PURPOSE: To report a case of cilioretinal artery occlusion following the intranasal injection of corticosteroids. METHODS: A 52-year-old man was referred to the ophthalmologic clinic due to a marked loss of vision in his right eye immediately after endoscopic sinus surgery. At that time, his vision was noted to be counting fingers in the right eye. His pupil was mid-dilated, fixed, and did not respond to light on examination. On ophthalmoscopy, macula edema with retinal ischemia, and a cherry-red spot were seen in the posterior pole of the retina. Ocular massage was carried out immediately after ophthalmologic examination. Three days later, visual acuity in the right eye improved to 0.15. Fluorescein angiography revealed filling defects of the cilioretinal artery and peripheral branches of the retinal arteries. In addition, areas of nonperfusion were observed. RESULTS: During the follow-up periods, macula edema resolved and visual acuity in the right eye improved to 1.2 after 3 months. Fluorescein angiogram was repeated and showed that the filling defects had disappeared. CONCLUSIONS: Retinal artery occlusion can occur after an intranasal injection of corticosteroids due to embolization of retinal circulation. This condition can be improved without complications by no other specific therapy.
Adrenal Cortex Hormones ; Arteries* ; Edema ; Fingers ; Fluorescein ; Fluorescein Angiography ; Follow-Up Studies ; Humans ; Ischemia ; Massage ; Middle Aged ; Ophthalmoscopy ; Pupil ; Retina ; Retinal Artery ; Retinal Artery Occlusion ; Retinaldehyde ; Visual Acuity

Extramammary Paget's disease is a rare cutaneous neoplasm mostly observed on the genital and perineal areas. In Korea, there has only been one report of extramammary Paget's disease occurring in the axilla. We herein report a case of extramammary Paget's disease of the axilla, confirmed by biopsy and immunohistochemical studies.
Axilla* ; Biopsy ; Korea ; Paget Disease, Extramammary*

Reconstruction of partial ear defects presents a unique and notable challenge to the dermatologist. This is due to the complex architecture of the external ear which is difficult to duplicate surgically. Several procedures are available for correction of defects to the external ear. However, the diversity of external ear shapes shows how difficult it is to achieve a certain solution to this problem. We report a case of auricular squamous cell carcinoma in which the skin defect is reconstructed by a staged supra-auricular interpolation pedicle flap.
Carcinoma, Squamous Cell ; Ear* ; Ear, External ; Skin

Lupus miliaris disseminatus faciei(LMDF) is a erythematous to yellowish asymptomatic papular eruption affecting the cental of the face, which runs a chronic course and terminating spontaneously with scarring. Histopathologically, epithelioid cell granuloma with caseation necrosis is seen in the dermis. Although the disease is self limited, the etiology and pathogenesis are unknown, so there is no effective treatment for LMDF. We report 3 cases of LMDF patients treated with Dapsone with effective results compared to natural history of this disease.
Cicatrix ; Dapsone* ; Dermis ; Epithelioid Cells ; Granuloma ; Humans ; Natural History ; Necrosis

ZD1839 (Iressa(R)) is a new anticancer agent, a selective epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor that blocks signal transduction pathway implicated in the proliferation and survival of cancer cells and other host-dependent process promoting cancer growth. But this agent can induce cutaneous side effects including acneiform eruption, dry skin, and hair abnormality, which is related with the interruption of normal epidermal and hair follicular kinetics. We report a case of hair change and acneiform eruption induced by ZD1839 (Iressa(R)).
Acneiform Eruptions* ; Hair* ; Kinetics ; Protein-Tyrosine Kinases ; Receptor, Epidermal Growth Factor ; Signal Transduction ; Skin

Twenty-nail dystrophy is a distinctive pattern of nail changes, in which all 20 nails are uniformly affected with excessive longitudinal ridging and loss of luster. It occurs at any age ranging from children to adulthood, however, it is most commonly diagnosed in children. It can be idiopathic or caused by other inflammatory dermatoses, but the exact cause and pathogenesis of these changes are so far unknown. Several treatment modalities have been employed for treatment of twenty-nail dystrophy, such as topical steroid, intralesional steroids injection, and topical PUVA, however, without much success. We herein report a case of an adults, patient with twenty-nail dystrophy which was successfully treated with topical 0.025% Tretinoin cream.
Adult ; Child ; Humans ; Skin Diseases ; Steroids ; Tretinoin*

Since 1970's, Tamoxifen has been used as an antiestrogen agent for adjuvant hormonal therapy, targeting hormone receptor positive breast cancer. Tamoxifen has adverse side effects such as menopausal hot flush, vaginal discharge, irregular menses, thromboembolism, and uterine endometrial carcinoma. Tamoxifen has structure and side effects similar to amphiphilic cationic agents like chlorpromazine, thorazine, amiodarone, and chloroquine. With long period use in high dose, tamoxifen can cause ocular side effects such as retinal crystalline deposition, macular edema, whorl-like corneal opacities, posterior subcapsular lens opacities, optic neuritis, and affected EOG. Recently several reports showed that ocular side effect could happen even in low dose standard treatment. We experienced a case of keratopathy of corneal opacity without disorder of retina, lens, and optic nerve in low dose tamoxifen therapy for breast cancer.
Amiodarone ; Breast Neoplasms* ; Breast* ; Cataract ; Chloroquine ; Chlorpromazine ; Corneal Opacity* ; Crystallins ; Electrooculography ; Endometrial Neoplasms ; Estrogen Receptor Modulators ; Female ; Humans ; Macular Edema ; Optic Nerve ; Optic Neuritis ; Retina ; Retinaldehyde ; Tamoxifen* ; Thromboembolism ; Vaginal Discharge

OBJECTIVES: To examine various dimensions of consumer ratings of health care service with factor analysis and to find which factors influence the overall quality of health care service. METHODS: A cross-sectional study was conducted on outpatients of a general hospital located in Sungnam City. A self-administered questionnaire was used to assess the consumer? ratings of health care service received. The response rate was 92.8% with a total of 537 persons completing the questionnaire. Factor analysis was performed on 34 items evaluating the quality of health care service. Items were grouped into 5 dimensions as a result of factor analysis and the reliability and validity of influence on patient service assessment were evaluated for each dimension. RESULTS: The 5 dimensions were as follows ; 1) physician services, 2) non-physician services, 3) process 4) facilities, and 5) cleanliness. A positive correlation with the quality of health care service was found for the dimensions of non-physician services and process, while no significant correlation was found for the dimensions of physician services, facilities, and cleanliness. CONCLUSIONS: The result of this study may provide basic information for the development of future self-administered questionnaires of consumer ratings and for the evaluation of quality improvement activities in hospital outpatient settings.
Consumer Satisfaction ; Cross-Sectional Studies ; Delivery of Health Care ; Factor Analysis, Statistical ; Gyeonggi-do ; Hospitals, General ; Humans ; Outpatients* ; Quality Improvement ; Quality of Health Care ; Surveys and Questionnaires ; Reproducibility of Results

PURPOSE: To determine the differential points of hard palate masses, using CT and MR. MATERIALS AND METHODS: MR (N=18) and CT (N=15) findings in 30 patients with pathologically-proven hard palate masses were reviewed. Masses originating in minor salivary glands were the most common (66.7%, N=20), and the remainder were accounted for by squamous cell carcinoma (N=5), lymphoma (N=2), malignant schwannoma (N=1), neurofibroma (N=1), and cholesterol granuloma (N=1). Location and demarcation of the lesions, MR signal intensity, degree of enhancement, internal architecture, and the patterns of adjacent tissue plane invasion were analyzed. RESULTS: The location of lesions originating in minor salivary glauds was as follows: paramedial, 73.7% (14/19); midline, 85.7% (6/7); and marginal,0% (0/4). On MR imaging, signal intensity and degree of enhancement showed no significant differential point except lower T2 signal intensity (3/5) and less enhancement (4/5) in squamous cell carcinoma than in other masses. Necrosiswas seen in 10/21 malignant masses (47.6%), poor demarcation in 10/21 (47.6%), bone invasion in 19/21 (90.5%), and tissue plane invasion in 15/21 (71.4%); in benign masses, the corresponding figures were 4/9 (44.4%), 1/9 (11.1%), 2/9 (22.2%), and 3/9 (33.3%). Two of 21 malignant masses (9.5%) showed none of the above charachteristics. CONCLUSION: Centrally located lesions most probably originate in minor salivary glands. In the hard palate, benign masses can show features which are generally thought to be those of malignant tumors, whereas malignant tumors can be free of such features; in differential diagnosis, caution is therefore required.
Carcinoma, Squamous Cell ; Cholesterol ; Diagnosis, Differential* ; Granuloma ; Humans ; Lymphoma ; Magnetic Resonance Imaging ; Neurilemmoma ; Neurofibroma ; Palate ; Palate, Hard* ; Salivary Glands, Minor

PURPOSE: Intracranial lesions may produce ophthalmic symptoms as chief complaints. The purpose of this study is to help ophthalmologists make an earlier diagnosis of the presence of an intracranial lesion. METHODS: The medical records of the patients diagnosed with an intracranial lesion at the department of ophthalmology were reviewed retrospectively. RESULTS: The mean age of 38 patients (Male: Female=18: 20) was 42.2 years. Visual disturbance was the most frequent symptom at presentation (63.2%), and there was strabismus, visual field defects, diplopia, and other complaints. The underlying problem was that for 23 patients, there was an initial misdiagnosis for 10 of them as having a retinal lesion or an optic neuropathy in 10, paralytic strabismus in 9, and there were other misdiagnoses as well. There were afferent pupillary defects in 12 and optic disc abnormalities in 8 patients. The most common type of visual field defects was a bitemporal hemianopsia. The final diagnosis was the presence of a brain tumor in 28, cerebral infarction in 5, carotid-cavernous fistula in 3, aneurysm in one, and histiocytosis in one patient. CONCLUSIONS: The patients that presented with ophthalmologic symptoms were diagnosed as having variable intracranial lesions. Therefore, it is important for the ophthalmologist to pay closer attention so as to discover the specific intracranial lesion through the exam of the pupil, the optic disc, and the visual field test.
Aneurysm ; Brain Neoplasms ; Cerebral Infarction ; Diagnosis ; Diagnostic Errors ; Diplopia ; Fistula ; Hemianopsia ; Histiocytosis ; Humans ; Medical Records ; Ophthalmology* ; Optic Nerve Diseases ; Pituitary Neoplasms ; Pupil ; Pupil Disorders ; Retinaldehyde ; Retrospective Studies ; Strabismus ; Visual Field Tests ; Visual Fields