A 46-year-old woman presented with multiple purpuric skin rashes together with splenomegaly and thrombocytopenia. The resected spleen weighed 720 gm, and contained multiple, discrete, dark red, bulging nodules throughout the entire splenic parenchyma. Microscopically, the nodules revealed various range of endothelial cell proliferation which included cavernous vasculature, anastomosing vascular channels, papillary intravascular growth and solid pattern. Intrasinusoidal sequestration of platelets along with extramedullary hematopoiesis was present in the neoplastic vascular spacws. Neither exposure to thorotrast nor vinyl chloride was nonfirmed. Ultrastructurally, the tumor cells demonstrated a row of pinocytotic vesicles, occasional intercellular junctional structures, and the paucity/absence of filamentous structures or Weibel-Palade bodies supports origin of sinus lining type cells. After splenectomy, the thrombocyte count returned to normal. We conclude this is the first case of primary splenic angiosarcoma with Kasabach-Merritt syndrome in Korean literature.
Female ; Humans

PURPOSE: To report the outcomes of clinical analysis on the negative culture rate of normal ocular surface flora and the anterior chamber penetration after the preoperative prophylactic use of 0.3% tosufloxacin ophthalmic solution. METHODS: From July 2010 to June 2012, 38 eyes of 38 patients who were scheduled to receive intravitreal injection or cataract surgery were examined for bacterial culture positive rate using conjunctival scraping. The patients were treated with 0.3% tosufloxacin eyedrops preoperatively 5 times a day for 2 days before surgery. After the treatment, the bacterial culture negative rate based on conjunctival scraping was assessed to evaluate the drug efficacy. Of the 38 patients, 19 had cataract surgery. The concentration of tosufloxacin at anterior chamber was assessed in the 19 patients. Additionally, any side effects from the drug were monitored during the treatment. RESULTS: Among the 38 eyes, 21 eyes showed a bacterial culture positive rate before treatment. After the drug treatment, the bacterial culture negative rate was 57.1% (12/21). Coagulase-negative staphylococci were most frequently cultured in 15 (39%) of the 38 eyes before treatment and the negative rate of bacterial culture was 86.7% (13/15) after treatment. Average antibiotic residue concentrations in aqueous humor was 0.050 +/- 0.038 microg/mL. No side effects from the drug were reported during the experimental period. CONCLUSIONS: Although the 0.3% tosufloxacin eyedrops were not effective in all bacterial strains and showed relatively low penetration rate into the anterior chamber, they were effective in some gram positive organisms, particularly in coagulase-negative staphylococci of normal ocular surface flora.
Anterior Chamber ; Antibiotic Prophylaxis ; Aqueous Humor ; Cataract ; Humans ; Intravitreal Injections ; Ophthalmic Solutions

PURPOSE: To evaluate the efficacy of pre- and post-operative use of topical 0.05% cyclosporine A (CsA) in mild dry eye patients having refractive surgery. METHODS: This randomized prospective study included 40 patients with mild dry eye syndrome who were scheduled for laser in situ keratomileusis (LASIK). All patients were divided into 2 groups. Patients in the CsA group used both 0.1% sodium hyaluronate (HA) and 0.05% CsA from 2 weeks before to 8 weeks after the surgery, while patients in the control group used 0.1% HA only. Ocular surface disease index (OSDI), tear film break-up time (TF-BUT), Oxford Stain Score (OSS), and tear osmolarity were evaluated before surgery and 1, 4, and 8 weeks after surgery. RESULTS: TF-BUT was significantly longer in the CsA group at 1 and 4 weeks post-operatively (p = 0.024, p = 0.036) compared to the control group. Tear osmolarity was significantly lower in the CsA group at 1 week post-operatively (p = 0.004) compared to the control group. CONCLUSIONS: The pre- and post-operative use of topical 0.05% CsA is effective in alleviating dry eye symptom after LASIK in patients with dry eye syndrome.
Cyclosporine* ; Dry Eye Syndromes ; Humans ; Hyaluronic Acid ; Keratomileusis, Laser In Situ ; Osmolar Concentration ; Prospective Studies ; Refractive Surgical Procedures* ; Tears

PURPOSE: To evaluate the efficacy of pre- and post-operative use of topical 0.05% cyclosporine A (CsA) in mild dry eye patients having refractive surgery. METHODS: This randomized prospective study included 40 patients with mild dry eye syndrome who were scheduled for laser in situ keratomileusis (LASIK). All patients were divided into 2 groups. Patients in the CsA group used both 0.1% sodium hyaluronate (HA) and 0.05% CsA from 2 weeks before to 8 weeks after the surgery, while patients in the control group used 0.1% HA only. Ocular surface disease index (OSDI), tear film break-up time (TF-BUT), Oxford Stain Score (OSS), and tear osmolarity were evaluated before surgery and 1, 4, and 8 weeks after surgery. RESULTS: TF-BUT was significantly longer in the CsA group at 1 and 4 weeks post-operatively (p = 0.024, p = 0.036) compared to the control group. Tear osmolarity was significantly lower in the CsA group at 1 week post-operatively (p = 0.004) compared to the control group. CONCLUSIONS: The pre- and post-operative use of topical 0.05% CsA is effective in alleviating dry eye symptom after LASIK in patients with dry eye syndrome.
Cyclosporine* ; Dry Eye Syndromes ; Humans ; Hyaluronic Acid ; Keratomileusis, Laser In Situ ; Osmolar Concentration ; Prospective Studies ; Refractive Surgical Procedures* ; Tears

PURPOSE: To report a case of rapidly progressing foveal atrophy with tuberculous serpiginous-like choroiditis. CASE SUMMARY: A 54-year-old female patient had decreased vision of hand motions (os) for 3 days. Fundus examination showed optic disc swelling and yellowish chorioretinal lesions in the posterior pole (os). Optical coherence tomography (OCT) showed intraretinal edema and subretinal fluid in the left macula. Routine laboratory tests, serologic tests, and magnetic resonance imaging results were normal except for erythrocyte sedimentation rate (28 mm/hr). Fluorescein angiography showed the chorioretinal lesions appeared to be early hypofluorescence followed by late hyperfluorescence. Indocyanine green angiography showed hypofluorescence during early and late phases and the result of interferon-gamma release assay was positive. Under diagnosis of tuberculous serpiginous-like choroiditis, anti-tuberculous therapy combined with systemic corticosteroid was started. Despite decreased optic disc swelling, OCT showed a rapid progression of foveal atrophy within 2 weeks. Twelve weeks later, visual acuity was finger count at 10 cm. Six months later, best-corrected visual acuity and foveal atrophy were no interval change. CONCLUSIONS: Tuberculous serpiginous-like choroiditis with foveal involvement can show rapidly progressive foveal atrophy and poor visual prognosis.
Angiography ; Atrophy ; Blood Sedimentation ; Choroid ; Choroiditis ; Edema ; Female ; Fingers ; Fluorescein Angiography ; Hand ; Humans ; Indocyanine Green ; Interferon-gamma Release Tests ; Magnetic Resonance Imaging ; Prognosis ; Serologic Tests ; Subretinal Fluid ; Tomography, Optical Coherence ; Vision, Ocular ; Visual Acuity

PURPOSE: The aim of the present study was to determine whether an association exists between UGT1A4 gene polymorphisms (P24T and L48V) and the occurrence of lamotrigine (LTG)-induced rash. METHODS: Ten patients with LTG-induced rash were examined for the P24T and L48V genetic polymorphisms. The results were compared with 42 epilepsy patients without LTG-induced rash and 143 non-exposure epilepsy patients. RESULTS: P24T polymorphism was not found; all studied subjects were homozygous for the 24P allele. Genetic heterogeneity of the L48V polymorphism existed, but the genetic proportions and allele frequencies of L48V polymorphism were not significantly different in the three groups of patients (p>0.05, by Fisher's Exact Test). CONCLUSION: The results of our study suggest that it is unlikely that the L48V polymorphism in the UGT1A4 gene is an important factor underlying LTG-induced rash development, especially in the absence of P24T polymorphism.
Alleles ; Epilepsy ; Exanthema* ; Gene Frequency ; Genetic Heterogeneity ; Humans ; Polymorphism, Genetic

No abstract available.
Kidney Failure, Chronic* ; Renal Dialysis*

A 45-year-old woman with recurrent disturbances of consciousness for 4 years with hypoglycemia was hospitalized with the clinical suspicion of an insulinoma. The findings of transabdominal ultrasonography, computed tomography and angiography were negative. Transhepatic venous sampling for pancreatic hormone assay showed sudden step-up of serum level of insulin in the venous blood from the tail of the pancreas. Finally, an endoscopic ultrasonographic examination established with certainty the origin of the tumor from the tail of the pancreas, which was subsequently confirmed at operation. In conclusion, endoscopic ultrasonography is a useful and valuable procedure for the localization of insulinoma especially in patient with insulinoma of the pancreas that cannot be localized by conventional methods.
Angiography ; Consciousness ; Endosonography* ; Female ; Humans ; Hypoglycemia ; Insulin ; Insulinoma* ; Middle Aged ; Pancreas ; Ultrasonography

Inflammatory pseudotumors, which clinically mimic neoplasms, are space-occupying collections of inflammatory cells, histiocytes, and fibroblasts. They are most often found in the orbits and lungs, but rarely in the head and neck region, and hardly ever in the nasal septum. Here we report on a 71-year-old woman with pseudotumor cerebri and an inflammatory pseudotumor of the nasal septum. This case demonstrates that inflammatory pseudotumor can cooccur in the brain and nasal septum.
Aged ; Brain ; Female ; Fibroblasts ; Granuloma, Plasma Cell* ; Head ; Histiocytes ; Humans ; Lung ; Nasal Septum* ; Neck ; Orbit ; Pseudotumor Cerebri

OBJECTIVE: To investigate the clinical applicability of the somatosensory evoked potentials (SEPs) study in early detection of diabetic neuropathy, and compare the results in different degrees of the disease. METHOD: The study was performed retrospectively with prospective data collection. The Toronto clinical scoring system was taken as well as nerve conduction study, needle electromyography, and SEPs study with median and posterior tibial nerve stimulations in thirty-eight diabetic patients and twenty non-diabetic adults. The subjects were divided into the non-neuropathy group and the neuropathy group, and the latter was divided into three subgroups (suspected, probable, and definite) according to the degree of neuropathy. Statistical analysis was performed with height and age-related correction of reference values of the latency of SEPs with posterior tibial nerve stimulation. RESULTS: The Toronto clinical scoring system showed concordance with the degree of the diabetic neuropathy (p<0.05, correlation coefficient=0.827). SEPs study with posterior tibial nerve stimulations showed statistically significant latency delay, not only in the neuropathy group, but also in the non-neuropathy group, compared with the non-diabetic group (p<0.05). Moreover, the latency delay was noted in proportion to the degree of the diabetic neuropathy within the neuropathy group. Interpretation of the data with height and age-corrected reference values of latency of posterior tibial SEPs had stronger correlation. CONCLUSION: The SEPs study is useful in the early diagnosis of diabetic neuropathy. However, application of the SEPs to clinical use needs to go through height and age correction.
Adult ; Data Collection ; Diabetic Neuropathies ; Early Diagnosis ; Electromyography ; Evoked Potentials, Somatosensory ; Humans ; Needles ; Neural Conduction ; Prospective Studies ; Reference Values ; Retrospective Studies ; Tibial Nerve