A 45-Year-old para 1-0-1-1 had submucosal myoma diagnosed by ultrasonogram and hysteroscopic examination. During 60 minutes hysteroscopic myomectomy, 8,000 ml of sorbitol-mannitol distention medium was used and 6,500 ml collected, resulting in a deficit of 1,500 ml. The patient received Ringer`s lactate 1,000 ml intravenously. Her urine output was 400 ml. Blood loss was 40 ml. After operation, hyponatremia(115 mEq/L) was developed and pulmonary edema was also diagnosed clinically at that time and later confirmed by chest radiograph. The judicious administration of diuretics and normal saline fluid replacement to prevent overcorrection to hypernatremia resulted in return of serum electrolytes to normal level and resolution of the pulmonary edema by postoperative day 1. We have experienced a case of pulmonary edema during hysteroscopic myomectomy with sorbitol-mannitol distention medium, which is presented with a brief review of literatures.
Diuretics ; Electrolytes ; Humans ; Hypernatremia ; Hyponatremia ; Lactic Acid ; Middle Aged ; Myoma ; Pulmonary Edema* ; Radiography, Thoracic ; Ultrasonography

No abstract available.
Stomach Neoplasms* ; Stomach* ; Water*

Purpose: To analyze the clinical manifestations of thyroid-associated ophthalmopathy accompanied by thyroid cancer. Methods: We performed a retrospective chart review of 33 patients diagnosed at our ophthalmology department with both thyroid- associated ophthalmopathy and thyroid cancer. We performed thyroid function tests at the first visit and at diagnosis of the thyroid cancer, and recorded the type of thyroid cancer, thyroidectomy history, clinical activity score (CAS), exophthalmometry, margin reflex distance (MRD) 1, diplopia, follow-up duration of ophthalmopathy, and ocular treatments. We divided patients into two groups according to the time of diagnosis of thyroid ophthalmopathy and thyroid cancer. Results: The average age of the 33 patients was 45.55 years, and eight and 25 were males and females, respectively. The average CAS score, exophthalmometry measurement, and MRD1 were 2.00 ± 1.67, 19.28 ± 3.24 mm, and 4.52 ± 1.58 mm, respectively. Patients whose ocular symptoms preceded the diagnosis of thyroid cancer tended to have a higher thyroid hormone level, CAS score, and exophthalmometry measurement, and required more ocular treatments, compared to the other patients. The average thyroid auto-antibody levels were increased in both groups. In patients whose ophthalmopathy preceded the thyroid cancer, exophthalmometry measurements were significantly decreased after thyroidectomy. Conclusions It is crucial to identify ophthalmopathy in association with thyroid cancer. Patients whose ocular symptoms started before the diagnosis of thyroid cancer may present with hyperthyroidism and severe ocular symptoms, and may need ocular treatments. Patients should be informed that thyroid-associated ophthalmopathy may develop after thyroidectomy or radioiodine therapy, and their ocular symptoms should be closely monitored.

Low back pain is common during pregnancy. However, the prevalence of symtomatic lumbar disc herniation is rare, and cauda equina syndrome due to disc herniation during pregnancy is even rarer. We report a rare case of lumbar disc herniation causing cauda equina syndrome during third trimester of pregnancy which successfully treated by endoscopic discectomy. This case shows that endoscopic discectomy can be the treatment option for the lumbar disc herniation during pregnancy.
Cauda Equina* ; Diskectomy* ; Female ; Humans ; Low Back Pain ; Polyradiculopathy* ; Pregnancy ; Pregnancy Trimester, Third* ; Pregnancy* ; Prevalence

Purpose: We report a case of Purtscher-like retinopathy after aortic valve replacement surgery.Case summary: A 52-year-old male with bacteremia suspicious of infectious endocarditis was referred to our department for ophthalmic examination. Inflammatory reaction was evident in both anterior chambers. Fundus examination revealed infiltrative lesions with a Roth spot, and the patient was diagnosed with chorioretinitis. After 3 days, aortic valve replacement surgery was performed in the cardiac surgery department using cardioplegic solutions. Ophthalmologic exams were repeated after the valve surgery. The Roth spot had disappeared and infiltrated, leaving a clear margin. An anterior chamber cell was not noted. However, there were newly developed peripapillary superficial cotton-wool spots and delayed hemorrhagic lesions. Based on the medical history and specific pathognomonic fundus findings, the patient was diagnosed with Purtscher-like retinopathy. Four months later, all characteristic funduscopic features of Purtscher-like retinopathy had disappeared, leaving a remaining retinal nerve fiber defect and central visual field defect without any ophthalmologic treatment. Conclusions Although rare, doctors should be aware of the possibility of Purtscher-like retinopathy after valve replacement surgery. Further studies are needed to understand the unknown pathophysiology of Purtscher-like retinopathy.

Purpose: This study aimed to systematically evaluate literature related to the effects of exercise intervention programs on physical or psychological variables of post-operative breast cancer patients in Korea, and identify the effectiveness of exercise intervention through meta-analysis. Methods: The review question was defined according to PICO-SD (Participants, Intervention, Comparisons, Outcomes, Study Design) to achieve a systematic literature review: “How does exercise intervention affect the physical or psychological outcome in post-operative breast cancer patients compared to the control group?” The subjects were randomized clinical trials (RCTs) studies released in Korea between 2010 and December 2020. Literature searches were conducted using four electronic databases, including Korean Studies Information Service System (KISS), Research Information Sharing Service (RISS), National Assembly Library, and DBpia. The search terms were ‘breast neoplasms’ or ‘breast cancer’ with ‘exercise’ or ‘exercise intervention’ or ‘exercise program.’ A total of 13 RCTs were finally selected. Results: The outcome variables were in the upper extremity range of motion (ROM), shoulder disability, pain and edema. The effect size of exercise intervention on ROM was 0.95(95% CI:0.58, 1.33)( p<.001); shoulder disability was -1.16(95% CI:-1.77, -0.55)(p<.001); pain was -1.24(95% CI:-1.58, -0.89) (p<.001); and edema was -0.03(95% CI:-0.39, 0.33)(p=.858). Conclusion This result suggests that oncology nurses may apply exercise intervention to improve ROM, shoulder disability, and to alleviate pain in post-op breast cancer patients.

Purpose: This study aimed to systematically evaluate literature related to the effects of exercise intervention programs on physical or psychological variables of post-operative breast cancer patients in Korea, and identify the effectiveness of exercise intervention through meta-analysis. Methods: The review question was defined according to PICO-SD (Participants, Intervention, Comparisons, Outcomes, Study Design) to achieve a systematic literature review: “How does exercise intervention affect the physical or psychological outcome in post-operative breast cancer patients compared to the control group?” The subjects were randomized clinical trials (RCTs) studies released in Korea between 2010 and December 2020. Literature searches were conducted using four electronic databases, including Korean Studies Information Service System (KISS), Research Information Sharing Service (RISS), National Assembly Library, and DBpia. The search terms were ‘breast neoplasms’ or ‘breast cancer’ with ‘exercise’ or ‘exercise intervention’ or ‘exercise program.’ A total of 13 RCTs were finally selected. Results: The outcome variables were in the upper extremity range of motion (ROM), shoulder disability, pain and edema. The effect size of exercise intervention on ROM was 0.95(95% CI:0.58, 1.33)( p<.001); shoulder disability was -1.16(95% CI:-1.77, -0.55)(p<.001); pain was -1.24(95% CI:-1.58, -0.89) (p<.001); and edema was -0.03(95% CI:-0.39, 0.33)(p=.858). Conclusion This result suggests that oncology nurses may apply exercise intervention to improve ROM, shoulder disability, and to alleviate pain in post-op breast cancer patients.

Purpose: We report a case of Purtscher-like retinopathy after aortic valve replacement surgery.Case summary: A 52-year-old male with bacteremia suspicious of infectious endocarditis was referred to our department for ophthalmic examination. Inflammatory reaction was evident in both anterior chambers. Fundus examination revealed infiltrative lesions with a Roth spot, and the patient was diagnosed with chorioretinitis. After 3 days, aortic valve replacement surgery was performed in the cardiac surgery department using cardioplegic solutions. Ophthalmologic exams were repeated after the valve surgery. The Roth spot had disappeared and infiltrated, leaving a clear margin. An anterior chamber cell was not noted. However, there were newly developed peripapillary superficial cotton-wool spots and delayed hemorrhagic lesions. Based on the medical history and specific pathognomonic fundus findings, the patient was diagnosed with Purtscher-like retinopathy. Four months later, all characteristic funduscopic features of Purtscher-like retinopathy had disappeared, leaving a remaining retinal nerve fiber defect and central visual field defect without any ophthalmologic treatment. Conclusions Although rare, doctors should be aware of the possibility of Purtscher-like retinopathy after valve replacement surgery. Further studies are needed to understand the unknown pathophysiology of Purtscher-like retinopathy.

Behcet's disease is a recurrent and multisystemic disorder which usually persists over many years and is classified under vasculitic syndrome. A classic triad in this disorder is composed of a recurrent oral ulcer, genital ulceration and uveitis. While intestinal Behcet's disease most commonly affects the ileoecal region, dysphagia associated with esophageal ulceration is very uncommon. A 34-year-old-female patient visited our hospital because of dysphagia, epigastric pain and fever. The patient had ulcers on the oral mucosa, soft palate and extemal genitalia. Multiple irregularly marginated ulcers surrounded with hyperemic edematous mucosa were found on the middle and distal esophagus and lesser curvature of the stomach by an esophagogastroduodenoscopic examination. The pathologic findings were non-specific ulcers with necrotizing vasculitis in the vulva and with suspicious vasculitis in the esophagus. So she was diagnosed to have a Behcets disease and was treated with steroid and sulfasalazine. In this study we report a case of esophageal involvement of Behcet's disease with a review of the literature.
Deglutition Disorders ; Esophagus ; Fever ; Genitalia ; Humans ; Mouth Mucosa ; Mucous Membrane ; Oral Ulcer ; Palate, Soft ; Stomach ; Sulfasalazine ; Ulcer ; Uveitis ; Vasculitis ; Vulva

BACKGROUND: Although targeted therapy and immuno-oncology have shifted the treatment paradigm for lung cancer, platinum-based combination is still the standard of care for advanced non-small cell lung cancer (NSCLC). Pemetrexed continuation maintenance therapy has been approved and increasingly used for patients with nonsquamous NSCLC. However, the efficacy of this strategy has not been proven in patients without driving mutations. The objective of this study was to compare the clinical benefit of pemetrexed continuation maintenance to conventional platinum-based doublet in epidermal growth factor receptor (EGFR)-negative lung adenocarcinoma. METHODS: A total of 114 patients with EGFR-negative lung adenocarcinoma who were treated with platinum doublet were retrospectively enrolled. We compared the survival rates between patients received pemetrexed maintenance after four-cycled pemetrexed/cisplatin and those received at least four-cycled platinum doublet without maintenance chemotherapy as a first-line treatment. RESULTS: Forty-one patients received pemetrexed maintenance and 73 received conventional platinum doublet. Median progression-free survival (PFS), which was defined as the time from the day of response evaluation after four cycles of chemotherapy to disease progression or death, was significantly higher in the pemetrexed maintenance group compared to conventional group (5.8 months vs. 2.2 months, p<0.001). Median overall survival showed an increasing trend in the pemetrexed maintenance group (22.3 months vs. 16.1 months, p=0.098). Multivariate analyses showed that pemetrexed maintenance chemotherapy was associated with better PFS (hazard ratio, 0.73; 95% confidence interval, 0.15–0.87). CONCLUSION: Compared to conventional platinum-based chemotherapy, premetrexed continuation maintenance treatment is associated with better clinical outcome for the patients with EGFR wild-type lung adenocarcinoma.
Adenocarcinoma* ; Carcinoma, Non-Small-Cell Lung ; Disease Progression ; Disease-Free Survival ; Drug Therapy* ; Humans ; Lung Neoplasms ; Lung* ; Maintenance Chemotherapy ; Multivariate Analysis ; Pemetrexed* ; Platinum ; Receptor, Epidermal Growth Factor ; Retrospective Studies* ; Standard of Care ; Survival Rate