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Orbital floor fractures are commonly encountered, but the dislocation of the eyeball into the maxillary sinus is relatively rare. When it does occur, globe dislocation can have serious consequences, including vision loss, enucleation, and orbito-ocular deformity. Immediate surgical intervention is typically attempted when possible. However, severe comorbidities and poor general health can delay necessary surgery. In this report, we present the surgical outcomes of a 70-year-old woman who received delayed treatment for traumatic eyeball dislocation into the maxillary sinus due to a subarachnoid hemorrhage and hemopneumothorax. Additionally, we propose a treatment algorithm based on our clinical experience and a review of the literature.
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Purpose@#To investigate the effect of preemptive systemic analgesia using patient-controlled analgesia (PCA) on postoperative pain after evisceration. @*Methods@#Of the patients who underwent evisceration under general anesthesia in our hospital, 55 who were able to evaluate pain using a numeral rating scale (NRS) were included. The patients were divided into two groups: group 1 used PCA after surgery, and group 2 used PCA preemptively before surgery. We compared the two groups in terms of the NRS pain scores on the day of surgery and 1, 2, and 3 days after surgery, and according to whether additional analgesics were used. @*Results@#The 55 patients included 17 in group 1 and 38 in group 2. The NRS at 3, 5, and 7 hours on the day of surgery tended to be lower in group 2, but not significantly (p > 0.05). The NRS on days 1 and 2 after surgery was significantly lower in group 2 (p = 0.014 and p = 0.027, respectively), and the NRS on day 3 after surgery was also lower, although not significantly (p = 0.059). Significantly fewer cases required additional analgesics in group 2 compared to group 1 on the day of surgery and 1, 2, and 3 days after surgery (p = 0.001, p < 0.001, p < 0.001, and p = 0.008, respectively). @*Conclusions@#Using preemptive systemic PCA in evisceration significantly reduced the postoperative pain, and PCA itself was an effective administration method due to the high rate of pain control without the need for additional analgesics.
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Interstitial granulomatous dermatitis (IGD) is a rare skin condition commonly associated with autoimmune diseases.Lesions typically occur bilaterally on the lateral trunk and proximal extremities and present as variable cutaneous lesions. A 63-year-old female with a 1-year history of a skin rash on her face visited the dermatology department of our hospital. The patient had received a dermal filler injection with unidentified gradients on the face of an unlicensed practitioner 20 years before. The lesions on the left cheek were tender, violaceous, coalescing, and annular. A violaceous round nodule with tenderness was observed on the left chin and glabella. She denied having any systemic complaints. The biopsy specimen showed diffuse interstitial CD68＋ histiocytic infiltration involving the reticular dermis around the degenerative collagen bundles. The patient was diagnosed with IGD. The patient was treated with systemic steroids and showed clinical improvement. Herein, we report a case of IGD after an unknown dermal filler injection, along with a literature review.
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With the advancement of Computer-Aided Design/Computer-Aided Manufacturing (CAD-CAM) technology, fabrication of dentures using this technology has gained popularity. As one of CAD-CAM technologies, digital complete denture system has been introduced, which fabricates complete dentures using subtractive manufacturing of monolithic block containing both the color of a denture base and an artificial tooth. In this case, two pairs of upper and lower dentures were fabricated for two patients. Two pairs of complete dentures were fabricated for a 74-year-old male and a 73-year-old female respectively by conventional denture fabrication method and digital method of milling. To obtain a digital complete denture, monolithic block (Ivotion, Ivoclar Vivadent, Schaan, Liechtenstein) was chosen for the materials to fabricate the digital complete dentures. An individual tray was designed using CAD software and manufactured by 3D printing technique. The final impression and interocclusal relationship were recorded using the fabricated individual tray. The final impression was scanned, and the complete denture design and try-in denture were 3D printed using CAD-CAM software. Subsequently, the monolithic block was milled, and the final dentures were fabricated and tried on patients. Previously mentioned two patient cases compared and analyzed stability, fit, speaking, mastication, aesthetics, and patient satisfaction of two pairs of dentures: one fabricated using CAD-CAM system and the other using traditional methods. This was performed to evaluate and report the findings from both denture-making approaches.
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Purpose@#We investigated the effect of preoperative administration of analgesics and sedatives on pain levels during silicone tube intubation conducted under local anesthesia in patients with acquired nasolacrimal duct stenosis. @*Methods@#We retrospectively reviewed the medical records from 121 patients at the ophthalmology department of our hospital from July 2016 to May 2022. In total, 71 patients were administered acetaminophen and diazepam orally, while the remaining 50 were not. Postoperative pain (measured using the visual analogue scale [VAS] score [0 = no pain, 10 = severe pain] immediately after operation), operative duration, and improvement in epiphora symptoms were compared between the two groups. @*Results@#The premedication group had significantly lower VAS scores than the non-premedication group (5.23 ± 2.75 vs. 6.34 ± 2.33, p = 0.02). It also had a notably shorter (p < 0.01) operation duration and higher subjective improvement rate of epiphora symptoms. However, premedication did not influence the tube retention period post-surgery (p = 0.86). @*Conclusions@#The administration of analgesics and sedatives prior to silicone tube intubation effectively mitigates operative pain and reduces operation duration. Furthermore, it may help improve postoperative epiphora symptoms.
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Background@#Prurigo nodularis (PN) is a severely pruritic chronic skin disease, and its management is challenging.Although some studies have described the natural course and demographics of PN, there are few studies on the quality of life (QOL) or psychological problems in patients with PN. @*Objective@#This study aimed to evaluate the QOL and psychological problems of PN patients and identify the factors which effect on the QOL and psychological problems of these patients. @*Methods@#We performed a cross-sectional study of 41 patients with PN who visited the Department of Dermatology at Konyang University Hospital between November 2022 and March 2023. Age, sex, clinical features, itch Numeric Rating Scale (NRS), Dermatology Life Quality Index (DLQI), Beck Depression Inventory (BDI), Insomnia Severity Index (ISI), and Beck Anxiety Inventory (BAI) were evaluated through the questionnaire. @*Results@#PN patients had mean DLQI, BDI, ISI, and BAI scores of 13.9, 15.0, 8.9, and 13.0, respectively. There were no significant differences in the DLQI, BDI, ISI, or BAI scores with respect to sex, smoking, alcohol, drug history, disease duration, or treatment duration. Patients with systemic diseases or other dermatologic diseases were more likely to have higher DLQI scores than those without any associated disease (p=0.043 and p=0.015). Moreover, patients with higher itch NRS scores had higher DLQI and ISI scores (p=0.002 and p=0.030). @*Conclusion@#We found that PN had a large impact on QOL and mental health. Therefore, we recommend that dermatologists pay close attention to the psychological aspects when treating and educating patients with PN.
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Clear cell acanthoma is a rare benign tumor, which usually presents as a solitary erythematous to brown colored papule or nodule, with a predilection for the lower leg of t hemiddle-aged and older individuals. An 11-year-old male presented with a 1-month history of bilateral brownish colored and exudative plaques on the both areolae.Histopathologic examination showed psoriasiform proliferation of pale keratinocytes and neutrophil exocytosis. Therefore, the patient was diagnosed with clear cell acanthoma. Typically, clear cell acanthoma occurs as a unilateral lesion on the leg in an adult. However, our case shows a bilateral lesion as well as the uncommon age and site.To our knowledge, this case of bilateral clear cell acanthoma has been rarely reported in Korea. Herein, we report a case of clear cell acanthoma that occurred on both areolae in a child.
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Primary cutaneous B-cell lymphomas are rare diseases comprising nodular to diffuse lymphoid cell infiltration with an overlying grenz zone and no epidermal involvement upon histological analysis. Diagnostics can become challenging when lymphomas exhibit the characteristics of both B and T-cells. Differential diagnoses may include reactive proliferations, cutaneous composite lymphomas, and transformed mycosis fungoides. Immunohistochemistry and gene arrangement tests may be beneficial to clarify the diagnosis. Herein, we report a rare case of epidermotropic EBV-positive cutaneous B-cell lymphoma along with a literature review.
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Objective@#Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. In contrast to neurocognitive measurements of inattention and impulsivity, there has been limited research regarding the objective measurement of hyperactivity in youths with ADHD. The purpose of the present study was to investigate the clinical effectiveness of a newly developed Robot-assisted Kinematic Measure for ADHD (RAKMA) in children with ADHD. @*Methods@#In total, 35 children with ADHD aged 5 to 12 years and 50 healthy controls (HCs) were recruited, and the parents completed the Child Behavior Checklist and the Korean ADHD Diagnostic Scale. RAKMA performance was represented by RAKMA stimulus–response and hyperactivity variables. We compared the RAKMA performance of those with ADHD and with that of HCs and also investigated the correlation between the RAKMA variables and ADHD clinical scale scores. @*Results@#Significant differences between the ADHD and HC groups were observed regarding most RAKMA variables, including correct reactions, commission errors, omission errors, reaction times, migration distance, and migration speed scores. Significant correlations were detected between various ADHD clinical scale scores and RAKMA variables. @*Conclusion@#The RAKMA was a clinically useful tool for objectively measuring hyperactivity symptoms in children with ADHD. Further studies with larger samples are warranted.
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Objective@#Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. In contrast to neurocognitive measurements of inattention and impulsivity, there has been limited research regarding the objective measurement of hyperactivity in youths with ADHD. The purpose of the present study was to investigate the clinical effectiveness of a newly developed Robot-assisted Kinematic Measure for ADHD (RAKMA) in children with ADHD. @*Methods@#In total, 35 children with ADHD aged 5 to 12 years and 50 healthy controls (HCs) were recruited, and the parents completed the Child Behavior Checklist and the Korean ADHD Diagnostic Scale. RAKMA performance was represented by RAKMA stimulus–response and hyperactivity variables. We compared the RAKMA performance of those with ADHD and with that of HCs and also investigated the correlation between the RAKMA variables and ADHD clinical scale scores. @*Results@#Significant differences between the ADHD and HC groups were observed regarding most RAKMA variables, including correct reactions, commission errors, omission errors, reaction times, migration distance, and migration speed scores. Significant correlations were detected between various ADHD clinical scale scores and RAKMA variables. @*Conclusion@#The RAKMA was a clinically useful tool for objectively measuring hyperactivity symptoms in children with ADHD. Further studies with larger samples are warranted.
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PURPOSE: Transforming growth factor-β-induced protein (TGFBIp) is highly expressed in the cornea, and mutant TGFBIp induces corneal diseases. However, the function of TGFBIp in cornea epithelium is not fully investigated. Here, we tested the importance of TGFBIp in regulation of gene expression and corneal epithelial cell (CEC) activity. MATERIALS AND METHODS: The effect of TGFBIp on CEC activity was analyzed by cell migration, adhesion, proliferation and wound healing assay. Analysis of gene expression was examined by western blot and quantitative reverse transcription PCR. RESULTS: The results demonstrated that TGFBIp increased adhesion, migration, proliferation, and wound healing of CECs. Analysis of gene expression presented that TGFBIp-stimulated CECs exhibited increased expression of mucin family genes, such as MUC1, -4, -5AC, and -16. Furthermore, TGFBIp treatment increased the expression of MUC1, -4, -5AC, -7, and -16 in conjunctival epithelial cells. TGFBIp also increased the activity of intracellular signaling molecules ERK and AKT in CECs. Using pharmacologic inhibitors of ERK and AKT, we showed that the expression of mucin genes by TGFBIp is mediated by the activation of ERK and AKT signaling. CONCLUSION: Our findings demonstrate that the locally generated TGFBIp in the cornea may contribute to wound healing of CECs by enhancing the migration, adhesion, and proliferation of CECs. In addition, our results suggest that TGFBIp has a protective effect on ocular surfaces by inducing the expression of mucin genes in corneal and conjunctival epithelial cells. These data suggest that TGFBIp is a useful therapeutic target for patients with corneal wounds.
Subject(s)
Humans , Blotting, Western , Cell Movement , Cornea , Corneal Diseases , Epithelial Cells , Epithelium , Gene Expression , Gene Expression Regulation , Mucins , Polymerase Chain Reaction , Reverse Transcription , Wound Healing , Wounds and InjuriesABSTRACT
PURPOSE: Pathologic aerophagia (PA) may lead to bowel perforation or volvulus in mentally retarded patients. The authors investigated the effects of clonazepam on the management of PA in children with severe to profound mental retardation (MR). METHODS: This study was undertaken as a retrospective case analysis of 21 PA patients with MR who were followed for over 12 months and diagnosed as having PA. Patients were assigned to two management groups, that is, to a clonazepam randomized open-labeled, treatment group or a reassurance group. The following were recorded and analyzed; age, response, remission rate to clonazepam treatment, and the side effect of clonazepam. It was defined positive response (response+) as being symptom-free for a whole week within 1 month of commencing treatment and remission(+) as being symptom-free for a whole month within 6 months of treatment. RESULTS: The average age of the 21 PA children with MR was 10 years and 13 patients were female. Symptom duration before diagnosis of PA was 7 months. Clinical features of the clonazepam-trial group (n=11) and the reassurance group (n=10) were non-significantly different. Response(+) was achieved by 2 patients (18.2%) in the clonazepam-trial group and by no patient in the reassurance group. Remission(+) was achieved by 6 patients (54.5%) in the clonazepam-trial group and by one patient (10%) in the reassurance group (p=0.040). CONCLUSION: When PA children with MR with severe bowel distention are considered for surgical treatment to prevent acute abdomen, a trial of clonazepam could be recommended.
Subject(s)
Child , Female , Humans , Abdomen, Acute , Aerophagy , Clonazepam , Diagnosis , Intellectual Disability , Intestinal Volvulus , Persons with Mental Disabilities , Retrospective StudiesABSTRACT
A 9-month-old infant presented with cough, tachypnea, and grunting was admitted. The patient was revealed to have cardiomegaly, high NT-proBNP, and severe left ventricular dilation and dysfunction; she was subsequently diagnosed with acute myocarditis and congestive heart failure. Intravenous immunoglobulin, inotropics, diuretics, angiotensin converting enzyme inhibitors and beta blocker were used. However, left hemiparesis suddenly developed at 30-day after treatment. Brain MRI showed high signal intensity in the right middle cerebral arterial territory on diffusion weighted brain MRI and in the left parietal lobe with gyral enhancement. Echocardiogram revealed no definite intraventricular thrombus. The patient was started on an antiplatelet agent only without anticoagulant therapy for the treatment of cerebral infarct in respect of the risk to the infant. Four years after the cerebral ischemic stroke (CIS), she showed complete recovery from hemiparesis, with no more CIS. In conclusion, severe ventricular dilatation and dysfunction can lead to thromboembolic events in infants. We should keep in mind that anticoagulant or antiplatelet agents can be used in specific situations.