Vocal cord paralysis following general anesthesia with endotracheal intubation: a clinical review on 43 cases

Background@#Vocal cord paralysis (VCP) is one of the most stressful experiences for patients undergoing general anesthesia. Moreover, it is a risk factor for aspiration pneumonia and may increase morbidity and mortality. We examined several clinical features of the condition by reviewing the medical records of patients who experienced VCP following general anesthesia. @*Methods@#We reviewed the medical records of 321 patients who consulted an otolaryngologist owing to hoarseness, sore throat, throat discomfort, or dysphagia after general anesthesia. Among these, we included in the present study 43 patients who were diagnosed with VCP by laryngoscopy, who did not have symptoms of suspected VCP before surgery, who had no past history of VCP, and for whom endotracheal intubation was not continued after surgery. @*Results@#The mean age of patients with VCP was 51.28 years. With respect to surgical site, the most common was upper limb surgery, performed in 12 cases (9 cases were performed in sitting posture. With respect to surgical duration, only 11 cases lasted less than 3 h, whereas 32 cases required a surgical duration longer than 3 h. The most common symptom of VCP was hoarseness. Nine of the patients with VCP recovered spontaneously, but VCP persisted in 13 cases until the final follow-up examination. @*Conclusions@#We hope that this study might call attention to the occurrence of VCP following general anesthesia. Moreover, it is necessary to further evaluate the reasons for the higher incidence of VCP in upper limb surgery performed in sitting posture.

5 Cases of Human Thelaziasis

Thelaziases in human is an opportunistic infection. The worms usually lie in the conjunctival sac or in the lacrimal apparatus, causing foreignbody sensation, tearing and conjunctival irritation, In most cases, patients find the worms themselves and visit the hospital. Having experienced and confirmed 5 cases of human subconjunctival infestation of Thelazia callipaeda, we report these with literature review.

Two Cases of Human Thelaziasis

The authors report two cases of Thelazia callipaeda in Korea. The patients complained of foreign body sensation, lacrirmation, and conjunctival reaction. The first case was a 24-year-old man who had a male and a female worms in the conjunctival sac of the eye. The gross appearance of the worms was white nematode, and their microscopic measurement are as follows: 8.22mm in length, 0.29mm in width, 0.02mm in length of oral cavity, 0.48mm in length of the esophagus, 190-360 cuticular striations per mm. The second case was a 9-years-old girl from whom the authors extracted 14 mobile worms in the conjunctival sac of the eye. The worms were 5 males and 9 females. Morphologic features are as follows; average length of the male and female 11mm and 16mm, 0.30mm and 0.29mm of width, 0.60mm and 0.64mm of the esophagus, 0.026mm and 0.03mm of the oral cavity respectively. They had about 240 cuticular striations per mm, and male had coiled tails. From the above findings, it was confirmed as T. callipaeda, and the authors report it with review of the literature.

Two Cases of Human Thelaziasis

The authors report two cases of Thelazia callipaeda in Korea. The patients complained of foreign body sensation, lacrirmation, and conjunctival reaction. The first case was a 24-year-old man who had a male and a female worms in the conjunctival sac of the eye. The gross appearance of the worms was white nematode, and their microscopic measurement are as follows: 8.22mm in length, 0.29mm in width, 0.02mm in length of oral cavity, 0.48mm in length of the esophagus, 190-360 cuticular striations per mm. The second case was a 9-years-old girl from whom the authors extracted 14 mobile worms in the conjunctival sac of the eye. The worms were 5 males and 9 females. Morphologic features are as follows; average length of the male and female 11mm and 16mm, 0.30mm and 0.29mm of width, 0.60mm and 0.64mm of the esophagus, 0.026mm and 0.03mm of the oral cavity respectively. They had about 240 cuticular striations per mm, and male had coiled tails. From the above findings, it was confirmed as T. callipaeda, and the authors report it with review of the literature.

A Case of Metastasis of the Malignant Melanoma from Untreated Choroidal Melanoma

A 47 year old man gave a history of progressive deterioration of vision in his right eye of more than 8 years duration, which culminated in total blindness. Since 1981 by several ophthalmologists, he had been diagnosed as retinal deta chment, a case of cysticercosis, or choroidal melanoma of the right eye. On admission, ultrasonogram and CT scan for the globe showed choroidal tu mor which entirely filled the vitreous cavity. Cytology for ascites disclosed malignant melanoma cells. Death from metastatic disease occurred four weeks after admission. The diffrentiation between primary and metastatic melanoma may be difficult. The followings are the noted help points: metastatic tumors are typically multiopIe and flat in the uveal tract: multiple tumor emboli are observed in choroid, ciliary body or retinal vessels: associated nevus cells at the base of tumor are lacking: and epitheloid cell types are consistently present. This case might be, morphologically and by his history, originated from a primary choroidal melanoma(epitheloid type).

A Case of Metastasis of the Malignant Melanoma from Untreated Choroidal Melanoma

A 47 year old man gave a history of progressive deterioration of vision in his right eye of more than 8 years duration, which culminated in total blindness. Since 1981 by several ophthalmologists, he had been diagnosed as retinal deta chment, a case of cysticercosis, or choroidal melanoma of the right eye. On admission, ultrasonogram and CT scan for the globe showed choroidal tu mor which entirely filled the vitreous cavity. Cytology for ascites disclosed malignant melanoma cells. Death from metastatic disease occurred four weeks after admission. The diffrentiation between primary and metastatic melanoma may be difficult. The followings are the noted help points: metastatic tumors are typically multiopIe and flat in the uveal tract: multiple tumor emboli are observed in choroid, ciliary body or retinal vessels: associated nevus cells at the base of tumor are lacking: and epitheloid cell types are consistently present. This case might be, morphologically and by his history, originated from a primary choroidal melanoma(epitheloid type).