Effect of lidocaine on pain caused by nasal pack removal after closed reduction of nasal bone fractures

Background@#Pain caused by nasal pack removal after closed reduction of nasal bone fractures is a common problem. This study investigated the effect of infiltrating lidocaine into nasal packs on the pain caused by pack removal after closed reduction of nasal bone fractures. @*Methods@#Seventy-five patients who underwent closed reduction of nasal bone fractures between March 2016 and March 2018 were enrolled in this prospective, randomized, single-blind study. Merocel (hydroxylated polyvinyl acetate) packs were applied bilaterally and retained for 5 days. Twenty minutes before removal, both packs were rehydrated with 6 mL of 2% lidocaine in 26 patients and with 6 mL of saline in 24 patients; the packs were not rehydrated in 25 patients. Visual analog scale (VAS) scores for pain on removal were recorded. @*Results@#The mean VAS score was 5.3±2.0 in all patients, 3.8±1.5 in the lidocaine group, 5.8±1.4 in the saline group, and 6.3±2.1 in the non-rehydrated group. There was a significant difference in the pain score between the lidocaine and saline groups (P<0.001) but not between the saline and non-rehydrated groups (P=0.186). @*Conclusions@#Infiltration of lidocaine into Merocel packs reduced the pain caused by pack removal after closed reduction of nasal bone fractures.

Image-guided navigation surgery for bilateral choanal atresia with a Tessier number 3 facial cleft in an adult

The coexistence of craniofacial cleft and bilateral choanal atresia has only been reported in three cases in the literature, and only one of those cases involved a Tessier number 3 facial cleft. It is also rare for bilateral choanal atresia to be found in adulthood, with 10 previous cases reported in the literature. This report presents the case of a 19-year-old woman with a Tessier number 3 facial cleft who was diagnosed with bilateral choanal atresia in adulthood. At first, the diagnosis of bilateral choanal atresia was missed and septoplasty was performed. After septoplasty, the patient’s symptoms did not improve, and an endoscopic examination revealed previously unnoticed bilateral choanal atresia. Computed tomography showed left membranous atresia and right bony atresia. The patient underwent an operation for opening and widening of the left choana with an image-guided navigation system (IGNS), which enabled accurate localization of the lesion while ensuring patient safety. Postoperatively, the patient became able to engage in nasal breathing and reported that it was easier for her to breathe, and there were no signs of restenosis at a 26-month follow-up. The patient was successfully treated with an IGNS.

The Usefulness of Surgical Treatment in Slow-Flow Vascular Malformation Patients

BACKGROUND: Many difficulties exist in establishing a treatment plan for slow-flow vascular malformation (SFVM). In particular, little research has been conducted on the surgical treatment of SFVMs. Thus, we investigated what proportion of SFVM patients were candidates for surgical treatment in clinical practice and how useful surgical treatment was in those patients. METHODS: This study included 109 SFVM patients who received care at the authors' clinic from 2007 to 2015. We classified the patients as operable or non-operable, and analyzed whether the operability and the extent of the excision varied according to the subtype and location of the SFVM. Additionally, we investigated complications and self-assessed satisfaction scores. RESULTS: Of the 109 SFVM patients, 59 (54%) were operable, while 50 (46%) were non-operable. Total excision could be performed in 44% of the operable SFVM patients. Lymphatic malformations were frequently non-operable, while capillary malformations were relatively operable (P=0.042). Total excision of venous malformations could generally be performed, while lymphatic malformations and combined vascular malformations generally could only undergo partial excision (P=0.048). Complications occurred in 11% of the SFVM patients who underwent surgery; these were minor complications, except for 1 case. The average overall satisfaction score was 4.19 out of 5. CONCLUSIONS: Based on many years of experience, we found that approximately half (54%) of SFVM patients were able to undergo surgery, and around half (44%) of those patients were able to fully recover after a total excision. Among the patients who underwent surgical treatment, high satisfaction was found overall and relatively few complications were reported.

Postoperative Speech Outcomes and Complications in Submucous Cleft Palate Patients

BACKGROUND: The postoperative speech outcomes of submucous cleft palate (SMCP) surgery are known to be poorer than those of other types of cleft palate. We attempted to objectively characterize the postoperative complications and speech outcomes of the surgical treatment of SMCP through a comparison with the outcomes of incomplete cleft palate (ICP). METHODS: This study included 53 SMCP patients and 285 ICP patients who underwent surgical repair from 1998 to 2015. The average age of the patients at the time of surgery was 3.9±1.9 years for the SMCP patients and 1.3±0.9 years for the ICP patients. A retrospective analysis was performed of the complications, the frequency of subsequent surgical correction for velopharyngeal dysfunction (VPD), and speech outcomes. RESULTS: In both the SMCP and ICP patients, no cases of respiratory difficulty, bleeding, or wound disruption were noted. Delayed wound healing and fistula occurred in 18.9% and 5.7% of the SMCP patients and in 14% and 3.2% of the ICP patients, respectively. However, no statistically significant difference in either delayed wound healing or fistula occurrence was observed between the two groups. The rate of surgical correction for VPD in the SMCP group was higher than in the ICP group. In the subset of 26 SMCP patients and 62 ICP patients who underwent speech evaluation, the median speech score value was 58.8 in the SMCP group and 66 in the ICP group, which was a statistically significant difference. CONCLUSIONS: SMCP and ICP were found to have similar complication rates, but SMCP had significantly worse speech outcomes.

A Case of Acute Kidney Cortex Necrosis Caused by Tranexamic-Acid / 대한내과학회지

Kidney cortex necrosis is a relatively rare cause of acute kidney injury and is characterized by complete or partial destruction of the renal cortex, but sparing of the medulla. Tranexamic acid has antifibrinolytic activity and is used to reduce bleeding. We report a rare case of kidney cortex necrosis caused by tranexamic acid. A 49-year-old woman complained of coughing up blood-tinged sputum. She had a history of bronchiectasis and was treated with tranexamic acid for 3 days. Four days after admission, she developed anuria and azotemia. Computerized tomography showed enhancement of the renal medulla, but not the bilateral renal cortex. The patient was treated with hemodialysis, and has since been maintained on hemodialysis for 6 months. Due to the development of kidney cortex necrosis in patients treated with tranexamic acid, all its potential complications should be considered.

The Relationship between Coronary Artery Calcification and Renal Function in Nondialyzed Patients

PURPOSE: Coronary artery calcification (CAC) has been described in individuals with chronic kidney disease (CKD), and its presence is associated with an increased risk of cardiovascular death. However, it is unclear whether there is an independent relationship between renal function and CAC. Therefore, we evaluated the association between renal function and CAC. MATERIALS AND METHODS: We retrospectively reviewed 870 Korean patients who had undergone computed tomographic coronary angiography. The glomerular filtration rate (GFR) was estimated using the Modification of Diet in Renal Disease study formula with an ethnic factor for the Korean population. The CKD stages were classified using estimated GFR (eGFR) and proteinuria. RESULTS: The mean age of the participants was 56.8+/-11.8 years, and the mean eGFR was 89.4+/-16.5 mL/min/1.73 m2. Hypertension and diabetes were noted in 41.5 and 17.0% of patients, respectively. There were 584 and 286 patients with no CAC and with CAC, respectively. After adjusting for confounding variables, late stage CKD was associated with CAC [odds ratio (OR) 2.80, 95% confidence interval (CI) 1.05-7.46]. However, early stage CKD was not associated with CAC (OR 1.61, 95% CI 0.92-2.82). Diabetes was an independent risk factor of CAC (OR 2.06, 95% CI 1.36-3.13). There was no significant association between proteinuria and CAC (OR 1.65, 95% CI 0.96-2.85). CONCLUSION: CAC is related to late stage CKD in nondialyzed patients. These findings emphasize that individuals with CAC should be considered a high-risk population for decreased renal function.

A Case of Acute Kidney Cortex Necrosis Caused by Tranexamic-Acid / 대한내과학회지

Kidney cortex necrosis is a relatively rare cause of acute kidney injury and is characterized by complete or partial destruction of the renal cortex, but sparing of the medulla. Tranexamic acid has antifibrinolytic activity and is used to reduce bleeding. We report a rare case of kidney cortex necrosis caused by tranexamic acid. A 49-year-old woman complained of coughing up blood-tinged sputum. She had a history of bronchiectasis and was treated with tranexamic acid for 3 days. Four days after admission, she developed anuria and azotemia. Computerized tomography showed enhancement of the renal medulla, but not the bilateral renal cortex. The patient was treated with hemodialysis, and has since been maintained on hemodialysis for 6 months. Due to the development of kidney cortex necrosis in patients treated with tranexamic acid, all its potential complications should be considered.

Concurrent renal and hepatic angiomyolipoma with pulmonary involvement in two patients with tuberous sclerosis / 대한내과학회지

Tuberous sclerosis (TS) involves multiple organs. Angiomyolipoma of the liver or kidney is one of the clinical manifestations of TS. However, coexistent renal and hepatic angiomyolipoma associated with TS is a rare condition. Pulmonary involvement is extremely rare, and occurs in only 0.1~1% of TS. We report two cases of concurrent renal and hepatic angiomyolipomas with pulmonary involvement in patients with TS. The first case was a 35 year-old woman who showed multiple angiomyolipomas in the liver and both kidneys and cystic parenchymal changes in the lungs. The other case was a 27-year-old woman who showed multiple angiomyolipomas in the liver and both kidneys, and multinodular pulmonary shadows. To the best of our knowledge, this is the first reported case of renal and hepatic angiomyolipomas associated with pulmonary involvement in Korea.

A Case of Acute Toxic Hepatitis and Acute Kidney Injury after Ingestion of Ulmus davidiana var. japonica Extracts / 대한신장학회지

Despite the splendid development of medicine, traditional alternative remedies have been widely used in Korea for a long time. Especially, the extract of elm bark is typical, common and easily obtained in a daily life. A scientific name of elm is Ulmus davidiana var. japonica. Although the study of pharmacologic effect and side effect is underway, the results are not yet enough to be applied in practice. Nevertheless, many people have the extracts of elm bark on expecting the improvement of health. We experienced a case of acute toxic hepatitis and acute kidney injury after complementary medication. She was a 48-year-old female patient who ingested 3-4 cups of extracts per day for 10 days to improve her health until admitted due to nausea, vomiting, and fatigue. The case report can suggest that ingestion of complementary medicine (elm bark root extracts) can be a cause of acute toxic hepatitis and acute kidney injury.

A Case of Peritonitis due to Comamonas testosteroni in a Patient on Continuous Ambulatory Peritoneal Dialysis / 대한신장학회지

Comamonas testosteroni has rarely been implicated as a human pathogen. We here present a case of peritonitis due to this organism in a patient on continuous ambulatory peritoneal dialysis (CAPD). A 32-year-old woman was admitted with abdominal pain and cloudy peritoneal effluent. Empirical intraperitoneal (IP) treatment with cefazolin and ceftazidime was started. The culture was positive for C. testosteroni and antibiotic was changed to ceftazidime IP. Four days after the ceftazidime treatment, the patient became asymptomatic. The follow-up culture from peritoneal effluent at 7th day was negative. This treatment was maintained for 21 days. After that, culture negative peritonitis occurred twice for 2 months in this patient, so CAPD catheter had to be removed. This is the first reported case of CAPD peritonitis caused by C. testosteroni. It is important for clinicians to recognize that CAPD peritonitis is caused by this organism which has been largely overlooked as a potential pathogen.

Kaposi's Sarcoma in a Patient on Hemodialysis / 대한신장학회지

Kaposi's sarcoma (KS) is an unusual multifocal neoplasm of vascular endothelial cell origin. The trunk, arms, head, and neck are the most common sites. It is common in men and has four distinct variants: classic, Africa-endemic, immunosuppressive drug-associated, and acquired immunodeficiency syndrome-associated KS. KS appears to develop immunosuppressed patients, but is uncommon in patients on dialysis. A 79-year-old man on hemodialysis for 2 months presented with pruritus over the entire body and multiple, discrete, variable-sized, dark blue papulonodules (papuloplaques, maculopapules) on the left arm and shoulder. A biopsy specimen form the left arm showed spindle cells with slit-like spaces and extravasated red blood cells. The specimen was positive for CD 34 antigen, and human herpesvirus 8 was detected. We report a case of KS that occurred in a 79-year-old patient on hemodialysis.