PURPOSE: To evaluate the efficacy of excision of avascular bleb and advancement of adjacent conjunctiva (EBAC) for treatment of hypotony after trabeculectomy with mitomycin C (MMC). METHODS: Fifteen patients (17 eyes) who received EBAC for correction of hypotony between September 1996 and October 2008 were reviewed retrospectively. The main outcomes were intraocular pressure (IOP) and postoperative complications. RESULTS: Hypotony (IOP <6 mmHg) of eight eyes (47.1%, seven patients) was caused by bleb perforation. Of these, two eyes (two patients) had a history of trauma. Hypotony appeared at 33.9+/-30.8 months, and EBAC was performed at 48.2+/-35.3 months after trabeculectomy with MMC. The mean follow-up period was 38.3+/-29.8 months. The qualified success rate of EBAC was 100% at 51 months after EBAC, and the complete success rate of EBAC was 76.5% at six months and 70.6% at 51 months, as determined by Kaplan-Meier analysis. Post-EBAC complications included blepharoptosis in four eyes (23.5%) and bleb perforation in one (5.9%). The blepharoptosis resolved within one month after EBAC in two patients. However, in the other patients, mild blepharoptosis remained at 17 and 22 months postoperatively. CONCLUSIONS: EBAC was found to be an effective method for treatment of hypotony after trabeculectomy with MMC, and postoperative blepharoptosis was a major complication.
Adolescent ; Adult ; Aged ; Blister/etiology/*surgery ; Conjunctiva/*surgery ; Female ; Follow-Up Studies ; Glaucoma/surgery ; Humans ; Intraocular Pressure ; Male ; Middle Aged ; Ocular Hypotension/etiology/physiopathology/*surgery ; Postoperative Complications ; Reoperation ; Retrospective Studies ; Trabeculectomy/adverse effects ; Treatment Outcome ; Young Adult

Purpose: This paper proposes a method to convert the measurement of the humerus from conventional two-dimensional (2D) to threedimensional (3D) measurements and apply it to clinical environments for diagnosis and surgery to improve results. Materials and Methods: In the developed software application, reflection and registration functions were implemented to quantify the difference between both sides of the humerus. Consistent measurements of the humerus were taken by defining the reference axis based on the Principal Component Analysis and aligning the humerus model with respect to the reference axis. Subsequently, the length, volume, the largest cross-sectional area in the head and condyle region, the position ratio of the largest cross-sectional area compared to the longitudinal length in the head and condyle region, and length and angle measurement between markups determined in the head and condyle region were examined. In addition, the automatic extraction of the head and groove, landmarks of the humerus proximal, was implemented. This study applied 40 humerus models (20 males and 20 females) to evaluate the measurements and automatic landmarkdetermination methods for humerus. Results: The measurements by this software application could provide consistent measurements of the same humerus. In addition, the position ratio of the largest cross-sectional area compared to the longitudinal length in the head and condyle region, proposed through this study, provides a similar ratio regardless of gender and side. Conclusion The software application developed in this study could measure the humerus and analyze its shape using an objective, reliable, and automatic method in a 3D environment. If the results of this study are applied to real clinical trials, diagnosis, and surgery could be conducted based on objective measurements, and improved results would be achieved. In addition, the study method could be expanded to other fields, such as orthopedics.

Purpose: This paper proposes a method to convert the measurement of the humerus from conventional two-dimensional (2D) to threedimensional (3D) measurements and apply it to clinical environments for diagnosis and surgery to improve results. Materials and Methods: In the developed software application, reflection and registration functions were implemented to quantify the difference between both sides of the humerus. Consistent measurements of the humerus were taken by defining the reference axis based on the Principal Component Analysis and aligning the humerus model with respect to the reference axis. Subsequently, the length, volume, the largest cross-sectional area in the head and condyle region, the position ratio of the largest cross-sectional area compared to the longitudinal length in the head and condyle region, and length and angle measurement between markups determined in the head and condyle region were examined. In addition, the automatic extraction of the head and groove, landmarks of the humerus proximal, was implemented. This study applied 40 humerus models (20 males and 20 females) to evaluate the measurements and automatic landmarkdetermination methods for humerus. Results: The measurements by this software application could provide consistent measurements of the same humerus. In addition, the position ratio of the largest cross-sectional area compared to the longitudinal length in the head and condyle region, proposed through this study, provides a similar ratio regardless of gender and side. Conclusion The software application developed in this study could measure the humerus and analyze its shape using an objective, reliable, and automatic method in a 3D environment. If the results of this study are applied to real clinical trials, diagnosis, and surgery could be conducted based on objective measurements, and improved results would be achieved. In addition, the study method could be expanded to other fields, such as orthopedics.

Purpose: This paper proposes a method to convert the measurement of the humerus from conventional two-dimensional (2D) to threedimensional (3D) measurements and apply it to clinical environments for diagnosis and surgery to improve results. Materials and Methods: In the developed software application, reflection and registration functions were implemented to quantify the difference between both sides of the humerus. Consistent measurements of the humerus were taken by defining the reference axis based on the Principal Component Analysis and aligning the humerus model with respect to the reference axis. Subsequently, the length, volume, the largest cross-sectional area in the head and condyle region, the position ratio of the largest cross-sectional area compared to the longitudinal length in the head and condyle region, and length and angle measurement between markups determined in the head and condyle region were examined. In addition, the automatic extraction of the head and groove, landmarks of the humerus proximal, was implemented. This study applied 40 humerus models (20 males and 20 females) to evaluate the measurements and automatic landmarkdetermination methods for humerus. Results: The measurements by this software application could provide consistent measurements of the same humerus. In addition, the position ratio of the largest cross-sectional area compared to the longitudinal length in the head and condyle region, proposed through this study, provides a similar ratio regardless of gender and side. Conclusion The software application developed in this study could measure the humerus and analyze its shape using an objective, reliable, and automatic method in a 3D environment. If the results of this study are applied to real clinical trials, diagnosis, and surgery could be conducted based on objective measurements, and improved results would be achieved. In addition, the study method could be expanded to other fields, such as orthopedics.

Purpose: This paper proposes a method to convert the measurement of the humerus from conventional two-dimensional (2D) to threedimensional (3D) measurements and apply it to clinical environments for diagnosis and surgery to improve results. Materials and Methods: In the developed software application, reflection and registration functions were implemented to quantify the difference between both sides of the humerus. Consistent measurements of the humerus were taken by defining the reference axis based on the Principal Component Analysis and aligning the humerus model with respect to the reference axis. Subsequently, the length, volume, the largest cross-sectional area in the head and condyle region, the position ratio of the largest cross-sectional area compared to the longitudinal length in the head and condyle region, and length and angle measurement between markups determined in the head and condyle region were examined. In addition, the automatic extraction of the head and groove, landmarks of the humerus proximal, was implemented. This study applied 40 humerus models (20 males and 20 females) to evaluate the measurements and automatic landmarkdetermination methods for humerus. Results: The measurements by this software application could provide consistent measurements of the same humerus. In addition, the position ratio of the largest cross-sectional area compared to the longitudinal length in the head and condyle region, proposed through this study, provides a similar ratio regardless of gender and side. Conclusion The software application developed in this study could measure the humerus and analyze its shape using an objective, reliable, and automatic method in a 3D environment. If the results of this study are applied to real clinical trials, diagnosis, and surgery could be conducted based on objective measurements, and improved results would be achieved. In addition, the study method could be expanded to other fields, such as orthopedics.

Erythropoietin combined with parenteral iron sucrose therapy is an alternative to blood transfusion in anemic patients. It was shown to be effective in surgical patients in several previous studies when used in conjunction with other methods. However, there are no guidelines about safety limits in dosage amounts or intervals. In this study, we report a case of significant postoperative hemorrhage managed with high dose parenteral iron sucrose, low dose erythropoietin, vitamin B12, vitamin C, and folic acid. An 80-year-old female patient presented for severe anemia after a total hip arthroplasty and refused an allogenic blood transfusion as treatment. The preoperative hemoglobin of 12.2 g/dL decreased to 5.3 g/dL postoperatively. She received the aforementioned combination of iron sucrose, erythropoietin, and vitamins. A total of 1,500 mg of intravenous iron sucrose was given postoperatively for 6 consecutive days. Erythropoietin was also administered at 2,000 IU every other day for a total of 12,000 IU. The patient was discharged in good condition on the twelfth postoperative day with a hemoglobin of 8.5 g/dL. Her hemoglobin was at 11.2 g/dL on the twentieth postoperative day.
Aged ; Aged, 80 and over ; Anemia/*drug therapy ; Arthroplasty, Replacement, Hip/*adverse effects ; Blood Transfusion ; Drug Therapy, Combination ; Erythropoietin/*administration & dosage ; Female ; Ferric Compounds/*administration & dosage ; Humans

The precise mechanism involved in DIC and delayed traumatic subarachnoid hemorrhage (DT-SAH) remains unclear in multiple-trauma patients. Hereby, we describe a polytraumatized patient with DIC who died due to DT-SAH. A 75-year-old female patient was admitted to our Emergency Department complaining of abdominal pain and drowsiness after a pedestrian accident. Her initial brain computerized tomography (CT) finding was negative for intracranial injury. However, her abdominal CT scan revealed a collection of retroperitoneal hematomas from internal iliac artery bleeding after a compressive pelvic fracture. This event eventually resulted in shock and DIC. An immediate angiographic embolization of the bleeding artery was performed along with transfusion and anti-thrombin III. Her vital signs were stabilized without neurological change. Fourteen hours after admission, she suddenly became comatose, and her follow-up brain CT scan revealed a dense DT-SAH along the basal cisterns with acute hydrocephalus. This event rapidly prompted brain CT angiography and digital subtraction angiography, which both confirmed the absence of any cerebrovascular abnormality. Despite emergency extraventricular drainage to reverse the hydrocephalus, the patient died three days after the trauma. This paper presents an unusual case of DT-SAH in a polytraumatized patient with DIC.
Abdominal Pain ; Aged ; Angiography ; Angiography, Digital Subtraction ; Arteries ; Brain ; Coma ; Dacarbazine ; Disseminated Intravascular Coagulation* ; Drainage ; Emergencies ; Emergency Service, Hospital ; Female ; Follow-Up Studies ; Hematoma ; Hemorrhage ; Humans ; Hydrocephalus ; Iliac Artery ; Multiple Trauma ; Shock ; Sleep Stages ; Subarachnoid Hemorrhage, Traumatic* ; Tomography, X-Ray Computed ; Vital Signs

OBJECTIVE: We describe a systematic review and meta-analysis of the performance of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) for detecting metastasis in ovarian cancer. METHODS: MEDLINE and Embase were searched for diagnostic accuracy studies that used 18F-FDG PET or PET/CT for pre-treatment staging, using surgical findings as the reference standard. Sensitivities and specificities were pooled and plotted in a hierarchic summary receiver operating characteristic plot. Potential causes of heterogeneity were explored through sensitivity analyses. RESULTS: Eight studies with 594 patients were included. The overall pooled sensitivity and specificity for metastasis were 0.72 (95% confidence interval [CI]=0.61–0.81) and 0.93 (95% CI=0.85–0.97), respectively. There was considerable heterogeneity in sensitivity (I2=97.57%) and specificity (I2=96.74%). In sensitivity analyses, studies that used laparotomy as the reference standard showed significantly higher sensitivity and specificity (0.77; 95% CI=0.67–0.87 and 0.96; 95% CI=0.92–0.99, respectively) than those including diagnostic laparoscopy (0.62; 95% CI=0.46–0.77 and 0.84; 95% CI=0.69–0.99, respectively). Higher specificity was shown in studies that confirmed surgical findings by pathologic evaluation (0.95; 95% CI=0.90–0.99) than in a study without pathologic confirmation (0.69; 95% CI=0.24–1.00). Studies with a lower prevalence of the FDG-avid subtype showed higher specificity (0.97; 95% CI=0.94–1.00) than those with a greater prevalence (0.89; 95% CI=0.80–0.97). CONCLUSION: Pre-treatment 18F-FDG PET/CT shows moderate sensitivity and high specificity for detecting metastasis in ovarian cancer. With its low false-positive rate, it can help select surgical approaches or alternative treatment options.
Electrons* ; Fluorodeoxyglucose F18 ; Humans ; Laparoscopy ; Laparotomy ; Neoplasm Metastasis* ; Ovarian Neoplasms* ; Population Characteristics ; Positron-Emission Tomography ; Positron-Emission Tomography and Computed Tomography ; Prevalence ; ROC Curve ; Sensitivity and Specificity

A 52-year-old woman with a history of general weakness, fatigue, weight loss, elevated serum levels of liver transaminase enzyme for three months underwent an F-18 FDG PET/CT scan to evaluate a cause of the hepatosplenomegaly found on abdominal ultrasonography. Initial PET/CT revealed markedly enlarged liver and spleen with intense FDG uptake. Otherwise, there were no areas of abnormal FDG uptake in whole body image. Histological evaluation by a hepatic needle biopsy demonstrated diffuse large B cell type lymphoma and final diagnosis for this patient was hepatosplenic B-cell lymphoma. She received five cycles of CHOP chemotherapy, and second PET/CT scan was followed after then. Follow-up PET-CT revealed normal sized liver with disappearance of abnormal FDG uptake. Hepatosplenic B-cell lymphoma is relatively rare and mostly presents as single or multiple nodules.1,2 Diffuse type hepatosplenic lymphoma is extremely rare and poorly recognized entity.3 The diagnosis is very difficult and complicated by the presence of misleading symptoms.4 In this rare hepatosplenic B-cell lymphoma case, F-18 FDG PET/CT scan provided a initial diagnostic clue of hepatosplenic lymphoma and an accurate chemotherapy response.
B-Lymphocytes ; Biopsy, Needle ; Body Image ; Fatigue ; Female ; Follow-Up Studies ; Hepatomegaly ; Humans ; Liver ; Lymphoma ; Lymphoma, B-Cell ; Middle Aged ; Spleen ; Weight Loss

Flavobacterium odoratum is an obligately aerobic, gram-negative, non-fermentative rod. It has been infrequently isolated from urine, stool, wound, sputum, and blood specimens, but clinical infections caused by this organism are extremely rare. We report a case of bacteremic cholangitis caused by F. odoratum. The organism was simultaneously isolated in blood and bile from a patient, who had fever, sustained jaundice and abdominal pain with adenocarcinoma of the common bile duct. The isolated organism showed the typical biochemical characteristics. The results of antimicrobial sensitivity test showed resistance to aminoglycosides and cephalosporins but susceptibility to imipenem and trimethoprim-sulfamethoxazole.
Abdominal Pain ; Adenocarcinoma ; Aminoglycosides ; Bile ; Cephalosporins ; Cholangitis* ; Common Bile Duct ; Fever ; Flavobacterium* ; Humans ; Imipenem ; Jaundice ; Sputum ; Trimethoprim, Sulfamethoxazole Drug Combination ; Wounds and Injuries