PURPOSE: To report clinical features and optical coherence tomographic findings of presumed atypical ocular tuberculosis associated with tuberculosis lymphadenitis and encephalomeningitis. CASE SUMMARY: A 28-year-old female with lymphadenitis in the axillary area presented with a fever and headache of a one week duration. CSF study and MRI findings implied tuberculosis encephalomeningitis, and presumed tuberculosis uveitis manifested with visual disturbance after five days. Ocular symptoms were aggravated and showed anterior iridocyclitis, vitritis, macular edema, and multifocal retinitis with miliary granuloma that was distinct from choroiditis or typical tuberculosis granuloma. After the patient received anti-tuberculosis medication and systemic corticosteroids, significant improvements in visual acuity, ocular findings and OCT results were observed. CONCLUSIONS: Ocular tuberculosis can present with various clinical findings, and caution should be taken so as not to misdiagnose based on these characteristics. In the present case, anti-tuberculosis medication and systemic steroids resulted in the resolution of inflammation. In such cases, monitoring the posterior pole lesion via OCT may be helpful in determining improvement.
Adrenal Cortex Hormones ; Adult ; Choroid ; Choroiditis ; Female ; Fever ; Granuloma ; Headache ; Humans ; Inflammation ; Iridocyclitis ; Lymphadenitis ; Macular Edema ; Meningitis ; Meningoencephalitis ; Retinitis ; Steroids ; Tuberculosis ; Tuberculosis, Miliary ; Tuberculosis, Ocular ; Uveitis ; Visual Acuity

PURPOSE: To evaluate the effect of high dose corticosteroid and optic canal decompression on the traumatic optic nerve injury. METHODS: Twenty six patients who were diagnosed to have traumatic optic nerve injury, were divided into two groups in which one group received corticosteroid therapy while the other group underwent optic canal decompression combined with corticosteroid therapy. RESULTS: Visual acuity increased by > OR =3 lines of LogMAR scale in 47% of the corticosteroid group, in 28% of operation and steroid group, and in 42% of overall cases. But the degree of visual acuity improvement had no difference between two groups(p=0.72). As the patients were divided into two groups based on initial visual acuity such as no light perception and light perception or better, the initial visual acuity did not have influence on the final visual outcome in both corticosteroid group and operation and steroid group(p=0.78, p=0.33). CONCLUSIONS: This result suggest that effect of high dose corticosteroid and optic canal decompression on traumatic optic nerve injury is not different.
Decompression* ; Humans ; Optic Nerve Injuries* ; Optic Nerve* ; Visual Acuity

No abstract available.
Arthritis, Juvenile*

No abstract available.
Fetal Blood* ; Humans ; Infant, Newborn* ; Phenotype

OBJECTIVES: This study was conducted to identify factors that affect medical service performance in rural health sub-centers and to develop a method to improve health sub-center performance that takes advantage of these insights. METHODS: This study included 1,242 South Korean health sub-centers that had been in operation at least since December 31, 2009 as units of analysis. After adjusting for population differences between areas, the performance of medical service among health sub-centers was analyzed according to medical services performed per person. We performed t-tests, ANOVA, Scheffe's tests and multiple regression analyses. RESULTS: The following were significant variables affecting the medical service performance of rural health sub-centers: number of hospitals and clinics, presence of community health practitioner posts, distance from health sub-centers to main public health centers, distance from health sub-centers to the nearest emergency medical facilities, and proportion of the local population aged 65 and over. In contrast, the proportion of the local population between ages 0-4 and the placement of public health doctors that had already completed their internship were not significant variables. CONCLUSIONS: The medical service performance of health sub-centers located in rural areas is significantly affected by local population and health care environment characteristics, and therefore, it is imperative to develop strategies to provide differentiated service based on these factors.
Aged ; Delivery of Health Care ; Emergencies ; Humans ; Imidazoles ; Internship and Residency ; Nitro Compounds ; Public Health ; Rural Health

PURPOSE: To report a case of bilateral upgaze palsy associated with unilateral midbrain hemorrhage in moyamoya disease. METHODS: A 29-year-old woman presented with a sudden decrease of consciousness and was diagnosed with a spontaneous brain hemorrhage in the right side of the midbrain, right basal ganglion, and third ventricle. The mentality was improved after external ventricular drainage of hemorrhage, but bilateral upgaze difficulty remained. We performed neuro-ophthalmic and radiologic evaluation of the cause of bilateral upgaze difficulty. RESULTS: She showed a upgaze limitation of -2 grade in the right eye and -3 grade in the left eye, but normal movements in other versions and ductions. There were normal responses in pupillary light reflex, forced duction and convergence tests, but no ocular elevation in the vertical vestibulo-ocular reflex. The Bell's phenomenon was absent. She was diagnosed with moyamoya disease through brain MRI and cerebral angiography, and we found a hemorrhage in the right area of the midbrain. This hemorrhagic area was consistent with the right rostral interstitial nucleus of the medial longitudinal fasciculus (riMLF). We think that the bilateral upgaze palsy was caused by damage to the riMLF in the affected side and to projections through the posterior commissure.
Adult ; Brain ; Cerebral Angiography ; Consciousness ; Drainage ; Female ; Ganglion Cysts ; Hemorrhage* ; Humans ; Intracranial Hemorrhages ; Magnetic Resonance Imaging ; Mesencephalon* ; Moyamoya Disease* ; Paralysis* ; Reflex ; Reflex, Vestibulo-Ocular ; Third Ventricle

PURPOSE: We investigated hemodynamic changes in the ophthalmic artery (OA) using color Doppler imaging (CDI) after two horizontal rectus muscles surgery. METHODS: Eyes of the surgical group (n=18) underwent surgery on two horizontal rectus muscles, and the control group was the contralateral eyes. CDI of the OA was performed before operation and on postoperative days (POD) 1, 7 and 30. Peak systolic (Vmax), end diastolic (Vmin), and mean (Vmean) blood flow velocities were measured, and resistivity index (RI) and pulsatility index (PI) were calculated. RESULTS: Vmax, Vmin and Vmean were significantly higher, and RI and PI were significantly lower in the surgical group than in the control group on POD 1 (p< 0.05). In the surgical group, Vmax, Vmin and Vmean were significantly higher, and RI and PI were significantly lower, on POD 1 than those mesured on other days (p< 0.05). CONCLUSIONS: We showed that surgery on the two horizontal rectus muscles increased OA blood flow during the early postoperative period.
*Ultrasonography, Doppler, Color ; Strabismus/*physiopathology/*surgery/ultrasonography ; Postoperative Period ; Ophthalmic Artery/*physiopathology/*ultrasonography ; Middle Aged ; Male ; Humans ; Hemodynamic Processes ; Female ; Child ; Adult ; Adolescent

Background and Objectives: The purpose of this study is to evaluate value of diagnostic tool for vocal cord palsy utilizing artificial intelligence without laryngoscopeMaterials and Method A dataset consisting of recordings from patients with unilateral vocal cord paralysis (n=54) as well as normal individuals (n=163). The dataset included prolonged pronunciations of the vowels /ah/, /u/, /i/, and vocal cord data from paralyzed patients. Various acoustic parameters such as Mel-frequency cepstral coefficients, jitter, shimmer, harmonics-to-noise ratio, and fundamental frequency statistics were analyzed. The classification of vocal cord paralysis encompassed paralysis status, paralysis degree, and paralysis location. The deep learning model employed the leave-one-out method, and the feature set with the highest performance was selected using the following methods. Results: Vocal Cord Paralysis Classifier: The classifier accurately distinguished normal voice from vocal cord paralysis, achieving an accuracy and F1 score of 1.0. Paralysis Location Classifier: The classifier accurately differentiated between median and paramedian vocal cord paralysis, achieving an accuracy and micro F1 score of 1.0. Breathiness Degree Classifier: The classifier achieved an accuracy of 0.795 and a mean absolute error of 0.2857 in distinguishing different degrees of breathiness. Conclusion Although the small sample size raises concerns of potential overfitting, this preliminary study highlights distinctive acoustic features in cases of unilateral vocal fold paralysis compared to those of normal individuals. These findings suggest the feasibility of determining the presence, degree, and location of paralysis through the utilization of acoustic parameters. Further research is warranted to validate and expand upon these results.

PURPOSE: Magnesium sulfate (MgSO4) is a commonly used drug for eclampsia prophylaxis and the first choice tocolytic agent for preterm labor. Recently it has been reported to have a fetal neuroprotective effect. This study was aimed to evaluate the influence of antenatal magnesium sulfate exposure on perinatal outcomes in very low birth weight infants (VLBWIs) with maternal preeclampsia. METHODS: We conducted a retrospective study of VLBWIs (n=81) with maternal preeclampsia (June 2005 through June 2012), who had been admitted to the NICU at Ewha Womans University Mok Dong Hospital. Clinical characteristics and neonatal complications were analyzed according to the antenatal exposure to MgSO4. Antenatal MgSO4 exposure was the only medication that had been administered up to the period of delivery. RESULTS: Among 81 neonates, 20 neonates were exposed to antenatal MgSO4. Mean gestational age was low in MgSO4 exposed group [29.5+/-2.8 vs. 31.6+/-2.3 weeks (P=0.02)]. The incidence of significant patent ductus arteriosus (S-PDA) was higher in MgSO4 exposed group after adjustment by gestational age (P=0.02). There were no differences between the two groups with regard to rates of respiratory distress syndrome, use of ventilator, retinopathy of prematurity, necrotizing enterocolitis, intraventricular hemorrhage, periventricular leukomalacia and mortality. CONCLUSION: Antenatal MgSO4 exposure was associated with a higher risk of significant PDA in VLBWIs with maternal preeclampsia.
Ductus Arteriosus, Patent ; Eclampsia ; Enterocolitis, Necrotizing ; Female ; Gestational Age ; Hemorrhage ; Humans ; Incidence ; Infant ; Infant, Newborn ; Infant, Very Low Birth Weight ; Leukomalacia, Periventricular ; Magnesium ; Magnesium Sulfate ; Neuroprotective Agents ; Obstetric Labor, Premature ; Pre-Eclampsia ; Pregnancy ; Retinopathy of Prematurity ; Retrospective Studies ; Ventilators, Mechanical

A knotted ureteral stent is an extremely rare condition, with fewer than 20 cases reported in the literature; however, it is difficult to treat. We report a case in which a folded Terumo guidewire was successfully used to remove a knotted stent percutaneously without anesthesia. We also review the current literature on predisposing factors and management strategies for knotted ureteral stents.
Anti-Bacterial Agents/therapeutic use ; Humans ; Kidney Calculi/*radiography/*therapy ; Lithotripsy ; Male ; Middle Aged ; Stents/*adverse effects ; Ureter