PURPOSE: This study was performed to evaluate the effect of bovine pericardium used in scleral ulcer resulting from excision of pterygium and MMC. METHODS: Nine eyes of 9 patients who had painful scleral ulcer resulting from excision of pterygium and MMC were repaired with bovine pericardium (Lyoplant(R)). The rotation conjunctival flap was placed over the graft area. We measured the results and complications of treatment. RESULTS: Eight patients showed loss of eyeball pain, epiphora, and inflammation. There were visual improvement, good conjunctival healing after the procedure. One patient showed loss of overlying conjunctiva and progression of scleral ulcer because of pseudomonas infection. After control of infection and secondary procedure, there were good conjunctival healing, relief of the symptom and visual improvement. CONCLUSIONS: The authors suggest bovine pericardium appears to be an excellent substitute for autogenous or homologous tissue in scleral ulcer treatment.
Conjunctiva ; Humans ; Inflammation ; Lacrimal Apparatus Diseases ; Pericardium* ; Pseudomonas Infections ; Pterygium ; Transplants ; Ulcer*

Thyroid cancer is a common endocrine malignancy with increasing incidence globally. Although most cases can be treated effectively, some cases are more aggressive and have a higher risk of mortality. Inhibiting RET and BRAF kinases has emerged as a potential therapeutic strategy for the treatment of thyroid cancer, particularly in cases of advanced or aggressive disease. However, the development of resistance mechanisms may limit the efficacy of these kinase inhibitors. Therefore, developing precise strategies to target thyroid cancer cell metabolism and overcome resistance is a critical area of research for advancing thyroid cancer treatment. In the field of cancer therapeutics, researchers have explored combinatorial strategies involving dual metabolic inhibition and metabolic inhibitors in combination with targeted therapy, chemotherapy, and immunotherapy to overcome the challenge of metabolic plasticity. This review highlights the need for new therapeutic approaches for thyroid cancer and discusses promising metabolic inhibitors targeting thyroid cancer. It also discusses the challenges posed by metabolic plasticity in the development of effective strategies for targeting cancer cell metabolism and explores the potential advantages of combined metabolic targeting.

Adenomyosis is a nonneoplastic hyperplastic lesion, characterized by invagination of proliferating endometrial glands into myometrium. In dogs, uterine adenomyosis is relatively rare and it is important in Toxicologic Pathology to differentiate other non-neoplastic and neoplastic lesions in uterus. In the present study, we report two cases of adenomyosis in the female beagle dogs used for a chemical toxicity test. Clinically, one out of the two female beagle dogs, 15 months of age, had vaginal bleeding for 2 weeks and the other one, 11 months of age, showed swelling of vulva for a week. At necropsy, the weight of uterus was markedly increased to 27.9 g and 15.8 g, compared with the mean value (4.01+/-2.37, n=6) of that of other normal dogs, respectively. The parameters of hematology and serum chemistry were ranged normal in both of the dogs with enlarged uterus. For differentiation of connective tissue with muscle fibers, Van Gieson stain was also performed in the serial tissue sections. Histopathologically, the lesions of the enlarged uteruses were characterized by proliferating endometrial glands into myometrium, surrounded by connective tissue. The endometrial glands were proliferating downward to myometrium or embedded in multiple clustered glands in deeper myometrium without compressing the adjacent muscle fibers. The gland epithelial cells are uniformly cuboidal shape with a dense and bottom-located nucleus. These gross and histological findings were consistent with adenomyosis.
Adenomyosis ; Animals ; Connective Tissue ; Dogs ; Endometrial Hyperplasia ; Epithelial Cells ; Female ; Hematology ; Humans ; Mice ; Muscles ; Myometrium ; Toxicity Tests ; Uterine Hemorrhage ; Uterus ; Vulva

OBJECTIVE: Delayed cerebral ischemia due to vasospasm after aneurysmal subarachnoid hemorrhage (SAH) is a leading cause of morbidity and mortality. Recent reports have confirmed that intra-arterial infusion of calcium-channel blockers, which are widely used to counteract vasospasm, is effective for treating SAH with a low risk of complications. Here we report on our experience with intra-arterial nicardipine angioplasty in a consecutive series of 32 patients with SAH. METHODS: This retrospective review evaluated a series of 32 consecutive patients with symptomatic vasospasm that was treated with intra-arterial nicardipine. The patients included in the study were diagnosed with aneurysmal SAH between January 2007 and February 2011. All the patients underwent microsurgical clipping or endovascular coiling. Angioplasty using intra-arterial nicardipine was performed in those patients who were refractory to medical therapy such as triple H therapy. RESULTS: The 32 patients underwent a total of 55 procedures. The total amount of nicardipine used in each angioplasty procedure did not exceed 12 mg, with a maximum dose of 3 mg for each vessel. The Glasgow Coma Scale (GCS) score improved in all patients with an average improvement of 2.4 (range : 1~5). During angioplasty, there were no complications such as thromboembolic events and/or acute transitory spasm. The clinical results were evaluated using the modified Rankin Scale (mRS). Good outcomes (mRS 0~2) were determined in 19 (63.3%) of the 30 patients. The 11 patients (36.7%) with poor outcomes initially had a high Hunt and Hess grade (III or IV) or they had intra-operative complications (mRS: 3~6). CONCLUSION: Our study results support the effectiveness and safety of low-dose nicardipine when performing intra-arterial angioplasty for the treatment of vasospasm after aneurysmal SAH.
Aneurysm ; Angioplasty ; Brain Ischemia ; Glasgow Coma Scale ; Glycosaminoglycans ; Humans ; Infusions, Intra-Arterial ; Nicardipine ; Retrospective Studies ; Spasm ; Subarachnoid Hemorrhage

OBJECTIVE: This study was conducted to assess the efficacy and safety of endovascular mechanical thrombectomy (EMT) for patients diagnosed with basilar artery (BA) occlusion. MATERIALS AND METHODS: We retrospectively analyzed clinical and imaging data of 16 patients diagnosed with BA occlusion who were treated with endovascular intervention from July 2012 to February 2013. Direct suction using the Penumbra system and thrombus retrieval by the Solitaire stent were the main endovascular techniques used to restore BA flow. The outcomes were evaluated based on rate of angiographic recanalization, rate of improvement of National Institutes of Health Stroke Scale (NIHSS) score, rate of modified Rankin Scale (mRS) at discharge and after 3 months, and rate of cerebral hemorrhagic complications. Successful recanalization was defined as achieving Thrombolysis In Cerebral Infarction (TICI) of II or III. RESULTS: Sixteen patients received thrombectomy. The mean age was 67.8 +/- 11 years and the mean NIHSS score was 12.3 +/- 8.2. Eight patients treated within 6 hours of symptom onset were grouped as A and the other 8 patients treated beyond 6 hours (range, 6-120) were grouped as B. Successful recanalization was met in six patients (75%) for group A and 7 (87.5%) for group B. Favorable outcome occurred in 4 patients (50%) for group A and 5 (62.5%) for group B. CONCLUSION: Our study supports the effectiveness and safety of endovascular mechanical thrombectomy in treating BA occlusion even 6 hours after symptom onset.
Basilar Artery ; Cerebral Infarction ; Endovascular Procedures ; Humans ; National Institutes of Health (U.S.) ; Retrospective Studies ; Stents ; Stroke ; Suction ; Thrombectomy ; Thrombosis

OBJECTIVE: This study was conducted to assess the efficacy and safety of endovascular mechanical thrombectomy (EMT) for patients diagnosed with basilar artery (BA) occlusion. MATERIALS AND METHODS: We retrospectively analyzed clinical and imaging data of 16 patients diagnosed with BA occlusion who were treated with endovascular intervention from July 2012 to February 2013. Direct suction using the Penumbra system and thrombus retrieval by the Solitaire stent were the main endovascular techniques used to restore BA flow. The outcomes were evaluated based on rate of angiographic recanalization, rate of improvement of National Institutes of Health Stroke Scale (NIHSS) score, rate of modified Rankin Scale (mRS) at discharge and after 3 months, and rate of cerebral hemorrhagic complications. Successful recanalization was defined as achieving Thrombolysis In Cerebral Infarction (TICI) of II or III. RESULTS: Sixteen patients received thrombectomy. The mean age was 67.8 +/- 11 years and the mean NIHSS score was 12.3 +/- 8.2. Eight patients treated within 6 hours of symptom onset were grouped as A and the other 8 patients treated beyond 6 hours (range, 6-120) were grouped as B. Successful recanalization was met in six patients (75%) for group A and 7 (87.5%) for group B. Favorable outcome occurred in 4 patients (50%) for group A and 5 (62.5%) for group B. CONCLUSION: Our study supports the effectiveness and safety of endovascular mechanical thrombectomy in treating BA occlusion even 6 hours after symptom onset.
Basilar Artery ; Cerebral Infarction ; Endovascular Procedures ; Humans ; National Institutes of Health (U.S.) ; Retrospective Studies ; Stents ; Stroke ; Suction ; Thrombectomy ; Thrombosis

The authors report here on a rare case of aneurysm involving the distal lenticulostriate artery (LSA) in a 66-year-old man who presented with intracerebral hemorrhage (ICH) in the right basal ganglia and also intraventricular hemorrhage (IVH). Three-dimensional computed tomography angiography (3D-CTA) and conventional cerebral angiography showed a 4 mm, round-shaped aneurysm in the right distal LSA and this was combined with moyamoya-like disease. We performed proximal clipping of the aneurysm using a microsurgical technique and we evacuated the hematoma. After the operation, there was recurrent bleeding around the operation site and hydrocephalus gradually developed, and we implanted a ventriculo-peritoneal (V-P) shunt. The patient did well after the final shunt surgery and rehabilitation. Presently, he has no motor weakness or significant neurologic deficit, but mild cognitive dysfunction remains. When spontaneous ICH occurs in an unusual site, a thorough investigation is important to rule out a structural vascular abnormality.
Aged ; Aneurysm ; Angiography ; Arteries ; Basal Ganglia ; Cerebral Angiography ; Cerebral Hemorrhage ; Hematoma ; Hemorrhage ; Humans ; Hydrocephalus ; Neurologic Manifestations

OBJECTIVE: Cerebral aneurysms which cause oculomotor nerve [cranial nerve (CN) III] palsy, are frequently found with a daughter sac of the aneurysm dome. We assumed that CN III might be compressed by the daughter sac and it would be more helpful not to fill the daughter sac with coils than vice versa during endosaccular embolization for recovering from CN III palsy, because it may give a greater chance for the daughter sac to shrink by itself later. We reviewed the initial results of our experiences of such cases. METHODS: Among 9 aneurysms accompanied by CN III palsy, 7 (6 unruptured, 1 ruptured) showed a daughter sac. We tried to fill the main dome completely and spare the daughter sac from coil filling to increase the possibility of decompression. We evaluated the short-term effectiveness of this concept using medical records and angiograms. RESULTS: After initial embolization, all of CN III palsy caused by unruptured aneurysms (6/6) resolved completely after various periods (3-90 days) of time. No adverse effects were noted during and after the procedures except for one case of harmless coil stretching during coil filling using double microcatheter. CONCLUSION: During the coil embolization of the cerebral aneurysm causing CN III palsy, sparing the daughter sac from coil packing while tightly packing the main dome, can be helpful in increasing the effectiveness of decompression. However, a long-term follow-up will be required.
Aneurysm ; Decompression ; Intracranial Aneurysm ; Medical Records ; Nuclear Family ; Oculomotor Nerve ; Oculomotor Nerve Diseases ; Paralysis

A 61-year-old man who had been diagnosed with prostate cancer 9 years ago and had been treated with pelvic irradiation and intermittent androgen deprivation therapy visited the emergency room because of back pain and weakness in both legs. Spine magnetic resonance imaging showed a lumbar epidural mass and spine metastasis. The whole-body workup revealed multiple metastases to the lymph nodes, bone, liver, and lung. The serum prostate-specific antigen was 0.02 ng/ml. He underwent laminectomy, posterior fixation, and epidural mass excision, and metastatic adenocarcinoma from the prostate was diagnosed. The patient underwent 1 cycle of docetaxel-based chemotherapy. More chemotherapy could not be done because of his general weakness. The patient died one month later of multiple organ failure.
Adenocarcinoma ; Back Pain ; Disease Progression ; Emergencies ; Humans ; Laminectomy ; Leg ; Liver ; Lung ; Lymph Nodes ; Magnetic Resonance Imaging ; Middle Aged ; Multiple Organ Failure ; Neoplasm Metastasis ; Prostate ; Prostate-Specific Antigen ; Prostatic Neoplasms ; Spine

BACKGROUND/AIMS: To investigate the rate of detection of monosodium urate (MSU) crystals in the synovial fluid (SF) of patients with acute gouty arthritis and factors associated with false-negative results. METHODS: A total of 179 patients with acute gouty arthritis who had undergone SF crystal examination were identified from the data warehouse of two university hospitals. Clinical and laboratory data were obtained from the medical records. RESULTS: The overall rate of detection of MSU crystals was 78.8%. In univariate analyses, the only significant differences between the variables of crystal-negative and crystal-positive patients were a lower C-reactive protein level (p = 0.040) and fewer patients undergoing emergent surgery in the crystal-positive group (p = 4.5 x 10(-6)). In logistic regression analyses, MSU crystal-negative results were significantly associated with the interval from arthritis onset to crystal examination (p = 0.042), and this was the most significant risk factor for arthroscopic surgery (p = 2.1 x 10(-4)). Seventeen patients who underwent arthroscopic surgery had a significantly longer hospital stay (p = 0.007) and a significant delay in gout treatment (p = 8.74 x 10(-5)). The distribution of crystal-negative patients differed significantly between the SF samples that were evaluated by both the laboratory medicine and the rheumatology departments (p = 1.2 x 10(-14)), and the kappa value was 0.108. CONCLUSIONS: Although several clinical features were associated with detection failure, SF MSU crystal identification was critically dependent on the observer. Considering the impact on the treatment outcomes, implementation of a quality control program is essential.
Acute Disease ; Aged ; Arthritis, Gouty/diagnosis/*metabolism/*surgery ; Arthroscopy ; Biological Markers/metabolism ; Crystallization ; False Negative Reactions ; Female ; Hospitals, University ; Humans ; Length of Stay ; Logistic Models ; Male ; Microscopy, Polarization ; Middle Aged ; Observer Variation ; Predictive Value of Tests ; Reproducibility of Results ; Republic of Korea ; Retrospective Studies ; Synovial Fluid/*metabolism ; Time Factors ; Time-to-Treatment ; Treatment Outcome ; Uric Acid/*metabolism