PURPOSE: To evaluate the clinical outcomes of epiretinal membrane (ERM) surgery with minimal exposure to indocyanine green (ICG) dye-assisted internal limiting membrane (ILM) peeling compared with no ICG dye. METHODS: We divided 33 eyes with ERM treated by vitrectomy into 2 groups. ICG dye was used in the first group of 18 eyes (ICG group) but not in the second group of 15 eyes (no dye [ND] group). In the ICG group, 0.25% diluted ICG dye was injected into the fluid-filled eye and removed with a back-flushing needle after 3-5 seconds to peel ILM. Value changes in several parameters including visual acuity, central macular thickness, Humphrey automated kinetic perimetric analysis, and peripapillary retinal nerve fiber layer (RNFL) thickness were followed up and compared according to ICG dye use. RESULTS: No differences were found between the 2 groups in terms of visual acuity, central macular thickness, and peripapillary RNFL thickness preoperatively and at 6 months postoperatively (p = 0.125 for visual acuity, p = 0.734 for central macular thickness, p = 0.615 for RNFL thickness). Six months after surgery, no significant increase was found in any region of visual field in the ICG group (p = 0.392). The visual field was significantly increased in the superior region in the ND group (p = 0.042). The RNFL thickness in the temporal quadrant was significantly reduced at 6 months postoperatively compared to baseline values in both groups (p = 0.011 for ICG group, p = 0.042 for ND group). CONCLUSIONS: ICG dye-assisted ILM peeling does not aggravate clinical outcomes of ERM surgery in terms of visual acuity, central macular thickness, visual fields, or RNFL thickness and can be safely utilized with proper techniques.
Epiretinal Membrane ; Indocyanine Green ; Membranes* ; Needles ; Nerve Fibers ; Retinaldehyde ; Visual Acuity ; Visual Fields ; Vitrectomy

BACKGROUND: The aim of this study was to investigate the feasibility and efficacy of emergent carotid artery stenting (CAS) for occlusion or high-grade stenosis of the internal carotid artery (ICA) in patients with acute ischemic stroke. METHODS: From November 2004 to May 2007, 17 patients admitted to the hospital within 12 hours of symptom onset with occlusion or a high-grade stenosis of the proximal ICA underwent emergent CAS. We analyzed risk factors, imaging findings, functional outcome scales, and peri-procedural complication. The outcome was measured by the modified Rankin scale (mRS) 3 months later and classified into good (mRS score of 0 to 2) or poor (mRS score of 3 to 6). RESULTS: All patients were recanalized successfully. The median National Institutes of Health Stroke Scale (NIHSS) score was 12.6 (range 4 to 24) just before the emergent CAS, which decreased to 9.4 and 8.2 at 1 day and 7 days after the stenting. Three months later, 12 patients showed good outcome while three had poor outcome and two of them died. Two patients (11.8%) exhibited symptomatic hemorrhagic transformation following the emergent CAS. Smoking status, and initial and immediate post-procedural NIHSS scores were associated with the outcome. CONCLUSIONS: Emergent CAS is a feasible and effective method in acute treatment of selected stroke patients with steno-occlusion of the proximal ICA.
Carotid Arteries ; Carotid Artery, Internal ; Constriction, Pathologic ; Humans ; National Institutes of Health (U.S.) ; Risk Factors ; Smoke ; Smoking ; Stents ; Stroke ; Weights and Measures

OBJECTIVE: To investigate the association between evoked potentials and fractional anisotropy (FA) ratio in posterior limb of the internal capsule and hand movement scale (HMS) in post-stroke hemiplegic patients. METHOD: Thirty-six post-stroke hemiplegic patients with a lesion in the internal capsule were included in this study. Diffusion tensor imaging (DTI) was performed with a 3.0 tesla MR at about 1 month after stroke. FA ratio was measured in posterior limb of the internal capsule of the patients. Motor evoked potential (MEP) was obtained by magnetic stimulation of the motor cortex and recorded from the abductor pollicis muscle. Somatosensory evoked potential (SSEP) was obtained by electrical stimulation of the median nerve at the wrist and recorded from the somatosensory cortex. Hand movement scale was obtained at about 1 month and 3 months after stroke. RESULTS: Hand movement scale at about 1 month and 3 months after stroke and FA ratio were reduced significantly in patients who showed no response on MEP. However, no significant differences were observed between the patients who showed SSEP response and those who did not. FA ratio and hand movement scale were highly correlated to each other. CONCLUSION: MEP and FA ratio can be helpful in assessing the hand function at about 1 month and 3 months in post-stroke hemiplegic patients.
Anisotropy ; Diffusion ; Diffusion Tensor Imaging ; Electric Stimulation ; Evoked Potentials ; Evoked Potentials, Motor ; Evoked Potentials, Somatosensory ; Extremities ; Hand ; Humans ; Internal Capsule ; Magnetics ; Magnets ; Median Nerve ; Motor Cortex ; Muscles ; Somatosensory Cortex ; Stroke ; Wrist

Two forms of priapism are known. The more common type, low-flow priapism, presents as a prolonged painful erection and is characterized by ischemia and a disordered veno-occlusive mechanism. The less common form, high-flow priapism, is characterized by absence of pain and ischemia and unregulated blood inflow from the artery to the cavernosal sinuses. Prompt relief of priapism is essential to prevent ischemia and fibrosis of the corpora with resultant impotence. According to the type of priapism, the therapeutic approach is different. We report a case of idiopathic priapism that was initially identified as low-flow priapism. However, during treatment, it was confirmed as high-flow priapism by the finding of an arteriocavernosal fistula on arteriography, and the abnormal erection subsided after arterial embolization. On arteriography, there was an aberrant artery from the right common penile artery, and we were able to seen an arterial blush from the aberrent artery to the right cavernosal base.
Angiography ; Arteries ; Erectile Dysfunction ; Fibrosis ; Fistula ; Ischemia ; Male ; Priapism*

Pulmonary epithelioid hemangioendothelioma (PEH) is a rare, low-to-intermediate malignant tumor of endothelial origin. Computed tomography (CT) findings of PEH demonstrate multiple small bilateral nodules; however, to the best of our knowledge, there were no reports on PEH coexisting with other malignancies. Here, we reported on a case involving PEH in a patient with colon cancer and breast cancer which was misconceived as pulmonary meta-stasis. A 63-year-old woman who suffered from constipation for 2 weeks visited our hospital. Colonoscopy showed a large mass with obstruction on hepatic flexure. The histological diagnosis was adenocarcinoma of the ascending colon. Multiple nodules in both lungs and breast were observed on a chest CT scan. A core biopsy of a breast nodule was performed and a diagnosis of invasive ductal carcinoma of the left breast was made. Pulmonary nodules observed on the chest CT scan was considered as pulmonary metastasis from colon or breast cancer. Laparoscopic right hemicolectomy was performed. At the same time, wedge resection of the lung was performed and pathological diagnosis was PEH. Radiologic features of PEH were difficult to distinguish from lung metastasis. Therefore the author reported a rare case involving PEH in a patient with primary malignancy of colon and breast.
Adenocarcinoma ; Biopsy ; Breast ; Breast Neoplasms ; Carcinoma, Ductal ; Colon ; Colon, Ascending ; Colonic Neoplasms ; Colonoscopy ; Constipation ; Diagnosis ; Female ; Hemangioendothelioma ; Hemangioendothelioma, Epithelioid* ; Humans ; Lung ; Middle Aged ; Neoplasm Metastasis* ; Tomography, X-Ray Computed

OBJECTIVE: This study aimed to assess the results of surgical and endovascular treatments in aneurysmal subarachnoid hemorrhage (SAH) patients older than 70 years. METHODS: This study included 18 patients, more than 70 years of age, treated for ruptured cerebral aneurysms between April 2004 and March 2009. In most cases, patients underwent the early obliteration procedure for each aneurysm, and we compared the clinical results according to the obliteration method (clipping or coiling). We assessed neurological outcomes at 6 months post-procedure according to the modified Rankin Scale (mRS): favorable (mRS score > 2) or unfavorable (mRS score > 2). RESULTS: Of the 18 patients, 12 (66.6%) underwent obliteration of the aneurysm sac via microvascular clipping patients, and 6 (33.3%) underwent endovascular coiling. At 6 months post-procedure, the clinical outcomes were favorable in 6 patients (33.3%), 5 (41.7%) who received microvascular clipping and 1 (16.7%) who underwent endovascular coiling. Unfavorable outcome was not statistically associated with poor initial clinical state, poor Fisher grade, occurrence of stroke, or hydrocephalus, although we frequently noted these variables in the unfavorable outcomes. CONCLUSIONS: In this study, aneurysm obliteration method (microvascular clipping vs. endovascular coiling) did not seem to significantly affect clinical outcomes. A poor initial clinical state, poor Fisher grade, occurrence of stroke, and hydrocephalus seemed to be associated with poor clinical outcomes.
Aged ; Aneurysm ; Humans ; Hydrocephalus ; Intracranial Aneurysm ; Stroke ; Subarachnoid Hemorrhage ; Treatment Outcome

We present a case of giant coronary arteriovenous fistula between left main coronary artery and pulmonary artery in a 60-year-old female who presented with anginal symptom. Dobutamine stress echocardiography and myocardial perfusion scan with (99m)Tc-MIBI revealed a reversible perfusion defect in the septal region. Coronary angiography demonstrated a giant coronary arteriovenous fistula origination from the left main coronary artery and draining into the pulmonary artery. This appears to be the first case in which dobutamine stress echocardiography and myocardial perfusion scan with (99m)Tc-MIBI demonstrated myocardial ischemia due to coronary steal in patient with a coronary arteriovenous fistula.
Arteriovenous Fistula* ; Coronary Angiography ; Coronary Vessels ; Dobutamine* ; Echocardiography, Stress* ; Female ; Humans ; Middle Aged ; Myocardial Ischemia ; Perfusion ; Pulmonary Artery ; Septum of Brain ; Tomography, Emission-Computed, Single-Photon*

A 50-year-old woman was referred to our hospital for evaluation of mental change and general weakness accompanied by an irregular and weak pulse. She had previously been diagnosed with Bartter's syndrome and had taken potassium-sparing diuretics. She had developed constipation that had led to abdominal pain and had taken excessive magnesium oxide over a long time. On admission, she was lethargic. Her blood pressure (BP) was 130/74 mmHg, with a heart rate varying from 30 to 78 beats/min. An electrocardiogram (ECG) revealed several abnormalities, including first degree AV block, QT prolongation, sinus pause with a junctional rhythm, and paroxysmal tachycardia alternating with sinus pause. Her serum concentration of magnesium was markedly elevated to 16.19 mg/dl. Hemodialysis and a calcium gluconate infusion was attempted to reduce magnesium levels and to counteract the cardiovascular effect of magnesium. As magnesium levels declined, her general medical condition improved and her ECG changes were normalized. Severe hypermagnesemia should be suspected as the cause of mental change, cardiovascular dysfunction, and variable ECG changes.
Abdominal Pain ; Atrioventricular Block ; Bartter Syndrome ; Blood Pressure ; Calcium Gluconate ; Constipation ; Depression ; Diuretics ; Electrocardiography ; Female ; Gluconates ; Heart Rate ; Humans ; Magnesium ; Magnesium Oxide ; Middle Aged ; Renal Dialysis ; Tachycardia, Paroxysmal

Background: and Purpose The associations between hearing loss (HL) and the mechanisms underlying cognitive impairment (CI) remain unclear. We evaluated the effects of clinical factors, vascular magnetic resonance imaging (MRI) markers, and CI mechanisms on HL. Methods: In total, 112 patients with CI (59% demented) and subjective HL prospectively underwent MRI, amyloid positron-emission tomography (PET), hearing evaluations, and neuropsychological tests including a language comprehension test. Patients were categorized into pure-Alzheimer’s disease-related CI (ADCI), pure-Lewy-body disease-related CI (LBCI), mixed-ADCI/LBCI, and non-ADCI/LBCI groups based on clinical features and PET biomarkers. Results: The risk of peripheral HL [defined as a pure-tone average (PTA) threshold >40 dB] was higher in the pure-LBCI group than in the pure-ADCI and mixed-ADCI/LBCI groups, and lower in the presence of ADCI. The non-ADCI/LBCI group had the most-severe vascular MRI markers and showed a higher risk of peripheral HL than did the pure-ADCI and mixed-ADCI/LBCI groups. While the pure-LBCI group had a higher risk of comprehension dysfunction than the pure-ADCI group regardless of the PTA and the score on the Korean version of the Mini Mental State Examination (K-MMSE), those in the pure-LBCI group even with a better K-MMSE score had a risk of comprehension dysfunction comparable to that in the mixed-ADCI/LBCI group due to a worse PTA. Conclusions Peripheral HL could be associated with the absence of significant β-amyloid deposition in patients with CI and characteristic of the pure-LBCI and non-ADCI/LBCI groups.

Aplastic anemia is characterized by multilineage bone marrow failure resulting in pancytopenia. There is no effective therapy for patients with severe aplastic anemia who were refractory to immunosuppresive therapy including antithymocyte globulin (ATG) or relapsed after allogeneic bone marrow transplantation. We report hereby that two patients with severe aplastic anemia who were relapsed after immu-nosuppresive therapy with ATG and cyclosporine A were successfully treated with low dose erythropoietin. Observed trilineage hematologic response was dependent on low dose erythropoietin therapy.
Anemia, Aplastic* ; Antilymphocyte Serum ; Bone Marrow ; Bone Marrow Transplantation ; Cyclosporine ; Erythropoietin* ; Humans ; Pancytopenia