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 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

Although Toxocara canis is known to cross the blood-brain barrier, central nervous system involvement is uncommon. Clinical manifestations vary and include cerebral infarction, meningoencephalitis, myelitis, vasculitis or seizure. However cerebral infarction and meningoencephalitis rarely occur simultaneously. We report a case of multiple cerebral infarction combined with eosinophilic meningoencephalitis in a patient with neurotoxocariasis. After control of increased intracranial pressure and treatment with albendazole and steroid, the patient’s clinical symptoms improved markedly.

No abstract available.
Abscess ; Carotid Arteries ; Stents

No abstract available.
Central Nervous System ; Lymphoma

No abstract available.
Cerebral Infarction ; Humans ; Intracranial Arteriosclerosis ; Subarachnoid Hemorrhage

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: The purpose of this study was to compare the clinical and functional outcomes in patients with primary base of tongue (BOT) cancer who received definitive radiotherapy (RT) or surgery followed by radiotherapy (SRT). MATERIALS AND METHODS: Between January 2002 and December 2016, 102 patients with stage I-IVB primary BOT cancer underwent either definitive RT (n=46) or SRT (n=56), and treatment outcomes were compared between two groups. The expression of p16 was also analyzed. RESULTS: The RT group had more patients with advanced T stage (T3-4) disease (58.7% vs. 35.7%, p=0.021) and who received chemotherapy (91.3% vs. 37.5%, p < 0.001) than the SRT group. At a median follow up of 36.9 months (range, 3.3 to 181.5 months), the 5-year overall survival (OS) and disease-free survival (DFS) were 75.5% and 68.7%, respectively. With respect to treatment group, the 5-year OS and DFS in the RT and SRT groups did not differ significantly (OS, 68.7% vs. 80.5%, p=0.601; DFS, 63.1% vs. 73.1%, p=0.653). In multivariate analysis, OS differed significantly according to p16 expression (p16-negative vs. p16-positive; hazard ratio [HR], 0.145; 95% confidence interval [CI], 0.025 to 0.853; p=0.033). Regarding DFS, p16 expression (p16-negative vs. p16-positive; HR, 0.164; 95% CI, 0.045 to 0.598; p=0.006) showed a significant effect in multivariate analysis. Functional defects (late grade ≥ 3 dysphagia or voice alteration) were more frequently reported in the SRT than in the RT group (16.1% vs. 2.2%, p=0.021). CONCLUSION: Despite advanced disease, patients in the RT group showed comparable survival outcomes and better functional preservation than those in the SRT group.
Chemoradiotherapy* ; Deglutition Disorders ; Disease-Free Survival ; Drug Therapy ; Follow-Up Studies ; Humans ; Multivariate Analysis ; Organ Preservation ; Radiotherapy ; Radiotherapy, Adjuvant* ; Tongue Neoplasms* ; Tongue* ; Treatment Outcome ; Voice