Of the complictions of cataract extraction, it is well known that hemorrhage, infection and delayed wound healing are more frequent in diabetics than in nondiabetics. But if the extraction was performed after diabetes has adequately controlled for several weeks prior to operation, the visual results are almost as good in diabetics as in non-diabetics. However, with precautions for these complications, the aut hers carefully performed cataract extraction in two juvenile diabetics, whose blood sugar level had been poorly controlled in spited of diabetic diet and subcutaneous injection of the insulin before and after operation. The visual results were very good in spite of high blood sugar level before operation.
Blood Glucose ; Cataract Extraction ; Cataract* ; Diet, Diabetic ; Hemorrhage ; Injections, Subcutaneous ; Insulin ; Wound Healing

Duane's retraction syndrome is a deficiency in abduction and a defect in abduction movements, with retraction and narrowing of the palpebral fissure of the affected eye. In addition, there are often an upshoot or downshoot of the affected eye on attempted abduction, widening of the palpebral fissure with abduction and mild to marked defect in convergence. But, the clinical picture in Duane's retraction syndrome is extremely variable. Two cases of Duane's retraction syndrome are presented, each of them is Duane's type I and type III, which are affected on left eye. The literatures relating to this syndrome are briefly reviewed.
Duane Retraction Syndrome*

Hepatoid adenocarcinoma (HAC) is a rare type of extrahepatic carcinoma whose morphology is similar to that of hepatocellular carcinoma (HCC). Metachronous HCC and HAC in the same patient is extremely rare. The case of a 68-year-old man with chronic hepatitis B infection who had both HCC and HAC of the stomach is reported herein. Nine years previously this patient had been diagnosed with HCC and received a right lobectomy. HCC that recurred at the caudate lobe at 6 months after the operation was successfully treated with transarterial chemoembolization. The patient was followed up regularly thereafter without evidence of tumor recurrence for 9 years. In July 2010 his serum alpha-fetoprotein (AFP) level elevated from 6.5 ng/mL to 625.4 ng/mL, and he developed a probable single metastatic lymph node around the hepatic artery without intrahepatic lesions. Subsequent evaluation with upper endoscopy revealed a 4-cm ulcerative lesion on the antrum of the stomach. Subtotal gastrectomy was performed with lymph-node dissection. Histologic examination revealed a special type of extrahepatic AFP-producing adenocarcinoma-HAC with lymph-node metastasis-which indicates that HAC can be a cause of elevated AFP even in patients with HCC. HAC should be considered if a patient with stable HCC exhibits unusual elevation of AFP.
Adenocarcinoma/*diagnosis/drug therapy/secondary ; Aged ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Camptothecin/analogs & derivatives/therapeutic use ; Carcinoma, Hepatocellular/*diagnosis/drug therapy/pathology ; Chemoembolization, Therapeutic ; Chemotherapy, Adjuvant ; Fluorouracil/therapeutic use ; Gastroscopy ; Humans ; Leucovorin/therapeutic use ; Liver Neoplasms/*diagnosis/drug therapy/pathology ; Lymph Nodes/surgery ; Lymphatic Metastasis ; Male ; Recurrence ; Silicates/therapeutic use ; Stomach Neoplasms/*diagnosis/drug therapy/secondary ; Titanium/therapeutic use ; Tomography, X-Ray Computed ; alpha-Fetoproteins/*analysis

Tracheobronchomegaly, or Mounier-Kuhn syndrome, is a rare clinical and radiologic condition characterized by marked tracheobronchial dilatation and recurrent lower respiratory tract infections. It is thought to be due to a congenital anomaly. A diagnosis is typically made using computed tomography (CT) and bronchoscopy. Symptoms can range from minimal with preserved lung function to severe respiratory failure. Here, we present the case of a 50-year-old male who was referred to our hospital for chronic cough, sputum, and dyspnea. In addition, the patient showed tracheobronchomegaly with bronchomalacia on CT and bronchoscopy. This report describes a rare case of Mounier-Kuhn syndrome with a literature review.
Bronchomalacia ; Bronchoscopy ; Cough ; Dilatation ; Dyspnea ; Humans ; Lung ; Male ; Middle Aged ; Respiratory Insufficiency ; Respiratory Tract Infections ; Sputum ; Tracheobronchomegaly

BACKGROUND: In Korea, paraquat accounts for most of fatal poisoning with 500 or more deaths per year. It has been known that patients who ingested more than 1/2 mouthful of 20% concentrate paraquat usually die of multiorgan failure and pulmonary fibrosis. But the effect of charcoal hemoperfusion which can enhance elimination of paraquat remains controversial. Because acute paraquat poisoning is also characterized by multiorgan failure including kidney and marked rebound in plasma paraquat level after hemoperfusion, Continuous veon-venous hemofiltration(CVVH) may have theoretical benefits in the treatment of paraquat poisoning. So we evaluated the effect of early charcoal hemoperfusion and prophylactic CVVH after hemoperfusion in patients with paraquat poisoning. METHODS: There were 80 patients with paraquat poisoning admitted within 24 hours after ingestion (August 1996 - March 1998). All of them were treated with hemoperfusion (duration of hemoperfusion, 6.4+/-3.0 hours) within 24 hours of ingestion. The amount of ingestion was 2.1+/-1.0 mouthful (as 20% concentrate) and 78 (98%) were urine sodium dithionite test positive which is a poor prognosis factor. Forty-four patients received hemoperfusion only and 36 were followed by CVVH (duration, 50.4+/-20.9 hours; ultrafiltration volume, 33.8+/-3.9 L/day) after hemoperfusion. RESULTS: There was no difference between the hemoperfusion group and hemoperfusion+CVVH group in age, sex, initial serum creatinine, arterial oxygen saturation, severity of poisoning (as assessed by serum paraquat level determined by HPLC and amount of ingestion), or in the time elapsed from ingestion to the beginning of hemoperfusion. The total mortality was 65% (52/80) with no difference between the hemoperfusion group (64%, 28/44) and hemoperfusion+CVVH group (67%, 24/36). The mortality according to amount of ingestion was as follows: < 1 mouthful, 0% (0/5); 1 mouthful, 53% (8/15); 2 mouthful, 65% (11/17); > or = 3 mouthful, 82% (27/33); unknown, 60% (6/10). CONCLUSION: Early hemoperfusion can be effective in reducing mortality in patients who ingest less than 2 mouthful. Even though prophylactic CVVH after hemoperfusion has no additional benefit in reducing mortality in paraquat poisoning, it prolonged the time to death after ingestion.
Charcoal ; Chromatography, High Pressure Liquid ; Creatinine ; Dithionite ; Eating ; Hemofiltration* ; Hemoperfusion* ; Humans ; Kidney ; Korea ; Mortality ; Mouth ; Oxygen ; Paraquat* ; Plasma ; Poisoning* ; Prognosis ; Pulmonary Fibrosis ; Ultrafiltration

Paraquat, a very potent herbicide, has produced many fatalities through indiscriminate usage and suicides. It is known that with ingestion of more than one mouthful of 20% paraquat, death usually occurs by pulmonary fibrosis. We experienced two cases of successful outcome in patients with paraquat poisoning complicated with pulmonary fibrosis through active, intensive treatment from the early phase after ingestion. They swallowed one to two mouthfuls of the 20% commercial paraquat, and received hemoperfusion within 2-3 hours after ingestion. Then, combination therapy with steroid, vitamin C, D-penicillamine, allopurinol, colchicine was administered from the early phase. They showed moderate to severe hypoxemia and pulmonary fibrosis on chest HRCT during hospital course, but recovered from hypoxemia and remained very well on follow up over 3 months and 12 months after ingestion, respectively. We report these cases with literature review on treatment and prognosis of paraquat poisoning.
Allopurinol ; Anoxia ; Ascorbic Acid ; Colchicine ; Eating ; Follow-Up Studies ; Hemoperfusion ; Humans ; Mouth ; Paraquat* ; Penicillamine ; Poisoning* ; Prognosis ; Pulmonary Fibrosis* ; Suicide ; Thorax

Paraquat, a very potent herbicide, has produced many fatalities through indiscriminate usage and suicides. It is known that with ingestion of more than one mouthful of 20% paraquat, death usually occurs by pulmonary fibrosis. We experienced two cases of successful outcome in patients with paraquat poisoning complicated with pulmonary fibrosis through active, intensive treatment from the early phase after ingestion. They swallowed one to two mouthfuls of the 20% commercial paraquat, and received hemoperfusion within 2-3 hours after ingestion. Then, combination therapy with steroid, vitamin C, D-penicillamine, allopurinol, colchicine was administered from the early phase. They showed moderate to severe hypoxemia and pulmonary fibrosis on chest HRCT during hospital course, but recovered from hypoxemia and remained very well on follow up over 3 months and 12 months after ingestion, respectively. We report these cases with literature review on treatment and prognosis of paraquat poisoning.
Allopurinol ; Anoxia ; Ascorbic Acid ; Colchicine ; Eating ; Follow-Up Studies ; Hemoperfusion ; Humans ; Mouth ; Paraquat* ; Penicillamine ; Poisoning* ; Prognosis ; Pulmonary Fibrosis* ; Suicide ; Thorax