Opacification of the cornea due to the deposition of lipids may be primary without evidence of previous corneal vascularization, or secondary to either preexisting corneal disease or systemic disturbances of lipid metabolism. If the deterioration of vision continues, penetrating keratoplasty may be needed. We evaluated a 19 year-old female patient referred to our department due to progressive corneal opacity in the left eye. She did not have significant past or family histories of corneal diseases. Ocular examinations revealed the whitish corneal deposits with deep stromal vascularization in her left eye. For confirmation of the diagnosis, lamellar keratectomy with amniotic membrane transplantation was performed and deep stromal vessels were photocoagulated using an argon laser. Histologic findings were compatible with lipid degeneration. The corneal opacities reduced markedly and did not show any evidence of recurrence during the follow up period of six months. Therefore, we report this case with the review of the literature.
Amnion* ; Argon ; Cornea ; Corneal Diseases ; Corneal Opacity ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Keratoplasty, Penetrating ; Light Coagulation* ; Lipid Metabolism ; Recurrence ; Young Adult

PURPOSE: The use of thyroidectomy has increased as a diagnostic technique for thyroid disease. However, performance of a, thyroidectomy is accompanied with complications. Post-thyroidectomy complications include recurrent laryngeal nerve palsy, hypocalcemia, hematoma, infection, and thyroid storm. The aim of this study was to determine the clinical incidence and to evaluate complications after a thyroidectomy, including recurrent laryngeal nerve palsy, hypocalcemia, hematoma, and scaring, following a retrospective review of cases. METHODS: From July 2004 to May 2006, 661 consecutive patients that had undergone a thyroidectomy were identified. Through a retrospective review, we evaluated the incidence and type of complications, including recurrent laryngeal nerve palsy, hypocalcemia, hematoma, and postoperative scaring. RESULTS: 1) Recurrent laryngeal nerve palsy was a very serious complication, but had a very low incidence. Eight cases out of 661 cases developed and most of the cases developed after a total thyroidectomy. 2) Hypocalcemia was the most common complication. Each incidence of hypocalcemia of methods of thyroid surgery was significant (P= 0.019) but, thyroid disease did not have significant difference (P=0.071). 3) The incidence of postoperative hematoma was 2.74% (18/655). Graves’ disease was more predominant than other diseases. CONCLUSION: Post-thyroidectomy complications and cosmetic problems include recurrent laryngeal nerve palsy, hypocalcemia, hematoma, and postoperative scar. An understanding of the incidence and review of complications after a thyroidectomy may reduce their incidence.

The purpose of the current study was to compare prognostic outcomes between patients with high-grade ovarian Sertoli-Leydig cell tumors (SLCTs) and those with other low-grade SLCTs. We retrospectively reviewed medical records for 24 patients pathologically diagnosed with SLCTs between 2006 to 2019 at two institutions. The patients were grouped according to pathological grade: SLCT was classified as grade 1, well differentiated; grade 2, intermediated differentiated; or grade 3, poorly differentiated (Meyer’s classification). Statistical analysis was performed to compare survival outcomes according to pathological grade. The median patient age was 42.5 years (range 16–75). Eighteen patients (75%) were International Federation of Gynecology and Obstetrics stage I, and none were diagnosed in stage IV. Nine patients (37.5%) were grade 3, and 15 patients (63.5%) were grades 1–2. When comparing clinical baseline characteristics of the grade 1–2 group with those of the grade 3 group, only serum CA125 level at diagnosis was significantly higher in the grade 3 group (38.34 vs. 382.29, p=0.002). Five patients experienced recurrence of grade 3 disease, while no recurrence was reported in grade 1–2 disease. Four of the five recurrent patients died. In result, grade 3 ovarian SLCT showed significantly poorer prognosis than grade 1–2 disease (overall survival, hazard ratio=14.25, 95% confidence interval= 1.881–108.0; log-rank p=0.010). Our findings were consistent with the concept that patients with stage I/grade 1–2 tumors have a good prognosis without adjuvant chemotherapy. Since grade 3 ovarian SLCT appears to be relatively more fatal than grade 1 or 2, patients with grade 3 SLCT might require more aggressive surgical intervention and post-treatment surveillance.

Background: Gallbladder cancer (GBC) is usually detected in advanced stages with a low 5-year survival rate. Delta-like ligand 4 (DLL4), vascular endothelial growth factor (VEGF), and hypoxia-inducible factor-2alpha (HIF2α) have been studied for their role in tumorigenesis and potential for therapeutic target, and multiple clinical trials of the agents targeting them are ongoing. We investigated the expression of these markers in surgically resected GBC and tried to reveal their association with the clinicopathologic features, mutual correlation of their expression, and prognosis of the GBC patients by their expression. Methods: We constructed the tissue microarray blocks of 99 surgically resected GBC specimens and performed immunohistochemistry of DLL4, VEGF, and HIF2α. We used the quantitative digital image analysis to evaluate DLL4 and VEGF expression, while the expression of HIF2α was scored manually. Results: The expression of VEGF and HIF2α showed a significant trend with tumor differentiation (p= .028 and p= .006, respectively). We found that the high DLL4 and VEGF expression were significantly correlated with lymph node metastasis (p= .047, both). The expression of VEGF and HIF2α were significantly correlated (p < .001). The GBC patients with low HIF2α expression showed shorter recurrence-free survival than those with high HIF2α expression. Conclusions This study suggested the possibility of the usage of DLL4 and VEGF to predict the lymph node metastasis and the possibility of VEGF and HIF2α to predict the expression level mutually. Further studies may be needed to validate our study results and eventually accelerate the introduction of the targeted therapy in GBC.

OBJECTIVE: To examine the clinical factors and brain lesion locations related to the patterns of dysphagia in stroke patients in a rehabilitation hospital. METHODS: The medical records of 116 stroke patients who underwent a videofluoroscopic swallowing study (VFSS) between January 2010 and January 2015 in a rehabilitation hospital were reviewed retrospectively. The swallowing-related parameters were assessed using a VFSS. The brain lesion locations were classified as the cortex, basal ganglia, thalamus, midbrain, pons, medulla, cerebellum, and others (subarachnoid or intraventricular hemorrhage). The ambulation ability was assessed using functional ambulation categories (FACs). The independence in the activities of daily living and the degree of cognitive impairment were assessed using the Korean versions of the modified Barthel index (K-MBI) and Mini-Mental State Examination (K-MMSE), respectively. After adjusting for the potential confounding factors in multivariate analysis, the odds ratios and confidence intervals of the stroke brain lesions were calculated and the clinical factors for predicting the VFSS findings were determined. RESULTS: Among the 116 patients, 35 (27%) had an impaired oral stage and 58 (50%) had aspiration. The impaired oral stage was associated significantly with the onset time, basal ganglia stroke, dietary and fluid intake methods at the time of the VFSS, symptoms of dysphagia, FACs, K-MBI, and K-MMSE. Aspiration was correlated with a pontine stroke, methods of dietary and fluid intakes at the time of the VFSS, symptoms of dysphagia, FACs, and K-MBI. Multivariate analysis showed that the pontine stroke and methods of dietary and fluid intake at the time of VFSS predicted aspiration after adjusting for the potential confounding factors. In subgroup analysis of the diet type, the liquid and semisolid aspirations were correlated with the dietary and fluid intake methods and pontine stroke, respectively. CONCLUSION: Patients with a pons lesion stroke, who are on a modified diet (fluid thickening and tube feeding), have higher risks of aspiration. This provides evidence for precise clinical reasoning in this specific patient group.
Activities of Daily Living ; Aspirations (Psychology) ; Basal Ganglia ; Brain ; Cerebellum ; Cognition Disorders ; Deglutition Disorders ; Deglutition* ; Diet ; Humans ; Medical Records ; Mesencephalon ; Multivariate Analysis ; Odds Ratio ; Oral Stage ; Pons ; Rehabilitation ; Retrospective Studies ; Stroke* ; Thalamus ; Walking

Allogenic peripheral blood stem cell transplantation (Allo-PBSCT) is being used to treat hematological malignancies with increasing frequency. Graft-versus-host disease (GvHD) is a complex complication of PBSCT. A 43-year-old woman came to the gynecology clinic for amenorrhea. She had been diagnosed with acute myeloid leukemia 2 years earlier and treated with induction and consolidation chemotherapy. After developing complete remission, she underwent Allo-PBSCT. When she started chemotherapy, her menstrual cycle completely disappeared. Fourteen months after menopausal hormone replacement therapy, it was discovered that her upper vaginal canal was completely obstructed. The lower vagina had an atrophic appearance. We report a rare case of partial vaginal obstruction as a complication of chronic GvHD and review the literature. We expect that this case report provides an opportunity to remind clinician of the gynecologic complications of GvHD.
Amenorrhea ; Consolidation Chemotherapy ; Female ; Graft vs Host Disease ; Gynecology ; Hematocolpos ; Hematologic Neoplasms ; Hormone Replacement Therapy ; Humans ; Leukemia, Myeloid, Acute ; Menstrual Cycle ; Peripheral Blood Stem Cell Transplantation ; Porphyrins ; Vagina

Surgical treatments for arthritis in the first metatarsophalangeal joint include arthrodesis, interposition arthroplasty using silicone or meniscus cartilage, and rarely arthroplasty. Although arthrodesis was performed successfully, pain can persist if the angle of fusion was inappropriate. Interposition arthroplasty can be tried for the treatment of persisting pain after the arthrodesis. Interposition arthroplasty using tensor fascia lata is known that has low risk of adhesions and easy to harvest. Compared to autologous grafts, grafting rates is high and low risk of rejection additionally. Herein, we report a successfully managed arthritis with severe pain with interposition arthroplasty using tensor fascia lata after a failed metatarsophalangeal joint arthrodesis.
Arthritis ; Arthrodesis* ; Arthroplasty* ; Cartilage ; Fascia Lata* ; Fascia* ; Metatarsophalangeal Joint* ; Silicon ; Silicones ; Transplants

Lichen sclerosus (LS) refers to a benign, chronic, progressive dermatologic condition that primarily causes anogenital lesions in middle aged women. But LS has been identifi ed in patients of all ages including those in the fi rst years of life. The risk of squamous cell carcinoma of the vulva is 4% to 5% in women with LS, and has been reported to be as high as 7% in some reviews. We recently encountered a case of LS in a post-menopausal woman without hormone therapy. To remind clinicians of the neglected issue of LS, we report a case of LS with literature review.
Carcinoma, Squamous Cell ; Female ; Humans ; Lichen Sclerosus et Atrophicus ; Lichens ; Middle Aged ; Postmenopause ; Vulva

The term rete ovarian cyst has been used mostly in animal pathology. Cysts of the ovarian hilus have been reported in experimental animals, but have not received attention in human beings. In the literature review, most women with these cysts were postmenopausal and the cysts were not malignancy. But, there have been some reports of hormonal imbalance associated with these cysts. This article reports the clinicopatholgical findings of a case of ovarian rete cyst in postmenopausal woman with some literature review.
Animals ; Female ; Humans ; Ovarian Cysts ; Ovary ; Postmenopause

OBJECTIVES: We investigated the relationship between bone mineral density (BMD) and hormone therapy (HT) and its duration in postmenopausal women. METHODS: We performed a retrospective study on 291 postmenopausal women who had their BMD and follow-up BMD measured in a university hospital. We analyzed BMD, HT types and HT duration according to clinical characteristics. RESULTS: The mean age of the study subjects was 53.7 +/- 5.9 years. HT types and HT duration were not statistically related to improvement in BMD (P = 0.956, 0.483). But osteoporosis in patients with hormone therapy improves bone mineral density showed statistical significance (P = 0.001). CONCLUSION: HT types and HT duration did not have any effect on bone mineral density, but further prospective multicenter studies regarding HT should be considered for osteoporosis.
Bone Density ; Female ; Follow-Up Studies ; Humans ; Osteoporosis ; Retrospective Studies