PURPOSE: To introduce a new convenient and accurate method to measure the angle kappa using ultrasound biomicroscopy (UBM) and corneal topography. METHODS: Data from 42 eyes (13 males and 29 females) were analyzed in this study. The angle kappa was measured using Orbscan II and calculated with UBM and corneal topography. The angle kappa of the dominant eye was compared with measurements by Orbscan II. RESULTS: The mean patient age was 36.4 ± 13.8 years. The average angle kappa measured by Orbscan II was 3.98°± 1.12°, while the average angle kappa calculated with UBM and corneal topography was 3.19°± 1.15°. The difference in angle kappa measured by the two methods was statistically significant (p < 0.001). The two methods showed good reliability (intraclass correlation coefficient, 0.671; p < 0.001). Bland-Altman plots were used to demonstrate the agreement between the two methods. CONCLUSIONS: We designed a new method using UBM and corneal topography to calculate the angle kappa. This method is convenient to use and allows for measurement of the angle kappa without an expensive device.
Corneal Topography* ; Humans ; Male ; Methods ; Microscopy, Acoustic* ; Ultrasonography*

PURPOSE: To report a case of migraine attacks with aura that occurred after percutaneous closure of an atrial septal defect (ASD) with the Amplatzer septal occluder device. CASE SUMMARY: A 58-year-old female presented with glare and scintillation that lasted 3 days. She had a history of percutaneous ASD intervention 3 weeks prior. Because ophthalmologic examination revealed nothing remarkable, the patient underwent observation. However, two months later, she revisited our department, presenting with aggravated glare, scintillation, and severe photophobia. Also, she presented with scintillation followed by a headache starting from the right temporal area extending to the occipital area. The patient was diagnosed with migraine with aura, which was newly developed after percutaneous ASD closure. After switching medication from acetylsalicylic acid to clopidogrel, the frequency and intensity of the headaches were reduced. No recurrence of ophthalmic symptoms or headache was observed during the 1-year follow-up. CONCLUSIONS: Percutaneous closure of ASD can be complicated by the appearance of migraine attacks with aura. When patients present with glare and scintillation, ophthalmologists must consider the possibility of migraine with aura and migraine induced by secondary causes. Thus, detailed history taking should be taken in order to make an early diagnosis of migraine.
Aspirin ; Early Diagnosis ; Epilepsy ; Female ; Follow-Up Studies ; Glare ; Headache ; Heart Septal Defects, Atrial* ; Humans ; Middle Aged ; Migraine Disorders* ; Migraine with Aura* ; Photophobia ; Recurrence ; Septal Occluder Device

Purpose: To describe the surgical technique and clinical outcome of autologous retinal free flap transplantation for recurrent giant macular hole retinal detachment (MH RD) in a high myopia patient.Case summary: A 71-year-old female had undergone pars plana vitrectomy (PPV), internal limiting membrane peeling, and endolaser photocoagulation at the margin of the hole with silicone oil tamponade for repair of myopic MH RD. Silicone oil was removed at postoperative 4 months and the retina was properly attached. Unfortunately, the retina redetached with a large MH, which developed 8 years after surgery. The patient underwent 3-port PPV under general anesthesia. A retinal flap was harvested from the mid-periphery of the superior detached retina. The retina was cut along the marked edge of the retinal flap except for a small attachment part (hinge). After fluid-air exchange, the hinge of the retinal free flap was gently dissected and then placed on the macular area with a drop of viscoelastics. Endolaser treatment was performed around the retinal flap harvest site and silicone oil was injected at the end of surgery. The 1 week postoperative optical coherence tomography showed MH closure, which was stable at postoperative 9 months. Conclusions Autologous retinal free flap transplantation is an effective method as a surgical option for recurrent giant MH RD in high myopia patients.

Transoral endoscopic thyroid surgery vestibular approach (TOETVA) is now widely performed globally with good cosmetic outcomes. However, there are complications related to this approach which surgeons should be aware of. We report here a 41-year-old female patient who had an unusual ocular complication after total thyroidectomy via TOETVA. She was diagnosed with papillary thyroid carcinoma and received total thyroidectomy via TOETVA. She complained of floating particles in her right eye immediately after the operation. Fundus examination revealed intraocular hemorrhage in her right eye. At one-month follow-up, all of the intraocular hemorrhage was improved by fundus examination, resolving her chief complaint. Surgeons and anesthesiologists should be aware of increased intracranial pressure during the TOETVA and possible ocular complications after the surgery, although they are rare.

OBJECTIVES: To assess innate and humoral immune responses in middle ear effusion of obese pediatric patients with otitis media with effusion (OME). METHODS: We evaluated 219 children with OME, of whom 21 were obese and 198 were non-obese. We compared the expression in middle ear effusion of mRNAs encoding toll-like receptors (TLR) 2, 4, 5, and 9; nucleotide-binding oligomerization domains (NOD) 1 and 2; retinoic acid-inducible gene (RIG)-I; interleukins (IL)-6, -10, and -12; interferon (IFN)-gamma; and tumor necrosis factor (TNF)-alpha mRNAs. We also compared the expression of immunoglobulins IgG, IgA, and IgM and the bacterial detection rate in the two groups. RESULTS: TLR2-mediated expression of IL-6 mRNA, TLR4-mediated expression of IL-6 and IL-10 mRNA, TLR5-mediated expression of IL-6, IL-10, and TNF-alpha mRNA, TLR9-mediated expression of IL-6 mRNA, and NOD2-mediated expression of IL-6, IL-12, and TNF-alpha mRNA were significantly lower in obese than in non-obese children (P<0.05). However, concentrations of IgG, IgA, and IgM in middle ear effusion were lower in obese than in non-obese children, but none of these differences was significant (P>0.05). CONCLUSION: Mean body mass index was higher and pattern-recognition receptor-mediated cytokine mRNA expression was lower in obese than in non-obese children with OME.
Bacteria ; Body Mass Index ; Child* ; Humans ; Immunity, Humoral ; Immunoglobulin A ; Immunoglobulin G ; Immunoglobulin M ; Immunoglobulins ; Interferons ; Interleukin-10 ; Interleukin-12 ; Interleukin-6 ; Interleukins ; Obesity ; Otitis Media with Effusion* ; Otitis Media* ; Otitis* ; RNA, Messenger* ; Toll-Like Receptors ; Tumor Necrosis Factor-alpha

Phenylpropanolamine is a sympathomimetic amine used widely as a decongestant or appetite suppressant. Reports of the myocardial injury from the use of phenylpropanolamine are rare and the mechanism of the myocardial injury is not known clearly. We experienced a case of myocardial injury after ingestion of phenyl-propanolamine. A 46-year-old woman was admitted because of chest pain and dyspnea after ingestion of 5 tablets of anorectic pill containing phenylpropanolamine 75 mg per tablet. The serum creatine kinase MB isoenzyme levels were elevated and electrocardiographic abnormalities suggesting myocardial infarction were seen in the precordial lead. In echocardiograpy, left ventricular anteroseptal wall motion was nearly akinetic but coronary angiography showed normal coronary arteries except sluggish blood flow in left anterior descending artery.
Appetite ; Arteries ; Chest Pain ; Coronary Angiography ; Coronary Vessels ; Creatine Kinase ; Dyspnea ; Eating* ; Electrocardiography ; Female ; Humans ; Middle Aged ; Myocardial Infarction ; Phenylpropanolamine* ; Tablets

Thirteen patients with malignant germ cell tumars of the ovary have been treated with a combination chemotherapy. The age of the patients ranged from ll to 50 years and there was no history of radiation therapy of chemotherapy except operation, Stage distributions are as follow ; 2 pstients are stage IV, 3 are stage II and remainied 8 are stage I. 4 patients with immature teratama and 2 patients with mixed germ cell tumor received VAC chemotherapy, as primary therapy, and among them 1 lost to follow up but remained 5 cases live without evidence of disease 39 to 83 gnontha. There were 3 patients with endodermal sinus tumor and 1 received VAC and remeined 2 received FVB as primary chemotherapy, Of them 1 died of disease after 9 months of oyeration and the other 2 live now with no evidence of disease. There were 2 patiente with dysgerminoma and 2 with primary ovarian choriocarcinoma. 1 patient with dysagerminoma and 1 wit choriocarcinoma were died because of chemotherapy toxicity, 1 patient with dysgerminoma, who refused further ehemotherapy after l course of chemot.herapy, died of progressive disease. l patient wit choriocarcinoma now live well without evidence of disease at 35 months. The combination chemotherapy using VAC or PVB regimen represents an effective treatment for malignant. germ cell turnars of the ovary and reveals moderate oxicity.
Choriocarcinoma ; Drug Therapy ; Drug Therapy, Combination* ; Dysgerminoma ; Endodermal Sinus Tumor ; Female ; Germ Cells* ; Humans ; Lost to Follow-Up ; Neoplasms, Germ Cell and Embryonal* ; Ovary ; Pregnancy

BACKGROUND AND OBJECTIVES: Diagnosis of nasal bone fracture is important because of not only deformity of the external nose but also because of other additional injuries around the nose. The purpose of this study is to explore the incidence, type, location and direction of nasal septal fracture in nasal bone fracture patients who were diagnosed by nasal bone CT. SUBJECTS AND METHOD: We analysed the medical records and films of 135 nasal bone fracture patients who were diagnosed by computerized tomography from January 2005 to September 2005. The nasal bone fracture was classified by six types on nasal bone CT: unilateral, bilateral, open book, impacted, greenstick, comminuted. The external deviation of nasal bone (20 degree below or up) and correlation between septal fracture and nasal bone fracture were analysed by chi-square test (p<0.05). RESULTS: The incidence of each type of nasal bone fracture is unilateral (41%), bilateral (18%), open book (8%), impacted (6%), green stick (17%), and comminuted (10%). The incidence of combined septal fracture was high in comminuted and impacted rather than in unilateral and bilateral (p<0.05). And there was no correlation between the directions of the trauma force and nasal septal deviation. CONCLUSION: The incidence of concurrent nasal septal fracture when nasal bone fracture occur is relatively high, so we must consider nasal septum more carefully on nasal trauma.
Congenital Abnormalities ; Diagnosis ; Humans ; Incidence ; Medical Records ; Nasal Bone* ; Nasal Septum ; Nose

Purpose: To evaluate the clinical usefulness of a low vision aid using a virtual reality device (LVA-VR) in patients with low vision. Methods: Forty low vision patients were enrolled in this prospective study. All subjects participated in a two-session LVA-VR training course. The binocular best-corrected distance, intermediate, and near visual acuities (BCDVA, BCIVA, and BCNVA, respectively) were measured, along with contrast sensitivity and reading performance, at baseline and after 2 weeks of LVA-VR use. All subjects also provided a self-rated functional score (SFS) and completed a satisfaction questionnaire following the study. Results: Thirty-nine subjects (mean age, 54.6 ± 22.7 years) completed the study. Significant improvements in BCDVA, BCIVA, BCNVA, and contrast sensitivity were observed after 2 weeks of LVA-VR use (p < 0.001). Reading accuracy also improved significantly (p = 0.027); however, the reading speed did not change. Subject functionality improved, as indicated by the increase in the SFS (11.8 ± 4.5 vs. 19.6 ± 5.3) (p < 0.001). Most patients were satisfied with their visual function improvement and found LVA-VR to be useful in their daily activities. No device-related adverse events were observed or indicated. Conclusions This study suggests that LVA-VR is beneficial for visual rehabilitation. Future technological advances are expected to improve LVA-VR performance and acceptability further for a better quality of life in low vision patients.

Purpose: To report the successful rehabilitation of a patient with anomalous head posture by using a virtual reality low vision aid (VRLVA).Case summary: A 75-year-old male diagnosed with age-related macular degeneration 15 years prior presented with an anomalous head posture for eccentric viewing. He had central scotoma within the central 10 degrees, and the preferred retinal locus (PRL) was localized to the inferonasal retina. The patient underwent a training session on the use of the VRLVA, which has a remapping function to remap distorted images, and those falling on the scotoma, to another location on the screen. After explaining the purpose of the VRLVA, the patient was given the device to use at home for two weeks. At two weeks after training, the patient could look straight ahead when using the VRLVA, without anomalous head posture. In addition, reading performance, including speed and accuracy, improved; moreover, he experienced no device-related adverse events. Conclusions By using the VRLVA, low-vision patients with anomalous head posture can shift images falling on the central scotoma to the PRL, thereby minimizing their anomalous head posture and improving reading performance. We expect that future technological advances, such as a wearable design and the use of lightweight material, will further improve the performance and acceptability of the VRLVA.