Purpose: We present a case of anterior displacement of the lens-iris diaphragm associated with Vogt–Koyanagi–Harada (VKH) disease.Case summary: A 35-year-old woman presented with decreased vision in her right eye. Examination revealed corrected visual acuity of 0.6 in the right eye and 1.0 in the left eye. Intraocular pressure (IOP) was 14 and 16 mmHg in the right and left eye, respectively. Spherical equivalent (SE) was -17.25 D in the right eye and -9.75 D in the left eye. Slit lamp examination and three-dimensional anterior segment photography revealed anterior displacement of the lens-iris diaphragm in both eyes. Two days later, the left eye developed similar symptoms with an SE of -15.5 D. Fundus examination revealed serous retinal detachment and fluorescein fundus photography demonstrated focal leakage leading to the diagnosis of atypical VKH disease. The patient was treated with oral corticosteroids and her symptoms resolved after 3 weeks. The Final SE was -10.25 D in the right eye and -9.75 D in the left eye. Conclusions We suggest there is an association between atypical VKH and anterior lens-iris diaphragm displacement in the absence of elevated IOP; early myopic shift may be associated with this presentation. Therefore, patients with isolated lens-iris diaphragm displacement, particularly those without a history of medications should be monitored for the possibility of developing VKH disease.

Purpose: We present a case of anterior displacement of the lens-iris diaphragm associated with Vogt–Koyanagi–Harada (VKH) disease.Case summary: A 35-year-old woman presented with decreased vision in her right eye. Examination revealed corrected visual acuity of 0.6 in the right eye and 1.0 in the left eye. Intraocular pressure (IOP) was 14 and 16 mmHg in the right and left eye, respectively. Spherical equivalent (SE) was -17.25 D in the right eye and -9.75 D in the left eye. Slit lamp examination and three-dimensional anterior segment photography revealed anterior displacement of the lens-iris diaphragm in both eyes. Two days later, the left eye developed similar symptoms with an SE of -15.5 D. Fundus examination revealed serous retinal detachment and fluorescein fundus photography demonstrated focal leakage leading to the diagnosis of atypical VKH disease. The patient was treated with oral corticosteroids and her symptoms resolved after 3 weeks. The Final SE was -10.25 D in the right eye and -9.75 D in the left eye. Conclusions We suggest there is an association between atypical VKH and anterior lens-iris diaphragm displacement in the absence of elevated IOP; early myopic shift may be associated with this presentation. Therefore, patients with isolated lens-iris diaphragm displacement, particularly those without a history of medications should be monitored for the possibility of developing VKH disease.

Purpose: We present a case of anterior displacement of the lens-iris diaphragm associated with Vogt–Koyanagi–Harada (VKH) disease.Case summary: A 35-year-old woman presented with decreased vision in her right eye. Examination revealed corrected visual acuity of 0.6 in the right eye and 1.0 in the left eye. Intraocular pressure (IOP) was 14 and 16 mmHg in the right and left eye, respectively. Spherical equivalent (SE) was -17.25 D in the right eye and -9.75 D in the left eye. Slit lamp examination and three-dimensional anterior segment photography revealed anterior displacement of the lens-iris diaphragm in both eyes. Two days later, the left eye developed similar symptoms with an SE of -15.5 D. Fundus examination revealed serous retinal detachment and fluorescein fundus photography demonstrated focal leakage leading to the diagnosis of atypical VKH disease. The patient was treated with oral corticosteroids and her symptoms resolved after 3 weeks. The Final SE was -10.25 D in the right eye and -9.75 D in the left eye. Conclusions We suggest there is an association between atypical VKH and anterior lens-iris diaphragm displacement in the absence of elevated IOP; early myopic shift may be associated with this presentation. Therefore, patients with isolated lens-iris diaphragm displacement, particularly those without a history of medications should be monitored for the possibility of developing VKH disease.

We report a case of mature cystic teratoma of the anterior mediastinum that ruptured into the pulmonary artery requiring an emergent surgical treatment. A 39-year-old woman presented an episode of massive hemoptysis and treated with bronchial artery embolization (BAE). On the 10th day after BAE, however, she developed sudden massive hemoptysis and had a deteriorated mental status. For a definitive treatment, she underwent the left pneumonectomy and the tumor resection in the anterior mediastinum. On histologic examination, the tumor disclosed cystic structures composed of mature squamous epithelium, pilosebaceous glands, mature fat tissue, cartilage and bone tissue. Also, there was intrapulmonary hemorrhage due to left pulmonary artery invasion of the tumor.
Adult ; Bone and Bones ; Bronchial Arteries ; Cartilage ; Epithelium ; Female ; Hemoptysis ; Hemorrhage ; Humans ; Lung ; Mediastinum ; Pneumonectomy ; Pulmonary Artery* ; Teratoma*

Tracheobronchial rupture following tracheal intubation with double-lumen endobronchial tube (DLT) is a rare complication, but may result in a massive air leakage with resultant pneumothorax, mediastinal emphysema and extensive subcutaneous emphysema in the postoperative period. We report a case of sustained laceration of the posterior membranous part of the trachea possibly due to overinflation of the double-lumen endobronchial tube. A 76-year-old, 45 kg, female was scheduled for a repair of her bronchopleural fistula. Following induction of anesthesia, intubation was performed with Robertshaw's DLT, and a tracheal cuff was inflated with 6 ml of air, but the sound of an air leak was heard coming from the patient's mouth during controlled ventilation. A further 5 ml of air was added 1 ml at a time into the tracheal cuff but the air leak sound continued. At that point, the sound was considered to originate from the bronchopleural fistula rather than from lack of sufficient air. After a thorough deflation of the tracheal cuff, 6 ml of air was reinjected and the operation was resumed. A 4 cm split was unexpectedly noticed in the posterior wall of the trachea during the operation and was repaired without complication.
Aged ; Anesthesia ; Female ; Fistula ; Humans ; Intubation ; Lacerations ; Mediastinal Emphysema ; Mouth ; Pneumothorax ; Postoperative Period ; Rupture* ; Subcutaneous Emphysema ; Trachea ; Ventilation

BACKGROUND: To evaluate the usefulness of admission and daily acute physiology and chronic health evaluation (APACHE) III score in relation to length of stay in the intensive care unit (ICU) for outcome prediction, 4,554 patients were studied. METHODS: These patients were admitted to the ICU from June 6, 1994 to December 31, 2002. Exclusion criteria included patients being treated for burns, having surgery for coronary artery bypass grafts, having a diagnosis of myocardial infarction, being under 16 years of age and being discharged less than 16 hours after admission. To evaluate the discrimination power of admission and daily APACHE III score, the area under the receiver operating characteristic curve was computed for each of the initial 16 days of ICU care. RESULTS: Admission APACHE III score loses discrimination power over time, from admission day to day 4 in the ICU, the area under the receiver operating characteristic curve was above 0.8 and after day 16, it dropped to below 0.7. However, daily APACHE III score maintained discrimination power at about 0.8 over time. CONCLUSIONS: In the early days after ICU admission, admission and daily APACHE III score are useful. With time daily APACHE III scores are more useful than admission APACHE III score.
APACHE* ; Burns ; Coronary Artery Bypass ; Diagnosis ; Discrimination (Psychology) ; Humans ; Intensive Care Units ; Length of Stay* ; Myocardial Infarction ; ROC Curve ; Transplants

Phosphodiesterases (PDEs) play a key role in the regulation of cyclic adenosine monophosphate (cAMP), which in turn mediates various cellular functions including learning and memory. We previously cloned and characterized three PDE4 isoforms (ApPDE4) from Aplysia kurodai. Using reverse transcription polymerase chain reaction (RT-PCR), we found that ApPDE4 isoforms are primarily expressed in the central nervous system. However, the detailed distribution of ApPDE4 mRNA in Aplysia individual ganglions was not evident. In this study, to determine the distribution of ApPDE4 mRNAs in Aplysia ganglions, we performed in situ hybridization (ISH) using a probe targeting ApPDE4, including the PDE catalytic domain. Interestingly, we found the strongest ISH-positive signals in the symmetrical bag cell clusters of the abdominal ganglion. The R2, R14, L7, L2 and L11 neurons in the abdominal ganglion, LP1 neuron in pleural ganglion, and metacerebral (MCC) neurons were ISH-positive. Mechanosensory neurons of the sensory cluster were also stained on the ventral aspect of the right and left pleural ganglia. Taken together, we found the detailed distribution of ApPDE4 mRNA in Aplysia ganglion and support their roles in serotonin (5-HT)-induced synaptic facilitation of Aplysia mechanosensory neurons.
Adenosine Monophosphate ; Aplysia* ; Catalytic Domain ; Central Nervous System ; Clone Cells ; Cyclic Nucleotide Phosphodiesterases, Type 4* ; Ganglia ; Ganglion Cysts ; In Situ Hybridization* ; Learning ; Memory ; Neurons ; Phosphoric Diester Hydrolases ; Polymerase Chain Reaction ; Protein Isoforms ; Reverse Transcription ; RNA, Messenger ; Serotonin

Assessing the working memory of the rodent by using a touch-screen system has several advantages (e.g., allowing highly accurate data collection and flexibility in memory task design). However, there is currently no available testing paradigm utilizing touch-screen systems that can assess working memory in the mouse. In this study, we developed a touch-screen testing paradigm in which mice were trained to choose a location that is matched to a sample location after a time delay. Consistent with previous studies, this study showed that mice could not only learn the rule in the delayed matched to position (DMTP), but also could retain a transitory memory of the sample position during delay. This indicates that a touch-screen system can provide a DMTP testing platform to assess working memory in the mouse.
Animals ; Data Collection ; Memory ; Memory, Short-Term* ; Mice* ; Pliability ; Rodentia

Holoprosencephaly is a rare malformation complex or development defect including different degrees of incomplete cleavages of the embryonic prosencephalon and varying degrees of the midface defects, resulting from the defect of prechordal mesoderm, migrating forward into the area anterior to the notochord during the third week of fetal development. Early antenatal diagnosis of holoprosencephaly is important to find out its severity, to predict its prognosis, and to determine proper management according to its prognosis and severity. The possibility of early antenatal diagnosis of holoprosencephaly by ultrasound has been suggested, but occasionally missed and rarely confirmed. We present one case of lobar holoprosencephaly, diagnosed postnatally and one case of alobar holoprosencephaly, diagnosed antenatally in our hospitals.
Fetal Development ; Holoprosencephaly* ; Mesoderm ; Notochord ; Prenatal Diagnosis ; Prognosis ; Prosencephalon ; Ultrasonography

Aberrant right subclavian artery (ARSA) is an anomaly with a reported incidence of 0.5% to 2%. Most patients with an ARSA remain asymptomatic; however about 10% of adult patients have compressive symptoms. A case is reported of a 64-year old female patient who had a few years of history of dysphagia and recurrent pneumonia. Angiography was performed, which demonstrated an ARSA with common origin of the right and left carotid arteries. Surgical correction was performed via right thoracotomy. The proximal aberrant artery was mobilized behind the esophagus. The distal, right subclavian artery was exposed, transected, and transposed with reimplantation into the aortic root by graft bypass.
Adult ; Angiography ; Arteries ; Carotid Arteries ; Deglutition Disorders* ; Esophagus ; Female ; Humans ; Incidence ; Middle Aged ; Pneumonia* ; Replantation ; Subclavian Artery* ; Thoracotomy ; Transplants ; Vascular Diseases