Isolated Left Trochlear Nerve Palsy Caused by Sphenoid Sinus Mucocele / 대한이비인후과학회지

Paranasal sinus mucoceles are an uncommon cause of isolated palsies of cranial nerves III, IV, and VI. The trochlear nerve has been reported to be less frequently affected than the abducens and oculomotor nerves. Isolated sphenoid sinus diseases may cause serious complications by involving adjacent vital structures such as the optic nerve, cavernous sinus, internal carotid artery, and cranial nerves III–VI. We report a case of a 76-year-old woman who presented to our emergency department with a chief complaint of acute double vision and headache. Her diplopia was diagnosed as left trochlear nerve palsy. Brain CT and MRI revealed expanding cystic lesions in both sphenoid sinuses with bony erosion of the left sinus wall. The patient underwent an endoscopic intranasal sphenoidotomy and recovered completely from diplopia at postoperative 2 months. The relationship between the trochlear nerve palsy and its anatomy is also discussed.

Laryngeal Verruca Vulgaris: A Case Report and Review of Literature

Verruca vulgaris of the larynx (VVL) is an extremely rare disease that can be easily misdiagnosed as papillary keratosis, squamous papilloma or verrucous carcinoma, which would have led to needless operation. We experienced a case of VVL in a 66-year-old man with 1-year history of progressive hoarseness. Whitish lesions in both vocal cords were observed by using indirect laryngoscopy and completely removed via microlaryngeal surgery with CO2 laser.

Clinical Experience of Kidney Transplantation in the Hallym University Hospital / 대한이식학회지

Renal transplantation has been adopted as the treatment of choices for most patients with a end stage renal disease. This is the presentation of our experience of renal transplantation at Hallym University Hospital. From March 1984 to July 1998, 207 cases of renal transplantations were performed, 15 cases out of which were lost during follow-up period and excluded from the study. The mean age of recipients was 37.1 years. The male to female ratio was 1.5:1. Eighty nine renal allografts (46.4%) were from living unrelated donors, 59 (30.7%) from living donors and 44 (22.9%) from cadaveric donors. As an immunosuppression theray, a triple regimen was used in 104 cases (54.2), a double regimen in 86 (44.8%) and a single regimen in one (0.5%). The overall rejection developed in 87 cases (45.3%). The rejection rate was 59.3% in renal allografts from living related donors, 37.1% from living unrelated donors and 43.2% from cadavaric donors. The OKT3 and the antilymphocyte globulin (ALG) were used for steroid resistent rejection in 8 and 2 cases, respectively. Post-transplant diabetes mellitus were noticed in 22 cases (11.5). The most common complication was infection (28.1%), and 11 recipeints (5.7%) died during follw-up period. Infection was the leading cause of mortality. The overall graft survival was 92.2% at 1 year span and 83.1% at 3 year span. The overall patient survival was 95.6% at 1 year span and 92.5% at 3 year span.

Relationship of Renal Implantation Biopsies and Acute Rejection during Immediate Posttransplantation Period / 대한이식학회지

Many factors can be recognized for the acute rejection such as: degree of HLA mismatching, cytokine gene expression, ischemic time, etc. Some authors have suggested the importance of early routine biopsy of renal allograft to predict acute rejection. This prospective study on renal implantation biopsies was performed to evaluate the relationship between the implantation biopsies and the acute rejection during the immediate post-transplantation period. From December 1996 to February 1998 implantation biopsies were performed on 46 renal allografts within 40~60 minutes after vascular anastomosis using tru-cut needle (18G). Two samples were obtained from transplanted kidney in each patient. Serial sections were stained for the light microscopic examination. The slides were evaluated for histologic features such as interstitial cellular infiltration, nephrosclerosis, tubular damage, glomerular neutrophil count (GL-PMN), and peritubular neutrophil count (PTC-PMN). Forty six biopsies were grouped into acute rejection group (R group, n=10) and non-rejection group (N group, n=36) during immediate posttransplantation period (1 month). Acute rejections were confirmed by ultrasonography guided biopsy. Histologic findings were classified according to Banff schema. The statistical analysis was performed by using Chi-Square Test and Spearman Rank Sum Test. During the immediate post-transplantation period, acute rejection developed in 10 cases (21.7%) of which 9 cases were the biopsy-proven rejection. The male to female ratio was 21:25. Recipients were ranged from 22 to 54 years old with a mean age of 38.2+/- 9.1. Original disease of recipient were chronic glomerulonephritis in 15 cases (32.6%), hypertension in 8 cases, diabetes mellitus in 3 cases, RPGN in 2 cases. Fifteen cases (32.6%) were of unknown etiology. The mean number of HLA mismatches was 4.6+/- 0.9 in R group, 4.7+/- 1.2 in N group, and the mean number of HLA-B & DR mismatches was 2.2+/- 0.4 in R group, 2.3+/- 0.7 in N group. The ratio of the living vs. cadaveric donors was 34:12. No statistical difference was observed between two groups in interstitial cellular infiltration, nephrosclerosis and tubular damage. The GL-PMN was 0.6 0.9 in R group, while 0.1 +/- 0.4 in N group. The PTC-PMN was 5.3+/- 3.3 in R group and 0.3+/- 1.1 in N group (p<0.05). The presence of more than five PTC-PMN count was related with the occurrence of acute rejection (p<0.01). In conclusion, the PTC-PMN of renal implantation biopsies is a possible predicting factor for acute rejection in this preliminary report.