PURPOSE: Recent studies have analyzed the short-term clinical outcomes of ndovascular management. However, the long-term outcomes are unknown. This study aimed to investigate clinical outcomes after endovascular management for ruptured pseudoaneurysm in patients after pancreaticoduodenectomy (PD). METHODS: The medical records of 2,783 patients who underwent PD were retrospectively reviewed at a single center. Of 62 patients who received intervention after pseudonaeurysm rupture, 57 patients (91.9%) experienced eventual success of hemostasis. The patients were composed as follows: (embolization only [EMB], n = 30), (stent-graft placement only [STENT], n = 19) and (both embolization and stent-graft placement simultaneously or different times [EMB + STENT], n = 8). Long-term complications were defined as events that occur more than 30 days after the last successful endovascular treatment. RESULTS: Among 57 patients, short-term stent-graft related complications developed in 3 patients (5.3%) and clinical complication developed in 18 patients (31.5%). Nine (15.8%) had long-term stent-graft related complications, which involved partial thrombosis in 5 cases, occlusion in 3 cases and migration in 1 case. Except for 1 death, the remaining 8 cases did not experience clinical complications. The stent graft primary patency rate was 88.9% after 1 month, 84.2% after 1 year, and 63.2% after 2 years. Of 57 patients, 30 days mortality occurred in 8 patients (14.0%). CONCLUSION: After recovery from initial complication, most of patients did not experience fatal clinical complication during long-term follow-up. Endovascular management is an effective and safe management of pseudoaneurysm rupture after PD in terms of long-term safety.
Aneurysm, False ; Blood Vessel Prosthesis ; Embolization, Therapeutic ; Follow-Up Studies ; Hemostasis ; Humans ; Medical Records ; Mortality ; Pancreaticoduodenectomy ; Retrospective Studies ; Rupture ; Stents ; Thrombosis

PURPOSE: The goal of this study was to evaluate the effect of vascular compliance, resistance, and pulse rate on the resistive index (RI) by using an electrical circuit model to simulate renal blood flow. METHODS: In order to analyze the renal arterial Doppler waveform, we modeled the renal blood-flow circuit with an equivalent simple electrical circuit containing resistance, inductance, and capacitance. The relationships among the impedance, resistance, and compliance of the circuit were derived from well-known equations, including Kirchhoff's current law for alternating current circuits. Simulated velocity-time profiles for pulsatile flow were generated using Mathematica (Wolfram Research) and the influence of resistance, compliance, and pulse rate on waveforms and the RI was evaluated. RESULTS: Resistance and compliance were found to alter the waveforms independently. The impedance of the circuit increased with increasing proximal compliance, proximal resistance, and distal resistance. The impedance decreased with increasing distal compliance. The RI of the circuit decreased with increasing proximal compliance and resistance. The RI increased with increasing distal compliance and resistance. No positive correlation between impedance and the RI was found. Pulse rate was found to be an extrinsic factor that also influenced the RI. CONCLUSION: This simulation study using an electrical circuit model led to a better understanding of the renal arterial Doppler waveform and the RI, which may be useful for interpreting Doppler findings in various clinical settings.
Compliance ; Computer Simulation ; Electric Impedance ; Heart Rate ; Jurisprudence ; Pulsatile Flow ; Renal Artery ; Renal Circulation ; Ultrasonography, Doppler

PURPOSE: To report a patient diagnosed with adult-onset vitelliform dystrophy (AOVD) who received an intravitreal injection of bevacizumab in both eyes. CASE SUMMARY: A 47-year-old female presented with blurred vision and metamorphopsia in both eyes. On color fundus photograph, small, round, yellowish dots on the foveola and subreitnal fluid were observed. Optical coherence tomography (OCT) showed thick hyperreflective structures in the retinal pigment epithelium (RPE) layer with serous retinal detachment and subretinal fluid. Despite an intravitreal injection of bevacizumab on both eyes, anatomical improvement was not observed on fundus photography and OCT.
Female ; Humans ; Intravitreal Injections* ; Middle Aged ; Photography ; Retinal Detachment ; Retinal Pigment Epithelium ; Subretinal Fluid ; Tomography, Optical Coherence ; Vision Disorders ; Vitelliform Macular Dystrophy* ; Bevacizumab

PURPOSE: We report a case of intravitreal bevacizumab injection for the treatment of choroidal neovascularization in morning glory syndrome. CASE SUMMARY: A 51-year-old male visited our hospital for a 1.5-year visual disturbance in his right eye. The patient's best-corrected visual acuity was 0.1 in the right eye. After fundus examination, we found characteristic findings of morning glory syndrome with submacular hemorrhage and serous retinal detachment in the right eye. Optical coherence tomography, fluorescein angiography and indocyanine green angiography were performed for evaluation. Retinoschisis, subretinal fluid, and choroidal neovascularization were detected, and thus bevacizumab was injected in the right eye. After intravitreal bevacizumab injection, retinoschisis was improved, and subretinal fluid was decreased. However, retinal pigment epithelial detachment was newly detected, and serous retinal detachment persisted. After 2 months, a second bevacizumab injection was performed. After these intravitreal bevacizumab injections at 1 and 2 months, visual acuity was 0.4 and 0.6, respectively. Visual acuity improved to 1.0 after 3 months. Visual acuity was maintained for at least 6 months with no relapse of choroidal neovascularization. CONCLUSIONS: The choroidal neovascularization in morning glory syndrome was effectively treated with intravitreal bevacizumab injections.
Angiography ; Choroidal Neovascularization* ; Fluorescein Angiography ; Hemorrhage ; Humans ; Indocyanine Green ; Male ; Middle Aged ; Recurrence ; Retinal Detachment ; Retinoschisis ; Subretinal Fluid ; Tomography, Optical Coherence ; Visual Acuity ; Bevacizumab

PURPOSE: The purpose of this study was to determine the diurnal blood pressure variation with retinal vein occlusion (RVO) using 24-hour ambulatory blood pressure monitoring (24-hour ABPM). METHODS: The subjects in this study visited the department of ophthalmology from May 2012 to December 2012 and were diagnosed with RVO but had no history of hypertension (HTN). Non-dipper was defined as a nocturnal systolic blood pressure (SBP) decrease less than 10%. These values were used to compare the 24-hour ABPM values of the RVO and the control groups. RESULTS: The 24-hour ABPM values, with the exception of the mean nightly SBP, were statistically different whne the RVO group was compared with the control group. The odds of an RVO patient being a non-dipper compared to dipper were 1.81 times greater than in the control. Additionally, the clinical SBP and DBP in the RVO group were not significantly different when the HTN group and the non-HTN group were compared. In contrast, the mean 24-hour SBP and the mean DBP were significantly different in regard to HTN. CONCLUSIONS: Patients with RVO have a tendency to maintain high BP throughout the day and also during the night. A patient with non-dipper status can be at risk for RVO, even if the patient does not have HTN. Therefore, 24-hour ABPM is an effective management approach for HTN in addition to strict BP control in patients with RVO.
Blood Pressure ; Blood Pressure Monitoring, Ambulatory ; Humans ; Hypertension ; Ophthalmology ; Retinal Vein ; Retinal Vein Occlusion ; Retinaldehyde

PURPOSE: To report a case of Vogt-Koyanagi-Harada (VKH) disease in a pregnant patient treated with intravitreal triamcinolone injection. CASE SUMMARY: A 21-year-old female in the 19th week of gestation presented with bilateral blurring of vision associated with mild headache and tinnitus. Her initial best corrected visual acuity was 0.15 in the right eye and 0.3 in the left eye. Multiple serous retinal detachment and anterior chamber inflammation were observed, and VKH disease was diagnosed. Because of her pregnancy, the patient did not want high-dose systemic prednisolone therapy which may cause an abortion or low birth weight infant when used in a pregnant patient. Therefore, an intravitreal triamcinolone (4 mg/0.1 ml) injection was given in the right eye and topical steroid eye drops were used in the left eye. After 1 day, serous retinal detachment was significantly decreased and anterior chamber inflammation disappeared in the right eye. After 1 week, no serous retinal detachment was observed. In the left eye, serous retinal detachment was decreased after using steroid eye drops. After 10 days, serous retinal detachment disappeared but anterior chamber inflammation was still observed. After 1 month, best corrected visual acuity was 1.0 in both eyes and serous retinal detachment had not recurred. On follow-up, VKH disease had not recurred and a healthy normal weight infant was delivered. CONCLUSIONS: Intravitreal triamcinolone injection is an effective and safe treatment for VKH disease in pregnant women.
Anterior Chamber ; Eye ; Female ; Follow-Up Studies ; Headache ; Humans ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Inflammation ; Ophthalmic Solutions ; Prednisolone ; Pregnancy ; Pregnant Women ; Retinal Detachment ; Tinnitus ; Triamcinolone* ; Uveomeningoencephalitic Syndrome* ; Vision, Ocular ; Visual Acuity ; Young Adult

PURPOSE: We report a case of dexamethasone intravitreal implant (Ozurdex(R); Allergan, Inc.) fragmentation during the injection procedure in macular edema due to central retinal vein occlusion. CASE SUMMARY: A 57-year-old man visited our hospital for visual disturbance in his right eye. The patient's best-corrected visual acuity was 0.02 in the right eye and 1.2 in the left eye. After fundus examination, the patient was diagnosed with central retinal vein occlusion with macular edema, thus bevacizumab was injected in the right eye. However, the macular edema did not improve, and a dexamethasone intravitreal implant was injected in the right eye. Immediately after the dexamethasone intravitreal implant injection, on fundus exam, the drug was observed to be fragmented into 3 pieces without any additional treatment. After 2 months, the patient's best-corrected visual acuity was 0.4 in the right eye and 1.2 in the left eye. Macular edema decreased according to optical coherence tomography. CONCLUSIONS: A case of dexamethasone intravitreal implant fragmentation during an injection procedure has not been previously reported in Korea. Although the drug fragmented, the treatment was effective without complications.
Antibodies, Monoclonal, Humanized ; Dexamethasone ; Eye ; Humans ; Korea ; Macular Edema ; Retinal Vein ; Visual Acuity ; Bevacizumab

OBJECTIVE: The purpose of this prospective study was to evaluate the effects of body mass index (BMI) on intra-abdominal pressure (IAP) and intraoperative blood loss (IBL) during lumbar spinal surgery. METHODS: Thirty patients scheduled for single level posterior lumbar interbody fusion were allocated equally to a normal group (Group 1, BMI;18.5-22.9 kg/m2), an overweight group (Group 2, BMI; 23-24.9 kg/m2), and an obese group (Group 3, BMI; 25.0-29.9 kg/m2) according to BMI. IAP was measured using a urinary bladder catheter; 1) supine after anesthesia induction, 2) prone at skin incision, 3) prone at the end of surgery. In addition, IBL was also measured in the three groups. RESULTS: IAP in the supine position was not significantly different in groups 1, 2, and 3 (2.7 mm Hg, 3.0 mm Hg, and 4.2 mm Hg, respectively) (p=0.258), and IAP in the prone position at incision increased to 7.8 mm Hg, 8.2 mm Hg, and 10.4 mm Hg, respectively, in the three groups, and these intergroup differences were significant, especially for Group 3 (p=0.000). IAP at the end of surgery was slightly lower (7.0 mm Hg, 7.7 mm Hg, and 9.2 mm Hg, respectively). IBLs were not significantly different between the three groups. However, IBLs were found to increase with IAP in the prone position (p=0.022) and BMI (p<0.05). CONCLUSION: These results show that BMI affects IAP in the prone position more than in the supine position during lumbar spinal surgery. In addition, IBLs were found to increase with IAP in the prone position and with BMI. Thus, IBLs can be expected to be higher in morbidly obese patients due to an increased IAP.
Anesthesia ; Body Mass Index ; Humans ; Overweight ; Prone Position ; Prospective Studies ; Skin ; Spine ; Supine Position ; Urinary Bladder

PURPOSE: Laparoscopic appendectomy isused as a three port technique for appendectomy. In children, single port laparoscopic appendectomy is difficult because they have a small peritoneal cavity for manipulation of laparoscopic instruments. We performed transumbilical laparoscopic assisted single port appendectomy (hybrid appendectomy) in children. METHODS: From March 2010 to July 2012, we performed transumbilical laparoscopic assisted single port appendectomy in 53 children. We made a vertical incision to the umbilicus approximately 1.5 cm, and a wound retractor (Applied Medical Resources Co., Ltd., Rancho Santa Margarita) was placed in the umbilical incision, and appendix exteriorized the extraperitoneum through the wound retractor. Appendectomy was performed conventionally. We had no conversion cases for laparotomy. RESULTS: A total of 53 patients, 29 females and 24 males, with a mean age of 8.5+/-2.0 years were enrolled in this retrospective study. The mean operative time was 29.4+/-9.4 minutes. There was no occurrence of complication or mortality. BMI was 17.8+/-4.9 kg/m2. And mean hospital stay was 3.2+/-1.0 days. CONCLUSION: In children, transumbilical single port laparoscopic appendectomy is technically difficult because they have a small peritoneal cavity. However, transumbilical laparoscopic assisted single port appendectomy (hybrid appendectomy) appearsto be a safe and effective technique for use in children, which allows for achievement of nearly scarless surgery.
Achievement ; Appendectomy ; Appendix ; Child ; Female ; Humans ; Laparoscopy ; Length of Stay ; Male ; Operative Time ; Peritoneal Cavity ; Retrospective Studies ; Umbilicus

OBJECTIVE: The objective of this study was to evaluate and compare the diagnostic value of the open biopsy technique and the percutaneous biopsy techniques in lumbar spondylodiscitis. METHODS: Between January 2004 and December 2009, we retrospectively reviewed the medical records of 57 patients with infectious lumbar spondylodiscitis. The etiologic diagnosis of the infectious spondylodiscitis was obtained by two methods. Of 57 cases, twenty-seven patients underwent open biopsy and thirty patients underwent percutaneous needle biopsy including computed tomography (CT) - guided and fluoroscopy-guided needle aspiration. All biopsies were performed by experienced two neurosurgeons and one interventional radiologist. RESULTS: Of the 57 cases radiologically consistent with spinal infection, 29 (50.9%) biopsy specimens resulted in positive cultures and 28 (49.1%) returned negative cultures. According to the type of biopsy techniques, the culture-positive rate was higher (p=0.005) in the open biopsy group than the percutaneous needle biopsy group. 19 (70.4%) of 27 biopsy specimens were positive in the open biopsy group, and 10 (33.3%) of 30 biopsy specimens were positive in the percutaneous needle biopsy group. Furthermore, the open biopsy showed higher positive culture rate than the percutaneous needle biopsy in cases with administration of empirical antibiotics although there was no statistically significant (p=0.137). CONCLUSIONS: Open biopsy should be considered for administration of organism-specific antibiotics for the successful treatment when percutaneous needle yield negative result. Furthermore, empirical antibiotics should be delayed until results of cultures unless the patient is severely septic, critically ill, neutropenic or neurologically compromised.
Anti-Bacterial Agents ; Biopsy ; Biopsy, Needle ; Critical Illness ; Discitis ; Humans ; Medical Records ; Needles ; Retrospective Studies