A 54-year-old male patient was seen in clinic for ocular pain and decreased vision in the right eye with duration of two days. He underwent a cataract operation for his right eye 12 years ago, then a sclera-fixated secondary intraocular implantation and pars plana vitrectomy three years ago due to intraocular lens dislocation. At the initial visit, his visual acuity was restricted to the perception of hand motion. An edematous cornea, cells, flare with hypopyon, and exposed suture material at were observed at the six o'clock direction by slit lamp. Vitreous opacity was noted from B-scan ultrasonography. The patient was diagnosed with late-onset endophthalmitis and an intravitreal cocktail injection was done. On the next day, the hypopyon was aggravated, and therefore a pars plana vitrectomy was performed. A vitreous culture tested positive for Citrobacter koseri. After 12 weeks, the best corrected visual acuity of the right eye improved to 0.7 and a fundus examination revealed a relatively normal optic disc and retinal vasculature. We herein report the first case of endophthalmitis caused by Citrobacter koseri in Korea. Exposed suture material was suspected as the source of infection in this case and prompt surgical intervention resulted in a relatively good visual outcome.
Anti-Bacterial Agents/administration & dosage ; Cataract Extraction/adverse effects ; Citrobacter koseri/*isolation & purification ; Diagnosis, Differential ; Endophthalmitis/diagnosis/*microbiology/therapy ; Enterobacteriaceae Infections/diagnosis/*microbiology/therapy ; Eye Infections, Bacterial/diagnosis/*microbiology/therapy ; Follow-Up Studies ; Humans ; Intravitreal Injections ; Lens Implantation, Intraocular/*adverse effects ; Male ; Microscopy, Acoustic ; Middle Aged ; Surgical Wound Infection/diagnosis/*microbiology/therapy ; Sutures/adverse effects/microbiology ; Visual Acuity ; Vitrectomy ; Vitreous Body/*microbiology

Pulmonary carcinosarcoma(Sarcomatoid carcinoma of the lung) is a rare pulmonary malignancy, which is defined as having an admixtture of both carcinomatous and sarcomatous components. Pulmonary carcinosarcoma occurs most frequentlly in males between 50 and 80 years of age. It predominantly affects the upper lobe and/or the principal bronchi, and is associated with a history of smoking. Here, we report a case of pulmonary carcinosarcoma with a left lobe atelectasis due to an endobronchial mass in a 56-year-old male. After a left pneumonectomy, the pathologic stage was IIb (T3N0M0). Four months later, an abdominal mass was observed and exploratory laparotomy revealed metastases of the pulmonary carcinosarcoma to the pelvic cavity.
Bronchi ; Carcinosarcoma* ; Humans ; Laparotomy ; Male ; Middle Aged ; Neoplasm Metastasis ; Pneumonectomy* ; Pulmonary Atelectasis ; Smoke ; Smoking

Digital subtraction angiography(DSA) was made in 72 patients at department of radiology, Seoul National University hospital from February 1982 to January 1983 with our system, SRM-II, developed by cooperation of department of medical engineering, Seoul National University Hospital. The results were as follows; 1. In the total 72 cases, vascular disease was 28 cases in which aortic disease including Takayasu's aortitis was 18 cases. Others were vascular tumors in 32 cases and various conditions such as renal donor and artificial arteriovenous shunt. 2. Extent of the lesion was well delineated especially in aortic disease in cluding 8 cases of Takayasu's aortitis, 6 cases of aortic aneurysm and 2 cases of Behcet's syndrome. 3. DSA can be done to outpatient without admission because of its simplicity and non-invasiveness. DSA is useful especially in the evaluation and follow-up of vascular disease and the diagnostic value is expected to grow continuously according to the renewal of system.
Angiography, Digital Subtraction* ; Aortic Aneurysm ; Aortic Diseases ; Aortitis ; Behcet Syndrome ; Follow-Up Studies ; Humans ; Outpatients ; Seoul ; Tissue Donors ; Vascular Diseases

Recently, technical developments in digital electronics and imge intensifier have improved the electronicrecording and processing of images. Both departments of radiology and of medical engineering of Seoul National Univeristy Hospital jointly developed idgital subtraction angiography system(SRM-I) and performed DSA in patients. The system was composed of angiography equipments, computer, video image storage and logarithmic amplifier. Fluoroscopic images were taken before and after 40-60 ml of contrast media were intravenously injected with speedfo 12-15 ml/sec. The images were recorded by V.T.R. with normal speed. The recorded images were processed with digitization, amplification, sutraction, enhancement, position manipulation and image smoothing. Arteriography of neck vessels, abdominal aorta and its branches and extremities were performed successfully by above mentioned methods in 20 cases and results were reviewed.
Angiography ; Angiography, Digital Subtraction ; Aorta, Abdominal ; Contrast Media ; Extremities ; Humans ; Neck ; Seoul

A 5-year-old girl was diagnosed with neurofibromatosis type 2 (NF-2) due to multiple neurofibromas, cafe-au-lait spots, and schwannomas of the brain. During ophthalmologic evaluation, a posterior subcapsular cataract and a gray-green colored subretinal lesion were found in right eye. Fluorescein angiography (FA) revealed a combined hamartoma of the retina and retinal pigment epithelium (CHRRPE). At age 9, she underwent cataract surgery. At this time FA and spectral-domain optical coherence tomography (SD-OCT) were taken. The SD-OCT showed an elevated hyperreflective mass in the retina with prominent attenuation of the inner and outer retina, but minimal attenuation in the photoreceptor layers. The underlying retina appeared to be disorganized and thick (791 microm). This is the first case report of SD-OCT imaging of a CHRRPE associated with NF-2 in a pediatric patient. By using SD-OCT in this patient, we could obtain detailed tumor characteristics, and SD-OCT may be helpful in the diagnosis and management of CHRRPE.
Child, Preschool ; Diagnosis, Differential ; Female ; Hamartoma/complications/*diagnosis ; Humans ; Neurofibromatosis 2/*complications/diagnosis ; Retinal Diseases/complications/*diagnosis ; Retinal Pigment Epithelium/*pathology ; Tomography, Optical Coherence/*methods ; Visual Acuity

BACKGROUND: Tracheal intubation is accompanied by varing degrees of sympathetic stimulation as reflected by increases in heart rate, and blood pressure and several clinical trials to reduce the effects on blood pressure and heart rate by pharmacologic agents such as and blockers, calcicum channel blockers, narcotics and lidocaine, have been reported. METHODS: To evaluate the effect of fentanyl, lidocaine, esmolol on the hemodynamic changes induced by intubation, we administered thiopental 5 mg/kg only (group 1, n=12), fentanyl 2 g/kg with thiopental 5 mg/kg (group 2, n=12), lidocaine 1 mg/kg with thiopental 5 mg/kg group 3, n=12) or esmolol 0.5 mg/kg with thiopental 5 mg/kg (group 4, n=12) for induction of anesthesia, and measured heart rate, systolic blood pressure, diastolic blood pressure, mean arteiral pressure, and rate-pressure products (RPP) before induction, after induction, after intubation and at 1, 2, 3, and 5 minutes after intubation. RESULTS: There was a significant increase in heart rate, systolic blood pressure and RPP after intubation and 1 min after intubation in all groups, but in group 2, group 3 and group 4, the cardiovascular responses were more attenuated compared to group 1. CONCLUSION: The preintubation intravenous injection of fentanyl, lidocaine and esmolol may offer important roles in the hemodynamically unstable patients because it attenuate cardiovascular responses with intubation.
Anesthesia ; Blood Pressure ; Fentanyl* ; Heart Rate ; Hemodynamics* ; Humans ; Injections, Intravenous ; Intubation ; Lidocaine* ; Narcotics ; Thiopental

A 60-year-old male was referred to the ophthalmologic clinic with aggravated anterior uveitis and corneal edema despite the use of topical and systemic steroids. He had undergone cataract surgery in both eyes 15 years previous. Slit lamp examinations revealed a retained lens fragment in the inferior angle of the anterior chamber, with severe corneal edema and mild anterior uveitis. The corneal edema and uveitis subsided following surgical extraction of the lens fragment. That a retained lens fragment caused symptomatic anterior uveitis with corneal edema 15 years after an uneventful cataract surgery is unique. A retained lens fragment should be considered as one of the causes of anterior uveitis in a pseudophakic patient.
Cataract Extraction/*adverse effects ; Corneal Edema/*etiology/*pathology ; Humans ; Lens, Crystalline/*pathology/surgery ; Male ; Middle Aged ; Postoperative Complications/pathology/surgery ; Pseudophakia/pathology ; Reoperation ; Severity of Illness Index ; Uveitis, Anterior/*etiology/*pathology

PURPOSE: To evaluate the availability of ultra-wide-field fundus photography compared to fundus examination after pupil dilatation in Korean patients with retinal break. METHODS: For this retrospective case review of consecutive 160 patients, 230 lesions with retinal breaks were recruited. The ultra-wide-field images were taken after fundus examination with pupil dilatation performed by a retinal specialist. We analyzed ultra-wide-field images according to patient characteristics and separated area. We divided lesions into anterior and posterior areas, and each area was separated into 4 quadrants (superior, inferior, temporal, and nasal). RESULTS: The sensitivity of ultra-wide-field imaging for detecting retinal break was 72% (95% confidence interval [CI] 65-79%), and the specificity was 94% (95% CI 90-98%). The sensitivity of detection of posterior retina was 89% (95% CI 85-93%), and that of anterior retina was 72% (95% CI 66-78%); this difference was significant (p = 0.007). There was a significant statistical difference at the inferior quadrant between anterior and posterior retina, but not at superior, temporal, or nasal quadrants. The sensitivity of detection in the inferior quadrant in the anterior retina was 43% (95% CI 29-57%). CONCLUSIONS: Ultra-wide-field fundus photography can detect retinal break, but there is limitation in anterior retinal lesions, especially the inferior area. Therefore, ultra-wide-field fundus photography cannot be an alternative method instead of fundus examination with pupil dilatation.
Dilatation ; Humans ; Methods ; Photography ; Pupil ; Retina ; Retinal Perforations* ; Retinaldehyde* ; Retrospective Studies ; Sensitivity and Specificity ; Specialization

OBJECTIVE: Biomarkers of attention deficit hyperactivity disorder (ADHD) are crucial for early diagnosis and intervention, in which the identification of biomarkers in other areas of the body that represent the immature brain of children with ADHD is necessary. The present study aimed to find biomarkers of ADHD in the retina and assessed the relationship between macular thickness of the retina and cortical thickness of the brain in children with ADHD. METHODS: Twelve children with ADHD and 13 control children were recruited for the study. To find ocular markers of ADHD, we investigated the correlation between clinical symptoms of ADHD assessed with the Korean ADHD Rating Scale (K-ARS), cortical thickness of the brain, and macular thickness measured with the mean thickness from the Early Treatment Diabetic Retinopathy Study (ETDRS). RESULTS: Children with ADHD showed increased macular thicknesses quantified as an ETDRS ring in both eyes, compared to control subjects. Moreover, the right inner ETDRS ring had a positive correlation with K-ARS scores. The ADHD group had an increased ratio of thickness of the right frontal lobe to that of the parietal cortex, compared with the control group. There were positive correlations between the means of the inner ETDRS ring (right) and the left paracentral/right isthmus cingulate thicknesses in the control group. However, there were negative correlations between the means of the inner ETDRS ring (right) and the left frontal pole/right pars triangularis thicknesses in the ADHD group. The results of both groups were at the uncorrected level. CONCLUSION: The different patterns of macular thickness might represent the immature cortical thickness of the brain in children with ADHD.
Attention Deficit Disorder with Hyperactivity ; Biomarkers ; Brain ; Broca Area ; Child ; Diabetic Retinopathy ; Diagnosis ; Early Diagnosis ; Frontal Lobe ; Humans ; Magnetic Resonance Imaging ; Parietal Lobe ; Pilot Projects ; Retina

Though intravenous digital subtraction angiography (IV DSA) has several advantages over conventionalangiography in diagnosis and follow up of various vascular disease, it also has several undesirable problems suchas large volume of the contrast medium and inferior image quality compared to conventional angiography. Sorecently intraarterial digital subtraction angiography (IA DSA) was introduced for better image quality usingsmall amount of contrast medium. The authours had good clinical results IA DSA which were made in 20 patients withour own system, SRM-II, developed by cooperation of Departements of Radiology and Medical engineering, Seoul.National University Hospital. Intraarterial digital substraction angiography was found to have several advantagesover conventional angiography: (a) small amount of contrast medium, (b) reduced need for selective arterialcatheterization,(c) lower film cost, (d) shortened examination time, (e) ability to obtain a “road map”, and (f)easier detection of contrast medium. Also IA DSA has several advantages over IV DSA : (a) less dependency oncardiac output, (b) far less vessel overlapping, (c) reduction in patient motion through less painful procedure byreduced volume of contrast media and shorter imaging time.
Angiography ; Angiography, Digital Subtraction ; Contrast Media ; Diagnosis ; Follow-Up Studies ; Humans ; Vascular Diseases