STUDY DESIGN: Two case reports. OBJECTIVES: We present two cases of quadriplegia after posterior decompression with fusion caused by a suspicious reperfusion injury of spinal cord without remarkable surgical insult. SUMMARY OF LITERATURE REVIEW: Posterior decompression and posterolateral fusion have been reported as effective procedures in patients with multilevel myelopathy. However, postoperative spinal cord injury without remarkable intraoperative technical damage has been reported in a few articles. Reperfusion mechanism was suggested as one of the leading causes and reported in some animal models. MATERIALS AND METHODS: There was one case of ossification of the posterior longitudinal ligament and one developmental multilevel stenosis that underwent laminectomy with lateral mass instrumentation. After surgery, the patients presented with quadriplegia; MRI demonstrated swelling of the spinal cord and intramedullary lesion in two cases. RESULTS: After surgery, the patients presented with quadriplegia; MRI demonstrated swelling of the spinal cord and intramedullary lesion in two cases. CONCLUSION: Although patients with such a medical condition are rare, it is difficult to predict postoperative swelling of the spinal cord before surgery. The surgeon should thus be aware of such rare disease conditions involving the spinal cord before the surgical procedure.
Constriction, Pathologic ; Decompression* ; Humans ; Laminectomy ; Longitudinal Ligaments ; Magnetic Resonance Imaging ; Models, Animal ; Quadriplegia ; Rare Diseases ; Reperfusion ; Reperfusion Injury* ; Spinal Cord Diseases ; Spinal Cord Injuries ; Spinal Cord*

A 56-year-old Korean woman presented with decreased visual acuity of the right eye. She had a history of two photodynamic therapy treatments for choroidal neovascularization (CNV) due to angioid streaks in her left eye with central scarring and low visual acuity. She was diagnosed with subfoveal CNV due to angioid streaks in her right eye and treated with six intravitreal bevacizumab (1.25 mg / 0.05 mL) injections over one year. Best corrected visual acuity improved from 20 / 125 at baseline to 20 / 50 at the final visit. The area of CNV had changed into a fibrotic scar by the final visit, and fluorescein angiography and indocyanine green angiography revealed no evidence of leakage. Optical coherence tomography showed that central macular thickness decreased from 311 microm at baseline to 203 microm with complete resolution of subretinal and intraretinal fluid at the final visit. Intravitreal bevacizumab for CNV associated with angioid streaks prevented the progression of disease and resulted in the improvement of visual acuity after one year of follow-up in our patient.
Angiogenesis Inhibitors/*administration & dosage ; Angioid Streaks/*complications ; Antibodies, Monoclonal/*administration & dosage ; Choroidal Neovascularization/*drug therapy/*etiology/physiopathology ; Female ; Follow-Up Studies ; Humans ; Intravitreal Injections ; Macula Lutea/drug effects/pathology ; Middle Aged ; Tomography, Optical Coherence ; Visual Acuity/drug effects

BACKGROUND: Inhaled nitric oxide therapy causes selective pulmonary vasodilation in congenital heart diseases with pulmonary hypertension. However discontinuation of inhaled nitric oxide therapy may be complicated by abrupt life-threatening rebound pulmonary hypertension(RPH) The purpose of this study was to prevent by comparing group I(without RPH n=13) and group II(with RPH n=6) to determine the risk factors involved inthe development of the RPH. MATERIAL AND METHOD: Between Januarty 6, 1998 and April 14, 1999. we studied 19 consecutive children who were treated with inhaled nitric oxide for clinically significant pulmonary hypertension after an open heart surgery for congenital heart disease. the ratio of males and females was 12:7 ranging in age from 10 days to 6040 days(16 years) To identify the effects of nitric oxide between two groups we measured heart rate mean and systolic pulmonary arterial pressure mean and systolic systemic arterial pressure central venous pressure pH paO2/FiO2 and O2 saturation before and after the initiation and just before the withdrawal of the inhaled nitric oxide. RESULT: In 6 of 19 patients(32%) withdrawal of inhaled nitric oxide caused RPH. In the two groups inhaled nitrix oxide decreased in pulmonary arterial pressure(PAP) without decreasing the systemic arterial pressure(SAP) and increased PaO2/FiO2 Compared with patients who had no RPH(group I) patients who had RPH(group II) were older in age (1204+/-1688 versus 546+/-1654 days p<0.05) received less nitric oxide therapy(34+/-18 versus 67+/-46 hours p<0.05) has shorter weaning process(5+/-3 versus 15-13 hours p<0.05) and received lowerconcentration of initial nitric oxide supply(11+/-8 versus 17+/-8 ppm p>0.05) and lower concentration just before the withdrawal nitric oxide(4.2+/-2.6 versus 5.6+/-2.6 ppm, p>0.05) CONCLUSION: We speculate that older age shorter of nitric oxide therapy shorter weaning process are the risk factors of RPH.
Arterial Pressure ; Central Venous Pressure ; Child ; Female ; Heart Defects, Congenital ; Heart Diseases ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Hypertension, Pulmonary* ; Male ; Nitric Oxide* ; Risk Factors ; Thoracic Surgery ; Vasodilation ; Weaning

PURPOSE: DiGeorge syndrome (chromosome 22q11.2 deletion syndrome) is a syndrome of multiple congenital anomalies characterized by hypoplasia or aplasia of the thymus and parathyroid, cardiovascular malformation, immune deficiency, cleft palate, characteristic facial features, and hypocalcemia. Ocular findings of DiGeorge syndrome are posterior embryotoxon, retinal vascular tortuosity, strabismus, ptosis, amblyopia and tilted optic disc. The authors present a case of DiGeorge syndrome with ocular manifestation not reported previously in Korea. Case summary: A six-year old female diagnosed with DiGeorge syndrome was referred to the authors' department within the hospital. The chief complaint was blurring vision in both eyes. Best corrected visual acuity of the right eye was 0.5 and of the left eye was 0.63. Cycloplegic refraction revealed high hyperopia and astigmatism in both eyes (OD: +7.25 Dsph; -2.5 Dcyl axis 180degrees, OS: +6.25 Dsph; -3.75 Dcyl axis 180degrees). In addition, hypertelorism, ptosis and tortuous retinal vessels during fundus examination were noted. CONCLUSIONS: Upon the initial diagnosis of DiGeorge syndrome in children, a comprehensive ocular examination is necessary because other ocular conditions may exist which can affect the visual development of the patient.
Amblyopia ; Astigmatism ; Axis, Cervical Vertebra ; Child ; Cleft Palate ; DiGeorge Syndrome ; Eye ; Female ; Humans ; Hyperopia ; Hypertelorism ; Hypocalcemia ; Korea ; Retinal Vessels ; Retinaldehyde ; Strabismus ; Thymus Gland ; Vision, Ocular ; Visual Acuity

PURPOSE: To describe a case of symptomatic rifabutin-related uveitis with hypopyon and vitreous opacity in apatient with acquired immunodeficiency syndrome infected with Mycobacterium tuberculosis. CASE SUMMARY: A 33-year-old male patient with acquired immunodeficiency syndrome was referred to our clinic for abruptly decreased vision in his right eye. Multi-drug therapy with rifabutin was administered for 5 weeks to treat tuberculosis enteritis and pulmonary tuberculosis. Visual acuity of the right eye was hand motion and hypopyon as well as vitreous opacity was found in ocular examinations. Other serologic tests, anterior chamber paracentesis and lumbar puncture test were normal. Rifabutin was immediately stopped and topical steroid and cycloplegics were administered, which resulted in resolution of the hypopyon, vitreous opacity and visual acuity. Four weeks after the initial episode, rifabutin was restarted to treat the pulmonary tuberculosis and rifabutin-related uveitis relapsed in the opposite eye. CONCLUSIONS: Rifabutin-related uveitis should be considered in cases of uveitis in immunosuppressive patients, especially in acquired immunodeficiency syndrome patients. Underlying disease and medication history should be carefully assessed.
Acquired Immunodeficiency Syndrome ; Adult ; Anterior Chamber ; Enteritis ; Eye ; Hand ; Humans ; Male ; Mycobacterium tuberculosis ; Mydriatics ; Paracentesis ; Rifabutin ; Serologic Tests ; Spinal Puncture ; Tuberculosis ; Tuberculosis, Pulmonary ; Uveitis ; Vision, Ocular ; Visual Acuity

PURPOSE: The objective of this study is to determine whether application of ventilation in line with compression rate in performance of CPR for cardiac arrest patients was helpful in maintaining an adequate ventilation rate. METHODS: Volunteers who received education on the revised 2010 CPR guidelines were randomly assigned to either a conventional ventilation (CV) group or a compression-adjusted ventilation (CAV) group. During performance of CPR, compression rate and ventilation rate were measured every minute, and the participants' roles were changed every two minutes; CPR was performed for a total of eight minutes. RESULTS: A total of 57 volunteers participated in this study. No statistically significant difference was observed between the compression rate of the CV group and that of the CAV group. However, regarding adequacy of the ventilation rate, greater improvement was observed in the CAV group, compared with the CV group (adequate ventilation: 86.2% vs. 46.4%, p<0.001). In addition, the median value of the ventilation rate was 8.4/min (IQR: 7.7-9.6) in the CV group and 9.5/min (IQR: 9.0-10.0) in the CAV group (p=0.003). CONCLUSION: When no other valid approach is available, use of the CAV method is conducive to maintenance of an adequate ventilation rate.
Cardiopulmonary Resuscitation ; Heart Arrest ; Humans ; Manikins ; Ventilation

PURPOSE: To report a case of endophthalmitis after 25-gauge transconjunctival sutureless vitrectomy. METHODS: A 60-year-old male patient underwent 25-gauge transconjunctival sutureless vitrectomy through the epiretinal membrane. He was diagnosed as endophthalmitis on 7th postoperative day. Immediate vitrectomy and intravitreal antibiotics injection was done. RESULTS: Coagulase-negative staphylococcus was identified in vitreous culture and incarcerated vitreous through the previous unsutured sclerotomies were found. During vitrectomy, we found generalized retinal necrosis and vascular occlusion with retinal hemorrhage, cheese like thick membrane firmly adherent to the retina due to inflammatory response. The organism was sensitive to antibiotics administered. After treatment, inflammatory response was controlled and the retina became stable but the visual outcome was poor. CONCLUSIONS: Vitreous incarceration through unsutured sclerotomy may occur after 25-gauge transconjunctival sutureless vitrectomy. This can be a possible conduit for bacteria in the eye and be a cause of endophthalmitis. Sutureless sclerotomy should be carefully monitered and managed postoperatively.
Anti-Bacterial Agents ; Bacteria ; Cheese ; Endophthalmitis* ; Epiretinal Membrane ; Humans ; Male ; Membranes ; Middle Aged ; Necrosis ; Retina ; Retinal Hemorrhage ; Retinaldehyde ; Staphylococcus ; Vitrectomy*

PURPOSE: To evaluate the efficacy of intravitreal injections of triamcinolone acetonide (TA) at the end of pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR). METHODS: We analyzed 50 patients (52 eyes) who underwent PPV for treatment of PDR and received an intravitreal injection of 4 mg TA at the end of surgery. The study group (Group 1) was compared with a control group (Group 2, 46 patients, 51 eyes) (matched with the study group for preoperative parameters) who underwent PPV without intravitreal injection of TA. RESULTS: In Group 1, the grade of anterior chamber cells at postoperative days 1 and 7 was significantly lower than that of Group 2. There was slight mean IOP elevation in Group 1 at postoperative weeks 2, 3, 4, and 8, but it was not statistically significant. Forty-four eyes (84.6%) from Group 1 showed better visual acuity at the last follow-up than at the preoperative visit (Group 1). Thirty-two eyes (62.8%) from Group 2 showed better visual acuity at the last follow-up than at the preoperative visit. The degree of visual improvement was 0.75 logMAR in Group 1 and 0.59 logMAR in Group 2. Vitreous hemorrhage occurred in 9 eyes (17.3%) from Group 1 and in 19 eyes (37.3%) from Group 2. However, the differences in the occurrence of neovascularization in iris and neovascular glaucoma between two groups were not statistically significant. CONCLUSIONS: Intravitreal TA injection at the end of PPV seems to be effective in improving visual acuity and decreasing early postoperative inflammation and the frequency of vitreous hemorrhage.
Anterior Chamber ; Diabetic Retinopathy* ; Follow-Up Studies ; Glaucoma, Neovascular ; Humans ; Inflammation ; Intravitreal Injections ; Iris ; Triamcinolone Acetonide* ; Triamcinolone* ; Visual Acuity ; Vitrectomy* ; Vitreous Hemorrhage

BACKGROUNDS: The purpose of this study was to examine the incidence of new fractures after treatment with alendronate or raloxifene in patients with compression fractures treated with cement augmentation. METHODS: 140 patients with compression fracture treated with vertebroplasty or kyphoplasty between January 2007 and January 2013 were divided into 3 groups, an unmedicated group (n=31), an alendronate group (n=49), and a raloxifene group (n=60). The incidence of new fractures in 3 groups were investigated. RESULTS: The incidence of new fractures was 29% (9 cases) in unmedicated group, 20% (10 case) in alendronate group, and 26% (16 case) in raloxifene group. Average period to new fracture was 16.2 months in alendronate group and 21.5 months in raloxifene group. CONCLUSIONS: After treatment with alendronate or raloxifene, BMD increased and incidence of new fractures decreased in patients with osteoporotic compression fracture treated with vertebroplasty or kyphoplasty. Patients with alendronate showed numerical improvement in BMD and incidence of new fractures than raloxifene. But, incidence of new fractures in spine and other site showed no statisically significant.
Alendronate ; Fractures, Compression ; Humans ; Incidence ; Kyphoplasty ; Osteoporosis ; Raloxifene Hydrochloride ; Spine ; Vertebroplasty

A 52-year-old woman with a gastric outlet obstruction (GOO) caused by pyloric cancer underwent pyloric endoscopic self-expandable metal stent (SEMS) insertion. She presented with abdominal distension 40 days later. The SEMS was dysfunctional, and endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ) was performed using an endoscopic nasobiliary drainage tube. A 16 mm×31 mm Niti-S ™ HOT SPAXUS™ (TaeWoong Medical, Gimpo, Korea) was inserted successfully between the stomach and the adjacent jejunum. After the procedure, the patient had a good oral intake for more than seven months. GOO is a mechanical obstructive condition caused by various benign and malignant conditions. Traditionally, surgical GJ and SEMS insertion have been used to treat GOOs. EUS-GJ is a feasible treatment option for patients with GOO and a pyloric metal stent dysfunction.