PURPOSE: To analyze the clinical features and determine the factors that affect glaucomatous change of patients with Posner-Schlossman syndrome (PSS). METHODS: A retrospective analysis of 51 eyes of 51 patients diagnosed with PSS was performed. We analyzed the factors including age of first attack, highest intraocular pressure (IOP), duration of the disease, number of the attacks and interval between attacks among the patients who developed glaucoma and those who did not and compared the 2 groups. RESULTS: The age of first attack was 34.73 +/- 10.77 years, and highest IOP was 47.75 +/- 9.43 mm Hg. Duration of the disease was 62.06 +/- 69.84 months, number of the attacks was 6.20 +/- 7.73 times, and interval between attacks was 12.65 +/- 8.95 months. Of 51 eyes of 51 patients, 12 eyes (23.5%) of 12 patients showed significant glaucomatous change. In the glaucoma group, highest IOP was 52.81 +/- 7.87 mm Hg, number of attacks was 11.91 +/- 10.63 times, and interval between attacks was 8.07 +/- 3.97 months. In the non-glaucomatous group highest IOP was 46.19 +/- 9.14 mm Hg, number of attacks was 4.59 +/- 5.94 times, and interval between attacks was 14.59 +/- 9.79 months, respectively. Highest IOP was significantly greater, number of attacks was higher, and interval was shorter with statistical significance in the glaucoma group (p = 0.025, p = 0.001, p = 0.028). CONCLUSIONS: A significant number of patients with PSS tend to show glaucomatous change over time. Patients with high IOP during attacks and those having frequent attacks with short intervals should be closely monitored and evaluation for glaucomatous damage is recommended.
Glaucoma ; Humans ; Intraocular Pressure ; Retrospective Studies ; Risk Factors*

PURPOSE: Cytomegalovirus (CMV) retinitis is common in patients with immunodeficient conditions caused by acquired immunodeficiency syndrome (AIDS), cytotoxic chemotherapy and immunosuppresive treatment. The purpose of this study was to assess the clinical manifestations and prognosis of CMV retinitis cases. METHODS: Thirty-one eyes of 21 patients who were diagnosed with CMV retinitis were retrospectively reviewed. The clinical manifestations and prognosis of all patients were analyzed. RESULTS: The average age of patients was 24.4+/-19.8 years. Eight patients were female and 13 patients were male. The predisposing conditions of patients were leukemia (nine patients), immunosuppressed conditions due to organ transplantation (three patients), AIDS (two patients) and other (seven patients). Eleven patients exhibited bilateral disease. The mean follow-up period was 31.3 months, and there were no differences between mean initial visual acuity (0.70+/-0.31) and mean visual acuity (0.77+/-0.20) at final visit. The major causes of visual loss were retinitis and atrophic changes involving the macula. Although retinitis was successfully treated with anti-viral agents in all cases, cataract (10 eyes, 31.3%), cystoid macular edema (four eyes, 12.5%), retinal detachment (two eyes, 6.3%), epiretinal membrane (two eyes, 6.3%) and immune recovery uveitis (two eyes, 6.3%) developed after the initial treatment. CONCLUSIONS: Although the visual prognosis of CMV retinitis was relatively good after administration of appropriate antiviral therapy, clinicians should remain alert for the development of late complications, including retinal detachment, cystoid macular edema and immune recovery uveitis.
Acquired Immunodeficiency Syndrome ; Cataract ; Cytomegalovirus ; Cytomegalovirus Retinitis ; Epiretinal Membrane ; Eye ; Female ; Follow-Up Studies ; Humans ; Leukemia ; Macular Edema ; Male ; Organ Transplantation ; Prognosis ; Retinal Detachment ; Retinitis ; Retrospective Studies ; Transplants ; Uveitis ; Visual Acuity

PURPOSE: We report two cases of mucocele formation after medial orbital wall fracture repair with an alloplastic implant. CASE SUMMARY: A 61-year-old man with a history of a medial orbital wall fracture repaired with an alloplastic implant five years earlier presented with a several-month history of left proptosis without diplopia, pain, or lid edema. A 55-year-old man with a history of a medial orbital wall fracture repaired with an alloplastic implant seven years prior, presented with a five.year history of left proptosis with diplopia. Computed tomography (CT) scans revealed a large cyst on the orbital medial wall, which surrounded the alloplastic implant and had no definite enhancement. The patients underwent orbital surgery to remove both the cyst and implant. Histologic examination of the cyst revealed a capsule lined with ciliated pseudostratified columnar epithelium. Both patients had an uncomplicated postoperative course with resolution of the proptosis. CONCLUSIONS: For cases that present with late proptosis after orbital fracture repair, mucocele formation should be included in the differential diagnosis.
Diagnosis, Differential ; Diplopia ; Edema ; Epithelium ; Exophthalmos ; Humans ; Middle Aged ; Mucocele ; Orbit ; Orbital Fractures

OBJECTIVE: Eleven patients treated with posterior cerebral artery(PCA) aneurysm during 6.3-years period are retrospectively reviewed to determine treatment outcome. METHODS: Eleven patients with PCA aneurysm were treated from January 1998 to May 2004. Their medical records and radiologic studies were reviewed retrospectively. The records of these patients were analysed with particular reference to their demographic details, mode of presentation, and treatment outcome. RESULTS: Of the 11 patients, 8 patients presented with symptoms related aneurysmal bleeding. Three patients had unruptured PCA aneurysms. Open or endovascular surgery was performed in 9 patients; None of these patients exhibited a third nerve palsy, visual field deficit, or hemiparesis at the time of presentation. Postoperatively, 2 made a good recovery, 2 had a moderate disability because of cerebral infarction after surgery, and 5 had a severe disability because of cerebral infarction after surgery. Of 2 conservatively treated patients, 1 was doing well but the other died as a result of brain swelling. CONCLUSION: The treatment of the PCA aneurysms is difficult regardless of the aneurysmal size, site, and treatment modality. All reasonable treatment to reduce the risk of associated morbidity should be considered.
Aneurysm ; Brain Edema ; Cerebral Infarction ; Hemorrhage ; Humans ; Intracranial Aneurysm* ; Medical Records ; Oculomotor Nerve Diseases ; Paresis ; Passive Cutaneous Anaphylaxis ; Posterior Cerebral Artery* ; Retrospective Studies ; Treatment Outcome ; Visual Fields

BACKGROUNDS: Moyamoya disease is a progressive occlusive cerebrovascular disease which has characteristics of distal ICA stenosis and basal collateral vessels. Various methods of surgical treatment are recommended in the literatures but surgical strategies and outcome are not well established yet. AIMS AND METHODS: The aims of study is to evaluate surgical outcomes of moyamoya disease and to establish surgical indications. Total 155 patients diagnosed with moyamoya disease since 1990, were analyzed retrospectively. Female was more predominant by 1.5 : 1. There were two peaks of age of onset at the 1st decade (39.0%) and 4th (15.9%). Familial occurrence was 6.8% (n=17). The mean duration of follow-up was 41.1 months (12-156 months). Moyamoya syndrome was excluded in this study. Surgical outcomes were measured by grading activity of daily living (ADL) and prognostic factors were analyzed statistically with SAS. RESULT: The most common clinical presentations were transient ischemic attacks (69.1%), followed by cerebral infarction (26.0%) and hemorrhage (4.9%) in pediatric patients, but in adult hemorrhage (49.2%) was the most prevalent. Recurrence of symptoms developed in 8 patients (11.4%) among 70 of cerebral infarction with mean intervals of 30.8 months and 7 patients (21.9%) among 32 of hemorrhage with mean interval of 42.3 months. Forty five (29.0%) of 155 patients showed stenosis of posterior cerebral arteries on cerebral angiography at the age of diagnosis. The surgical treatment were performed at 183 hemispheres of 115 patients, direct bypass surgery was done in 10 hemispheres, indirect bypass surgery in 169 hemispheres (106 EDAMS, 14 EDAS, 40 frontal EDS or burr hole, 6 EDAMS and EDAS, 3 others), combined direct and indirect bypass surgery in 4 hemispheres. The improvement of ADL was not so different between 68 (59.1%) of 115 patients treated with surgery and 23 (57.5%) in 40 patients with conservative care. The initial and final grade of ADL of pediatric patients were better than those of adult (p<0.01). The grades of ADL of patients with transient ischemic attack were better than those with infarction or hemorrhage (p<0.01). Those patients with recurrent hemorrhage were poorer in the outcome than recurrent infarction (p<0.05). The incidence of recurrent infarction in the surgical cares was lower than that in conservative care (5.9% vs 26.3%, p<0.05), but there was no statistical difference between two groups with regard to rebleeding (8.3% vs 30.0%, p>0.1). Significant prognostic factors affecting outcomes of moyamoya disease age at onset, clinical features, and initial grade of ADL. CONCLUSION: Children with transient ischemic attack were the best, but adults with recurrent hemorrhage were the worst in outcomes. Surgical treatment for moyamoya disease should be carefully tailored according to age of onset and clinical features regardless of surgical methods. Further prospective study is indicated to determine optimal treatment guideline for moyamoya disease.
Activities of Daily Living ; Adult ; Age of Onset ; Cerebral Angiography ; Cerebral Infarction ; Child ; Constriction, Pathologic ; Diagnosis ; Female ; Follow-Up Studies ; Hemorrhage ; Humans ; Incidence ; Infarction ; Ischemic Attack, Transient ; Moyamoya Disease* ; Posterior Cerebral Artery ; Recurrence ; Retrospective Studies

OBJECTIVE: Transseptal or sublabial transsphenoidal surgery has been standard teatment for pituitary tumors for decades. However, as an alternative to this surgery endonasal endoscopic technique has been reported with encouraging results. We have started endoscopy-assisted transsphednoidal surgery from May 1998. In this paper we analyzed the methods, outcome, advantage and disadvantage of this surgical approach for the purpose of planning optimal treatment of pituitary tumors. METHODS: This study consisits of 13 cases of pituitary tumors who were treated by endoscopy-assisted transsphenoidal surgery using one nostril from May 1998 to July 1999. Mean follow up period was 12.9 months. RESULTS: There was no septal or sublabial incision and little surgical damage to nasal structure. With this technique, rapid surgical approach and short hospital day were possible, being 3-6 days in patients without CSF leakage. Using various angled endoscope, good surgical view was obtained. Initially it was difficult to use various instruments in narrow nasal cavity, but became feasible after several procedures. Among 13 cases, total removal was possible in 11 cases. One of two cases in whom tumor was incompletely removed underwent gamma-knife radiosurgery and second underwent reoperation through subfrontal approach. There were 6 cases of hormone secreting tumors and hormonal remission was achived in all of these cases. Postoperative complications were CSF leakage(6 cases), diabetes insipidus(2 cases) and panhypopituitarysm(1 case). Lumbar drainage was done in all cases of CSF leakage. CONCLUSION: The advantage of endoscopy-assisted transsphenoidal surgery are rapid surgical approach, low postoperative morbidity, short hospital day and good surgical view. The disadvantage of this appoach are difficulty in manupulating various instruments in narrow nostril and difficulty in distance perception but these problems can be overcome by practice and using stereoscopic endoscope.
Distance Perception ; Drainage ; Endoscopes ; Endoscopy* ; Follow-Up Studies ; Humans ; Nasal Cavity ; Pituitary Neoplasms* ; Postoperative Complications ; Radiosurgery ; Reoperation

OBJECTIVE: The increasing use of sensitive neuroimaging techniques has demonstrated that significant percentage of patients with intractable complex partial seizures have brain masses, especially in temporal lobe. The optimal surgical solution for these patients is still open to debate. The purpose of our investigation is to evaluate the surgical outcome of patient with lesion-related temporal lobe epilepsy with respect to the types of surgery and the location of lesion. PATIENTS AND METHODS: From DEC. 1993 to Dec. 1997, 35 patients with intractable epilepsy and space occupying temporal lobe lesion identified in preoperative MRI were included in this study. The types of surgery were lesionectomy, anterior temporal lobectomy with or without hippocampectomy. The location of lesion was divided as anteromedial group and lateral cortical group. The postoperative seizure outcomes according to the type of surgery and location of the lesion were compared. RESULTS: Twenty-six of 34 patients(76.5%) were seizure-free after surgery. The Engel's class was favorable after anterior temporal lobectomy with or without hippocampectomy(p=.044). CONCLUSION: It is favorable to perform anterior temporal lobectomy for the treatment of intractable epilepsy with space-occipying lesion in temporal lobe. The resection of the hippocampus can be individualized.
Anterior Temporal Lobectomy ; Brain ; Epilepsy ; Epilepsy, Temporal Lobe ; Hippocampus ; Humans ; Magnetic Resonance Imaging ; Neuroimaging ; Seizures* ; Temporal Lobe*

The gastrointestinal mesenchymal tumors (GIMTs) form a heterogenous group with controversy centering on both the cell of origin and the prediction of clinical behavior. They include a small group of tumors with mature smooth muscle or Schwann cell differentiation and a larger group with inconsistent or no evidence of differentiation. Tumors in the latter are now referred to as gastrointestinal stromal tumors (GISTs). A clinicopathologic and immunohistochemical study was performed on 53 cases of GIMTs to identify cellular differentiation and predictors of clinical behavior. Fifty three cases of GIMTs could be histologically and immunophenotypically divided into three categories, 6 leiomyomas (11.3%), 4 schwannomas (7.6%), and 43 GISTs (81.1%). All leiomyomas (SMA desmin ) and schwannomas (S-100 ) were located in stomach and negative for CD34 and CD117. Thirty nine cases of GISTs were either CD34 (n=26) or CD117 (n=23) immunoreactive. Of these 39 GISTs, 26 were negative for myoid (SMA, desmin) and neural marker (S-100), 10 SMA desmin-S-100-, two SMA-desmin-S-100 , and one SMA desmin-S-100 . Two out of 4 GISTs, which were negative for CD34 and CD117, were immunohistochemically considered leiomyosarcoma (SMA desmin ). GISTs of small intestine had a tendency to be malignant than those of stomach. Pathologic grade of GISTs was not correlated with cellular differentiation. In 29 GISTs with clinical follow-up information, tumor size, mitotic counts, Ki-67 labelling index, tumor necrosis, mucosal invasion, and CD34 expression were significantly correlated with metastasis/recurrence.
Cell Differentiation ; Desmin ; Follow-Up Studies ; Gastrointestinal Stromal Tumors ; Intestine, Small ; Leiomyoma ; Leiomyosarcoma ; Muscle, Smooth ; Necrosis ; Neurilemmoma ; Stomach

Moyamoya disease is a cerebrovascular disease of unknown etiology which leads to spontaneous occlusion of circle of Willis. Cerebral ischemic or hemorrhagic episodes occur as moyamoya disease progresses. To establish an efficient collateral circulation for the ischemic brain of this disease many surgical the therapeutic methods have been proposed. We analyzed the surgical results of encephaloduroarteriomyosynangiosis(EDAMS) and compared with that of direct bypass surgery, superfical temporal artery to middle ce rebral artery(STA-MCA) anastomosis to determine the efficacy of new indirect revascularization procedure, EDAMS, in the treatment of moyamoya disease. Twenty three patients with moyamoya disease who underwent revascularization procedure were included in this study. EDAMS was performed on 18 sides in 16 patients and STA-MCA anastomosis was done on 12 sides in 7 patients. Two patients underwent encephaloduroarteriosynangiosis(EDAS). The surgical results of EDAMS were excellent to good in 14 patients and fair in 2 patients. No statistical significance of the outcome was observed in comparision of EDAMS and STA-MCA anastomosis(p-value=0.471). Regardless of surgical procedures, outcome of child-onset moyamoya disease was found to be superior to those of adult-onset moyamoya disease(p-delete=0.024). In conclusion, EDAMS is considered to be one of the effective indirect revascularization methods to prevent the ischemic attack and establish the revascularization for moyamoya disease.
Brain ; Circle of Willis ; Collateral Circulation ; Humans ; Moyamoya Disease ; Temporal Arteries

OBJECTIVE: This study was undertaken to review the mortality, complications, risk factors and the surgical outcome in long-term follow-up cases of brain abscess. METHODS: The authors studied medical records and radiological findings in patients with brain abscess who underwent operations in our hospital from 1990 to 1997. RESULTS: There were 44 cases and the ratio of male to female was 32:12 which shows predominance in male. The ages of patients ranged from 2 to 73(average: 40). Lesions were located at frontal lobe in 16 cases, temporal in 8, parietal in 7, occipital in 5, cerebellum in 6, and multiple in 2. The ranges of follow-up periods were from 1 month to 96 months(average: 20.5 months). The primary origins of infection were found in only 15 cases(34%) and in 32 cases(73%), the organisms were identified from culture. The operative modalities were as follows; abscess aspiration (stereotactic or sono-guided) in 42 times and abscess excision in 13 times. There were 2 operations in 7 cases and 3 in 2 cases. In 2 cases, recurrences were occurred during antibiotics therapy after first operation. Three patients(6.8%) died due to sepsis in 2 cases, increased intracranial pressure in 1 case. We analysed 19 cases who were followed-up more than 12 months. In this group, there were intermittent seizures in 2 cases, antibiotics(metronidazole) induced polyneuropathy in 1 case, and avascular necrosis of hip in 2 cases which were suspected to have relation to long-term high dose steroid therapy. But there were no other sequalae or neurological deficits. CONCLUSION: The complication rate from long-term follow-up was high(26%) but the mortality rate was low(6.8%). Additionally, the findings such as multiple lesions, empyema, and fungal infection are suspected to be risk factors in mortality cases.
Abscess ; Anti-Bacterial Agents ; Brain Abscess* ; Brain* ; Cerebellum ; Empyema ; Female ; Follow-Up Studies ; Frontal Lobe ; Hip ; Humans ; Intracranial Pressure ; Male ; Medical Records ; Mortality ; Necrosis ; Polyneuropathies ; Rabeprazole ; Recurrence ; Risk Factors ; Seizures ; Sepsis