Acute scrotum is any pathologic condition of the scrotum or intrascrotal contents that requires emergency medical or surgical management. Management of each disease entity is different, but the differential diagnosis is very difficult. So many testes had been lost due to delay of the adequate surgery and unnecessary explorations had been taken under the misdiagnosis. Clinical observations were carried out on 59 patients with acute scrotum admitted to the department of urology, Ewha Womans University Hospital during 10 years from April, 1976 to March, 1986. There were 36 patients with acute epididymitis, 6 spermatic cord torsion and 17 scrotal trauma, the mean age was 32.6 year old in acute epididymitis, 12.8 spermatic cord torsion and 23.5 scrotal trauma. Symptoms and signs showed no significant difference from each disease entity, but Prehn`s sign was somewhat useful to differentiate each one. In half patients with spermatic cord torsion that had arrived to the hospital within 24 hours from onset of symptom, the testes could be saved. Testicular scan with 99mTc-perte- chnetate was performed in 14 patients and the diagnostic accuracy was 93%, 21 patients with acute epididymitis had urinary tract infection and spermatic cord torsion occurred in 2 patients with cryptorchidism.
Cryptorchidism ; Diagnosis, Differential ; Diagnostic Errors ; Emergencies ; Epididymitis ; Female ; Humans ; Male ; Scrotum* ; Spermatic Cord Torsion ; Testis ; Urinary Tract Infections ; Urology

Purpose: To report a case of multiple retinal capillary hemangioma associated with neurofibromatosis type 1 and resulting neovascularglaucoma.Case summary: A 13-year-old boy was admitted with complaint of visual disturbance and dull pain in his left eye which had beguntwo weeks prior. Lisch nodules were observed in his left iris and corneal opacity with neovascularization of the iris and anglewere detected in the same eye. Multiple retinal capillary hemangiomas with increased tortuosity and congestion of feeding retinalvessels were observed on the upper equator of the left retina; in addition, vitreous hemorrhage was observed. There were noother abnormalities except iris mammillations in the right eye. Numerous café au lait macules were observed on the patient’s entirebody. He also exhibited axillary freckling. On brain magnetic resonance imaging, T2-weighted signal intensity was increasedin the basal ganglia, left thalamus, and cerebellar white matter; however, no vessel abnormalities were observed on magneticresonance angiography. High intraocular pressure (IOP) persisted despite the use of IOP lowering agents and IOP was normalizedafter trabeculectomy with mitomycin C administration. Conclusions This case shows that multiple retinal capillary hemangiomas can be accompanied by neurofibromatosis type 1,which may result in neovascular glaucoma.

Purpose: To report a case of extensive syphilitic punctate inner retinitis (SPIR) triggering bilateral macular ischemia after intravitreal triamcinolone injections, and the multimodal retinal imaging findings.Case summary: A 69-year-old male patient with nonproliferative diabetic retinopathy was transferred to our hospital because of bilateral visual deterioration (to counting fingers) after the first intravitreal triamcinolone injection. Fundus examination revealed numerous yellow punctate precipitates in the superficial retinae, retinal arteriolitis, and vitritis. The punctate lesions and surrounding retinal regions showed decreased vascular density on optical coherence tomography angiography, and focal hypofluorescence on fluorescein angiography. The patient was positive for all of the Venereal Disease Research Laboratory test, the fluorescent treponemal antibody-absorption test, and Treponema pallidum hemagglutination; we diagnosed bilateral SPIR. After treatment with aqueous crystalline penicillin solutions (24 million units per day for 14 days), the punctate lesions reduced but arteriolitis progressed to obliterative vasculitis. After 6 months, the bilateral SPIR and vitritis resolved, and the bilateral visual acuity improved to 20/100. However, inner retinal and macular ischemia persisted because of capillary nonperfusion attributable to obliterative vasculitis. Conclusions Extensive SPIR can develop after an initial intravitreal steroid injection; the inner retinal ischemia and visual loss may persist after treatment because obliterative vasculitis develops. Therefore, patients scheduled for intravitreal steroid injections should be screened for syphilis infection.

Purpose: To evaluate the clinical outcomes and prognostic factors of double-dose aflibercept in patients with refractory neovascular age-related macular degeneration (nAMD). Methods: We reviewed the medical records of nAMD patients treated with a double dose of aflibercept (4 mg/0.1 mL) due to an inadequate response to standard 8-weekly intravitreal injections of 2 mg/0.05 mL aflibercept. The assessment at week 8 after treatment included changes in subretinal/intraretinal fluid (SRF/IRF) and best-corrected visual acuity, with patients showing absence or reduction in SRF/IRF classified as the response group. Baseline factors influencing clinical outcomes were analyzed, including central macular thickness (CMT), central choroidal thickness (CCT), size of choroidal neovascularization (CNV), CNV subtype, and maximum height of SRF and IRF. Results: The study included 95 eyes of 95 subjects, with 61 eyes (64.2%) categorized as the response group following double-dose treatment. Responders exhibited thicker CCT (290.4 μm vs. 194.0 μm, p < 0.001), thinner CMT (251.2 μm vs 311.1 μm, p = 0.018), smaller CNV area (2.718 mm2 vs. 3.964 mm2, p = 0.034), and a higher prevalence of type 1 CNV (85.2% vs. 58.8%, p = 0.011) compared to the non-response group. Multivariate binary logistic regression analysis identified thicker CCT (p < 0.001, r = 1.016), thinner CMT (p = 0.014, r = 0.988), smaller CNV area (p = 0.015, r = 0.662), and type 1 CNV (p = 0.001, r = 0.061) as factors associated with better anatomical outcomes. Conclusions Double-dose aflibercept was effective in 64% of patients with refractory nAMD, suggesting it may be considered for those with small CNV areas, thinner CMT, and thicker CCT.

Purpose: To evaluate the clinical outcomes and prognostic factors of double-dose aflibercept in patients with refractory neovascular age-related macular degeneration (nAMD). Methods: We reviewed the medical records of nAMD patients treated with a double dose of aflibercept (4 mg/0.1 mL) due to an inadequate response to standard 8-weekly intravitreal injections of 2 mg/0.05 mL aflibercept. The assessment at week 8 after treatment included changes in subretinal/intraretinal fluid (SRF/IRF) and best-corrected visual acuity, with patients showing absence or reduction in SRF/IRF classified as the response group. Baseline factors influencing clinical outcomes were analyzed, including central macular thickness (CMT), central choroidal thickness (CCT), size of choroidal neovascularization (CNV), CNV subtype, and maximum height of SRF and IRF. Results: The study included 95 eyes of 95 subjects, with 61 eyes (64.2%) categorized as the response group following double-dose treatment. Responders exhibited thicker CCT (290.4 μm vs. 194.0 μm, p < 0.001), thinner CMT (251.2 μm vs 311.1 μm, p = 0.018), smaller CNV area (2.718 mm2 vs. 3.964 mm2, p = 0.034), and a higher prevalence of type 1 CNV (85.2% vs. 58.8%, p = 0.011) compared to the non-response group. Multivariate binary logistic regression analysis identified thicker CCT (p < 0.001, r = 1.016), thinner CMT (p = 0.014, r = 0.988), smaller CNV area (p = 0.015, r = 0.662), and type 1 CNV (p = 0.001, r = 0.061) as factors associated with better anatomical outcomes. Conclusions Double-dose aflibercept was effective in 64% of patients with refractory nAMD, suggesting it may be considered for those with small CNV areas, thinner CMT, and thicker CCT.

Purpose: To assess the impact of toxoplasma immunoglobulin G (IgG) titers on the diagnosis of active ocular toxoplasmosis. Methods: We retrospectively analyzed the medical records of patients tested for toxoplasma IgG at our uveitis clinic. Active ocular toxoplasmosis was clinically diagnosed based on wide-angle fundus photography and disease progression. Patients with IgG titers ≥ 30 IU/mL were classified as seropositive-high titer, those with IgG titers of 1.6-30 IU/mL as seropositive-low titer, and the remaining patients as seronegative. We compared the proportion of active ocular toxoplasmosis among these groups. Additionally, we evaluated the sensitivity and specificity of each titer and attempted to determine an ideal reference titer for toxoplasma IgG in diagnosing active ocular toxoplasmosis. Results: Out of 824 patients, 86 (10.4%), 88 (10.7%), and 650 (78.9%) were categorized as seropositive-high titer, seropositivelow titer, and seronegative, respectively. Among these patients, 34 in the seropositive-high titer group and 2 in the seropositive- low titer group were clinically diagnosed with active ocular toxoplasmosis. The false-positive rate was significantly different between the groups, being 60.5% in the seropositive-high titer group and 97.7% in the seropositive-low titer group (p < 0.001). The receiver operating characteristic curve indicated that 37.70 IU/mL could be an ideal reference titer for diagnosing ocular toxoplasmosis. Conclusions The false-positive rate was notably lower (60.5%) in patients with IgG titers ≥ 30 IU/mL compared to those with titers of 1.6-30 IU/mL (97.7%). Therefore, not only the presence of IgG but also the level of titer appears to be important in diagnosing ocular toxoplasmosis.

Purpose: To evaluate the clinical outcomes and prognostic factors of double-dose aflibercept in patients with refractory neovascular age-related macular degeneration (nAMD). Methods: We reviewed the medical records of nAMD patients treated with a double dose of aflibercept (4 mg/0.1 mL) due to an inadequate response to standard 8-weekly intravitreal injections of 2 mg/0.05 mL aflibercept. The assessment at week 8 after treatment included changes in subretinal/intraretinal fluid (SRF/IRF) and best-corrected visual acuity, with patients showing absence or reduction in SRF/IRF classified as the response group. Baseline factors influencing clinical outcomes were analyzed, including central macular thickness (CMT), central choroidal thickness (CCT), size of choroidal neovascularization (CNV), CNV subtype, and maximum height of SRF and IRF. Results: The study included 95 eyes of 95 subjects, with 61 eyes (64.2%) categorized as the response group following double-dose treatment. Responders exhibited thicker CCT (290.4 μm vs. 194.0 μm, p < 0.001), thinner CMT (251.2 μm vs 311.1 μm, p = 0.018), smaller CNV area (2.718 mm2 vs. 3.964 mm2, p = 0.034), and a higher prevalence of type 1 CNV (85.2% vs. 58.8%, p = 0.011) compared to the non-response group. Multivariate binary logistic regression analysis identified thicker CCT (p < 0.001, r = 1.016), thinner CMT (p = 0.014, r = 0.988), smaller CNV area (p = 0.015, r = 0.662), and type 1 CNV (p = 0.001, r = 0.061) as factors associated with better anatomical outcomes. Conclusions Double-dose aflibercept was effective in 64% of patients with refractory nAMD, suggesting it may be considered for those with small CNV areas, thinner CMT, and thicker CCT.

Purpose: To evaluate the clinical outcomes and prognostic factors of double-dose aflibercept in patients with refractory neovascular age-related macular degeneration (nAMD). Methods: We reviewed the medical records of nAMD patients treated with a double dose of aflibercept (4 mg/0.1 mL) due to an inadequate response to standard 8-weekly intravitreal injections of 2 mg/0.05 mL aflibercept. The assessment at week 8 after treatment included changes in subretinal/intraretinal fluid (SRF/IRF) and best-corrected visual acuity, with patients showing absence or reduction in SRF/IRF classified as the response group. Baseline factors influencing clinical outcomes were analyzed, including central macular thickness (CMT), central choroidal thickness (CCT), size of choroidal neovascularization (CNV), CNV subtype, and maximum height of SRF and IRF. Results: The study included 95 eyes of 95 subjects, with 61 eyes (64.2%) categorized as the response group following double-dose treatment. Responders exhibited thicker CCT (290.4 μm vs. 194.0 μm, p < 0.001), thinner CMT (251.2 μm vs 311.1 μm, p = 0.018), smaller CNV area (2.718 mm2 vs. 3.964 mm2, p = 0.034), and a higher prevalence of type 1 CNV (85.2% vs. 58.8%, p = 0.011) compared to the non-response group. Multivariate binary logistic regression analysis identified thicker CCT (p < 0.001, r = 1.016), thinner CMT (p = 0.014, r = 0.988), smaller CNV area (p = 0.015, r = 0.662), and type 1 CNV (p = 0.001, r = 0.061) as factors associated with better anatomical outcomes. Conclusions Double-dose aflibercept was effective in 64% of patients with refractory nAMD, suggesting it may be considered for those with small CNV areas, thinner CMT, and thicker CCT.

No abstract available.

Purpose: To report a case of spontaneous closure of a chronic recurrent full-thickness macular hole (FTMH) in a previously vitrectomized eye.Case summary: A 58-year-old female who underwent vitrectomy for the treatment of a rhegmatogenous retinal detachment (RRD) on the right eye 2 years ago complaint of decreased vision on the same eye. The best corrected visual acuity (BCVA) was 0.2. The fundus photograph and optical coherence tomography revealed a FTMH with perifoveal cystoid macular edema (CME). While surgical treatment for the macular hole (MH) was scheduled, the spontaneous closure of MH was observed with resolution of CME. BCVA improved to 0.5. During the long-term follow-up periods, FTMH with CME recurred 2 times or more. In all events, the hole was spontaneously closed in 1 month, accompanied with resolution of CME. Conclusions A FTMH with CME developed 3 times for 11 years following RRD repair, which was spontaneously closed with CME resolution in a month. In case of chronic recurrent FTMH in vitrectomized eye, it would be better to determine surgical treatment after closely monitoring changes in hole and CME.