Choroidal Thickness Changes Following Vitrectomy in Epiretinal Membrane Based on the Optical Coherence Tomography Pattern

PURPOSE: To analyze the influence of morphological classification in epiretinal membrane (ERM) based on surgical outcomes and optical coherence tomography (OCT) of the postoperative choroidal thickness. METHODS: This observational study included 122 eyes with ERM who underwent vitrectomy. Using OCT, the preoperative ERM was classified into six types: cystoid macular edema (CME), convex, flat, normal foveal contour (Normal), pseudolamellar hole (PLH), and vitreomacular traction (VMT). The preoperative multifocal electroretinogram (mfERG), postoperative change in subfoveal choroidal thickness (SCT), central macular thickness (CMT), and best-corrected visual acuity (BCVA) were compared. RESULTS: Preoperative subfoveal choroidal thickness increased in the VMT type compared to the fellow eye (207 µm vs. 234 µm, p = 0.028). Choroidal thickness decreased in all types at 12 months after vitrectomy (all, P < 0.05). There was a positive linear correlation between the mfERG and the preoperative BCVA (p = 0.001). The initial visual acuity was best in the Normal type followed by the flat, PLH, convex, CME, and VMT types (p = 0.001). The final visual acuity was the best in the Normal type, followed by the PLH, Flat, VMT, Convex, and CME types (p = 0.030). Gas tamponade during the surgery did not affect the surgical outcomes of the CMT (p = 0.458), BCVA (p = 0.550), and SCT (p = 0.127). CONCLUSIONS: Preoperative SCT increased only in the VMT type, but choroidal thickness decreased in all types after vitrectomy, regardless of the preoperative morphology.

A Case of Primary Mucinous Adenocarcinoma of the Lower Eyelid

PURPOSE: To report a rare case of a recurrent painless mass of the right lower eyelid, which was histologically diagnosed as a mucinous adenocarcinoma. CASE SUMMARY: A 59-year-old male had a painless nodule on the right lower eyelid for 2 years. He had a history of five laser treatments done by a dermatologist prior to the initial presentation. Surgical shave biopsy was performed and a histopathological examination revealed a mucinous adenocarcinoma. We subsequently performed a pentagonal excision of the lower eyelid with assisted frozen biopsy until no tumor cells were seen at the margin. A postoperative whole-body positron emission tomography scan, chest computerized tomography, gastrointestinal endoscopy, and colonoscopy excluded systemic metastases. No recurrence has been observed for 18 months after the surgery. CONCLUSIONS: Primary mucinous adenocarcinoma is a rare disorder of the eyelid. Because it has various morphologies, and the final diagnosis can only be made by histopathological examination. If there is a recurrent mass at the eyelid margin, adenocarcinoma should be considered as the differential diagnosis. A complete surgical excision is recommended to prevent local recurrence.

A Case of Streptococcus dysgalactiae Endophthalmitis after Cataract Surgery

PURPOSE: To report the first case of endophthalmitis due to Streptococcus dysgalactiae after phacoemulsification and posterior chamber intraocular lens implantation in the Republic of Korea. CASE SUMMARY: A 65-year-old male was transferred because of endophthalmitis following cataract surgery. His initial visual acuity was light perception. Because inflammation of the anterior chamber and vitreous cavity progressed rapidly, we performed total pars planar vitrectomy and intraocular lens extraction in addition to administering intravitreal antibiotics and intravitreal dexamethasone injections. Streptococcus dysgalactiae was identified in samples cultured from the vitreous and anterior chamber fluid. Four days after surgery, we washed the anterior chamber and intravitreal antibiotics were again injected because of increased inflammation of the anterior chamber and vitreous. The patient was discharged 25 days after surgery but corneal neovascularization, contraction, edema, infiltration, and hypopyon remained. Visual acuity progressed to no light perception and there was shrinkage of the globe. CONCLUSIONS: Endophthalmitis due to Streptococcus dysgalactiae is very rare. We report the first case of endophthalmitis caused by Streptococcus dysgalactiae in the Republic of Korea. The prognosis for recovery was poor despite aggressive treatment.

Procalcitonin as a Prognosis Marker for the Severe Sepsis and Septic Shock Patients in Emergency Department / 대한구급학회지

BACKGROUND: Advance in sepsis management has increased the survival of patients with sepsis. However, severe sepsis and septic shock patients still have high mortality. We intend to verify the use of the procalcitonin (PCT) level as a prognosis marker in patients with severe sepsis or septic shock in the emergency department (ED). METHODS: ED Patients with severe sepsis or septic shock were enrolled in our study. We used mortality and Intensive Care Unit (ICU) days as a prognosis index, and compared the PCT level in survivors and non-survivors. We introduced the simplified acute physiology score 3(SAPS3) to assess the severity of the patients and analyzed whether or not the PCT level correlated with the severity index. RESULTS: The PCT level in septic shock patients [7.36 (0.92-33.69, IQR)] was higher than that in severe sepsis patients [3.24 (0.36-10.53, IQR)] (p = 0.04). However, there was no significant PCT level difference between survivors [median (IQR), 6.59 (0.60-29.25)] and non-survivors [median (IQR), 3.49 (0.40-20.41)] (p = 0.293). The SAPS3 score was higher in the non-survivor group [median (IQR), 64 (59.0-71.5)] than in the survivor group [median (IQR), 77 (68.5-82.0)] (p = 0.001). The PCT level did not correlate with either ICU days or hospital days. CONCLUSIONS: Using the PCT level as a prognosis factor in severe sepsis and septic shock patients in ED has little value.

Cause, effect and coping skills of stress in physicians and nurses of an emergency department

PURPOSE: The emergency department (ED) has been considered highly stressful environment to work in. However, there has been no study evaluating the stresses endured by emergency staffs in Korea. This study aims to evaluate the cause and effect of stress, and coping methods used by doctors and nurses under stress from working in an emergency department. METHODS: Interns, residents and nurses of an emergency center were given questionnaires that included general health questionnaire (GHQ)-12 scale and modified Holmes & Rahe (HR) scale to examine the cause and effect of stress, and determine the coping methods they used to alleviate stress. A score of greater than 20 in the GHQ-12 scale and greater than 80 in the HR scale were considered as significant for stress. The stress scales were compared among the three groups using analysis of variance and chisquare test. RESULTS: A total of 111 participants consisting of 46 interns, 19 residents, and 46 nurses were surveyed. While the GHQ-12 score showed no difference between groups, the HR score showed significant differences among residents (82.4+/-23.0), nurses (73.6+/-13.2), and interns (70.1+/-17.7). Each stress score did not differ according to the age, gender, marital status, or presence of lover. Most frequently recorede effects of stress were difficulty waking up and fatigue. Most frequent coping methods employed were sleeping and smoking. CONCLUSION: This study suggests that ED staffs, especially residents, were exposed to significant amount of stress.

A Pilot Evaluation of Cast Immobilization of Intact Upper Extremity: A New Therapeutic Approach for Spastic Hemiplegic Cerebral Palsy

OBJECTIVE: To investigate the functional facilitation effect on an affected side of spastic hemiplegic cerebral palsy by immobilizing the intact side with a cast. METHOD: Five hemiplegic cerebral palsies, who had been treated by general rehabilitation therapy during previous 6 months and showed no functional improvement were studied. Their intact arms were immobilized by scotch short arm casts for 6 weeks. And, the therapeatic effects of this method were evaluated by the Box and Block Test of manual dexterity, Erhardt Developmental Prehension Assesment and Brain Perfusion SPECT. RESULTS: 1. Box and Block test: Before the cast immobilization method, hemiplegic cerebral palsies could transfer a mean of 5.4+/-3.36 cubic rods from one to the other side, and after the treatment a mean of 8.0+/-1.41 cubic rods with the affected arm. 2. Erhardt Developmental Prehension Assesment: Before the treatment, the grasp motion of round rod, cubic rod, and button suited in a mean of 5.1+/-3.0 months, and after the treatment, suited in a mean of 8.2+/-0.66 months. 3. Brain Perfusion SPECTs did not change before and after the cast immobilization method. 4. There was no adverse effect resulting from the cast immobilization method on an intact side. CONCLUSION: We concluded that the cast immobilization method on an intact side could be a new beneficial rehabilitation method for the treatment of spastic hemiplegic cerebral palsies.

Changes of Gait Patterns by the Ankle Foot Orthoses with a Variable Ankle Joint Stop

OBJECTIVE: To investigate the changes of gait patterns in subjects who use the ankle foot orthoses (AFOs) with a variable ankle joint stop. METHOD: Six young subjects without a known physical disability were involved in this study. Double upright AFOs with three kinds of ankle joint stops (eg. AFOs with 85o posterior stop, 90o posterior stop, and 95o posterior stop) were used for the right foot and a rigid shoe was used for the left foot. Gait patterns of the subjects using the AFOs with a variable ankle joint stop were evaluated with the three dimensional gait analysis system. RESULTS: The gait patterns of the subjects with a 85o posterior stop AFO showed a shorter duration of single support phase than the subjects with a 90o posterior stop or 95o posterior stop. They showed the increased maximal knee flexion angles, decreased knee extension angles and decreased ankle range of motions by the kinematics. These linear changes in parameters and kinematics were statistically significant. In kinetics, the gait patterns of the subjects using a AFO with 85o posterior stop had the largest maximal knee flexion moment and the gait patterns of the subjects using a AFO with 95o posterior stop had the largest maximal knee extension moment. However these results were not statistically significant. CONCLUSION: For the patients with uncontrolled ankle motion, the AFOs with 90o or 95o posterior stop would be more desirable than the AFOs with 85o posterior stop, for the clearance of foot and stability of knees but not for the correction of the knee hyperextension.