Purpose: To report a case of Descemet stripping automated endothelial keratoplasty (DSAEK) for graft failure after re-penetrating keratoplasty (PK).Case summary: A 33-year-old man of Indian nationality who had developed right eye amoeba keratitis and had received two penetrating keratoplasties and allogeneic kerato-limbal transplant in India sought treatment at our hospital. During the follow-up, Ahmed valve transplantation was performed under the diagnosis of secondary glaucoma in his right eye; the patient also underwent conjunctival recession and conjunctival permanent amniotic membrane transplantation as corneal neovascularization had progressed. Subsequently, the corneal transplantation failed and DSAEK was performed. At 7 months after the operation, the right-eye visual acuity was 20/320 without any complications. Conclusions DSAEK may restore good vision without complications in patients with repeated corneal graft failure after PK from corneal endothelial cell failure followed by corneal neovascularization and glaucoma surgery but with good stromal conditions. We present this case, along with a review of the literature. Future studies will require more surgical patients.

Purpose: To report a case of Descemet stripping automated endothelial keratoplasty (DSAEK) for graft failure after re-penetrating keratoplasty (PK).Case summary: A 33-year-old man of Indian nationality who had developed right eye amoeba keratitis and had received two penetrating keratoplasties and allogeneic kerato-limbal transplant in India sought treatment at our hospital. During the follow-up, Ahmed valve transplantation was performed under the diagnosis of secondary glaucoma in his right eye; the patient also underwent conjunctival recession and conjunctival permanent amniotic membrane transplantation as corneal neovascularization had progressed. Subsequently, the corneal transplantation failed and DSAEK was performed. At 7 months after the operation, the right-eye visual acuity was 20/320 without any complications. Conclusions DSAEK may restore good vision without complications in patients with repeated corneal graft failure after PK from corneal endothelial cell failure followed by corneal neovascularization and glaucoma surgery but with good stromal conditions. We present this case, along with a review of the literature. Future studies will require more surgical patients.

OBJECTIVES: The neutrophil gelatinase-associated lipocalin (NGAL) level following non cardiac surgery is useful for predicting acute kidney damage. However, there is insufficient conclusive evidence as to whether NGAL can be used to predict subclinical AKI following non-cardiac surgery. METHODS: We measured serum NGAL and creatinine levels in 41 patients following non-cardiac surgery, and the increase of these variables was used to predict acute decreases in kidney function. RESULTS: The study included a total of 41 patients. The mean age was 64.65 ± 17.09 years. The serum creatinine concentration was increased 12 hours after surgery. The mean SD serum NGAL decreased after 4hours after surgery and continued to decrease after 12 hours after surgery. The incidence of subclinical AKI determined by the 4 hour serum NGAL level was 10(24.4%), and the incidence of serum creatinine elevation was 0(0.0%). The incidence of subclinical AKI determined by the 12 hour serum NGAL level was 4(9.8%), and the incidence of subclinical AKI determined by serum creatinine was 4(9.8%). The elevation of NGAL was more rapid than the serum creatinine 4 hours after surgery. CONCLUSIONS: We verified the usefulness of the serum NGAL level as a predictive factor for subclinical AKI after non-cardiac surgery.
Acute Kidney Injury* ; Creatinine ; Humans ; Incidence ; Kidney ; Lipocalins ; Neutrophils* ; Prognosis* ; Thoracic Surgery

OBJECTIVE: The spot sign is related with the risk of hematoma expansion in spontaneous intracerebral hemorrhage (ICH). However, not all spot sign positive patients undergo hematoma expansion. Thus, the present study investigates the specific factors enhancing the spot sign positivity in predicting hematoma expansion. METHODS: We retrospectively studied 316 consecutive patients who presented between March 2009 to March 2011 with primary ICH and whose initial computed tomography brain angiography (CTA) was performed at our Emergency Department. Of these patients, 47 primary ICH patients presented spot signs in their CTA. We classified these 47 patients into two groups based on the presence of hematoma expansion then analyzed them with the following factors : gender, age, initial systolic blood pressure, history of anti-platelet therapy, volume and location of hematoma, time interval from symptom onset to initial CTA, spot sign number, axial dimension, and Hounsfield Unit (HU) of spot signs. RESULTS: Of the 47 spot sign positive patients, hematoma expansion occurred in 26 patients (55.3%) while the remaining 21 (44.7%) showed no expansion. The time intervals from symptom onset to initial CTA were 2.42+/-1.24 hours and 3.69+/-2.57 hours for expansion and no expansion, respectively (p=0.031). The HU of spot signs were 192.12+/-45.97 and 151.10+/-25.14 for expansion and no expansion, respectively (p=0.001). CONCLUSIONS: The conditions of shorter time from symptom onset to initial CTA and higher HU of spot signs are the emphasizing factors for predicting hematoma expansion in spot sign positive patients.
Angiography ; Blood Pressure ; Brain ; Cerebral Hemorrhage* ; Emergency Service, Hospital ; Hematoma* ; Humans ; Retrospective Studies

BACKGROUND: Hypertrophic scars and keloids are prevalent and emotionally debilitating dermatologic diseases. Various treatment modalities have been advocated to treat hypertrophic scars and keloids. OBJECTIVE: This study prospectively assessed the safety and efficacy of using intense pulsed light (IPL) on scars that originate from surgery. METHODS: A total 22 patients with surgically induced hypertrophic scars and keloids were treated with IPL. Treatment was administrated at 4-week intervals, with an average of 3.5 sessions (range=1~10). The scars were evaluated for pigmentation, pliability, height, vascularity, pain and pruritus by using the modified Vancouver Scar Scale (MVSS). The subjective assessment of satisfaction was scored by the patients on a 25% increment of satisfaction scale. Evaluations were performed monthly during the follow-up period. RESULTS: There was overall clinical improvement for the appearance of the scars. Although statistically significant improvement was not shown (p=0.47), the average MVSS showed a trend for favorable effects on the scars with the successive IPL treatments. The patients who had higher baseline MVSS (> or =10) demonstrated statistically significant improvements with the successive IPL treatments (p<0.05). The degree of the patient's satisfaction also improved with the treatment for all of the patients (p<0.05). The adverse effects were negligible. CONCLUSION: IPL is one of the effective, safe methods to improve the clinical appearance of surgically induced hypertrophic scars and keloids and this treatment had high patient satisfaction and relatively few side effects.
Cicatrix ; Cicatrix, Hypertrophic ; Follow-Up Studies ; Humans ; Keloid ; Light ; Patient Satisfaction ; Pigmentation ; Pliability ; Prospective Studies ; Pruritus

Neurofibromatosis is an autosomal dominant hereditary disorder with an overall incidence of one in 3,000~4,000, and type 1 (Von Recklinghausen's neurofibromatosis) characterized by the presence of multiple cutaneous neurofibromas, axillary and groin freckling, and cafe- au-lait spot. The neurofibromatosis type 1 gene is a tumor suppressor gene. Patients with the neurofibromatosis type 1 are at increased risk of developing nervous system neoplasm, including plexiform neurofibromas, optic gliomas, ependymomas, meningiomas, astrocytomas, and pheochromocytomas. Neurofibromas may undergo secondary malignant degeneration and sarcomatous changes. Patients with neurofibromatosis type 1 show a high incidence of Wilm's tumor, rhabdomyosarcoma, nonlymphocytic leukemia, and pheochromocytoma but the gastrointestinal involvement appears to be relatively rare and usually consists of neurofibroma, ganglioneuroma, and leiomyoma. We have identified a case of early gastric adenocarcinoma and intraabdominal schwannoma in a 65-year-old man afflicted with neurofibromatosis type 1.
Adenocarcinoma* ; Aged ; Astrocytoma ; Ependymoma ; Ganglioneuroma ; Genes, Tumor Suppressor ; Groin ; Humans ; Incidence ; Leiomyoma ; Leukemia ; Meningioma ; Nervous System Neoplasms ; Neurilemmoma* ; Neurofibroma ; Neurofibroma, Plexiform ; Neurofibromatoses* ; Neurofibromatosis 1* ; Optic Nerve Glioma ; Pheochromocytoma ; Rhabdomyosarcoma ; Wilms Tumor

The anal canal is the most distal part of the gastrointestinal tract, and it is developed and formed during the embryonic period. Infection is the most common disease process that occurs around the anorectum, yet tumors or cysts are occasionally encountered. The abnormal development of these parts of the gastrointestinal track during the embryonic period can result in congenital lesions that are discovered in young children or adults. A 72-year-old woman presented to us with postprandial lower abdominal discomfort and fecal incontinence. An anorectal mass was felt on the rectal examination. The colonoscopy demonstrated a submucosal tumor that was closely located to the anorectal junction. The tumor was excised with a snare and it was diagnosed as an analgland cyst due to the histologic features. It is necessary to differentiate anal gland cyst from the other diseases that have submucosal characters, such as carcinoid tumor.
Child ; Adult ; Male ; Female ; Humans ; Cysts

Choledochoduodenal fistula (CDF) occurring simultaneously with pancreaticoduodenal fistula is extremely rare. CDF has known to be a chronic sequela of cholelithiasis, but it is unknown whether pancreaticoduodenal fistula results from chronic cholelithiasis as well. We report a case of cholelithiasis accompanied with choledochoduodenal and pancreaticoduodenal fistula opening into small suprapapillary diverticulum in a 80-year-old woman.
Aged, 80 and over ; Biliary Fistula/*complications ; Cholelithiasis/complications ; Common Bile Duct Diseases/*complications ; Diverticulum/*complications ; Duodenal Diseases/*complications ; Female ; Humans ; Intestinal Fistula/*complications ; Pancreatic Fistula/*complications

Eosinophilic fasciitis (EF) is a rare disorder of unknown etiology characterized by eosinophilia, indurations of the skin, and inflammation of the fascia. Magnetic resonance imaging (MRI) has been used to assist the diagnosis and to monitor the response to treatment, and the commonly used therapy has been corticosteroids. However, the use of ultrasonography (US) in the diagnosis and the management of EF has not been reported previously in Korea. In addition, the effects of methotrexate (MTX) treatment have rarely been reported in corticosteroid-resistant patients with EF. Here, we describe two cases of EF resistant to corticosteroid therapy alone where the combination of MTX and corticosteroids was effective. Furthermore, we show that US is useful modality in supporting the clinical diagnosis and monitoring the response to treatment of patients with EF.
Adrenal Cortex Hormones ; Diagnosis ; Eosinophilia ; Eosinophils* ; Fascia ; Fasciitis* ; Humans ; Inflammation ; Korea ; Magnetic Resonance Imaging ; Methotrexate* ; Skin ; Ultrasonography*

OBJECTIVE: The aim of our study was to compare the accuracy of CT and 18F-FDG PET for detecting peritoneal metastasis in patients with gastric carcinoma. MATERIALS AND METHODS: One-hundred-twelve patients who underwent a histologic confirmative exam or treatment (laparotomy, n = 107; diagnostic laparoscopy, n = 4; peritoneal washing cytology, n = 1) were retrospectively enrolled. All the patients underwent CT and 18F-FDG PET scanning for their preoperative evaluation. The sensitivities, specificities and accuracies of CT and 18F-FDG PET imaging for the detection of peritoneal metastasis were calculated and then compared using Fisher's exact probability test (p < 0.05), on the basis of the original preoperative reports. In addition, two board-certified radiologists and two board-certified nuclear medicine physicians independently reviewed the CT and PET scans, respectively. A receiver-operating characteristic curve analysis was performed to compare the diagnostic performance of CT and 18F-FDG PET imaging for detecting peritoneal metastasis. RESULTS: Based on the original preoperative reports, CT and 18F-FDG PET showed sensitivities of 76.5% and 35.3% (p = 0.037), specificities of 91.6% and 98.9% (p = 0.035), respectively, and equal accuracies of 89.3% (p = 1.0). The receptor operating characteristics curve analysis showed a significantly higher diagnostic performance for CT (Az = 0.878) than for PET (Az = 0.686) (p = 0.004). The interobserver agreement for detecting peritoneal metastasis was good (κ value = 0.684) for CT and moderate (κ value = 0.460) for PET. CONCLUSION: For the detection of peritoneal metastasis, CT was more sensitive and showed a higher diagnostic performance than PET, although CT had a relatively lower specificity than did PET.
*Tomography, Emission-Computed ; Stomach Neoplasms/*pathology ; Sensitivity and Specificity ; Retrospective Studies ; Radiopharmaceuticals/diagnostic use ; ROC Curve ; *Positron-Emission Tomography ; Peritoneal Neoplasms/*radiography/*radionuclide imaging/*secondary ; Middle Aged ; Male ; Iohexol/analogs & derivatives/diagnostic use ; Humans ; Fluorodeoxyglucose F18/diagnostic use ; Female ; Contrast Media ; Aged, 80 and over ; Aged ; Adult ; Adolescent