A Case of Keratoconjunctivitis Sicca Associated Idiopathic Hypereosinophilic Syndrome

PURPOSE: To report a case of the keratoconjunctivitis sicca (KCS) associated idiopathic hypereosinophilic syndrome (IHES). METHODS: We present a report and review of a 53-year-old man who suffered from IHES and KCS. The ocular examination showed conjunctival papillary hypertrophy, interpalpebral corneal and conjunctival punctate staining with fluorescein dye, and peripheral corneal neovascularization. His Schirmer I test results were nearly zero mm of wetting in both eyes. Impression cytology showed squamous metaplasia. RESULTS: He had treated with low dose systemic steroid since October 2003. Because he showed a side effect of steroid induced myopathy, we could not increase the dosage. We added topical steroid (Pred Forte(R)), conservative free artificial tear and topical antibiotics, after which his ocular condition improved. Neovascularization was regressed, punctate staining decreased, and his visual acuity increased to 20/25 2 months later. CONCLUSIONS: This case demonstrates that the KCS can be associated with IHES and be treated with systemic and topical steroid.

Achilles Allograft Reconstruction of a Chronic Patellar Tendon Rupture: A Case Report / 대한정형외과학회잡지

Chronic ruptures of the patellar tendon are uncommon injuries. They are technically difficult to repair because of scar formation, poor quality of the remaining tendon, and quadriceps muscle atrophy and contracture. We report a case on the reconstruction of a chronic patellar tendon rupture. The reconstruction was performed 18 months after the injury, using an Achilles tendon allograft and reinforcing suprapatellar wire. At four weeks postoperative, the patient had attained 70degrees C flexion and 10degrees C extension lag. Nine months after the index procedure, the patient regained 130degrees C flexion and 5degrees C extension lag, and 85% quadriceps strength. The technique accomplished the preoperative goals of restoring quadriceps function and anatomic position of the patella as well as allowing early mobilization after surgery. Although this reconstructive procedure is technically demanding, the functional results obtained can be excellent. We recommend the use of this technique for chronic patellar tendon ruptures that cannot be primarily repaired.

Dopa-responsive Dystonia Misdiagnosed as Cerebral Plasy: A Case Report / 대한정형외과학회잡지

Dopa-responsive dystonia (DRD) is a slowly progressive dystonia with childhood onset and is characterized by marked diurnal fluctuation of symptoms, dramatic response to levodopa treatment and concurrent signs of parkinsonism. We report a 16-year-old girl diagnosed as DRD. Around the age of 11, gait disturbance was developed with equinocavovarus deformity of both feet. The plantar fasciotomy, triple arthrodesis and posterior tibialis tendon transfer for left foot with the diagnosis of cerebral palsy were done. She complained of a persistent dystonia of all extremities after operation and was successfully treated with low-dose levodopa after a diagnosis of DRD. For the accurate diagnosis and prevention of unnecessary operation, trial of levodopa is warranted in patients suspected with cerebral palsy with similar symptoms of DRD.