Intraoperatively Observed Lacrimal Obstructive Features and Surgical Outcomes in External Dacryocystorhinostomy

PURPOSE: To analyze the features of lacrimal drainage system obstruction confirmed during external dacryocystorhinostomy surgeries and report the surgical outcomes. METHODS: We reviewed the medical records of a total of 769 cases who underwent external dacryocystorhinostomy for primary lacrimal drainage obstruction between 2005 and 2014. Data about detailed location and extent of obstruction were collected intraoperatively. The sites of obstruction were classified into nasolacrimal duct obstruction (NLDO), common canalicular obstruction (CCO), and canalicular obstruction. Lacrimal sac mucosa and lumen were grossly inspected, and the frequency of lacrimal sac changes, such as significant inflammation or fibrosis, was analyzed in cases of CCO or canalicular obstruction. The surgical success rate was also evaluated including effect of lacrimal sac status in the CCO and canalicular obstruction groups. RESULTS: Of 769 cases, primary NLDO with patent canaliculi was diagnosed intraoperatively in 432 cases (56.2%), CCO in 253 (32.9%), and canalicular obstruction in 84 (10.9%). Of 253 cases with CCO, 122 (48.2%) showed clear lacrimal sac lumen, and the other 131 (51.8%) showed significant inflammation or fibrosis of the lacrimal sac. In cases with canalicular obstruction, 35 of 84 (41.7%) showed a clear lacrimal sac, and the other 49 cases (58.3%) cases revealed mucosal changes of the lacrimal sac. The functional success rate was 87.5% for primary NLDO, 75.5% for CCO, and 72.6% for canalicular obstruction. In the CCO group, the functional success rate was lower in cases with significant lacrimal sac change (p = 0.044). CONCLUSIONS: Even in patients with CCO or canalicular obstruction, a large number of cases have lacrimal sac changes, and those changes were associated with lower functional success rate.

Verrucous Carcinoma of the Eyelid

No abstract available.

Cervical Spinal Epidural Hematoma Following Cervical Posterior Laminoforaminotomy

A 65-year-old man who had lateral cervical disc herniation underwent cervical posterior laminoforaminotomy at C5-6 and C6-7 level right side. During the operation, there was no serious surgical bleeding event. After operation, he complained persistent right shoulder pain and neck pain. Repeated magnetic resonance image (MRI) showed diffuse cervical epidural hematoma (EDH) extending from C5 to T1 level right side and spinal cord compression at C5-6-7 level. He underwent exploration. There was active bleeding at muscular layer. Muscular active bleeding was controlled and intramuscular hematoma was removed. The patient's symptom was reduced after second operation. Symptomatic postoperative spinal EDH requiring reoperation is rare. Meticulous bleeding control is important before wound closure. In addition, if patient presents persistent or aggravated pain after operation, rapid evaluation using MRI and second look operation is needed as soon as possible.

Transdural Nerve Rootlet Entrapment in the Intervertebral Disc Space through Minimal Dural Tear : Report of 4 Cases

Four patients underwent lumbar surgery. In all four patients, the dura was minimally torn during the operation. However, none exhibited signs of postoperative cerebrospinal fluid leakage. In each case, a few days after the operation, the patient suddenly experienced severe recurring pain in the leg. Repeat magnetic resonance imaging showed transdural nerve rootlets entrapped in the intervertebral disc space. On exploration, ventral dural tears and transdural nerve rootlet entrapment were confirmed. Midline durotomy, herniated rootlet repositioning, and ventral dural tear repair were performed, and patients' symptoms improved after rootlet repositioning. Even with minimal dural tearing, nerve rootlets may become entrapped, resulting in severe recurring symptoms. Therefore, the dural tear must be identified and repaired during the first operation.

Three Cases of Ophthalomplegic Migraine

PURPOSE: To report three cases of ophthalmoplegic migraine which is a rare condition characterized by the association of headaches with an oculomotor nerve palsy. CASE SUMMARY: A 44-year-old male and two eight-year-old females were presented with diplopia developed after headaches. All of the three patients showed abnormal eye movement and they had past episodes of transient diplopia with headaches. Visual evoked potential (VEP), cerebrospinal fluid (CSF) examination, laboratory findings, and other neurologic tests were all normal, also there was no tumor or cerebrovascular disease on brain MRA & MRI. The symptoms of all patients improved gradually within several weeks from first the visit, with complete recovery seen in all three. CONCLUSIONS: Any patient who has a headache with paresis of the extraocular muscle should be considered for ophthalmoplegic migraine. To diagnose ophthalmoplegic migraine, family history, past medical history, associated symptoms and signs, neurologic examinations and neuroimaging tests are needed.

Changes in Visual Field Index After Cataract Extraction

PURPOSE: To investigate the changes of visual field index (VFI) compared with mean deviation (MD) and pattern standard deviation (PSD) before and after cataract surgery. METHODS: The present study included 77 eyes of 77 patients who were diagnosed with both glaucoma and cataracts and underwent cataract surgery. Preoperative and postoperative VFI, MD, and PSD were examined. Lens opacity type was classified as cortical, nucleosclerosis, or posterior subcapsular opacity (PSCO), and the MD, PSD, and VFI were compared before and after cataract surgery. RESULTS: Preoperative and postoperative MD were -13.64+/-8.97, -11.94+/-9.67(p=0.113), PSD were 6.18+/-3.30, 5.91+/-3.31(p=0.344), and VFI were 67.00+/-33.43, 70.55+/-33.19(p=0.440), respectively. MD showed statistically significant difference in cortical and PSCO type before and after cataract surgery. PSD (p=0.025) and VFI (p=0.020) showed a statistically significant difference in cortical type. CONCLUSIONS: VFI is an effective parameter to monitor the progression of glaucoma in cataract patients with nucleosclerosis and PSCO, but has limitations in cataract patients with cortical opacity.

Comparison of Total Deviation of Standard Automated Perimetry and Matrix FDT in Preperimetric Glaucoma Patients

PURPOSE: To compare the results of total deviation (TD) as measured by standard automated perimetry (SAP) and measured with of Matrix Frequency-doubling Technology (FDT) in patients with preperimetric glaucoma. METHODS: Fifty-two eyes of 52 patients with preperimetric glaucoma were included. Subjects were examined with Matrix FDT and Stratus optical coherence tomography (OCT), and the results of each examination were analyzed. The proportions of abnormal results in SAP TD, Matrix TD, and Matrix pattern deviation (PD) were calculated. Among the results of tests, the following correlations were evaluated: SAP TD and Matrix, and visual fields and OCT. In addition, the differences in peripapillary retinal nerve fiber layer thickness (RNFL) according to the result of SAP TD in preperimetric patients with abnormal Matrix PD were analyzed. RESULTS: A abnormalities in SAP TD, Matrix TD and Matrix PD were found in 22 (42.3%), 34 (65.4%), 41 (78.9%) eyes, respectively. There was marginal correlation between SAP TD and Matrix PD (p=0.07). No significant correlation was found between SAP TD and OCT, although Matrix PD and OCT did show significant correlation (p<0.05). In preperimetric patients with abnormal Matrix PD, RNFL thickness was significantly lower in the abnormal SAP TD group than in the normal SAP TD group on average, in the superior quadrant, and at the 12 o'clock and 5 o'clock positions (p<0.05). CONCLUSIONS: In patients with preperimetric glaucoma, 42.3% and 78.9% had glaucomatous VF defects in SAP TD and Matrix PD, respectively. These results were higher than expected, especially those of SAP TD.

Vision-Correction Effect of RGP Contact Lens in Patients With Corneal Opacity Following Repaired Corneal Perforations

PURPOSE: To investigate the effect of rigid gas permeable (RGP) contact lenses in patients with corneal scar and opacity following repair of corneal perforations. METHODS: A total of 10 eyes from 10 patients undergoing repair of corneal perforating injuries and fitted with RGP contact lenses were examined in the present study. The mean postoperative 3-month visual acuities, refraction, corneal topography, keratometry, best corrected visual acuities with spectacles and RGP lenses at an average of postoperative 3 months were evaluated. RESULTS: Eight eyes had corneal opacities at the central and 2 eyes at the peripheral portion. Four patients had previous cataract surgery or cataract surgery with intraocular lens insertion due to traumatic cataract. The mean postoperative 3-month LogMAR visual acuity was 1.14 +/- 0.53. Corneal topography showed irregular astigmatism in all patients and the mean keratometric astigmatism was 4.03 +/- 4.06 diopters. The mean best corrected LogMAR visual acuities with spectacles was 0.91 +/- 0.64 and with the RGP contact lens was 0.25 +/- 0.35. A comparative analysis of improvement in visual acuity with the RGP contact lens over spectacle correction was found to be statistically significant (p = 0.005). Patients wore the lenses for more than 6 hours daily for the mean follow-up period (12.10 +/- 7.80 months). CONCLUSIONS: In patients with corneal scar and opacity following repair of corneal perforations, RGP contact lens fitting should be considered first before surgical corrections such as keratoplasty.

The Relationship Between Asphericity and Visual Acuity After Wearing Reverse-Geometry Lens

PURPOSE:To report the change of corneal asphericity and the relationship between asphericity and visual acuity after wearing the reverse-geometry lens. METHODS: The authors reviewed out-patient records of 37 consecutive patients wearing reverse-geometry lenses. The patients were followed up from July 2004 to December 2007. The unaided visual acuity (VA), spherical equivalent (SE) and asphericity before and after wearing the lens were compared. The relationship of SE and final VA, initial astigmatism and final VA, and asphericity and final VA was also analyzed. In addition, the relationship between the increment of VA and asphericity was determined. RESULTS: VA and SE improved and the asphericity decreased after wearing the lens (p<0.05). There was high correlation between the spherical equivalent and final visual acuity (p<0.001), and no correlation between asphericity and final visual acuity (p=0.358) was observed. However, the lower the initial asphericity, the greater the increment of visual acuity observed (p=0.048). CONCLUSIONS: Initial corneal asphericity can be a predictor of increment of VA after wearing reverse-geometry lenses.

Analysis of Refractive Error and Corneal Asphericity in Elementary School Students in Ilsan City

PURPOSE: To determine the relationships among refractive error, corneal asphericity, and axial length in elementary school students. METHODS: One hundred eleven eyes from 56 subjects were included in this study. All subjects underwent cycloplegic refraction corrected to the spherical equivalent. Axial length was measured, and corneal topography was performed. Corneal asphericity was assessed using eccentricity (e) calculated according to the formula Q=-e2. The relationship among spherical equivalent, asphericity, and axial length was determined using a linear regression model. RESULTS: Subjects were between 8 and 12 years of age (mean, 9.99+/-1.33). The average spherical equivalent was -1.38+/-2.08D (-7.13~2.63D), the average axial length was 23.84+/-1.17 mm (20.10~26.37 mm), and the average corneal asphericity was -0.29+/-0.10 (-0.55~-0.07). An increase in myopia was positively correlated with an increase in axial length (p<0.0001). The degree of myopia was negatively associated with corneal asphericity (p=0.019). An increase in axial length was related to an increase of negativity in asphericity (p=0.012). CONCLUSIONS: An increase in myopia was correlated with an increase in axial length. As the degree of myopia and axial length increased, corneal asphericity became more prolate. A longitudinal study with more subjects is required to validate these results.

Epidural Hematomas due to Occipital Artery Injury Following Ventriculoperitoneal Shunt and Extraventricular Drainage

Ventriculoperitoneal (VP) shunt is a common treatment for hydrocephalic patients. However, complications, such as shunt tube occlusion, infection, intracranial hemorrhage, seizure can occur. Of these, intracranial hemorrhage may occur due to intracranial vascular injury or a rapid decrease of intracranial pressure (ICP). Most of these hemorrhages are subdural hematomas (SDH) while a few are epidural hematomas (EDH). It is extremely rare for an intracranial hemorrhage to occur due to an extension of the bleeding from an injured extracranial vessel. We report two cases of EDH due to occipital artery injury following VP shunt and extraventricular drainage (EVD).

Correlation between Symptomatic Vasospasm and Leukocyte, Platelet Count Following Aneurysmal Subarachnoid Hemorrhage: Clinical Research / 대한뇌혈관외과학회지

OBJECTIVE: The mechanisms of vasospasm after subarachnoid hemorrhage (SAH) are still poorly understood. In recent studies, many authors have suggested that platelet aggregation and consumption within the cerebral vessels after SAH is one of the mechanisms of vasospasm. Some authors reported that leukocytosis is a predictive factor of vasospasm. Therefore, we analyzed fever and the leukocyte and platelet counts in patients with aneurismal SAH. Through this analysis, we tried to investigate the predictive factors of symptomatic vasospasm. METHODS: We studied 130 patients who had undergone an aneurysmal neck clipping operation or Guglielmi detachable coil (GDC) embolization within 48 hours after the onset of SAH. Age, gender, hypertension, a history of cerebrovascular accident, aneurysm location, Fisher grade, Hunt-Hess classification, Glasgow coma scale, Glasgow outcome scale, fever, leukocyte, platelet count and the radiologic finding were retrospectively analyzed for both the patients with aneurysmal neck clipping and those with endovascular intervention. RESULTS: One hundred thirty patients were treated for aneurysmal SAH during the review period. Forty nine patients (37.7%) developed symptomatic vasospasm. Symptomatic vasospasm occurred 5.7 days after aneurysmal SAH. During the early hospital period, the Fisher grade (P=0.018), fever (>37.5 degrees C, P=0.029), progressive leukocytosis (WBC>15,000/mm3, P=0.027) and the ratio of thrombocytopenia (platelet count in the hospital/platelet count on admission 37.5 degrees C, odd ratio (OR): 4.022, 95% confidence interval (CI): 1.022-6.866), progressive leukocytosis (WBC>15,000/mm3, OR: 8.182, 95% CI: 1.624-13.417) and the ratio of thrombocytopenia (platelet count in hospital/platelet count on admission < or = 0.67, OR: 11.851, 95% CI: 2.311-21.161) were independent predictors of symptomatic vasospasm on multivariated analysis. CONCLUSION: These results indicated that the Fisher grade, fever and daily monitoring of the leukocyte and platelet counts were important for predicting symptomatic vasospasm after aneurysmal SAH. Especially, fever, leukocytosis and a low platelet count were independent predictors.

Escherichia coli Susceptibility to Antimicrobials in Children with Urinary Tract Infection

PURPOSE: This study was performed to identify longitudinal changes in the prevalence of organisms isolated from urinary tract infection(UTI) and in the pattern of Escherichia coli susceptibility to antibiotics during the past 10 years in children with UTI. METHODS: We performed a retrospective study of a total of 192 urine cultures from children with UTI in the Department of Pediatrics, Seoul Adventist Hospital over two periods(1st: 1995-2000, 2nd:2001-2005). Antimicrobial susceptibility of the isolates was compared between the two groups. RESULTS: The pathogens of UTI in the two groups were similar. In the first period, E. coli was the leading uropathogen(66.2%) followed by Klebsiella pneumoniae(7.8%), Enterobacter cloacae(6.5%), and others(19.5%). In the second period, E. coli was the leading uropathogen (67%) followed by K. pneumoniae(12.2%), E. cloacae(3.5%), Enterobacter aerogenes(3.5%), and others(13.8%). The susceptibility pattern of E. coli to amoxicillin/clavulanate(87.5%, 81.0 %) did not present any statistically significant difference between the two periods(P>0.05). The susceptibility of E. coli to TMP/SMX(52.4%, 50.0%) was still low with no significant difference between the two periods(P>0.05). CONCLUSION: Our results suggest that the use of amoxicillin/clavulanate is still an excellent therapeutic option in children with UTI. The low rate of susceptibility to TMP/SMX against uropathogens suggest that TMP/SMX may be reevaluated as the first-line therapeutic drug for UTI.

An Analysis of Correlation with Visual Acuity, Refractive Error and Corneal Astigmatism after Wearing of Reverse Geometry Lenses

PURPOSE: To evaluate correlations with refractive error, astigmatism and uncorrected visual acuity after Ortho-K LKTM lens wear. METHODS: Sixty-one eyes of 32 patients who had been wearing reverse geometry lenses for over 5 weeks were recruited. Uncorrected visual acuity, subjective refraction on retinoscopy, objective refraction measured by an autorefractometer, and corneal astigmatism were measured by corneal topography before, at 2 days, and 1, 3, and 5 weeks after lenses fitting. RESULTS: Uncorrected visual acuity improved from 0.12+/-0.10 to 0.95+/-0.15 after 5 weeks. Subjective refraction on retinoscopy and objective refraction measures with the autorefractometer were -3.52+/-1.65D and -4.06+/-1.73D, respectively before wearing the lenses. These decreased to -0.08+/-0.40D and -1.98+/-2.04D, respectively after 5 weeks. The astigmatism detected by corneal topography improved from 0.93+/-0.49 to 1.20+/-1.03 after 5 weeks. Uncorrected visual acuity was correlated with the refractive error measured by subjective refraction with retinoscopy rather than that by objective refraction with the autorefractometer. Corneal astigmatism measured by corneal topography correlated with the refraction detected by the autorefractometer. CONCLUSIONS: Subjective refraction by retinoscopy rather than refraction found objectively using the autorefractometer, was highly correlated with uncorrected visual acuity (r=0.77~0.87) which seems to be useful in evaluating myopia patients. The astigmatism determined by autorefractometer examination had high correlation with that determined by corneal topography (r=0.51~0.76). This result appears useful in decisions related to the decentering of lenses.

A Case of Tuberculous Spondylitis Combined with Schwannoma of Spinal Cord

The authors report a very rare case of tuberculous spondylitis combined with a schwannoma of spinal cord. A 39-year-old man was admitted because of paraparesis(G1/G2). MRI showed severe cord compression at two different levels. One was by the bulged soft tissue and subligamentous abscess extending from T7 to T9 and the other was by an intradural extramedullary cord tumor at the level of T1-2. At first operation, T8 corpectomy and T7-9 plate fixation with autogenous iliac bone graft were performed. After then, Paraparesis was improved(G2/G3) postoperatively. The second operation underwent two weeks later. The tumor was totally removed and shortly after second operation, paraparesis was markedly improved(G3/G4). Histological diagnosis were tuberculous spondylitis and schwannoma, respectively. The authors reviewed this case where good surgical outcome was obtained by two stage operation.

A study on Evaluating Solute Excretion in the Normal Neonate

Fine needle aspiration biopsy cytology (FNA) is an important diagnostic tool in the management of thyroid nodule. Especially, papillary carcinoma of the thyroid has distinct morphologic features that allow a definite cytologic diagnosis with high degree of accuracy. We examined the characteristic cytologic features of 57 cases of papillary carcinoma of the thyroid, and their frequency and diagnostic significance were evaluated. The results obtained are summerized as follows : 1. In pattern of cellular arrangement, papillary structure with or without stroma is predominant feature (96%). 2. In individual cell morphology, grooved nuclei (95%), intranuclear cytoplasmic invagination (89%) and nuclear lobulation(74%) are most frequent and important cytologic findings. 3. Chromatin pattern is usually fine. Coarse chromatin is infrequent finding (37%). Nucleoli are inconspicuous. Cytoplasm is plump and distinctly eosinophilic. 4. Psammoma bodies are identified only in 4 cases (7%), but they are considered as helpful diagnostic features. 5. There are other associated findings including multinucleated giant cells (51%), macrophages (37%) and cystic degeneration(16%).

A Study on Method for Screening of Hypercalciuria in Children

A 33-year-old woman who was diagnosed as medullary carcinoma by fine needle aspiration of thyroid mass is presented. The smear revealed dispersed pattern and small clusters of cells without follicular or papillary structures. The nuclei were round, oval or spindle shaped and eccentrically located. The cytoplasm was abundant and showed red-stained cytoplasmic granulation and tail-like projection with indistinct border. Clumps of amorphous, light-green material were intermingled with tumor cells.

Effect of Unilateral Ureteral Obstruction(UUO) on the Expression of Platelet-Derived Growth Factor(PDGF) in the Sprague-Dawley Rat / 대한신장학회잡지

Unilateral ureteral obstruction(UUO) results in severe renal vascular constriction through the activation of renin-angiotensin system, which causes progressive tubulointerstitial fibrosis. Platelet-derived growth factor(PDGF) plays an important role in stimulating myofibroblasts and regulating synthesis of extracellular matrix in renal interstitial proliferation and fibrosis. This study was designed to investigate the relationship between unilateral ureteral obstruction and PDGF expression in tubulointerstitial fibrosis of the kidney. Eleven adult male Spraugue-Dawley rats were carried out unilateral ureteral ligation and sham operation. After 14 days, control kidney, UUO kidney and intact opposite(IO) kidney were harvested. Tissue fibrosis was quantified morphologically using the point detection method after Masson-Trichrome stain. Expression of PDGF-A and B was determined by immunohistochemical staining, RT-PCR and Western blot assay. Results were as follows: 1) UUO and IO group resulted in reduced kidney weight compared with control group(p<0.05). 2) Collagen deposition was increased in the renal cortex of UUO group(p<0.05). 3) PDGF-A and B mRNA expression was increased significantly compared with control and IO group(p< 0.05). 4) PDGF-A and B protein expression were increased in UUO and IO group(p<0.05). 5) On the immunohistochemical staining for PDGF- A and B, staining intensity was increased significantly at the renal cortex, interstitium and tubular epithelial cells in the UUO group. This results indicated that PDGF-A and B plays important role in tubulointerstitial fibrosis developed after unilateral ureteral obstruction and compensatory fibroproliferative growth in contralateral kidney.

Treatment of Cerebral Arteriovenous Malformations by Preoperative Embolization and Microsurgery

No abstract available.

Clinical Analysis of Anterolateral Approach with Instrumentation for the Thoracolumbar Lesions

Forty one patients with unstable thoracolumbar lesions were treated using anterior internal fixation device. There were 39 cases with unstable thoracolumbar fracture, 1 case with post-traumatic kyphosis, and 1 case with aspergillosis spondylitis. The procedures consisted of anterior decompression through vertebrectomy and discectomy, interbody fusion using autogenous iliac bone or rib, realignment and stabilization with Kaneda device(7 cases), or Z-plate ATL device(34 cases). Most patients with incomplete neurologic deficit were improved one or two grades according to Frankel's classification. No patient showed neurological deterioration after surgery. We concluded that the anteroloteral approach with instrumentation in various unstable thoracolumbar lesions would provide satisfactory neurologic improvement as well as immediate firm stability with early ambulation and high fusion rate involving only a minimum number of motion segments.