PURPOSE: To evaluate the outcome after Ahmed valve implantation in patients with neovascular glaucoma when using intraoperative mitomycin C (MMC) and postoperative 5-fluorouracil (5-FU). METHODS: A total of 40 eyes of 40 patients with neovascular glaucoma who received antiglacomatous medication without previous glaucoma surgery were included in the present study. The patients received Ahmed valve implantation and intraoperative MMC and postoperative 5-FU. Failure was defined as the first occurrence of any of the following: 1) the first of three consecutive visits where intraocular pressure (IOP) was >18 mmHg or 20% IOP reduction from baseline and the final number of topical medication did not reduce by at least two from baseline, 2) the need for additional surgery, or 3) the occurrence of a serious complication. RESULTS: The cumulative success rate was 77.5% at 12 months. The final number of topical medication after Ahmed valve implantation was 0.73+/-0.78, and the change in the number of medication from baseline was -2.18+/-0.84. Serious complications such as endophthalmitis, valve exposure or prolonged hypotony were not observed. CONCLUSIONS: The adjunctive use of intraoperative MMC and postoperative 5-FU with Ahmed valve implantation results in a high success rate and good IOP control and did not show serious complications within the postoperative period.
Endophthalmitis ; Eye ; Fluorouracil ; Glaucoma ; Glaucoma, Neovascular ; Humans ; Intraocular Pressure ; Mitomycin ; Postoperative Period

PURPOSE: To report a simple surgical technique for rebuilding the palpebral tarsal plate using a Medpor(R) sheet. The formation of a palpebral tarsal plate is very important in the reconstruction of the eyelid. Transplantation of cartilaginous tissue is often necessary to create the palpebral tarsal plate. However obtaining enough cartilaginous tissue is difficult. CASE SUMMARY: Eyelid reconstruction and surgical resection of each lesion was attempted on two patients clinically diagnosed with basal cell carcinoma and sebaceous gland carcinoma between August, 2006 and November, 2007. Reconstruction was performed using a modified Cutler-Beard method or the sebaceous gland carcinoma that occurred in the upper eyelid, and a modified Tenzel semicircular rotational flap procedure was used or the basal cell carcinoma that occurred in the lower eyelid. For the reconstruction of tarsus, 0.45 mm Medpor(R) sheet was used. Complications, such as shortage of eyelid movement, dragging of eyelid or unstable eyelid margin, did not occur after the operations in either subject. In the case of the upper eyelid reconstruction, the eyelid became stiff at the early stage, but the condition improved after 6 months. CONCLUSIONS: The reconstruction of the palpebral tarsal plate using a Medpor(R) sheet is considered an effective and safe technique for the reconstruction of an eyelid.
Animals ; Ankle ; Carcinoma, Basal Cell ; Eyelids ; Humans ; Sebaceous Glands ; Transplants

Nasal lymphoma is an uncommon neoplasm in the sinonasal tract. The NK/T-cell type of lymphoma is more commonly found in Asian populations. However, B-cell lymphoma is more common in the western countries whereas it is rare in Asia. Recently, we experienced two cases of sinonasal B-cell lymphoma, which are rare cases in Korea, one in an advanced stage and one in an early stage. Both patients had no specific nasal symptoms or systemic B symptoms (fever, night sweat, weight loss). As our cases demonstrate, diagnosis of B cell lymphoma is often delayed in many cases because B-cell lymphoma does not show any specific symptoms. Thus, careful physical examination and biopsy under suspicion of malignancy are important for early diagnosis of nasal lymphoma.
Asia ; Asian Continental Ancestry Group ; B-Lymphocytes ; Biopsy ; Humans ; Korea ; Lymphoma ; Lymphoma, B-Cell ; Physical Examination ; Sweat

BACKGROUND AND OBJECTIVES: The pathogenesis of cholesteatoma behind an intact tympanic membrane remains controversial. Squamous metaplasia of the middle ear mucosa is thought to be a possible mechanism in such cases. However, to date, no definitive experimental results have proved the association. This study was undertaken to investigate whether normal human middle ear epithelial (NHMEE) cells undergo keratinizing squamous differentiation in retinoic acid (RA)-deficient culture. MATERIALS AND METHOD: We examined the morphological differences between RA-deficient and RA-sufficient cultures, and determined the expressions of the mucin gene and cornifin-alpha mRNAs as indicators of mucous and squamous differentiation, respectively. RESULTS: Histomorphologically, the NHMEE cells differentiated into a keratinizing squamous epithelium in RA-deficient culture. In addition, the expressions of mucin gene 5AC (MUC5AC) and MUC8 mRNA were suppressed, and the expression of cornifin-alpha mRNA increased progressively as a function of differentiation in RA-deficient culture. CONCLUSION: Our study shows that RA depletion induces keratinizing squamous differentiation in NHMEE cell culture.
Cell Culture Techniques ; Cholesteatoma ; Ear, Middle* ; Epithelial Cells* ; Epithelium ; Humans* ; Metaplasia ; Mucins ; Mucous Membrane ; RNA, Messenger ; Tretinoin* ; Tympanic Membrane

OBJECTIVES: The objective of this study was to develop evidence- and consensus-based clinical safety usage guidelines for sedative hypnotics using the Delphi technique. METHODS: A group of 15 sleep experts from Korean Academy of Sleep Medicine were chosen for this study comprising a three-round web-based Delphi survey. The first round survey was composed of 39 questions to identify problems with sedative hypnotics usage in Korean clinical practice and the result roughly outlined what should be included in the guidelines. The second round survey was composed of 21 questions to collect specific opinions of experts on clinically important issues in prescribing sedative hypnotics, and its result provided the basis for the guidelines. A third round survey aimed to evaluate the reliability and validity of the established guidelines. RESULTS: In the third round, all 17 items showed a median of 4 or more, with an average of 4.12 and a standard deviation of 0.32. Thus we present safety usage guidelines with 13 propositions for prescription, maintenance, and withdrawal of sedative hypnotics. CONCLUSION The safety usage guidelines on sedative hypnotics developed from this study could lead to safe and effective prescription of hypnotics in clinical practice, especially for the non-experts in sleep medicine. Furthermore, the guidelines will help to improve the quality of insomnia treatment by contributing to the establishment of a safe regime for sedative hypnotics without excessive use of drugs.

Majority of .hepatocellular carcinoma is evolved from a well differentiated cancerous condition such as hypetptastic lesions eg; adenomatous hyperplasia in cirrhotic liver or de no vo carcinogenesis and prolifenation along with dedifferentiation. Adenomatous hyperplasia is may be seen in severe acute hepatic injury, like svhmassive hepatic necrosis, or in chronic liver diseases, particularly liver cirrhosis and it has recently attracted much interest from both clinicians and pathologists because it is regarded as a precursor lesion of hepatocObdar carcinoma. Hepatic. denomatous hyperplasia resembling focal nodular hyperplasia might have developed from localized vascular changes associated with chronic liver disease, pre-existing arterial malformation and early stage of angiogenesis in hepatocarcinogenesis. .fie present a patient who developed hepatocellular carcinoma after hepatic artery ligation.
Carcinogenesis ; Carcinoma, Hepatocellular* ; Focal Nodular Hyperplasia ; Hepatic Artery* ; Humans ; Hyperplasia ; Ligation* ; Liver ; Liver Cirrhosis ; Liver Diseases ; Necrosis

PURPOSE: Anesthesia and surgery commonly cause hypothermia, and this caused by a combination of anesthetic-induced impairment of thermoregulatory control, a cold operation room environment and other factors that promote heat loss. All the general anesthetics markedly impair normal autonomic thermoregulatory control. The aim of this study is to evaluate the effect of two different types of propofol versus inhalation anesthetic on the body temperature. MATERIALS AND METHODS: In this randomized controlled study, 36 patients scheduled for elective laparoscopic gastrectomy were allocated into three groups; group S (sevoflurane, n=12), group L (lipid-emulsion propofol, n=12) and group M (micro-emulsion propofol, n=12). Anesthesia was maintained with typical doses of the study drugs and all the groups received continuous remifentanil infusion. The body temperature was continuously monitored after the induction of general anesthesia until the end of surgery. RESULTS: The body temperature was decreased in all the groups. The temperature gradient of each group (group S, group L and group M) at 180 minutes from induction of anesthesia was 2.5+/-0.6degrees C, 1.6+/-0.5degrees C and 2.3+/-0.6degrees C, respectively. The body temperature of group L was significantly higher than that of group S and group M at 30 minutes and 75 minute after induction of anesthesia, respectively. There were no temperature differences between group S and group M. CONCLUSION: The body temperature is maintained at a higher level in elderly patients anesthetized with lipid-emulsion propofol.
Aged ; Aging ; Anesthesia, General/*methods ; Anesthetics, Combined/administration & dosage ; Anesthetics, Inhalation/*administration & dosage ; Anesthetics, Intravenous/*administration & dosage ; Body Temperature/*drug effects ; Body Temperature Regulation/drug effects ; Fat Emulsions, Intravenous ; Female ; Humans ; Male ; Methyl Ethers/*administration & dosage ; Middle Aged ; Propofol/*administration & dosage

Primary frontal sinus lymphoma is a very uncommon disease. In all the previously reported cases, the presenting symptoms have been due to the tumor mass effect. We present an unusual case report of an immunocompetent patient who presented with facial palsy, and then progressively developed other cranial nerve palsies over several months. He was later diagnosed with diffuse large B cell lymphoma originating from the frontal sinus. The patient underwent chemotherapy, but eventually had to receive autologous peripheral blood stem cell transplantation. He is currently disease-free. The clinical course, diagnostic workup, and therapeutic outcome are described.
Adult ; Cranial Nerve Diseases/*diagnosis/pathology ; Frontal Sinus/*pathology ; Humans ; Lymphoma/*diagnosis/pathology ; Male

Pure primary hepatic rhabdomyosarcoma in adult is very uncommon. There have been only five previous case of primary rhabdomyosarcoma of the adult liver. A case of hepatic ihabdomyosarcoma was diagnosed in a 52 year-old female. She was admitted to the hospital due to the epigastric pain and weight loss. A CT scan of the abdomen showed a large hypodense mass with focal calcification occupies most of the both lobes of the liver. The liver biopsy showed massive liver tumor composed entirely of oval shaped cells showing light microscopic and immunohistochemical evidence of rhabdomyoblastic differentiation. We report a case of hepatic rhabdomyosarcoma with review of literature.
Abdomen ; Adult ; Biopsy ; Female ; Humans ; Liver* ; Rhabdomyosarcoma* ; Tomography, X-Ray Computed ; Weight Loss

BACKGROUND AND OBJECTIVES: Three-dimensional (3D) imaging is gaining popularity and has been partially used in robotic surgery but not in sinonasal surgery owing to technical problems. This is not only the first pilot study to evaluate the usefulness of newly-developed ‘twin lens’ HD-3D endoscope (Machida), but also the first clinical study to compare this instrument with the pre-existing ‘insect eye’ 3D endoscope (Visionsense). MATERIALS AND METHOD: A total of 45 surgeries for cerebrospinal fluid leakage, angiofibroma, or sinonasal malignancy were performed using a 3D endoscope between November 2011 and October 2013 (‘insect eye’ Visionsense VSII 3D: 29 cases, ‘twin lens’ Machida HD-3D: 16 cases). RESULTS: Depth perception and recognition of anatomical structures were all excellent in the two 3D methods. The ‘twin lens’ HD-3D endoscope provided better image resolution and naturalness of color and showed less unfavorable phenomena such as image blurring and blackout than the ‘insect eye’ 3D endoscope. CONCLUSION: If the technical limitations are solved, the 3D endoscope will be used as a substitute and a standard tool in endoscopic sinonasal surgery rather than as supplement to the two-dimensional (2D) endoscope in the near future.
Angiofibroma ; Cerebrospinal Fluid Leak ; Clinical Study ; Depth Perception ; Endoscopes* ; Imaging, Three-Dimensional ; Methods ; Paranasal Sinus Neoplasms ; Pilot Projects ; Sinusitis