Two Case Reports of Newly Diagnosed Crohn’s Disease after COVID-19 in Pediatric Patients / 대한소화기학회지

Since the coronavirus disease 2019 (COVID-19) outbreak caused by the severe acute respiratory syndrome-coronavirus-2 virus (SARS-CoV-2), various complications have been reported. Although most COVID-19 cases exhibited flu-like symptoms, COVID-19 may dysregulate the immune response and promote overwhelming levels of inflammation in some patients. Inflammatory bowel disease (IBD) is caused by dysregulated or inappropriate immune responses to environmental factors in a genetically susceptible host, and a SARS-CoV-2 infection may act as a possible cause of IBD. This paper describes two pediatric patients who developed Crohn’s disease following a SARS-CoV-2 infection. They were previously healthy before the SARS-CoV-2 infection. On the other hand, they started to develop fever and gastrointestinal symptoms several weeks after recovery from the infection. They were diagnosed with Crohn’s disease by imaging and endoscopic studies, and their symptoms improved after treatment with steroids and azathioprine. This paper suggests that a SARS-CoV-2 infection may trigger IBD in predisposed patients.

Clinical Comparison of Autorefractor versus Retinoscopic Refraction in Children according to the Age

PURPOSE: We analyzed the difference in values between noncycloplegic and cycloplegic autorefraction and refraction, as measured by ophthalmologist, in children according to age. METHODS: We classified the 84 children (153 eyes) whose best corrected visual acuity was better than 0.6 into four groups according to age. The first age group ranged from 29 to 57 months (36 eyes); the second age group ranged from 58 to 75 months (47 eyes); the third age group ranged from 76 to 95 months (36 eyes); and the fourth age group ranged from 96 to 121 months (34 eyes). The children were examined with an autorefractometer (Canon Auto Ref RK-2) and a retinoscope before and after cycloplegia. RESULTS: The children in all age groups tend to show more myopia in autorefraction than refraction regardless of cycloplegia. Also, differences in spherical component and spherical equivalents in noncycloplegic autorefraction and cycloplegic refraction were regarded as significant statistically (P<0.05) in all age groups. However, in all groups, none of the refractive values in cycloplegic autorefraction and refraction were statistically significant. CONCLUSION: Refraction measurement should be recommended for cycloplegic refraction in children. It is suggested that cycloplegic autorefraction could be useful for the refraction partially.

The Evaluation of the Difference between the Calculated Estimated Post-operative Refraction and the Real Post-operative Refraction for Five Types Intraocular Lenses

PURPOSE: To evaluate and compare the difference of predictive post-operative refraction preoperatively and real post-operative refraction among five types of intraocular lens. METHODS: We reviewed retrospectively 567 cataractous eyes that had undergone phacoemulsification or ECCE with posterior chamber intraocular lens (IOL) implantation by the same surgeon. Applied IOLs were AMO(R) Phacoflex(R) II SI40NB, Acrysof(R) MA60BM, Sensar(TM) AR40e, CeeOn(TM) 811B and CeeOn(TM) 720A. Prediction of post-operative refraction (predictive refraction) was calculated by the SRK/T formula with manufactured A constant. Post-operative manifest refraction (real refraction) was done at least 2 months postoperatively. We compared the difference between the predictive refraction and the real refraction by paired t-test. RESULTS: Total studied eyes were 390 eyes. In all groups, more myopic shift were observed than predicted. In AMO(R) Phacoflex(R) II SI40NB group, statistically significant difference was seen in postoperative manifest refraction over the predictive refraction as much as mean 0.46 diopter myopically (p<0.05, paired t-test), but others were not. In the AR40e implanted group, the error of predictive refraction was the smallest among groups. CONCLUSIONS: Prediction of postoperative refractive state was influenced by various clinical factors. Using a revised A constant, predictive error would be decreased. We recommend that every cataract surgeon had better have one's original A constant over each IOL and A constant may be revised when major surgical or biomedical measurement settings were changed.

The Analysis of Causes of the Postoperative Enophthalmos in Adult Blowout Fractures

PURPOSE: To evaluate clinical characteristics of adult blowout fractures who underwent orbital wall reconstruction and relationships between clinical factors and post operative complications. METHODS: The medical records of 29 patients with orbital blowout fractures who underwent orbital wall reconstruction were retrospectively reviewed from March, 2000 to November, 2001. Various clinical factors including cause of insult, fracture size, associated injuries, and preoperative enophthalmos were evaluated. Further factors which causes late postoperative enophthalmos were analyzed. RESULTS: Blowout fracture occurred most frequently between the ages of 20 and 29 years and was more common in male than female. The violence was the most common cause, and the most common fracture site was inferior wall combined with medial wall. After surgery extraocular movement limitation and diplopia were improved or eliminated. Preoperative mean enophthalmos was 2.83 mm and postoperative mean enophthamos was 1.27 mm. Fracture size was more predictable to late postoperative enophthalmos than the degree of preoperative enophthalmos measurement (Percent of Predication; with preoperative enophthalmos = 25%, with fracture size = 52%, p<0.05). CONCLUSIONS: In adult, the size of blowout fracture was large. Therefore enophthalmos was common complication after orbital wall reconstruction. The estimation of fracture size by using computed tomography was more predictable to late postoperative enophthalmos and easily accessible in clinic room as well as simple, therefore it is helpful to decide the early surgical reduction.

The Effects of Riluzole and Trolox in Transient Retinal Ischemia

PURPOSES: To evaluate the effect of riluzole (water soluble vitamin E, antioxidant) and trolox(glutamatergic neurotransmission antagonist) in transient retinal ischemia. METHODS: The effects of two drugs were investigated in a gerbil model of retinal ischemic injury. Retinal ischemia was induced by clipping both common carotid arteries for 15 minutes. In group I (10 eyes), 10 gerbils received an intraperitoneal injection of the saline, and in group II (10 eyes), riluzole was injected 30 minutes before ischemia and 30 minutes after the end of the ischemic insult and once daily during the recovery period. In group III (10 eyes), trolox was injected and in group IV (10 eyes), riluzole and trolox were injected in a same manner. Electroretinograms were recorded before ischemia and after 1 hour, 2 days, and 7days of reperfusion. Retinas were harvested for histopathology (hematoxyline-eosin staining and Tdt-dUTP terminal nick-end labeling method). RESULTS: Ischemia for 15 minutes caused reduction of a- and b- waves of the electroretinogram. Treatments with riluzole or trolox significantly enhanced the recovery of the reduced a-and b-waves after reperfusion. Combined treatment with riluzole and trolox also enhanced the recovery of the reduced a-and b-waves, but synergistic effect was not observed. Riluzole and trolox also prevented or attenuated ischemia induced cell death (necrosis and apoptosis). CONCLUSIONS: Riluzole and trolox acted in vivo as a potent neuroprotective agents against transient retinal ischemic model. Therefore, riluzole and trolox may be a major drug for use in the protection against retinal ischemic injury.

Breast Cancer Metastasis to Retrobulbar Area

PURPOSE: To report a case of metastatic breast adenocarcinoma to the orbit 4 years after the treatment of primary cancer. METHOD: Case presentation RESULT: The 53-year-old female presented with proptosis in her right eye of 2 months duration. She had a history of modified radical mastectomy and adjuvant chemotherapy for primary breast adenocarcinoma 4 years ago. Exophthalmometry showed her right eye to be protruded 4mm than her left eye. Adduction of her right eye was limited. Orbital CT revealed enhancing round mass on the right retrobulbar area. Excisional biopsy revealed and histopathologic exam was confirmed the mass to be an adenocarcinoma from breast. No other metastatic lesion was identified. CONCLUSION: Our case showed that breast carcinoma might metastasise to orbit several years following treatment of primary cancer. High index of suspicion is warranted.

A Peculiar Type of Anomalous Pancreaticobiliary Ductal Union / 대한소화기내시경학회지

Anomalous pancreaticobiliary ductal union (APBDU) is an uncommon anomaly, defined as the junction between the common bile duct and the pancreatic duct outside the duodenal wall and beyond the influence of the sphincter of Oddi. This anomaly, which has been recognized frequently since the introduction of ERCP, is believed to be associated with biliary tract lesions such as congenital biliary dilatation, biliary tract carcinoma, and pancreatic lesions such as pancreatitis new paragraph. A 28-year-old male was admitted due to sudden abdominal pain and vomiting. An ERCP revealed a peculiar type of APBDU; the duct of Wirsung and CBD fused and formed a long common channel before entering the major papilla, and the duct of Santorini connected to the duct of Wirsung is patent. So, when contrast dye was inserted into the minor papilla, both the CBD and the duct of Wirsung were made visible. This case of the peculiar type of APBDU which showed characteristic ERCP findings are herein reported.

A Case of Lipoid Pneumonia after Ingestion of Green Perilla Oil / 결핵

We report a case of lipoid pneumo nia in a 57-year-old man who had a history of ingestion of green perilla oil and residual neurologic deficit of cerebral infarction with right hemiparesis. Lipoid pneumonia was diagnosed by bronchoalveolar lavage.

A case of Thrombotic thrombocytopenic purpura - hemolytic uremic syndrome presenting with cortical blindness confirmed by MRI / 대한내과학회지

Thrombotic thrombocytopenic purpura (TTP) and the related hemolytic uremic syndrome (HUS) are disorders characterized by thrombocytopenia, microangiopathic hemolytic anemia, a variable degree of impairment of renal function and fluctuating neurological symptoms, which are thought to be due to platelet activation and subsequent formation of thrombi in the microcirculation. The fact that there was no clear-cut clinical and laboratory features that differentiate HUS from TTP has lead to view these two syndromes as a clinical continuum. Microvascular thrombosis is the typical lesion and closely related with endothelial injury and platelet activation. Pathologic alterations of the brain parenchyma are mainly manifested by small multiple infarcts. Numerous cases of CNS complications of these syndromes have been evaluated by using CT, but few reports have mentioned the MR findings. We experienced a case of TTP-HUS that had clinical features of cortical blindness and the brain lesion was confirmed by MRI showing cerebral infarct at the occipital area but it was reversible course. So we report this case with a brief review of literature.

Lipid-lowering effect of omega-3 fatty acid in patients with hypercholesterolemia

No abstract available.

Effect of the computerized EKG system on the family medicine residents' interpretation of EKGs

No abstract available.