A Case of Sympathetic Ophthalmia due to Corneal Perforation in a Patient with Meningioma

PURPOSE: To describe a case of sympathetic ophthalmia due to corneal perforation caused by exposure keratitis in a patient with recurrent sphenoid wing meningioma. CASE SUMMARY: A 34-year-old female patient presented with proptosis in her left eye caused by left sphenoid greater wing meningioma despite tumor debulking surgery and radiation treatment. The cornea was perforated with prolapsed iris due to exposure keratitis, thus enucleation of the left eye was performed. After 2 weeks, an inflammatory reaction occurred in both eyes, keratic precipitates on corneal endothelium, exudative retinal detachment, and multiple granulomatous nodules on the right eye retina. The patient was diagnosed with sympathetic ophthalmia, thus enucleation of the left eye and debulking of the tumor were performed followed by a high-dose intravenous steroid therapy. At 5 months postoperatively, slit lamp biomicroscope showed no chamber reaction; improved disc swelling and exudative retinal detachment in the right eye were observed. CONCLUSIONS: Despite conservative treatment for exposure keratitis due to proptosis caused by malignant sphenoid meningioma, corneal perforation can develop. Because sympathetic ophthalmia can occur, the other eye should be monitored.

Aortic intramural hematoma after thrombolysis in a patient with acute massive pulmonary embolism

No abstract available.

A Case of Angiographic Embolization of Aortoenteric Fistula Caused by Endovascular Stent Grafting for an Abdominal Aortic Aneurysm / 대한소화기학회지

Aortoenteric fistula (AEF) developed after treatment for an abdominal aortic aneurysm (AAA) is a rare but usually fatal complication. We report a rare case of AEF bleeding after endovascular stent grafting for AAA which was managed angiographically. An 81-year-old man presented with hematochezia and acute abdominal pain for 1 day ago. Four years ago, an aortic stent was implanted in the infrarenal aorta for AAA. Endoscopies were performed to evaluate the hematochezia. Evidence of gastrointestinal bleeding was observed, but a clear bleeding point was not detected on upper endoscopy and colonoscopy. Contrast-enhanced computed tomography performed subsequently showed that the bleeding point was located in the fourth portion of the duodenum as an AEF caused by an inflammatory process in the stent-graft. Intra-arterial angiography showed a massive contrast leakage into the bowel via a small fistula from around the aortic stent graft site. Embolization was successfully performed by injecting a mixture of glue and lipiodol into the AEF tract. The patient was discharged with no evidence of gastrointestinal bleeding after the embolization.

An Unusual Case of Duodenal Obstruction due to Metastatic Cervical Cancer

We report a rare case of cervical cancer with duodenal obstruction accompanied by obstructive symptoms, which was treated using duodenal stenting. A 48-year-old woman was diagnosed with stage IV cervical cancer (according to the International Federation of Gynecology and Obstetrics staging system), which had invaded the vagina, the uterine body, and the external iliac and common iliac lymph nodes. Endoscopy showed an encircling mass with erythematous mucosa and luminal narrowing in the second and third portions of the duodenum, which prevented the endoscope from advancing. We placed an uncovered stent in the duodenum, which ameliorated abdominal discomfort, nausea, and vomiting, and simultaneously performed a biopsy. Endoscopic stent insertion appears to be the most effective treatment for duodenal obstruction in patients with advanced cancer.

A Case of Anaplastic Carcinoma of the Pancreas Mimicking a Gastrointestinal Stromal Tumor / 대한내과학회지

Anaplastic carcinoma of the pancreas is an extremely rare but aggressive, rapidly progressive tumor. It often presents with invasion of adjacent organs and distant metastases. Most cases are inoperable and confirmed by autopsy. A correct diagnosis of stomach invasion by anaplastic carcinoma of the pancreas is important due to the risk of bleeding, perforation by rapid tumor growth, and a poor prognosis. However, an accurate diagnosis is difficult as a result of the various clinical presentations, symptoms, and radiological findings. We herein report a case of anaplastic carcinoma of the pancreas in a 78-year-old woman who presented with stomach invasion mimicking a gastrointestinal stromal tumor.

Is Endoscopic Mucosal Resection a Sufficient Treatment for Low-Grade Gastric Epithelial Dysplasia?

BACKGROUND/AIMS: The rate of diagnosis of gastric adenoma has increased because esophagogastroduodenoscopy is being performed at an increasingly greater frequency. However, there are no treatment guidelines for low-grade dysplasia (LGD). To determine the appropriate treatment for LGD, we evaluated the risk factors associated with the categorical upgrade from LGD to high grade dysplasia (HGD)/early gastric cancer (EGC) and the risk factors for recurrence after endoscopic treatment. METHODS: We compared the complication rates, recurrence rates, and remnant lesions in 196 and 56 patients treated with endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR), respectively, by histologically confi rming low-grade gastric epithelial dysplasia. RESULTS: The en bloc resection rate was significantly lower in the EMR group (31.1%) compared with the ESD group (75.0%) (p1 cm with surface redness and depressions. CONCLUSIONS: For the treatment of LGD, EMR resulted in a higher incidence of uncertain resection margins and a lower en bloc resection rate than ESD. However, there was no signifi cant difference in recurrence rate.

A Full-Thickness Macular Hole in a Female Adult with Bilateral Retinal Capillary Hemangiomas

PURPOSE: We report a case of a full-thickness macular hole treated in a female adult with bilateral retinal capillary hemangiomas. CASE SUMMARY: A 20-year-old woman with bilateral retinal capilliary hemangiomas presented with blurred vision in her right eye. A thin epiretinal membrane and impending macular hole were found that did not appear to be related with a 2-disc-diameter-sized retinal angioma, telangiectactic vessels, and hard exudates in the lower retinal area of her right eye. Four months later, optical coherence tomography revealed a full-thickness macular hole in her right eye. A vitrectomy was performed, and the full-thickness macular hole was completely resolved.

A Case of Choroidal Neovascularization Occurring after Macular Hole Surgery

PURPOSE: To report a case of choroidal neovascularization after successful macular hole surgery in an eye with macular drusen. CASE SUMMARY: A 66-year-old woman visited our clinic complaining of decreased visual acuity in her right eye. Fundoscopy showed a full thickness macular hole in the right eye and bilateral scattered drusen. The patient underwent uncomplicated pars plana vitrectomy, internal limiting membrane peeling using triamcinolone, and perfluoropropane (C3F8) gas tamponade. One month after vitrectomy, the macular hole was closed. Twenty-four months following the macular hole surgery, the patient presented with defective vision in the right eye. Fluorescein angiography showed classic subfoveal choroidal neovascularization. Intravitreal bevacizumab was administrated three times in the right eye; however, visual improvement was not observed. CONCLUSIONS: In eyes with macular hole and drusen, the possibility of choroidal neovascularization developing after macular hole surgery should be considered.

Endothelial Dysfunction in the Smokers Can Be Improved with Oral Cilostazol Treatment

BACKGROUND: Smoking is one of well known environmental factors causing endothelial dysfunction and plays important role in the atherosclerosis. We investigated the effect of cilostazol could improve the endothelial dysfunction in smokers with the measurement of flow-mediated dilatation (FMD). METHODS: We enrolled 10 normal healthy male persons and 20 male smokers without any known cardiovascular diseases. After measurement of baseline FMD, the participants were medicated with oral cilostazol 100 mg bid for two weeks. We checked the follow up FMD after two weeks and compared these values between two groups. RESULTS: There was no statistical difference of baseline characteristics including age, body mass index, serum cholesterol profiles, serum glucose and high sensitive C-reactive protein between two groups. However, the control group showed significantly higher baseline endothelium-dependent dilatation (EDD) after reactive hyperemia (12.0 +/- 4.5% in the control group vs. 8.0 +/- 2.1% in the smoker group, p = 0.001). However, endothelium-independent dilatation (EID) after sublingual administration of nitroglycerin was similar between the two groups (13.6 +/- 4.5% in the control group vs. 11.9 +/- 4.9% in the smoker group, p = 0.681). Two of the smoker group were dropped out due to severe headache. After two weeks of cilostazol therapy, follow-up EDD were significantly increased in two groups (12.0 +/- 4.5% to 16.1 +/- 3.7%, p = 0.034 in the control group and 8.0 +/- 2.1% to 12.2 +/- 5.1%, p = 0.003 in the smoker group, respectively). However, follow up EID value was not significantly increased compared with baseline value in both groups (13.6 +/- 4.5% to 16.1 +/- 3.7%, p = 0.182 in the control group and 11.9 +/- 4.9% to 13.7 +/- 4.3%, p = 0.430 in the smoker group, respectively). CONCLUSION: Oral cilostazol treatment significantly increased the vasodilatory response to reactive hyperemia in two groups. It can be used to improve endothelial function in the patients with endothelial dysfunction caused by cigarette smoking.

Prevalence and Patterns of Left Ventricular Dysfunction in Patients with Pheochromocytoma

BACKGROUND: Excessive catecholamine release in pheochromocytoma is known to cause transient reversible left ventricular (LV) dysfunction, such as in the case of pheochromocytoma-associated catecholamine cardiomyopathy. We investigated patterns of clinical presentation and incidence of LV dysfunction in patients with pheochromocytoma. METHODS: From January 2004 to April 2011, consecutive patients with pheochromocytoma were retrospectively studied with clinical symptoms, serum catecholamine profiles, and radiologic findings. Patterns of electrocardiography and echocardiography were also analyzed. RESULTS: During the study period, a total of 36 patients (21 males, 49.8 +/- 15.8 years, range 14-81 years) with pheochromocytoma were included. In the electrocardiographic examinations, normal findings were the most common findings (19, 52.8%). LV hypertrophy in 12 cases (33.3%), sinus tachycardia in 3 (8.3%), ischemic pattern in 1 (2.8%) and supraventricular tachycardia in 1 (2.8%). Echocardiographic exam was done in 29 patients (80.6%). Eighteen patients (62.1%) showed normal finding, 8 (27.6%) revealed concentric LV hypertrophy with normal LV systolic function, and 3 (10.3%) demonstrate LV systolic dysfunction (LV ejection fraction < 50%). Three showed transient LV dysfunction (2 with inverted Takotsubo-type cardiomyopathy and 1 with a diffuse hypokinesia pattern). Common presenting symptoms in the 3 cases were new onset chest discomfort and dyspnea which were not common in the other patients. Their echocardiographic abnormalities were normalized with conventional treatment within 3 days. CONCLUSION: Out of total 36 patients with pheochromocytoma, 3 showed transient LV systolic dysfunction (catecholamine cardiomyopathy). Pheochromocytoma should be included as one of possible causes of transient LV systolic dysfunction.

A Case of Colonic Metastasis from Borderline Ovarian Cancer

This report describes the case of a patient who had previously undergone surgery for resection of bilateral ovarian tumors and after 5 years presented with colonic metastasis. A 70-year-old woman visited the hospital for a clinical survey due to severe anemia. In 2007, the patient was diagnosed with cancer (papillary serous adenocarcinoma) in both ovaries. The patient had undergone total abdominal hysterectomy with bilateral salpingo-oophorectomy followed by postoperative adjuvant chemotherapy. After treatment, the patient was stable during follow-up. After 5 years, she underwent incidental colonoscopic examination because of severe anemia. The colonoscopic findings revealed an elevated irregular lesion in the descending colon. Colonic metastasis from the papillary serous adenocarcinoma of the ovary was confirmed by immunohistochemical staining during the pathological diagnosis.

A Case of Bilateral Corneal Wound Dehiscence With Iris Prolapse After Coronary Bypass Surgery

PURPOSE: To report a case of bilateral corneal wound dehiscence with iris prolapse after coronary artery bypass surgery. CASE SUMMARY: A 65-year-old woman complained of sudden bilateral vision loss. Slit lamp microscope examination showed bilateral corneal wound dehiscence, collapse of the anterior chamber and iris prolapse. The patient had a history of bilateral cataract surgery one-month earlier and a coronary artery bypass surgery one-day previously. The authors resutured the corneal wound and performed an emergency iris repositioning. Postoperative 1 day, the best corrected visual acuity (BCVA) was 0.3 in the right eye and hand motion in the left eye. Total hyphema was observed in the left eye. At postoperative 2 months, the right eye had a BCVA of 0.63 with a sutured state of the corneal wound, and the left eye had a BCVA of light perception with a clotted hemorrhage in the anterior chamber. CONCLUSIONS: When a patient with a history of a previous sutureless cataract surgery has a coronary bypass surgery under general anesthesia, corneal wound dehiscence and iris prolapse may occur. For those patients, the authors recommend suturing the corneal wound instead of sutureless cataract surgery.

Thrombotic Occlusion of the Radial Artery as a Complication of the Transradial Coronary Intervention

No abstract available.

A Case with Acute Pulmonary Thromboembolism Associated with Nephrotic Syndrome

Though nephrotic syndrome is associated with various thromboembolic phenomena, acute pulmonary thromboembolism is a rare complication. We experienced a case with acute pulmonary thromboembolism in a patient with generalized edema and profound proteinuria. Subsequent investigation revealed that the pulmonary thromboembolism was secondary to nephrotic syndrome due to membranous glomerulonephritis. This thromboembolic complication was successfully treated with thrombolysis and anticoagulation.

A Case with Acute Pulmonary Thromboembolism Associated with Nephrotic Syndrome

Though nephrotic syndrome is associated with various thromboembolic phenomena, acute pulmonary thromboembolism is a rare complication. We experienced a case with acute pulmonary thromboembolism in a patient with generalized edema and profound proteinuria. Subsequent investigation revealed that the pulmonary thromboembolism was secondary to nephrotic syndrome due to membranous glomerulonephritis. This thromboembolic complication was successfully treated with thrombolysis and anticoagulation.

Prelude of Tragedy: Entrapped Huge Thrombi into a Patent Foramen Ovale Impending Paradoxical Embolism

Infrequently, patent foramen ovale or atrial septal defect act as a passage for the venous thrombi to reach the arterial circulation. These arterial thrombi can evoke tragic paradoxical embolisms. We report a case of impending paradoxical embolism due to a huge thrombus trapped through a patent foramen ovale in a 66-year-old man who presented with sudden dyspnea and chest discomfort in ten days after colon cancer surgery. The transthoracic echocardiogram demonstrated signs of acute right ventricular pressure overload and a huge linear mass wedged in a patent foramen ovale. On the intraoperative transesophageal echocardiography, the huge linear mass was freely floating in both right and left cardiac chambers passing through atrial septum. To prevent paradoxical embolism from this thrombus, he underwent emergent embolectomy and about 25 cm sized linear thrombus entrapped PFO was successfully removed.

The Clinical Consideration of Sensory Strabismus

PURPOSE: To evaluate the factors influencing the direction of sensory strabismus and the consequent surgical outcomes. METHODS: We retrospectively reviewed the medical records of 150 sensory strabismus patients who had undergone surgery. Consisting of 38 esotropes and 112 exotropes. Parameters considered were the cause of vision loss, the age at vision loss, the refractive error of the sound eye, the interorbital distance in the posteroanterior view of the orbit, the deviation angle at postoperative 6 months and 1 year. Patients were excluded if the cause of vision loss was strabismic amblyopia. RESULTS: The major causative factors of sensory strabismus were corneal opacity (26.7%) followed in frequency by cataract (22.7%), and optic nerve disorder (15.3%). The age at vision loss, the refractive error of the sound eye, and the inner and outer interorbital distance were statistically significant among the considered factors in determining the direction of sensory strabismus. At postoperative 6 months, 69.3% of the patients maintained the alignment within 10 PD of orthotropia and 70.4% at 1 year. CONCLUSIONS: We considered that the age at vision loss, the refractive error of the sound eye, and the inner and outer interorbital distance could play a role in determining the direction of sensory strabismus. In spite of the deficit of sensory fusion, the surgical outcomes of sensory strabismus remained favorable at 1 year after surgery.

The Effect of PRK and LASIK for the Correction of Postkeratoplasty Astigmatism

PURPOSE: To evaluate the effect of photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) procedure on eyes with high astigmatism after penetrating keratoplasty. METHODS: Thirteen eyes of 12 patients who had PRK (6 eyes) or LASIK (7 eyes) after penetrating keratoplasty were retrospectively reviewed. All patients had a stable postkeratoplasty astigmatism over 4.0D for a minimum of 6 months after all sutures were removed. We followed up patients in early phase (1~3 months) and late phase (6~12 months). RESULTS: Mean preoperative astigmatism in PRK patients was 7.96 +/- 2.63D and in LASIK patients 8.27 +/- 2.96D. Astigmatic magnitude decreased 54% in early phase, and 34% in late phase in PRK group. It decreased 58% in early phase, and 55% in late phase in LASIK group. The reduction of astigmatism and postoperative regression were not stastically significant between two groups. Postoperative uncorrected visual acuity improved 67% in PRK group and 86% in LASIK group above 2 Snellen chart lines. Postoperative corneal haze developed in 3 eyes of PRK group. CONCLUSIONS: PRK and LASIK resulted in improved uncorrected visual acuity and refraction in postkeratoplsty eyes with high astigmatism. But both procedures showed cylinderical undercorrection and postoperative regression in refraction. Mild corneal haze was common after PRK procedure.

Clinical Consideration of Prednisolone Induced Cataract

PURPOSE: The purpose of this paper was to examine the correlation between the development of posterior subcapsular cataract and the dosage and duration of systemic steroid therapy. METHODS: Twenty-two eyes which underwent cataract surgery at our ophthalmologic department were enrolled, along with 20 randomly selected eyes, which received prednisolone therapy at least for 1 year. We examined prednisolone dosage, duration and systemic disorders. We compare daily prednisolone dosage, and duration between the subcapsular opacity group and the non-subcapsular opacity group. SPSS, with 2 way- ANOVA system, was used for statistical analysis. RESULTS: The development of posterior subcapsular cataract was correlated with the daily prednisolone dosage, but not with the duration of prednisolone therapy (p<0.05). CONCLUSIONS: Careful attention to the daily steroid dosage is required to prevent posterior subcapsular cataract formation.

A Case of Ochrobactrum Anthropi Endophthalmitis after Cataract Surgery

PURPOSE: To report a case of Ochrobactrum anthropi endophthalmitis following cataract extraction and intraocular lens implantation. METHODS: A 57-year-old man was refered for evaluation and management of chronic uveitis on his left eye. He had undergone cataract surgery 1 year previously. His visual acuity of left eye was 20/100. The left eye had marked inflammation in anterior chamber and vitreous cavity. We performed pars plana vitrectomy with removal of the intraocular lens and intravitreal antibiotics injection (Amikacin 0.4 mg/0.1 ml). RESULTS: Microbiologic examination of the anterior chamber fluid, intraocular lens disclosed Ochrobactrum anthropi, a gram-negative bacillus. Twelve weeks after vitrectomy, his left corrected visual acuity was 20/25 and anterior segment showed no inflammatory cell.