Paralytic lagophthalmos and ectropion by leprosy are serious complications of facial paralysis, which may lead to exposure keratitis, corneal ulceration, and further lead to blindness. In 1995 and 1997, we reported in this journal on the surgical treatment of 38 patients and 98 patients suffering with paralytic lagophthalmos and ectropion. In the first report of 1995, for lid closing I(Ahn) performed the method of traditional surgery such as temporal muscle transfer, medial and lateral canthoplasty as well as gold implant. In the 2nd report of 1997, we(Ahn and Park) presented the results of our combination treatment that changed the design and weight of the gold plate inserted in upper lid, and the medial canthoplasty and horizontal shortening in lower lid. Combination treatment provided for near normal eye closure and aesthetically pleasing appearance without the drawbacks associated with other methods such as eye clinching in concert with mouth closure, donor site deformities resulting from temporalis muscle transfer, and over exposure of carbuncle due to stretching effects of lateral canthoplasty. We have now found that raising the level of the lower lid margin to the sclera is important in concealing the scleral show due to drooping of the lower lid. We grafted conchal cartilage in a 5 x 35 mm sized band, which was fixed at the medial and lateral canthal area in 57 patients during the recent 3 years. We also added the ancillary procedure of the horizontal shortening in cases of highly atonic lower lid. We have noted that gold implantation in the upper eyelid and cartilage graft in the lower eyelid, with optional horizontal shortening, successfully corrected the lagophthalmos and ectropion due to facial nerve palsy.
Blindness ; Carbuncle ; Cartilage* ; Congenital Abnormalities ; Corneal Ulcer ; Ectropion* ; Eyelids ; Facial Nerve ; Facial Paralysis ; Humans ; Keratitis ; Leprosy ; Mouth ; Paralysis ; Sclera ; Temporal Muscle ; Tissue Donors ; Transplants

PURPOSE: To investigate the change of retinal volume according to anterior segment refractive power using contact lens by spectral domain optical coherence tomography (SD-OCT). METHODS: The retinal volume was measured using a SD-OCT (Heidelberg retinal angiography Spectralis + OCT, Heidelberg Engineering, Heidelberg, Germany) in 60 subjects without any underlying disease. The same examiner performed a 31-section macular volume-scan at 240 µm intervals, re-measured the same area by changing the refractive power of the anterior segment by wearing soft contact lenses of +6.0 diopters and −6.0 diopters. By using the ImageJ software to calculate the cross-sectional area and of the cross-sectional area and the volume was measured. RESULTS: The mean age of the participants was 25.6 ± 1.5 years and the mean axial length was 25.7 ± 1.57 mm. The volume of the posterior pole retina measured without the contact lens was 13.48 ± 0.05 and the mean volume of the retina measured with +6.0 diopter and −6.0 diopter contact lens in the same patient was 13.47 ± 0.07 mm³ and 13.48 ± 0.05 respectively. The mean volume was significantly lower(p = 0.036) in the measurement with the +6.0 diopter lens than in the measurement without the lens, and the mean volume was significantly higher in the measurement with the +6.0 diopter lens (p = 0.042). The change in retinal thickness was increased with longer axial length (r = 0.32, p < 0.05), but the central foveal thickness did not correlate with anterior corneal power (p = 0.463). CONCLUSIONS: The volume of the retina measured using the SD-OCT is affected by the refractive power of the anterior segment and the axial length. Therefore, it is necessary to consider the change of refractive index because it can change the retinal volume measured by SD-OCT.
Angiography ; Contact Lenses, Hydrophilic ; Humans ; Refractometry ; Retina ; Retinaldehyde ; Tomography, Optical Coherence

OBJECTIVE: Cranial nerve dysfunction is common after endovascular treatment of a cavernous sinus dural arteriovenous fistula and sometimes this symptom persists. We reviewed the treatment outcomes of the patients with cavernous sinus dural arteriovenous fistula and who were treated with endovascular technique, and we analyzed the characteristics of those patients who had cranial nerve palsy after treatment. METHODS: Between May 2003 and July 2010, 25 patients were treated by an endovascular technique at our institution. Their medical records were reviewed and we analyzed their data, including the clinical presentation, the neurological deficits, the radiographic features and the treatment outcomes. RESULTS: In our series, a total of 25 patients (28 cases) received endovascular treatment. There were four male patients and twenty one female patients with an age range of 26-78 years (mean age : 57.4 years). Complete occlusion was observed in nineteen cases (67.9%) and 5 cases (17.9%) showed near complete occlusion. Additional procedures were required for four cases with fistulas that were partially occluded by previous treatment. Twenty four patients (96%) showed improved symptoms during the follow up and only one patient suffered from persistent symptoms. Procedure-related complications were observed in 2 cases. New cranial nerve palsy was observed in four patients (16%) and two patients experienced aggravation of their existing cranial nerve palsy. One of them had persistent deficits at the final follow up. CONCLUSION: Sufficient occlusion and avoidance of over-compaction of coils are important to prevent cranial nerve palsy when performing endovascular treatment of cavernous sinus dural arteriovenous fistulas.
Cavernous Sinus ; Caves ; Central Nervous System Vascular Malformations ; Cranial Nerve Diseases ; Cranial Nerves ; Endovascular Procedures ; Female ; Fistula ; Follow-Up Studies ; Humans ; Male ; Medical Records ; Retrospective Studies

Purpose: The purpose of this study was to analyze the transcriptomic changes in the striatum of amyloid precursor protein/presenilin 1 (APP/PS1) transgenic mice and uncover its association with the methyl-CpG binding protein 2 (MeCP2) mediated-changes in striatal epigenetic signature during Alzheimer disease (AD) pathological progression. Methods: To observe transcriptomic alterations in the striatum before the onset of cognitive impairment in APP/PS1 mice, quantitative 3’mRNA sequencing was performed with RNA extracted from the striatum of 6-month-old and 12-month-old wildtype and APP/PS1 mice. In addition, chromatin immunoprecipitation sequencing was conducted with the DNA from wildtype and APP/PS1 mice of the same age as aforementioned. For transcriptomic analysis, comparison terms were constructed based on aging and transgene expression—normal-aging (12-month-old wildtype/6-month-old wildtype), early-AD (6-month-old APP/PS1/6-month-old wildtype), and late-AD (12-month-old APP/PS1/6-month-old wildtype). To compare the changes in biological pathways and networks, we analyzed gene lists from each comparison term via bioinformatics tools including DAVID (Database for Annotation, Visualization, and Integrated Discovery), STRING (Search Tool for the Retrieval of Interacting Genes/Proteins), and SynGO (Synaptic Gene Ontologies). Furthermore, to assume the effect MeCP2 in AD pathological conditions may have on the transcriptome regulation, analysis of the common genes from Quant-Seq and MeCP2-ChIP-Seq was performed. Results: Enriched pathways including immune system and inflammatory response were confirmed in normal- aging and lateAD, respectively. In particular, enriched pathways of gene expression regulation, transcriptional regulation, and protein catabolic pathways were found to be significantly altered in early-AD. MeCP2-bound genes that were significantly altered in the transcriptome were suggested to be target genes that have a role in the striatum of the early-stage AD model. Conclusions This study confirmed that the alteration of the striatal transcriptomic profile in APP/PS1 mice was involved with several biological pathways. Additionally, comparative analysis of the transcriptomic changes and the MeCP2 bound regions found that a group of differentially expressed genes may be regulated under the epigenetic control of MeCP2.

Cytologic diagnosis of nuclear protein in testis (NUT) midline carcinoma (NMC) is important due to its aggressive behavior and miserable prognosis. Early diagnosis of NMC can facilitate proper management, and here we report two rare cases of thoracic NMC with cytohistologic correlation. In aspiration cytology, the tumor presented with mixed cohesive clusters and dispersed single cells, diffuse background necrosis and many neutrophils. Most of the tumor cells had scanty cytoplasm and medium-sized irregular nuclei, which had fine to granular nuclear chromatin. Interestingly, a few dyskeratotic cells or squamoid cell clusters were present in each case. Biopsy specimen histology revealed more frequent squamous differentiation, and additional immunohistochemistry tests showed nuclear expression of NUT. Because this tumor has a notorious progression and has been previously underestimated in terms of its prevalence, awareness of characteristic findings and proper ancillary tests should be considered in all suspicious cases.
Biopsy ; Chromatin ; Cytoplasm ; Diagnosis ; Early Diagnosis ; Immunohistochemistry ; Lung ; Necrosis ; Neutrophils ; Nuclear Proteins ; Nuts ; Prevalence ; Prognosis ; Testis

No abstract available.
Central Nervous System ; Lymphoma

Acute puerperal uterine inversion is a rare postpartum obstetric complication; however, without rapid diagnosis and appropriate management, it is life-threatening. Substantial bleeding hinders the verification of a partially inverted uterus, possibly delaying the treatment. Herein, we present the report of a 32-year-old female presenting with massive postpartum bleeding managed by uterine artery embolization. The peculiar course of the uterine artery bowing inferiorly along the inverted fundus during embolization could uncover the uterine inversion, which was not diagnosed by physical examination and CT. In conclusion, uterine artery embolization is not only an effective therapeutic strategy for postpartum hemorrhage but also a valuable tool for diagnosing uterine inversion.

PURPOSE: To evaluate the clinical outcomes of patients who underwent radiation therapy with or without targeted molecular therapy for the treatment of spinal metastasis from renal cell carcinoma (RCC). MATERIALS AND METHODS: A total of 28 spinal metastatic lesions from RCC patients treated with radiotherapy between June 2009 and June 2015 were retrospectively reviewed. Thirteen lesions were treated concurrently with targeted molecular therapy (concurrent group) and 15 lesions were not (nonconcurrent group). Local control was defined as lack of radiographically evident local progression and neurological deterioration. RESULTS: At a median follow-up of 11 months (range, 2 to 58 months), the 1-year local progression-free rate (LPFR) was 67.0%. The patients with concurrent targeted molecular therapy showed significantly higher LPFR than those without (p = 0.019). After multivariate analysis, use of concurrent targeted molecular therapy showed a tendency towards improved LPFR (hazard ratio, 0.13; 95% confidence interval, 0.01 to 1.16). There was no difference in the incidence of systemic progression between concurrent and nonconcurrent groups. No grade ≥2 toxicities were observed during or after radiotherapy. CONCLUSION: Our study suggests the possibility that concurrent use of targeted molecular therapy during radiotherapy may improve LPFR. Further study with a large population is required to confirm these results.
Carcinoma, Renal Cell* ; Follow-Up Studies ; Humans ; Incidence ; Molecular Targeted Therapy* ; Multivariate Analysis ; Neoplasm Metastasis* ; Radiotherapy ; Retrospective Studies ; Treatment Outcome*

PURPOSE: Cell-free DNA (cfDNA) is gaining attention as a novel biomarker for oncologic outcomes. We investigated the clinical significance of cfDNA in hepatocellular carcinoma (HCC) patients treated with radiotherapy (RT). MATERIALS AND METHODS: Fifty-five patients with HCC who received RT were recruited from two prospective study cohorts: one cohort of 34 patients who underwent conventionally fractionated RT and a second of 21 patients treated with stereotactic body radiation therapy. cfDNA was extracted and quantified. RESULTS: In total, 30% of the patients had multiple tumors, 77% had tumors >2 cm, and 32% had portal vein tumor thrombus. Optimal cut-off values for cfDNA levels (33.65 ng/mL and 37.25 ng/mL, before and after RT) were used to divide patients into low-DNA (LDNA) and high-DNA (HDNA) groups. The pre-RT HDNA group tended to have more advanced disease and larger tumors (p=0.049 and p=0.017, respectively). Tumor response, intrahepatic failure-free rates, and local control (LC) rates were significantly better in the post-RT LDNA group (p=0.017, p=0.035, and p=0.006, respectively). CONCLUSION: Quantitative analysis of cfDNA was feasible in our cohorts. Post-RT cfDNA levels were negatively correlated with treatment outcomes, indicating the potential for the use of post-RT cfDNA levels as an early predictor of treatment responses and LC after RT for HCC patients.
Biomarkers ; Carcinoma, Hepatocellular* ; Cohort Studies ; DNA* ; Humans ; Plasma* ; Portal Vein ; Prospective Studies ; Radiotherapy* ; Thrombosis

Purpose: In Alzheimer disease (AD), brain regions such as the cortex and the hippocampus show abundant amyloid load which correlates with cognitive function decline. Prior to the significant development of AD pathophysiology, patients report the manifestation of neuropsychiatric symptoms, indicating a functional interplay between basal ganglia structures and hippocampal regions. Zinc finger and BTB domain-containing protein 16 (ZBTB16) is a transcription factor that controls the expression of downstream genes and the involvement of ZBTB16 in the striatum undergoing pathological aging in AD and the resulting behavioral phenotypes has not yet been explored. Methods: To study molecular alterations in AD pathogenesis, we analyzed the brain from amyloid precursor protein (APP)/ presenilin 1 (PS1) transgenic mice. The molecular changes in the striatal region of the brain were analyzed via the immunoblotting, and the quantitative RNA sequencing. The cognitive impairments of APP/PS1 mice were assessed via 3 behavioral tests: 3-chamber test, Y-maze test, and noble object recognition test. And multielectrode array experiments for the analysis of the neuronal activity of the striatum in APP/PS1 mice was performed. Results: We found that the alteration in ZBTB16 levels that occurred in the early ages of the pathologically aging striatum coalesces with the disruption of transcriptional dysregulation while causing social memory deficits, anxiety-like behavior. The early ZBTB16 knockdown treatment in the striatum of APP/PS1 mice rescued cognition that continued into later age. Conclusions This study demonstrates that perturbation of transcriptional regulation of ZBTB16 during pathological aging may influence cognitive impairments and reveals a potent approach to targeting the transcriptional regulation of the striatum for the treatment of AD.