Is increased Mean platelet volume associated with neurologic outcome after non-traumatic subarachnoid hemorrhage?

Objective@#This study evaluated the clinical usefulness of mean platelet volume (MPV) for predicting functional outcomes in subarachnoid hemorrhage (SAH) patients. @*Methods@#This is a retrospective analysis of patients who were diagnosed with SAH in the emergency room. Based on their modified Rankin Scale (mRS) score, patients were divided into two groups: 0-2 (good outcome) and 3-6 (poor outcome). Univariable and multivariable analyses were performed to investigate whether MPV, along with other multiple factors, was associated with poor prognosis. Receiver operating characteristic (ROC) curve analysis was performed to determine the value of MPV as a predicting factor of neurological prognosis. Compared to other factors, Hunt Hess grade (HHG) and modified Fisher grade (mFG) considerably influenced the outcomes in both groups (Model 1; model including all factors). Hence, a new model (Model 2) was constructed, comprising multiple factors excluding these two factors. @*Results@#A total of 143 patients were included in this study. Although MPV was different between the two groups, it was not a significant factor in Model 1 in the multivariable analysis. In Model 2, MPV (odds ration [OR], 1.71; 95% confidence interval [CI], 1.05-2.8), age (OR, 1.06; 95% CI, 1.03-1.1), and surgical treatment (OR, 0.37; 95% CI, 0.15-0.87) were significant factors related to poor outcomes. Area under the curve (AUC) of Model 1 was 0.93, 0.85 in HHG; 0.78 in Model 2, 0.65 in mFG, and 0.62 in MPV. @*Conclusion@#Although MPV differed significantly between the good and poor outcome groups, it is insufficient to predict poor outcomes in SAH patients as an independent biomarker.

Selective Laser Trabeculoplasty for Medically Uncontrolled Pseudoexfoliation Glaucoma in Korean Patients

Purpose@#This study investigated the efficacy and safety of selective laser trabeculoplasty (SLT) in Korean patients with medically uncontrolled pseudoexfoliation glaucoma (PEXG). @*Methods@#This retrospective observational study enrolled 43 medically uncontrolled PEXG patients who underwent a 360° SLT and were followed up for at least 12 months after SLT. The intraocular pressure (IOP) before and after SLT at 1 week, 1, 3, 6, and 12 months was evaluated. Treatment success was defined as an IOP reduction of ≥20% from the baseline and an IOP equal to lower than 22 mmHg without additional anti-glaucomatous intervention. Additionally, every follow-up medical record was reviewed to assess any possible side effects of SLT. @*Results@#Based on the Kaplan-Meier survival analysis, the treatment success rate at 12 months after SLT was 41.9% (18 eyes). For the success group at the 12 months follow-up, SLT showed a mean IOP reduction of 10.3 ± 5.0 mmHg (from 25.6 ± 4.4 to 15.2 ± 2.9 mmHg; 39.3%, p < 0.05). Among the 25 eyes that were considered as the treatment failure group, 14 eyes underwent glaucoma filtering surgeries, four eyes received additional SLT, and further intervention and follow-up was refused for seven eyes. During the overall follow-up period, there were no significant adverse events. @*Conclusions@#SLT is a partially effective and safe procedure for lowering IOP in Korean patients with medically refractory PEXG. Therefore, it can be considered as one of the alternative treatment modalities in patients who are at high risk for conventional filtering surgery.

The Gut Microbiome: Human Health and Inflammatory Skin Diseases

The human microbiome is a rich environment consisting ofbacteria, fungi and other commensal microorganisms of thegut, mucosa and skin. The functional role of the gut microbiomeincludes facilitation in metabolism of macronutrients,maturation of the immune system, and production of pro- oranti-inflammatory signaling molecules and peptides. Theidentification of these resident organisms has brought abouta new understanding of disease processes. Nevertheless,more questions remain regarding the interactions within themicrobiome, its interactions with the host, and its contributionsto the pathophysiology of disease. The purpose of thisreview is to examine the existing medical literature to highlightthe role of the gut microbiome in human health, alsopaying attention to its role in several inflammatory skin diseases,namely atopic dermatitis, psoriasis, and rosacea.

Usefulness of Neurtiophil Gelatinase-Associated Lipocalin as a Prognosis Predictor in Heart Failure Patients in Emergency Department

PURPOSE: We aimed to investigate the clinical use of plasma neutrophil gelatinase-associated lipocalin (NGAL) in the emergency department (ED), especially for predicting the prognosis of heart failure. METHODS: In a retrospective study, patient selection was based on those who visited the ED between January 2015 and September 2015 and were diagnosed with heart failure and underwent laboratory tests, including B-type natriuretic peptide (BNP) and NGAL. They were divided in two groups, according to the presence or absence of the following events: one or more intubations, admission of intensive care unit (ICU), coronary angiography, renal replacement therapy, extracorporeal membrane oxygenation, intra-aortic balloon pumping, cardiopulmonary resuscitation (CPR), or death. RESULTS: We studied 63 patients with heart failure. The absence group consisted of 29 subjects, and the presence group consisted of 34 subjects. Patients who were younger, had a history of diabetes mellitus, had high level of serum creatinine, low estimated glomerular filtration (eGFR), high creatine kinase (CK) or high NGAL were associated with higher incidence of events and were statistically significant (p<0.001, 0.02, 0.005, 0.035, 0.03, 0.003). In the case of BNP, the presence group showed a higher value compared with the absence group, but was not statistically significant. In a multivariated logistic regression, age (OR=0.868, 95% confidence interval 0.788-0.956, p=0.004) and NGAL (OR=1.004, 95%CI 1.001-1.007, p=0.021) were considered as meaningful factors for predicting the event. CONCLUSION: NGAL elevation in this study showed to be a meaningful factor, indicating a prognosis to those patients who visited the ED and were diagnosed as heart failure.

Pigment Dispersion Syndrome and Reverse Pupillary Block after Implantable Collamer Lens with Central Hole Implantation

PURPOSE: To report a case of pigment dispersion syndrome and reverse pupillary block secondary to the implantation of implantable collamer lens (ICL) with a central hole (AQUA ICL®) that was treated with ICL removal and laser peripheral iridotomy (LPI). CASE SUMMARY: A 29-year-old woman with myopia in both eyes underwent implantation of AQUA ICL®. Four weeks postoperatively, the intraocular pressure (IOP) increased to 34 mm Hg and the patient showed pigment dispersion syndrome in both eyes. Since the IOP did not reduce with the maximum tolerable medical therapy, the ICLs were removed 8 weeks after implantation. The pigment dispersion subsided and IOP reduced shortly after ICL removal. However, 4 weeks after removal of ICL, posterior iris bowing and reverse pupillary block occurred in the right eye and the IOP increased to 46 mm Hg. LPI was performed in the right eye, and the reverse pupillary block was dissolved after a reduction in pigment dispersion. The IOP subsequently normalized to 13 mm Hg. Two weeks later, prophylactic LPI was performed in the left eye. Four weeks after prophylactic LPI, selective laser trabeculoplasty was performed on both eyes. As a result, the IOP was 11 mm Hg in the right eye and 12 mm Hg in the left eye after 4 weeks of treatment with topical IOP-lowering medications. CONCLUSIONS: The present case indicates that implantation of ICL with a central hole can lead to early postoperative pigment dispersion syndrome. When this condition persists and is accompanied by reverse pupillary block after ICL removal, LPI can be partially effective.

Simplified Correction of Ischemic Index in Diabetic Retinopathy Evaluated by Ultra-widefield Fluorescein Angiography

PURPOSE: To develop a novel, simplified method for correcting the ischemic index of nonperfused areas in diabetic retinopathy (DR). METHODS: We performed a retrospective review of 103 eyes with naive DR that underwent ultra-widefield angiography (UWFA) over a year. UWFAs were graded according to the quantity of retinal non-perfusion, and uncorrected ischemic index (UII) and corrected ischemic index (CII) were calculated using a simplified, novel method. RESULTS: The average differences between UII and CII in the non-proliferative DR group and the proliferative DR group were 0.7 +/- 0.9% in the 50% CII group, respectively. A CII >25% was critical for determining DR progression (p < 0.001). CONCLUSIONS: Distortion created by UWFA needs to be corrected because the difference between UII and CII in DR increases with the ischemic index.

Simplified Correction of Ischemic Index in Diabetic Retinopathy Evaluated by Ultra-widefield Fluorescein Angiography

PURPOSE: To develop a novel, simplified method for correcting the ischemic index of nonperfused areas in diabetic retinopathy (DR). METHODS: We performed a retrospective review of 103 eyes with naive DR that underwent ultra-widefield angiography (UWFA) over a year. UWFAs were graded according to the quantity of retinal non-perfusion, and uncorrected ischemic index (UII) and corrected ischemic index (CII) were calculated using a simplified, novel method. RESULTS: The average differences between UII and CII in the non-proliferative DR group and the proliferative DR group were 0.7 +/- 0.9% in the 50% CII group, respectively. A CII >25% was critical for determining DR progression (p < 0.001). CONCLUSIONS: Distortion created by UWFA needs to be corrected because the difference between UII and CII in DR increases with the ischemic index.

A Case of Malignant Glaucoma in a Vitrectomized Eye

PURPOSE: To report a case of malignant glaucoma in an eye vitrectomized 5 years previously due to endophthalmitis. CASE SUMMARY: A 55-year-old male visited clinic due to a painful right eye 2 days in duration. Five years ago, he suffered endophthalmitis in his right eye and underwent pars plana vitrectomy. On slit-lamp examination, shallow anterior chamber depth of 2 central corneal thickness and corneal edema were observed along with remnant cortical lens material behind the intraocular lens. Intraocular pressure was 68 mm Hg measured using applanation tonometry. Maximal medical treatment failed to lower the intraocular pressure on the first day of visit. The very next day, anterior chamber became shallower less than 0.5 central corneal thickness and intraocular pressure was 70 mm Hg. Posterior capsular syndrome was suspected on anterior optical coherence tomography and neodymium:yttrium-aluminum-garnet laser posterior capsulotomy was performed, however, normal anterior chamber could not be restored. Despite continuous medical therapy for 3 weeks, the patient's symptoms worsened and intraocular pressure increased over 99 mm Hg and therefore, the Ahmed glaucoma valve was implanted. One day after the operation, intraocular pressure decreased to 10 mm Hg and anterior chamber depth became deeper with the depth of over 5 central corneal thickness. At the final visit 4 months postoperatively, intraocular pressure and normal anatomy of the anterior segment were well maintained. CONCLUSIONS: Malignant glaucoma syndrome can occur even in vitrectomized eyes and capsular block syndrome can initiate this. Malignant glaucoma syndrome in a vitrectomized eye resistant to maximal medical treatment can be treated with Ahmed valve implantation.

Traumatic Rupture of the Superior Oblique Muscle Tendon

Traumatic rupture of the superior oblique muscle is rare. We report a case of a 54-year-old man injured by the metal hook of a hanger, resulting in a rupture of the superior oblique muscle tendon. He complained of torsional diplopia when in the primary position. The distal margin of the superior oblique muscle was reattached to sclera 5 and 9 mm apart from the medial insertion of the superior rectus muscle. One week after the operation, torsional diplopia disappeared. However, a 4-prism diopter ipsilateral hypertropia was observed. Three months later, hypertropia gradually increased to 20 prism dioptors and the second operation was done to correct vertical diplopia.

Risk Factors for Neovascular Glaucoma after Vitrectomy in Patients with Proliferative Diabetic Retinopathy

PURPOSE: The use of pre- and intraoperative vitreous bevacizumab injection and combined lens extraction with vitrectomy in patients with proliferative diabetic retinopathy (PDR) is increasing. In this study we analyzed the incidence and risk factors of neovascular glaucoma (NVG) after vitrectomy for PDR. METHODS: Patients who underwent vitrectomy for PDR from January 2004 to June 2011 were retrospectively reviewed. The minimum follow-up was 12 months. The cumulative incidence of NVG was calculated using the Kaplan-Meier survival analysis. The patients were divided into 4 groups according to lens status (preoperative pseudophakic group, simultaneous cataract surgery group, sequential cataract surgery group, non-cataract surgery group). The differences in incidence between the groups were determined by the Chi-square test. Finally, to analyze the risk factors associated with the occurrence of NVG, the Cox's regression model was used. RESULTS: Of the 614 eyes (402 patients), 284 were males and 330 were females. The mean age was 55.8 +/- 10.46 years (range 30-81 years) and the mean follow-up period was 36.6 months (range 1-93 months). Thirty-four of 614 patients (5.5%) developed postoperative NVG after vitrectomy. The probability of NVG occurrence at 6 and 12 months after vitrectomy was 0.7% and 2.5%, respectively. The incidence between the 4 groups did not show a statistically significant difference. The risk factors for postoperative NVG were male gender (RR = 3.01 p = 0.004), preoperative intravitreal bevacizumab injection (RR = 7.20, p < 0.001), and reoperation (RR = 3.18, p = 0.0037). CONCLUSIONS: The frequency of NVG after vitrectomy in patients with PDR was 5.5%. Lens status was not associated with NVG occurrence. The risk factors related to NVG were male gender, preoperative intravitreal bevacizumab injection, and reoperation.

Comparison of Clinical Results Between OZil(R) Mode and Hyperpulse Mode in Phacoemulsification

PURPOSE: To compare the intraoperative and short term postoperative outcomes of cataract surgery performed with custom pulse mode of OZil(R) and hyperpulse mode of conventional phacoemulsification METHODS: The patients underwent cataract surgery using the OZil(R) custom pulse mode phacoemulsification (Group 1, n=30) or the conventional phaco Hyperpulse mode one (Group 2, n=36) of Infiniti Vision System. Mean ultrasound time, CDE (Cumulated dissipated energy) and total BSS volume were measured during operation. Best corrected visual acuity, central corneal thickness and endothelial cell counts were checked on 1 day, 1 momth, 2 months after surgery. RESULTS: CDE was decreased significantly in group 1 (p0.05). At 2 months, the endothelial thickness was 552.94+/-27.95 micrometer in group 1, and 568.00+/-31.22 micrometer in group 2 and the endothelial cell counts was 2683.0+/-235.6 cell/mm2 and 2694.2+/-407.9 cell/mm2, respectatively. There were no significant differences in two groups. CONCLUSIONS: The OZil(R) custom pulse mode phacoemulsification is an effective procedure in cataract surgery as much as the conventional hyperpulse mode phacoemulsification.

Consecutive Exotropia After Bilateral Medial Rectus Recession for Infantile Esotropia

PURPOSE: To evaluate associated factors by comparing the patients with consecutive exotropia to the patients with orthophoria after undergoing surgery for infantile esotropia. METHODS: The study consisted of 50 patients who underwent bilateral medial rectus recession and attended follow-ups until eight years of age. The authors retrospectively investigated the clinical characteristics ofage at operation, duration between diagnosis and operation, the spherical equivalent of both eyes, the deviated angle at the first visit and immediately before the operation, the recession amount, and the total follow-up period. RESULTS: During the mean follow-up period of 78.51+/-54.70 months, 13 patients (26%) had consecutive exotropia, 27 patients (54%) had orthophoria and 10 patients (20%) had remnant esotropia. As the result of comparing orthophoric patients to consecutive exotropic patients, there were no significant differences in the birth weights, the deviated angles at the first visit and immediately before the operation, the spherical equivalents of both eyes, the ages at operation, the recession amounts, and the durations between diagnosis and operation. However, in consecutive exotropia, inferior oblique muscle overaction was 46.5%, dissociated vertical deviation was 46.5% in orthophoric patients, inferior oblique muscle overaction was 19.24%, and dissociated vertical deviation was 8.7%. CONCLUSIONS: A thorough follow-up is necessary when inferior oblique muscle overaction and dissociated vertical deviation occur after undergoing a bilateral medial rectus operation.

A Case of Bart's Syndrome / 대한피부과학회지

Aplasia cutis congenita is a rare congenital skin defect that presents with sharply outlined ulcerations. The most common site of this disease is the scalp, yet when other areas of the body are involved, there is higher incidence of concomitant congenital diseases or malformations. Bart's syndrome is a rare inherited condition with congenital skin defects that are associated with epidermolysis bullosa. An infant presented with congenital skin defects on the leg, and the infant had recurrent bullous skin lesions on the both hands, feet, wrists and ankles. The skin defect caused only small scar formation and no handicap regarding function and appearance, yet continuously new bullous lesion developed and healed on the both distal extremities. He was diagnosed as suffering with epidermolysis bullosa with the histological findings of epidermal cleavage and negative direct immunofluorescence findings. Herein, we report on a case of Bart's syndrome that displayed aplasia cutis congenita over the lower extremities and skin blistering.

A Case of Precursor B-cell Lymphoblastic Lymphoma Misdiagnosed as Rosacea / 대한피부과학회지

Precursor B-cell lymphoblastic lymphoma is a rare type of non-Hodgkin's lymphoma seen exclusively in children and young adults. The neoplasm is rare in old age. We report a case of a 58-year-old male, who presented with variable-sized, erythematous to brownish papules and plaques on the scalp and face. There were no other symptoms. Pathological examination showed non-specific, sparse superficial and deep perivascular lymphocyte infiltration. We diagnosed the condition as rosacea and prescribed 100 mg of minocycline per day for 10 days. When he was seen 10 days later, his skin lesions were aggravated and re-biopsy was completed. Histopathology revealed diffuse infiltrates of small to medium-sized lymphoid cells with blastic nuclear chromatin and a high mitotic rate. Immunohistochemical study showed that infiltrated lymphoid cells were precursor B-cell type. Physical examination and staging work-up revealed extensive involvement of lymphoma in bilateral kidney, heart, pancreas, axial and proximal appendicular bones, scalp and cervical lymph node. The patient is being treated with combination chemotherapy.

A Case of Fibrous Hamartoma of Infancy in an Adult / 대한피부과학회지

Very rare and unique tumors of infants, fibrous hamartomas were first described by Reye in 1956 as a subdermal fibromatous tumor of infancy. The tumors can occur at birth and are usually diagnosed within the first 2 years of life. The oldest patient reported in the literature was an 11-year-old child. The common sites of involvement are the axillae, upper arms, and upper trunk. Although the lesion is not distinctive clinically, it has a characteristic microscopic appearance of fibrous tissue forming trabeculae, small, round cells that represent primitive mesenchyme, and mature adipose tissue. Herein, we report a case of fibrous hamartoma of infancy in a 26-year-old man, on the uncommon site of a lower extremity.

Solitary Kaposi's Sarcoma of the Lower Lid in an HIV-Negative Patient

PURPOSE: To report a case of solitary Kaposi's sarcoma (KS) of eyelid in an HIV-negative patient, which has not yet been reported in domestics. CASE SUMMARY: A 76-year-old woman was seen at our clinic with a purplish nodular mass on her left lower lid that had grown up for 4 months prior. There were no abnormal findings in the body except eyelid. In the routine laboratory examinations, the result of HIV test was negative. The lesion was completely excised and the eyelid was reconstructed by semicircular rotational flap procedure. The histopathologic examination showed spindle cells of mild atypism, intermixed with slit-like vascular spaces and red blood cell extravastaion. These findings coincided with KS and polymerase chain reaction was positive for human herpes virus-8. During 10 months follow up, there was no evidence of tumor recurrence and systemic abnormalities. CONCLUSIONS: We experienced that Kaposi's sarcoma can occur solitarily in the eyelid of HIV-negative patient and favorable prognosis can be obtained by only surgical resection.

Radiation Recall Dermatitis Induced by Methotrexate / 대한피부과학회지

Radiation recall dermatitis is the development of an inflammatory reaction in the previously irradiated area, precipitated by the administration of certain drugs. A 54-year-old man was diagnosed with follicular lymphoma, grade 3 and stage 3. Cancer recurred two years after complete remission obtained by chemotherapy and radiotherapy. Therefore, he was again treated with fludarabine and mitoxantrone for five cycles, then underwent an allogeneic peripheral blood stem cell transplantation (PBSCT). The patient started to receive methotrexate the day after PBSCT. On the day of the first methotrexate administration, the patient developed erythematous erosions with pruritus and severe pain in the previously irradiated area. The skin lesion resolved almost completely after dressing with topical antibiotics and wet dressing with 0.3% aluminium solution for 2 weeks. We report a case of radiation recall dermatitis in a patient with follicular lymphoma that occurred after receiving methotrexate.

A Case of Idiopathic Neutrophilic Eccrine Hidradenitis / 대한피부과학회지

Neutrophilic eccrine hidradenitis (NEH) is a rare neutrophilic dermatosis which clinically presents with various cutaneous manifestations with or without tenderness and pruritus. NEH has a characteristic histologic pattern, with necrosis of the eccrine glands and local neutrophilic infiltrations. It occurs mostly in patients receiving chemotherapy for acute myeloblastic leukemia or, less frequently, other malignancies. More recently, NEH has been observed in other conditions, such as infections, drugs or even in generally healthy individuals. We report a case of a 29- year-old female with no remarkable medical history who has suffered from a solitary skin-colored indurated macule with tenderness on the left sole for 2 weeks. The skin biopsy showed typical features of neutrophilic eccrine hidradenitis. The patient was successfully treated with oral prednisolone for 2 weeks and an intralesional injection of triamcinolone.

Multiple Eruptive Dermatofibromas in a Patient with Systemic Lupus Erythematosus and Juvenile Rheumatoid Arthritis / 대한피부과학회지

Solitary dermatofibroma shows a common occurrence, especially on the lower limbs of young women, while multiple eruptive dermatofibromas are rare and are thought to be associated with altered immunity, such as autoimmune diseases and immunosuppression. We report a patient with systemic lupus erythematosus (SLE) and juvenile rheumatoid arthritis (JRA) who developed multiple, eruptive dermatofibromas while she was being treated with systemic corticosteroid. We also review literature on the previously reported cases of multiple eruptive dermatofibromas associated with SLE.

Two Cases of Dermatofibroma with Sclerotic Fibroma-like Change / 대한피부과학회지

Sclerotic fibroma is often regarded as a unique proliferating lesion, but some authors regard it as an end stage of other neoplasms, especially dermatofibroma. We report two cases of dermatofibroma with sclerotic fibroma-like change. The skin biopsy specimens from different patients showed a common finding of dermatofibroma, while some portions of the tumor were replaced by thick, hyalinized, eosinophilic collagen bundles and empty clefts with low cellularity, which was histologically similar to sclerotic fibroma. According to these findings, dermatofibroma with sclerotic fibroma-like change can be evidence of the possible pathogenesis of sclerotic fibroma.