Purpose: We report a case of macular, serous retinal detachment associated with hypotony in a patient with pachychoroid disease developing after Ahmed valve implantation.Case summary: A 77-year-old male visited our clinic with uncontrolled intraocular pressure (IOP; 32 mmHg) in his left eye despite maximal tolerable medical therapy. A prolapsed vitreous filled the anterior chamber. Swept-source optical coherence tomography (SS-OCT) revealed that the subfoveal choroidal thickness was about 510 μm, indicating pachychoroid. Vitrectomy was performed to remove the prolapsed vitreous. The IOP remained 32 mmHg 3 weeks after vitrectomy. Ahmed valve implantation was performed and hypotony developed 10 days postoperatively. Choroidal detachment was apparent and SS-OCT revealed macular accumulation of subretinal fluid. The subfoveal choroidal thickness increased to a level beyond the SS-OCT measurement range. Partial tube ligation was performed to treat the hypotony 18 days after Ahmed valve implantation; the IOP decreased to 14 mmHg at 6 weeks postoperatively. The macular, serous retinal detachment disappeared and the subfoveal choroidal thickness fell to the preoperative value. Conclusions Hypotony after Ahmed valve implantation can manifest as serous retinal detachment under the fovea accompanied by an increase in choroidal thickness in an eye with underlying pachychoroid.

PURPOSE: To evaluate the role of surgical clips and scars in determining electron boost field for early stage breast cancer undergoing conserving surgery and postoperative radiotherapy and to provide an optimal method in drawing the boost field. MATERIALS AND METHODS: Twenty patients who had 4~7 surgical clips in the excision cavity were selected for this study. The depth informations were obtained to determine electron energy by measuring the distance from the skin to chest wall (SCD) and to the clip implanted in the most posterior area of tumor bed. Three different electron fields were outlined on a simulation film. The radiological tumor bed was determined by connecting all the clips implanted during surgery. Clinical field (CF) was drawn by adding 3 cm margin around surgical scar. Surgical field (SF) was drawn by adding 2 cm margin around surgical clips and an ideal field (IF) was outlined by adding 2 cm margin around both scar and clips. These fields were digitized into our planning system to measure the area of each separate field. The areas of the three different electron boost fields were compared. Finally, surgical clips were contoured on axial CT images and dose volume histogram was plotted to investigate 3-dimensional coverage of the clips. RESULTS: The average depth difference between SCD and the maximal clip location was 0.7+/-0.56 cm. Greater difference of 5 mm or more was seen in 12 patients. The average shift between the borders of scar and clips were 1.7, 1.2, 1.2, and 0.9 cm in superior, inferior, medial, and lateral directions, respectively. The area of the CF was larger than SF and IF in 6/20 patients. In 15/20 patients, the area difference between SF and IF was less than 5%. One to three clips were seen outside the CF in 15/20 patients. In addition, dosimetrically inadequate coverage of clips (less than 80% of prescribed dose) were observed in 17/20 patients when CF was used as the boost field. CONCLUSION: The electron field determined from clinical scar underestimates the tumor bed in superior-inferior direction significantly and thereby underdosing the tissue at risk. The electron field obtained from surgical clips alone dose not cover the entire scar properly. As a consequence, our technique, which combines the surgical clips and clinical scars in determining electron boost field, was proved to be effective in minimizing the geographical miss as well as normal tissue complications.
Breast Neoplasms ; Breast* ; Cicatrix* ; Humans ; Radiotherapy ; Skin ; Surgical Instruments* ; Thoracic Wall

Cutaneous metastasis from lung cancer is less common than metastasis from other organs. However, lung cancer is the most common origin of cutaneous metastasis in men and the second most common in women. Recognition of cutaneous metastatic cancer is important because it can be the first sign of visceral cancer. Although skin metastasis can appear on any cutaneous surface, the most common site is the chest wall. The prognosis for patients having lung cancer with cutaneous metastasis is very poor because the disease is advanced, with the involvement of other sites such as the brain, liver, bone, and adrenal gland. Herein, we report a case of an 87-year-old male with an undifferentiated metastatic carcinoma of the scrotum originating from lung cancer which was found later than the cutaneous metastatic cancer.
Adrenal Glands ; Aged, 80 and over ; Brain ; Female ; Humans ; Liver ; Lung Neoplasms* ; Lung* ; Male ; Neoplasm Metastasis ; Prognosis ; Scrotum ; Skin ; Thoracic Wall

A 40-year-old female visited our clinic for visual disturbance of the right eye, in which a few creamy-yellow retinal lesions and visual field constrictions were noted. She had been treated for primary CNS lymphoma and was in complete remission. After failure to follow-up for three months, she lost vision in the right eye, at which time active panuveitis was seen. Decreased vision and field constriction was observed in the left eye. Her left eye showed a granular pattern and dye leakage from the vessels and disc on fluorescein angiography and small RPE humps were seen in optical coherence tomography (OCT). Diffuse large malignant B-cells with strong immunoreactivities with CD20 immunostaining were seen in the epiretinal membrane biopsy specimen. Intravitreal injections of methotrexate (MTX) (800 microgram/0.1 ml in the right eye, 400 microgram/0.05 ml in the left eye) were performed twice weekly for one month, once weekly for the following month, once every two weeks for the next month, followed by nine monthly injections. Both eyes were free from malignant cells on vitreous biopsy six months later. There was no leakage seen by angiography, but the granular pattern persisted. Visual field constriction was slightly improved, and the small RPE humpsdetachments seen in OCT disappeared. EOG Arden ratio was decreased in both eyes, and b wave amplitude of scotopic ERG was decreased in the left eye. She was free from recurrence until six months later. No ocular complications except minimal opacity of the crystalline lenses were noted in both eyes.
Adult ; Antimetabolites, Antineoplastic/*administration & dosage ; Drug Administration Schedule ; Eye Neoplasms/*drug therapy ; Female ; Humans ; Injections ; Lymphoma/*drug therapy ; Methotrexate/*administration & dosage ; Treatment Outcome ; Vitreous Body

Light chain deposition disease (LCDD) is characterized by the deposition of abnormal immunoglobulin light chains in many organs, including kidney. It is usually associated with multiple myeloma or other lymphoproliferative disorders. Myeloma usually occurs in old age and may develop after renal transplantation thus being categorized as posttransplant lymphoproliferative disease (PTLD). Renal LCDD usually presents with variable degree of proteinuria and renal insufficiency. The diagnosis of LCDD depends on histologic findings with detection of monoclonal immunoglobulin light chain. Histologically, it is characterized by nodular glomerulosclerosis. We report the first case of de novo LCDD associated with myeloma after renal transplantation in Korea. With advancing renal transplantation and increasing old aged renal recipients, myeloma or LCDD should be included in the differential diagnoses of renal recipient patients with deteriorating renal function.
Aged ; Diabetic Nephropathies ; Diagnosis, Differential ; Humans ; Immunoglobulin Light Chains ; Kidney ; Kidney Transplantation ; Korea ; Light ; Lymphoproliferative Disorders ; Multiple Myeloma ; Proteinuria ; Renal Insufficiency ; Transplantation, Homologous

PURPOSE: To evaluate the movement of surgical clips implanted in breast tumor bed during normal breathing. MATERIALS AND METHODS: Seven patients receiving breast post-operative radiotherapy were selected for this study. Each patient was simulated in a common treatment position. Fluoroscopic images were recorded every 0.033 s, 30 frames per 1 second, for 10 seconds in anterior to posterior (AP), lateral, and tangential direction except one patient's images which were recorded as a rate of 15 frames per second. The movement of surgical clips was recorded and measured, thereby calculated maximal displacement of each clip in AP, lateral, tangential, and superior to inferior (SI) direction. For the comparison, we also measured the movement of diaphragm in SI direction. RESULTS: From AP direction's images, average movement of surgical clips in lateral and SI direction was 0.8+/-0.5 mm and 0.9+/-0.2 mm and maximal movement was 1.9 mm and 1.2 mm. Surgical clips in lateral direction's images were averagely moved 1.3+/-0.7 mm and 1.3+/-0.5 mm in AP and SI direction with 2.6 mm and 2.6 mm maximal movement in each direction. In tangential direction's images, average movement of surgical clips and maximal movement was 1.2+/-0.5 mm and 2.4 mm in tangential direction and 0.9+/-0.4 mm and 1.7 mm in SI direction. Diaphragm was averagely moved 14.0+/-2.4 mm and 18.8 mm maximally in SI direction. CONCLUSION: The movement of clips caused by breathing was not as significant as the movement of diaphragm. And all surgical clip movements were within 3 mm in all directions. These results suggest that for breast radiotherapy, it may not necessary to use breath-holding technique or devices to control breath.
Breast Neoplasms* ; Breast* ; Diaphragm ; Humans ; Radiotherapy ; Respiration* ; Surgical Instruments*

In this study, we developed the disc-type bio-cartilage reconstruction strategies for transplantable hyaline cartilage for reconstructive surgery using 3D-cell sheet culture of human bone marrow stromal cells and human costal chondrocytes. We compared chondrogenesis efficiency between different chondrogenic-induction methods such as micromass culture, pellet culture, and 3D-cell sheet culture. Among them, the 3D-cell sheet culture resulted in the best chondrogenesis with the disc-type bio-cartilage (>12 mm diameter in size) in vitro, but sometimes spontaneous curling and contraction of 3D-cell sheet culture resulted in the formation of bead-type cartilage, which was prevented by type I collagen coating or by culturing on amniotic membrane. Previously, it was reported that tissue-engineered cartilage reconstructed in vitro does not maintain its cartilage phenotype after transplantation but tends to transform to other tissue type such as bone or connective tissue. However, the disc-type bio-cartilage of 3D-cell sheet culture maintained its hyaline cartilage phenotype even after exposure to the osteogenic-induction condition in vitro for 3 weeks or after the transplantation for 4 weeks in mouse subcutaneous. Collectively, the disc-type bio-cartilage with 12 mm diameter can be reproducibly reconstructed by the 3D-cell sheet culture, whose hyaline cartilage phenotype and shape can be maintained under the osteogenic-induction condition as well as after the transplantation. This disc-type bio-cartilage can be proposed for the application to reconstructive surgery and repair of disc-type cartilage such as mandibular cartilage and digits.
Amnion ; Animals ; Bone Marrow* ; Cartilage ; Chondrocytes* ; Chondrogenesis ; Collagen Type I ; Connective Tissue ; Humans* ; Hyalin* ; Hyaline Cartilage* ; In Vitro Techniques ; Mesenchymal Stromal Cells* ; Mice ; Phenotype*

Background/Aims: Lumican, a small leucine-rich proteoglycan, has shown osteoprotective effects by synchronously stimulating bone formation and suppressing bone resorption. To clarify the role of lumican in human bone metabolism, the association between lumican concentrations and osteoporosis-related phenotypes was evaluated using bone marrow (BM) samples directly reflecting local microenvironments. Methods: BM aspirates were obtained from 77 patients during hip surgery for either fragility hip fractures (HF) (n = 29) or osteoarthritis (n = 48) and centrifuged. Concentrations of lumican and biochemical bone markers in BM supernatants were measured using enzyme linked immunosorbent assays. Results: After considering confounders, lumican concentrations in BM supernatants were 16.9% lower in patients with HF than in controls, with each increase in the standard deviation of lumican concentration being associated with a 61% lower likelihood of HF. The odds ratios for HF decreased linearly with increasing lumican tertiles in BM, with the odds of having fragility HF markedly lower in participants in the highest than in the lowest lumican tertile. Higher lumican level correlated significantly with higher femur neck bone mineral density and higher bone-specific alkaline phosphatase levels, but not with tartrate-resistant acid phosphatase 5b concentrations, in BM supernatants. Conclusions These data clinically validate previous in vitro and animal experiments showing the beneficial roles of lumican for bone homeostasis and suggest that lumican may contribute to a reduction in fracture risk in humans mainly through its stimulation of bone formation.

BACKGROUND: The Pap smear has brought about a dramatic improvement in the prevention of cervical cancer in women worldwide. In an effort to decrease the occasional false negatives in the Pap smear and further increase the screened population, ThinPrep Pap Test (TP), a fluid-based cytology collection method, has been developed. With preservation of claimed advantages of TP, we have developed a Pap test solution for manual preparatory process and compared our manually processed fluid-based Pap smear with TP to identify cytologic similarities and differences between the two methods. METHODS: Cervical swipes of 204 patients were prospectively collected in the 'Pap solution' and also in PreservCyt solution for TP. Diagnoses and smear characteristics were compared. RESULTS: The diagnoses of the paired smears agreed in 190 of the 204 cases (93.1%). The smear characteristics regarding overall cellularity and background cellularities were similar in the two methods and the stainability of the cells was virtually the same. CONCLUSIONS: The 'Pap solution' has similar performance characteristics as TP in many aspects. With its advantages of cost-effectiveness and easier preparatory process, the 'Pap solution' can match previously implemented thin layer preparation.
Female ; Humans ; Prospective Studies ; Uterine Cervical Neoplasms

We report a case of a 38-year-old male with extranodal NK/T-cell lymphoma, nasal type, showing unusual clinical and pathological features. The patient was admitted for soft tissue swelling and tenderness in both legs. The patient had been treated intermittently 8 months prior for repeated muco-cutaneous ulcers. A muscle biopsy showed medium-sized atypical lymphoid cells with bizarre nuclei and plump cytoplasm, infiltrating to the skeletal muscle fibers with angiocentricity. The immunoresults were Ki-1+, CD56+, cytoplasmic CD3+, with EBV-in situ hybridization +. The patient rapidly deteriorated and died of sepsis and respiratory failure shortly after initiation of low-dose chemotherapy. A careful review of previous biopsies revealed scarce atypical lymphoid cells around vessels with similar immunoprofiles without the presence of Ki-1 positive cells. This case emphasizes that an extranodal NK/T-cell lymphoma may have a dermatomyositis-like diffuse presentation. Ki-1 co-expression can be an unexpected event in a process of the disease course; however, this should be validated with future studies.
Adult ; Biopsy ; Cytoplasm ; Dermatomyositis* ; Drug Therapy ; Humans ; Leg ; Lymphocytes ; Lymphoma* ; Male ; Muscle Fibers, Skeletal ; Respiratory Insufficiency ; Sepsis ; Ulcer