14 eyes of 11 patients with chronic angle-closure glaucoma(CACG) undergoing extracapsular cataract extraction(ECCE) with posterior chamber intraocular lens(PCIOL) implantation(group 1) and 14 eyes of 12 patients without glaucoma undergoing ECCE/PCIOL(group 2) were studied to assess the effect on anterior chamber depth, anterior chamber angle, and intraocular pressure (IOP). We measured the anterior chamber depth and angle using the EAS-1000 Scheimpflug camera. Following ECCE/PCIOL in group 1, the anterior chamber depth increased 1.00 +/- 0.25mm(p=0.0001), the anterior chamber angle widened 15.36 +/- 5.61 degrees(p=0.0001), and the postoperative IOP drop of 4.7mmHg(23.9%) showed statistical significance. Group 2 showed the increase of anterior chamber depth 0.22 +/- 0.44mm(p=0.0964), the widening of anterior chamber angle 2.51 +/- 2.65 degrees(p=0.0047), and the decrease of IOP 0.9mmHg(6.2%, p=0.0933). The effects on anterior chamber depth, anterior chamber angle, and rap were statistically significant between the two groups. Based on these results, we recommend that eyes with cataract and CACG may be considered for ECCE/PCIOL implantation as a first procedure rather than combined cataract and filtering surgery.
Anterior Chamber ; Cataract Extraction* ; Cataract* ; Filtering Surgery ; Glaucoma ; Glaucoma, Angle-Closure* ; Humans ; Intraocular Pressure

We studied the relationship of deviated eye with dominant eye, dominant hand and visual acuity in 109 horizontal strabismic patients. Control group of 109 normal subjects without strabismus or specific ocular diseases were also examined. Right ocular dominance in normal subjects was noted in 66.1%. Strabismic patients showed ocular dominance of nondeviated eye in 78.5%. The dominance of right hand in normal subjects were noted in 89.0% and those were 82.6% in strabismic patients. Better visual acuity of right eye were noted in 40.4% of normal subjects, and 28.4% in left eye. Equal visual acuity between two eyes were 31.2% of the subjects. Strabismic patients showed better visual acuity in 70.9% of nondevia ted eye. Based on these results, the correlation of nondeviated eye with dominant eye, and better visual acuity were statistically significant(p<0.01, respectively), but not with dominant hand(p>0.05).
Dominance, Ocular ; Hand* ; Humans ; Strabismus* ; Visual Acuity

Jensen procedures with medial rectus recession were performed on 13 eyes of 10 patients with lateral rectus palsy caused by trauma. The cases were reviewed retrospectively to assess efficacy of the procedure and long-term stability. After the average 10.2 months of follow-up period, the 7 patients on whom unilateral Jensen procedures and medial rectus muscle recession were performed improved an average of 45.0 delta, and the 3 patients who underwent bilateral Jensen procedures and medial rectus muscle recession improved an average of 82.3 delta. Preoperatively, 12 eyses demonstrated abduction of -4, and 1 eye demonstrated abduction of -1. Postoperatively, abductions of eyes are as follows: 3 eyes -4, 5 eyes -3, 3 eyes -2, and 2 eyes -1. 10 eyes (76.9%) showed improved abduction of lateral rectus muscle, but 3 eyes(23.1%) were not changed. 4 patients(40.0%) acquired a functional area of diplopia free vision, but 6 patients(60.0%) did not, 1 patient developed diplopia postoperatively. No significant cases of vertical deviation were created. One showed anterior segment ischemia, but recovered without complications. Based on these results, the Jensen procedure combined with medial rectus recession is effective in correcting palsies of the lateral rectus muscle that is not recovered.
Abducens Nerve Diseases* ; Diplopia ; Follow-Up Studies ; Humans ; Ischemia ; Paralysis ; Retrospective Studies

Intra-abdominal desmoplastic small round cell tumor (DSRCT) is a highly malignant tumor of uncertain histogenesis. Here we report a case of DSRCT involving the stomach, initially misdiagnosed as gastric cancer. A 12-year-old boy presented with upper abdominal pain developed 1 month prior. On gastroscopy, a 7-cm mass was noted involving the esophago-gastric junction to the fundus, and positron emission tomography showed multiple hot uptakes suggesting distant metastasis. Gastroscopic biopsy showed poorly differentiated malignant cells. We diagnosed as stage IV gastric cancer and treated with 6 cycles of chemotherapy. Laparotomy revealed a huge gastric mass along with peritoneal disseminations. Palliative proximal gastrectomy was performed. Pathological examination revealed transmural involvement of DSRCT, and t(11;22)(p12;q12) was demonstrated on fluorescence in situ hybridization test. The chemotherapeutic regimen was changed and the patient underwent 8 additional cycles of post-operative chemotherapy. The patient is now alive and the residual tumor shows no significant changes after chemotherapy.
Abdominal Pain ; Biopsy ; Child ; Desmoplastic Small Round Cell Tumor ; Fluorescence ; Gastrectomy ; Gastroscopy ; Humans ; In Situ Hybridization ; Laparotomy ; Neoplasm Metastasis ; Neoplasm, Residual ; Positron-Emission Tomography ; Stomach ; Stomach Neoplasms

BACKGROUND: Primary liver tumors account for less than 2% of pediatric malignancies, and the best treatment is complete surgical excision. The aim of this study was to review the results of liver transplantation (LT) for primary hepatomas in children. METHODS: The medical records of patients who underwent LT for unresectable primary hepatoma between May 1996 and December 2009 were reviewed retrospectively. RESULTS: Seven of 130 patients (5.3%, M:F=4:3) underwent LT for unresectable hepatoma. The median age at transplantation was 9 years (range, 6 months-14 years). Two patients were transplanted for hepatitis B virus-associated hepatocellular carcinoma (HCC), 2 for hepatoblastoma, 1 for hemangioendothelioma, 1 for angiosarcoma, and 1 for intrahepatic cholangiocarcinoma after a Kasai operation for biliary atresia. There was no post-LT treatment except in patients with HCC who were taking immunoglobulin prophylaxis against hepatitis B. Four patients (2 HCC, 1 hepatoblastoma, 1 hemangioendothelioma) are now alive and well after 7.8, 7.2, 7.7, 6.3 years of follow-up, respectively. Three patients died after transplantation; 1 for the recurrent cholangiocarcinoma in the transplanted liver 1 year after the transplantation and 1 who underwent LT for the recurrent hepatoblastoma for the primary non-function 10 days after the transplantation. One patient died of metastatic angiosarcoma (bone) 2.5 years after LT. CONCLUSIONS: LT can be tried for unresectable primary hepatoma in children and, although limited, the outcome was successful in patients with HCC, hepatoblastoma, or hemangioendothelioma. Careful patient selection, based on the pre-transplant histological diagnosis, seems to be related to better outcome.
Biliary Atresia ; Carcinoma, Hepatocellular ; Child ; Cholangiocarcinoma ; Follow-Up Studies ; Hemangioendothelioma ; Hemangiosarcoma ; Hepatitis B ; Hepatoblastoma ; Humans ; Immunoglobulins ; Liver ; Liver Neoplasms ; Liver Transplantation ; Medical Records ; Patient Selection ; Transplants

PURPOSE: Hepatoblastoma is the most common malignant liver tumor in children. The aim of this study was to review our results of hepatoblastoma treatment and to determine the role of surgical treatment in hepatoblastoma. METHODS: This is a retrospective clinical study. The medical records of patients with hepatoblastoma, treated between October 1994 and October 2009, were reviewed. The patients were classified according to the pretreatment extent of disease (PRETEXT) grouping system. The main outcome variable was survival. Secondary outcome variables were complete, partial and no response to chemotherapy and surgery, when indicated. RESULTS: Twenty-seven patients were treated during the observation period. Eighteen were males. Five were PRETEXT group I, 8 group II, 13 group III and 1 group IV. Complete excision was achieved in all patients except in one case that underwent liver transplantation (group IV). Median follow-up and survival rate were 2.3 years and 100%, 6.6 years and 75%, 5.8 years and 92%, 7.7 years and 100%, for groups I to IV, respectively. Twenty patients are currently considered to be in complete response status and three patients are receiving postoperative chemotherapy. Four patients died; the causes of death were cytomegalovirus hepatitis, bone marrow suppression during adjuvant chemotherapy, primarynonfunction after the transplantation for recurrent tumor and metachronous rectal cancer, respectively. CONCLUSION: Favorable long-term outcome could be expected for hepatoblastoma with complete tumor excision and adjuvant chemotherapy.
Bone Marrow ; Cause of Death ; Chemotherapy, Adjuvant ; Child ; Cytomegalovirus ; Follow-Up Studies ; Hepatitis ; Hepatoblastoma ; Humans ; Liver ; Liver Transplantation ; Male ; Medical Records ; Rectal Neoplasms ; Retrospective Studies ; Survival Rate ; Transplants

Pediatric lymphangioma can occur at any site. However the neck is the most common site. There are two treatment modalities (surgical excision and intralesional injection) for lymphangiomas. But, the treatment guide line for lymphangioma has not been established, yet. The aim of this study is to establish the treatment guide line based on our experience with lymphangiomas. Medical records of 82 cases of lymphangioma were reviewed retrospectively. On MRI (magnetic resonance image) findings, lymphangiomas were divided into 4 groups by the proportion of the cyst bigger than 2 cm in diameter of the tumor; group A-proportion of cyst occupies more than 75%, group B-proportion of the cyst 50~75%, group C-25~50%, and D in less than 25%. All patients were treated with OK-432 intralesional injection as the initial treatment. The effective response rates of OK-432 in group A & B were 88.2% and 88.8%, respectively. Group C response was 38.0% and D only 20.0%. Twenty-three patients received surgical excision. The result of surgical excision was generally satisfactory. Surgical site infection occurred in 1 case and postoperative bleeding in 1 case. Theses results indicate that intralesional injection of OK-432 could be the first line therapy in group A & B. In group C, OK-432 would be better as the first line therapy than surgery. For the group D, surgical excision should be the first line of treatment.
Hemorrhage ; Humans ; Injections, Intralesional ; Lymphangioma ; Medical Records ; Neck ; Picibanil ; Retrospective Studies

Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the most common cause of euvolemic hypo-osmotic hyponatremia. There are several etiologies of SIADH including neuroendocrine tumor, pulmonary disease, infection, trauma, and medications. Here, we report a case of SIADH associated with a schwannoma involving the mediastinum in a 75-year-old woman who presented with nausea, vomiting, and general weakness. Laboratory testing showed hypo-osmolar hyponatremia, with a serum sodium level of 102mmol/L, serum osmolality of 221mOsm/kg, urine osmolality of 382mOsm/kg, urine sodium of 55 mmol/L, and plasma antidiuretic hormone (ADH) of 4.40 pg/mL. Chest computed tomography identified a 1.5-cm-sized solid enhancing nodule in the right lower paratracheal area. A biopsy specimen was obtained by video-assisted thoracoscopic surgery, which was diagnosed on pathology as a schwannoma. The hyponatremia was completely resolved after schwannoma resection and plasma ADH level decreased from 4.40 pg/mL to 0.86 pg/mL. This case highlights the importance of suspecting and identifying the underlying cause of SIADH when faced with refractory or recurrent hyponatremia, and that on possibility is mediastinal schwannoma
Aged ; Biopsy ; Female ; Humans ; Hyponatremia ; Inappropriate ADH Syndrome ; Lung Diseases ; Mediastinum ; Nausea ; Neurilemmoma* ; Neuroendocrine Tumors ; Osmolar Concentration ; Pathology ; Plasma ; Sodium ; Thoracic Surgery, Video-Assisted ; Thorax ; Vomiting

Autoimmune pancreatitis is now considered to be a systemic fibroinflammatory disease that can involve multiple organs. As it is associated with IgG4-positive plasma cells by an autoimmune mechanism, extrapancreatic organs as well as the pancreas could be affected with a lymphoplasmacytic infiltrate. The proximal bile duct, the salivary gland, the retroperitoneum and the kidney are well known to be involved with, but less is known about the involvement of hollow viscus which is pathologically associated with autoimmune pancreatitis. We report here on a case of gastric involvement in a 53-year-old man with autoimmune pancreatitis.
Bile Ducts ; Humans ; Immunoglobulin G ; Kidney ; Middle Aged ; Pancreas ; Pancreatitis ; Pancreatitis, Chronic ; Plasma Cells ; Salivary Glands

Male factors account for 20% to 50% of infertility cases, and infection in the genitourinary tract may play a contributing role in up to 15% of male infertility. Leukocytospermia is a well-known indicator of infection or inflammation in the male sex glands and the urogenital tract. Although great deal of effort has been expended to elucidate definite management strategies in infertile men with leukocytospermia, the gold standard of treatment remains unclear. Until recently, broad spectrum antibiotics and antioxidants have been used in the treatment of leukocytospermia for male infertility to eliminate infection and reduce reactive oxygen free radicals produced inside cellular mitochondria as a result of inflammation. The present review reveals that antibiotics might improve sperm parameters, the rate of resolution of leukocytospermia, the bacteriologic cure rate, and even the pregnancy rate, although some reports conflict. Antioxidants might also have clinical benefits for sperm function as shown by in vitro studies. However, the data are insufficient to conclude whether antibiotics and antioxidants for the treatment of infertile men with leukocytospermia are effective or not. Better designed investigations into leukocytospermia are needed.
Anti-Bacterial Agents ; Antioxidants ; Free Radicals ; Humans ; In Vitro Techniques ; Infertility ; Infertility, Male* ; Inflammation ; Leukocytes ; Male ; Male* ; Mitochondria ; Oxygen ; Pregnancy Rate ; Semen Analysis ; Spermatozoa