The Dandy-Wlaker syndrome is a developmental disoeder characterized by cystic dilatation of the fourth ventricle and agenesis or hypoplasia of the cerebellar vermis and is usually associated with hydrocephalus. This syndrome is also associated with intracranial malformations such as agenesis of corpus callosum, and extracranial malformations such as facial anormalies (cleft palate, cleft lip, and ocular anomalies), polycystic kidney, and cardiac anormalies. Reported associated ophthalmic anomalies are microphthalmos, coloboma, and congenital cataract.We experienced a case of infantile esotropia in abnormal insertion and direction of lateral rectus muscle as a variant of the Dandy-Walker syndrome accompanied by cleft palate and cleft lip in a 19-month-old male infant. Subsequent treatment of the 30delta esodeviation and left inferior oblique muscle overaction, including resection of the lateral rectus muscle in both eyes and the myectomy of the inferior oblique muscle in the left eye, yielded satisfactory results, so we report this case, with a review of the pertinent literature, as the first case of Dandy-Walker syndrome associated with esotropia with abnormal course of lateral rectus muscle in Korea.
Agenesis of Corpus Callosum ; Cleft Lip ; Cleft Palate ; Coloboma ; Dandy-Walker Syndrome* ; Dilatation ; Esotropia* ; Fourth Ventricle ; Humans ; Hydrocephalus ; Infant ; Korea ; Lip ; Male ; Microphthalmos ; Polycystic Kidney Diseases

PURPOSE: To evaluate malignancy risk according to ultrasound (US) features and size change on follow-up US in mixed echoic thyroid nodules and to suggest management guidelines thereof. MATERIALS AND METHODS: Among patients who underwent US-guided fine needle aspiration biopsy, 316 mixed echoic nodules in 303 patients were included after excluding the patients with pure solid or cystic nodules or without further cytopathologic evaluation. We evaluated malignancy risk according to US features and changes in size and shape on follow-up US. RESULTS: The malignancy rate was 31.6% (6 of 19) for nodules with suspicious US features and 2.7% (8 of 297) for nodules without suspicious US features (p<0.001). Among 265 nodules with no suspicious US features and initial benign cytology, 15 nodules with suspicious US change and decreased size, 25 nodules with no suspicious US change and increased size, and 225 nodules with no suspicious US change and no change in size were observed on follow-up USs. The malignancy risk thereof was 0%, 0% and 0.4%, respectively (p=1.000). CONCLUSION: Mixed echoic nodules with no suspicious US features and benign cytology can be followed up using US, as they revealed very low malignancy rates, even if they showed growth on follow-up US.
Adult ; Biopsy, Fine-Needle/methods ; Female ; Humans ; Male ; Middle Aged ; Thyroid Neoplasms/diagnosis/ultrasonography ; Thyroid Nodule/*diagnosis/*ultrasonography

PURPOSE: Grape seed-derived polyphenols (GSPs) provide a concentrated source of polyphenols having antioxidant capacity. In this study we investigated the cytoprotective effect of GSP against oxidative stress-induced cell damage in cultured human retinal pigment epithelial (RPE) cells. METHODS: Cultured adult retinal pigment epithelium (ARPE)-19 cells were incubated with GSP from Vitis vinifera (0.1, 0.5, 1, 5 or 10 microg/mL) for 24 hours and treated with hydrogen peroxide (H2O2, 0.4 mM) for 24 hours to induce oxidative stress. Cell viability was measured using 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) assay. Intracellular reactive oxygen species (ROS) was quantified using 2',7'-dichlorofluorescein diacetate (DCF-DA) fluorescence. RESULTS: The percentage of viable RPE cells was significantly lower in cultures treated with H2O2 0.4 mM than in control cultures. GSP significantly reduced H2O2-induced cell death in a dose dependent manner. GSP at 0.1, 0.5, 1, 5 and 10 microg/mL significantly reduced cell mortality due to the treatment with H2O2. Intracellular ROS production increased significantly in cultures treated with H2O2 0.4 mM compared with control. There was a significant dose-dependent decrease in intracellular ROS levels after treatment of RPE with GSP. CONCLUSIONS: GSP, a natural polyphenolic compound, can protect RPE cells from H2O2-induced oxidative stress and reduce intracellular ROS production by scavenging free radicals. This suggests potential effects of polyphenolic compounds against retinal diseases associated with oxidative stress.
Adult ; Cell Death ; Cell Survival ; Epithelial Cells* ; Fluorescence ; Free Radicals ; Grape Seed Extract ; Humans ; Hydrogen Peroxide ; Mortality ; Oxidative Stress* ; Polyphenols ; Proanthocyanidins ; Reactive Oxygen Species ; Retinal Diseases ; Retinal Pigment Epithelium ; Retinaldehyde* ; Vitis

PURPOSE: The purpose was to compare the frequency of metastatic and nonmetastatic lymph nodes diagnosed by fine needle aspiration biopsy cytology (FNAC) and thyroglobulin concentration from fine needle aspiration biopsy washout fluid (FNAB-Tg) in an indeterminate range (0.2-100 ng/mL), and to evaluate the most appropriate threshold value of FNAB-Tg in an indeterminate range. MATERIALS AND METHODS: We performed ultrasound-guided FNAB and FNAB-Tg in suspicious metastatic cervical lymph nodes of papillary thyroid carcinoma and performed surgery. Ninety-five lymph nodes with indeterminate values of FNAB-Tg ranging from 0.2-100 ng/mL in ninety-two patients were included in this study. The diagnostic performances in multiple Tg levels (0.7, 1.0, 5.0, 10.0, 20.0, 50.0) were evaluated to compare with FNAB cytology using sensitivity, specificity, and accuracy with area under the curve (AUC) analysis. RESULTS: Forty-two were metastatic lymph nodes and fifty three were nonmetastatic lymph nodes. FNAB-Tg ranged from 0.22 to 90.9 ng/mL in metastatic lymph nodes (mean; 34.3+/-33.3 ng/mL) and 0.20 to 56.7 ng/mL in nonmetastatic lymph nodes (mean; 4.9+/-11.1 ng/mL) (p<0.001). The most excellent diagnostic performance was displayed in 5 ng/mL of FNAB-Tg with AUC of 0.76, sensitivity, specificity, accuracy, 69.0, 83.0, and 76.8, respectively. However, there was no significant difference from 10 ng/mL FNAB. CONCLUSION: We ascertained that 5 ng/mL yielded the most excellent diagnostic performance among FNAB-Tg levels in the present setting with a large series with the indeterminate range (0.2-100 ng/mL) of FNAB-Tg values. These results need additional confirmation under different laboratory conditions.
Biopsy, Fine-Needle/*methods/standards/statistics & numerical data ; Body Fluids/metabolism ; Carcinoma, Papillary/*metabolism/*secondary/ultrasonography ; Humans ; Lymph Nodes/metabolism/pathology/ultrasonography ; Lymphatic Metastasis ; Retrospective Studies ; Sensitivity and Specificity ; Thyroglobulin/*metabolism ; Thyroid Neoplasms/*metabolism/*secondary/ultrasonography ; Ultrasonography, Interventional

PURPOSE: To evaluate the effects of macular ischemia and early treatment on the visual outcomes of patients with branch retinal vein occlusion (BRVO). METHODS: This study retrospectively reviewed the records of 42 patients who were treated with an intravitreal bevacizumab injection for BRVO, repeated 3 times at 6-week intervals and were whose data available for a follow-up period of at least 4 years. Best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) results before treatment and at 6, 12, 24, 36 and 48 months after the 3 serial injections, were measured. We assessed macular ischemia, time to the first treatment, and the relationship of these with BCVA. RESULTS: Mean BCVA (log MAR) was significantly improved from 0.67 +/- 0.43 at baseline to 0.30 +/- 0.30 at 48 months (p < 0.001). Four years after treatment, mean BCVA in the macular non-ischemic group was better than in the ischemic group, but this relationship did not hold for mean change in BCVA. There was a statistically significant (p < 0.05) difference between the early (< or =6 weeks) and late (>6 weeks) treatment groups in BCVA and mean change in BCVA after 48 months. There was statistically significant (p < 0.05) difference between the early (< or =6 weeks) and late (>6 weeks) treatment groups with macular ischemia in BCVA after 48 months. CONCLUSIONS: In patients with BRVO, a significant visual improvement was maintained after intravitreal bevacizumab injections, despite the presence of macular ischemia. Early treatment (within 6 weeks) is more effective for maintaining and improving visual acuity. Similar results in the macular ischemia group confirmed the importance of early treatment.
Follow-Up Studies ; Humans ; Ischemia* ; Retinal Vein Occlusion* ; Retinal Vein* ; Retinaldehyde* ; Retrospective Studies ; Tomography, Optical Coherence ; Visual Acuity ; Bevacizumab

PURPOSE: To investigate the effect of prophylactic intraocular pressure (IOP)-lowering medication after intravitreal dexamethasone implantation. METHODS: This is a retrospective analysis of 39 eyes undergoing intravitreal dexamethasone implantation for macular edema. Eyes were divided into two groups, those which had used prophylactic IOP-lowering medication and those which had not. IOP was measured preoperatively, at one week, and monthly until six months post-injection in each group. RESULTS: The mean pre-injection IOP for the group that had not used prophylactic IOP-lowering medication and the group that had was 13.95 +/- 3.32 mm Hg and 13.56 +/- 3.71 mm Hg, the mean post-injection IOP at two months was 15.81 +/- 3.75 mm Hg and 12.56 +/- 5.02 mm Hg, and that at six months was 12.90 +/- 2.95 mm Hg and 11.44 +/- 3.59 mm Hg, respectively. The difference between the two groups was statistically significant at one week, one month, two months, and three months (p = 0.001, 0.002, 0.011, 0.035, respectively). A greater than 22 mm Hg increase in IOP was seen in four eyes (19.05%) in the group that had not used IOP-lowering medication and in one eye (5.56%) in the group that had. A greater than 5 mm Hg increase in IOP from baseline was seen in eight eyes (38.10%) in the group that had not used IOP-lowering medication and in one eye (5.56%) in the group that had. CONCLUSIONS: After intravitreal dexamethasone implantation, prophylactic IOP-lowering medication will significantly prevent IOP increase and decrease the number of patients requiring additional treatment that could cause potential damage to the retina and optic nerve.
Dexamethasone* ; Humans ; Intraocular Pressure ; Macular Edema ; Optic Nerve ; Retina ; Retrospective Studies

PURPOSE: To investigate the effect of prophylactic intraocular pressure (IOP)-lowering medication after intravitreal dexamethasone implantation. METHODS: This is a retrospective analysis of 39 eyes undergoing intravitreal dexamethasone implantation for macular edema. Eyes were divided into two groups, those which had used prophylactic IOP-lowering medication and those which had not. IOP was measured preoperatively, at one week, and monthly until six months post-injection in each group. RESULTS: The mean pre-injection IOP for the group that had not used prophylactic IOP-lowering medication and the group that had was 13.95 +/- 3.32 mm Hg and 13.56 +/- 3.71 mm Hg, the mean post-injection IOP at two months was 15.81 +/- 3.75 mm Hg and 12.56 +/- 5.02 mm Hg, and that at six months was 12.90 +/- 2.95 mm Hg and 11.44 +/- 3.59 mm Hg, respectively. The difference between the two groups was statistically significant at one week, one month, two months, and three months (p = 0.001, 0.002, 0.011, 0.035, respectively). A greater than 22 mm Hg increase in IOP was seen in four eyes (19.05%) in the group that had not used IOP-lowering medication and in one eye (5.56%) in the group that had. A greater than 5 mm Hg increase in IOP from baseline was seen in eight eyes (38.10%) in the group that had not used IOP-lowering medication and in one eye (5.56%) in the group that had. CONCLUSIONS: After intravitreal dexamethasone implantation, prophylactic IOP-lowering medication will significantly prevent IOP increase and decrease the number of patients requiring additional treatment that could cause potential damage to the retina and optic nerve.
Dexamethasone* ; Humans ; Intraocular Pressure ; Macular Edema ; Optic Nerve ; Retina ; Retrospective Studies

A pulmonary thromboembolism (PTE) causes a dramatic pressure overload to the right heart. Previous case reports have shown that elevated right atrial pressure secondary to a PTE can cause right-to-left shunting in the presence of an atrial septal aneurysm (ASA). A 57-year-old female with diabetes, hypertension, and an old cerebral infarction was admitted to our hospital with acute PTE. Initial transthoracic echocardiography (TTE) showed an ASA swing from the right side to the left side, and right-to-left shunting was detected immediately in the agitated saline test. However, definite signs of pressure overload of the right heart were not detected in the TTE. This educational case shows that right-to-left shunting via a patent foramen ovale in the ASA can cause normal right atrial pressure, thus masking the pressure overload of the right heart in a patient with PTE.
Aneurysm ; Atrial Pressure ; Cerebral Infarction ; Dihydroergotamine ; Echocardiography ; Female ; Foramen Ovale, Patent ; Heart ; Humans ; Hypertension ; Masks ; Middle Aged ; Pulmonary Embolism

This study was conducted to analyze how appropriate the on-line nutrition information was externally as a web information. Four-hundred-ninety-seven web sites from 5 internet search engines (Yahoo, Empas, Nate, Hanmir, Naver) were selected on the basis of April 25th, 2004. The skillful personnels monitored them about 8 evaluating categories: clarity, purpose, authority, durability, advertisement, privacy and/or security, responsibility, and contents. Forty percent of the selected web sites were operated by the companies which had commercial purpose like internet shopping malls and 5.6% by academies, societies, research institutions, schools/colleges and public institutions. Most of web sites (76.1%) were managed for advertisements and sales of companies' commodities, and 32.6% had the food and nutrition information as first purpose. Ninety-three percent of web sites were targeted to healthy individuals through whole life cycle. Specifically, there were lots of web sites for the obesity which were offered by diet related companies. Of the 497 web sites, 193 mentioned the name providing the nutrition information, but only 1/3 had reliability on their specialty. As a source of nutrition information, 52.7% of web sites were using 'books of the major field' and 42.0% 'newspapers' and 23.7% 'broadcasting', respectively. Most web sites mentioned 'setting-up date' but not 'renewal date'. Thirty-six percent of web sites took '2 - 3 days' for the operators to answer the questions through the bulletin. Forty-seven percent of web sites answered '1 - 10 questions' per 1 week, but 40.1% of them didn't answer for a week at all. There were 118 web sites (23.7%) to record the connected frequencies and 36.0% of them put the advertisements. Around 96% of web sites mentioned feedback addresses. Among the menus of web sites, 68.0% were about self-advertisement and 64.0% about nutrition information. Each web site was scored to judge its external quality according to the operators by selecting 13 items. Web sites managed by public institution had highest scores (9.5), and lowest in private vendors', food companies' and individual web pages. Among search engines, Naver got the highest score of 7.0 and Nate the lowest one of 6.1. As it was only the pilot study, there were several limits in evaluating tools, time and monitored quantity. To make monitoring of on-line nutrition informations actively, standardized monitoring forms might be developed under the integrated studies.
Academies and Institutes ; Commerce ; Diet ; Internet ; Life Cycle Stages ; Obesity ; Pilot Projects ; Privacy ; Search Engine

We report the surgical endodontic treatment of a maxillary first premolar with a lateral lesion that originated from an accessory canal. Although lesions originating from accessory canals frequently heal with simple conventional endodontic therapy, some lesions may need additional and different treatment. In the present case, conventional root canal retreatment led to incomplete healing with the need for further treatment (i.e., surgery). Surgical endodontic management with a fast-setting calcium silicate cement was performed on the accessory canal using a dental operating microscope. At the patient's 9-month recall visit, the lesion was resolved upon radiography.
Bicuspid ; Calcium ; Dental Pulp Cavity ; Radiography ; Retreatment ; Silicate Cement ; Silicates