Purpose: To investigate the efficacy of outpatient clinic-based sutureless amniotic membrane transplantation (AMT) along with therapeutic contact lens (T-lens) application in eyes with persistent epithelial defects (PED). Methods: Nine eyes of nine patients (mean age, 71.7 ± 5.2 years) diagnosed with PED and treated with in-office sutureless AMT combined with T-lens application were retrospectively reviewed. Demographics, systemic diseases, PED etiology, corneal epithelial defect size, visual acuity, corneal scraping culture results, and clinical course were evaluated. Results: Among nine eyes with PED, three had neurotrophic keratopathy, four had infectious keratitis (three with fungal keratitis and one with bacterial keratitis), one had limbal deficiency, and one had marginal keratitis. The mean epithelial defect size (calculated as an average of the horizontal and vertical diameters) was 3.13 ± 1.42 mm, and the mean duration from AMT to epithelial healing was 30.1 ± 10.5 days (range, 14–51 days) in successful trials. The success rates were 77.8% (7/9) per patient and 66.7% (8/12) per trial. The causes of failure in two patients were AMT displacement and uncontrolled infection. Conclusions Our results demonstrate that in-office sutureless AMT combined with T-lens application can be used in patients with PED who are refractory to medications. It will be especially helpful for elderly patients because of its easy-to-use method. To achieve successful outcomes with AMT, an appropriate periocular environment as well as infection control need to be considered.

PURPOSE: The Purposes of this article are to illustrate the typical imaging features of eight patients with this syndrome and to discuss the advantage of each imaging modality with a concise review of literatures. MATERIALS AND METHODS: We retrospectively reviewed plain skull radiographs (6), computd tomographic(CT) scans(8), magnetic resonnance(MR) images(4) and cerebral angiograms(3) of eight patients with Sturge-Weber syndrome. We analyzed the radiographic findings of Stu rge-Weber syndrome and compared the findings of CT, MR and angiography. RESULTS: Plain radiographs showed characteristic gyriform calcifications(3) after 2 years of age. CT scans excellently demonstrated cortical calcifications(5), prominently enhancing choroid plexi(5) and dilated periventricular veins(2). MR revealed dilated deep cerebral veins as tubular or spot-like signal void structures at periventricular areas(3) and showed stripes of cortical enhancement after gadolinium infection(2). Angiograph showed dilated tortuous medullary and deep cerebral veins(3) as the collateral pathways of blood shunting. MR was superior to CT in the detection of parenchymal atrophy, venous abnormalities and the extent of angiomatous involvement. Angiography showed enlarged deep cerebral or medullary veins better than MR imaging. CONCLUSION: We think that each imaging modalit including CT, MR or angiography has unique advantages in the diagnosis of this syndrome but MR will be used frequently because of its superior ability for the detection of atrophy, vascular abnormalities and direct visualization of leptomeningeal angiomatosis with contrast enhancement.
Angiography ; Angiomatosis ; Atrophy ; Cerebral Veins ; Choroid ; Diagnosis ; Gadolinium ; Humans ; Magnetic Resonance Imaging ; Retrospective Studies ; Skull ; Sturge-Weber Syndrome* ; Tomography, X-Ray Computed ; Veins

PURPOSE: Visual internal urethrotomy is a standard therapy for incomplete urethral stricture, and may also be a reasonable initial treatment for a complete urethral stricture of less than 1cm. However, it has not yet been determined which length is most suitable for an internal urethrotomy of a complete urethral stricture. To answer this question, we retrospectively assessed the success rate and complications of an internal urethrotomy as an initial treatment for a complete urethral stricture. MATERIALS AND METHODS: Between January 1991 and December 2000, an internal urethrotomy was performed on 28 patients for a complete urethral stricture. A primary successful result was defined as; a patient requiring only one operation, and a peak flow rate of more than 15ml/s. A secondary successful result was defined as; no recurrences within six months, and peak flow rate of more than 15ml/s.1,2 RESULTS: A primary successful result was seen in 73.3 and 15.4% of patients, with a urethral stricture of less than, and greater than 2cm, respectively. A secondary successful result was seen in 100 and 92.3% of the patients with a urethral stricture of less than (average number of operation: 1.4 times), and greater than 2cm (average number of operation: 2.8 times), respectively. CONCLUSIONS: In this study, we found that a visual internal urethrotomy might be considered, not only as an initial method of treatment when a complete urethral stricture is less than 2cm, but also as a possible method of treatment when a stricture is more than 2cm.
Constriction, Pathologic ; Humans ; Recurrence ; Retrospective Studies ; Urethral Stricture*

An endodermal sinus tumor is a malignant germ cell tumor that usually arises in the gonads, but on rare occasion occurs in extragonadal locations. Our case was that of a 3 year old girl who complained of a rapid growing orbital mass. On histologic examination it revealed the typical picture of an endodermal sinus tumor and it also disclosed a positive reaction for alphafetoprotein using an immunoperoxidase technique. An orbital exenteration was performed followed by chemotheraphy, but the patient died 5 months after the onset of the disease.

Radiologic findings of hemangioendothelioma of the liver were retrospectively analyzed in twelve infants. The radiological examinations included were sonography in 12 patients, computed tomograpy (CT) in six, magnetic resonance (MR) imaging in five, and angiography in two. Four patients were diagnosed pathologically, two by angiography, five by follow-up sonography, and one by clinical presentation with sonography. The common radiologic findings of the hemangioendothelioma were well circumscribed heterogeneous echogenic mass (75%) on sonography, peripheral massive enhancement (67%) on CT, bright high signal intensity on T2-weighted MR image (100%), and homogenous or peripheral enhancement (75%) on Gd-DTPA enhanced T1-weighted MR image. Dilated proximal aorta and enlarged draining hepatic veins on angiography an d other studies were also important findgdings. The follow-up sonography demonstrated the involution of lesions with some calcification in four patients and complete resolution in one. The authors believe that these findings in an under the age of 6 months strongly suggest the diagnosis of hemangioendothelioma of the liver, and follow-up sonography should be done.
Angiography ; Aorta ; Diagnosis ; Follow-Up Studies ; Gadolinium DTPA ; Hemangioendothelioma* ; Hepatic Veins ; Humans ; Infant ; Liver* ; Retrospective Studies

OBJECTIVE: This study was designed to evaluate the effect of stretching on decreasing spasticity of ankle plantar flexor muscles by biomechanical assessments. METHOD: Twenty two ankle joints of nineteen patients with upper motor neuron lesion were included. The spasticity was assessed both clinically and biomechanically before and after stretching of ankle plantar flexor muscles by tilt table. For clinical assessment modified Ashworth scale (MAS) was used. For biomechanical assessment, ankle plantar flexor muscles were stretched isokinetically while EMG signals were recorded simultaneously and peak eccentric torque, stiffness index and stretch reflex threthold speed (SRTS) were measured. RESULTS: Two cases showed improvement in MAS after stretching but the others did not. SRTS of ankle plantar flexor was increased significantly while peak eccentric torque and stiffness index were unchanged. CONCLUSION: Passive stretching of ankle plantar flexor muscles decreased the stretch threshold, that is a neural component of spasticity but it did not decrease the mechanical component of spasticity.
Ankle Joint ; Ankle* ; Humans ; Motor Neurons ; Muscle Spasticity* ; Muscle Stretching Exercises* ; Muscles* ; Reflex, Stretch ; Torque

A 29 years old woman had suffered from posterior neck and right shoulder pain for one year. She was given a spinal manipulation that was by a non-licentiate at a non-hospital. Posterior neck and shoulder pains were worsened and headache was developed after the spinal manipulation. She was recommended to be kept on the manipulation. Although physical finding was non-specific, radiologic findings of CT and MRI revealed atlantoaxial subluxation. After cervical immobilization and anti-inflammatory drug medication for three months, she recovered and did return to her work. We expect that atlantoaxial subluxation after spinal manipulation is not rare even in healthy young person without underlying pathology and can progress to serious complications unless detailed examination and management are undertaken.
Adult ; Female ; Headache ; Humans ; Immobilization ; Magnetic Resonance Imaging ; Manipulation, Spinal* ; Neck ; Pathology ; Shoulder Pain

PURPOSE: The efficacy of extracorporeal shock wave lithotripsy (ESWL) in the treatment of pediatric urolithiasis was evaluated, and a retrospective analysis of the feasibility of various methods of pain control for ESWL performed according to the age of the patients. MATERIALS AND METHODS: Between 1987 and 2004, 30 boys and 32 girls diagnosed with urolithiasis were treated. Their records were reviewed and analyzed for metabolic and anatomical anomalies, the size and location of the stones and for the treatment outcomes and complications. RESULTS: The success rates were 27.4, 61.3 and 80.6% after one, two and three sessions of ESWL, respectively, with an overall success rate of 93.5%. The locations of the stone were the upper calyx, the mid calyx, the lower calyx, the upper ureter, the mid ureter and the lower ureter in 6, 4, 7, 15, 4 and 25 cases, respectively. All patients underwent ESWL with a piezoelectric lithotriptor (EDAP LT02). There was only one patient who required general anesthesia. Most of the patients younger than 6 years underwent the ESWL with IM or IV sedation only. Generally, the patients older than 6 years old required no sedation. Pyelonephritis occurred in one patient (1.6%). CONCLUSIONS: ESWL is an efficient and safe treatment modality for pediatric urolithiasis. Patients older than 6 years can undergo ESWL with analgesics or oral sedation only.
Analgesics ; Anesthesia ; Anesthesia, General ; Child ; Female ; Humans ; Lithotripsy* ; Pediatrics ; Pyelonephritis ; Retrospective Studies ; Shock* ; Ureter ; Urolithiasis*

Laryngeal involvement in systemic lupus erythematosus (SLE) is rare. It can range from mild ulcerations, vocal cord paralysis, and edema to necrotizing vasculitis with airway obstruction. The causes of vocal cord paralysis included vasculitis of the vasa nervorum, neuritis, thromboembolic effect on recurrent laryngeal nerves, and compression of the left recurrent laryngeal nerve by an enlarged left pulmonary artery. Few cases on the association of vocal cord palsy and pulmonary hypertension in SLE patient have been reported. We report a case of left vocal cord palsy and pulmonary hypertension in a patient with SLE who experienced improvement of vocal cord palsy and dyspnea after steroid pulse therapy.
Airway Obstruction ; Dyspnea ; Edema ; Humans ; Hypertension, Pulmonary* ; Lupus Erythematosus, Systemic* ; Neuritis ; Pulmonary Artery ; Recurrent Laryngeal Nerve ; Ulcer ; Vasa Nervorum ; Vasculitis ; Vocal Cord Paralysis* ; Vocal Cords*

PURPOSE: Four techniques of intracorporeal lithotripsy are now available: ultrasonic, electrohydraulic, laser and Lithoclast. Among these methods, we studied retrospectively the efficacy and safety of Lithoclast and electrohydraulic lithotripsy(EHL) in the treatment of ureteral stones. MATERIALS AND METHODS: From May 1994 to October 1997, a total of 70 cases with ureteral stones were randomized to either method(39 to Lithoclast and 31 to electrohydraulic lithotripsy). RESULTS: Overall success rates were 84.6%(33 cases among 39cases) for Lithoclast and 83.9%(26 cases among 31 cases) for EHL, so both methods are equivalent in efficacy. The success rates according to location were 85.7% in proximal ureter, 82.4% in middle ureter, 86.7% in distal ureter for Lithoclast and 78.6%, 90.0%, 85.7% for EHL. The success rates according to size were 90.0% in<5mm, 83.3% in 5-9mm, 80.0% in > or =10mm for Lithoclast and 100%, 77.8%, 90.0% for EHL respectively. There were 6 failures with Lithoclast due to upward migration of stone. There were 5 failures with EHL due to upward migration(3 cases), extremely hard consistency(1 case) and poor visual field(1 case). Complications of ureteroscopic stone removal were fever(1 case), ureteral perforation(1 case) with Lithoclast and hematuria(1 case) with EHL, which were treated conservatively. CONCLUSIONS: We have found that efficacy and safety of EHL is as satisfactory as Lithoclast in skilled hands.
Hand ; Lithotripsy* ; Retrospective Studies ; Ultrasonics ; Ureter ; Ureteral Calculi