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

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

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

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

We report a case of B-cell lymphoma primarily involving the skin in a 12-year-old boy. The histopathologic findings were compatible with those of small lymphocytic type of non-Hodgkin's lymphoma. A cutaneous lesion was the sole manifestation of his disease without any other organ involvement. Immunophenotypic studies and immunoglobulin gene rearrangement with Southern blot analysis determined its lineages and monoclonality with result of B-cell lineage neoplasm, i. d. CD20⁺, C1323⁺, CD35⁻ and rearranged band on JH probe. We treated him with surgical excision and CVP regimen of chemotherapy (cyclophosphamide, vincristine, prednisolone). There is no recurrence or metastasis during the last six months.
B-Lymphocytes ; Blotting, Southern ; Child ; Drug Therapy ; Genes, Immunoglobulin ; Humans ; Immunophenotyping ; Lymphoma, B-Cell* ; Lymphoma, Non-Hodgkin ; Male ; Neoplasm Metastasis ; Recurrence ; Skin ; Vincristine

We report a 58-year-old woman with an unusual clinical presentation of macular amyloidosis who had erythematous depressed patches without rippled pattern. The lesion was localized involving only the face: both lateral sides of the forehead. A skin biopsy revealed amyloid deposits on the papillay dermis. An immunofluorescence study demonstrated positivity for IgA in the amyloid deposits. The skin lesion of this patient could easily be confused with chronic cutaneous lupus erythematousus and the immunofluorescence finding suggests the possibility of specific immunoglobulin absorption of amyloid deposits.
Absorption ; Amyloid ; Amyloidosis ; Biopsy ; Dermis ; Female ; Fluorescent Antibody Technique ; Forehead ; Humans ; Immunoglobulin A ; Immunoglobulins ; Middle Aged ; Plaque, Amyloid ; Skin

Scrub typhus (tsutusgamushi disease) is an acute febrile illness caused by Orientia tsutsugamushi, which is endemic in the Asia-Pacific area. Scrub typhus in pregnant woman is uncommon and some reports have suggested that this disease may be associated with increased fetal loss. An effective and safe treatment regime for scrub typhus on pregnancy has not been established and the clinical outcome on the pregnant woman and fetus is unclear. We report a case of scrub typhus during pregnancy treated with azithromycin, which showed no recurrence and no fetal and neonatal complications.
Azithromycin ; Female ; Fetus ; Humans ; Orientia tsutsugamushi ; Pregnancy ; Pregnant Women ; Recurrence ; Scrub Typhus

Immunoglobulin G4 (IgG4)-related disease (IgG4RD) is a relatively recently recognized entity that is histopathologically characterized by an extensive infiltration of lymphocytes and IgG4-positive plasma cells with dense fibrosis. IgG4RD is now known to affect any organ system, and a few cases of gastrointestinal lesions have also been reported. However, solitary IgG4RD of the stomach is still very rare. Furthermore, as it can mimic malignant conditions, it is important to recognize this disease to avoid unnecessary surgery. Herein, we present a case of IgG4RD presenting as an isolated subepithelial mass in the stomach.
Fibrosis ; Granuloma, Plasma Cell* ; Immunoglobulins* ; Lymphocytes ; Plasma Cells ; Stomach* ; Unnecessary Procedures

Cowden syndrome is a rare autosomal dominant disorder characterized by mucocutaneous alterations including multiple facial trichilemmomas, oral mucosal papillomatosis, and acral keratoses. Extracutaneous lesions include polyposis of the gastrointestinal tract, and other multiple hamartoma of the internal organs. A 39 year-old man presented with multiple verruca-like papules and lichenified patches on the face, one year ago. He had been treated for atopic dermatitis for more than 10 years. Although he had been treated in accordance with atopic dermatitis for 1 year, his skin lesions had not improved, so a skin biopsy was performed. The skin biopsy specimen revealed the typical finding of trichilemmoma. Colonoscopy diagnosed diffuse colorectal polyposis. The clinical and hisopathologic findings were consistent with Cowden syndrome. We, herein, report a case of Cowden syndrome with atopic dermatitis.
Adult ; Biopsy ; Colonoscopy ; Dermatitis, Atopic ; Gastrointestinal Tract ; Hamartoma ; Hamartoma Syndrome, Multiple* ; Humans ; Keratosis ; Papilloma ; Skin