Purpose: To report recurrent idiopathic choroidal neovascularization (CNV) in an adolescent.Case summary: A 14-year-old male presented with reduced vision in the right eye, 3 weeks in duration. His best-corrected visual acuity (BCVA) was 0.2. He lacked any medical or ocular history, any family history of retinal disease, and any trauma history. Autorefraction yielded a spherical equivalent of -4.75 diopters. Neither posterior staphyloma nor myopic macular degeneration was apparent in a fundus photograph. However, the photograph revealed a greyish foveal lesion with a subretinal hemorrhage, but was otherwise unremarkable. Optical coherence tomography and fluorescein angiography revealed foveal CNV with a subretinal hemorrhage and fluid. As no feature known to cause CNV was apparent, we diagnosed idiopathic CNV and prescribed right-eye intravitreal ranibizumab injections. After treatment, the BCVA became 1.0, but the CNV continued to recur; he has received 26 intravitreal ranibizumab injections over the last 47 months. Conclusions Most idiopathic CNVs in adolescents are well-treated with fewer injections. However, CNV can continue to recur; multiple intravitreal injections and careful monitoring may be required.

Purpose: The results of the Hahn Chun Suk color test (Hahn test) and the Farnsworth-Munsell D-15 test (D-15 test) were compared in patients with acute optic neuritis. Methods: Patients with acute optic neuritis evaluated using both the Hahn and D-15 tests in the acute phase and 2 months later were evaluated. The results of the acute phase tests were compared. Correlations were sought between color deficiency and all of visual acuity, the visual field index (VFI), and the severity of optic disc edema. Changes in the test results 2 months later were also evaluated and correlated with other visual functions. Results: Twenty-seven eyes of 22 patients were enrolled. The mean patient age was 49.4 years and the logarithm of the minimum angle of resolution visual acuity 0.5. In the acute phase, the perception number was 10.06 in the Hahn test. On the D-15 test, the ‘strong’ grade predominated (40.7%). The concordance rates of severity and type were 55.6 and 54.5% between the two tests. In 9 of 12 eyes exhibiting inconsistent severity, the D-15 test afforded better results than did the Hahn test. A significant positive correlation was evident between the Hahn test results and visual acuity (r = 0.560, p = 0.002). The mean deviation (MD) and the VFI also correlated with the results of the Hahn test (r = -0.432, p = 0.027 for the MD; r = -0.517, p = 0.007 for the VFI). The D-15 test results correlated only with visual acuity (r = 0.476, p = 0.012). After 2 months, the results of both tests correlated significantly only with visual acuity. Conclusions In the acute phase, the concordances of the Hahn and D-15 test results were 55.6% in terms of severity and 54.5% in terms of type. The Hahn test results correlated with the visual acuity and VFI. In contrast, the D-15 test results correlated with visual acuity only.

PURPOSE: To evaluate the effect of intravitreal aflibercept according to subfoveal choroidal thickness in patients with polypoidal choroidal vasculopathy (PCV). METHODS: We retrospectively analyzed the medical records of 60 eyes from 60 patients with PCV treated with intravitreal aflibercept. The patients were followed for at least 6 months after the first injection. Using software, subfoveal choroidal thickness was manually measured as the distance from the hyper-reflective line of Bruch's membrane to the chorioscleral interface on optical coherence tomography. The patients were divided into three groups based on subfoveal choroidal thickness. Visual acuity, subfoveal choroidal thickness, central macular thickness and largest pigment epithelial detachment (PED) height, polyp regression rate, and dry macula rate were evaluated to analyze the anatomical and functional outcomes. RESULTS: Baseline mean subfoveal choroidal thickness were 178.50 ± 28.42 µm in the thin group (14 eyes, 23.3%), 287.03 ± 43.58 µm in the medium group (33 eyes, 55.0%), and 379.77 ± 17.09 µm in the thick group (13 eyes, 21.7%). Baseline age, sex, visual acuity, central macular thickness, and the largest PED height did not differ significantly among the three subgroups. Only the thin group showed significant improvement of visual acuity at 6 months (p = 0.005). Subfoveal choroidal thickness, central macular thickness, and largest PED height were significantly decreased after treatment in all subgroups and did not differ among the subgroups. Compared with the other groups, the thin subfoveal choroidal thickness group showed higher polyp regression rate at 3 months and higher dry macula rate at 6 months (p = 0.013 and p = 0.004, respectively). CONCLUSIONS: Intravitreal aflibercept injection was effective for the treatment of PCV, and thin subfoveal choroidal thickness was associated with better anatomical and functional outcomes.
Bruch Membrane ; Choroid* ; Humans ; Medical Records ; Polyps ; Retrospective Studies ; Tomography, Optical Coherence ; Visual Acuity

PURPOSE: The tunneled hemodialysis catheter has been widely used for a temporary or an alternative permanent vascular access in patients requiring hemodialysis. The tunneled hemodialysis catheter is also widely used for a reliable vascular access in children who need stem cell transplantation. METHOD: We reviewed the results of 150 catheters inserted in 108 patients for the duration of the indwelling catheter, the complication rate and the reasons for insertion and removal. RESULT: The mean duration of the indwelling catheter was 5.7 months (1 d~52.2 mo). In the stem cell transplantation group, the mean duration of the indwelling catheter was significantly longer than for the hemodialysis group (mean: 9.9 mo vs. 3.6 mo, P<0.05). Fifty-one catheters (39.8%) were removed due to complications. The most common complications were infection (n=23: 17.9%) and dislocation (n=15: 11.7%). In the hemodialysis group, the complication-related catheter removal was more frequent than in the stem cell transplantation group (43.9% vs. 32.6%, P<0.05). CONCLUSION: The tunneled hemodialysis catheter remains a reliable short-term vascular access for hemodialysis and a good vascular access in stem cell transplantation.
Catheterization, Central Venous ; Catheters* ; Catheters, Indwelling ; Child* ; Dislocations ; Humans ; Renal Dialysis* ; Stem Cell Transplantation

A microemulsion formulation of cyclosporine (CsE) is more bioavailable than conventional cyclosporine (CsA) in renal transplants. Because the risk of acute and chronic rejection is related inversely to cyclosporine bioavalability and cyclosporine has a low therapeutic window, these benefits of CsE with an improved pharmacokinetic profile on clinical efficacy are also of interest. To assess the long-term safety and tolerability of CsE, this comparable study was performed. One hundred thirty one primary living donor renal recipients were included in this study. They were divided two groups in the CsE group (N=50) and CsA group (N=81) who had been received either CsE or CsA as a main immunosuppressant since their transplantation for two years. There were no differences between two groups in initial dose at that time of transplantation, target trough level, strategies of anti-rejection therapy. Acute rejections occurred less frequently in CsE group than CsA group (9/50 vs. 28/81, p=0.041). No significant differences were noted in incidence of chronic rejection, graft loss, drug-associated com plications such as hypertension, diabetes mellitus, infection and survival rates of grafts and patients. Renal function, as measured by serum creatinine levels was comparable over time in both groups. The mean daily doses of CsE were higher than CsA group since post-transplant six months, but, no significant differences in trough levels between the two grups. There were marked decreases in standard deviation of daily doses and trough level those meant inter-individual variations in CsE group compared to those of CsA group. In conclusion, despite the more predictable and stabilized pharmacokinetic benefits in CsE group, no significant increases in the incidence of drug-associated adverse effects were observed within post-transplant two years. The safety, tolerability, efficacy of CsE and CsA were comparable.
Allografts* ; Creatinine ; Cyclosporine* ; Diabetes Mellitus ; Graft Rejection ; Humans ; Hypertension ; Immunosuppression ; Incidence ; Kidney Transplantation ; Living Donors ; Survival Rate ; Transplants

PURPOSE: In the passive Heymann nephritis (PHN) rat model of membranous nephropathy, complement induces glomerular epithelial cell injury and proteinuria, which is partially mediated by reactive oxygen species (ROS), TGF-beta, and COX-2. In the current study, we determined the effect of a selective COX-2 inhibitor (celecoxib) and vitamin C on the enzyme system associated with ROS, TGF-beta, and COX-2 in PHN. METHODS: Four groups of rats with PHN were dosed with polyethylene glycol vehicle (P; n=4), celecoxib (COXi; n=8), vitamin C (VC; n=8), or celecoxib and vitamin C (COXi+VC; n=8) from days 7-21. Each group was then divided into 2 subgroups reflecting the day of the experiment (day-14 and -21 subgroups). RESULTS: The urine protein was significantly reduced in the VC and COXi+VC groups (subgroup day- 14) compared to the P group (p<0.05). The glomerular TGF-beta expression was reduced in the COXi+ VC group (subgroup day-21) compared to the P group (p<0.05). Glomerular COX-2 expression was increased in the COXi, VC, and COXi+VC groups compared to the P group (p<0.05). The COXi, VC, and COXi+VC groups (subgroup day-21) had decreased activity of lipid peroxide and xanthine oxidase and increased activity of xanthine dehydrogenase, superoxide dismutase, GSH-Px, and catalase. This antioxidant activity was highest in the COXi+VC group (p<0.05). CONCLUSION: Selective COX-2 inhibitors possess antioxidant effects. The combination of a COX-2 inhibitor and vitamin C was more effective than COX-2 inhibitor or vitamin C alone in increasing antioxidant activity and decreasing TGF-beta.
Animals ; Antioxidants ; Ascorbic Acid ; Catalase ; Complement System Proteins ; Cyclooxygenase 2 ; Cyclooxygenase 2 Inhibitors ; Epithelial Cells ; Glomerulonephritis, Membranous ; Polyethylene Glycols ; Proteinuria ; Pyrazoles ; Rats ; Reactive Oxygen Species ; Sulfonamides ; Superoxide Dismutase ; Transforming Growth Factor beta ; Vitamins ; Xanthine Dehydrogenase ; Xanthine Oxidase

Benzbromarone is a uricosuric agent for hyperuricemia and gout. Some of its well-known side effects include hypersensitivity, renal calculi, and gastrointestinal problems. Although the drug was withdrawn from U.S. market due to severe hepatotoxicity, it is still available in some countries including Korea. We describe a 19-year-old male who was admitted with general weakness and azotemia after use of benzbromarone. A kidney biopsy revealed acute tubular necrosis without an evidence of urate nephropathy. After discontinuation of benzbromarone, the renal function returned to baseline. This is the first case of acute tubular necrosis associated with benzbromarone use.
Azotemia ; Benzbromarone ; Biopsy ; Gout ; Humans ; Hypersensitivity ; Hyperuricemia ; Kidney ; Kidney Calculi ; Korea ; Male ; Necrosis ; Transplants ; Uric Acid ; Young Adult

Background: This clinical trial was conducted to determine whether combined use of magnesium sulfate and vitamin C more significantly reduced postoperative fentanyl consumption and pain than magnesium sulfate or vitamin C alone. Methods: The prospective, double-blinded, randomized controlled study enrolled 132 patients scheduled for laparoscopic gynecologic surgery. The patients were randomly allocated to one of the four groups (n = 33 for each group; Group M [magnesium sulfate 40 mg/kg], Group V [vitamin C 50 mg/kg], Group MV [magnesium sulfate 40 mg/kg and vitamin C 50 mg/kg] and Group C [isotonic saline 40 ml]). Cumulative postoperative fentanyl consumption (primary endpoint measure), postoperative pain score by numeric rating scale, and postoperative nausea and vomiting were recorded at 1, 6, 24, and 48 h after discharge from the postanesthesia care unit. Results: Cumulative postoperative fentanyl consumption was significantly less in Groups M, V, and MV than in Group C at all time points. Group MV showed significantly less cumulative postoperative fentanyl consumption than Group M at postoperative 24 h (mean ± standard deviation, 156.6 ± 67.5 vs. 235.6 ± 94.6 μg, P = 0.001), as well as significantly less consumption than Groups M and V at postoperative 48 h (190.8 ± 74.6 vs. 301.0 ± 114.8 or 284.1 ± 128.6 μg, P < 0.001, P = 0.003, respectively). Conclusions Combined use of magnesium sulfate and vitamin C provides an additional benefit in postoperative pain management after laparoscopic gynecologic surgery in comparison to single administration of magnesium sulfate or vitamin C.

Adding to the previous reports about the infectious complications in renal transplant recipients in azathioprine era, we conducted this retrospective study to analyse the incidence and pattern of posttransplant infections in cyclosporin era and its impact on graft and patient survival. Among 482 patients who performed renal transplantation (tpl) from Mar. 1985 to Dec. 1997 at Seoul National University Hospital, 133 infections developed in 105 patients (21.8% incidence). These infections were grouped into 3 categories; Perioperative (infection within first month after tpl: N=19), Early (infection between 1 to 6 months after tpl: N=24), and Late (infection more than 6 months after tpl: N=87). According to the anatomical site of infection, skin (49 cases) was the most common site of infection, followed by lung (36), oropharynx (13), urinary tract (12). Regarding the etiologic organisms of microbiologically documented 108 infections, viral infections were most common (60.2%), followed by bacterial (22.2%), fungal (14.8%), and others (2.8%). In viral infections, Varicella zoster virus infection was most common (58%). Bacterial infections included 12 Mycobacteral infections, 10 Gram (-), and 2 Gram (+) bacterial infections. In fungal infections, tinea was most common in 8 cases, followed by candidiasis in 3, cryptococcosis in 2, and aspergillosis in 1. Incidence of rejection episode was statistically higher in patients with infection than those without infection (40.0% vs 28.4%; p=0.023). Among 28 mortalities, infection-related deaths were 7. In conclusion, aggressive diagnostic strategies including invasive procedures to characterize the organisms and specific treatment is the best way to reduce the morbidity and mortality.
Aspergillosis ; Azathioprine ; Bacterial Infections ; Candidiasis ; Cryptococcosis ; Cyclosporine* ; Herpesvirus 3, Human ; Humans ; Incidence ; Kidney Transplantation* ; Lung ; Mortality ; Opportunistic Infections ; Oropharynx ; Retrospective Studies ; Seoul ; Skin ; Tinea ; Transplantation ; Transplants ; Urinary Tract

Localized tenosynovial giant cell tumor (TGCT) usually occurs in the hand and foot regions. However, localized TGCT with extensive cartilaginous metaplasia is rare, especially in the tendon sheath of the toe. Here, we report a case of localized TGCT with cartilaginous metaplasia in a 57-year-old man. The tumor presented as a lobular mass measuring 2.2 cm in its greatest dimension and arose in the flexor digitorum tendon sheath of the right 2nd toe. Clinically, the mass was palpable 1 year ago and brought pain during walking. Microscopically, the mass was composed of focal conventional TGCT and cartilaginous components. The conventional TGCT areas consisted of mononuclear cells, multinucleated giant cells, and hemosiderin deposition. The chondroid areas were extensive and comprised more than 90% of the whole tumor. In this case, the mononuclear cells in the conventional TGCT areas showed focal immunohistochemical staining for podoplanin and S100 protein as well as diffuse staining for CD68, which is consistent with the staining pattern of conventional TGCT. The mononuclear cells in the chondroid areas were focal positive for podoplanin and diffuse positive for S100 protein. Chondroid metaplasia in diffuse TGCT has been reported in 10 cases involving the temporomandibular, elbow, and hip joints. However, there has been no report of a localized form of chondroid TGCT involving an extra-articular region.
Elbow ; Foot ; Giant Cell Tumors* ; Giant Cells ; Hand ; Hemosiderin ; Hip Joint ; Humans ; Metaplasia ; Middle Aged ; Staphylococcal Protein A ; Tendons ; Toes* ; Walking