on for a recurrent hernia. With the recurrent hernias, the operation times were longer and the use of general anesthesia was more frequent. Of the recurrent hernia types, direct hernias were the most frequent. More than half the recurrent hernias were operated on 5 years after the primary hernia repairs. The recurrent hernia was treated with or without a mesh in 33 (94.3%) and 2 cases (5.7%), respectively. In the previous operations, mesh had or had not been used in 30 (85.7%) and 5 cases (14.3%), respectively. CONCLUSION: In the recurrent hernia group, the most frequent type of previous repair was an operation without a mesh. A direct hernia was the most frequent type of recurrence. The recurrent hernias were mostly repaired using a mesh.

Surgical Results of Zygomatico-Orbital Complex Fractures according to the 3-dimensional Classification

PURPOSE: To classify zygomatico-orbital fractures based on Zingg's classification and to evaluate the results of treatment. METHODS: Thirty patients who were diagnosed with zygomatico-orbital fracture between 2000 and 2004 were classified based on Zingg's classification, were treated and followed up for more than 3 months. Of the 30 patients, 28 received surgical treatment, including Gillies reduction or open reduction and rigid fixation with a microplate. RESULTS: The mean follow-up period was 6 months. Most of the patients were satisified with the results of surgery. There were no secondary operations due to facial asymmetry, secondary wound infection, microplate exposure or paresthesia. However, there were 3 re-operations for diplopia, enophthalmos, and lower eyelid retraction, respectively; the conditions had persisted until postoperative 2 weeks. CONCLUSIONS: The use of 3-dimensional Zingg's classification for zygomatico-orbital fractures appeared to be beneficial in making more accurate diagnoses and in determining surgical treatment. Oculoplastic approaches, including subciliary or transconjunctival incision, Gillies reduction and rigid fixation with a microplate, are considered to be good methods for the treatment of zygomatico-orbital fractures, as they are associated with exact anatomical and functional restoration and few complications.