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Purpose@#To determine subjective symptoms and medical history of patients with intermittent exotropia in a large study population. @*Methods@#The Korean Intermittent Exotropia Multicenter Study (KIEMS) is a nationwide, observational, cross-sectional, multicenter study conducted by the Korean Association for Pediatric Ophthalmology and Strabismus including 5,385 patients with intermittent exotropia. Subjective symptoms and medical history of patients with intermittent exotropia were extracted by a comprehensive survey based on a self-administered questionnaire according to the study protocol of the KIEMS. @*Results@#The mean age of symptom onset was 5.5 years. The most common symptom reported in patients with intermittent exotropia was photophobia (52.1%), followed by diplopia at near fixation (7.3%) and distance fixation (6.2%). Preterm birth was found in 8.8%, and 4.1% had perinatal complications. A family history of strabismus was present in 14.9%, and 5.5% of patients had a family member who underwent strabismus surgery. @*Conclusions@#The KIEMS is one of the largest clinical studies on intermittent exotropia. Intermittent exotropia frequently caused photophobia and diplopia, and patients with a family history was not uncommon.
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Purpose@#To document changes in the optical coherence biometry data over 1 year of Korean children aged 6 to 9 years with myopia and hyperopia. @*Methods@#We used fluorescein angiography to retrospectively study changes in refractive errors over 1 year in 60 children who visited our hospital between December 2019 and June 2022. The IOL master 700 platform was used to derive axial length, corneal curvature (the K value), central corneal thickness, anterior chamber depth, lens thickness, and the white-to-white size at 1-year intervals. The Mann-Whitney and Wilcoxon signed-ranked tests were used to compare the values. A p-value < 0.05 was taken to indicate a significant difference. @*Results@#The mean ages of hyperopic and myopic children were 6.27 ± 0.87 and 6.93 ± 0.87 years at initial presentation. Significant 1-year changes in axial length, anterior depth, and lens thickness were apparent. The mean corneal curvature, and central corneal and lens thicknesses were significantly higher in hyperopic than myopic children but the axial length and anterior chamber depth were significantly greater in myopic children. However, after 1 year, the lens thicknesses did not significantly differ between the two groups. @*Conclusions@#Over 1 year of early life, changes in the mean corneal curvature and lens thickness were significant in hyperopic children and changes in the axial length and anterior depth were significant in myopic children. Thus, the eye growth pattern may differ between hyperopic and myopic children.
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Purpose@#We report a case of papilledema without the typical symptoms of arteritic anterior ischemic optic neuropathy, ultimately diagnosed as a subtype of giant cell arteritis, which has not been reported previously in Korea.Case summary: A 72-year-old man visited the hospital with decreased visual acuity in his left eye of 0.02 that had occurred 1 week prior. Optic disc swelling and relative afferent pupillary disorder were also evident in the left eye. Magnetic resonance imaging revealed no specific findings, leading to a diagnosis of anterior ischemic optic neuropathy. Afterwards, there was no improvement in visual acuity, and optic nerve atrophy occurred. Six months later, the patient complained of decreased visual acuity in the contralateral eye; the same clinical findings as in the left eye were confirmed. Temporal artery biopsy was performed, ultimately revealing a subtype of giant cell arteritis. @*Conclusions@#This case was finally diagnosed as a subtype of giant cell arteritis through temporal artery biopsy, despite the absence of typical clinical symptoms of this condition. Although giant cell arteritis is rare in Korea, it can cause permanent blindness. Therefore, the possibility of giant cell arteritis should always be considered with optic disc swelling in both eyes.
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Purpose@#To compare IOL Master 700 with autokeratometer and video pupillometer in measurement of pupil diameter and corneal curvature. @*Methods@#Pupil diameter were measured with IOL Master 700 and video pupilometer, horizontal keratometry and vertical keratometry were measured with IOL Master 700 and autokeratometer in 100 eyes of 50 children. Paired t-test and Pearson's correlation analysis were used to compare the differences among the devices. Agreement between measurement was analyzed using Bland Altman plot and intraclass correlation coefficient. @*Results@#Comparing IOL Master 700 and video pupilometer for pupil diameter, there was no significant difference (p > 0.05). There was also no significant difference between IOL Master 700 and autokeratometer in measurement of vertical keratometry (p > 0.05). However, regarding horizontal keratometry there was significant difference between IOL Master 700 and autokeratometer, horizontal keratometry measured with IOL Master 700 was steeper than with auto keratometer, +0.105 diopters (D) in right eye and +0.130 D in left eye (p < 0.05). @*Conclusions@#There was good agreement between IOL Master 700 and comparator instruments in regards to pupil diameter and corneal curvature. IOL Master 700 can be helpful in uncooperative children for measuring pupil diameter and corneal curvature at the same time.
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Purpose@#To compare IOL Master 700 with autokeratometer and video pupillometer in measurement of pupil diameter and corneal curvature. @*Methods@#Pupil diameter were measured with IOL Master 700 and video pupilometer, horizontal keratometry and vertical keratometry were measured with IOL Master 700 and autokeratometer in 100 eyes of 50 children. Paired t-test and Pearson's correlation analysis were used to compare the differences among the devices. Agreement between measurement was analyzed using Bland Altman plot and intraclass correlation coefficient. @*Results@#Comparing IOL Master 700 and video pupilometer for pupil diameter, there was no significant difference (p > 0.05). There was also no significant difference between IOL Master 700 and autokeratometer in measurement of vertical keratometry (p > 0.05). However, regarding horizontal keratometry there was significant difference between IOL Master 700 and autokeratometer, horizontal keratometry measured with IOL Master 700 was steeper than with auto keratometer, +0.105 diopters (D) in right eye and +0.130 D in left eye (p < 0.05). @*Conclusions@#There was good agreement between IOL Master 700 and comparator instruments in regards to pupil diameter and corneal curvature. IOL Master 700 can be helpful in uncooperative children for measuring pupil diameter and corneal curvature at the same time.
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Purpose@#We describe the clinical features of patients with rhinogenic optic neuropathy caused by paranasal sinus disease. @*Methods@#Nine patients (11 eyes) diagnosed with rhinogenic optic neuropathy were retrospectively reviewed. All exhibited sphenoid or posterior ethmoid sinus lesions on magnetic resonance imaging and corresponding visual acuity or visual field defects. Patients with other causes of optic neuropathy were excluded. We recorded symptoms and symptom durations, best-corrected visual acuity, relative afferent pupillary defects, color vision test results, fundus morphology, optical coherence tomographic data, and visual field test results before and after endoscopic sinus surgery. @*Results@#The involved sinuses were the sphenoid alone (five eyes), posterior ethmoid alone (two eyes), and both (four eyes). The underlying sinus pathologies included six eyes with sinusitis and three with mucoceles. The best-corrected visual acuity exceeded 20/40 for nine eyes, the color vision test results were normal for all eyes, and relative afferent pupillary defects were noted in three eyes of unilaterally affected patients. The Humphrey visual field test revealed paracentral scotomas (three eyes, 27.3%), nasal defects related to the vertical meridian (three eyes, 27.3%), arcuate defects (two eyes, 18.2%), and a horizontal altitudinal defect (one eye, 9.1%). Six patients underwent endoscopic sinus surgery. Three patients who underwent early interventions (within 4 weeks of onset) experienced full visual recovery. @*Conclusions@#In patients with suspected optic neuropathy, a paranasal sinus lesion adjacent to the optic canal should be considered. Prompt diagnosis and early intervention (endoscopic sinus surgery) are recommended for patients with rhinogenic optic neuropathy to reduce the incidences of visual loss and visual field defects.
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Purpose@#We describe the clinical features of patients with rhinogenic optic neuropathy caused by paranasal sinus disease. @*Methods@#Nine patients (11 eyes) diagnosed with rhinogenic optic neuropathy were retrospectively reviewed. All exhibited sphenoid or posterior ethmoid sinus lesions on magnetic resonance imaging and corresponding visual acuity or visual field defects. Patients with other causes of optic neuropathy were excluded. We recorded symptoms and symptom durations, best-corrected visual acuity, relative afferent pupillary defects, color vision test results, fundus morphology, optical coherence tomographic data, and visual field test results before and after endoscopic sinus surgery. @*Results@#The involved sinuses were the sphenoid alone (five eyes), posterior ethmoid alone (two eyes), and both (four eyes). The underlying sinus pathologies included six eyes with sinusitis and three with mucoceles. The best-corrected visual acuity exceeded 20/40 for nine eyes, the color vision test results were normal for all eyes, and relative afferent pupillary defects were noted in three eyes of unilaterally affected patients. The Humphrey visual field test revealed paracentral scotomas (three eyes, 27.3%), nasal defects related to the vertical meridian (three eyes, 27.3%), arcuate defects (two eyes, 18.2%), and a horizontal altitudinal defect (one eye, 9.1%). Six patients underwent endoscopic sinus surgery. Three patients who underwent early interventions (within 4 weeks of onset) experienced full visual recovery. @*Conclusions@#In patients with suspected optic neuropathy, a paranasal sinus lesion adjacent to the optic canal should be considered. Prompt diagnosis and early intervention (endoscopic sinus surgery) are recommended for patients with rhinogenic optic neuropathy to reduce the incidences of visual loss and visual field defects.
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Hepatocellular carcinoma (HCC) has extremely poor prognosis. Immunotherapy has emerged as a new treatment for a number of cancers. Adoptive immunotherapy is one of the important cancer immunotherapy, which relies on the various lymphocytes including cytotoxic T lymphocytes, natural killer (NK) and cytokine induced killer cells. Also, there has been advance in techniques of NK cell activation to more effectively kill the cancer cells. Of note, recently the blocking antibodies targeting programmed cell death protein 1 (PD-1) have shown promising results in diverse cancers including HCC. We report our recent experience of a patient accompanying advanced HCC with extrahepatic metastases. Disease progression had occurred after sorafenib administration, while the patient showed local tumor control and tumor marker decrease by NK cell immunotherapy combined with PD-1 inhibitor therapy. Though, there was no definite survival advantage due to impaired liver function, which might be caused by treatment related toxicities as well as cancer progression.
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Humanos , Anticorpos Bloqueadores , Carcinoma Hepatocelular , Morte Celular , Células Matadoras Induzidas por Citocinas , Progressão da Doença , Imunoterapia , Imunoterapia Adotiva , Células Matadoras Naturais , Fígado , Linfócitos , Metástase Neoplásica , Prognóstico , Receptor de Morte Celular Programada 1 , Linfócitos T CitotóxicosRESUMO
PURPOSE: In recent years, there has been an increase in the number of strabismus operations performed on patients aged 60 years and over. This study aims to establish the characteristics and outcomes of old age strabismus. METHODS: Patients aged 60 years and over who underwent strabismus surgery between January 2011 and December 2015 were included in this study. The purpose of surgery, type of strabismus, etiology, postoperative recurrence, prevalence of general and ocular complications, and postoperative diplopia rate were reviewed. RESULTS: Ninety-eight patients aged 60 years or older were identified, and 58.2% of patients had strabismus surgery to improve diplopia, while 41.8% chose surgery for cosmetic purposes. Esotropia was the most common type of strabismus found in 40.8% of the patients, and horizontal-vertical combined type was the second highest at 29.6%. The etiology of strabismus was similarly high in both the restrictive pattern (31.6%) and neuro-paralytic pattern (30.6%). The recurrence rate after strabismus surgery was 4.1%, and the reoperation rate was 3.1%. The remnant diplopia rate after surgery in patients with diplopia was 15.8%, and the diplopia occurring rate in patients who underwent surgery for cosmetic purposes was 4.9%. No severe ocular complications such as anterior segment syndrome or eyeball rupture occurred. Anesthesia related problems did not occur in any of the patients who underwent general anesthesia. CONCLUSIONS: Strabismus in patients aged 60 years and over is an effective and safe way to improve diplopia and cosmetic status by restoring ocular alignment.
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Humanos , Anestesia , Anestesia Geral , Diplopia , Esotropia , Prevalência , Recidiva , Reoperação , Ruptura , EstrabismoRESUMO
BACKGROUND/AIMS: Colonoscopic perforations have been managed with exploratory laparotomy, and have resulted in some morbidity and mortality. Recently, laparoscopic surgery is commonly performed for this purpose. The aim of this study was to compare the outcomes of several management strategies for iatrogenic colonoscopic perforations. METHODS: We retrospectively reviewed the medical records of patients who had been treated for colonoscopic perforation between January 2004 and April 2013 at CHA Bundang Medical Center in Korea. RESULTS: A total of 41 patients with colonoscopic perforation were enrolled. Twenty patients underwent conservative management with a success rate of 90%. Surgical management was performed in 23 patients including two patients who were converted to surgical management after the failure of the initial conservative management. Among 14 patients who underwent surgery at 8 hours after the perforation, there was no considerable difference in adverse outcomes between the laparotomy group and the laparoscopic surgery group. The medical costs and claim rate were 1.45 and 1.87 times greater in the exploratory laparotomy group, respectively. CONCLUSIONS: Conservative management of colonoscopic perforation could be an option for patients without overt symptoms of peritonitis or with a small defect size. If surgical management is required, laparoscopic surgery may be considered as the initial procedure even with a delayed diagnosis.
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Humanos , Colonoscopia , Diagnóstico Tardio , Coreia (Geográfico) , Laparoscopia , Laparotomia , Prontuários Médicos , Métodos , Mortalidade , Peritonite , Estudos RetrospectivosRESUMO
Nodular regenerative hyperplasia (NRH) is an uncommon liver condition characterized by diffuse transformation of the hepatic parenchyma into regenerative nodules without fibrosis. Portal vasculopathy caused by abnormal hepatic venous flow may induce hepatocyte hyperplasia, which forms regenerative nodules. Underlying diseases or certain drugs may also be the cause of NRH. This condition is often underdiagnosed as the patients remain asymptomatic until development of portal hypertension, and histopathologic confirmation by liver biopsy is the only way of making a definite diagnosis. The management mainly involves prevention and treatment of the complications of portal hypertension. The frequency of diagnosis of NRH has increased rapidly in recent years, however, only a few cases have been reported in Korea. Here, we report on a case of NRH of the liver combined with toxic hepatitis.
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Feminino , Humanos , Pessoa de Meia-Idade , Alanina Transaminase/análise , Aspartato Aminotransferases/análise , Bilirrubina/sangue , Doença Hepática Induzida por Substâncias e Drogas/complicações , Úlcera Duodenal/patologia , Endoscopia do Sistema Digestório , Hiperplasia Nodular Focal do Fígado/complicações , Fígado/enzimologia , Imageamento por Ressonância Magnética , Tomografia Computadorizada por Raios XRESUMO
No abstract available.
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Pré-Escolar , Humanos , Masculino , Análise Mutacional de DNA , Doenças em Gêmeos/genética , Ectopia do Cristalino/genética , Proteínas da Matriz Extracelular , Proteínas dos Microfilamentos/genética , Mutação , Gêmeos MonozigóticosRESUMO
BACKGROUND/AIMS: The vascular calcification (VC) score on a plain X-ray is associated with cardiovascular disease and mortality in hemodialysis (HD) patients. This study examined the correlations among the VC scores for the hands and pelvis X-rays, arterial stiffness, inflammation, and nutrition in HD patients. METHODS: VC was evaluated using plain x-rays of the hands and pelvis. Patients were categorized into the VC (+) (VC score > or = 3) or VC (-) (VC score < 3) groups. We measured the pulse wave velocity (PWV), ankle brachial index (ABI), and augmentation index (AI). RESULTS: The mean age of the patients was 55.6 +/- 13.2 years. The prevalence of diabetes mellitus (DM) was significantly higher in the VC (+) group than in the VC (-) group (87.5 vs. 34.2%, p < 0.05). The serum PTH (98.4 +/- 141.9 vs. 183.6 +/- 231.3 pg/mL, p < 0.05) and albumin (3.7 +/- 0.5 vs. 3.9 +/- 0.3 g/dL, p < 0.05) levels were significantly lower and PWV was significantly (p < 0.05) higher in the VC (+) group. In multiple linear regression analysis, only the presence of diabetes mellitus was significantly related to the VC score. CONCLUSIONS: The VC score was associated with the serum PTH and albumin, as well as with vascular stiffness. C-reactive protein did not show any significant association with the VC score.
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Humanos , Índice Tornozelo-Braço , Proteína C-Reativa , Doenças Cardiovasculares , Diabetes Mellitus , Mãos , Inflamação , Modelos Lineares , Mortalidade , Pelve , Prevalência , Análise de Onda de Pulso , Diálise Renal , Calcificação Vascular , Rigidez VascularRESUMO
Systemic lupus erythematosus (SLE) is a chronic inflammatory disease of unknown etiology and is characterized by presence of variable pathogenic auto-antibodies and multiple organ involvement. Serositis is common in SLE, but peritoneal involvement is relatively rare. This is a case report of 28-year-old female who initially presented with abdominal pain and ascites. After ruling out many other possibilities such as liver cirrhosis, neoplasm, and infectious etiologies, we confirmed SLE with clinical features, serologic tests and radiological findings. To conclude, her abdominal pain and ascites were caused by lupus peritonitis. After administration of corticosteroid therapy, her symptoms fairly improved.
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Adulto , Feminino , Humanos , Dor Abdominal , Ascite , Cirrose Hepática , Lúpus Eritematoso Sistêmico , Peritonite , Testes Sorológicos , SerositeRESUMO
Myocarditis is an inflammatory disease of the myocardium caused by various infectious or noninfectious triggers. Although viral infections are important causes of myocarditis, some drugs or toxins can also cause myocarditis. We report a case of life-threatening fulminant myocarditis which followed an extensive coffee diet program. Despite medical treatment, the patient was not able to maintain hemodynamic stability. She was supported by extracorporeal membrane oxygenation and completely recovered 3 months later.
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Humanos , Café , Dieta , Oxigenação por Membrana Extracorpórea , Hemodinâmica , Miocardite , Miocárdio , ToxoidesRESUMO
Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease. In patients with SLE, the prevalence of antiphospholipid antibodies is considerably higher, and is largely responsible for thrombosis. Splenic infarction is a rare complication of arterial thrombosis in patients with SLE. It is important to consider splenic infarction in a patient with SLE complaining of left upper quadrant (LUQ) pain because of the possibility of severe infarction-related complications, such as subcapsular hemorrhage and splenic rupture. We report a case of solitary splenic infarction in a patient with SLE. The only symptom was LUQ pain of 3-day duration. Lupus anticoagulant activity was positive and abdominal-pelvic computed tomography (CT) was consistent with splenic infarction. She did not show any other evidence of thrombotic events. The patient was diagnosed with antiphospholipid syndrome that presented as a splenic infarction in a SLE patient.
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Humanos , Anticorpos Antifosfolipídeos , Síndrome Antifosfolipídica , Doenças Autoimunes , Hemorragia , Inibidor de Coagulação do Lúpus , Lúpus Eritematoso Sistêmico , Prevalência , Infarto do Baço , Ruptura Esplênica , TromboseRESUMO
We report a case of invasive pulmonary aspergillosis invading the mediastinum and the left atrium. A 70-year-old woman was hospitalized for dyspnea. She had been well controlled for her diabetes mellitus and hypertension. The chest X-ray disclosed mediastinal widening, and the computed tomography scan of the chest showed that there was a large mediastinal mass and this lesion extended into the left atrium and right bronchus. The cardiac echocardiography showed that a huge mediastinal cystic mass compressed in the right atrium and a hyperechoic polypoid lesion in the left. The pathology from the bronchoscopic biopsy observed abundant fungal hyphae which was stained with periodic acid-Schiff and Gomori's methenamine silver. Despite the treatment with antifungal agents, she died from cardiac tamponade after three months. Invasive pulmonary aspergillosis, which involves the mediastinum and the heart, is very rare in immunocompetent patients.
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Idoso , Feminino , Humanos , Antifúngicos , Biópsia , Brônquios , Tamponamento Cardíaco , Diabetes Mellitus , Dispneia , Ecocardiografia , Coração , Átrios do Coração , Neoplasias Cardíacas , Hipertensão , Hifas , Imunocompetência , Aspergilose Pulmonar Invasiva , Cisto Mediastínico , Neoplasias do Mediastino , Mediastino , Metenamina , Patologia , TóraxRESUMO
We report a case of invasive pulmonary aspergillosis invading the mediastinum and the left atrium. A 70-year-old woman was hospitalized for dyspnea. She had been well controlled for her diabetes mellitus and hypertension. The chest X-ray disclosed mediastinal widening, and the computed tomography scan of the chest showed that there was a large mediastinal mass and this lesion extended into the left atrium and right bronchus. The cardiac echocardiography showed that a huge mediastinal cystic mass compressed in the right atrium and a hyperechoic polypoid lesion in the left. The pathology from the bronchoscopic biopsy observed abundant fungal hyphae which was stained with periodic acid-Schiff and Gomori's methenamine silver. Despite the treatment with antifungal agents, she died from cardiac tamponade after three months. Invasive pulmonary aspergillosis, which involves the mediastinum and the heart, is very rare in immunocompetent patients.
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Idoso , Feminino , Humanos , Antifúngicos , Biópsia , Brônquios , Tamponamento Cardíaco , Diabetes Mellitus , Dispneia , Ecocardiografia , Coração , Átrios do Coração , Neoplasias Cardíacas , Hipertensão , Hifas , Imunocompetência , Aspergilose Pulmonar Invasiva , Cisto Mediastínico , Neoplasias do Mediastino , Mediastino , Metenamina , Patologia , TóraxRESUMO
BACKGROUND/AIMS: The point mutations in 23S rRNA gene accounts for the majority of the clarithromycin resistance of Helicobacter pylori. This study aimed to investigate the association between the clarithromycin-resistance of H. pylori and the failure of primary H. pylori eradication therapy in Jeju Island. METHODS: Between April 2011 and October 2012, 6,937 patients underwent endoscopy, and H. pylori infection was evaluated in 2,287 patients (33.0%). Total of 110 patients with H. pylori infection were treated with proton pump inhibitor (PPI)-based triple therapy. The result of eradication was evaluated with urea breath test, histology and PCR which were conducted 4 weeks from the last dose of medicine. RESULTS: The patients who had point mutations were 33 (26.0%). A2142G and A2143G mutations were observed in 10 patients (7.9%) and 23 patients (18.1%). Among 110 patients treated with PPI-based triple therapy, the success rate of the eradication therapy was 52.7% (58/110) and 70.7% (58/82) by intention-to-treat and per-protocol analysis, respectively. Fifteen of the 24 patients who failed the eradication therapy showed point mutations; 1 patient (4.2%) showed A2142G mutation and 14 patients (58.3%) showed A2143G mutation. Patients with A2143G mutation H. pylori showed higher failure rate of 87.5%. Patients with A2142G mutation H. pylori showed similar failure rate compared to those of the patients with wild type H. pylori. CONCLUSIONS: In Jeju Island, the frequency of 23S rRNA point mutations is similar (26.0%) with other regions of Korea (15.8-31.3%). A2143G mutation is associated with the failure of H. pylori eradication.