ABSTRACT
Perioperative stroke is one of the most fatal complications for patients as well as for doctors. It is defined as a brain infarction or hemorrhage, occurring during or within 30 days after a surgical procedure. Most of the perioperative strokes have ischemic etiology while only 1% has hemorrhagic etiology, according to one study. The incidence of perioperative stroke is influenced by the complexity and type of the surgery. Generally, its incidence is very low, being about to 0.1-1.9%, with majority of the cases pertaining to cardiac, vascular, neurological surgeries. Based on our research, most cases are perioperative strokes that occur after cardiac and vascular surgeries. Here we report two cases of cerebral infarction after endoscopic sinus surgery, which are very rare.
ABSTRACT
Langerhans cell histiocytosis (LCH) is commonly characterized by abnormal function and differentiation or proliferation of monocytes. In LCH, granulomatous lesions, including langerine-positive histocytes and inflammatory infiltrates, can occur to all tissues, particularly well in the bones, skin, lungs, and pituitary gland. In case of external auditory canal LCH, conductive hearing loss may occur, and the most common symptom is otorrhea. Here we present a case that 49-year-old male with external auditory canal mass. Since no invasive findings were seen in radiologic study, endoscopic transcanal excision was performed and LCH was proven by pathologic report. We present this case of external auditory canal LCH with the review of literature.
ABSTRACT
Background and Objectives@#Near-infrared (NIR) fluorescence photo imaging provides real time parathyroid anatomy enhancement. Moreover, autofluorescence enables intraoperative virtual reality parathyroid exploration of the optical characteristics of the parathyroid gland. This study was performed to demonstrate the new technique of visualizing the parathyroid gland using video-guided autofluorescence during thyroid and parathyroid surgery and to evaluate the outcomes. This is the first study that introduces the video-monitoring technique for intraoperative parathyroid mapping.Subjects and Method A total of 26 patients underwent 18 total thyroidectomies and 8 hemithyroidectomies in 2016. Fifty-six parathyroid glands were enrolled in this study. Surgery was performed by NIR video-monitoring via thyroid lateral side dissection to find the parathyroid tissues and extract the thyroid glands. With the operation room light turned on, the parathyroid glands were identified by the video-guided autofluorescence detection technique carried out in 3 stages (P1, P2, and P3), which are imaging with surgeon’s eyes before parathyroids exposure (P1), after identification (P2), and in extracted specimen (P3). @*Results@#The parathryoid autofluorescence could be video-monitored in real time by our NIR camera system with the indoor room light turned on. Of the total 56 parathyroids, 52 were detected by fluorescence. Of these, the location of 43 glands were predicted by using the high signal in a before-exposure state and the glands were confirmed as containing parathyroid tissues [in P1, sensitivity=82.69%, positive predictive value (PPV)=100.00%]. Of the nine glands that did not show high signals in P1, seven glands visually showed fluorescence signals (in P1 and P2, sensitivity=96.15%, PPV=100.00%). One of the two glands that showed high signals in the extracted tissue was identified as parathyroid, but the other one was proved not by histologic examination by despite high intensity fluorescence signal (in P1-P3, sensitivity=100.00%, PPV=98.08%). The accuracy of video-guided parathyroid mapping in P1, P2, and P3 were 83.93%, 96.43%, and 96.43%, respectively. @*Conclusion@#This is the first study that demonstrates the parathyroid gland autofluorescence as a real-time video-monitoring technique and shows that it could be applied to real surgery. Although parathyroid autofluorescence is a phenomenon seen in the invisible wavelength, our data suggest that the operator can see the parathyroid fluorescent signal in real time on the video-monitor. This technique could help the operator to predict the gland location and preserve them safely.