PURPOSE: To compare the outcomes of indocyanine green (ICG) and triamcinolone (TA) assisted internal limiting membrane (ILM) peeling during idiopathic macular hole surgery. METHODS: Fifty-four eyes of 54 patients with idiopathic macular hole underwent pars plana vitrectomy including peeling of the posterior cortical hyaloid and peeling of the internal limiting membrane. For enhanced visualization of ILM, ICG was used in 25 eyes and TA in the remaining 29 eyes. Postoperative visual acuity was measured and OCT was performed. RESULTS: Anatomical closure was achieved in 25 eyes (100%) in ICG group and 28 eyes (97%) in TA group, Best corrected visual acuity improvement by > or =2 lines was in 15 eyes (60%) in ICG group and 18 eyes (62%) in TA group. Postoperative visual improvement rates by > or =20/50 were 10 eyes (40%) in ICG group and 9 eyes (31%) in TA group. CONCLUSIONS: Peeling of the internal limiting membrane using triamcinolone and indocyanine green was safe and effective for anatomic and functional success in idiopathic macular hole surgery. Further studies of the toxicity of TA, ICG and the result of internal limiting membrane peeling is needed.
Humans ; Indocyanine Green* ; Membranes ; Retinal Perforations* ; Triamcinolone* ; Visual Acuity ; Vitrectomy

It is established that intracranial hemorrhage is relatively common benign intracranial diseases in adult. This is very rare in children reports are limited to a few cases or to those cited in reviews of series of intracranial hemorrhage in adult group. We wish to report three cases of large intracranial hematoma in three infants. The diagnosis was greatly facilitated by the CT scan and the treatment did by the microsurgical methods.
Adult ; Cerebral Hemorrhage* ; Child ; Diagnosis ; Hematoma ; Humans ; Infant ; Intracranial Hemorrhages ; Tomography, X-Ray Computed

BACKGROUND: Carotid endarterectomy has been proven to be beneficial for the prevention of strokes in both symptomatic and asymptomatic patients with significant carotid stenosis. Even if there is no consensus as to the most appropriate monitoring method for detecting cerebral ischemia during carotid endarterectomy, electroencephalography (EEG) and/or somatosensory evoked potential (SSEP) has been extensively used to evaluate cerebral functions. We estimated the efficacy of EEG and SSEP for detecting cerebral ischemia during carotid endarterectomy in conscious patients. METHODS: One or both of 16-channel EEG and SSEP monitoring were performed in 103 patients scheduled for carotid endarterectomy under cervical plexus block. We estimated the sensitivity and specificity of EEG and SSEP for detecting cerebral ischemia expressed by altered consciousness and shunt insertion. RESULTS: During carotid clamp in 74 cases studied, significant EEG changes were noted in 5 of the 16 patients who had cerebral ischemia, however 11 patients had no EEG changes despite cerebral ischemia. During carotid clamp in 84 cases studied, significant SSEP changes were noted in 7 of the 19 patients who had cerebral ischemia, however 12 patients had no SSEP changes despite cerebral ischemia. The sensitivity and specificity for detecting cerebral ischemia were 31% and 86% for EEG and 37% and 95% for SSEP, respectively. CONCLUSIONS: We conclude that EEG and SSEP monitoring during carotid endarterectmy under regional anesthesia is not a sensitive method for detecting cerebral ischemia.
Anesthesia, Conduction* ; Brain Ischemia* ; Carotid Stenosis ; Cervical Plexus ; Consciousness ; Consensus ; Electroencephalography* ; Endarterectomy, Carotid* ; Evoked Potentials, Somatosensory* ; Humans ; Sensitivity and Specificity ; Stroke

A case of sphenoid sinus mucoceles that also partially involved posterior ethmoid and frontal sinuses is described. Diplopia following severe headache of sudden onset developed to 43 year old man. MRI revealed high signal intensity either on T1WI and on T2 WI. The mucoceles of sphenoid sinus and ethmoid sinus were removed by transnasal simple drainage and the postoperative result was satisfactory.
Adult ; Diplopia ; Drainage ; Ethmoid Sinus ; Frontal Sinus ; Headache ; Humans ; Magnetic Resonance Imaging ; Mucocele* ; Sphenoid Sinus*

A case of large aneurysm of azygos anterior cerebral artery(Azygos ACA) is reported. This 52-year-old male patient became unconscious suddenly on working. The CT scan demonstrated small amount of hemorrhage in the interhemispheric fissure and basal cistern and huge intraventricular hematoma with marked dilatation of all ventricles. Emergency external ventricular drainage was done and his consciousness recovered to the level of possible spontaneous eye opening. 4-vessels angiography done a month later revealed a large revealed a large fusiform aneurysm at the bifurcation of distal end of azygos ACA. Authors preferred interhemispheric approach and clipped the aneurysmal neck uneventfully. Despite the successful clipping of the aneurysm confirmed by postoperative angiography, preoperative mutism, spastic weakness of lower extremities and urinary incontinence didn't recovered. This case suggests that preoperative neurological status is no less critical to the postoperative outcome than surgical technique. This is the first case of large aneurysm at this site so far as we know.
Aneurysm* ; Angiography ; Anterior Cerebral Artery* ; Consciousness ; Dilatation ; Drainage ; Emergencies ; Hematoma ; Hemorrhage ; Humans ; Lower Extremity ; Male ; Middle Aged ; Muscle Spasticity ; Mutism ; Neck ; Tomography, X-Ray Computed ; Urinary Incontinence

Two cases of cavernous hemangioma of the cauda equina are presented. Cavernous hemangioma of the cauda equina is rare vascular malformation. This is the fifth and sixth case of cavernous hemangioma of the cauda equina in the literature. These cases are female patients. MRI is more sensitive method than spinal myelography and CT in diagnosis of cavernous hemangioma of the cauda equina. Total removal was possible without immediate post-operative complication.
Cauda Equina* ; Diagnosis ; Female ; Hemangioma, Cavernous* ; Humans ; Magnetic Resonance Imaging ; Myelography ; Vascular Malformations

PURPOSE: Radial shortening osteotomy and ulnar lengthening osteotomy for decreasing axial loading have been known to treatment for avascular necrosis of lunate bone. The purpose of this study was to evaluate the clinical outcomes of radial shortening osteotomy for Lichtman stage III Kienbock disease. MATERIALS AND METHODS: Between December 2001 and October 2008, thirteen patients with Kienbock disease underwent a radial shortening osteotomy at our institution. On the basis of Lichtman classification, six had stage IIIA and seven had stage IIIB. Radiographic measurement of the ulnar variance and the carpal height ratio were assessed preoperatively and at the follow-up. Patients were examined for wrist pain, range of motion at flexion and extension and grip strength both preoperatively and postoperatively. The clinical outcomes was evaluated through the modification of Evans scoring system. RESULTS: All thirteen had maintained the preoperative stage at the follow-up. In ulnar variance, negative variance was seven. The carpal height ratio was increased mean 0.018 at the follw-up. Pain in VAS was improved mean 3.6 at the follow-up. In range of motion of wrist flexion-extension, in the eleven which had limitation of motion preoperatively, all eleven showed improvement. In grip strength, among the ten which had decreased preoperatively, eight showed improvement and two showed no change at the follw-up. The clinical outcomes were good in eight, fair in three and poor in two. Among the five, negative ulnar variance of stage IIIB, three had good, two had fair clinical outcomes. CONCLUSIONS: We found that radial shortening osteotomy can prevent disease progression, also show good clinical results for stage IIIB Kienbock disease as well as stage IIIA.
Disease Progression ; Follow-Up Studies ; Hand Strength ; Humans ; Lunate Bone ; Necrosis ; Osteonecrosis ; Osteotomy ; Range of Motion, Articular ; Wrist

Primary Sjogren's syndrome is a chronic autoimmune disorder characterized by xerostomia and keratoconjunctivitis sicca result from lymphocytic infiltrations of salivary and lacrimal glands.It may accompany by the wide spectrums of extraglandular symptoms,such as musculoskeletal,pulmonary,renal,intestinal,hematologic,and nervous system.However,overt cardiac manifestations are very rare and are documented only a few cases sporadically. We report a patient with primary Sjogren's syndrome who developed reversible congestive heart failure as part of a myocarditis.A 39-year-old woman with primary Sjogren's syndrome developed fatigue,dyspnea,and abdominal discomfort.An echocardiography revealed global hypokinetic left ventricle with markedly decreased ejection fraction (EF=39%),abnormal restrictive filling pattern,secondary tricuspid valve insufficiency and no pericardial effusion or thickening.A myocardial biopsy disclosed myocardial degeneration with lymphocyte infiltration.Following treatment with digitalis,diuretics,ACE inhibitor and corticosteroid,the symptoms of congestive heart failure improved.A repeat echocardiography showed an improved ventricular contractility and recovered both diastolic (normalized E/A ratio)and systolic (EF=50%)functions.
Adult ; Biopsy ; Echocardiography ; Female ; Heart Failure ; Heart Ventricles ; Humans ; Keratoconjunctivitis Sicca ; Lymphocytes ; Myocarditis* ; Pericardial Effusion ; Sjogren's Syndrome* ; Tricuspid Valve Insufficiency ; Xerostomia

Camurati-Engelmann disease (CED) is an autosomal dominant progressive diaphyseal dysplasia caused by mutations in the transforming growth factor-beta1 (TGFB1) gene. We report the first Korean family with an affected mother and son who were diagnosed with CED. The proband is a 19-yr-old male with a history of abnormal gait since the age of 2. He also suffered from proximal muscle weakness, pain in the extremities, and easy fatigability. Skeletal radiographs of the long bones revealed cortical, periosteal, and endosteal thickenings, predominantly affecting the diaphyses of the upper and lower extremities. No other bony abnormalities were noted in the skull and spine and no remarkable findings were seen on laboratory tests. The patient's mother had a long-standing history of mild limb pain. Under the impression of CED on radiographic studies, we performed mutation analysis. A heterozygous G to A transition at cDNA position +653 in exon 4 of the TGFB1 gene (R218H) was detected in the patient and his mother.
Adult ; Amino Acid Substitution ; Camurati-Engelmann Syndrome/*diagnosis/radiography ; DNA Mutational Analysis ; Diaphyses/radiography ; Heterozygote ; Humans ; Korea ; Male ; Muscle Weakness/radiography ; Pedigree ; Transforming Growth Factor beta1/*genetics

Highly active antiretroviral therapy (HAART), which restores specific immune responses, may paradoxically cause an inflammatory reaction known as immune reconstitution inflammatory syndrome (IRIS). We report a patient with acquired immune deficiency syndrome, who presented Molluscum contagiosum as IRIS after HAART, the first case in Korea.
Acquired Immunodeficiency Syndrome ; Antiretroviral Therapy, Highly Active ; HIV ; Humans ; Immune Reconstitution Inflammatory Syndrome ; Iris ; Korea ; Molluscum Contagiosum ; Skin ; Skin Manifestations