Clinical Features of Recurrent Intermittent Exotropia after Reoperation for Intermittent Exotropia

PURPOSE: We reviewed the clinical features of intermittent exotropic patients who experienced recurrence after reoperation for intermittent exotropia, and identified the risk factors and prognoses. METHODS: The incidences, risk factors, treatment modalities, and prognoses of patients with recurrent exotropia were analyzed in 39 patients who underwent reoperation due to a relapse of exotropia after the first intermittent exotropia. RESULTS: Among 39 patients, 24 (61.5%) had recurrent intermittent exotropia and 15 patients had no recurrence with intermittent exotropia. There was no difference in the recurrence of intermittent exotropia with age, deviation, refraction, anisometropia, outward discrepancy, and the vertical deviation before the reoperation. However, when the first operation was performed with bilateral lateral rectus recession and the reoperation was performed with bilateral medial rectus resection or unilateral medial rectus resection, intermittent exotropia tended to recur more than when the first operation was performed with one eye with lateral rectus recession and medial rectus resection, followed by reoperation with the other lateral rectus recession and medial rectus resection (p 10 prism diopters (p < 0.05). CONCLUSIONS: The factors affecting recurrence after intermittent exotropia surgery involve surgical factors such as the surgical method and the postoperative overcorrection.

Recurred Macrodystrophia Lipomatosa of the Foot: A Case Report / 대한족부족관절학회지

We reported on a rare case of recurred macrodystrophia lipomatosa of the foot, and reviewed the literature. A 62-year-old male patient presented with right foot second toe pain; preoperative magnetic resonance imaging and radiograph examination was performed. After surgery the biopsy confirmed the diagnosis. American Orthopaedic Foot and Ankle Society score was checked before and after surgery. Wide excision of the affected area including ray amputation is an effective way to prevent recurrence and relieve the pain after surgery. The 2nd toe ray amputation was performed in the treatment of recurred macrodystrophia lipomatosa of the foot, and is thought to be an effective way to relieve pain and prevent recurrence. After minimally invasive surgery with complete excision surgery, additional data on recurrence and pain relief rate are needed.

Treatment of Recurred Iris Cyst with Laser Photocoagulation and Cystotomy

PURPOSE: To report a case of recurred iris cyst 11 years after treatment with endodiathermy, which was treated with laser photocoagulation and cystotomy followed by intraocular pressure elevation and underwent anterior chamber irrigation. CASE SUMMARY: A 46-year-old female presented to our department with decreased vision in her left eye that had persisted for several months. The patient had a history of surgical removal of an iris cyst with endodiathermy 11 years ago. Slit lamp examination showed an iris cyst adjacent to the nasal corneal limbus. The cyst was filled with turbid fluid. It distorted the pupil and threatened visual axis. Iris cystotomy (diameter larger than 500 microm) was done with diode laser photocoagulation and a neodymiumdoped yttrium aluminium garnet laser. At the same day, the patient's intraocular pressure elevated to 50 mm Hg in spite of maximal conservative treatment and went through anterior chamber irrigation. After six months, the iris cyst was adhered to corneal endothelium and disappeared. Visual acuity and intraocular pressure was within normal range. CONCLUSIONS: An iris cyst can recur after treatment with endodiathermy. Recurred iris cyst can be successfully treated with laser photocoagulation and cystotomy. However, turbid fluid inside the cyst may outflow to the anterior chamber and cause secondary ocular hypertension after treatment, so careful observation is needed.

A Case of Recurred Cholesteatoma Removal via Middle Cranial Fossa Approach / 대한이비인후과학회지

Cholesteatoma is a benign disease but it has an aggressive feature that may lead to serious conditions. Many strategies have been introduced for the treatment cholesteatoma, yet no definite single method has been established: it should be treated respectively regarding the completion of cholesteatoma, conservation of tympanic mucosa, proper ventilation of middle ear and preservation of hearing. A 25-year old patient visited our clinic for right-sided facial paralysis of 5 days. The patient underwent canal wall down mastoidectomy 10 years ago due to cholesteatoma and a few revision surgeries under local anesthesia for recurrence. Pre-operative temporal bone CT showed suspected recurred cholesteatoma in internal auditory canal and labyrinthine segment of facial nerve nearby. The patient underwent a removal of cholesteatoma via middle cranial fossa approach. This case report is a successful completion of recurred cholesteatoma, for which no recurrence is shown. Facial nerve function is improved at postoperative 1 year.

Recurred Parathyroid Carcinoma: A Case of Cervical Recurrence Presenting Discrepancy between Image Findings and Operative Findings / 대한내분비외과학회지

Parathyroid carcinoma is a rare malignancy presenting hyperparathyroidism. At times, diagnosis and localization are difficult. The optimum treatment for parathyroid carcinoma is en bloc resection when malignancy is highly suspicious or diagnosed. However, even after the adequate surgical treatment, persistent or recurrent disease is well encountered. Here we report a case with recurred parathyroid carcinoma presenting discrepancy between image findings and operative findings.

Treatment of MFH(Malignant fibrous histiocytoma) in Extremity

PURPOSE: Malignant fibrous histiocytoma(MFH) is the most common soft tissue sarcoma in adult. As to this date, tissue development, treatment and prognosis of the tumor has not been definitely clarified, however, it has been reported that wide surgical resection of the tumor along with the radiotheraphy and chemotheraphy is needed for treatment. In MFH with high recurrence rate, the reconstruction method and points to be considered for reconstruction in recurrent case were studied in 10 patients who were treated in our hospital. METHODS: From August of 1991 to August 2007, location of tumor, initial mass size, 1st recurred period, lymph node metastasis, recurrence rate, treatment modality, complication, reconstruction in recurrent defect, and follow up period was studied in 10 patients who underwent reconstruction at our Plastic surgery department following wide excision. RESULTS: The average age was 62.8(46-73) years old, average follow up period was 7.7(1-17) years. Various reconstructions has been performed for recurrent cases and postoperative chemotheraphy and radiotheraphy was done. As for reconstruction in recurrent cases, After wide excision, local flap was performed in 6 cases, and free flap in 2 cases. After radiotherapy, osteoradionecrosis was occurred in 4 cases. Recurrence rate was 1-5(2.6) times and reconstruction due to recurrence was 7 out of 10 cases(70%). CONCLUSION: The treatment modality of MFH is not yet defined. Due to it's high recurrence rate, radiotherapy and chemotherapy is commonly combined with surgery. Even still, additional excision and reconstruction may be required. Therefore, possibility of re-operation must be considered when performing every excision and reconstruction; in case a recurrence or osteoradionecrosis occurs. Free flap coverage should be left as the last resort, according to the principle of reconstruction. Nevertheless, if the defect is large or osteoradionecrosis is present, it will benefit greatly to the patient's quality of life.

Results of Re-operation on the Deviated Eye in Patients with Sensory Heterotropia

PURPOSE: To evaluate the result of re-operation on the deviated eye of recurred, consecutive or undercorrected sensory strabismus after surgery. METHODS: The medical records of 11 patients who had received second strabismus operation on the deviated eye due to recurred, consecutive or undercorrected sensory strabismus were studied retrospectively. RESULTS: Among the 11 patients, five patients were operated for recurred exotropia after surgery of sensory exotropia (group 1), two for consecutive exotropia after surgery of sensory esotropia (group 2), and four for undercorrected esotropia after surgery of sensory esotropia (group 3). Re-operation was performed 19.2+/-12.6 years after the first operation and the mean preoperative deviation before re-operation was 30.0+/-8.66 prism diopters (PD), 32.5+/-10.6PD, and 32.5+/-8.66PD, respectively. In all cases, a small amount of recession or resection compared with the usual surgical dosage was applied in re-operation on the deviated eye. The mean follow-up period after re-operation was 12.3+/-14.2 (1-48 months). Among the 11 patients, postoperative deviations less than 10PD were achieved postoperatively in 8 (72.7%) at 1 month and of the 8 patients with follow-up data beyond 6 months, 5 (62.5%) showed orthotropia within 10PD at 6 months or later. CONCLUSIONS: The surgical result of re-operation on the deviated eye of recurred, consecutive or undercorrected sensory strabismus after the first surgery was satisfactory in spite of the reduced amount of surgical correction compared with the surgical dosage recommended for the non-operated eye.

Results of Re-operation on the Deviated Eye in Patients with Sensory Heterotropia

PURPOSE: To evaluate the result of re-operation on the deviated eye of recurred, consecutive or undercorrected sensory strabismus after surgery. METHODS: The medical records of 11 patients who had received second strabismus operation on the deviated eye due to recurred, consecutive or undercorrected sensory strabismus were studied retrospectively. RESULTS: Among the 11 patients, five patients were operated for recurred exotropia after surgery of sensory exotropia (group 1), two for consecutive exotropia after surgery of sensory esotropia (group 2), and four for undercorrected esotropia after surgery of sensory esotropia (group 3). Re-operation was performed 19.2+/-12.6 years after the first operation and the mean preoperative deviation before re-operation was 30.0+/-8.66 prism diopters (PD), 32.5+/-10.6PD, and 32.5+/-8.66PD, respectively. In all cases, a small amount of recession or resection compared with the usual surgical dosage was applied in re-operation on the deviated eye. The mean follow-up period after re-operation was 12.3+/-14.2 (1-48 months). Among the 11 patients, postoperative deviations less than 10PD were achieved postoperatively in 8 (72.7%) at 1 month and of the 8 patients with follow-up data beyond 6 months, 5 (62.5%) showed orthotropia within 10PD at 6 months or later. CONCLUSIONS: The surgical result of re-operation on the deviated eye of recurred, consecutive or undercorrected sensory strabismus after the first surgery was satisfactory in spite of the reduced amount of surgical correction compared with the surgical dosage recommended for the non-operated eye.

A Case of Recurred Malignant Proliferating Trichilemmal Tumor of the Scalp

PURPOSE: To report the case of recurred malignant proliferating trichilemmal tumor on scalp METHODS: Case report and literature review RESULTS: A 40-year-old man presented with a recurred malignant proliferating trichilemmal tumor, which developed on the occipital area. It was 8 x 9 x 4.5 cm in size, protruded, firm and non-tender mass. This tumor was widely excised including normal skin margin and pericranium. Immediate reconstruction using free latissimus dorsi muscle flap and skin graft were done. Histopathologic examination revealed abrubt, compact trichilemmal keratinization in the central area of lobular epithelial proliferation. CONCLUSION: There has been no recurrence of tumor during follow-up period of nine months without adjuvant chemotherapy or radiotherapy.

Recurred Diffuse Pigmented Villonodular Synovitis of Ankle Joint: Case Report / 대한족부족관절학회지

Pigmented villonodular synovitis (PVNS) in ankle is relatively uncommon. This disorder results in increased proliferation of synovium causing villous or nodular changes containing histiocytes, fibroblasts, multinucleated giant cell, and hemosiderin. PVNS is classified into two different type : localized and diffuse. Diffuse type of PVNS in ankle is more common than localized type. Also, recurrence of diffuse type is more frequent. We report a case of diffuse type of PVNS which was recurred soon after the excision.

Frontalis Muscle Flap or Levator Resection for the Correction of Recurred Blepharoptosis

The challenge of accurately predicting eyelid height without recurrence after blepharptosis surgery is a well-known problem even in competent hands. The authors had experienced 24 recurred blepharoptosis cases from March 1999 to Feburuary 2004. 17 cases were unilateral recurred cases and the remains were bilateral cases. Previous methods in recurrent cases are as follows; Levator aponeurosis plication(2 cases), Levator resection(7 cases), Frontalis sling(15 cases). The period from first operation to secondary revision are between about 6 months to 25 years and mean period is about 6 years. The authors had managed recurrent cases with frontalis muscle advancement flap technique in 13 recurrent cases which had poor levator function or in case of frontalis muscle flap was already used. Levator resection was addressed in 11 cases which reserved levator function of more than 3mm. In Frontalis muscle flap case, the authors fixed superior-based frontalis muscle flap to tarsal plate through tunnel which was made with orbicularis oculi muscle. Among Levator resection cases, 8 cases were delayed correction cases and another 3 cases were immediate revision cases within 2 weeks after correction operation. The majority of our series recorded as satisfactory results. But, three of them gained undercorrection in follow-up period. Except for lid edema, troublesome complication just like exposure keratitis, corneal erosion was not observed. It can be safely suggested from our study that frontalis muscle advancement flap and levator resection are reasonable options in the correction of moderate to severe recurrent blepharptosis cases and the choice of recurred case management method should be accordance with levator function of patient and previously used techniques.

Removal of Recurred Pleomorphic Adenoma of Lacrimal Gland Via Coronal Approach

Pleomorphic adenoma that occurs in the orbit is rare but takes a great part of the tumors of the lacrimal glands. The tumor appears as a palpable mass in the upper and outer quadrant of the orbit. Common symptom is proptosis associated with some displacement of globe and some limitation of ocular movements. During the operation, injury to capsule surrounding the tumor leads to recurrence or malignant transformation of tumor by seeding of tumor cells into adjacent tissues. Therefore, complete removal of tumor without any injury to capsule is important. We report a case of recurred pleomorphic adenoma of lacrimal gland, which was removed via superolateral orbitotomy through coronal incision. The tumor was completely removed with no significant difficulties during operation. Coronal approach for removal of benign mixed tumor of lacrimal gland provides wide exposure of the tumor for complete removal of the mass and good cosmetic effects.

Recurred Ameloblastoma: A Case Report

A Recurred Case of Subacute Necrotizing Lymphadenitis(Kikuchi's Disease) During Childhood

Subacute necrotizing lymphadenitis, or Kikuchi's disease, primarily affects the cervical lyrnph nodes of lung adults and has a self-limited clinical course. Differential diagnoses are malignant lymphoma and systemic lupus erythematosus. Recurrence rate is low as 3.3%, and there have been a few reports describing the recurrence of the disease. The symptoms in almost all recurrent cases were similar to those of the early stages of the disease. The etiology of the disease remains unknown, but various viral infections and autoimmune processes have been postulated to be the cause. A 6-year-old boy presented with a fever of approximately 40C degrees, painless lumps on both sides of the neck, and intermittent abdominal pain for 2 weeks. Subacute necrotizing lymphadenitis was diagnosed 3 years before admission, which was reported by us in 1996. Diagnosis of recurred subacute necrotizing lymphadenitis was confirmed by histological examination of the lymph node. We report a recurred case of subacute necrotizing lymphadenitis during childhood.

The Clinical Results of Limbal Conjunctival Autograft Transplantation with Intraoperative Mitomycin C Application for Recurrent Pterygia

The recurrence is common problem to treat pterygium. Many surgical procedures were adopted to reduce the recurrence rate. We evaluated the surgical results of limbal conjunctival autograft transplantation (LCAT) accompanying application of 0.02% mitomycin C intraoperatively in 10 patients (10 eyes) who had a recurrent pterygium. There were 7 eyes with first recurrence and 3eyes with second recurrence. Mean age of the patients was 57.4 years, and mean follow-up period was 9.3 months. After a pterygium was excised, a sponge soaked in a solution of mitomycin C 0.02% was applied to the sclera at the site of the surgical bed for 2 minutes, then superior temporal limbal tissue was taken with conjunctival flap and transplanted to the excised area. None of all cases recurred for follow-up period and donor conjunctival site was well reepithelialized. In concluion, LCAT accompanying application of 0.02% mitomycin C intraoperatively was effective and safe method for recurrent pterygium.

Prognostic Factors Influenced to the Recurred Colorectal Cancer and Treatments

PURPOSE: Recurrent disease after curative surgery for primary colorectal cancer is well-known problem. Recurred colorectal cancer, even hepatic metastasis, can be operable in case of non-systemic metastasis. In those cases, a favorable prognosis is expected. But, regrettably in most cases which showed recurrence after curative surgery poor prognosis was remained. METHODS: In our hospital, we have experienced 98 patients with recurred colorectal cancer among 607 patients who had curative operation from Jan. 1980 to Feb. 1998. We analyzed retrospectively those patients and considered factors which influenced recurrence of disease and prognosis (type of recurrence, age, sex, location of tumor, histology of tumor, size of tumor, depth of tumor invasion, lymph node involvement, tumor stage, DNA ploidy pattern, serum CEA level, oncogene expression of tumor and reoperation). RESULTS: 1) The Mean of disease-free interval after curative operation was 15.9 months (range: 3.0~44.5 months). 2) Among total patients with recurrence, patients with local recurrence were 29 cases (29.6%), those with liver metastasis were 29 cases (29.6%), lung metastasis were 7 cases (7.1%), lung and liver metastasis were 7 cases (7.1%), peritoneal metastasis were 18 cases (18.4%), lymph node metastasis were 7 cases (7.1%), brain metastasis was 1 case (1.0%). 3) The curative reoperation was performed in 19 patients (19.4%). Those procedures were abdominoperineal resection (4), local perineal resection (6), hepatic resection (2), Hartmann's procedure (2), segmental resection of ileum (2), Whipple's operation (1), resection of ileal pouch in patient with FAP (1), oophorectomy (1). 4) Those factors which influenced recurrence were tumor stage, histologic type of tumor, depth of tumor invasion, lymph node status, preoperative serum CEA level. 5) The mean survival time of patients with recurred colorectal cancer was 25.1 months. The 36 months survival rate of patients with recurred colorectal cancer among various sites of recurrence was different significantly (p=0.04). Those patients with local recurrence showed most favorable prognosis (42.0% in 36 months survival rate) and those with liver metastasis showed worst prognosis (4.7%). 6) The 36 months survival rate of reoperative group was 54.3% and that of non-operative group was 20.5 months. The result of two groups was statistically different (p<0.001). CONCLUSIONS: We concluded that those factors which influenced recurrence in colorectal cancer were tumor stage, histologic type, invasion depth, lymph node status, and preoperative serum CEA level. Also the survival rate of reoperative group was higher than that of non-operative group statistically.

Failed Back Surgery Syndrome: Etiology and the Results of the Treatment / 대한척추외과학회지

STUDY DESIGN: We retrospectively analyzed 26 cases of failed back surgery syndrome. OBJECTIVE: To reveal the cause of failure, to analyze the results of treatment and to report how to prevent failure. SUMMARY OF LITERATURE REVIEW: The trend term failed back surgery syndrome(FBSS) is used to describe a heterogenous group of patients whose unifying factor is a persisting complaint of back and leg pain. FBSS is a serious problem to both patient and surgeon, and incidence is about 10-15 percent. MATERIALS AND METHOD: Twenty-six patients, who diagnosed as FBSS were followed up for 28 months on an average from 1994 to 1997. We analyzed cause of failure, treatment modalities and results of treatment. Clinical result was evaluated by Kirkaldy-Willis criteria. RESULTS: The causes of FBSS were recurred disc(9 cases), spinal stenosis(7 cases), epidural fibrosis(4 cases), segmental instability(2 cases) infection(2 cases), hematoma and worker's compensation(1 case each). The clinical results were good in case of recurved disc and having symptom free interval more than 6 months. According to kirkaldy-willis criteria, excellent and good results were in 18 cases of 26 cases and most of excellent results were obtained from recurred disc and combined spinal stenosis. CONCLUSION: Removal of mechanical cause and decompression were the most commonly used treatment modalities and posterolateral or anterior fusion was performed when instability was suspected.

Recurred Left Atrial and Left Ventricular Myxoma after Surgical Excision of Biatrial Atrial Myxoma

We report on a 28 years old female with recurred cardiac myxomas who presented with dizziness, headache, and blurred vision. She had an excision of biatrial atrial myxomas 10 years age. Varying sized multiple cerebral aneuysms and myxomas in left atrium and left ventricle were found on a cerebral angiogram and echocardiogram, respectively. After wide excision including interatrial septum and part of left ventricular septum, her symptoms were much improved.

Nuss procedure by Video-assisted thoracoscopy for the correction of recurred pectus excavatum / 重庆医科大学学报

Objective:To investigate the short-term effects of minimally invasive repair of recurred pectus excavatum.Methods:Eight patients were all treated with Nuss procedure,which were performed under general anesthesia with endotracheal intubation.A transverse incision was made in each lateral chest wall and a steel bar was passed under the sternum from the right thoracic cavity under thoracoscope,then the bar was turned over to raise the sternum to the normal position.The bar was fixed to ribs by using one stabilizing bar.Results:Eight cases all got the successful operation.The operation time ranged from 30 to 70 min(average 45 min) and the post-operative hospital stay ranged from 5 to 7 days.The post-operative pain were less than 3 days and without pneumothorax and subcutaneous emphysema.No unilateral stabilizing bar displacement and incision infection were found.Conclusion:The Nuss procedure is safe and effective for the correction of recurred pectus excavatum with good short-term results.