PURPOSE: To evaluate the effectiveness of Ahmed valve implantation for refractory glaucoma following pars plana vitrectomy. METHODS: Seventeen eyes of 15 patients suffering from secondary glaucoma following pars plana vitrectomy underwent Ahmed valve implantation. All the eyes were in critical condition, and intraocular pressure could not be controlled with anti-glaucoma medications. Success was characterized by an intraocular pressure less than 22 mmHg and greater than 6 mmHg, regardless of anti-glaucoma medication usage. RESULTS: The total success rate was 83.4% at 6 months and 76.4% at the final visit. The reduction in intraocular pressure and the number of medications used postoperatively were both statistically and clinically significant (p< 0.005). Postoperative complications included: transiently increased intraocular pressure, transient hyphema, early postoperative hypotony, choroidal detachment, malposition of the valve tip, and phthisis bulbus. CONCLUSIONS: Ahmed valve implantation is a safe and effective method for refractory glaucoma following vitrectomy.
Vitrectomy/*adverse effects ; Treatment Outcome ; Retrospective Studies ; Prosthesis Implantation/*instrumentation ; Prosthesis Design ; Postoperative Complications ; Middle Aged ; Male ; Intraocular Pressure/physiology ; Humans ; *Glaucoma Drainage Implants ; Glaucoma/etiology/physiopathology/*surgery ; Follow-Up Studies ; Female ; Aged ; Adult

A 19-year-old man noticed a very slowly spreading erythematous macular lesion on his cheek when he was 5 years old. This asymptomatic and well circumscribed patch was covered with fine scales. He sought first medical attention at the age of 12 years and diagnosis was cutaneous tuberculosis was made by skin biopsy. Seven years after the second biopsy was made and it revealed a few spores within giant cells in the upper dermis. By mycologic study, it was identified as Paecilomyces lilacinus. The patient was put on the treatment of topical and oral antifungal agents. The skin lesion showed signs of improvement after 12 weeks of treatment.
Antifungal Agents ; Biopsy ; Cheek ; Child, Preschool ; Dermis ; Diagnosis ; Giant Cells ; Humans ; Paecilomyces* ; Skin ; Spores ; Tuberculosis, Cutaneous ; Weights and Measures ; Young Adult

BACKGROUND: Extensive alopecia areata (EAA) is resistant to multiple individual treatment modalities and has poor prognosis for cosmetically adequate regrowth. Anthralin is a widely used topical anti-psoriatic drug that may have an immunomodulating effect on AA as is does in psoriasis. But, there has only been small number of clinical trials of anthralin in the treatment of AA. OBJECTIVE: The purposes of the study were to evaluate the efficacy, prognostic factor, side effects and recurrence rate of topical anthralin therapy in treatment-resistant EAA. METHODS: A total of 16 cases of EAA (>50% scalp hair loss) who had failed in previous treatments were subjected in this study. Anthralin in 0.5% concentrations was applied to alopectic lesions for 1 hour daily over 4 weeks, gradually increasing anthralin concentration until low-grade erythema and pruritus develops. Treatment was withdrawn after complete response or if there were no signs of improvement at 6 months. Responders were followed up for 6 months after discontinuation of therapy. RESULTS: The overall response rate was 62.5%, complete response (>90% regrowth or cosmetically acceptable appearance) was obtained in 25% of cases and, good response (50~99% regrowth) in 39.5% of cases. In this study, among the investigated prognostic factors, there were no statistically significant factors (p<0.05, Fisher exact test). The most frequent side effects were therapeutically induced mild pruritus (93.8%), erythema (93.8%) and scale (56.3%). Other side-effects were transient folliculitis (31.3%) and regional lymph adenopathy (12.5%). Relapse was observed in 60% of responders after 6 month of follow up. CONCLUSION: Topical anthralin for treatment-resistant EAA is an effective therapy with tolerable side effects. Therefore, we propose the topical anthralin as a reasonable therapeutic option for treatment-resistant EAA.
Alopecia ; Alopecia Areata ; Anthralin ; Erythema ; Folliculitis ; Hair ; Prognosis ; Pruritus ; Psoriasis ; Recurrence ; Scalp

OBJECTIVE: Tuberculosis is a chronic infection caused by Mycobacterium tuberculosis that can appear throughout the entire body; however, intraocular tuberculosis is rare. We report a case of tuberculous neuroretinitis accompanied by periphlebitis. METHODS: A 17-year-old female was referred with the diagnosis of retinal vasculitis. In the fundus of her right eye, an edematous disc, serous detachment of the macula, multiple hard exudates, and vascular sheathing around the veins were noted. Also, she had no direct light reflex in her right eye. Although her chest X-ray showed no abnormalities, the Tuberculin test was positive; therefore, the condition was diagnosed with a neuroretinitis accompanied by periphlebitis caused by Mycobacterium tuberculosis. RESULTS: High-dose steroid treatment decreased peripapillary edema but did not improved visual acuity. Treatment with antituberculosis medicine resulted in the recovery of her visual acuity and in fundus changes. CONCLUSIONS: Ocular tuberculosis commonly appears as perivasculitis; however, it can cause a visual disturbance by invading the retina and optic nerve simultaneously.
Adolescent ; Diagnosis ; Edema ; Exudates and Transudates ; Female ; Humans ; Mycobacterium tuberculosis ; Optic Nerve ; Phlebitis ; Reflex ; Retina ; Retinal Vasculitis ; Retinitis* ; Thorax ; Tuberculin Test ; Tuberculosis ; Tuberculosis, Ocular ; Veins ; Visual Acuity

PURPOSE: We attempted to determine the cause of iatrogenic fractures and to prevent their occurrence during nailing using lateral entry portal on femur shaft fracture. MATERIALS AND METHODS: We conducted a retrospective study of 160 patients who had been treated with nailing using a lateral entry portal for femur shaft fractures. We compared 18 patients (group 1) with iatrogenic fractures on the femur proximal portion with 18 patients (group 2) who had no fracture, and then surveyed and analyzed the characters of the fracture, position of the portal, nail size, and complications. RESULTS: In distribution of primary femur shaft fractures, there were eight cases of proximal portion, nine cases of mid-portion, and one case of distal portion. In that of iatrogenic fractures, there were nine cases of medial fractures, five cases of lateral fractures, four cases of anterior fractures. In the entry portal of group 1, mean 1.82 mm leaned to the lateral side in antero-posteriorview, mean 5 mm leaned to the anterior side in lateral view. Anterior leaning of the entry portal was statistically significant with iatrogenic fracture. CONCLUSION: The more the entry portal leaned to the lateral and anterior side, the greater the frequency of occurrence of iatrogenic fractures. To prevent iatrognic fracture, through preoperative X-ray, we must have a precise understanding and measure anatomical bowing and variance of the femur, and must pay attention to operative procedures during the operation.
Femoral Fractures ; Femur* ; Fracture Fixation, Intramedullary ; Humans ; Retrospective Studies ; Surgical Procedures, Operative

Rheumatoid neutrophilic dermatitis (RND) is a rare distinctive complication of rheumatoid arthritis (RA). Clinically, RND is characterized by slightly tender erythematous patches and papules, often associated with vesicles or pustules, which are symmetrically distributed on the extensor surfaces of the extremities. Histopathological findings revealed a dermal neutrophilic infiltration with leukocytoclasia without vasculitis. We report a case of rheumatoid neutrophilic dermatitis associated with seronegative RA.
Arthritis ; Arthritis, Rheumatoid ; Dermatitis ; Extremities ; Neutrophils ; Vasculitis

STATEMENT OF PROBLEM: The success of titanium implants is due to osseointegration or the direct contact of the implant surface and bone without a fibrous connective tissue interface. PURPOSE: The purpose of this study was to evaluate the osteoblast precursor response to titanium - 10 tantalum - 10 niobium (Ti-Ta-Nb) alloy and its sputtered coating. MATERIAL AND METHODS: Ti-Ta-Nb coatings were sputtered onto the Ti-Ta-Nb disks. Ti6-Al-4V alloy disks were used as controls. An osteoblast precursor cell line, were used to evaluate the cell responses to the 3 groups. Cell attachment was measured using coulter counter and the cell morphology during attachment period was observed using fluorescent microscopy. Cell culture was performed at 4, 8, 12 and 16 days. RESULTS: The sputtered Ti-Ta-Nb coatings consisted of dense nanoscale grains in the range of 30 to 100 nm with alpha-Ti crystal structure. The Ti-Ta-Nb disks and its sputtered nanoscale coatings exhibited greater hydrophilicity and rougher surfaces compared to the Ti-6Al-4V disks. The sputtered nanoscale Ti-Ta-Nb coatings exhibited significantly greater cell attachment compared to Ti-6Al-4V and Ti-Ta-Nb disks. Nanoscale Ti-Ta-Nb coatings exhibited significantly greater ALP specific activity and total protein production compared to the other 2 groups. CONCLUSIONS: It was concluded that nanoscale Ti-Ta-Nb coatings enhance cell adhesion. In addition, Ti-Ta-Nb alloy and its nanoscale coatings enhanced osteoblast differentiation, but did not support osteoblast precursor proliferation compared to Ti-6Al-4V. These results indicate that the new developed Ti-Ta-Nb alloy and its nanoscale Ti-Ta-Nb coatings may be useful as an implant material.
Alloys ; Cell Adhesion ; Cell Culture Techniques ; Cell Line ; Connective Tissue ; Edible Grain ; Hydrophobic and Hydrophilic Interactions ; Microscopy ; Niobium ; Organothiophosphorus Compounds ; Osseointegration ; Osteoblasts ; Tantalum ; Titanium

STATEMENT OF PROBLEM: The poor chemical bonding of a denture base resin to cast titanium framework often introduces adhesive failure and increases microleakage. PURPOSE: This study evaluated the shear bond strengths of a heat cure denture base resin to commercially pure titanium, Ti-6Al-4V alloy and a cobalt-chromium alloy using two adhesive primers. MATERIAL AND METHODS: Disks of commercially pure titanium, Ti-6Al-4V alloy and a cobalt-chromium alloy were cast. Specimens without the primer were also prepared and used as the controls. The shear bond strengths were measured on a screw-driven universal testing machine. RESULTS: The primers significantly (P < .05) improved the shear bond strengths of the heat cure resin to all metals. However, the specimens primed with the Alloy primer(R) (MDP monomer) showed higher bond strength than those primed with the MR bond(R) (MAC-10 monomer) on titanium. Only adhesive failure was observed at the metal-resin interface in the non-primed specimens, while the primed specimens showed mixed failure of adhesive and cohesive failure. CONCLUSIONS: The use of appropriate adhesive metal primers makes it possible not only to eliminate the need for surface preparation of the metal framework before applying the heat cure resins, but also reduce the need for retentive devices on the metal substructure. In particular, the Alloy primer(R), which contains the phosphoric acid monomer, MDP, might be clinically more acceptable for bonding a heat cure resin to titanium than a MR bond(R), which contains the carboxylic acid monomer, MAC-10.
Adhesives ; Alloys ; Collodion ; Denture Bases ; Dentures ; Hot Temperature ; Metals ; Phosphoric Acids ; Titanium

Metastatic cancer of the umbilicus is very rare and is called Sister Mary Joseph's nodule. Metastasis to the umbilicus usually presents as diffuse spreading of primary cancer or recurrence after treatment of primary cancer, carries very poor prognosis, and is generally inoperable. However, umbilical metastasis presents rarely as a first sign of primary cancer and can lead to its diagnosis. The diagnosis is usually made with the histologic examination and the most common primary cancer is an adenocarcinoma of the stomach. We report a case of umbilical metastasis as a first sign of gastric cancer which leads to its diagnosis. This report emphasizes the need for careful evaluation of any umbilical lesion.
Adenocarcinoma ; Humans ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Siblings ; Sister Mary Joseph's Nodule ; Stomach ; Stomach Neoplasms ; Umbilicus

Pilomatricoma is a common, benign, cutaneous neoplasm, differentiating towards elements of the hair matrix and shaft. It typically presents as a deep-seated, solitary, firm nodule with overlying normal epidermis. However, pilomatricoma with bullous appearance is very rare. We report two cases of pilomatricoma with bullous appearance. The first case was an 11-year-old male who presented with 6 month history of a soft, erythematous, translucent polypoid mass on the left upper arm. The other case was a 20-year-old female who presented with 12 month history of a soft, slightly-brownish, peduncluated mass with indurated nodules on the left upper arm. In both cases, the histopathologic findings revealed multiple islands of shadow cells, with small foci of basophilic cells at the periphery of the deep dermis. There was dilation of lymphatic vessels in the overlying dermis, which explained the clinical bullous appearance.
Arm ; Basophils ; Child ; Dermis ; Epidermis ; Female ; Hair ; Humans ; Islands ; Lymphatic Vessels ; Male ; Pilomatrixoma* ; Young Adult