We report two cases of malignant lymphoma of mucosa-associated lymphoid tissue arising in the conjunctiva. Case 1, an 18-year-old girl, showed her left lower conjunctival swelling for four months and Case 2, a 29-year-old man, showed similar lesions on both his eyes for one year. Histologically, both cases revealed monomorphous dense lymphoid infiltrates invading the overlying conjunctival epithelium with diffuse patterns. The infiltrates were composed of small lymphocytes admixed with centrocyte-like cells within the conjunctival epithelium and stroma in association with B-cell lineage. No relapse was noted during the period of about 1½ years follow-up in case 1 treated by local excision only and in the follow-up period of 2 months in case 2 treated by local excision and subsequent chemotherapy.
Adolescent ; Adult ; B-Lymphocytes ; Conjunctiva* ; Drug Therapy ; Epithelium ; Female ; Follow-Up Studies ; Humans ; Lymphocytes ; Lymphoid Tissue* ; Lymphoma* ; Recurrence

PURPOSE: To compare the short-term effects of intravitreal versus posterior subtenon injection of triamcinolone acetonide for diabetic macular edema. METHODS: This is a prospective and interventional study. Sixty eyes of 60 patients who had diffuse diabetic macular edema were assigned to receive a single intravitreal injection (4 mg) or a single posterior subtenon injection (40 mg) of triamcinolone acetonide. The central retinal thickness was measured using optical coherent tomography before injection and at 1 and 3 months after injection. Visual acuity and intraocular pressure (IOP) were also measured. RESULTS: Both intravitreal and posterior subtenon injections of triamcinolone acetonide resulted in significant improvements in visual acuity at 1 month and 3 months after injection. Both groups resulted in a significant decrease in central macular thickness (CMT) at 1 month and 3 months post-injection. IOP in the intravitreal injection group was significantly higher than in the posterior subtenon injection group at 3 months after injection. CONCLUSIONS: The posterior subtenon injection of triamcinolone acetonide had a comparable effect to the intravitreal triamcinolone injection and showed a lower risk of elevated IOP. Posterior subtenon injection of triamcinolone acetonide may be a good alternative for the treatment of diffuse diabetic macular edema.
Vitreous Body ; Visual Acuity ; Triamcinolone Acetonide/*administration & dosage/therapeutic use ; Treatment Outcome ; Tomography, Optical Coherence ; Prospective Studies ; Orbit ; Middle Aged ; Male ; Macular Edema, Cystoid/*drug therapy/etiology/pathology ; Injections ; Humans ; Glucocorticoids/*administration & dosage/therapeutic use ; Fundus Oculi ; Follow-Up Studies ; Fluorescein Angiography ; Female ; Diabetic Retinopathy/*complications/pathology ; Aged

The purpose of this study was to evaluate the humeral tunnel characters and clinical relevance according to entry point of the humeral tunnel in the baseball players. It was hypothesized that the medial collateral ligament (MCL) reconstruction with nonanatomical starting location of the humeral tunnel (inferior edge of the medial epicondyle: group NA) provided less favorable radiological and clinical outcomes compared to that with anatomical starting location (original footprint of the MCL: group A). The retrospective case review yielded 19 consecutive athletes who underwent isolated MCL reconstruction using the docking technique. Three dimensional-computed tomography scan was performed at 3 months, and the iso-surfacing by marching cubes algorithm were applied to evaluate the length and angle of humeral tunnel. Three outcome measures were used in this study: the visual analog scale for pain, range of motion and the Conway scale. The angle of the humeral tunnel was measured 12.2° (range, 7.9°–25.2°) in the group NA and 15.5° (range, 9.8°–30.4°) in the group A (p<0.05). The mean length of humeral tunnel is measured 16.3 mm (range, 11.7–20.1 mm) in the group NA and 15.2 mm (range, 10.3–19.1 mm) in the group A (p<0.05). MCL reconstruction brought substantial improvement in pain and function. However, between-group comparison revealed no statistical differences in all outcome measurements. The MCL reconstruction using the docking technique provided favorable clinical outcomes in baseball players. Although the humeral tunnel angle and length were different depending on the humeral entry points, clinical differences between the two entry points were not found.
Athletes ; Baseball* ; Collateral Ligaments* ; Humans ; Outcome Assessment (Health Care) ; Range of Motion, Articular ; Retrospective Studies ; Visual Analog Scale

Leiomyoma is rare. Most of patients present with urinary tract infection, hematuria, dyspareunia, or complaint of mass. A case of leiomyoma on urethrovaginal septum in a 36 years old female was presented. The presenting symptom was a protruding mass at the anterior vaginal wall The mass was removed surgically and confirmed as a leiomyoma pathologically.
Adult ; Dyspareunia ; Female ; Hematuria ; Humans ; Leiomyoma* ; Urinary Tract Infections

PURPOSE: To report a case of cancer-associated retinopathy developed in a patient with small cell lung cancer, which is a kind of paraneoplastic syndrome. METHODS: A 78-year-old woman presented complaining of decreased visual acuity and visual field that had developed about 15 days previously. She was diagnosed with small cell lung cancer 1.5 years ago and underwent 3 cycles of chemotherapy. At presentation, the best-corrected visual acuity was hand motion in both eyes and there was no afferent pupillary defect. Slit-lamp biomicroscopic examination revealed no specific abnormality in the anterior segment of either eye, and intraocular pressure was normal. Posterior segment examination demonstrated remarkable arteriolar narrowing in both eyes, but there was little doubt about the presence of an optic nerve lesion such as optic disc edema or pallor. RESULTS: Fluorescein angiography and brain magnetic resonance imaging (MRI) revealed no significant abnormalities. However, electroretinograms (ERG) demonstrated marked reduction in the a and b waves. Visual evoked response was delayed for the latency period. She was treated with systemic steroid, after which her visual acuity gradually improved.
Aged ; Brain ; Drug Therapy ; Edema ; Evoked Potentials, Visual ; Female ; Fluorescein Angiography ; Hand ; Humans ; Intraocular Pressure ; Latency Period (Psychology) ; Magnetic Resonance Imaging ; Optic Nerve ; Pallor ; Paraneoplastic Syndromes ; Paraneoplastic Syndromes, Ocular* ; Pupil Disorders ; Small Cell Lung Carcinoma* ; Visual Acuity ; Visual Fields

PURPOSE: To quantitatively compare the role of posterior vitreous detachment in macular edema associated with branch retinal vein occlusion (BRVO) using OCT. METHODS: A retrospective study of 36 eyes with BRVO-associated macular edema was carried out from November 2003 to February 2005. There was posterior vitreous detachment (PVD) in 23 eyes [PVD (+) group], and vitreoretinal attachment on the fovea in 31 eyes [PVD (-) group]. PVD was detected with an indirect ophthalmoscope or 90D lens. The foveal thicknesses of the two groups were measured and compared. RESULTS: The mean foveal thicknesses of the PVD (-) and PVD (+) groups were 398.0+/-217.2 micrometer and 233.6+/-80.6 micrometer, respectively (p=0.000, Mann-Whitney test). The mean BCVA (log MAR) was 0.77+/-0.52 in the PVD (-) group and 0.40+/-0.37 in the PVD (+) group (p=0.002, Mann-Whitney test). CONCLUSIONS: The extent of macular edema associated with BRVO was significantly less in the PVD(+) group and BCVA was significantly better in the PVD (+) group as well.
Macular Edema* ; Ophthalmoscopes ; Retinal Vein Occlusion* ; Retinal Vein* ; Retinaldehyde* ; Retrospective Studies ; Vitreous Detachment*

A 26-year-old Korean man had an erythematous scaly plaque on his right thigh for fifteen years. He was diagnosed with chronic eczema and treated with topical steroid, but no clinical improvement was obtained for 15 years. Laboratory studies including complete blood cell count, urinalysis, liver and renal function test, and peripheral blood smear were normal. A biopsy specimen showed hyperkeratosis, acanthosis, and mononuclear cellular infiltration in the epidermis. These cells had a perinuclear halo and showed a Pautrier's microabscess like configuration. In the dermis, there was a band like infiltration of inflammatory cells. Infiltrates of the epidermis were negative for leukocyte common antigen(CD45) and positive for Pan T cell(CD45RO). He was treated with topical PUVA twice a week for twelve weeks. Clinical and pathological improvements were obtained. We propose PUVA may be a useful therapeutic modality to treat Woringer Kolopp disease.
Adult ; Biopsy ; Blood Cell Count ; Dermis ; Eczema ; Epidermis ; Humans ; Leukocytes ; Liver ; Pagetoid Reticulosis* ; Thigh ; Urinalysis

Ganglioneruroblastoma and neuroblastoma are among commonest types of childhood malignancy and a number of unique paraneoplastic syndromes have associated with both localized and disseminated neuroblastoma. The coincidence of neuroblastoma and myoclonic encephalopathy or other paraneoplastic syndromes occurs relatively rare, and therefore, failure to recognize this association could result in delays in both diagnosis and treatment, and the result could prove to be unfortunately fatal. The mechanism which underlies the remote damaging effect of neural crest tumor, especially neuroblastoma, on the nervous system resulting in myoclonic encephalopathy is by no means clear. In addition the nature and the extent of the pathologic lesion are inconsistent. We experienced a case of myoclonic encephalopathy associated with an occult mediastinal ganglioneuroblastoma in a 22-month-old girl who was hospitalized for inability to walk without support and tilting of the head to the left side. She became increasingly ataxic, and during the hospitalization myoclonic jerks of upper extremities and head along with chaotic, rapidly flickering, multidirectional spontaneous eye movements, were noted. Laboratory data included normal complete blood count, urinalysis, BUN and creatinine, electrolytes and bone marrow. Chest X-ray and chest CT revealed a relatively well marginated right posterior mediastinal mass. In a 24 hours urine excretion test, VMA and catecholamines were increased. Over the next 2 weeks, a surgical exploration revealed a right posterior mediastinal mass. Microscopically the mass proved to be a ganglioneuroblastoma, extending to right innominate artery and right axillary lymph nodes. Within 2 weeks after the surgery, radiotherapy (2,400 rads) and chemotherapy (CTX, DTIC, VCR) were started, but corticosteroid was not used. She has been free of tumor and abnormal neurological systemic symptoms and signs for 1 1/2 year since the completion of chemotherapy. In the 3 1/2 years follow-up period, her neurologic symptoms has completely resolved by the completion of 2 years chemotherapy. We report a case of mycoclonic encephalopathy associated with hidden ganglioneuroblastoma in 22-month-old girl.
Blood Cell Count ; Bone Marrow ; Brachiocephalic Trunk ; Catecholamines ; Creatinine ; Dacarbazine ; Diagnosis ; Drug Therapy ; Electrolytes ; Epilepsies, Myoclonic* ; Eye Movements ; Female ; Follow-Up Studies ; Ganglioneuroblastoma* ; Head ; Hospitalization ; Humans ; Infant ; Lymph Nodes ; Myoclonus ; Nervous System ; Neural Crest ; Neuroblastoma ; Neurologic Manifestations ; Paraneoplastic Syndromes* ; Radiotherapy ; Thorax ; Tomography, X-Ray Computed ; Upper Extremity ; Urinalysis

The use of artificial skins for full thickness wounds is an accepted technique, but unfortunately the take rate is low and the aesthetical result is not acceptable. The freeze-drying treatment of allogenic tissues can destroy cells with preserving the structural organization of extracellular matrices, permitting allogenic transplantation. In this study we investigated a new method to process the allogenic skin for transplantable allogenic dermis and this dermis was evaluated in a full thickness wound model. The results are as followings; 1. After treatment with NaCl and SDS solution and then with freeze-drying method, the allogenic dermis shows acellular dermal matrix with preserved normal extracellular matrix. 2. This allogenic dermis became completely incorporated into the wound without evidence of rejection or replacement by scar tissue. 3. The take rate of thin autografts overlying the allogenic dermis that were applied simultaneously was comparable to take rate of autograft alone. 4. The reduction in secondary contraction by allogenic dermis treated wounds was significant. 5. After grafting with cultured keratinocytes, the degree of epithelial coverage was 70% at 2 weeks. In conclusion, the allogenic dermis processed with our method displayed lack of antigenicity, and rapid revascularization. This allogenic dermis can permit simultaneous engraftment of an overlying STSG or cultured kerationocytes, reduce secondary contraction and improve cosmesis of full thickness wounds.
Acellular Dermis ; Autografts ; Cicatrix ; Dermis* ; Extracellular Matrix ; Keratinocytes ; Skin ; Skin, Artificial ; Transplants ; Wounds and Injuries*

BACKGROUND: Doxylamine succinate(DS) is an antihistamine commonly used as an over-the-counter medication to relieve insomnia and frequently involved in overdoses. Its overdoses are dominated by anticholinergic effect. Recently it was revealed that DS had a direct effect on muscle, while its exact mechanism is not clear yet. We evaluated the patients with rhabdomyolysis induced by DS overdose for patients disposition based upon clinical decision, especially by creatinine phosphokinase(CPK). METHODS: We reviewed retrospectively the medical records of patients admitted by DS overdose from Jan. 1998 to Oct. 1999. Seventy and nine cases of DS overdose were evaluated with respect to age and sex distribution, amount ingested, clinical symptomatology, time from ingestion to visit, pattern of CPK, amount of bicarbonate used as therapy, complication and prognosis, especially in patients complicated rhabdomyolysis. RESULTS: Rhabdomyolysis, diagnosed as more than 1,000I. U/L of CPK, has been noted in 25(31.6%) of 79 cases of DS overdose visited to our emergency department(ED). In patients diagnosed rhabdomyolysis, the number of man was 10 cases(40%) and the number aged between 20 and 40 years was 22 cases(88%). The average time from DS ingestion to ED visit was 459 minutes. The amount of DS ingested was 500-5,000mg(mean, 1,980mg). 13(52%) cases ingested less than 2,250mg of DS. The initial levels of CPK(range, 48-14900I. U/L; normal range, 26-200I. U/L) after admitting to our emergency department were normal in 15 cases(60%) of rhabdomyolysis patients. The range of peak CPK levels after ingestion was 607 to 412,500I. U/L(mean, 33,550I. U/L). Its peak time was 6 to 96 hours(mean, 28.96 hours). In 14 cases(67%) of 21 visiting within 24 hours after ingestion, peak time of CPK ranged 12 to 24 hours after ingestion. The amount of bicarbonate used as therapy of rhabdomyolysis ranged 100 to 2,740mEq(mean, 656mEq) and all patients was discharged after improvement without other complication including acute renal failure. CONCLUSIONS : Although patients ingested less than 2,250mg of DS, emergency physicians should observe them more than 24 hours after DS ingestion with CPK follow-up after gastric irrigation and charcoal administration.
Acute Kidney Injury ; Charcoal ; Creatinine ; Doxylamine* ; Eating ; Emergencies ; Emergency Service, Hospital ; Follow-Up Studies ; Gastric Lavage ; Humans ; Medical Records ; Prognosis ; Reference Values ; Retrospective Studies ; Rhabdomyolysis* ; Sex Distribution ; Sleep Initiation and Maintenance Disorders ; Succinic Acid*