Bromfenac as Adjunctive Treatment with Intravitreal Bevacizumab in Branch Retinal Vein Occlusion of Macular Edema

PURPOSE: To evaluate the effectiveness of 0.1% topical bromfenac as an adjunctive treatment with intravitreal bevacizumab (IVB) injection for branch retinal vein occlusion (BRVO) patients.METHODS: We retrospectively evaluated 68 eyes of 68 patients with macular edema (ME) secondary to BRVO who were treated with IVB injection and followed up for at least 12 months. Of the 68 eyes, 38 were treated with IVB combined with 0.1% topical bromfenac and 30 were treated with IVB alone. IVB reinjection was performed in cases of recurrence. The primary outcome measurement was the number of IVB injections. Changes in the best-corrected visual acuity (BCVA) and central foveal thickness (CFT) during the 12-month follow-up were compared.RESULTS: There was no significant difference in the BCVA or CFT between the two groups at the initial and final examinations. However, the number of IVB injections was significantly lower in the 0.1% bromfenac-treated eyes (p < 0.01) than in the control eyes (4.1 ± 0.7 vs. 5.0 ± 0.6 times).CONCLUSIONS: Compared to IVB monotherapy, topical bromfenac as an adjunctive treatment with IVB injection of eyes with ME secondary to BRVO did not affect visual outcomes, but it reduced the number of IVB injections.

Isolated Pulmonary Langerhans Cell Histiocytosis in an Infant Diagnosed by CD1a Immunostaining of Bronchoalveolar Lavage Cells: A Case Report and Literature Review / 임상소아혈액종양

Isolated pulmonary Langerhans cell histiocytosis (LCH) is a very rare disease in childhood. We report a case of a 5-month-old girl with isolated pulmonary LCH, who was transferred due to incidental chest x-ray finding of multiple cystic lesions without any clinical symptoms. Chest computed tomography (CT) finding suggested that pulmonary LCH was likely, but evaluations including lung biopsy were negative. At a follow-up visit three months later, we performed bronchoalveolar lavage (BAL) fluid analysis and confirmed the presence of CD1a-positive cells, thereby confirming diagnosis of pulmonary LCH. After completing eight months of chemotherapy, yearly follow-up evaluations were performed and there has been no evidence of reactivation of the disease for four years. Based on our case, we suggest that BAL with immunohistochemical staining can be a valuable modality to eliminate the possibility of infection and other infiltrating disorders, and diagnose pulmonary LCH in case of suspicious pulmonary lesions.

Recurrent pyogenic liver abscess as a presenting manifestation of colorectal cancer

No abstract available.

Isolated Pulmonary Langerhans Cell Histiocytosis in an Infant Diagnosed by CD1a Immunostaining of Bronchoalveolar Lavage Cells: A Case Report and Literature Review / 임상소아혈액종양

Isolated pulmonary Langerhans cell histiocytosis (LCH) is a very rare disease in childhood. We report a case of a 5-month-old girl with isolated pulmonary LCH, who was transferred due to incidental chest x-ray finding of multiple cystic lesions without any clinical symptoms. Chest computed tomography (CT) finding suggested that pulmonary LCH was likely, but evaluations including lung biopsy were negative. At a follow-up visit three months later, we performed bronchoalveolar lavage (BAL) fluid analysis and confirmed the presence of CD1a-positive cells, thereby confirming diagnosis of pulmonary LCH. After completing eight months of chemotherapy, yearly follow-up evaluations were performed and there has been no evidence of reactivation of the disease for four years. Based on our case, we suggest that BAL with immunohistochemical staining can be a valuable modality to eliminate the possibility of infection and other infiltrating disorders, and diagnose pulmonary LCH in case of suspicious pulmonary lesions.

Anatomical Characteristics of End-stage Exudative Age-related Macular Degeneration Refractory to Intravitreal Anti-vascular Endothelial Growth Factor Injection

PURPOSE: To analyze the anatomical characteristics on spectral-domain optical coherence tomography (SD-OCT) of patients who are legally blind (less than 20/1,000) due to end-stage exudative age-related macular degeneration (AMD) that does not require intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection. METHODS: After anti-VEGF injections (active group), 120 eyes of 103 exudative AMD patients experienced visual acuity improved by at least 2 lines or improvement on SD-OCT. In addition, 55 eyes of 54 end-stage exudative AMD patients who did not respond to treatment or who were legally blind due to foveal scar at the first visit (end-stage group) were evaluated retrospectively. Changes in retinal structures of the 2 groups were analyzed by SD-OCT at the last visit. RESULTS: The mean age of the end-stage group was about 5 years older than the active group. During the follow-up period, subretinal hemorrhage, intraretinal hemorrhage and retinal pigment epithelium tear occurred more frequently in the end-stage group than in the active group (p < 0.05). Intra-retinal fluids and subretinal fluids were more frequently administered in the active group than in the end-stage group, and thick subretinal hyper-reflective materials (SRHRM), fibrovascular pigment epithelial detachment (PED) and extensive inner segment/outer segment (IS/OS) line disruption were observed in all eyes of the end-stage group. The size and thickness of PED, foveal thickness and SRHRM thickness were significantly larger in the end-stage group than in the active group (p < 0.05). Disciform retinal scars were eventually formed in most of the end-stage group. CONCLUSIONS: In end-stage exudative AMD, the presence of retinal hemorrhage and retinal pigment epithelium tear during follow-up, or the findings of thick SRHRM, fibrovascular PED, and extensive IS/OS line disruption on SD-OCT suggest weak expected effect of intravitreal anti-VEGF injection, which can act as a reference for determining the timing of treatment termination.

Anatomical Characteristics of End-stage Exudative Age-related Macular Degeneration Refractory to Intravitreal Anti-vascular Endothelial Growth Factor Injection

PURPOSE: To analyze the anatomical characteristics on spectral-domain optical coherence tomography (SD-OCT) of patients who are legally blind (less than 20/1,000) due to end-stage exudative age-related macular degeneration (AMD) that does not require intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection. METHODS: After anti-VEGF injections (active group), 120 eyes of 103 exudative AMD patients experienced visual acuity improved by at least 2 lines or improvement on SD-OCT. In addition, 55 eyes of 54 end-stage exudative AMD patients who did not respond to treatment or who were legally blind due to foveal scar at the first visit (end-stage group) were evaluated retrospectively. Changes in retinal structures of the 2 groups were analyzed by SD-OCT at the last visit. RESULTS: The mean age of the end-stage group was about 5 years older than the active group. During the follow-up period, subretinal hemorrhage, intraretinal hemorrhage and retinal pigment epithelium tear occurred more frequently in the end-stage group than in the active group (p < 0.05). Intra-retinal fluids and subretinal fluids were more frequently administered in the active group than in the end-stage group, and thick subretinal hyper-reflective materials (SRHRM), fibrovascular pigment epithelial detachment (PED) and extensive inner segment/outer segment (IS/OS) line disruption were observed in all eyes of the end-stage group. The size and thickness of PED, foveal thickness and SRHRM thickness were significantly larger in the end-stage group than in the active group (p < 0.05). Disciform retinal scars were eventually formed in most of the end-stage group. CONCLUSIONS: In end-stage exudative AMD, the presence of retinal hemorrhage and retinal pigment epithelium tear during follow-up, or the findings of thick SRHRM, fibrovascular PED, and extensive IS/OS line disruption on SD-OCT suggest weak expected effect of intravitreal anti-VEGF injection, which can act as a reference for determining the timing of treatment termination.

Short-Term Comparison of Surgical Results between One-Haptic and Two-Haptics Transscleral Fixation of Intraocular Lens

PURPOSE: To compare the short-term clinical outcomes of transscleral fixation intraocular lens (IOL) with two haptics or one haptic. METHODS: We retrospectively reviewed the medical records of 26 patients with transscleral fixation of IOL (11 with one-haptic fixation, 15 with two-haptic fixation) except in patients whose visual acuity is not expected to improve due to retinal problems or ocular trauma. We analyzed the manifest refraction, visual acuity, refractive error preoperatively and postoperatively, preoperative IOL decentration, operating time, and postoperative complications. RESULTS: When comparing the two groups preoperatively, the mean lens decentration in the one-haptic group was 2.73 ± 2.88 mm and 4.59 ± 2.18 mm in the two-haptics group. The decentration in the two-haptic group was greater than in the one-haptic group, but not significantly. Visual acuity and refractive power were not significantly different between the groups. The mean operation time (minutes) was 65.00 ± 22.69 and 93.66 ± 29.54 in the one-haptic and two-haptic groups, respectively. The operation time in the one-haptic group was significantly shorter than in the two-haptic group (p = 0.020). When comparing visual acuity preoperatively and postoperatively, both groups showed significant improvement (p < 0.01). However, refractive error and postoperative IOL decentration were similar between the groups. CONCLUSIONS: The short-term surgical results of transscleral fixation using the two surgical techniques were not different; one-haptic transscleral fixation was preferred due to shorter operation time and lower patient discomfort.

Test Guidelines for Initial Diagnosis of Hematologic Neoplasms

The standardization committee of the Korean Society for Laboratory Hematology sought to establish standardized testing guidelines for the diagnosis of hematologic malignancies. The guidelines were developed on the basis of survey results and international guidelines, including the National Comprehensive Cancer Network Guidelines and European LeukemiaNet recommendations. The committee expects that the diagnostic guidelines presented here will enhance diagnostic test standardization and clinical decision making and that the novel developments due to new molecular technologies will be integrated into the diagnostic algorithms through ongoing consensus initiatives.

Low prealbumin levels are independently associated with higher mortality in patients on peritoneal dialysis

BACKGROUND: Prealbumin, a sensitive marker for protein–energy status, is also known as an independent risk factor for mortality in hemodialysis patients. We investigated the impact of prealbumin on survival in incident peritoneal dialysis (PD) patients. METHODS: In total, 136 incident PD patients (mean age, 53.0 ± 15.8 years) between 2002 and 2007 were enrolled in the study. Laboratory data, dialysis adequacy, and nutritional parameters were assessed 3 months after PD initiation. Patients were classified into 2 groups according to prealbumin level: high prealbumin (≥ 40 mg/dL) and low prealbumin (< 40 mg/dL). RESULTS: The patients in the low-prealbumin group were older and had more comorbidities such as diabetes and cardiovascular diseases compared with the patients in the high-prealbumin group. Mean subjective global assessment scores were lower, and the high-sensitivity C-reactive protein levels were higher in the low-prealbumin group. Serum creatinine, albumin, and transferrin levels; percent lean body mass; and normalized protein catabolic rate were positively associated, whereas subjective global assessment scores and high-sensitivity C-reactive protein levels were negatively associated with prealbumin concentration. During the median follow-up of 49 months, patients in the lower prealbumin group had a higher mortality rate. Multivariate analysis revealed that prealbumin < 40 mg/dL (hazard ratio, 2.30; 95% confidence interval, 1.14–4.64) was an independent risk factor for mortality. In receiver operating characteristic curves, the area under the curve of prealbumin for mortality was the largest among the parameters. CONCLUSION: Prealbumin levels were an independent and sensitive predictor for mortality in incident PD patients, showing a good correlation with nutritional and inflammatory markers.

Characteristics of Polypoidal Choroidal Vasculopathy Associated with Subretinal Hemorrhage

PURPOSE: To evaluate the clinical features and risk factors of hemorrhagic complications in polypoidal choroidal vasculopathy (PCV) using spectral domain-optical coherence tomography (SD-OCT) and indocyanine green angiography (ICGA). METHODS: We respectively reviewed the data from 43 patients (45 eyes) diagnosed with PCV who received ICGA between January 2010 and October 2013. The patients were divided into 2 groups: 16 patients (17 eyes) with subretinal hemorrhage (subretinal hemorrhagic PCV group) and 27 patients (28 eyes) without subretinal hemorrhage (control group). Based on the ICGA and SD-OCT findings, the number, morphology, location, size of polyps, pigment epithelial detachment (PED), and serous retinal detachment (SRD) were measured and compared between the 2 groups. We also analyzed systemic diseases and history of antithrombotic agents associated with subretinal hemorrhage in PCV. RESULTS: The size of polyps measured by ICGA was significantly different between the 2 groups (p = 0.006). As the size of polyps increased, the size of subretinal hemorrhage, height of PED, base diameter and height of SRD increased (p 0.05). CONCLUSIONS: The patients in the subretinal hemorrhagic PCV group had larger-sized polyps than the patients in the control group. This result suggests that eyes with larger-sized polyps are at risk for hemorrhagic complications and require more careful follow-up and observation in PCV treatment-naive patients.