Successful Tracheal Intubation Using Rigid Video-Stylet in a Ptiaent with Tracheobronchopathia Osteochondroplastica / 계명의대학술지

Tracheobronchopathia osteochondroplastica (TO) is a rare dysplastic disease of the trachea characterized by cartilaginous or bony nodules in the tracheobronchial lumen. Rigid video-stylet is an intubating device that provides favorable conditions even in the difficult cases. In this report, we describe a successful airway management using the rigid video-stylet in a 62-year-old man with unanticipated difficult intubation later diagnosed for TO. He was planned for elective percutaneous nephrolithotomy under general anesthesia. He was healthy without any airway symptoms. With the rigid video-stylet, we not only performed successful tracheal intubation but also examined endotracheal lumen simultaneously. Using the rigid video-stylet, we noticed multiple whitish projecting nodules in the trachea, which were the typical findings for TO.

A Case of Laryngeal Web Injury during Intubation in Pediatric Patient / 계명의대학술지

Laryngeal web is a rare congenital disease, and its incidence has been estimated to be 1 in 10,000 live births. A 4-year-old female child with laryngeal web was scheduled for laryngeal web removal. Smooth intubation without causing damages to the laryngeal web is important during induction. Also, it is very important to select the appropriate tube size during pediatric anesthesia. There is lack of a registered cuffed micro-laryngeal surgery (MLS) tube 3.5 mm inner diameter (ID) in Korea, and also our hospital did not have an uncuffed MLS tube 4.0 mm ID. Therefore we could not select the appropriate size of the laser tube. The patient's laryngeal web was slightly injured during intubation. We report a case of laryngeal web injury caused by intubation for laryngeal web removal and wish to state that there is lack of a registered laser tube in the size, such as a cuffed MLS tube 3.5 mm ID.

Results of Urine Culture and Antimicrobial Sensitivity Tests According to the Voiding Method Over 10 Years in Patients with Spinal Cord Injury

PURPOSE: We studied the results of urine cultures and antimicrobial sensitivity tests according to the voiding method used by spinal cord injury (SCI) patients over a recent 10-year period. MATERIALS AND METHODS: We retrospectively analyzed 1,236 urine samples and their antimicrobial sensitivity tests for 112 patients who had used only one voiding method between January 2000 and December 2009. The voiding methods were classified into four groups: clean intermittent catheterization (CIC), suprapubic catheterization, urethral Foley catheter, and spontaneous voiding. RESULTS: Of the 1,236 urine samples, 925 (74.8%) were positive and 279 (30.2%) had more than one bacteria. The CIC group showed the lowest rate of bacteriuria, colony counts, and polymicrobial infection (p<0.001). Causative organisms were mostly Gram-negative bacteria (84%), including Pseudomonas aeruginosa (22.9%), Escherichia coli (21.1%), Klebsiella species (6.7%), and Citrobacter species (6.3%). The rate of Gram-positive bacterial infection was 13.6%, and major pathogenic organisms were Streptococcus species (8.6%) and Staphylococcus species (2.6%). Major pathogenic organisms and the results of antimicrobial sensitivity tests differed according to the voiding method. CONCLUSIONS: Although the patient's condition and preferences are important when choosing the method of bladder management, CIC is the best voiding method for reducing urinary tract infections in SCI patients. When immediate use of antibiotics is needed for treatment of urinary tract infections, an appropriate antibiotic can be chosen according to the voiding method on the basis of our study and can be administered before the results of an antimicrobial sensitivity test are available.

Primary Classic Kaposi's Sarcoma of the Penis in an HIV-Negative Patient

Kaposi's sarcoma (KS) is a multifocal hemorrhagic sarcoma that occurs primarily on the extremities. KS limited to the penis is rare and a well-recognized manifestation of acquired immune deficiency syndrome (AIDS). However, KS confined to the penis is extraordinary in human immunodeficiency virus (HIV)-negative patients. We present the case of a 68-year-old man with a dark reddish ulcerated nodule on the penile skin, which was reported as a nodular stage of KS. We detected no evidence of immunosuppression or AIDS or systemic involvements in further evaluations. In his past medical history, the patient had undergone three transurethral resections of bladder tumors due to urothelial cell carcinoma since 2000 and total gastrectomy, splenectomy, and adjuvant fluorouracil/cisplatin chemotherapy for 7 months due to advanced gastric carcinoma in 2005. The patient was circumcised and has had no recurrence for 2 years.

A Case of Bronchiolitis Interstitial Pneumonitis / 결핵및호흡기질환

Bronchiolitis interstitial pneumonitis (BIP), an unclassified and newly described interstitial pneumonia, has a combined feature of prominent bronchiolitis, interstitial inflammation, and fibrosis. It is distinct from bronchiolitis obliterans or bronchiolitis obliterans organizing pneumonia (BOOP). BIP has a better prognosis than common cases of interstitial pneumonia. However, BIP has a poorer prognosis than BOOP. BIP's response to corticosteroids is not as successful as BOOP's response to this treatment. We encountered the case of a 31-year-old woman with BIP with an initial presentation of dyspnea and a cough that had lasted for 3 months. The patient's chest CT scan demonstrated patchy ground glass opacities and multiple ill-defined centrilobular nodules in both lungs, suggesting military tuberculosis or nontuberculous mycobacterial infection. A video-assisted thoracoscopic lung biopsy resulted in the diagnosis of BIP. Clinical symptoms, pulmonary lesions, and pulmonary function tests were improved after oral glucocorticoid therapy.

Castleman Disease Misdiagnosed as a Neoplasm of the Kidney

Castleman disease, or angiofollicular lymph node hyperplasia, is a fairly rare benign tumor of lymphoid origin. Most cases tend to present as a mediastinal mass. We report a 58-year-old man with Castleman disease of the right perirenal space. This case was diagnosed preoperatively as nonconventional renal cell carcinoma (RCC) or renal oncocytoma because the enhancing mass abutted the renal cortex. The patient underwent a radical nephrectomy and a histopathological analysis showed the unicentric plasma cell type of Castleman disease. A preoperative diagnosis of Castleman disease is difficult; therefore, a surgical resection and a histological evaluation can provide an accurate diagnosis of this tumor. Taking this case into consideration, we suggest that Castleman disease should be included in the differential diagnosis of renal tumors.

Acute and Subacute Stent Thrombosis in a Patient With Clopidogrel Resistance: A Case Report

Drug-eluting stents (DES) are considered the treatment of choice for most patients with obstructive coronary artery disease when percutaneous intervention (PCI) is feasible. However, stent thrombosis seems to occur more frequently with DES and occasionally is associated with resistance to anti-platelet drugs. We have experienced a case of recurrent stent thrombosis in a patient with clopidogrel resistance. A 63-year-old female patient suffered from acute myocardial infarction and underwent successful PCI of the left anterior descending coronary artery (LAD) with two DESs. She was found to be hyporesponsive to clopidogrel and was treated with triple anti-platelet therapy (aspirin 100 mg, clopidogrel 75 mg, and cilostazol 200 mg daily). Three days after discharge, she developed chest pain and was again taken to the cardiac catheterization laboratory, where coronary angiography (CAG) showed total occlusion of the mid-LAD where the stent had been placed. After intravenous administration of a glycoprotein IIb/IIIa inhibitor, balloon angioplasty was performed, resulting in Thrombolysis In Myocardial Infarction (TIMI) III antegrade flow. The next day, however, she complained of severe chest pain, and the electrocardiogram showed marked ST-segment elevation in V1-V6, I, and aVL with complete right bundle branch block. Emergent CAG revealed total occlusion of the proximal LAD due to stent thrombosis. She was successfully treated with balloon angioplasty and was discharged with triple anti-platelet therapy.

The effect of ultrasonic cleaning on the elimination of postoperative residual protein from the proseal(TM) laryngeal mask airway / 대한마취과학회지

BACKGROUND: Reusable Proseal(TM) laryngeal mask airways (PLMAs) can act as a vector for the transmission of prion diseases such as variant Creutzfeldt-Jacob disease. This study tested the hypothesis that supplementary ultrasonic cleaning facilitates the removal of protein deposits on PLMAs after anesthesia. METHODS: After clinical use, 40 PLMAs were randomly allocated into two groups. In the first group, the PLMAs were washed by hand and were then subsequently placed in an autoclave at 134degrees C for 40 min (Group 1, n = 20). In the second group, the PLMAs were washed by hand and ultrasonic cleaning using an enzymatic solution for 5 min, and were then subsequently placed in an autoclave (Group 2, n = 20). In both groups, protein deposits were detected on PLMAs by erythrosin staining. A staining score designated as none (0%), mild (0-20%), moderate (20-80%) and severe (80-100%), was assigned to each site (outer surface, inner surface and edges of the cuff, airway and drain tube, finger strap) according to the percentage of the stained surface area. RESULTS: Despite the cleaning of the masks, residual protein was found on the outer surface, inner surface and edge of the cuff, airway and drain tube, and finger strap of the PLMAs in both groups. Similar scores were observed for each part of the cleaned PLMAs in both groups, except for the outer surface of the PLMAs in Group 2 (P < 0.05). CONCLUSIONS: We conclude that the use of an ultrasonic cleaner with an enzymatic solution may be effective to cleanse the outer surface of the PLMAs, but there were no differences in the total scores for both groups.