Carcinoid tumor of stomach continue to interest clinician because of the rarity and difficulty in diagnosis clioically with infrequent classical carcinoid syndrome. Recently, we experienced a case of gastric carcinoid with hemetemesis and melena. We feel that this case is an instructive example of the fascinating variety of entities which can result in massive upper gastrointestinal bleeding. So we present this case with s review of relevant literatures.
Carcinoid Tumor* ; Diagnosis ; Hemorrhage* ; Melena ; Stomach

PURPOSE: To report a case of Vogt-Koyanagi-Harada (VKH) disease in a pregnant patient treated with intravitreal triamcinolone injection. CASE SUMMARY: A 21-year-old female in the 19th week of gestation presented with bilateral blurring of vision associated with mild headache and tinnitus. Her initial best corrected visual acuity was 0.15 in the right eye and 0.3 in the left eye. Multiple serous retinal detachment and anterior chamber inflammation were observed, and VKH disease was diagnosed. Because of her pregnancy, the patient did not want high-dose systemic prednisolone therapy which may cause an abortion or low birth weight infant when used in a pregnant patient. Therefore, an intravitreal triamcinolone (4 mg/0.1 ml) injection was given in the right eye and topical steroid eye drops were used in the left eye. After 1 day, serous retinal detachment was significantly decreased and anterior chamber inflammation disappeared in the right eye. After 1 week, no serous retinal detachment was observed. In the left eye, serous retinal detachment was decreased after using steroid eye drops. After 10 days, serous retinal detachment disappeared but anterior chamber inflammation was still observed. After 1 month, best corrected visual acuity was 1.0 in both eyes and serous retinal detachment had not recurred. On follow-up, VKH disease had not recurred and a healthy normal weight infant was delivered. CONCLUSIONS: Intravitreal triamcinolone injection is an effective and safe treatment for VKH disease in pregnant women.
Anterior Chamber ; Eye ; Female ; Follow-Up Studies ; Headache ; Humans ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Inflammation ; Ophthalmic Solutions ; Prednisolone ; Pregnancy ; Pregnant Women ; Retinal Detachment ; Tinnitus ; Triamcinolone* ; Uveomeningoencephalitic Syndrome* ; Vision, Ocular ; Visual Acuity ; Young Adult

BACKGROUND/AIMS: Most patients with acute viral hepatitis A have a favorable course, but a few of them suffer from severe forms of hepatitis such as fulminant hepatitis. This study was carried out to identify the factors influencing the severity of acute viral hepatitis A. METHODS: We retrospectively reviewed the medical records of 713 patients with acute hepatitis A, who were divided into two groups: severe hepatitis A (N=87) and non-severe hepatitis A (N=626). Severe hepatitis was defined as fulminant hepatitis or prolongation of prothrombin time (INR> or =1.5). Clinical variables were compared between the two groups. RESULTS: The incidence of fulminant hepatitis was 1.4 % (10/713) in patients with acute hepatitis A. Thirty-three (4.6 %) cases exhibited HBsAg positivity. In multivariate analyses, significant alcohol intake and the presence of HBsAg were significant predictive factors of fulminant hepatitis A, and significant alcohol intake and age were significant predictive factors of severe hepatitis A. HBeAg and HBV-DNA status did not affect the clinical course of hepatitis A in chronic hepatitis B carriers. CONCLUSIONS: While most patients with acute hepatitis A have an uncomplicated clinical course, our data suggest that a more-severe clinical course is correlated with being older, significant alcohol intake, and chronic hepatitis-B-virus infection. (
Acute Disease ; Adult ; Age Factors ; Alcohol Drinking ; Female ; Hepatitis A/complications/*diagnosis ; Hepatitis B Surface Antigens/blood ; Hepatitis B, Chronic/complications ; Humans ; Liver Failure, Acute/epidemiology/etiology ; Male ; Middle Aged ; Predictive Value of Tests ; Prothrombin Time ; Retrospective Studies ; Severity of Illness Index

PURPOSE: We evaluate in vitro and in vivo efficacy of newly developed gentamicin loaded PLGA microspheres for the treatment of musculoskeletal infection. MATERIALS AND METHODS: Controlled gentamicin sulfate releasing microspheres manufactured from biodegradable PLGA were prepared with an Oil/Oil solvent evaporation method for the treatment of musculoskeletal infection. The in vitro release amount of GS was analyzed by high performance liquid chromatography (HPLC) and the released GS activity was determined by microbiological assay using staphylococcus (S) aureus, respectively. The results of inhibition zone test agree well with the HPLC results obtained from the in vitro release test. RESULTS: The microspheres of different size were obtained with varying the experimental conditions, and the shape of microspheres was smooth and spherical. The PLGA microspheres release gentamicin for 67 days in in vitro test. There was significant inhibition around microphere PLGA from 1 day to 7th week in inhibition zone test The inhibition was reduced after 8th week. and there was no inhibition at 9th week PLGA microspheres. CONCLUSION: It can be suggested that GS/PLGA MSs implantable system that provided a prolonged delivery of GS was found to be effective against S. aureus infection for desired period.
Chromatography, High Pressure Liquid ; Chromatography, Liquid ; Gentamicins* ; Microspheres* ; Staphylococcus ; Staphylococcus aureus

OBJECTIVE: During anterior clinoidectomy for aneurysms of ophthalmic artery or paraclinoidal lesions, not only optic nerve but also cranial nerves passing through the superior orbital fissure (SOF) can be damaged by mechanical or thermal injury. Particularly, revision for paraclinoidal lesions can give further damage to the cranial nerves because of the obscure anatomical structure resulting from the tight fibrous adhesion. Thus, to reduce the damage of the cranial nerves passing through the SOF during the anterior clinoidectomy or optic canal decompression via the extradural or intradural route, morphometric relationship of juxta-clinoidal cranial nerves were studied. MATERIALS AND METHODS: Using 15 adult formalin fixed cadavers, the anatomical landmarks for measurements were chosen as follows: lateral entry point of optic nerve into the optic canal (LON), tip of anterior clinoid process (ACP), tip of posterior clinoid process (PCP), upper border of lesser wing of sphenoid bone, and lateral end of SOF. The measurements were carried out as follows: 1) distance from the LON to the dural entry point (DEP) of the third (III), fourth (IV), and ophthalmic branch of the fifth (V1) nerves into the tentorium, 2) distance from the tip of PCP to the DEP of III and VI cranial nerves, 3) distance from the LON to the cranial nerves within intradural space before passing through SOF, 4) The shortest depth from the tip of ACP and the edge of lesser wing to the cranial nerves passing through the cavernous sinus, 5) distance from the lateral end of SOF to the cranial nerves just before passing through the annular tendon. RESULTS: The mean distance from the LON to the DEP of the III, IV, and V1 cranial nerves were 10.4 mm, 18.8 mm, and 23.4 mm, respectively. The mean distance from the tip of PCP to the DEP of the III and VI cranial nerves were 5.4 mm and 18.6 mm, respectively. DEP of the III cranial nerve was corresponded with the just anterior coronal plane of PCP. The mean distance from the LON to the III, IV, and V1 cranial nerves passing through the SOF were 7.2 mm, 10.0 mm, 10.5 mm and 10.6 mm, respectively. The III cranial nerve located at a mean depth of 3.4 mm from the tip of ACP. The IV, V1 , and VI cranial nerves located at a mean depth of 2.1 mm, 2.4 mm and 7.4 mm from the upper border of lesser wing of sphenoid bone, respectively. The III cranial nerve splitted into superior and inferior divisions at a mean distance of 1.51 mm from the lateral end of SOF, just before where it passes through the SOF. The mean distance from the lateral end of SOF to the lateral margins of the III, IV and frontal nerves of V1 were 12.5 mm, 11.0 mm and 10.2 mm, respectively. CONCLUSION: DEP of the III cranial nerve was corresponded with the just anterior coronal plane of PCP and was about a half distance from PCP than from LOP. DEP of the IV cranial nerve looks like same site as that of V1 cranial nerve, but IV cranial nerve located at just superior to V1. From the LON, III, IV, V1 , and VI CNs latero-inferiorly passed through the SOF. The III cranial nerve located at the most medial portion of SOF with a mean distance of 7 mm, and the IV, V1 and VI cranial nerves were arranged in the same order as vertical arrangement with a mean distance of 10 mm. The cranial nerves just before passing through SOF were located at a range of 7.8 to 20 mm from the lateral end of SOF. This study facilitates an understanding of the anatomy of juxta-sellar region and may help to reduce the cranial nerve injury at the surgery around juxta-clinoidal CNs.
Adult ; Aneurysm ; Cadaver ; Cavernous Sinus ; Cranial Nerve Injuries ; Cranial Nerves* ; Decompression ; Formaldehyde ; Humans ; Ophthalmic Artery ; Optic Nerve ; Orbit ; Sphenoid Bone ; Tendons

PURPOSE: In recent, years, an increase of syphilis infections has become an issue in Korea as well as globally. Herein, we report a recent clinical manifestation of syphilitic uveitis in a Korean population. METHODS: Over a 5-year period (2007-2012), we collected and analyzed the medical records of 16 patients with syphilitic uveitis in three tertiary eye clinics in Pusan. Sixteen patients were confirmed to have syphilis based on serological tests. Retrospective chart review was performed to determine the best corrected visual acuity, anterior and posterior segments, and treatment regimen, as well as ancillary test results including fluorescein angiogram (FAG). RESULTS: Of the 16 patients, 12 were males and four were females. The mean age of the patients was 51.16 years. Non-granulomatous anterior uveitis was observed in nine eyes (47.4%). Vitritis was the most frequently observed posterior segment finding (16 eyes, 84.2%). Retinal vasculitis and chorioretinitis were found in 11 (57.9%) and five eyes (26.3%), respectively. All patients had negative results in the serum HIV antibody test. Of the 16 patients, 15 were treated with penicillin or ceftriaxone due to neurosyphilis. Mean visual acuity improved from 1.33 +/- 1.1 to 0.58 +/- 0.68 after treatment. CONCLUSIONS: Clinical manifestation of syphilitic uveitis in Korean patients is different from occurrences in Western countries. Ophthalmological findings of syphilitic uveitis are diverse; thus, serological testing for syphilis is recommended for all uveitis patients. Further research regarding long-term treatment, relapse of syphilitic uveitis, and complications is necessary.
Busan ; Ceftriaxone ; Chorioretinitis ; Female ; Fluorescein ; HIV ; Humans ; Korea ; Male ; Medical Records ; Neurosyphilis ; Penicillins ; Recurrence ; Retinal Vasculitis ; Retrospective Studies ; Serologic Tests ; Syphilis ; Uveitis* ; Uveitis, Anterior ; Visual Acuity

BACKGROUND: The radial forearm flap is a versatile, widely used flap. However, the possibility of donor site complications has led to concern over its use. Some surgeons prefer using other flaps whose donor sites can be closed primarily with less morbidity, including avoiding unpleasant scarring. However, in our experience, donor site stability of the radial forearm flap can be reliably achieved by using well-implemented specific procedures. Here, we present a collection of donor site cases of the radial forearm flap and investigate factors that affect the aesthetic results as the basis for a reference for selecting a radial forearm flap. METHODS: In this retrospective study, we reviewed 171 cases in which a radial forearm flap was used for free tissue transfer after resecting head and neck cancer. We focused on donor site morbidity rates. Each operation involved a detailed procedure designed to minimize donor site morbidity. Moreover, statistical investigations were conducted for 22 cases to determine factors affecting the scar appearance. RESULTS: Only one case developed total skin graft necrosis as a major complication. Scar-related aesthetic results were acceptable, and the body-mass index, body weight, diabetes, and cardiac problems were significant factors related to the appearance of scars. CONCLUSIONS: Performing the radial forearm flap using a well-implemented detailed technique helps achieve acceptable donor site morbidity results. The aesthetic results were more promising for patients without excess body weight, diabetes, or cardiac problems. Therefore, anxiety about donor site morbidity should not be a reason to avoid selecting the radial forearm flap in suitable patients.
Anxiety ; Body Weight ; Cicatrix ; Esthetics ; Forearm* ; Free Tissue Flaps* ; Head and Neck Neoplasms ; Humans ; Necrosis ; Retrospective Studies ; Skin ; Skin Transplantation ; Tissue Donors* ; Transplants

OBJECTIVE: To investigate the effects of different pilot-drilling methods on the biomechanical stability of self-tapping mini-implant systems at the time of placement in and removal from artificial bone blocks. METHODS: Two types of artificial bone blocks (2-mm and 4-mm, 102-pounds per cubic foot [102-PCF] polyurethane foam layered over 100-mm, 40-PCF polyurethane foam) were custom-fabricated. Eight mini-implants were placed using the conventional motor-driven pilot-drilling method and another 8 mini-implants were placed using a novel manual pilot-drilling method (using a manual drill) within each of the 2-mm and 4-mm layered blocks. The maximum torque values at insertion and removal of the mini-implants were measured, and the total energy was calculated. The data were statistically analyzed using linear regression analysis. RESULTS: The maximum insertion torque was similar regardless of block thickness or pilot-drilling method. Regardless of the pilot-drilling method, the maximum removal torque for the 4-mm block was statistically higher than that for the 2-mm block. For a given block, the total energy at both insertion and removal of the mini-implant for the manual pilot-drilling method were statistically higher than those for the motor-driven pilot-drilling method. Further, the total energies at removal for the 2-mm block was higher than that for the 4-mm block, but the energies at insertion were not influenced by the type of bone blocks. CONCLUSIONS: During the insertion and removal of mini-implants in artificial bone blocks, the effect of the manual pilot-drilling method on energy usage was similar to that of the conventional, motor-driven pilot-drilling method.
Foot ; Linear Models ; Polyurethanes ; Torque

PURPOSE: The present study was designed to examine the distribution and type of dorsal root ganglion (DRG) cells innervating the medial and lateral collateral ligaments and patellar tendons of the rat knee joint. MATERIALS AND METHODS: We selectively injected neural tracers (FG and HRP) into both collateral ligaments and patellar tendons and then charaterized the distribution and type of DRG cells in section. RESULTS: FG-labelled DRG cells, innervating the medial and lateral collateral ligaments, were located in L1-S3 (former) and L1-L5 (later). The HRP-labelled DRG cells innervating the medial and lateral collateral ligaments were smaller than 600 m2. FG-labelled DRG cells innervating the patellar tendons were found in L1 to S1. The HRP-labelled cells innervating the patellar tendons were variable in size (100 m2 to 3000 m2). CONCLUSION: This study indicates that the DRG origins of sensory nerves in the collateral ligaments and the patellar tendon of the rat knee joint are different. The majority of DRG cells innervating the patellar tendons are proprioceptive and mechanoceptive sensory cells. This finding suggests that the patellar ligaments have more neurological functions than the collateral ligaments.
Animals ; Collateral Ligaments ; Diagnosis-Related Groups ; Ganglia, Spinal* ; Knee Joint* ; Knee* ; Lateral Ligament, Ankle* ; Ligaments ; Patellar Ligament* ; Rats* ; Spinal Nerve Roots* ; Tendons

Biphenotypic acute leukemia (BAL) is a subtype of leukemia of ambiguous lineage in the World Health Organization classification system. About one third of the cases have the Philadelphia chromosome, and some cases are associated with other structural abnormalities involving 11q23. BAL is known to have a poor prognosis in both children and adults. According to the previously reported BAL cases with positive BCR-ABL fusion gene, most of the BCR-ABL mRNA transcript type was e1a2. So, we describe here a 30-year-old adult BAL case with the karyotype 46,XY,t(9;22)(q34;q11.2) resulting in a very rare b3a2 type of BCR-ABL mRNA transcript.
Adult ; Child ; Classification ; Humans ; Karyotype ; Leukemia ; Leukemia, Biphenotypic, Acute* ; Philadelphia Chromosome ; Prognosis ; RNA, Messenger* ; World Health Organization