Effects of Glaucoma Medication on Dry Eye Syndrome and Quality of Life in Patients with Glaucoma

Purpose@#To investigate ocular surface diseases and changes in the quality of life of patients using glaucoma medications. @*Methods@#Participants were divided into the normal (31 individuals, 62 eyes) and glaucoma medication (30 patients, 60 eyes) groups. Changes in tear break-up time, lipid layer thickness (LLT), corneal and conjunctival staining scores, ocular surface disease index (OSDI), and Visual Function Questionnaire 25 (VFQ-25) score were assessed for 1 year. @*Results@#The change in mean LLT was lower in glaucomatous eyes than in control eyes (p = 0.019) after 1 year. The results of OSDI deteriorated (p’ = 0.008), but conjunctival staining and Schirmer test results showed improvement in glaucomatous eyes compared to those in control eyes (p’ =0.035 and 0.009, respectively). The average LLT decreased at 6 and 12 months, but there was no change at 24 months. In pairwise analysis, the decrease in LLT over the first 6 months was statistically significant (p < 0.001) and remained unchanged until 24 months. Among the VFQ items, scores for near activity and social function deteriorated over 1 year in the medication group (p’ = 0.033 and 0.015, respectively). However, there was no difference in the total VFQ score. @*Conclusions@#Significant reduction in LLT and deterioration of OSDI were observed in the medication group compared to the control group. However, this deterioration was observed only in the first 6 months. There was no significant difference in the VFQ total score. Nonetheless, there were significant differences in near activity and social function between the control and medication groups. Therefore, the results of this study showed that although glaucoma medication worsened eye dryness, the change was limited and did not worsen the quality of life. Glaucoma medication should be used with the consideration that they can limit near activity and social functioning.

Pseudopapilledema Combined with Idiopathic Papilledema in a Child Receiving Growth Hormone Treatment

Purpose@#We report a case of pseudopapilledema combined with idiopathic papilledema in a pediatric patient receiving growth hormone treatment.Case summary: An 11-year-old girl without any underlying disease presented with bilateral transient visual obscurations, a dark-adaptation disorder, and helplessness that developed while she had been on growth hormone therapy for 3 months at a local clinic. Reduced visual acuity (from 20/20 to 20/25) was observed on physical examination and bilateral optic disc edema on fundus examination, growth hormone was immediately discontinued. Four weeks later, fundus examination revealed papilledema of both eyes with mild red-green dyschromatopsia. Recombinant growth hormone-associated idiopathic papilledema combined with pseudopapilledema was suspected. Although growth hormone, had been discontinued, we scheduled further observation of the papilledema. @*Conclusions@#Papilledema was observed on fundus examination during growth hormone treatment and four weeks after discontinuation thereof. The symptoms improved, but mild papilledema combined with pseudopapilledema remained.

Pseudopapilledema Combined with Idiopathic Papilledema in a Child Receiving Growth Hormone Treatment

Purpose@#We report a case of pseudopapilledema combined with idiopathic papilledema in a pediatric patient receiving growth hormone treatment.Case summary: An 11-year-old girl without any underlying disease presented with bilateral transient visual obscurations, a dark-adaptation disorder, and helplessness that developed while she had been on growth hormone therapy for 3 months at a local clinic. Reduced visual acuity (from 20/20 to 20/25) was observed on physical examination and bilateral optic disc edema on fundus examination, growth hormone was immediately discontinued. Four weeks later, fundus examination revealed papilledema of both eyes with mild red-green dyschromatopsia. Recombinant growth hormone-associated idiopathic papilledema combined with pseudopapilledema was suspected. Although growth hormone, had been discontinued, we scheduled further observation of the papilledema. @*Conclusions@#Papilledema was observed on fundus examination during growth hormone treatment and four weeks after discontinuation thereof. The symptoms improved, but mild papilledema combined with pseudopapilledema remained.

Asymmetry of Peak Thicknesses between the Superior and Inferior Retinal Nerve Fiber Layers for Early Glaucoma Detection: A Simple Screening Method

PURPOSE: To assess whether the asymmetry in the peripapillary retinal nerve fiber layer (pRNFL) thickness between superior and inferior hemispheres on optical coherence tomography (OCT) is useful for early detection of glaucoma. MATERIALS AND METHODS: The patient population consisted of Training set (a total of 60 subjects with early glaucoma and 59 normal subjects) and Validation set (30 subjects with early glaucoma and 30 normal subjects). Two kinds of ratios were employed to measure the asymmetry between the superior and inferior pRNFL thickness using OCT. One was the ratio of the superior to inferior peak thicknesses (peak pRNFL thickness ratio; PTR), and the other was the ratio of the superior to inferior average thickness (average pRNFL thickness ratio; ATR). The diagnostic abilities of the PTR and ATR were compared to the color code classification in OCT. Using the optimal cut-off values of the PTR and ATR obtained from the Training set, the two ratios were independently validated for diagnostic capability. RESULTS: For the Training set, the sensitivities/specificities of the PTR, ATR, quadrants color code classification, and clock-hour color code classification were 81.7%/93.2%, 71.7%/74.6%, 75.0%/93.2%, and 75.0%/79.7%, respectively. The PTR showed a better diagnostic performance for early glaucoma detection than the ATR and the clock-hour color code classification in terms of areas under the receiver operating characteristic curves (AUCs) (0.898, 0.765, and 0.773, respectively). For the Validation set, the PTR also showed the best sensitivity and AUC. CONCLUSION: The PTR is a simple method with considerable diagnostic ability for early glaucoma detection. It can, therefore, be widely used as a new screening method for early glaucoma.

The Analysis of Retinal Nerve Fiber Layer in Amblyopia Using Spectral Domain Optical Coherence Tomography

PURPOSE: To determine whether retinal nerve fiber layer (RNFL) thickness and optic nerve head parameters differ in the amblyopic and normal fellow eyes of hyperopic anisometropic amblyopic patients using spectral domain optical coherence tomography (SD-OCT). METHODS: This study included 30 patients with hyperopic anisometropic amblyopia; patient eyes were divided into 30 anisometropic amblyopic eyes and 30 normal fellow eyes. RNFL thickness, disc area, rim area, average cup-to-disc ratio, and cup volume were obtained using SD-OCT. Axial length was obtained using the IOL Master®, and the interocular differences between group were analyzed. RESULTS: Nasal quadrant RNFL thickness of amblyopic eyes was significantly thicker than that of normal fellow eyes in amblyopic patients (p = 0.010). Among optic nerve parameters, cup volume of amblyopic eyes was significantly smaller than that of normal fellow eyes (p = 0.021). No significant relationship between refractive error and RNFL thickness was observed, and a significant positive linear relationship was observed between neural rim area and RNFL thickness (rho = 0.426, p = 0.005). CONCLUSIONS: SD-OCT analysis of hyperopic anisometropic amblyopic eyes demonstrated a significant increase in nasal RNFL thickness compared to fellow non-amblyopic eyes. No optic nerve head parameters except cup volume showed significant change.

A Case of Monocular Retinal Blot Hemorrhage in a Patient with Raynaud's Phenomenon

PURPOSE: To report a case of retinal blot hemorrhage localized to 1 eye accompanied by Raynaud's phenomenon. CASE SUMMARY: A 65-year-old female was referred for vision disorder in the right eye. She had been taking an antihypertensive drug since diagnosed with systemic hypertension 2 years previously. On initial examination, her best corrected visual acuity was 20/25 in the right eye and 20/20 in the left eye and intraocular pressure was 15 mm Hg in the right eye and 21 mm Hg in the left eye. Fundus examination showed retinal blot hemorrhage across the entire retina and increased retinal vascular tortuosity. No specific finding was found on visual field examination, transthoracic ultrasonography and carotid Doppler ultrasound. The blood test was positive for antinuclear and anticentromere antibodies, thus she was referred to the rheumatologic department. The patient was diagnosed with primary Raynaud's phenomenon because no correlation with other rheumatologic diseases was found. Subsequently, she was scheduled for regular follow-ups with a prescription of circulatory stimulant. Five months later, her best corrected visual acuity was 20/20 in the both eyes and retinal blot hemorrhage in the right eye was significantly decreased based on fundus examination. CONCLUSIONS: In the case of atypical retinal blot hemorrhage without other ophthalmic causes except Raynaud's phenomenon, the change in retinal circulatory autoregulation associated with the mechanism of retinal blot hemorrhage can be presumed. Therefore, a close examination and history taking should be conducted so that Raynaud's phenomenon as a pathological factor is not overlooked.

Juvenile Hemangioma Occurred in Distal Femoral Epiphysis / 대한골관절종양학회지

A hemangioma occurred in the bony epiphysis is extremly rare. A 5-year-old boy visited to our hospital with pain and flexion contracture on the right knee. MRI showed some lesions scattered in the epiphysis of the distal femur and the proximal tibia. Biopsy specimen from the distal femoral epiphysis revealed pathologic findings compatible with hemangioma. On 8 years follow-up, the lesion in the distal femoral epiphysis had been cured, and those in the proximal tibial epiphysis were spontaneously disappeared without surgery. The scanogram shows no leg length discrepancy and angular deformity. We reports a rare case of hemangioma occurred in the bony epiphysis with the results of 8 year follow-up with the review of literatures.

A Case of Steroid Refractory Acute GVHD Treated with IL-2 & TNF-alpha Blocker in a Myelodysplastic Syndrome Patient who Underwent Unrelated Allogeneic Stem Cell Transplantation

Hematopoietic stem cell transplantation has evolved as a central treatment modality for the management of various hematologic malignancies. Despite adequate posttransplantation immunosuppressive therapy, acute GVHD remains a major cause of morbidity and mortality, even for the patients who have received HLA identical sibling grafts. Once established, acute GVHD is difficult to treat, and the best primary treatments such as corticosteroid have shown responses of approximately 50%. Once GVHD becomes steroid-refractory, the chances of survival are slim at best, and the possibility of long-term complications from chronic GVHD is almost always the rule. Many agents are currently being evaluated to treat this malady, including ATG, monoclonal antibodies, pentostatin, denileukin diftitox, etc. We reported here on a case of steroid refractory acute GVHD that was treated with IL-2 and TNF-alpha blocker in myelodysplastic syndrome patient who underwent unrelated allogeneic stem cell transplantation.

Perforated Appendicitis Presenting as a Bladder Tumor in a 3 Year-Old Girl / 대한비뇨기과학회지

Large bladder masses in children are extremely rare pathological lesions. They can present as a gross hematuria, with irritable or obstructive voiding symptoms and a urinary tract infection. Their differential diagnosis must include for genitourinary malignancies, such as rhabdomyosarcoma, as well as benign inflammatory lesions. A case of a bladder mass in a three-year-old girl is reported, which was finally diagnosed as localized perforated appendicitis.

A Case of Ki-1 Positive Large-Cell Lymphoma Transformed from Mycosis Fungoides / 대한피부과학회지

Mycosis fungoides(MF) is a cutaneous T-cell lymphoma of low-grade malignancy characterized by the proliferation of small to medium-sized cerebriform lymphoid cells confined to the skin. It usually shows favorable prognosis, but morphologic transformation occurs in some cases and is often associated with a more aggressive clinical course. Herein we report a case of Ki-1 positive large cell lyrnphoma (Ki-1 LCL) which developed in the plaque stage of mycosis fungoides. Although the lesions responded well to low-dose methotrexate therapy and there was no evidence of local or systemic recurrence until now, continuous follow-up is needed because the prognosis of transformed MF is known to be poor compared with primary cutaneous Ki-1 LCL. We also discussed the differential diagnosis of primary cutaneous Ki-1 positive lymphoproliferative disorders.

Frequency Trends of Basal Cell Carcinoma, Squamous Cell Carcinoma and Melanoma in Korea, between Mid-1980s and Mid-1990s

BACKGROUND: Malignant skin cancers in Korea have been increasing as in other countries, but the previous epidemiological studies have been only attempted by a single hospital unit in a limited period of time. OBJECTIVE: This study aimed to investigate and compare the frequencies, age, sex distribution, and anatomical location of the frequent skin cancers collected from several hospitals over a 10 year period between 1984-5 and 1994-5. METHODS: 258 cases of skin cancer from 4 different places in Seoul were collected for the study. Histopathological records from pathology departments and medical records were reviewed to obtain information about the frequencies. RESULTS: Overall there were 141 cases of squamous cell carcinoma (SCC)1 basal cell carcinoma (BCC), and malignant melanoma (MM) in the mid-eighties and 117 in the mid-nineties. SCC was the most common skin cancer in both periods but the frequencies and the SCC/BCC ratio dropped at the later period. The ratio of males to females was getting smaller at 1.4:1 in the mid-eighties and 1.1:1 in the mid-nineties. BCC was concentrated on the face and SCC was rather evenly distributed over the body surface. The predilection site of malignant melanoma (MM) was quite different between the two periods. The lower extremities was the main site in the mid-nineties and the head and neck in the mid-eighties. CONCLUSION: Although there was no statistical significance, the BCC/SCC ratio was increased and the male/female ratio decreased at the later period.

Surgical Treatment of Pulmonary Blastoma: A Case Report / 대한흉부외과학회지

Pulmonary blastoma are a family of tumors in which the glands or mesenchyme composing the neoplasm are primitive or embryonal in appearance. We report a pulmonary blastoma occurring in a 31 years old man. An abnormal shadow was detected in the right lower lung field in a routine chest X-ray film. The preoperative imaging films showed about a 5cm sized well circumscribed solid tumor of the right lung. A preoperative clinical diagnosis of primary lung cancer was considerd. The operative field showed that the hard, round mass, 6 x 5 x 4cm in diameter was localized in middle lobe of the right lung, and partially adhered to the upper lobe, pericardium and diaphragm. Right middle lobe lobectomy, right upper lobe wedge resection, partial pericardiectomy and diaphragm resection with plication was performed with radical lymph node dissection. Histopathologic diagnosis was pulmonary blastoma (Biphasic blastoma). It is considered that the prognosis of biphasic blastoma is worse than WDFA(well differentiated fetal adenocarcinoma). There are no other available treatments except for surgical resection. It is suggested that it is necessary to collect as many cases as possible, to make definite classifications and to examine the clinical course and prognosis of pulmonary blastoma.

Clinical and Histopathologic Study of Eosinophilic Cellulitis

Eosinophilic cellulitis is a rare dermatosis originally described by Wells as "recurrent granulomatous dermatitis with eosinophilia", then called Wells' syndrome. The etiology is unknown, although a hypersensitivity mechanism is suspected. Flame figures are considered as a characteristic histologic feature of Wells' syndrome. To clarify the nature of eosinophilic cellulitis and its flame figures, the authors have reviewed five cases of eosinophilic cellulitis with its clinical and histopathologic findings. Cutaneous lesions were variable in appearance and was confused with angioedema, urticarial vasculitis, erydiema multiforme, morphea or granuloma annulare. Microscopically, early lesions (2-7 days) showed diffuse dermal eosinophilic infiltration with widespread degranulation, sometimes extended into the underlying muscle. Subepidermal bulla was present in one case. Subsequently, granulomatous features with characteristic "flame figures" became apparent (several months). Collagen alteration by eosinophilic granules resulted in flame figure formation and a granulomatous response. In two patients, there were possible relationships between drug and flare-ups of eosinophilic cellulitis, but the others, no contributory precipitating factors were found. We think that eosinophilic cellulitis represents a severe anaphylactic hypersensitivity reaction to various stimuli showing characteristic histopathology with recurrent episodes and frequent hypereosinophilia in the peripheral blood.

A Case of Malignant Lymphoma Misdiagnosed as Focal Lymphoid Hyperplasia in the Esophagus

Esophageal involvement by malignant lymphoma is extremely rare. A case of follicular lymphoma of the esophagus, misdiagnosed as focal lymphoid hyperplasia (pseudolymphoma) in a 72-year-old man is presented. The esophagogram revealed diffuse narrowing of the lumen in the middle and distal portion without ulceration. The resected esophagus showed mural thickening without any remarkable mucosal change. Microscopically, the esophagus showed scattered follicular lymphoid aggregates in the submucosa, extending into periadventitial fat tissue. Most follicles were devoid of germinal center and consisted of loosely aggregated small cleaved cells without atypia. The surrounding stroma of the submucosa showed dense fibrosis entrapping the infiltrating small lymphocytes in a "indian-file" appearance. There were some reactive follicles with germinal center. In the lamina propria, many plasma cells and a few eosinophils were infiltrated. The gene rearrangement study showed rearranged band for Jk probe which confirmed monoclonal B-cell nature of infiltrated small lymphoid cells. The small cleaved lymphocytes arranged in follicles were positive for L26 and bcl-2 protein. This case demonstrated the necessity of immunophenotypic and gene rearrangement study in the diagnosis of pseudolymphoma in the digestive tract.

Two cases of angioedema due to C1 inactivator deficiency / 소아알레르기및호흡기학회지

No abstract available.

Primary Malignant Hemangiopericytoma of the Lung: A case report

Primary pulmonary hemangiopericytoma is a rare, potentially malignant tumor and assumes more malignant course than that originated in the soft tissue. It can be asymtomatic until attaining a large size within the lung. We report a case of malignant hemangiopericytoma of the lung in a 29 year old man. It represented as a sharply demarcated, huge homogeneous opaque mass in the right upper lobe. The cytologic and histologic features were that of malignant hemangiopericytoma.