The vitrectomy and silicone oil injection has been used occasionally for the advertent retinal detachment, but the silicone oil placement within the vitreous cavity may cause the complications in such as band keratopathy, emulsification of silicone oil, iritis and glaucoma, etc. Especially, in the phakic eyes, the silicone oil may enter the anterior chamber in the form of a suspension of fine globules resembling an inverted hypopyon and it is called the hyperoleon. The authors observed a case of hyperoleon 4 months after surgery, reporting it with the review of literatures.
Anterior Chamber ; Glaucoma ; Iritis ; Retinal Detachment ; Silicone Oils ; Vitrectomy

Six patients with macular hole and retinal detachment and no visible vitreoretinal connection examined by slitlamp and 3-mirror contact lens were treated by two methods. In two patients with relatively localized retinal detachment in central fundus, 0.7ml or more of pure SF6 gas was injected into vitreous cavity by 27 gauge needle after paracentesis was done because of keeping the large space of gas injection as preventmg the increase of lOP. In the remained 4 patients, 1.2ml or more of pure SF6 gas was injected into vitreous cavity after the subretinal fluid was released externally, and then paracentesis was done because of preventing the increase of lOP. After operation, all patients were placed in prone position for 6 hours or more in a day. In 5 of 6 patients, the retina remained attached duing more than 6 months. Even if 2 with posterior staphyloma in 6 patients were treated with two or more operations, 1 patient was failed. Although visual improvement at 6 months after operation was limited due to macular degeneration, the visual acuity were above 0.05 in 3 patients. This operation is simple and safe and not damaged en macula. This procedure is good surgical method in patients with retinal detachment wirh macular hole but without other breaks or visible vitreous adhesion or posterior staphyloma.
Drainage* ; Humans ; Macular Degeneration ; Needles ; Paracentesis* ; Prone Position ; Retina ; Retinal Detachment* ; Retinal Perforations* ; Retinaldehyde* ; Subretinal Fluid* ; Visual Acuity

Six patients with macular hole and retinal detachment and no visible vitreoretinal connection examined by slitlamp and 3-mirror contact lens were treated by two methods. In two patients with relatively localized retinal detachment in central fundus, 0.7ml or more of pure SF6 gas was injected into vitreous cavity by 27 gauge needle after paracentesis was done because of keeping the large space of gas injection as preventmg the increase of lOP. In the remained 4 patients, 1.2ml or more of pure SF6 gas was injected into vitreous cavity after the subretinal fluid was released externally, and then paracentesis was done because of preventing the increase of lOP. After operation, all patients were placed in prone position for 6 hours or more in a day. In 5 of 6 patients, the retina remained attached duing more than 6 months. Even if 2 with posterior staphyloma in 6 patients were treated with two or more operations, 1 patient was failed. Although visual improvement at 6 months after operation was limited due to macular degeneration, the visual acuity were above 0.05 in 3 patients. This operation is simple and safe and not damaged en macula. This procedure is good surgical method in patients with retinal detachment wirh macular hole but without other breaks or visible vitreous adhesion or posterior staphyloma.
Drainage* ; Humans ; Macular Degeneration ; Needles ; Paracentesis* ; Prone Position ; Retina ; Retinal Detachment* ; Retinal Perforations* ; Retinaldehyde* ; Subretinal Fluid* ; Visual Acuity

OBJECTIVES: The differentiation of tuberculous effusion from the other causes of exudative pleural effusion remained difficult even with aids of biochemical analyses and pleural biopsy. As the pathophysiology of tuberculous pleural effusion is an enhanced cell mediated immunity, Adenosine deaminase(ADA) and various cytokines including Inteferon-γ, tumor necrosis factor alpha(TNF-α) are considered as useful diagnostic tools in differentiating exudative pleural effusion The author would like to demonstrate the diagnostic usefulness of TNF-α in the differentiation of exudative pleural effusion, and compared the discriminating ability of TNF-α with ADA. METHODS: Pleural fluids obtained from 80 patients (tuberculous : 39, malignant : 31, parapneumonic : 10) with exudate pleural effusions were processed for cell counts and biochemical analysis including ADA and TNF-α RESULTS: Tuberculous pleural fluid showed higher levee of ADA and TNF-α, 48.7α 32.7U/L and 184.1±214.2pg/mL than that of non-tuberculous effusion 26.0α41.3U/L and 44.1α114.2pg/mL, respectively (ADA, TNF-α : p<0.05, p<0.01). Receiver operating characteristics(ROC) curves were generated for ADA and TNF-α, and the best cut-off value for adenosine deaminase and TNF-α were considered as 30U/L and 15pg/ml, respectively. Comparing the area under the ROC curves, there was no significant difference between ADA and TNF-α CONCLUSION: For the differential diagnosis of tuberculous pleural effusion from the other causes of exudative pleural effusions, TNF-α as well as ADA was considered as useful diagnostic method. However adding TNF-α to ADA has no further diagnotic benefit than ADA alone.
Adenosine ; Adenosine Deaminase ; Biopsy ; Cell Count ; Cytokines ; Diagnosis, Differential ; Exudates and Transudates ; Humans ; Immunity, Cellular ; Pleural Effusion* ; ROC Curve ; Tuberculosis ; Tumor Necrosis Factor-alpha*

Background: A recent concern in breast reconstruction procedures is skin color mismatch of the pedicled transverse rectus abdominis myocutaneous (TRAM) flap. With the goal of objectively quantifying the skin tone of the TRAM flap donor site, contralateral breast, and flap, a comparative study was conducted. Methods: This study was conducted in July 2021, included 17 patients who received delayed breast reconstruction via TRAM flaps from January 2016 to December 2020 with at least 12 months of follow-up. Melanin levels and redness values of the flap, abdomen, and contralateral breast were measured in patients using a skin pigmentation analyzer. Furthermore, in 20 healthy women in their 40s to 60s, measurements were made of the abdomen, as well as breast. Results: The contralateral breast had lower mean melanin and redness than the abdomen. The flaps had slightly higher melanin levels than the contralateral breasts. The flaps tended to have higher redness values, but the difference was not significant. The difference between the flap and abdomen was significant for melanin, but not redness. Preoperative radiotherapy did not affect skin tone. The upper abdomen showed lower melanin and redness than the lower abdomen. Conclusions The breast had a brighter skin tone than the abdomen. The upper abdomen showed brighter skin tone than the lower abdomen, and the area used as the donor site of the TRAM flap presented the same tendency. In the process of TRAM flap engrafting, the melanin level of the tissue decreases, and the redness value tends to increase slightly compared to the contralateral breast.

Primary cutaneous marginal zone B-cell lymphoma (PCMZL) is an uncommon type of malignant lymphoma that mainly occurs in the trunk and upper extremity, with less frequent incidence observed on the head. Herein, we report the early diagnosis and treatment of a rare case of facial PCMZL in an Asian patient. A 51-year-old man presented with masses on the forehead and nose tip, which he had incidentally discovered 2 months previously. The masses appeared as a papule on the forehead and a patch on the nose. There were no signs of infection or bleeding, and the patient reported no other symptoms. After complete surgical excision, PCMZL was diagnosed based on the permanent biopsy. The histopathological findings revealed lymphoid aggregations with multifocal granulomas. Further treatment and follow-up were conducted at the hematology and oncology department. Despite its rarity in Asian populations, cutaneous lymphoma should be included in the differential diagnosis of facial masses. Early diagnosis and treatment based on a physical examination, imaging study, and excisional biopsy are important for a favorable prognosis.

Posttraumatic pseudoaneurysm of the face is caused by blunt, penetrating, or surgical trauma. Although its incidence is low, pseudoaneurysm rupture can cause a life-threatening, massive hemorrhage. A 48-year-old man visited our emergency center due to a fall-down accident. Three-dimensional computed tomography (CT) showed a comminuted zygomaticomaxillary complex fracture of the left face. After open reduction and internal fixation, the surgical wound healed without any complications. However, the patient was readmitted 10 days after surgery due to pus-like discharge from the wound. Contrast-enhanced CT to find the abscess unexpectedly revealed a pseudoaneurysm in the left retromaxillary area. Massive oral bleeding occurred on the night of re-hospitalization and emergency surgery was done. The bleeding site was identified as a pseudo-aneurysmal rupture of the posterior superior alveolar artery in the retromaxillary area. Hemostasis was achieved by packing Vaseline gauze in the maxillary sinus using an endoscope. Delayed rupture and massive bleeding of posttraumatic retromaxillary pseudoaneurysm after a zygomaticomaxillary fracture is a low-probability, but high-impact event. Therefore, additional contrast-enhanced CT should be considered to evaluate the possibility of a posttraumatic pseudoaneurysm in cases of severe comminuted zygomaticomaxillary fracture.

Posttraumatic pseudoaneurysm of the face is caused by blunt, penetrating, or surgical trauma. Although its incidence is low, pseudoaneurysm rupture can cause a life-threatening, massive hemorrhage. A 48-year-old man visited our emergency center due to a fall-down accident. Three-dimensional computed tomography (CT) showed a comminuted zygomaticomaxillary complex fracture of the left face. After open reduction and internal fixation, the surgical wound healed without any complications. However, the patient was readmitted 10 days after surgery due to pus-like discharge from the wound. Contrast-enhanced CT to find the abscess unexpectedly revealed a pseudoaneurysm in the left retromaxillary area. Massive oral bleeding occurred on the night of re-hospitalization and emergency surgery was done. The bleeding site was identified as a pseudo-aneurysmal rupture of the posterior superior alveolar artery in the retromaxillary area. Hemostasis was achieved by packing Vaseline gauze in the maxillary sinus using an endoscope. Delayed rupture and massive bleeding of posttraumatic retromaxillary pseudoaneurysm after a zygomaticomaxillary fracture is a low-probability, but high-impact event. Therefore, additional contrast-enhanced CT should be considered to evaluate the possibility of a posttraumatic pseudoaneurysm in cases of severe comminuted zygomaticomaxillary fracture.

Background/Aims: Tegoprazan, a novel potassium-competitive acid blocker, is expected to overcome the limitations of proton pump inhibitors and effectively control nocturnal acid breakthrough. To evaluate the pharmacodynamics of tegoprazan versus dexlansoprazole regarding nocturnal acid breakthrough in healthy subjects. Methods: In a randomized, open-label, single-dose, balanced incomplete block crossover study, 24 healthy male volunteers were enrolled and randomized to receive oral tegoprazan (50, 100, or 200 mg) or dexlansoprazole (60 mg) during each of two administration periods, separated by a 7- to 10-day washout period. Blood samples were collected for pharmacokinetic parameter analysis; gastric monitoring was performed for pharmacodynamic parameter evaluation. Results: All 24 subjects completed the study. Average maximum plasma concentration, area under the plasma concentration–time curve, and mean time with gastric pH >4 and pH >6 for tegoprazan demonstrated dose-dependent incremental increases. All the tegoprazan groups reached mean pH ≥4 within 2 hours, whereas the dexlansoprazole group required 7 hours after drug administration. Based on pharmacodynamic parameters up to 12 hours after evening dosing, 50, 100, and 200 mg of tegoprazan presented a stronger acid-suppressive effect than 60 mg of dexlansoprazole. Moreover, the dexlansoprazole group presented a comparable acid-suppressive effect with the tegoprazan groups 12 hours after dosing. Conclusions All the tegoprazan groups demonstrated a significantly faster onset of gastric pH increase and longer holding times above pH >4 and pH >6 up to 12 hours after evening dosing than the dexlansoprazole group.

BACKGROUND: It has been well known that bronchial asthma is a chronic airway inflammatory disorder. Recently, sputum specimen induced with hypertonic saline was introduced as a simple and useful noninvasive medium to investigate airway inflammation and symptom severity in patients with asthma. We examined the eosinophil, cationic protein (ECP), interleukin(IL)-3, IL-5, granulocyte-macrophage colony-stimulating factor (GM-CSF), and nitric oxide (NO) derivatives in induced sputum from patients with bronchial asthma in order to determine the role of NO and various inflammatory cytokines as a useful markers of airway inflammation of changes in pulmonary function tests and symptoms. METHODS: A total 30 patients with bronchial asthma received oral prednisolone 30 mg daily for 2 weeks. Forced expiratory volume in one second (FEV), total blood eosinophil count, and induced sputum eosinophil count, ECP, IL-3, IL-5, GM-CSF, and NO derivatives were determined before and after the administration of prednisolone. RESULTS: Of the 30 patients, 13 (43.3%) were male and 17 (56.7%) were female. The mean age of patients was 41.8 years (range 19-64 years). Two patients could not produce sputum at the second study and 3 could not be followed up after their first visit. Two weeks after the prednisolone administration, there was a significant increase in FEV1 (% of predicted value) from 78.1±20.6% to 90.3±18.3% (P<0.001). The eosinophil percentages in induced sputum were significantly decreased after treatment with prednisolone, with values of 56.1±27.2% versus 29.6±21.3% (P<0.001), and ECP were 134.5±68.1 µm/L versus 41.5±42.4 µm/L (P<0.001) respectively. After the prednisolone treatments, the eotaxin concentration also showed a decreasing tendency from 26.7±12.8 pg/ml to 21.7±8.7 pg/ml. There was a decreasing tendency but no significant differences in total blood eosinophil count(425.7±265.9 vs 287.7±294.7) and in the concentration of NO derivatives (70.4±44.6 µmol%/L vs 91.548.3 µmol/L) after the predinisolone treatments. IL-3, IL-5, GM-CSF were undetectable in the sputum of most subjects either before the prednisolone treatments of after the treatments. Before the prednisolone treatments, a significant inverse correlation was observed between FEV1 and sputum ECP (r=-0.364, P<0.05) and there was a significant correlation between sputum eosinophils and eotaxin (r=0.369, P<0.05). CONCLUSION: The eotaxin and ECP concentration in induced sputum may be used as markers of airway inflammation after treatments in bronchial asthma. In addition, the measurement of sputum eosinophil percentages is believed to be a simple method displaying the degree of airway inflammation and airway obstruction before and after the predinisolone treatment in bronchial asthma. However, unlike exhaled NO, the examination of NO derivatives with Griess reaction in induced sputum is considered an ineffective marker of changing airway inflammation and obstructing symptoms.
Airway Obstruction ; Asthma* ; Cytokines ; Eosinophils ; Female ; Forced Expiratory Volume ; Granulocyte-Macrophage Colony-Stimulating Factor ; Humans ; Inflammation ; Interleukin-3 ; Interleukin-5 ; Male ; Nitric Oxide* ; Prednisolone ; Respiratory Function Tests ; Sputum*