Topical fibronectin, autologous and homologous, was used to treat nine patients (eleven eyes) with persistent corneal epithelial defects and corneal ulcers that failed to improve with standard therapy. The fibronectin was purified from autologous and homologous plasma by gelatin-Sepharose 4B affinity chromatography and administered topically, 500 micrograms/ml five times a day, for three weeks. Complete or nearly complete reepithelialization was achieved in all patients regardless of the source of fibronectin, autologous or homologous. But healing times varied. The average healing time was 41.7 +/- 14.7 days (35.7 +/- 12.4 days for autologous, 50.8 +/-14.4 days for homologous). Ocular symptoms were relieved significantly, and no side effects were observed. Over an average follow-up period of 5.2 months, no recurrences were noted. The results showed that homologous, as well as autologous, fibronectin was effective in patients with persistent corneal epithelial defects and corneal ulcers.
Administration, Topical ; Adult ; Aged ; Blood Proteins/isolation & purification ; Chromatography, Affinity ; Corneal Diseases/*drug therapy ; Corneal Ulcer/*drug therapy ; Epithelium/drug effects ; Female ; Fibronectins/administration & dosage/isolation & purification/*therapeutic use ; Humans ; Male ; Middle Aged ; Visual Acuity ; Wound Healing/drug effects

PURPOSE: To report a case of proptosis occurring during a Valsalva maneuver in a neurofibromatosis patient with an arachnoid cyst. CASE SUMMARY: A 42-year-old man diagnosed with type I neurofibromatosis visited our hospital with a 20-year history of enophthalmos in the left eye. The patient also complained of exophthalmos during the abdominal straining. On exophthalmometry, a 4 mm enophthalmos was found. The patient also presented with a limited motion to the superior and lateral direction. There was an ocular pulsation corresponding to the heart rate. During the Valsalva maneuver, a marked exophthalmos of the left eye occurred. The patient had light brown spots on the skin of the face and body trunk. Following an orbital computed tomography (CT), defects of the left sphenoid bone were present. Posteriorly, an arachnoid cyst was found; however, there was a lack of varix. The archnoid cyst was also observed to expand into the orbit during the Valsalva maneuver and forward the globe. CONCLUSIONS: To date, cases of proptosis occurring during a Valsalva maneuver by causes other than orbital varix are rare. Herein, the authors report a case with a review of literature.
Adult ; Arachnoid ; Enophthalmos ; Exophthalmos ; Eye ; Heart Rate ; Humans ; Light ; Neurofibromatoses ; Orbit ; Skin ; Sphenoid Bone ; Sprains and Strains ; Valsalva Maneuver ; Varicose Veins

PURPOSE: Although, urgent intubation is commonly thought to be associated with a high complication rate and poor outcome, early intubation before deterioration and airway compromise is recommended. We designed a study to evaluate the factors associated with the mortality rate of non-traumatic patients intubated in an emergency department (ED). METHODS: Data were retrieved retrospectively from the patient registry for patients >15-years-of-age who had received ED intubation from June 1, 2007 to June 30, 2008. Patient demographic data, clinical and laboratory findings, vital signs, and specific data concerning intubation procedures were included. Acute physiologic and chronic health evaluation (APACHE) II scores were calculated for every patient. RESULTS: From the initial 241 non-traumatic ED intubated patients, 115 were excluded for out-of-hospital arrests, inadequate data, and undetected esophageal intubation. The remaining 126 patients were enrolled in this study. Sixty (47.6%) patients died during hospital treatment. From multivariate logistic regression analysis, respiratory rate and the time from ED arrival to intubation were associated with increased mortality, which showed an odds ratio (95% Cl) of 1.081 (1.026~1.141) and 1.428 (1.066~1.91), respectively. CONCLUSION: The increase in respiratory rate and the time interval of intubation from ED arrival to intubation in non-traumatic patients are related to increased in-hospital mortality.
Emergencies ; Hospital Mortality ; Humans ; Intubation ; Logistic Models ; Odds Ratio ; Respiratory Rate ; Retrospective Studies ; Time Factors ; Vital Signs

PURPOSE: To report MALT (mucosa associated lymphoid tissue) type lymphoma in ocular adnexa. METHODS: This retrospective study included 11 patients (13 cases) of MALT type lymphoma between August 1995 and July 2000. We identified 11 lymphoma cases with MALT characteristics by conventional examination and immunohistochemical staining. Twelve cases were treated with partial excision and radiotherapy, one case with partial excision and chemotherapy. RESULTS: The patients consisted of 4 females and 7 males with an age range of 29~88 (average 48) years old. Mean follow up period was 24.8 (6~60) months following treatment. Eleven patients had ocular adnexal involvement at presentation; 7 eyes in conjunctiva, 5 eyes in orbit and one in eyelid. All cases represented extranodal marginal zone B-cell lymphoma by REAL classification. Control of lymphomas was achieved in all but 4 cases which developed recurrence after irradiation and chemotherapy, and were salvaged with further radiotherapy. Complications such as cataract, radiation retinopathy, ptosis and alopecia developed later in 4 eyes. CONCLUSIONS: Surgical excision and radiotherapy seemed to be effective for the treatment of primary ocular adnexal MALT lymphoma. Long-term follow up should be warranted.
Alopecia ; Cataract ; Classification ; Conjunctiva ; Drug Therapy ; Eyelids ; Female ; Follow-Up Studies ; Humans ; Lymphoma* ; Lymphoma, B-Cell, Marginal Zone ; Male ; Orbit ; Radiotherapy ; Recurrence ; Retrospective Studies

Fatal complications including cerebral edema and neurologic collapse occur during treatment of diabetic ketoacidosis(DKA). A 6-week-old female infant with fever, dehydration and drowsy mental status was diagnosed as DKA and neurologically deteriorated during treatment. The cranial computed tomography scan revealed multifocal brain infarctions of the left caudate nucleus, bilateral frontal periventricular white matter, and right parietal cortex. A moderate amount of hemorrhage was also noted in both lateral ventricles. She recovered rapidly with supportive treatment over time. The clinical course and radiologic findings of this patient emphasize the importance of brain infarction as a cause of persistent neurologic loss in children with DKA.
Brain Edema ; Brain Infarction* ; Brain* ; Caudate Nucleus ; Child ; Dehydration ; Diabetic Ketoacidosis* ; Female ; Fever ; Hemorrhage* ; Humans ; Infant* ; Lateral Ventricles ; Rabeprazole

PURPOSE: To report the anatomic and visual results of vitrectomy without scleral buckling in rhegmatogenous retinal detachment. METHODS: Primary vitrectomy without scleral buckling for the treatment rhegmatogenous retinal detachment was done in 41 eyes (41 patients) and followed up for a mean period of 21.5 months(range 6~65 months). Indications of primary vitrectomy were uncertain preoperative breaks, the presence of large breaks, the presence of breaks near equator, multiple breaks, proliferative vitreoretinopathy not related to breaks and presence of inferior vitreous hemorrhage. RESULTS: The anatomic success rate after a single operation was 90.2%. Visual acuity was improved or stable in 37 eyes (90.2%). Progression of lens opacity (35.7%) and formation of epiretinal membrane (12.2%) constituted the major complications after primary vitrectomy. CONCLUSIONS: Primary vitrectomy without scleral buckling can be a safe, effective method to repair primary rhegmatogenous retinal detachments in selective cases.
Cataract ; Epiretinal Membrane ; Retinal Detachment* ; Retinaldehyde* ; Scleral Buckling ; Visual Acuity ; Vitrectomy* ; Vitreoretinopathy, Proliferative ; Vitreous Hemorrhage

PURPOSE: To report a case of inflammatory granuloma in the right medial canthal area which occurred seven years after a cosmetic collagen-containing dermal filler injection in the forehead. CASE SUMMARY: A-47-year-old female, who had been treated with collagen-containing filler 7 years earlier, presented with a mass in the right medial canthal area discovered 20 days previously. There was mild tenderness and the mass was firm and not fixed. The patient reported that the size of the mass was slowly increasing. Orbital computed tomography and magnetic resonance imaging showed an approximate 1 cm-sized, poorly defined, enhancing nodular thickening without evidence of bony erosion. The mass was removed through a skin incision and unidentified foreign bodies were found around the mass. On histopathologic examination, it was diagnosed as inflammatory granuloma caused by foreign substances. CONCLUSIONS: Collagen-containing fillers are widely used in cosmetic surgery for their lasting effect and few complications. However some complications such as inflammatory granuloma may occur at the injection site or other sites, even several years after operation.
Collagen ; Cosmetics ; Female ; Foreign Bodies ; Granuloma ; Humans ; Magnetic Resonance Imaging ; Orbit ; Skin ; Surgery, Plastic

In order to evaluate the effects of a topical application of homologous fibronectin on the healing of skin wounds, we made 2 excisional wounds on the back skin of each rat, applied ointment with or without fibronectin purified from citrated homologous plasma, and evaluated the effect according to wound size and microscopic findings. Excised lesions treated with carrier alone, but the difference was significant only in the early phase of wound healing, 2 and 3 days, according to wound size and microscopic changes. A significant decrease in wound size could be found in both groups, treated with ointment containing and not containing fibronectin, between day 4 and 9 when wound contraction was a major contributor to wound closure. Therefore it can be concluded that topical application of fibronectin has a beneficial effect on wound healing during its early phase, but no significant influence on wound contraction.
Administration, Topical ; Animals ; Fibronectins/blood/*therapeutic use ; Ointment Bases ; Rats ; Rats, Inbred Strains ; Skin/pathology ; Wound Healing/*drug effects

PURPOSE: We report a case of recurred systemic malignant lymphoma developed after the treatment for ocular adnexal benign reactive lymphoid hyperplasia. CASE SUMMARY: A 71-year-old female visited our hospital for right upper eyelid swelling and proptosis that had been progressing slowly for 4 years. Orbital computed tomography (CT) showed enlargement of the bellies of lateral and superior rectus muscles in the right orbit, but other abnormal findings were not detected in the systemic evaluation. Through incisional biopsy, benign reactive lymphoid hyperplasia was diagnosed on histopathologic examination. Upper eyelid swelling and proptosis resolved after radiation therapy. Fifty-one months after the treatment of benign reactive lymphoid hyperplasia, the patient visited our hospital again for a painful mass that had developed in the left neck. On neck CT, it showed enlargement of the left cervical lymph node and asymmetrical thickening of the left oropharyngeal wall. Systemic MALT lymphoma was confirmed, and radiation therapy was performed. According to neck CT, four months after radiation therapy, the enlargement and thickening resolved. CONCLUSIONS: Because there is a possibility of systemic malignant lymphoma after benign reactive lymphoid hyperplasia, continuous follow-up and repeated systemic evaluation should be required after treatment of ocular adnexal benign reactive lymphoid hyperplasia.
Aged ; Biopsy ; Exophthalmos ; Eyelids ; Female ; Follow-Up Studies ; Humans ; Lymph Nodes ; Lymphoma* ; Lymphoma, B-Cell, Marginal Zone ; Muscles ; Neck ; Orbit ; Pseudolymphoma*

PURPOSE: To investigate the efficacy of fibrin glue used in conjunctival resection for conjunctivochalasis with epiphora. METHODS: Twenty-three patients (42 eyes) with conjunctivochalasis without nasolacrimal duct obstruction underwent conjunctival resection using either absorbable sutures (11 patients, 20 eyes, Group 1) or fibrin glue (12 patients, 22 eyes, Group 2) to attach the conjunctiva to the sclera. Outcomes recorded were improvement of epiphora, postoperative discomfort, and operation time. Postoperative discomfort was analyzed only in one eye (right eye) in case that the both eyes were operated. RESULTS: Epiphora completely improved in 6 eyes (30%) in Group 1 and 8 eyes (36.4%) in Group 2, partially improved in 9 eyes (45%) and 8 eyes (36.4%), and did not improved in 5 eyes (25%) and 6 eyes (27.2%), respectively (p=1.000). On the first day postoperatively, postoperative eye discomfort developedin 7 eyes (63.6%) in Group 1 and 5 eyes (41.7%) in Group 2 (p=0.414). Throughout the following week, the discomfort lasted in 6 eyes (54.5%) in Group 1 and 1 eye (13.6%) in Group 2 (p=0.027). The mean operation time was 25.0 (+/-2.6) minutes in Group 1 and 12.0 (+/-2.4) minutes in Group 2 (p<0.001). CONCLUSIONS: The success rates were similar in the two groups. However, the use of fibrin glue significantly reduces the postoperative discomfort and the operation time. Therefore, the use of fibrin glue in conjunctival resection of conjunctivochalasis seems to be an effective method.
Conjunctiva ; Eye ; Fibrin ; Fibrin Tissue Adhesive ; Humans ; Lacrimal Apparatus Diseases ; Nasolacrimal Duct ; Sclera ; Sutures