Purpose: We report a case of secondary Descemet membrane endothelial keratoplasty (DMEK) to treat graft failure after Descemet stripping endothelial keratoplasty (DSEK).Case summary: A 66-year-old female underwent DSEK of her right eye to treat pseudophakic bullous keratopathy that developed after cataract surgery and intraocular lens exchange. After 5 years, she complained of decreased vision; graft failure was observed. Secondary DMEK was performed; no additional air injection was needed. The corrected visual acuity was 0.2, 3 months after surgery, and the cornea became clear. Conclusions Visual recovery can be achieved by performing secondary DMEK after primary DSEK graft failure.

Purpose: We report a case of secondary Descemet membrane endothelial keratoplasty (DMEK) to treat graft failure after Descemet stripping endothelial keratoplasty (DSEK).Case summary: A 66-year-old female underwent DSEK of her right eye to treat pseudophakic bullous keratopathy that developed after cataract surgery and intraocular lens exchange. After 5 years, she complained of decreased vision; graft failure was observed. Secondary DMEK was performed; no additional air injection was needed. The corrected visual acuity was 0.2, 3 months after surgery, and the cornea became clear. Conclusions Visual recovery can be achieved by performing secondary DMEK after primary DSEK graft failure.

A 61-year-old man presented with cognitive dysfunction and an 8-month history of progressive gait disturbance. Brain MRI revealed communicating hydrocephalus. Under the impression of normal pressure hydrocephalus, cerebrospinal fluid (CSF) study was done and showed unusually increased opening pressure (40 cm H2O) and protein concentration (650 mg/dl). Spine MRI was performed to rule out the possibility of intraspinal tumor. It revealed cauda equina mass, which was confirmed to be schwannoma pathologically. Intraspinal tumor should be suspected in patients with abnormally increased CSF opening pressure and/or CSF protein who presented as normal pressure hydrocephalus.
Brain ; Cauda Equina* ; Cerebrospinal Fluid ; Gait ; Humans ; Hydrocephalus ; Hydrocephalus, Normal Pressure* ; Magnetic Resonance Imaging ; Middle Aged ; Neurilemmoma* ; Spine

Nail-patella syndrome is a relatively rare autosomal dominant disorder characterized by dysplastic nail, hypoplastic or absent patella, and dislocation of radial head and iliac horns. In addition, renal abnormalities have been reported. The usual clinical signs of the renal involvement are asymptomatic proteinuria, microscopic hematuria, and in some cases progression to end stage renal disease. We present the case of adult with nail-patella syndrome, who developed proteinuria. Electron microscopy revealed irregular thickening of the glomerular basement membrane with areas of rarefaction, giving rise to a pathognomonic "moth-eaten" appearance.
Adult ; Animals ; Dislocations ; Glomerular Basement Membrane ; Head ; Hematuria ; Horns ; Humans ; Kidney Failure, Chronic ; Microscopy, Electron ; Nail-Patella Syndrome* ; Patella ; Proteinuria

PURPOSE: The results of a simple retrograde balloon dilation for treating ureteral strictures was analyzed in order to evaluate the efficacy of this procedure and the factors affecting the success rate. MATERIALS AND MTHODS: A prospective study was performed on 43 ureteral strictures (22 malignant, 21 benign) from 37 patients, who were treated with retrograde balloon dilation from October 1997 to May 1999. After the stricture segments were dilated, ureteral stents were indwelled uniformly for 3 weeks. The strictures were followed up radiographically at 1, 3, 6, 12 and 24 months after treatment. The success was defined by a symptomatic and radiographic improvement. The follow-up period ranged from 3 to 43 months (mean 21 months). The prognostic factors affecting the success rate were analyzed. RESULTS: The success rate of the benign strictures at 12 months was much higher than that of malignant strictures (60% vs, 15%, p=0.0019). Although 48% of the patients with strictures shorter than 2cm were successful after 12 months, only 9% of those with strictures longer than 2cm were successful (p=0.0124). Other prognostic factors such as sex, age, location, presence of immediate success and the grade of hydronephrosis were has little effect on the success rate. Multivariate analysis revealed that etiology was the only significant prognostic factor affecting the final outcome (p=0.0371), and that stricture length was the only significant prognostic factor in the benign cases (p=0.0375). CONCLUSIONS: Considering its minimal invasiveness, a simple retrograde balloon dilation appears to be a reasonably effective treatment modality for a benign ureteral stricture with a short segment (2cm).
Constriction, Pathologic* ; Follow-Up Studies ; Humans ; Hydronephrosis ; Multivariate Analysis ; Prospective Studies ; Stents ; Ureter* ; Ureteral Obstruction

PURPOSE: The results of a simple retrograde balloon dilation for treating ureteral strictures was analyzed in order to evaluate the efficacy of this procedure and the factors affecting the success rate. MATERIALS AND MTHODS: A prospective study was performed on 43 ureteral strictures (22 malignant, 21 benign) from 37 patients, who were treated with retrograde balloon dilation from October 1997 to May 1999. After the stricture segments were dilated, ureteral stents were indwelled uniformly for 3 weeks. The strictures were followed up radiographically at 1, 3, 6, 12 and 24 months after treatment. The success was defined by a symptomatic and radiographic improvement. The follow-up period ranged from 3 to 43 months (mean 21 months). The prognostic factors affecting the success rate were analyzed. RESULTS: The success rate of the benign strictures at 12 months was much higher than that of malignant strictures (60% vs, 15%, p=0.0019). Although 48% of the patients with strictures shorter than 2cm were successful after 12 months, only 9% of those with strictures longer than 2cm were successful (p=0.0124). Other prognostic factors such as sex, age, location, presence of immediate success and the grade of hydronephrosis were has little effect on the success rate. Multivariate analysis revealed that etiology was the only significant prognostic factor affecting the final outcome (p=0.0371), and that stricture length was the only significant prognostic factor in the benign cases (p=0.0375). CONCLUSIONS: Considering its minimal invasiveness, a simple retrograde balloon dilation appears to be a reasonably effective treatment modality for a benign ureteral stricture with a short segment (2cm).
Constriction, Pathologic* ; Follow-Up Studies ; Humans ; Hydronephrosis ; Multivariate Analysis ; Prospective Studies ; Stents ; Ureter* ; Ureteral Obstruction

The clinical presentation of intraductal papillary mucinous tumor (IPMT) of the pancreas is characterized by chronic or recurrent attacks of abdominal discomfort often in association with low level pancreatic enzyme elevations. The episodes of pancreatitis due to IPMT of the pancreas are usually mild in severity. Recently, however, we experienced a case of IPMT of the pancreas causing severe acute pancreatitis with a protracted course in a 65 year-old woman. Initially, she presented with pancreatic ascites and hyperenzynemia without duct ectasia and mucus extrusion through the papillary orifice. Refeeding caused aggravation of hyperenzynemia and abdominal pain. The 4th follow-up abdominal computed tomography taken about 2 months after admission only revealed marked dilatation of the main pancreatic duct. Distal pancreatectomy disclosed IPMT, combined type and carcinoma in situ histologically. The patient has been followed for 2 years after operation with an uneventful clinical course. We herein report a case of IPMT of the pancreas with an unusual presentation.
Abdominal Pain ; Aged ; Ascites ; Carcinoma in Situ ; Dilatation ; Dilatation, Pathologic ; Female ; Follow-Up Studies ; Humans ; Mucins* ; Mucus ; Pancreas* ; Pancreatectomy ; Pancreatic Ducts ; Pancreatitis*

Intraductal papillary mucinous tumor (IPMT) of the pancreas, a lesion consisting of mucin-producing cells with neoplastic potential, is characterized by duct ectasia, mucin hypersecretion, often extensive papillary intraductal growth, varying degrees of cytologic atypia, and relatively indolent growth. The clinical presentation of IPMT of the pancreas is characterized by chronic or recurrent attacks of abdominal discomfort often in association with low level pancreatic enzyme elevations. Less commonly these lesions may be detected as asymptomatic radiographic abnormalities. Interestingly, a case of a minute IPMT (2 mm in height and 7 mm in length, adenoma) in the main pancreatic duct presenting with acute pancreatitis in a 55 year-old man has been reported in the Japanese literature. Recently, we also experienced a case of a minute IPMT in a branch pancreatic duct causing repeated bouts of acute pancreatitis in a 75 year-old man. A filling defect at the neck of the main pancreatic duct seen on an endoscopic retrograde pancreatogram performed after recovery of the second attack of acute pancreatitis led the patient to undergo an exploratory laparotomy. After a near-total pancreatectomy was carried out, a minute (3 x 7 mm) IPMT of borderline malignancy was discovered in a branch duct at the head portion near the pancreatic neck without any lesions in the main pancreatic duct. Surprisingly, despite the resective surgery the patient died of carcinomatosis 8.5 months after the operation. We herein report a case of a minute but aggressive IPMT of the pancreas with a review of the literature.
Acute Disease ; Aged ; Case Report ; Cholangiopancreatography, Endoscopic Retrograde ; Human ; Male ; Mucins/secretion* ; Pancreatic Ducts/pathology ; Pancreatic Neoplasms/pathology ; Pancreatic Neoplasms/complications* ; Pancreatitis/etiology* ; Recurrence ; Tomography, X-Ray Computed

No abstract available.
Animals ; DNA* ; LLC-PK1 Cells* ; Swine

Intraductal papillary mucinous tumors (IPMT) of the pancreas is a lesion consisting of mucin-producing cells with neoplastic potential. This unique group of tumors is characterized by duct ectasia, mucin hypersecretion, often extensive papillary intraductal growth, varying degrees of cytologic atypia, and relatively indolent growth. Now IPMT of the pancreas also includes intraductal papillary neoplasms that do not hypersecrete mucin. The clinical presentation of IPMT of the pancreas is characterized by chronic or recurrent attacks of abdominal discomfort often in association with low level pancreatic enzyme elevations. The episodes of pancreatitis due to IPMT of the pancreas are mild in severity. Recently, we was experienced a case of a minute IPMT causing repeated bouts of acute pancreatitis in a 75 year-old man. An endoscopic retrograde pancreatogram revealed a filling defect at the neck of the main pancreatic duct. A near-total pancreatectomy was performed and a minute (3x7 mm) IPMT of borderline malignancy was found in a branch duct at the pancreatic head. Surprisingly, despite the resective surgery the patient died of carcinomatosis. 8.5 months after the operation. This case of a minute but aggressive IPMT of the pancreas is herein reported with a review of the relevant literature.
Aged ; Carcinoma ; Dilatation, Pathologic ; Head ; Humans ; Mucins* ; Neck ; Pancreas* ; Pancreatectomy ; Pancreatic Ducts ; Pancreatitis*