ABSTRACT
A 38-year-old woman presented with a week’s history of binocular horizontal double vision and acute vertigo with gaze-induced nystagmus. We considered a diagnosis of one of the six syndromes of the sixth cranial nerve and evaluated several causes. She had history of severe anemia, vitamin B12 deficiency, and hypertension. Magnetic resonance imaging with angiography showed stenosis of the right vertebral artery and hyperintensity on both basal ganglia. As we describe here, we should consider vertebrobasilar insufficiency as a cause for sixth cranial nerve palsy if a patient has high risk for microvascular ischemia, even in the absence of acute brain hemorrhage or infarction.
ABSTRACT
Background and Objectives@#We aimed to measure the head dimensions on computed tomography (CT) images, to compare them to directly measured head dimensions, and to predict a new parameter of bone thickness for aiding bone conduction implant (BCI) placement. @*Subjects and Methods@#We reviewed the facial and mandibular bone CT images of 406 patients. Their head sizes were analyzed using five parameters included in the 6th Size Korea project, and they were divided into age groups (ranging from the 10s to the 80s). We compared the head length, head width, sagittal arc, bitragion arc, and head circumference in the CT and Size Korea groups. We also added the parameter bone thickness for aiding BCI placement. @*Results@#All the head size parameters measured using CT were significantly smaller than those measured directly, with head length showing the smallest difference at 7.85 mm. The differences in the other four parameters between the two groups according to patient age were not statistically significantly different. Bone thickness had the highest value of 4.89±0.93 mm in the 70s and the lowest value of 4.10±0.99 mm in the 10s. Bone thickness also significantly correlated with head width (p=0.038). @*Conclusions@#Our findings suggested that the CT and direct measurements yielded consistent data. Moreover, CT enabled the measurement of bone sizes, including bone thickness, that are impossible to measure directly. CT measurements may complement direct measurements in the Size Korea data when used for developing bone conduction hearing devices (BCIs and headsets) for the Korean population.
ABSTRACT
Sebaceous carcinoma is a relatively rare and aggressive malignant tumor. Periocular area (especially eyelid) is the most common lesion to occur, and the most common extraocular lesion is the parotid gland. Because the lesion also mimic other benign inflammatory diseases, this leads to delayed diagnosis or misdiagnosis. Here, we report a 58-year-old male patient who presented with a non-tender painless left parotid mass after wide excision of sebaceous carcinoma in the left eyelid two years ago. When he was diagnosed with sebaceous carcinoma of left eyelid, there was a small left parotid tumor on the computed tomography. But no further examination and treatment were performed. Two years later, physical examination revealed growing parotid tumor and multiple neck nodes on the left side. After radical parotidectomy and neck dissection, histological examination showed a sebaceous carcinoma and neck node metastasis. Considering the aggressiveness of sebaceous carcinoma, further evaluation for parotid glands should be considered when sebaceous carcinoma of the eyelid was discovered. Postoperative chemoradiotherapy was performed for disease control. Follow up after two years, and computed tomography showed no sign of recurrence.
ABSTRACT
Sebaceous carcinoma is a relatively rare and aggressive malignant tumor. Periocular area (especially eyelid) is the most common lesion to occur, and the most common extraocular lesion is the parotid gland. Because the lesion also mimic other benign inflammatory diseases, this leads to delayed diagnosis or misdiagnosis. Here, we report a 58-year-old male patient who presented with a non-tender painless left parotid mass after wide excision of sebaceous carcinoma in the left eyelid two years ago. When he was diagnosed with sebaceous carcinoma of left eyelid, there was a small left parotid tumor on the computed tomography. But no further examination and treatment were performed. Two years later, physical examination revealed growing parotid tumor and multiple neck nodes on the left side. After radical parotidectomy and neck dissection, histological examination showed a sebaceous carcinoma and neck node metastasis. Considering the aggressiveness of sebaceous carcinoma, further evaluation for parotid glands should be considered when sebaceous carcinoma of the eyelid was discovered. Postoperative chemoradiotherapy was performed for disease control. Follow up after two years, and computed tomography showed no sign of recurrence.
ABSTRACT
PURPOSE: In Korea, trauma is the 3rd most common cause of death. The trauma treatment system is divided into pre-hospital and hospital stages. Deaths occurring in the pre-hospital stage are 50% of the total death, and 20% of those are deaths that are preventable. Therefore, the purpose of our study is to calculate the preventable death rates caused by trauma in our current pre-hospital system, to analyze the appropriateness of the treatment of traumatized patients and to draw a conclusions about the problems we have. METHODS: The study was done on traumatized patients who expired at the emergency department from January 1, 2005, to December 31, 2009, at the Korea University Medical Centers in Anam, Guro and Ansan. The data on the patients were reviewed retrospectively based on characteristics, conditions on admission and trauma severity. The patient's RTS (revised trauma score) and ISS (injury severity score) was calculated. Preventable death rate was calculated by TRISS (the trauma score-injury severity score). RESULTS: A total of 168 patients were enrolled. All patients were intubated and underwent CPR. Of the total, 72% patients were male, and traffic accidents were the most common form of trauma (52.4%), falls being second (28.6%). Head injury, solitary or multiple, was the most common cause of death (55.4%). Thirty-eight (38, 22.6%) deaths were preventable. The 22.6% preventable death rate consisted of 15.5% potentially preventable and 7.1% definitely preventable deaths. Based on a logistic regression analysis, the relationship between the time intervals until transfusion and imaging and death was statistically significant in the hospital stage. In the pre-hospital stage, transit time from the site of the injury to the hospital showed a significant relationship with the mortality rate. CONCLUSION: One hundred sixty-eight (168) patients died of trauma at the 3 hospitals of Korea University Medical Center. The TRISS method was used to calculate the preventable death rate, with a result of 22.6%. The only factor that was significant related to the preventable death rate in the pre-hospital stage was the time from injury to hospital arrival, and the time intervals until transfusion and imaging were the two factors that showed significance in the hospital stage. Shortening the time of treatment in the field and transferring the patient to the hospital as quickly as possible is the most important life-saving step in the pre-hospital stage. In the hospital stage, the primary survey, resuscitation and diagnosis should proceed simultaneously.