Purpose: We report a case of bilateral nasal and temporal four-site scleromalacia following cosmetic conjunctivectomy, successfully managed with simultaneous restoration surgery at all four sites using autologous tragal perichondrium and preserved scleral graft.Case summary: A 56-year-old woman who underwent cosmetic conjunctivectomy on both eyes 15 years earlier, presented with intermittent eye pain. Examination revealed scleromalacia with calcium plaques in all four nasal and temporal scleral areas. The most extensive avascular area was in the nasal region of the right eye, and the most prominent uveal exposure was in the nasal area of the left eye. Considering the lesion and exposure sizes of the avascular zone and uvea exposure, preserved sclera was transplanted to the temporal and nasal areas of the right eye, while autologous tragal perichondrium was transplanted to the nasal area of the left eye. Tenon's capsule vessels were fixed with pedicle flaps in all four surgical areas for vascularization. Frozen amniotic membrane was transplanted in the nasal area of the left eye, where the conjunctival defect was substantial, and in the lateral area of the left eye, where no graft was used. The conjunctival epithelium was closed using autologous conjunctival flaps in all four areas. Post-surgery, successful engraftment and vascularization of the graft materials were observed in both eyes. Conclusions Even with multiple areas of scleromalacia in both eyes, successful results can be achieved during simultaneous surgery if an appropriate graft material is selected and the surgery is performed utilizing principles of tissue restoration.

Purpose: We report a case of bilateral nasal and temporal four-site scleromalacia following cosmetic conjunctivectomy, successfully managed with simultaneous restoration surgery at all four sites using autologous tragal perichondrium and preserved scleral graft.Case summary: A 56-year-old woman who underwent cosmetic conjunctivectomy on both eyes 15 years earlier, presented with intermittent eye pain. Examination revealed scleromalacia with calcium plaques in all four nasal and temporal scleral areas. The most extensive avascular area was in the nasal region of the right eye, and the most prominent uveal exposure was in the nasal area of the left eye. Considering the lesion and exposure sizes of the avascular zone and uvea exposure, preserved sclera was transplanted to the temporal and nasal areas of the right eye, while autologous tragal perichondrium was transplanted to the nasal area of the left eye. Tenon's capsule vessels were fixed with pedicle flaps in all four surgical areas for vascularization. Frozen amniotic membrane was transplanted in the nasal area of the left eye, where the conjunctival defect was substantial, and in the lateral area of the left eye, where no graft was used. The conjunctival epithelium was closed using autologous conjunctival flaps in all four areas. Post-surgery, successful engraftment and vascularization of the graft materials were observed in both eyes. Conclusions Even with multiple areas of scleromalacia in both eyes, successful results can be achieved during simultaneous surgery if an appropriate graft material is selected and the surgery is performed utilizing principles of tissue restoration.

Purpose: We report a case of bilateral nasal and temporal four-site scleromalacia following cosmetic conjunctivectomy, successfully managed with simultaneous restoration surgery at all four sites using autologous tragal perichondrium and preserved scleral graft.Case summary: A 56-year-old woman who underwent cosmetic conjunctivectomy on both eyes 15 years earlier, presented with intermittent eye pain. Examination revealed scleromalacia with calcium plaques in all four nasal and temporal scleral areas. The most extensive avascular area was in the nasal region of the right eye, and the most prominent uveal exposure was in the nasal area of the left eye. Considering the lesion and exposure sizes of the avascular zone and uvea exposure, preserved sclera was transplanted to the temporal and nasal areas of the right eye, while autologous tragal perichondrium was transplanted to the nasal area of the left eye. Tenon's capsule vessels were fixed with pedicle flaps in all four surgical areas for vascularization. Frozen amniotic membrane was transplanted in the nasal area of the left eye, where the conjunctival defect was substantial, and in the lateral area of the left eye, where no graft was used. The conjunctival epithelium was closed using autologous conjunctival flaps in all four areas. Post-surgery, successful engraftment and vascularization of the graft materials were observed in both eyes. Conclusions Even with multiple areas of scleromalacia in both eyes, successful results can be achieved during simultaneous surgery if an appropriate graft material is selected and the surgery is performed utilizing principles of tissue restoration.

Purpose: We explored changes in the various clinical parameters of dry eye disease (DED), including the tear matrix metalloproteinase 9 (MMP-9) level, soon after cataract surgery. We sought correlations between such changes and ocular surface discomfort. Methods: In 106 patients (106 eyes) who underwent cataract surgery, we evaluated meibomian gland dysfunction, tear secretion, corneal sensitivity, tear break-up time, corneal erosion status, the Sjögren’s International Collaborative Clinical Alliance (SICCA) ocular staining score, tear osmolarity, the tear MMP-9 level, and the ocular surface disease index (OSDI) before, and 1 week and 1 month after surgery. All eyes were instilled with topical moxifloxacin, a steroid, and a non-steroidal anti-inflammatory drug daily for 1 month postoperatively. The 1-month delta OSDI scores correlated with the 1-month delta DED parameters. We compared the latter parameters between patients in whom the MMP-9 level decreased (MMP-9-decreased group) at 1 month with those in whom it did not (MMP-9-not decreased group). Results: Overall, 89.5% of total patients exhibited preoperative DED. The tear MMP-9 level fell at 1 month postoperatively, tear secretion (evaluated using the Schirmer I test) decreased at 1 week, and the OSDI scores fell at both 1 week and 1 month. We found no significant correlation between the 1-month delta OSDI scores and the 1-month delta DED parameters. The 1-month OSDI score fell to a significantly greater extent in the MMP-9-decreased group. Conclusions Routine, local anti-inflammatory treatment after cataract surgery may briefly reduce the tear MMP-9 level and ocular surface discomfort.

Purpose: We explored changes in the various clinical parameters of dry eye disease (DED), including the tear matrix metalloproteinase 9 (MMP-9) level, soon after cataract surgery. We sought correlations between such changes and ocular surface discomfort. Methods: In 106 patients (106 eyes) who underwent cataract surgery, we evaluated meibomian gland dysfunction, tear secretion, corneal sensitivity, tear break-up time, corneal erosion status, the Sjögren’s International Collaborative Clinical Alliance (SICCA) ocular staining score, tear osmolarity, the tear MMP-9 level, and the ocular surface disease index (OSDI) before, and 1 week and 1 month after surgery. All eyes were instilled with topical moxifloxacin, a steroid, and a non-steroidal anti-inflammatory drug daily for 1 month postoperatively. The 1-month delta OSDI scores correlated with the 1-month delta DED parameters. We compared the latter parameters between patients in whom the MMP-9 level decreased (MMP-9-decreased group) at 1 month with those in whom it did not (MMP-9-not decreased group). Results: Overall, 89.5% of total patients exhibited preoperative DED. The tear MMP-9 level fell at 1 month postoperatively, tear secretion (evaluated using the Schirmer I test) decreased at 1 week, and the OSDI scores fell at both 1 week and 1 month. We found no significant correlation between the 1-month delta OSDI scores and the 1-month delta DED parameters. The 1-month OSDI score fell to a significantly greater extent in the MMP-9-decreased group. Conclusions Routine, local anti-inflammatory treatment after cataract surgery may briefly reduce the tear MMP-9 level and ocular surface discomfort.

Central airway obstruction can result from various benign and malignant conditions, and often requires prompt palliation. The efficacies of a variety of bronchoscopic techniques for the treatment of central airway obstruction such as electrocautery, laser, brachytherapy, argon plasma coagulation and cryotherapy have been established. An insulation-tipped diathermic knife-2 (IT knife-2) was initially introduced for gastrointestinal endoscopic submucosal dissection and has been used globally as a safe and effective instrument. However, its use has not been reported for the treatment of endotracheal or endobronchial lesions. Here, we report the case of central airway obstruction in a 65-year-old male due to malignancy and a 52-year-old-female with post-radiation bronchial stenosis that were treated successfully with the IT-knife-2 via flexible bronchoscopy.
Aged ; Airway Obstruction* ; Argon Plasma Coagulation ; Brachytherapy ; Bronchoscopy ; Constriction, Pathologic ; Cryotherapy ; Electrocoagulation ; Humans ; Lung Neoplasms ; Male

Perforation of the hypopharynx, which can occur after anterior cervical approach, is a very rare type of complication. If diagnosed late, it can lead to very fatal course, such as mediastinitis and hematosepsis. Therefore, a precise and prompt diagnosis is crucial. When conservative treatment alone is not expected to heal the perforated site or is likely to lead to serious complications, surgical treatment becomes necessary. This report demonstrates that surgical intervention performed immediately after an early diagnosis can lead to the successful treatment of a large perforation in the hypopharynx on a 58-year-old male patient.
Early Diagnosis ; Humans ; Hypopharynx ; Male ; Mediastinitis

Amanita Pers. is a well-known monophyletic mushroom genus with a broad distribution. However, the diversity of Korean Amanita species has been underestimated, and most taxonomic studies conducted in Korea have only investigated their morphological characteristics. This approach is frequently insufficient for correct identification in fungal classification; therefore, we constructed a phylogeny of Amanita subgen. Lepidella in order to understand the phylogenetic placements of 16 Amanita specimens collected in Korea in 2012. The phylogeny constructed using the sequence data of the internal transcribed spacers and the partial large subunit of ribosomal RNA identified nine Amanita species (A. citrina, A. excelsa var. spissa, A. flavipes, A. fritillaria, A. oberwinklerana, A. pallidorosea, A. rubescens, A. subjunquillea, and A. volvata); of these, A. fritillaria, A. oberwinklerana, and A. pallidorosea are new to Korea.
Agaricales ; Amanita* ; Classification ; Fritillaria ; Korea* ; Phylogeny ; RNA, Ribosomal

PURPOSE: Masseter muscle is an important muscle of mastication. Because it has a great influence on the shape of low facial contour, patients who have masseteric hypertrophy show square-shaped jaw appearance. As aesthetic procedures for the reduction of the masseter muscle volume, radiofrequency ablation or botulinium toxin injection is at the center of attention. Authors studied the anatomical measurement of the thickness and width of masseter muscle and the surface mapping of the maximal thickness point using computed tomography(CT) scan to identify the useful guide for the injection of botulinum toxin in masseteric hypertrophy patients. METHODS: We analyzed 2 mm-thickness OMU(ostiomeatal unit) CT of 112 normal people(224 masseter muscles) taken from June 2009 to May 2010. First, we measured the thickness, width and depth of the masseter muscle from the skin surface and analysed each by side, sex and age, respectively. The distribution of the thickness of the muscle and the correlation of thickness and width of the muscle were studied also. Second, we underwent surface mapping of the maximal thickness point using CT analysis by means of checking the vertical and horizontal distance from the angle of the mandible. RESULTS: The average thickness and width of the masseter muscle was 17.73 mm and 40.78 mm in the male patients and were 14.33 mm and 37.42 mm in the female patients. Statistically, both figures of the male patients were larger than those of the female patients. However, the depth of the muscle from the skin surface in female patients (7.37 mm) was larger than that of the male patients(6.15 mm). There were no statistical difference in side or age. The width and thickness of the masseter muscle were in the positive correlation. The location of maximal thickness point of the masseter muscle was 27.77 mm vertically and 27.68 mm horizontally in the male patients, and 25.19 mm vertically and 25.42 mm horizontally in the female patients from the angle of mandible. CONCLUSION: We were able to present statistical evidence of the diagnosis and treatment of the masseteric hypertrophy regarding the anatomical measurements such as the thickness and width. And the maximal thickness point of the masseter muscle may be a useful guide for the clinical procedures of botulinium toxin injection.
Botulinum Toxins ; Female ; Humans ; Hypertrophy ; Jaw ; Male ; Masseter Muscle ; Mastication ; Muscles ; Skin

Angiogenesis is a multi-step process that involves the activation, proliferation, and migration of endothelial cells. We have recently shown that TGF-beta1 can induce mouse macrophages to produce VEGF, a potent angiogenic factor. In the present study, we explored whether TGF-beta1 has a similar effect on mouse dendritic cells. First, we show that under hypoxic conditions, TGF-beta1 induced the expression of VEGF transcripts in bone marrow-derived dendritic cells. Overexpression of Smad3/4 further augmented TGF-beta1-induced VEGF transcription, while overexpression of DN-Smad3 decreased VEGF transcription in DC2.4 cells, a mouse dendritic cell line. We also show that TGF-beta1 and Smads are involved in the induction of VEGF protein secretion. Interestingly, under the same conditions, the expression of VEGF receptor 1 (Flt-1) was also elevated at both the transcriptional and protein levels. Additionally, we found that the TGF-beta1-induced VEGF secretion in activated DC2.4 cells has wound-healing properties. Finally, Smad7 and Smurf1 negatively regulated the TGF-beta1-induced and Smad3/4-mediated VEGF expression. Taken together, these results indicate that TGF-beta1 can enhance the expression of VEGF and Flt-1 through the typical Smad pathway in mouse dendritic cells.
Angiogenesis Inhibitors/*metabolism ; Animals ; Cell Line ; Dendritic Cells/*metabolism ; Macrophages/metabolism ; Mice ; Mice, Inbred BALB C ; RNA, Messenger/metabolism ; Signal Transduction ; Smad2 Protein/metabolism ; Smad3 Protein/metabolism ; Smad4 Protein/metabolism ; Smad7 Protein/metabolism ; Transforming Growth Factor beta1/metabolism/*pharmacology ; Vascular Endothelial Growth Factor A/*secretion ; Vascular Endothelial Growth Factor Receptor-1/*metabolism