PURPOSE: To report a case of abducens nerve palsy after a percutaneous nerve blocking procedure for trigeminal neuralgia. CASE SUMMARY: A 35-year-old female complaining of stabbing pain in the right maxillary area 4 months in duration was diagnosed with trigeminal neuralgia at a pain clinic. The patient underwent a percutaneous trigeminal nerve blocking procedure using alcohol at the right maxillary nerve. After the procedure, the patient was referred to an ophthalmologic service for horizontal diplopia and abduction defect of her right eye. Her corrected visual acuity, intraocular pressure, pupillary response, anterior segment and fundus were normal bilaterally. The patient had right esotropia of 38 prism diopters in primary gaze (70 prism diopters in right gaze, 20 prism diopters in left gaze) with limited abduction of -3 in the right eye. She was diagnosed with abducens nerve palsy of the right eye. Three months after initial presentation, the patient had intermittent esotropia of 4 prism diopters at right gaze and orthophoria at the other diagnostic gazes; she presented no diplopia. CONCLUSIONS: In the present case study, abducens nerve palsy following a percutaneous trigeminal nerve blocking procedure resolved over 3 months. Because the abducens nerve is adjacent to the trigeminal nerve near the foramen ovale based on anatomical structure, when performing a percutaneous trigeminal blocking procedure, the surgeon should be aware that deep needle puncture could cause abducens nerve palsy.
Abducens Nerve ; Abducens Nerve Diseases ; Diplopia ; Esotropia ; Eye ; Female ; Foramen Ovale ; Humans ; Intraocular Pressure ; Maxillary Nerve ; Needles ; Nerve Block ; Pain Clinics ; Punctures ; Trigeminal Nerve ; Trigeminal Neuralgia ; Visual Acuity

This study is to find out changes in medical practice at a university hospital before and after covering intraocular lens (IOL) from the health insurance benefit. The coverage started on March 1, 1993 and a total of 596 cases who were discharged from July 1 to December 31, 1992 and 580 cases who were discharged from July 1 to December 31, 1993 were analyzed. Since the standard reimbursement scheme was changed from March 1, 1993, the charges for 1992 were transformed into 1993 scheme. Major findings are as follows: Average length of stay was statistically significantly decreased from 8.24 days in 1992 to 6 86 days in 1993. Charges except IOL has been statistically significantly decreased from 501,000 won in 1992 to 444,000 won in 1993. Charges for drugs and injection have been reduced. However, charge per day for them was not much different. This is due to decrease in length of stay. Charges for laboratory tests and radiologic examination were quite the same. charges which are not covered by the insurance remained the same. The revenue of the hospital was reduced as expected. However, the hospital reduced the length of stay and increase the turnover rate in order to compensate the potential loss of revenue due to the difference of reimbursement between the out-of-pocket expense and the insurance coverage. By introducing the IOL benefit in the insurance, the insured pays less, hospital generates more revenue through shortening the hospital stay, and the total medical care cost becomes less nationwidely.
Health Care Costs ; Insurance ; Insurance Coverage ; Insurance, Health* ; Length of Stay ; Lenses, Intraocular*

PURPOSE: To evaluate the clinical features of unilateral amblyopia with myopic anisometropia at a tertiary center. METHODS: The medical records of 102 children wearing spectacles due to myopic anisometropia with an interocular difference in spherical equivalent (SE) ≥ 1.00 diopters (D) with a follow-up ≥ 1 year were reviewed. Patients were classified into mild or severe groups according to an interocular SE difference ≥ 3.00D. The frequency of amblyopia (interocular difference ≥ two lines of visual acuity [VA]) and response to patching, the magnitude of anisometropia, and the frequency of combined ocular or systemic disorders except refractive errors were compared between the two groups. The VA and refractive errors were measured four months and one year after spectacle correction and at the last follow-up. RESULTS: In all, 61 patients with mild myopic anisometropia and 41 patients with severe myopic anisometropia started to wear spectacles at a mean age of 5.2 years old and were followed-up during a mean period of 34.6 months. The frequency of amblyopia decreased more prominently in the mild group: 82.0% in the mild group vs. 92.7% in the severe group four months after spectacle correction and 45.9% in the mild group vs. 87.8% in the severe group at the last follow-up. At baseline, the mild group had anisometropia of 1.42 ± 0.66D, while the severe group had anisometropia of 5.47 ± 2.09D. The magnitude of anisometropia tended to increase by 0.42D but not significantly: +0.78D in the mild group and −0.02D in the severe group. More than half of the patients had combined disorders: 57.4% in the mild group and 53.7% in the severe group. CONCLUSIONS: Severe myopic anisometropic amblyopia at a tertiary center showed little improvement and the magnitude of anisometropia did not change.
Amblyopia ; Anisometropia ; Child ; Eyeglasses ; Follow-Up Studies ; Humans ; Medical Records ; Refractive Errors ; Visual Acuity

PURPOSE: To investigate the relationship between myopic progression and exodrift after surgery in patients with intermittent exotropia (X[T]). METHODS: Eighty-five patients who underwent bilateral lateral rectus recession for X(T) and had a follow-up of more than 1 year were recruited for the present study. Progression of myopia was determined by measuring the difference in spherical equivalent of both eyes between the initial and final refraction divided by the total follow-up time per patient. Postoperative exodrift was calculated by subtracting the deviation at postoperative 6 weeks from the deviation at the last follow-up, and the deviation at postoperative day 1 from the deviation at postoperative 6 weeks. Linear regression was conducted to determine the relationship between postoperative exodrift and myopic progression. The risk factors for recurrence, defined as exodeviation of 10 prism diopters or more at the final examination, were also analyzed. RESULTS: Sixty-eight (80.0%) subjects showed myopic progression of -0.50 diopters or more, and 47 (55.3%) had recurrence of exotropia during the mean follow-up period of 37.9 months. Patients with myopic progression showed more exotropic drift after postoperative 6 weeks than the patients without myopic progression (p < 0.01). Immediate postoperative overcorrection, oblique dysfunction, and a short follow-up period were associated with a low recurrence, whereas preoperative angle of exodeviation, sensory status, and age at the time of surgery were not. CONCLUSIONS: In patients who underwent bilateral lateral rectus recession for X(T), a greater myopic progression was related with greater postoperative exodrift. As the development of myopia was observed to be axial in nature, the results from the present study raises the possibility that ocular elongation may reduce the effect of recession.
Exotropia ; Eye ; Follow-Up Studies ; Humans ; Linear Models ; Myopia ; Recurrence ; Risk Factors

Gout is the most common inflammatory arthritis in men over 40 years old and the prevalence is increasing. Asymptomatic hyperuricemia is predisposing condition of gout but the frequency of progression to acute gout is not high enough to need prophylactic treatment. In acute gout flare, first line therapy is non-steroid anti-inflammatory agents (NSAIDs) or corticosteroids, depending on comorbidities. Colchicine is now second line therapy. Urate lowering therapy for gout needs to be initiated when the second attack occurs in a year. Allopurinol, a xanthine oxidase inhibitor, has been the most widely used agent for the treatment of chronic gout. Now, febuxostat has emerged as a new xanthine oxidase inhibitor that is expected to be useful in patients with mildly decreased renal function. Uricosuric agents are alternative therapies for patients with preserved renal function and no history of nephrolithiasis. During urate lowering therapy, the dose should be titrated upward until the serum uric acid level is kept less than 6mg/dL. When initiating urate lowering therapy, concurrent prophylactic therapy with NSAIDs or low dose colchicine for more than six months is recommended for reducing flare-ups. In chronic gout treatment, dietary modification seems to have minimal effect, but alcohol drinking and weight control can be recommended.
Adrenal Cortex Hormones ; Alcohol Drinking ; Allopurinol ; Anti-Inflammatory Agents ; Anti-Inflammatory Agents, Non-Steroidal ; Arthritis ; Arthritis, Gouty ; Colchicine ; Comorbidity ; Complementary Therapies ; Food Habits ; Gout ; Humans ; Hyperuricemia ; Male ; Nephrolithiasis ; Prevalence ; Thiazoles ; Uric Acid ; Uricosuric Agents ; Xanthine Oxidase ; Febuxostat

Background: There is limited evidence on the safety of coronavirus disease 2019 (COVID-19) vaccination during pregnancy and lactation. Thus, we aimed to evaluate the association between COVID-19 vaccination during pregnancy and lactation and reporting risk of adverse pregnancy or lactation outcomes. Methods: Using VigiBase, we performed a disproportionality analysis with caseon case design. Cases were defined based on the Standardized MedDRA Queries (SMQs) of “pregnancy and neonatal topics” and non-cases were defined as all other adverse events. We included all reports with COVID-19 vaccines as the suspected cause. Using the full database as the comparators, reporting odds ratios (RORs) with 95% confidence intervals (CIs) were estimated by logistic regression while adjusting for maternal age. Infants’ age and sex were additionally adjusted in analyzing the risk of COVID-19 vaccination during lactation. Results: We identified 10,266 and 6,474 reports with the SMQ of “pregnancy and neonatal topics” associated with COVID-19 vaccines during pregnancy and lactation, respectively. No significant RORs of adverse pregnancy outcomes associated with COVID-19 vaccines during pregnancy were observed; however, “functional lactation disorders” showed significant disproportionality during lactation with adjusted ROR of 1.48 (95% CI, 1.21–1.79). Further analysis that analyzed “functional lactation disorders” at a preferred term level, showed higher ROR in mastitis (2.76 [95% CI, 1.45–5.27]). Conclusion Overall, we did not observe a positive association between COVID-19 vaccination during pregnancy and risk of reporting adverse pregnancy outcomes. However, we found a significant disproportionate reporting association between COVID-19 vaccination during lactation and “functional lactation disorders”, specifically mastitis. Continuous surveillance is warranted to confirm the safety of COVID-19 vaccine during pregnancy and lactation.

Metastatic disease involving the thyroid gland is uncommon. Thyroid metastases has been previously described from several primary cancers of lung, breast, and kidney. Because of the lower incidence and ambiguous clinical significance, it is not easy to consider thyroid metastasis and decide the optimal time for performing diagnostic examination. Here, we reported two cases of metastatic diseases of thyroid in patients who had underlying Hashimoto’s thyroiditis: a 39-year-old woman who had thyroid metastasis of breast cancer with underlying Hashimoto’s thyroiditis, and a 44-year-old woman with metastatic lung cancer.

CD4+/CD56+ hematodermic neoplasm is a rare and aggressive lesion that affects many organs, and skin involvement is highly characteristic. It is also termed blastic natural killer cell lymphoma in the World Health Organization classification. Several origins of tumor cells have been proposed, but recent studies have shown a relationship with plasmacytoid dendritic cells. A 2-year-old boy presented with multiple bruise-like violaceous subcutaneous nodules and plaques on the trunk, upper and lower extremities. Histological examination showed small-to-medium-sized blastoid cellular infiltration in the dermis and subcutaneous tissue. Tumor cells were positive for CD4, CD56 and TdT, and negative for CD8, CD20 and MPO. It primarily affects elderly patients, but, in this case, occurred in an infant. Due to its rarity, we present a case of CD4+/CD56+ hematodermic neoplasm affecting a pediatric patient.
Aged ; Dendritic Cells ; Dermis ; Humans ; Infant ; Killer Cells, Natural ; Lower Extremity ; Lymphoma ; Preschool Child ; Skin ; Subcutaneous Tissue ; World Health Organization

Lichen planus pigmentosus (LPP) is an uncommon variant of lichen planus, which manifests as hyperpigmented dark brown macular hyperpigmentations chiefly involving the face and upper extremities. The histopathologic changes consist of vacuolar degeneration of the basal layer, presence of dermal melanophages, and lichenoid lymphocytic infiltrations. LPP with exclusive localization in intertriginous areas is named as LPP-inversus, and is infrequently reported in previous dermatologic literature. A 16-year-old girl presented with several brownish to dark grayish patches on both axilla for 7 months. The lesions were asymptomatic and did not have preceding erythema. The patient had not come into contact with any chemicals and denied existence of previous allergy episodes, and her medical history was non-contributory. A skin biopsy from a brownish patch revealed vacuolar alteration of the basal layer, and band-like lymphocytic infiltration with pigment incontinence. We report a typical case of LPP-inversus with relevant literature.
Adolescent ; Axilla ; Biopsy ; Erythema ; Humans ; Hypersensitivity ; Lichen Planus ; Lichens ; Skin ; Upper Extremity

No abstract available.
Fistula* ; Stomach* ; Tuberculosis*