PURPOSE: To evaluate the efficacy of optical coherence tomography angiography (OCTA) by measuring the foveal avascular zone (FAZ) area in patients with branch retinal vein occlusion (BRVO). METHODS: Thirty four eyes of 34 patients with BRVO were retrospectively reviewed. The area of the FAZ was calculated using fluorescein angiography (FAG) and OCTA. The FAZ area was divided into two groups according to the presence of macular edema, which was determined based on the central foveal thickness (300 µm), and then the measured areas were compared. RESULTS: Pearson's correlation analysis revealed a significant positive correlation between FAG and the superficial capillary plexus (SCP) in OCTA with or without macular edema (r = 0.845, p = 0.001). However, there was not a significant correlation between FAG and the deep capillary plexus (DCP) in OCTA (r = 0.001, p = 0.996). In addition, the FAZ area measured by FAG and OCTA in the SCP showed a significant agreement between the two methods (intraclass correlation coefficient [ICC] = 0.916, p = 0.001). However, there was no significant relation found for the FAZ area between FAG and OCTA in the DCP (ICC = 0.001, p = 0.501). CONCLUSIONS: In the patients with BRVO, OCTA can be used to measure the FAZ areas in both the SCP and DCP, beyond measurement of the FAZ area at the two-dimensional cross section used during FAG. The FAZ area in the SCP via OCTA showed a statistically significant correlation with the FAZ area determined by FAG, but there was no such correlation in the DCP. That said, the FAZ area in the DCP was positively correlated with a decrease in visual acuity among the patients, which may be an indicator of visual prognosis.
Angiography* ; Capillaries ; Fluorescein Angiography ; Humans ; Macular Edema ; Prognosis ; Retinal Vein Occlusion* ; Retinal Vein* ; Retinaldehyde* ; Retrospective Studies ; Tomography, Optical Coherence* ; Visual Acuity

Rhabdomyoma is the most common benign cardiac neoplasm in neonates. Most patients with rhabdomyoma experienced spontaneous regression. Yet some of them need surgical therapy because of hemodynamic problems of the heart such as arrhythmia, outflow tract obstruction and valvular dysfunction. We found multiple masses in both ventricles on the patient's fetal echocardiogram. Heart failure caused by severe left ventricular outflow tract obstruction quickly presented after birth. The mass interfering with the outflow tract was resected via the transaortic approach at the first day of birth. Postoperative echocardiography showed complete release of the outflow tract obstruction. He was discharged on the postoperative day 8. During the 3 years of follow up, we found that the sizes of the remnant masses had gradually decreased.
Arrhythmias, Cardiac ; Echocardiography ; Follow-Up Studies ; Heart ; Heart Failure ; Heart Neoplasms ; Hemodynamics ; Humans ; Infant, Newborn ; Parturition ; Rhabdomyoma

OBJECTIVES: This study was to examine the effectiveness of computerized cognitive ability enhancement program (CCAEP) using Smart-toy. The CCAEP using Smart-toy which can interact with children via bluetooth is a kids-friendly and convenient method for improving children's cognitive abilities by increasing their motivation for performing the program. We developed the CCAEP which designed to train auditory-verbal memory, visual-spatial memory, auditory-verbal working memory, and visual-spatial working memory. METHODS: Eighteen children aged 8 to 10 participated in CCAEP individual training composed of 8 sessions of 40 minutes each for 4 weeks. The effect of the training was measured with Smart Toyweb's cognitive assessment tasks (smart device based assessment) as well as traditional neuropsychological tests before and after the training. RESULTS: Children showed significant improvement in auditory-verbal memory, visual-spatial memory, auditory-verbal working memory and visual-spatial working memory abilities after the training. CONCLUSION: This study demonstrated promising results suggesting the effectiveness of CCAEP using Smart-Toy in clinical settings as well as school and home situations. Further controlled study with larger sample size including various clinical groups is needed to confirm the present results.
Child* ; Humans ; Memory ; Memory, Short-Term ; Methods ; Motivation ; Neuropsychological Tests ; Sample Size

PURPOSE: To describe a patient who presented with central serous chorioretinopathy after 2 months of tadalafil administration without any other underlying disease or medication. CASE SUMMARY: A 49-year-old male patient was transferred from a local clinic with metamorphopsia and decreased visual acuity in the right eye. His visual acuity was 6/20 in the right eye and 18/20 in the left eye. The fundus examination showed a large serous detachment between the superior and inferior blood vessel arcades in the right retina. In his medical history, he used tadalafil three times a week for 2 months. His medication was then stopped, and a follow-up examination was scheduled. After 2 months, a fundus examination showed resolution of the subretinal fluid, and his corrected visual acuity recovered to 20/20. CONCLUSIONS: Tadalafil (Cialis®) is a phosphodiesterase (PDE)-5 inhibitor and predominantly prescribed for the treatment of erectile dysfunction. PDE–5 inhibitors may be potent vasodilators in the retina and choroid, and may induce choroidal vessel engorgement leading to leakage across the retinal pigment epithelium and accumulation of subretinal fluid in selected patients. When making a diagnosis as central serous chorioretinopathy, the physician should confirm the causative drugs that are easy to miss, by performing a thorough review of the patient's medical history and promptly terminating the causative drugs.
Blood Vessels ; Central Serous Chorioretinopathy ; Choroid ; Diagnosis ; Erectile Dysfunction ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Retina ; Retinal Pigment Epithelium ; Subretinal Fluid ; Tadalafil ; Vasodilator Agents ; Vision Disorders ; Visual Acuity

PURPOSE: We report a case of spontaneous recovery of an iris cyst with only tuberculosis medication and conservative eye drops when uveitis and angle closure occurred because of a cyst in a patient with peritoneal tuberculosis. CASE SUMMARY: A 49-year-old female who was diagnosed with iritis and treated with steroid eye drops visited our clinic because of decreased visual acuity 1 month prior. There were anterior chamber inflammation cells and an iris cyst completely obstructing the anterior chamber at 12 o'clock. At the time, the patient had been diagnosed with peritoneal tuberculosis in the Department of Internal Medicine and Gynecology and had been treated with surgery and medication. The patient had no past history of glaucoma, but when the iris cyst developed, the intraocular pressure increased to 29 mmHg and anterior inflammatory cells were seen in the range of +1 to +2. The primary lesion of tuberculosis improved and the iris cyst disappeared with treatments involving medication for tuberculosis, steroid eye drops, and glaucoma eye drops, without invasive treatments such as alcohol curettage, laser treatment, or cyst resection. CONCLUSIONS: If an iris cyst is a new lesion of the eye, it is necessary to identify the pattern and cause of the iris cyst first, and if a secondary benign iris cyst is suspected, the primary treatment of the causative disease is necessary rather than prompt invasive treatment.
Anterior Chamber ; Curettage ; Female ; Glaucoma ; Gynecology ; Humans ; Inflammation ; Internal Medicine ; Intraocular Pressure ; Iris ; Iritis ; Middle Aged ; Ophthalmic Solutions ; Peritonitis, Tuberculous ; Tuberculosis ; Uveitis ; Visual Acuity

The foot or lower extremity is rarely the initial site in adult-onset dystonia, whereas dystonia in children often begins in the foot. Isolated lower extremity dystonia in adults is rarely on a primary basis. Oral anti-dystonic medications have been found unsatisfactory in providing adequate symptomatic relief. On the other hand, botulinum toxin injections have been reported as beneficial. It is also known that personalized orthosis can be an effective solution for patients of dystonia. The purpose of this report is to demonstrate a case of primary focal foot dystonia that was effectively treated with botulinum toxin injection and the custom-made ankle-foot orthosis.

The foot or lower extremity is rarely the initial site in adult-onset dystonia, whereas dystonia in children often begins in the foot. Isolated lower extremity dystonia in adults is rarely on a primary basis. Oral anti-dystonic medications have been found unsatisfactory in providing adequate symptomatic relief. On the other hand, botulinum toxin injections have been reported as beneficial. It is also known that personalized orthosis can be an effective solution for patients of dystonia. The purpose of this report is to demonstrate a case of primary focal foot dystonia that was effectively treated with botulinum toxin injection and the custom-made ankle-foot orthosis.

PURPOSE: ST-elevation myocardial infarction (STEMI) patients may visit the emergency department (ED) complaining of sensations of pain other than the chest. We investigated our performance of reperfusion therapy for STEMI patients presenting with non-chest pains. MATERIALS AND METHODS: This was a retrospective observational cohort study. STEMI patients who underwent primary percutaneous coronary intervention (PCI) were divided into a chest pain group and a non-chest pain group. Clinical differences between the two groups and the influence of presenting with non-chest pains on door-to-electrocardiograms (ECG) time, door-to-balloon time, and hospital mortality were evaluated. RESULTS: Of the 513 patients diagnosed with STEMI, 93 patients presented with non-chest pains. Patients in the non-chest pain group were older, more often female, and had a longer symptom onset to ED arrival time and higher Killip class than patients in the chest pain group. There was a statistically significant delay in door-to-ECG time (median, 2.0 min vs. 5.0 min; p<0.001) and door-to-balloon time (median, 57.5 min vs. 65.0 min; p<0.001) in patients without chest pain. In multivariate analysis, presenting with non-chest pains was an independent predictor for hospital mortality (odds ratio, 2.3; 95% confidence interval, 1.1-4.7). However, door-to-ECG time and door-to-balloon time were not factors related to hospital mortality. CONCLUSION: STEMI patients presenting without chest pain showed higher baseline risk and hospital mortality than patients presenting with chest pain. ECG acquisition and primary PCI was delayed for patients presenting with non-chest pains, but not influencing hospital mortality. Efforts to reduce pre-hospital time delay for these patients are necessary.
Aged ; Aged, 80 and over ; Chest Pain/*diagnosis ; Electrocardiography ; Female ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Myocardial Infarction/mortality/*surgery ; Retrospective Studies

BACKGROUND: Tumor-associated macrophages (TAMs) play a tumorigenic role related to advanced staging and poor prognosis in many human cancers including thyroid cancers. Yet, a functional role of TAMs in papillary thyroid carcinoma (PTC) has not been established. The aim of this study was to investigate TAM expression in human PTC with lymph node (LN) metastasis. METHODS: Thirty-six patients who underwent surgery after being diagnosed with PTC with LN metastasis were included. Primary tumor tissues were immunohistochemically stained with an anti-CD68 antibody and clinical characteristics according to TAM density were evaluated. RESULTS: The TAM densities (CD68+ cells) varied from 5% to 70%, in all tumor areas, while few cells were stained in adjacent normal tissues. TAMs were identified as CD68+ cells with thin, elongated cytoplasmic extensions that formed a canopy structure over tumor cells. Comparing clinicopathologic characteristics between tumors with low (<25%) and high (25% to 70%) TAM densities, primary tumors were larger in the high density group than in the low density group (2.0+/-0.1 vs. 1.5+/-0.1; P=0.009). CONCLUSION: TAMs were identified in primary PTC tumors with LN metastasis and higher TAM densities were related to larger tumor sizes, suggesting a tumorigenic role of TAMs in human PTCs.
Carcinoma ; Cytoplasm ; Factor IX ; Humans ; Lymph Nodes ; Macrophages ; Neoplasm Metastasis ; Prognosis ; Thyroid Gland ; Thyroid Neoplasms

BACKGROUND: The surgical strategies for carotid endarterectomy (CEA) vary in terms of the anesthesia method, neurological monitoring, shunt usage, and closure technique, and no gold-standard procedure has been established yet. We aimed to analyze the feasibility and benefits of CEA under regional anesthesia (RA) and CEA under general anesthesia (GA).METHODS: Between June 2012 and December 2017, 65 patients who had undergone CEA were enrolled, and their medical records were prospectively collected and retrospectively reviewed. A total of 35 patients underwent CEA under RA with cervical plexus block, whereas 30 patients underwent CEA under GA. In the RA group, a carotid shunt was selectively used for patients who exhibited negative results on the awake test. In contrast, such a shunt was used for all patients in the GA group.RESULTS: There were no cases of postoperative stroke, cardiovascular events, or mortality. Nerve injuries were noted in 4 patients (3 in the RA group and 1 in the GA group), but they fully recovered prior to discharge. Operative time and clamp time were shorter in the RA group than in the GA group (119.29±27.71 min vs. 161.43±20.79 min, p<0.001; 30.57±6.80 min vs. 51.77±13.38 min, p<0.001, respectively). The hospital stay was shorter in the RA group than in the GA group (14.6±5.05 days vs. 18.97±8.92 days, p=0.022). None of the patients experienced a stroke or restenosis during the 27.23±20.3-month follow-up period.CONCLUSION: RA with a reliable awake test reduces shunt use and decreases the clamp and operative times of CEA, eventually resulting in a reduced length of hospital stay.
Anesthesia ; Anesthesia, Conduction ; Anesthesia, General ; Carotid Arteries ; Cervical Plexus Block ; Endarterectomy ; Endarterectomy, Carotid ; Follow-Up Studies ; Humans ; Length of Stay ; Medical Records ; Methods ; Mortality ; Myocardial Infarction ; Operative Time ; Prospective Studies ; Retrospective Studies ; Stroke