Increased depression risk in patients with abdominal aortic aneurysm: a nationwide cohort study

Purpose@#Abdominal aortic aneurysm (AAA) is a critical disease. Most studies of AAA consider reoperation rate, complications, or mortality, but do not consider a patient’s mental state. However, there is a possibility of interaction between AAA and depression in disease development and prognosis. We investigated the incidence and risk ratio of depression in patients with AAA using nationwide data. @*Methods@#We selected subjects from National Health Insurance System database who were diagnosed with AAA between 2009 and 2015 and survived at least 1 year after diagnosis or AAA surgery (n = 10,373). We determined the control group using propensity score matching by age and sex. The control group had about 3 times the number of subjects as the AAA cohort (n = 31,119). @*Results@#The incidence of depression was 1.4 times higher in the AAA group than the control group. We further analyzed the incidence of depression in the AAA group according to treatment modalities (nonsurgical vs. surgical or nonsurgical vs. open surgical aneurysm repair vs. endovascular aneurysm repair) but found no significant difference among them. The incidence of depression was significantly higher in patients aged <65 years than in patients aged ≥65 years (hazard ratio, 1.539 vs. 1.270; P < 0.001). @*Conclusion@#The incidence of depression was higher in the AAA group, with an especially high risk for depression in patients aged <65 years. The psychiatric status of patients with AAA should be carefully monitored for clinicians to intervene when appropriate.

Left Side Approach in Laparoscopic Transabdominal Preperitoneal Inguinal Herniorrhaphy is Feasible for Any Type of Inguinal Hernia

PURPOSE: The transabdominal preperitoneal (TAPP) method has been as popular as the totally extraperitoneal (TEP) approach for laparoscopic inguinal hernia repair. The preferred approach to TAPP has been inserting two operative trocars in the contralateral midclavicular line, respectively. This can be uncomfortable for surgeons with a shorter reach. For this reason, we developed an only left side TAPP approach(L-TAPP) through an ipsilateral trocar position on the patient's left side regardless location of inguinal hernia. METHODS: We included patients who underwent laparoscopic inguinal hernia repair by a single surgeon between April 2016 and August 2017. The patients were divided into TEP and L-TAPP groups and compared regarding the clinical characteristics and surgical outcomes. RESULTS: There were no differences in clinicopathologic characteristics between the 33 patients in L-TAPP group and 11 patients in TEP group. The mean operative time for the L-TAPP group was 71.4±20.5 min, and 75.8±17.4 min for the TEP group (p=0.522). The mean length of hospital stay for the L-TAPP group was 2.5±0.7 days, and 2.5±0.5 days (p=0.797) for the TEP group. There was one postoperative scrotal hematoma and cord edema in the TEP group and no complications in the L-TAPP group (p=0.219). There were no early recurrences in both groups. CONCLUSION: In conclusion, L-TAPP is a feasible and safe procedure compared with TEP. In addition, this procedure might be adopted with more comfort for surgeons who have short reaches.

Eosinophilic organ infiltration without eosinophilia or direct parasite infection

No abstract available.

A Case of Delayed Recovery from Antibody-Mediated Rejection / 대한내과학회지

Antibody-mediated rejection (ABMR) in kidney transplant recipients is mediated by donor-specific antibodies. It is the major cause of graft failure in noncompliant patients and is associated with reduced long-term graft survival. We present a case of delayed recovery of renal function despite aggressive therapy after acute ABMR. A 49-year-old male on triple-drug maintenance immunosuppression (prednisolone, cyclosporine, and azathioprine), who underwent cadaveric donor renal transplantation 14 years earlier, visited our clinic with a serum creatinine level (SCr) of 1.9 mg/dL. The kidney biopsy revealed acute ABMR with diffuse C4d immunopositivity. We started steroid pulse therapy and bortezomib with plasmapheresis. Nevertheless, the SCr increased. Consequently, antithymocyte globulin (ATG) and intravenous immunoglobulin were administered. The SCr increased further to 4.1 mg/dL. Therefore, we performed a second kidney biopsy, which showed no change. Finally, we used rituximab. Fortunately, the SCr decreased gradually and returned to baseline.

A Case of Cryptococcal Myofascitis in a Patient with Iatrogenic Cushing's Syndrome / 대한내과학회지

The skin is the third most common site of cryptococcosis after infections of the central nervous system and lungs. However, cryptococcosis rarely involves deep soft tissue. Here, we report a case of cryptococcal cellulitis and myofascitis in a 72-year-old woman with iatrogenic Cushing's syndrome. Despite the administration of antibiotics, the patient continued to suffer from aggravated wounds and pain. Cultures of pus and an excisional biopsy of the skin revealed Cryptococcus neoformans. She was treated successfully with intravenous fluconazole (400 mg/day) for 14 days followed by oral fluconazole (400 mg/day) for 12 months.

Dapsone-induced drug reaction with eosinophilia and systemic symptoms syndrome, misdiagnosed as lymphoma

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a life-threatening adverse drug reaction with systemic manifestations. Dapsone is known to be useful for treatment of leprosy and various dermatologic conditions. We report a patient with prurigo pigmentosa who developed DRESS syndrome after dapsone treatment. She presented with lymphadenopathy, fever, eosinophilia, skin rash, and elevated liver enzymes. Initial lymph node and skin biopsy was suggestive of peripheral T-cell lymphoma. Initially, she was treated with chemotherapy. A week later after complete remission of skin symptoms, new skin lesions recurred. TCR-gene rearrangement was examined to show negative results and she was diagnosed as dapsone induced DRESS syndrome. This case emphasizes the importance of differential diagnosis of lymphoma and DRESS syndrome.

A Case of Pleural Endometriosis Presented as Right Sided Hemothorax in a Patient Who Underwent Kidney Transplantation / 영남의대학술지

Thoracic endometriosis is an uncommon disease that has four main forms: catamenial pneumothorax, hemothorax, hemoptysis, and pulmonary nodules. Since the growth of endometrial tissue depends on the presence of estrogen, thoracic endometriosis usually occurs in menstruating women between 25 and 35 years of age. Menstrual disturbances are common in women with chronic kidney disease (CKD). However, they could be reversed after kidney transplantation. Therefore, previously asymptomatic endometriosis may become symptomatic after kidney transplantation. A 49-year-old woman with CKD underwent kidney transplantation. A month later, she experienced dyspnea, and hemothorax in her right hemithorax. However, there was no evidence of infectious diseases and malignancy in thoracentesis, pleural biopsy, and computed chest tomography (CT). The serum and pleural fluid levels of his carbohydrate antigen 125 were elevated. Hemothorax secondary to pleural endometriosis was suspected. We tried hormonal therapy, and the hemothorax disappeared. At the sixth-month follow-up, there was no recurrence of hemothorax.

Ultrasound Biomicroscopic Changes after Laser Iridotomy or Trabeculectomy in Angle-closure Glaucoma

This study was performed to demonstrate the ultrasound, biomicroscopic and dimensional changes of angle structure after laser iridotomy (LI) and primary trabeculectomy (PT) in primary angle-closure glaucoma (PACG). Angle-opening distance at a point 500 (m from the scleral spur (AOD500), trabecular-iris angle (theta1), trabecular ciliary process distance (TCPD), ciliary process-iris angle (CPI), iris thickness (ID1, ID3), length of iris-lens contact distance (ILCD) and anterior chamber depth (ACD) were assessed before and after each procedure. Thirteen patients with LI and 16 with PT were prospectively enrolled. There were statistically significant increases in AOD500, theta1, and ILCD in both groups. CPI was decreased in both groups. ACD, TCPD, and iris thickness were not changed significantly. The changes in angle configuration after LI or PT may result more from alterations in aqueous pressure gradients across the iris and the changes of configuration were greater in the iris roots without rotation of ciliary body. However, we didn't find any significant differences in the changes of parameters between the two procedures.

Comparison of Surgical Results between Bilateral and Unilateral Lateral Rectus Recession in 20~25 Prism Diopters Intermittent Exotropia

PURPOSE: To compare the postoperative results of unilateral lateral rectus recession with bilateral lateral rectus recession between 20 prism diopters (PD) and 25 PD intermittent exotropia for basic type. METHODS: We analyzed retrospectively the data of 27 patients underwent unilateral lateral rectus recession and 38 patients underwent bilateral lateral rectus recession with 20 PD and 25 PD intermittent exotropia for basic type from June 1996 to May 2000 at the Department of Ophthalmology of Chonnam National University Hospital. RESULTS: There were 10 cases (37.0%) in unilateral group and 8 cases (21.1%) in bilateral group showing undercorrection in the amount of deviation more than 10 PD and 2 cases (5.3%) in bilateral group showing overcorrection in the amount of deviation more than 10 PD, and there was no overcorrection in unilateral group. There was a tendency of recurrence of exotropia during the first postoperative month, but the alignment after 1 month postoperative was not much different from the alignment at the last follow-up. The mean amount of correction after surgery was 13.78+/-7.65 PD (Mean+/-SD) in unilateral group and 20.32+/-8.37 PD (Mean+/-SD) in bilateral group (P=0.002). Success rate was 73.6% in bilateral group, better than 63.0% in unilateral group although there was no statistically significant difference (p>0.05). CONCLUSIONS: The undercorrection rate of bilateral lateral rectus recession is less than that of unilateral lateral rectus recession and more satisfactory surgical outcome was obtained in bilateral lateral rectus recession; therefore bilateral lateral rectus recession can lead to good result in 20~25 PD intermittent exotropia for basic type.

Intraocular Foreign Bodies: Clinical Characteristics and Visual Prognosis

PURPOSE: To determine the clinical characteristics and visual prognosis of intraocular foreign bodies (IOFBs). METHODS: We analyzed the patients with surgical removal of IOFB and follow-up of 4 months or longer. RESULTS: Of all 126 eyes of 126 patients, 118 patients (93.6%) were men and mean age was 42.7 years. The cause was lawn mower in 49 eyes (38.9%). Metal composition was in 114 eyes (90.5%), corneal inlet was present in 101 eyes (80.2%) and posterior location was in 97 eyes (73.0%) were there. Visual acuity was worse than 0.04 in 77 eyes (61.1%) before operation and in 36 eyes (28.6%) at the final visit. The final visual acuity was significantly related with initial visual acuity (criterion: 0.1, P=0.001), wound length (criterion: 3 mm, P< 0.001), location (anterior vs. posterior location, P< 0.001) and size (criterion: 3mm, P< 0.001) of IOFB, traumatic cataract (P=0.011), vitreous hemorrhage (P=0.001) and retinal tear (P< 0.001), respectively. CONCLUSION: Lawn mower is the main cause of IOFB and the countermeasure should be needed for it. Initial visual acuity, location and size of IOFB, wound length, vitreous hemorrhage and retinal tear may be the important factors on visual prognosis of IOFB.

Ultrasound biomicroscopic dimensions of the anterior chamber in angle-closure glaucoma patients

In order to evaluate the morphologic types of appositional angle-closure glaucoma, biometric measurements were made in angle-closure glaucoma patients using Ultrasound biomicroscopy (UBM). Twenty-six patients with primary angle-closure glaucoma and 21 cataract patients with as a control group were examined. The angle-closure glaucomatous eyes were classified as type B in which the angle closure started at the bottom of the angle and type S in which the angle closure occurred in the vicinity of Schwalbe's line. The trabecular-ciliary process distance (TCPD, type B; 873.20+/-86.77 microm, type S; 832.52+/-82.96 microm, control; 1233.50+/-73.01 microm, p = 0.000) and the angle opening distance (AOD500, type B; 89.75+/-63.27 microm, type S; 88.85+/-72.95 microm, control; 304.40+/-104.30 microm, p = 0.000) were significantly shorter in patients with angle closure vice control group. No significant difference were noted in the three groups of patients in regards to iris thickness or ciliary process-iris angle. In this study, we have demonstrated that there are two types of appositional angle-closure and have shown the forward rotation of the ciliary process without changes of the ciliary process-iris angle in cases of angle-closure glaucoma.

Posterior Epidural Migration of Herniated Lumbar Intervertebral Disc: Two Cases Report / 대한척추외과학회지

STUDY DESIGN: case report and review of the literature OBJECTIVES: to report two cases of posterior epidural migration of herniated lumbar intervertebral disc and review the literature Summary of Background Data : Posterior epidural migration of herniated lumbar intervertebral disc is extremely rare. The large size of the fragment eventually exceeded the limits of the anterior epidural space and the fragment subsequently settled posterior the thecal sac because of spatial and size constraints. MATERIALS AND METHODS: Two cases of herniation of intervertebral disc which were caused by posteriorly migrated disc material were treated surgically with open discectomy. The magnetic resonance images, surgical treatment and related literature are reviewed. RESULTS: Preoperative magnetic resonance images of the posterior epidural migration of herniated lumbar intervertebral disc showed a large epidural mass. The mass was of intermediate signal intensity on T1-weighted images, was of low signal intensity on T2-weighted images and was enhanced marginally with gadolinium-DTPA on T1-weighted images. Immediately after operation, a significant reduction of symptoms were achieved. The patients recovered fully at two year follow-up. CONCLUSIONS: Lumbar disc herniation by posterior epidural migration of sequestered fragment can be diagnosed with clinical findings and MRI including Gadolinium-DTPA enhancement. It should be differentiated from epidural mass and could be managed surgically with good results.

Transient Cortical Blindness Related to General Anesthesia

PURPOSE: We report a case of cortical blindness due to transient cerebral ischemia associated with general anesthesia. METHODS: A 45 year-old woman complained of bilateral visual loss after emergent incision and drainage for the treatment of extensive pyogenic abscess around the left mandibular space causing severe respiratory distress, and transient cerebral ischemia due to difficult tracheal intubation. At first ophthalmologic examination, 8 days after the operation, visual acuity was hand movement. Functions of external ocular muscles, blinking reflex, accommodation, pupillary light reflex, color vision test, intraocular pressure, and the findings of anterior segment, optic nerve and fundus were normal. Humphrey visual field examination showed nonspecific visual field defect, and pattern visual evoked potential examiantion showed flattening of waveforms. Both brain magnetic resonance imaging and electroencephalography were normal. However, brain single positron emission computerized tomography demonstrated general decrease of blood perfusion in the cerebrum including the occipital lobes. RESULTS: Without any specific treatment, her vision improved gradually, and 6 weeks after operation, it was 0.4 in the right and 0.7 in the left eye. After 3 months, it was 0.9, and no other abnormal ocular findings were noted on both eyes. CONCLUSIONS: Cortical blindness can occur by transient cerebral ischemia associated with general anesthesia, and its visual prognosis may be good.