PURPOSE: To report a case of herpes simplex keratitis after descemet stripping automated endothelial keratoplasty (DSAEK). CASE SUMMARY: A 66-year-old male underwent DSAEK in his right eye due to bullous keratopathy after cataract surgery. The corneal epithelium which was removed during surgery was healed, but the patient was experiencing pain and decreased visual acuity in his right eye 1 month after surgery. Increasing corneal epithelial defects and corneal edema were observed on slit-lamp examination. Therapeutic soft contact lenses and artificial tears were used for treatment but were not effective, thus amniotic membrane transplantation was performed. Three months after transplantation, the epithelial defect appeared as a geographic ulcer suspecting to be herpes simplex keratitis; therefore, ganciclovir ophthalmic ointment and oral acyclovir were administered. Six months after antiviral therapy, the epithelial lesion of herpes simplex keratitis completely disappeared, leaving only mild corneal opacity. CONCLUSIONS: If corneal epithelial defects are persistent after DSAEK in patients even with no past history of herpes simplex keratitis, herpes simplex keratitis should be considered in the differential diagnosis.
Acyclovir ; Aged ; Amnion ; Cataract ; Contact Lenses, Hydrophilic ; Corneal Edema ; Corneal Transplantation ; Diagnosis, Differential ; Epithelium, Corneal ; Eye ; Ganciclovir ; Herpes Simplex ; Humans ; Keratitis, Herpetic ; Male ; Methylmethacrylates ; Ophthalmic Solutions ; Polystyrenes ; Transplants ; Ulcer ; Visual Acuity

PURPOSE: To evaluate the long-term changes in the corneal sensitivity and to analyze which tear film parameters correlate with corneal sensitivity after penetrating keratoplasty (PKP). METHODS: Twenty-eight eyes of 28 patients who underwent PKP were included in the present study. Corneal sensitivity, Schirmer test, tear break-up time, tear clearance rate, and keratoepitheliopathy were evaluated at 1, 3, 6, 12, and 24 months postoperatively. Then, which tear film parameters correlated with corneal sensitivity during the follow-up period were analyzed. RESULTS: Corneal sensitivity was 5.18 +/- 3.96 mm at one month postoperatively and increased to 29.64 +/- 12.39 mm (p < 0.05) at 24 months postoperatively but was still not in the normal range. Tear break-up time and keratoepitheliopathy improved at postoperative three months and six months, respectively, compared with one month postoperatively, and both measures normalized at 24 months postoperatively. Schirmer test results and tear clearance rate were in the normal range during the follow-up period. Corneal sensitivity was correlated with tear break-up time from three to 24 months postoperative and with tear clearance rate from one month to 24 months postoperative (p < 0.05). CONCLUSIONS: Change in corneal sensitivity after penetrating keratoplasty correlates with tear break-up time and tear clearance rate; therefore, tear break-up time and tear clearance rate can be used as parameters for management of dry eye after PKP.
Eye ; Follow-Up Studies ; Humans ; Keratoplasty, Penetrating ; Reference Values ; Tears

PURPOSE: To review the recent changes in the clinical features of ocular trauma in pediatric patients younger than 15 years of age. METHODS: We performed a retrospective study using clinical records of 147 patients from 1993 to 1998, and those of 175 pediatric patients younger than 15 years old from 2003 to 2007. RESULTS: The most common cause of pediatric ocular trauma in the 2000's was fist blow (66 patients, 37.7%), while that in the 1990's was trauma by stick or branch (20 patients, 13.6%) (p < 0.001). The number of patients with perforating ocular trauma decreased to 25 patients (14.3%) in the 2000's, from 55 patients (37.4%) in the 1990's (p < 0.001). The number of patients who received surgery due to ocular trauma was 87 (59.2%) in the 1990's, decreasing to 53 (30.3%) in the 2000's (p < 0.001). The number of orbital wall reconstructions increased from 6 patients (6.9%) in the 1990's to 20 patients (37.7%) in the 2000's, a statistically significant increase (p < 0.001). CONCLUSIONS: Perforating ocular trauma decreased in children in the studied age range, but non-perforating injuries caused by fist blow were increased in the years studied. These results indicate that management or establishment of preventive for pediatric violence will be helpful to lower the frequency of pediatric ocular traumas.
Child ; Eye ; Humans ; Orbit ; Retrospective Studies ; Violence

PURPOSE: To evaluate clinical effects of intracameral voriconazole injection in fungal keratitis refractory to conventional therapy. METHODS: Thirty-eight eyes of 38 patients with fungal keratitis were included in this study. The patients were divided into 3 groups: 13 patients with intracameral voriconazole injection (50 microg/0.1 ml; group A), 11 patients with intracameral amphotericin B injection (10 microg/0.1 ml; group B), and 14 patients with conventional therapy only (group C). Clinical factors including treatment success rate and time to successful treatment were evaluated. RESULTS: Treatment success was accomplished in 12 eyes in group A (92.3%), 10 eyes in group B (90.9%), and 12 eyes in group C (85.7%). Time to treatment success in group A, B, and C was 36.1 +/- 10.4 days (p = 0.04), 34.2 +/- 7.8 days (p = 0.03), and 49.5 +/- 16.7 days, respectively. Patients who had received intracameral voriconazole injection or amphotericin B showed faster fungal keratitis improvement than patients who received conventional treatment. Time to re-epithelialization and time to disappearance of hypopyon showed a similar clinical course. CONCLUSIONS: Intracameral voriconazole injection, which has a similar therapeutic effect as intracameral amphotericin B injection in the management of fungal keratitis, can be helpful in the treatment of intractable fungal keratitis.
Amphotericin B ; Eye ; Humans ; Keratitis ; Pyrimidines ; Re-Epithelialization ; Time-to-Treatment ; Triazoles

Diffuse pulmonary nodular lesions have many causes. When they are caused by infection, the likely organisms are M. tuberculosis and various fungi. Silicosis, eosinophilic granuloma and pulmonary metastasis should be considered for differential diagnosis. Differential diagnosis needs detailed clinical history, physical examination and various laboratory tests. A case of persistent diffuse pulmonary nodular lesions which had persisted 5 years is reported. The patient was a 25 years old man with minimal pulmonary symptoms. Detailed past history and physical examination suggested thyroid tumor. Chest radiography showed numerous evenly sized well-defined nodules scattered in entire lung fields. Previous chest X-rays showed similar nodular lesions, which had lasted for 5 years. The number of nodules was slightly increased. Neck CT showed heterogenous mass in left lobe of thyroid gland and multiple lymphadenopathies along both internal jugular chains. Total thyroidectomy was performed. A case of lung metastasis which progressed slowly in papillary thyroid cancer is reported.
Diagnosis, Differential ; Eosinophilic Granuloma ; Fungi ; Humans ; Lung ; Neck ; Neoplasm Metastasis ; Physical Examination ; Radiography ; Silicosis ; Thorax ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy ; Tuberculosis

BACKGROUND AND OBJECT: Immunostimulatory CpG-oligodeoxynucleotides (ISS CpG-ODN) up-regulate the TH1-type immune response and down-regulate the TH2-type response. This study was performed to investigate the immune response changes resulting from ISS CpG-ODN on bronchial hyperrestponsiveness, eosinophilic inflammation and mucus hypersecretion in rat asthma. MATERIALS AND METHODS: 10 normal controls(NC) and 26 asthmatic rats, which were generated by ovallbumin(OVA) sensitization and challenge, were studied. The asthmatic rats were randomized into 11 asthma controls(AC) and 15 in the asthma-CpG treatment group(CpG). The CpG group was administered ISS CpG-ODN intramuscularly and the AC group was administered a placebo(0.9% NaCl)on day 15 and 20. After CpG-ODN or placebo administration, we measured the IFN-(TH1-type cytokine) and IL-4(TH2-type cytokine) levels in the bronchoalveolar lavage fluid(BALF), the specific airway resistance(sRaw), eosinophilic fraction in BALF, eosinophilic infiltration, goblet cell dysplasia and MUC5AC gene expression in the lung tissue. RESULTS: In the BALF of the CpG group, the IFN-γ concentration was significantly high and the IL-4 concentration was significantly low when compared with the AC group. Both the sRaw and eosinophilic fraction, and infiltration into the BALF and lung tissue significantly lower in the CpG group when compared with the AC group. However, little difference in goblet cell dysplasia and MUC5Ac gene expression was observed between the CpG group and the Ac group. CONCLUSION: ISS CpG-ODN decreases bronchial hyperresponsiveness and eosinophilic inflammation in the rat asthma model through the up-regulation of the TH1-type immune response with the down-regulation of the TH2-type response. However, the effect of these immune response changes on mucus hypersecretion was is not remarkable in this study.
Animals ; Asthma* ; Bronchoalveolar Lavage ; Down-Regulation ; Eosinophils ; Gene Expression ; Goblet Cells ; Inflammation ; Interleukin-4 ; Lung ; Mucus ; Rats* ; Up-Regulation

Cryoglobulinemia is the presence of globulins in the serum that precipitate on exposure to cold temperatures (cryoglobulins). Pulmonary complications of cryoglobulinemia include interstial infiltration, impaired gas exchange, small airway disease and pleurisy. Only one other acute respiratory distress syndrome(ARDS) case has been described in patients with cryoglobulinemia. A 55-years old man was admitted with dyspnea. He had been diagnosed as being a hepatitis B virus antigen carrier 15 years age. On the first admission, chest radiography showed a bilateral pleural effusion and a patchy infiltration on both lungs. On protein-and immuno-electrophoresis, cryoglobulinemia was confirmed. The patient was treated with corticosteroid and plasmapheresis. Forty-five days after the diagnosis, the patient complained of progressive dyspnea and showed a diffuse bilateral pulmonary infiltration on chest radiography. Despite intensive care with mechanical ventilation, the patient died as consequence of hypoxemia and multiple systemic organ failure. On a pathologic examination of the postmortem lung biopsy, multiple necrotizing vasculitis and increased infiltration of the lymphocytes and monocytes were observed. In conclusion, ARDS developed as a result of pulmonary hemorrhage due to cryoglobulinemia-associated vasculitis.
Anoxia ; Biopsy ; Cold Temperature ; Cryoglobulinemia ; Diagnosis ; Dyspnea ; Globulins ; Hemorrhage ; Hepatitis B virus ; Humans ; Critical Care ; Lung ; Lymphocytes ; Monocytes ; Plasmapheresis ; Pleural Effusion ; Pleurisy ; Radiography ; Respiration, Artificial ; Respiratory Distress Syndrome, Adult* ; Thorax ; Vasculitis

Lichen planus is a chronic inflammatory disease that mainly involves the skin and oral mucosa. We report the case of a 57-year-old female who presented with a 6-week history of localized violaceous papules on her back and both extremities. Prior to presentation, she had received acupuncture on her back and both extremities, and 2 weeks later skin lesions occurred along the treated area. From the histopathologic findings of the lesion, the patient was diagnosed with lichen planus and treated with intralesional and topical corticosteroids. Dermatologic diseases such as atypical mycobacterial infection, foreign body granuloma and contact urticaria associated with traditional Korean medicine treatments have been reported. To the best of our knowledge, there has been only one report of eruptive lichen planus triggered by acupuncture in English literature to date. Herein, we report this rare and interesting case of lichen planus related to acupuncture.
Acupuncture* ; Adrenal Cortex Hormones ; Extremities ; Female ; Granuloma, Foreign-Body ; Humans ; Lichen Planus* ; Lichens* ; Middle Aged ; Mouth Mucosa ; Skin ; Urticaria

Primary lung cancer frequently metastasizes to distant organs. But breast is a very rare site of metastasis. So, accurate diagnosis is essential to rule out primary breast cancer. A 62-year old woman who had complained of cough was diagnosed as small cell lung carcinoma of the right lower lobe. She had a 2.5cm sized lobular mass in left upper mid portion of breast. Sonoguided breast biopsy revealed small cell carcinoma consistent with metastatis from primary lung cancer. She also had bone metastses to the scapula and the vertebrae. We report the case of metastatic breast cancer from small cell lung carcinoma.
Biopsy ; Breast Neoplasms ; Breast* ; Carcinoma, Small Cell ; Cough ; Diagnosis ; Female ; Humans ; Lung Neoplasms ; Middle Aged ; Neoplasm Metastasis ; Scapula ; Small Cell Lung Carcinoma* ; Spine

A 58-year-old man was admitted after suffering dyspnea and pleuritic chest pain on his right side for one week. A chest X-ray revealed necrotizing pneumonia and a lung abscess on right upper lobe. Despite of antibiotics and supportive care, a complicated parapneumonic effusion developed on his right side. Closed thoracostomy was performed for drainage. However, after the thoracostomy, a bronchopleural fistula (BPF) occurred with a continuous air leak. After 30 days intensive therapy, the underlying necrotizing pneumonia and lung abscess resolved, but the BPF continued. Bronchoscopic treatment was performed because the patient was a poor candidate for surgery. After localizing the BPF with a systemic occlusion of the segmental bronchi, small strips of Gelfoam were placed in the suction channel of the flexible bronchoscopy, and either flushed with a saline solution or inserted with forceps until the cessation of air leak. The patient was discharged 10 days after the bronchoscopic treatment.
Male ; Humans