Increased amount of pleural effusion during head-down tilt position in ovarian cancer patient with ascites: A case report

Pseudo-Meigs syndrome is accompanied with pleural effusion, ascites and a benign or malignant tumor of ovary, tubes, uterus, round ligament or colon. We reported a case of hypoxia in an ovarian cancer patient with moderate ascites after head-down tilt position for central venous catheterization under general anesthesia. Massive pleural effusion was detected on portable chest X-ray, which was not observed in a preoperative radiologic test. The patient had no respiratory symptoms and breath sound was normal in both lungs prior to surgery. The pleural effusion was resolved by a chest tube insertion.

Surgical correction of septal deviation after Le Fort I osteotomy / 대한악안면성형재건외과학회지

BACKGROUND: The Le Fort I osteotomy is one of the most widely used and useful procedure to correct the dentofacial deformities of the midface. The changes of the maxilla position affect to overlying soft tissue including the nasal structure. Postoperative nasal septum deviation is a rare and unpredicted outcome after the surgery. There are only a few reports reporting the management of this complication. CASE PRESENTATION: In our department, three cases of the postoperative nasal septum deviation after the Le Fort I osteotomy had been experienced. Via limited intraoral circumvestibular incision, anterior maxilla, the nasal floor, and the anterior aspect of the septum were exposed. The cartilaginous part of the nasal septum was resected and repositioned to the midline and the anterior nasal spine was recontoured. Alar cinch suture performed again to prevent the sides of nostrils from flaring outwards. After the procedure, nasal septum deviation was corrected and the esthetic outcomes were favorable. CONCLUSION: Careful extubation, intraoperative management of nasal septum, and meticulous examination of pre-existing nasal septum deviation is important to avoid postoperative nasal septum deviation. If it existed after the maxillary osteotomy, septum repositioning technique of the current report can successfully correct the postoperative septal deviation.

Myofascial pain syndrome of gluteus minimus mimicking lumbar radiculitis: A case report

Myofascial pain syndrome (MPS) can be characterized by pain caused by trigger points (TrPs) and fascial constrictions. Patients with MPS of the gluteus minimus muscles often complain of symptoms such as hip pain, especially when standing up after sitting or lying on the affected side, limping, and pain radiating down to the lower extremities. A 24-year-old female patient presenting with motor and sensory impairments of both lower extremities was referred to our pain clinic after initially being diagnosed with lumbar radiculitis. Under the impression of MPS of the gluteus minimus muscles following through evaluation and physical examination of the patient, we performed trigger point injections under ultrasonography guidance on the myofascial TrPs. Dramatic improvement of the patient's symptoms was observed following this treatment, and she was discharged without any further remaining symptoms.

Ventricular Fibrillation Soon after Endobronchial Epinephrine Application in a Young Man: A Case Report / 대한구급학회지

Ventricular fibrillation and cardiac arrest rarely occur after local application of epinephrine. Local and superficial application of epinephrine is a common hemostatic method during bronchoscopy, especially after biopsies. Although high plasma levels following endobronchial application of epinephrine have been observed in previous animal studies, there is no report of ventricular fibrillation after a usual dose of endobronchial application of epinephrine during bronchoscopy. We present a case of endobronchial epinephrine-induced ventricular fibrillation and cardiac arrest in a 31-year-old man with no previous history of cardiac disease.

The clinico-stastistical analysis of the treatments of the 139 Ameloblastomas

INTRODUCTION: Ameloblastoma is a benign but locally invasive tumor with a high recurrence rate. The aim of this study was to make an easier diagnosis and treatment planning of ameloblastoma. MATERIALS AND METHODS: From January 1993 to October 2009, 139 cases from 123 patients, who had been diagnosed with ameloblastoma through radiologic and biopsy in the department of oral and maxillofacial surgery of Kyunpook National University, were selected as the subjects in this study. According to the medical charts, 9 factors (age, gender, location, chief complaints, duration, radiographic findings, size and recurrence) concerned in deciding the treatment method and the relevance between each factor and the treatment methods were examined.(Conservative treatments were marsupialization, enucleation, curettage and lateral decortication. Radical treatments included block excision, resection and hemisection) RESULTS: In the patients under the age of 20, 77.14% had conservative treatments, whereas 22.86% underwent radical treatments. In the patients over the age of 20, 44.23% were treated conservatively treatments, and 55.77% underwent radical treatments. For unilocular types, 28.57% had conservative treatments, whereas 71.43% had radical treatments. For the multilocular types, 66.67% underwent conservative treatments, and 33.33% had radical treatments. For the primary cases, 58.68% were treated conservatively and 41.32% had radical treatments. For the recurrent cases, 16.67% and 83.33% underwent conservative and radical treatments, respectively. CONCLUSION: There was statistical significance in the factors affecting the treatment methods, such as age, radiographic findings and recurrence.

Polymorphous low-grade adenocarcinoma on hard palate: case report

Polymorphous low-grade adenocarcinomas (PLGA) are distinctive salivary gland neoplasms with a propensity to arise from the minor salivary glands. The most frequent location of PLGA is the palate, even though other locations have been described. Previously used terms for PLGA include lobular carcinoma and terminal duct carcinoma. Although the frequency of the tumor is unknown, the recognition of PLGA as an individual tumor has increased with the establishment of specific histopathological criteria characterizing the PLGA. The first choice of treatment is a wide surgical excision including the subjacent bone if necessary. The prognosis is generally good and the recurrence rate ranges from 17% and 22%. Distant metastases is unusual (9%) but occur mainly in the regional lymph nodes. This is a case report of a 67 year old female patient with PLGA who was treated with a wide excision by layers (2 stage) of the lesion including the surrounding bone. We present this case with a review of the relevant literature.

Three Cases of Endoscopic Mucosal Resection of Rectal Carcinoid Tumor by Band Ligation and the Snare Resection Technique / 대한소화기내시경학회지

Many reports have shown that endoscopic polypectomy or endoscopic mucosal resection can successfully remove tumor less than 1.0 cm in size. However, most carcinoid tumors in the rectum occur in the submucosal layer so that the entire tumor cannot be completely removed via endoscopic polypectomy or endoscopic mucosal resection. Endoscopic mucosal resection can also cause perforation of the intestinal wall and bleeding. Due to these reasons, instead of these two conventional methods, endoscopic mucosal resection using a ligation device is currently being used for the treatment of rectal carcinoid tumor. Recent studies that used this method have reported that endoscopic mucosal resection of rectal carcinoid tumor by band ligation and the snare resection technique is safe with minimal complications and this is quite useful to completely remove rectal carcinoid tumor.

A Case of Pasteurella Multocida Prosthetic Valve Endocarditis with Multiple Peripheral Arterial Embolism

Infective endocarditis caused by Pasteurella multocida is a rare disease with a high mortality rate. Most patients have a previous history of animal contact. The most common comorbid condition is a chronic liver disease, which is attributable to the high mortality rate. Over half of the patients who survived the disease had required valve replacement surgery. We report the case of a 70-year-old man diagnosed with prosthetic valve endocarditis caused by Pasteurella multocida and complicated with multiple peripheral arterial embolism. He had neither any underlying immunocompromising diseases nor previous history of animal contact. He was successfully cured after antibiotic therapy for 6 weeks without valve replacement surgery.

Follicular Dendritic Cell Sarcoma: A Case Report and Review of the Literature / Journal of the Korean Cancer Association, 대한암학회지

Follicular dendritic cells (FDC) are non-lymphoid, non-phagocytic accessory cells of the immune system and these cells are essential for antigen presentation and regulation of the reactions in germinal centers. Follicular dendritic cell sarcoma (FDCS) is a rare neoplasm that shows a low-to-intermediate malignant potential. The most commonly involved sites are the lymph nodes, but FDCS may also occur at a variety of extranodal sites, including the oral cavity, tonsils, gastrointestinal tract and liver. We describe here a 79-year-old woman who had FDCS with extensive lymph node involvement, dry cough, and an itching sensation. The patient improved after systemic chemotherapy.

A Case of Death Due to Hemophagocytic Lymphohistiocytosis Accompanied by Scrub Typhus

Hemophagocytic lymphohistiocytosis (HLH) is a rare disease with a high mortality rate. It is associated with a variety of bacterial, viral, fungal, and parasitic infections. In the literature, there are several cases of HLH associated with scrub typhus in adults, all of which were successfully treated with antibiotic therapy for scrub typhus. This report describes a case of HLH accompanied by scrub typhus in an 81-year-old woman, in whom the disease progressed despite doxycyclin therapy. The patient refused to receive immunosuppressive chemotherapy for HLH and died 5 weeks after admission due to multi-organ failure. To our knowledge, this is the first case of death due to scrub typhus-associated HLH in an adult.

Three Cases of Endoscopic Hemostasis of Gastric Ulcer Bleeding from an Exposed Blood Vessel with Using Histoacryl (N-Butyl-2-Cyanoacrylate) / 대한소화기내시경학회지

Upper gastrointestinal bleeding is a primary and emergency complication of peptic ulcer. Injection of Histoacryl (N-butyl-2-cyanoacrylate) is an effective endoscopic hemostasis procedure to treat peptic ulcer bleeding. However, Histoacryl injection is not a widely used method because of its various and sometimes severe complications. Therefore, the use of Histocaryl should be considered as a second line treatment modality to achieve therapeutic endoscopic hemostasis when the conventional treatment modalities fail or the patient has a high risk of needing operative therapy. Three patients, who had gastric ulcer bleeding from an exposed blood vessel, were each treated by an injection of Histoacryl diluted with Lipiodol at a dilution ratio of 1:1. All 3 procedures were successfully accomplished without any complications.

Syringocystadenocarcinoma Papilliferum: A Case Report

Syringocystadenocarcinoma papilliferum (SCACP) is a rare form of adenocarcinoma of the skin. This is the malignant counterpart of syringocystadenoma papilliferum (SCAP) and usually develops on the scalp in a long-standing lesion identified clinically as SCAP. We describe a 65-yr-old Korean man with a nodule on the right supra-pubic area with a 2-yr duration. Histologically this tumor had a similar overall configuration as in SCAP, but the tumor was asymmetric and poorly circumscribed, extending into the deep dermis and showed cytologic atypia. The tumor cells showed positive reaction to GCDFP-15, but negative reaction to CEA and HMFG-1. We established the diagnosis of SCACP in the patient, and a wide excision was performed to remove the tumor. The patient has been well without relapse or metastasis for 2 yr.

A Case of Cutaneous Spindle Cell Squamous Cell Carcinoma / 대한피부과학회지

Spindle cell squamous cell carcinoma (SCSCC) is rare. As in many rare cases, the dignity is difficult to determine. A comprehensive immunohistochemical analysis was conducted, and histopathological findings were also assessed prior to diagnosis. A 77-year-old female patient presented with a dome-shaped ulcerative nodule on her left cheek which was 1.5 cm in diameter and expanding slowly. After resection, conventional histopathological investigation showed spindle-shaped cells with hyperchromatic nuclei infiltrating the dermis in a whorl-like pattern. Furthermore, immunohistochemical investigation revealed SCSCC was positive for cytokeratins (cam 5.2, 34betaE12), and mesenchymal marker (vimentin), but was negative for pancytokeratin (AE1/3). The SCSCC was surgically removed 12 months ago and no relapse has been observed since the removal. Comprehensive immunohistochemical analysis is essential, along with assessment of morphological findings prior to diagnosis. In addition, more case reports on SCSCC should be cumulated to determine a precise prognosis.

A Case of Varicella Pneumonia in Healthy Adult / 대한피부과학회지

Varicella (chicken pox) is a common and contagious childhood disease. Varicella is uncommon in adults but potentially life-threatening because of serious complications such as pneumonia, hepatitis, disseminated intravascular coagulation and encephalitis. Among them, varicella pneumonia is the most common and serious complication of varicella infection in adults, with a reported incidence in healthy adults that is 25-fold greater than in children. Herein, we described a case of varicella pneumonia in a 36 year old healthy male patient. The patient presented with disseminated vesicular lesions, a fever, cough and mild dyspnea. A Tzanck smear of a vesicle showed multinucleated giant cells. A chest radiograph showed multiple, tiny nodules in both lungs and lymphadenopathy in the perihilar area. The patient was successfully treated with systemic acyclovir and corticosteroid for 15 days.

Two Cases of Dermatophytosis in Patients with Psoriasis / 대한의진균학회지

Psoriasis and tinea corporis have similar lesions that scaly erythematous patches, plaques and papules, and dermatophytosis have been considered rare in psoriasis. So, when the psoriatic lesion is resistant to conventional treatments, we regard worsening condition of psoriasis. It is difficult for us to diagnose dermatophytosis in the patient with psoriasis, when the lesion is atypical by steroid application. We report two cases of dermatophytosis in psoriatic patients. They had scaly lesions that suggested worsening of psoriasis but were not respond to conventional treatments. We found many hyphae on KOH examination from the lesions and isolated and identified Trichophyton rubrum on fungal culture. It is necessary for physicians to check dermatophytosis in patients who had atypical lesions or not better with conventional treatments.

A Case of Acantholytic Acanthoma / 대한피부과학회지

Acantholytic acanthoma is a benign neoplasm of the epidermal keratinocytes. It presents as a solitary, asympomatic, keratotic papule or nodule. The histopathologic features are outstanding acantholysis throughout the malpighian layer, hyperkeratosis, papillomatosis, and acanthosis. It is usually seen in older men, most commonly on the trunk. It has a tendency to be diagnosed clinically as a keratosis. Only 4 cases of acantholytic acanthoma have been reported in Korea. We report a case of acantholytic acanthoma in a 70-year-old man who presented with keratotic papules on his back.

A Comparative Study of KOH Preparation, Fungal Culture, Histopathologic Examination and Polymerase Chain Reaction for Diagnosis in Onychomycosis / 대한의진균학회지

BACKGROUND: Onychomycosis is one of the most common nail disorders, and it is necessary of mycologic confirmation to treat correctly. It has been reported that histopathologic evaluation and polymerase chain reaction (PCR) of the nail plate by nail clipping might be a useful supportive method for identification of causative fungi showing higher detection rates. Objective: This study was designed to compare diagnostic efficacy of KOH preparation, fungal culture, histopathologic examination and PCR in onychomycosis. METHODS: Using 60 nail samples from 60 patients with clinically suspected onychomycosis, KOH preparation and fungal culture with nail and subungual tissue was performed. And histopathologic examination with PAS staining and PCR with DNA extracted from paraffin block was performed. RESULTS: The results are summarized as follows: 1. The positive rates of conventional KOH preparation, fungal culture, histopathologic examination and PCR were 87.5%, 8.9%, 87.5% and 83.9%. 2. In histopathologic examination, fungi were distinguished as 3 groups based on Kim and Cho's classification (1997): dermatophytes, Candida sp. and non-dermatophytic mold (NDM). Fifteen of 49 samples are dermatophytes, 1 is Candida sp., and 7 are NDM, 8 are dermatophytes and Candida sp. mixed infections, 18 are dermatophytes and NDM mixed infections. 3. In PCR, 1 of 47 samples is Trichophyton rubrum, 4 are Candida sp. and 39 samples are NDM. CONCLUSION: Histopathologic examination in onychomycosis is considered to be an useful supportive method in diagnosis and identification of causative fungi in onychomycosis.

Body Weight Gain and Metabolic Changes in Patients with Schizophrenia during 12-Week Randomized Treatment of Ziprasidone and Risperidone / 대한정신약물학회지

OBJECTIVE: Body weight gain and metabolic syndrome are frequent adverse side effects of atypical antipsychotics. However, ziprasidone has been reported to have less effect on body weight and other metabolic parameters of patients, such as blood glucose and cholesterol. In this study, changes in the body weight and metabolic parameters were compared between the treatment groups of ziprasidone and risperidone in the patients with schizophrenia or schizoaffective disorder. METHODS: Patients shown acute exacerbation of schizophrenia or schizoaffective disorder diagnosed by DSM-IV diagnostic criteria were randomly assigned to ziprasidone 40-80 mg b.i.d. (N=56) or risperidone 1-4 mg b.i.d. (N=56) for 12 weeks. Body weight was measured before treatment and at 1st, 2nd, 4th, 6th, 12th week after treatment. The serum levels of glucose and cholesterol were checked before treatment and 12th week after treatment, and serum levels of prolactin before treatment and at 4th and 12th week after treatment. RESULTS: Less gain of body weight was shown in the patients treated with ziprasidone compared to those treated with risperidone. Mean body weight gain for 12 weeks were 0.8 kg and 3.5 kg in the ziprasidone and risperidone group, respectively. There was significant difference in weight gain between these two groups from 4th week. Serum prolactin elevation was higher in the risperidone group than in the ziprasidone group. However, there were no significant differences in the effects on the level of blood glucose and cholesterol between two treatment groups. CONCLUSION: This study shows that ziprasidone had less effect on body weight and prolactin compared to risperidone in the patients with schizophrenia or schizoaffective disorder in Korea. Although further studies are necessary to investigate the long-term effects, the less effect of ziprasidone on body weight and serum prolactin in schizophrenia and schizoaffective patients in Korea may help to enhance treatment compliance and lessen the cardiovascular risks.

A Clinical and Mycological Study of Tinea Pedis / 대한의진균학회지

BACKGROUND: Tinea pedis is the most common dermatophytosis in Korea. It has been increased gradually with time. Its characteristics may change with social environments. OBJECTIVE: The purpose of this study is to evaluate the clinical characteristics of tinea pedis according to clinical type and its mycologic findings. METHODS: We performed clinical and mycological studies on 74 patients with tinea pedis among outpatients clinic of Department of Dermatology in Yeungnam University Hospital and Catholic Skin Clinic for 3 months, from January 2005 to March 2005. RESULTS AND CONCLUSIONS: 1. The age distribution showed patients in their 60s and older than 60s to be most common. The ratio of male to female was 1.32:1 2. According to clinical types, the ratio of interdigital type was the highest (50%), followed by interdigital combined hyperkeratotic type (44.6%), interdigital combined with vesicular type (4%) and vesicular type (1.4%). There are no hyperkeratotic type and hyperkeratotic combined vesicular type. 3. The duration of longer than 5 years of tinea pedis was 73%. The proportion of interdigital combined with vesicular type was more common in its duration of longer than 10 years than its duration of less than 10 years. The durations of vesicular type and interdigital combined vesicular type were more than 5 years. 4. The rate of family history of tinea pedis was 52.7%. The broader area of involved site in the patients was, the higher the positivity in family history. 5. The rate of coexistent dermatophytosis with tinea pedis was 82.5%, and tinea unguium was the most common (79.7%). 6. The positive rate of culture was 68.9%, and Trichophyton(T.) rubrum was the most common isolates (96%) followed by T. mentagrophytes (4%). Compared with previous studies, age of patients with tinea pedis was older and duration was longer, the rate of coexistent dermatophytosis was increased, especially in tinea unguium.

Prevalence of Tinea Pedis and Onychomycosis in the Aged / 대한의진균학회지

BACKGROUND: Tinea pedis and onychomycosis is a common disease and the proportion of that in the aged has been significantly increased. Although there have been many reports about tinea pedis and onychomycosis, very few studies about that in the aged have yet been conducted. OBJECTIVE: The purpose of this study is to evaluate the prevalence and clinical features of tinea pedis and onychomycosis in the aged. METHODS: One hundred twenty-six persons over 65 years old who visited the Daegu public aged welfare center (57 persons), Seongju public health center (38 persons) and hospitalized Yeungnam University Yeongcheon hospital (31 persons) from September 20, 2005 to October 7, 2005 were examined clinically and evaluated tinea pedis and onychomycosis. Their clinical lesions were confirmed by KOH preparation and fungal culture. RESULT: Among 126 examined, 62 persons (49.2%) had tinea pedis and/or onychomycosis. Prevalence of the tinea pedis and/or onychomycosis of male (53.2%) was higher than that of female (38.2%). There was no difference in the prevalence between the living area or age. Most common clinical type of tinea pedis was hyperkeratotic type (n=21/66.7%). All patients with onychomycosis were distal subungual onychomycosis. In this study common underlying disease was hypertension (22.6%), diabetes mellitus (8.1%) and cerebrovascular accident (8.1%), however, there was no correlation between underlying diseases and the prevalence of tinea pedis and/or onychomycosis. Among 87 persons, 21 strains of dermatophytes were isolated. They were 19 strains of Trichophyton(T.) rubrum, 2 strains of T. mentagrophytes. The rate of previous treatment for this problem was 32.6%. CONCLUSIONS: All this finding suggest that the prevalence of tinea pedis and/or onychomycosis in the aged was high and they did not know about the disease. Tinea pedis and/or onychomycosis in the aged could become a source of infection and complication. Therefore, it is necessary to educate them and support to treat the disease effectively. Future studies including a large number of examinee and correlation of other diseases will be needed.