The case reported here, concerns a spontaneous low-flow fistula between the carotid arterial network and the cavernous sinus, with ophthalmological symptoms such as conjunctival congestion and diplopia in a 41-year-old woman. The patient has suffered from diabetes without trauma history. Patient's ocular symptoms and signs were only present in the left eye with best-corrected visual acuity 0.04 at the time of presentation. Other ophthalmic findings were exophthalmos, elevated intraocular pressure, and visual field defects. Enlarged extraocular muscles and proptosis were found on orbital computed tomography leading to the misdiagnosis of orbial pseudotumor or thyroid rbitopathy. Carotid angiography showed dural carotid-cavernous sinus fistula, which involved left-side internal and external carotid arterial network and right-side internal carotid arterial network. Orbital color Doppler imaging showed a flow reversal with a systolic component in the enlarged superior ophthalmic vein. We were able to diagnose dural carotid-cavernous sinus fistula. Dural carotid-cavernous sinus fistula was closed successfully by embolization via the vein without omplication. The visual acuity, proptosis, and dilated and tortuous vessels of the conjunctiva improved.
Adult ; Angiography ; Carotid-Cavernous Sinus Fistula ; Cavernous Sinus ; Conjunctiva ; Diagnostic Errors ; Diplopia ; Estrogens, Conjugated (USP) ; Exophthalmos ; Female ; Fistula* ; Humans ; Intraocular Pressure ; Muscles ; Orbit ; Thyroid Gland ; Veins ; Visual Acuity ; Visual Fields

Perfluorocarbon liquids have been shown to be a useful intraoperative adjunct in managing complicated retinal detachment. To prove the effectiveness of intraoperative use of perfluorocarbon liquid and the improvement of surgical and functional outcomes, we retrospcetively evaluated the clinical results of the patients[13 eyes]who had retinal detachment complicated with proliferative vitreoretinopathy [over PVR Grade C4, C4 :7 eyes, C5 :6 eyes]. We performed standard 3-port pars plana vitrectomy in all eyes included in this study.Perfluorodecalin[DK-line]was used as a shortterm vitreous substitute intraoperatively and removed before the end of the surgery. The mean follow-up period was 15 months.Anatomical success rate was 86%[6 eyes]in Grade C4, 67%[4 eyes]in Grade C5, Visual acuity was over 5/200 in one eye[8%]and there was improvement in 5 eyes[40%] although it was below 5/200. Consequently, we could easily manage the retinal detachment with PVR with help of intraoperative perfluorocarbon liquid and could improve the postoperative surgical and visual outcomes.
Follow-Up Studies ; Retinal Detachment ; Visual Acuity ; Vitrectomy ; Vitreoretinopathy, Proliferative*

The purpose of the study is to describe the cases with prepapillary or peripapillary vascular malformation who have experienced mild vitreous hemorrhage. Five patients [5 eyes], 1 male and 4 females, were included in the study.The vascular malformation was unilaterally present in all patients.Vitreous hemorrhage occurred from the area of retinal vascular malformation near or on the optic nerve, and cleared without further complications. Fluorescein angiographic feature of each eye was normal. Arteriovenous communication, secondary retinal exudation, or vascular leakage from vascular malformation was not observed. Each patient showed improvement in visual acuity of 2 lines or more. This benign, congenital vascular malformation may be non-progressive and infrequently cause mild vitreous hemorrhage.Therapeutic intervention was not necessary in these cases.
Female ; Fluorescein ; Hemorrhage ; Humans ; Male ; Optic Nerve ; Retinaldehyde ; Vascular Malformations* ; Visual Acuity ; Vitreous Hemorrhage

No abstract available.
Fractures, Open*

Churg-Strauss syndrome is a rare primary vasculitis called allergic granulomatosis angiitis. There is a substantial overlap of symptoms or signs between different vasculitides, so that a diagnosis of any vasculitis can be determined by a combination of clinical symptoms and laboratory tests. We report a case of a 54-year-old woman who had bronchial asthma, eosinophilia, peripheral polyneuropathy, pulmonary infiltrate, maxillary sinusitis, and extravascular eosinophilic infiltration on skin biopsy. So she was diagnosed as having Churg-Strauss syndrome, but she was antineutrophil cytoplasmic antibodies-negative on immunologic study. She had fever and showed cardiac involvement that was presented as cardiomegaly and pulmonary edema at chest radiography and left ventricular hypertrophy on electrocardiography. After steroid therapy, general condition and skin manifestation were rapidly improved.
Antibodies, Antineutrophil Cytoplasmic ; Asthma ; Biopsy ; Cardiomegaly ; Churg-Strauss Syndrome ; Cytoplasm ; Electrocardiography ; Eosinophilia ; Eosinophils ; Female ; Fever ; Humans ; Hypertrophy, Left Ventricular ; Maxillary Sinus ; Maxillary Sinusitis ; Middle Aged ; Polyneuropathies ; Pulmonary Edema ; Skin ; Skin Manifestations ; Thorax ; Vasculitis

PURPOSE: To evaluate the clinical features of high myopic eyes with cataracts implanted with negative power intraocular lenses (IOLs) at the time of cataract surgery. METHODS: A retrospective chart review was conducted of 18 eyes of 14 patients who underwent cataract surgery with negative power IOLs and 10 eyes in 9 patients with low power IOLs. We investigated axial length, IOL power, preoperative and postoperative best-corrected visual acuity (BCVA) and preoperative and postoperative spherical equivalent (SE) refractive errors. RESULTS: Mean BCVA showed significant improvement in both groups. We measured postoperative SE refraction and the difference between the mean intended and the mean achieved SE refractive errors in the negative power group (17 eyes) was +1.59 ± 1.34 D and +0.31 ± 0.50 D in the low power group. CONCLUSIONS: BCVA was significantly improved in the majority of eyes, although they had myopic macular degeneration or posterior staphyloma. However, the mean achieved postoperative SE refraction was more hyperopic than the predicted postoperative SE error. Additionally, hyperopic refractive error was greater in the negative power group than the low power group. Therefore, we recommend that postoperative hyperopic refractive error should be considered when performing cataract surgery in high myopic patients.
Cataract Extraction* ; Cataract* ; Humans ; Lens Implantation, Intraocular* ; Lenses, Intraocular* ; Macular Degeneration ; Myopia* ; Refractive Errors ; Retrospective Studies ; Visual Acuity

Signet ring cell carcinoma has been previously described in many organs, most frequently in the stomach, and rarely in the colon, rectum, gallbladder, pancreas, breast, nadsal cavity, prostate, urinary bladder and ureter. Signet ring cell carcinomas in the lung, especially, when examined by small biopsies, are generally believed to be metastatic. This case was diagnosed by bronchoscopic biopsy. We also examined various organs by noninvasive method, including UGI series, barium enema and abdomen CT scarf, but all studies were nomal. Patient received cisplatin and etoposide combination chemotherapy followed by local radiotherapy ai a primary non-small cell lung cancer. Patient died of his disease 6 months after diagnosis. Now we report a case of primary signet ring cell carcinoma of the lung.
Abdomen ; Barium ; Biopsy ; Breast ; Carcinoma, Non-Small-Cell Lung ; Carcinoma, Signet Ring Cell* ; Cisplatin ; Colon ; Diagnosis ; Drug Therapy, Combination ; Enema ; Etoposide ; Gallbladder ; Humans ; Lung Neoplasms ; Lung* ; Pancreas ; Prostate ; Radiotherapy ; Rectum ; Stomach ; Ureter ; Urinary Bladder

BACKGROUND: In 1987, the British Thoracic Society (BTS) subjected an extensive list of patient variables to statistical analysis in a prospective study of prognosis in 453 adults with communityacquired pneumonia and, subsequently published guidelines for management of severe community acquired pneumonia. It was hoped that those at risk of dying from community acquired pneumonia could be easily identified and treated appropriately, thereby reducing mortality. To date, severe community acquired pneumonia has not been well studied in Korea. Therefore, we studied retrospectively 10 patients dying of severe community acquired pneumonia in Dongsan Hospital to see clinical manifestations of .dying of severe community-acquired pneumonia. METHODS: Between July 1987 and july 1993, 498 patients were admitted to Keimyung University Dongsan Hospital with community acquired pneumonia, and 77 of them received intensive care. Of the 77 patients, 10 patients died. We reviewed medical records of these patients. RESULTS: 1) The mean age of the patients was 56.2 years(range, 25 to 75 years). There were 7 men and 3 women. Seven patients(70%) were older than 60years of age. 2) The clinical features on admission were as follows: tachypnea, hypoxemia, mental change, cyanosis, leukopenia, leukocytosis, azotemia, hypotension, hypoalbuminemia in order of frequency. Three patients had one abnormal physical finding, 3 patients had 2, 2 patients had 3, and 2 patients had none of these abnormal physical findings. All patients had at least one of the abnormal laboratory findings. 3) A potential bacterial pathogen was isolated in sputum culture from 2 patients. One was E.coli, the other Enterobacter species. Sputum stain were positive in eight cases (G(+)cocci in six, G(+)cocci and G(-)bacilli in two). 4) Features of respiratory failure were the main reasons for ICU transfer, but two patients were transferred only following a cardiac or respiratory arrest in the general ward. 5) The mean of 2.7 different antibiotics were given to the patients. The aminoglycoside and first generation cephalosporin were the most frequently prescribed antibiotics, followed by the third generation cephalosporin and vancomycin. The most frequently prescribed antibiotics combination was a 1st generation cephalosporin plus an aminoglycoside. 6) Save patients death(70%) occured after admission within the first five days, and a mean duration of hospitalization was 11.2 days. CONCLUSION: As the results show most death occured within the first days after admission and aged patients; consequently, an aggressive intensive treatment should be provided early to the patients with severe community acquired pneumonia, and we should pay more attention to the aged patients.
Adult ; Anoxia ; Anti-Bacterial Agents ; Azotemia ; Cyanosis ; Enterobacter ; Female ; Hope ; Hospitalization ; Humans ; Hypoalbuminemia ; Hypotension ; Critical Care ; Korea ; Leukocytosis ; Leukopenia ; Male ; Medical Records ; Mortality ; Patients' Rooms ; Pneumonia* ; Prognosis ; Prospective Studies ; Respiratory Insufficiency ; Retrospective Studies ; Sputum ; Tachypnea ; Vancomycin

BACKGROUND: To decide the optimal antibiotics and application of chest tube, examination of pleural fluid is fundamental in the management of empyema. Some criteria for drainage of pleural fluid have been recommended but some controversies have been suggested. Recently, newer radiologic methods including ultrasound and computed tomography scanning, have been applied to the diagnosis and management of pleural effusions. We undertook a retrospective analysis of 30 patients with pleural effusion who had CT scans of the chest in order to apply the criteria of Light et at retrospectively to patients with loculation and to correlate the radiologic appearance of pleural effusions with pleural fluid chemistry. METHOD: We analyzed the records of 30 out of 147 patients with pleural effusion undergoing chest CT scans. RESULTS: 1) Six of the pleural fluid cultures yielded gram negative organisms and three anaerobic bacterias and one Staphylococcus aureus and one non-hemolytic Streptococci. No organism was cultured in nineteen cases(63.0%). 2) The reasons for taking chest CT scans were to rule out malignancy or parenchymal lung disease(46.7%), Poor response to antibiotics(40.0%), hard to aspirate pleural fluid(10.0%) and to decide the site for chest tube insertion(3.3%). 3) There was no significant correlations between ATS stages and loculation but there was a tendency to Inoculate in stage III. 4) There was a significant inverse relationship between the level of pH and loculation(P<0.05) but there appeared to be no relationship between pleural fluid, LDH, glucose, protein, loculation and pleural thickening. 5) In 12 out of 30, therapeutic measures were changed according to the chest CT scan findings. CONCLUSION: We were unable to identify any correlations between the plerual fluid chemistry, ATS stages and loculations except pH, and we suggest that tube thoracotomy should be individualized according to the clinical judgement arid serial observation. All patients with empyema do not need a chest CT scan but a CT scan can provide determination of loculation, guiding and assessing therapy which should decrease morbidity and hospital stay.
Anti-Bacterial Agents ; Bacteria, Anaerobic ; Chemistry ; Chest Tubes ; Diagnosis ; Drainage ; Empyema* ; Glucose ; Humans ; Hydrogen-Ion Concentration ; Length of Stay ; Lung ; Pleural Effusion ; Retrospective Studies ; Staphylococcus aureus ; Thoracotomy ; Thorax* ; Tomography, X-Ray Computed* ; Ultrasonography

Since coronary arteriovenous fistula(CAVF) was first reported by Krause in 1865, more than 400 cases have been reported. It is relatively rare disease and originates more commonly in the right than in the left coronary artery. We report a case of CAVF between right coronary artery and right ventricular inflow tract with significant left to right shunt in a 34-year old female who was admitted for the cardiomegaly on routine chest X-Ray. It was detected by transthoracic and transesophageal echocardiography, and confirmed by cardiac catheterization and coronary angiography. The opening of the fistula draining into the right ventricle was obliterated with sutures. There was no significant shunt in postoperative cardiac catheterization and coronary angiography.
Adult ; Arteriovenous Fistula* ; Cardiac Catheterization ; Cardiac Catheters ; Cardiomegaly ; Coronary Angiography ; Coronary Vessels ; Echocardiography ; Echocardiography, Transesophageal* ; Female ; Fistula ; Heart Ventricles ; Humans ; Rare Diseases ; Sutures ; Thorax