Acute exacerbation of COPD increases the risk of hip fractures: a nested case-control study from the Korea National Health Insurance Service

Background/Aims@#Hip fracture and acute exacerbation of chronic obstructive pulmonary disease (AE-COPD) could increase mortality in patients with COPD. There are no data on the relationship between AE-COPD and hip fracture, which may significantly affect the prognosis of patients with COPD. Therefore, we conducted this study to determine the effects of AE-COPD on hip fractures in patients with COPD. @*Methods@#This retrospective, nested, case-control study included 253,471 patients with COPD (≥ 40 years of age) identified from the Korea National Health Insurance Service-National Health Screening Cohort (NHIS-HEALS) from 2002 to 2015. Among 176,598 patients with COPD, 1,415 patients with hip fractures were identified. Each case was matched to one control for age (within 10 years), sex, and year of COPD diagnosis. We estimated the adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for hip fractures associated with AE-COPD using conditional logistic regression analysis, adjusting for underlying diseases and smoking history. @*Results@#In patients with AE-COPD, the risk of hip fracture was 2.50 times higher, regardless of systemic corticosteroid use and underlying disease (aOR, 2.50; 95% CI, 1.67 to 3.75). The risk of hip fracture increased if there was one episode of AE in the year before hip fractures (aOR, 2.25; 95% CI, 1.66 to 3.05). Moreover, the risk of hip fracture also increased in patients with more than two episodes of AE the year before hip fractures (aOR, 2.57; 95% CI, 1.61 to 4.10). @*Conclusions@#AE-COPD increases the risk of hip fracture regardless of underlying diseases, including osteoporosis, and treatment with systemic corticosteroids.

Evaluation of Cumulative and Conditional Antibiotic Release from Vancomycin-Embedded Fibrin Sealant and Its Antibacterial Activity : An In Vitro Study

Objective@#: Fibrin sealants have been used for hemostasis, sealant for cerebrospinal fluid leakage, and adhesive barrier in neurosurgery. Further, as its clinical use and role of an effective drug delivery vehicle have been proposed. This study was performed to measure antibacterial activity and continuous local antibiotic release from different concentrations of vancomycin-impregnated fibrin sealant in vitro. @*Methods@#: Antibacterial activity was investigated by disk diffusion test by measuring the diameter of the growth inhibition zone of bacteria (methicillin-resistant Staphylococcus aureus, ATCC29213) from vancomycin-embedded fibrin sealant disc diluted at five different concentrations (C1–C5; 8.33, 4.167, 0.83, 0.083, and 0.0083 mg/disc, respectively). Continuous and conditioned release of vancomycin concentration (for 2 weeks and for 5 days, respectively) were also measured using high-performance liquid chromatography (HPLC) method. To mimic the physiologic wound conditions with in vitro, conditioned vancomycin release in phosphate buffer solution (PBS) was measured and replaced PBS for five consecutive days, half a day or completely daily. @*Results@#: In the disk diffusion test, the mean diameters of bacterial inhibition zone were 2.54±0.07 cm, 2.61±0.12 cm, and 2.13±0.15 cm (C1, C2, and C3 respectively) but 1.67±0.06 cm and 1.23±0.15 cm in C4 and C5, respectively. Continuous elution test elicited the peak release of vancomycin from the fibrin sealant at 48 hours, with continued release until 2 weeks. However, conditioned vancomycin release decreased to half or more on day 2, however, the sustainable release was measured over the therapeutic dose (10–20 μg/mL) for 5 days and 4 days in assays of half and total exchange of PBS. @*Conclusion@#: This study suggests that fibrin sealant can provide an efficient vehicle for antibiotic drug release in a wide range of neurosurgical procedures and the safe and effective therapeutic dose will be at the concentration embedded of 4.167 mg/disc or more of vancomycin.

HL301 in the treatment of acute bronchitis: a phase 2b, randomized, double-blind, placebocontrolled, multicenter study

There is insufficient quality data to recommend the use of herbs for the treatment of acute bronchitis. Small number of randomized trials of plant extracts for this purpose were determined to be low quality and there are concerns for the safety. HL301 is a combined product of seven medicinal plants. In the present study, we tried to evaluate the efficacy and safety of HL301 for the treatment of acute bronchitis with a randomized, double-blind, placebo-controlled, multicenter trial design. Methods: A total of 166 patients with acute bronchitis were randomized to receive placebo or HL301 (600 mg/day) for 7 days. The primary endpoint was change in bronchitis severity score (BSS) from baseline visit (visit 2) to the end of treatment (visit 3). Other efficacy variables were the change of each component of the BSS (cough, sputum, dyspnea, chest pain, and crackle) with treatment, response rate, improvement rate, satisfaction rate and number of rescue medications taken. Results: Changes in the BSS from visit 2 to visit 3 were higher in the HL301 group than in the placebo group both in the full analysis set (4.57 ± 1.82 vs. 3.15 ± 3.08, p < 0.01) and in the per protocol set (4.62 ± 1.81 vs. 3.30 ± 3.03, p < 0.01). Four BSS components (cough, sputum, dyspnea, and chest pain) improved more with HL301 treatment than with placebo treatment. Participants treated with HL301 showed higher response, improvement, and satisfaction rates and less use of rescue medication than the placebo group. Conclusions: HL301 (600 mg/day) was effective and safe for symptomatic treatment of acute bronchitis.

Treatment of pulmonary tuberculosis

Tuberculosis (TB) remains the world's leading cause of death from a single infectious disease. In addition, the incidence of TB is high in South Korea. Effective TB control requires early diagnosis and initiation of appropriate treatment. Therefore, it is very important for clinicians to understand evidence-based practical recommendations and to be familiar with up-to-date treatment regimens. In this review, we first describe anti-TB drugs, including new drugs. Secondly, we discuss the treatment of drug-susceptible TB. Finally, we present treatment strategies for drug-resistant TB, which is divided into isoniazid-resistant TB, rifampin-resistant TB, and multi-drug resistant TB. For the treatment of drug-susceptible TB, we recommend 2 months of 4 drugs (isoniazid, rifampin, ethambutol, and pyrazinamide) followed by 4 months of 2 drugs (isoniazid and rifampin). For the treatment of isoniazid-resistant TB, we recommend 6 to 9 months of 4 drugs (rifampin, ethambutol, pyrazinamide, and levofloxacin or moxifloxacin). For the treatment of multi-drug resistant TB (MDR-TB), we recommend a minimum of 5 secondary drugs, including an injectable agent and quinolone. Although the World Health Organization recommended a shorter MDR-TB regimen in 2016, the Korean guidelines for tuberculosis have not yet accepted the shorter regimen. The treatment regimen of TB differs depending on the drug resistance pattern. Therefore, it is important to treat TB properly after confirming the drug resistance pattern. In addition, as new drugs are developed, new treatment guidelines for MDR-TB should be developed that are appropriate for circumstances in Korea.

Treatment of pulmonary tuberculosis

Tuberculosis (TB) remains the world's leading cause of death from a single infectious disease. In addition, the incidence of TB is high in South Korea. Effective TB control requires early diagnosis and initiation of appropriate treatment. Therefore, it is very important for clinicians to understand evidence-based practical recommendations and to be familiar with up-to-date treatment regimens. In this review, we first describe anti-TB drugs, including new drugs. Secondly, we discuss the treatment of drug-susceptible TB. Finally, we present treatment strategies for drug-resistant TB, which is divided into isoniazid-resistant TB, rifampin-resistant TB, and multi-drug resistant TB. For the treatment of drug-susceptible TB, we recommend 2 months of 4 drugs (isoniazid, rifampin, ethambutol, and pyrazinamide) followed by 4 months of 2 drugs (isoniazid and rifampin). For the treatment of isoniazid-resistant TB, we recommend 6 to 9 months of 4 drugs (rifampin, ethambutol, pyrazinamide, and levofloxacin or moxifloxacin). For the treatment of multi-drug resistant TB (MDR-TB), we recommend a minimum of 5 secondary drugs, including an injectable agent and quinolone. Although the World Health Organization recommended a shorter MDR-TB regimen in 2016, the Korean guidelines for tuberculosis have not yet accepted the shorter regimen. The treatment regimen of TB differs depending on the drug resistance pattern. Therefore, it is important to treat TB properly after confirming the drug resistance pattern. In addition, as new drugs are developed, new treatment guidelines for MDR-TB should be developed that are appropriate for circumstances in Korea.

The Prevalence and Characterization of Cerebral Microbleeds in Young People Having Intracerebral Hemorrhage

OBJECTIVE: Cerebral microbleeds (CMBs) are known as the neuroimaging markers of risk in stroke and dementia. Many studies on CMBs in elderly patients with hemorrhagic or ischemic stroke have been reported; however, reports on CMBs in young populations with intracerebral hemorrhage (ICH) are lacking. MATERIALS AND METHODS: A total of 272 patients aged 18–54 years presented to our hospital with ICH between December 2009 and August 2017. Among these, CMB presence, count, and topography with respect to ICH were evaluated on magnetic resonance imaging (MRI) gradient echo images (GREs). We also evaluated the prevalence and risk factors of CMBs. RESULTS: Among 272 patients, only 66 underwent GRE T2-weighted MRI. CMBs were detected in 40 patients (61%), with 29 (73%) being of the multifocal type. Among the 219 CMBs, 150 (68.5%) were of the deep type and 69 (31.5%) of the lobar type. CMB prevalence was higher in men. In multivariate logistic regression analysis, history of hypertension (adjusted odds ratio [aOR], 4.048; 95% confidence interval [CI], 1.14–14.32; p = 0.030), and male sex (aOR, 4.233; 95% CI, 1.09–16.48; p = 0.037) were independently associated with CMBs. CONCLUSION: In young patients who presented with spontaneous ICH, CMBs were highly prevalent in 61% of patients and strongly associated with history of hypertension and male sex.

Efficacy and Safety of Autologous Stromal Vascular Fraction in the Treatment of Empty Nose Syndrome

OBJECTIVES: Regenerative treatment using stem cells may serve as treatment option for empty nose syndrome (ENS), which is caused by the lack of turbinate tissue and deranged nervous system in the nasal cavity. We aimed to assess the efficacy and safety of the autologous stromal vascular fraction (SVF) in the treatment of ENS. METHODS: In this prospective observational clinical study, we enrolled 10 ENS patients who volunteered to undergo treatment of ENS through the injection of autologous SVF. Data, including demographic data, pre- and postoperative Sino-Nasal Outcome Test-25 (SNOT-25) scores, overall patient satisfaction, and postoperative complications, were prospectively collected. Nasal secretion was assessed using the polyurethane foam absorption method, and the levels of biological markers were analyzed in both ENS group and control group using enzyme-linked immunosorbent assay. The SVF extracted from abdominal fat was diluted and injected into both inferior turbinates. RESULTS: Among the 10 initial patients, one was excluded from the study. Subjective satisfaction was rated as “much improved” in two and “no change” in seven. Among the improved patients, the mean preinjection SNOT-25 score was 55.0 and the score at 6 months after injection was 19.5. However, the average SNOT-25 score of nine participants at 6 months after injection (mean±standard deviation, 62.4±35.8) did not differ significantly from the baseline SNOT-25 score (70.1±24.7, P>0.05, respectively). Among the various inflammatory markers assessed, the levels of interleukin (IL)-1β, IL-8, and calcitonin gene-related peptide were significantly higher in ENS patients. Compared with preinjection secretion level, the nasal secretions from SVF-treated patients showed decreased expressions of IL-1β and IL-8 after injection. CONCLUSION: Although SVF treatment appears to decrease the inflammatory cytokine levels in the nasal mucosa, a single SVF injection was not effective in terms of symptom improvement and patient satisfaction. Further trials are needed to identify a more practical and useful regenerative treatment modality for patients with ENS.

Delayed diagnosis of allergic bronchopulmonary aspergillosis due to absence of asthmatic symptoms

Allergic bronchopulmonary aspergillosis (ABPA) is a pulmonary disease with small prevalence. Exposure to aspergillus mold causes immunologic hypersensitivity and may cause ranges of symptoms from minimal to detrimental outcomes. Diagnosing and treating the disease before the development of bronchiectasis may save the patient from poor outcomes. This report presents a case of recurrent ABPA without any symptom of asthma, which impeded the correct diagnosis even after numerous hospitalizations.

Intravenous immunoglobulin therapy in a selective IgG3 deficient patient with recurrent respiratory infections and asthma attacks

The IgG subclass deficiency is defined as a significant decrease in the serum concentrations of one or more subclasses of IgG in a patient whose total IgG concentration is normal. IgG subclass deficiency can predispose to recurrent sinopulmonary infections. A 29-year-old female patient with a 4-year history of bronchial asthma presented with cough, sputum, dyspnea, and recurrent respiratory infections. She had frequently been treated with antibiotics and systemic steroids for recurrent respiratory infections and acute asthma exacerbations. Chest X-ray and computed tomography showed pectus excavatum and bronchial wall thickening without lung parenchymal abnormalities. On immunological evaluation, she was found to have a low serum IgG3, with normal total IgG concentration. Under diagnosis of selective IgG3 deficiency, she was started on monthly infusions of intravenous immunoglobulin (IVIG) therapy. The frequency and severity of respiratory infections and acute asthma exacerbations were markedly decreased during 3 years of IVIG therapy. Our case report suggests that a patient who has underlying selective IgG3 deficiency and asthma may benefit from IVIG therapy as this can significantly reduce the incidence and severity of recurrent respiratory infections and acute asthma exacerbations.

Intratympanic Steroid and Oral Diuretics Combination Therapy for Acute Low Frequency Sensorineural Hearing Loss without Vertigo / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The effectiveness of intratympanic dexamethasone injections (ITD) alone is compared against the combination therapy of ITD and oral diuretics as treatments for acute low frequency sensorineural hearing loss (LFHL) without vertigo. SUBJECTS AND METHOD: A total of 36 patients, with LFHL 0.05). For subjective symptoms, there were no statistically significant differences in the improvement rate in either group (combination 58.8% vs. ITD only 63.2%, p>0.05). In pure tone audiometry, the improvement rate of the combination group was not significantly different from that of the ITD only group (76.5% vs. 73.7%, p>0.05). There was a significant correlation between the complete recovery rate and duration of symptoms. CONCLUSION: ITD alone is an effective treatment modality for LFHL within 1 month after onset. Diuretics have no additive effect for the recovery of hearing in patients with acute LFHL without vertigo.

Caudal Septal Extension Graft Using Nasal Septal Osteocartilaginous Graft / 대한이비인후과학회지

The septal extension graft from the septum has become a common method of correcting a small or drooping nose in Korea. It can provide superior tip projection and definition if there is a sufficient amount of cartilage and nasal septal stability. In our case, the caudal type septal extension graft was applied unilaterally using septal osteocartilaginous graft harvested in one piece during septoplasty. It was useful in patients who needed septal extension graft in spite of the insufficient amount of available septal cartilage. For those patients, it could be used to achieve the cephalic rotation of drooping tip and the strengthening of septal support effectively. The nasal septal osteocartilaginous graft may serve as an alternative material for conchal cartilage or costal cartilage for caudal septal extension graft if the stable nasal support is maintained and the harvested graft is applied appropriately.

The Effect of High Frequency Sensorineural Hearing Loss on Auditory Temporal Resolution: Gaps-In-Noise Test Performance in Older and Young Adults with Normal Hearing / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Auditory temporal resolution, which refers to the time-related aspects of acoustic processing, can be evaluated by the Gaps-In-Noise (GIN) test. We investigated whether the presence of high frequency sensorineural hearing loss (HF-SNHL) affects the temporal resolution of GIN performance in older adults with normal hearing. SUBJECTS AND METHOD: Hearing tests including the GIN test were performed in 87 subjects with normal pure tone average. The GIN threshold and percentage of correct answers were compared among 4 groups of participants; older adults with normal hearing (n=18), older adults with HF-SNHL (n=24), young adults with normal hearing (n=24) and young adults with HF-SNHL (n=21). RESULTS: There was no significant difference in the mean GIN thresholds between the HF-SNHL group (5.8+/-0.8 msec) and the normal hearing group (6.0+/-0.8 msec) in older adults, whereas the mean GIN thresholds of HF-SNHL group was higher than that of the normal group in young adults (4.6+/-0.3 msec vs. 4.2+/-0.5 msec, p<0.05). The mean percentage of correct answers of HF-SNHL group (62.5+/-5.5%) was not significantly different from that of the normal hearing group (60.6+/-3.9%) in the old, unlike in the young (71.3+/-4.0% with HF-SNHL vs. 76.9+/-4.3% with normal hearing, p<0.05). Age only showed a significant correlation with the GIN performance. Neither the GIN threshold nor the GIN perception level had any relation with the presence of HF-SNHL in older adults. CONCLUSION: We found no evidence that supported the influence of HF-SNHL on auditory temporal resolution in older adults. These results imply that HF-SNHL may be of little importance in gap detection after age-related changes in central auditory system.

Two Cases of Newly Diagnosed Asthma with Spontaneous Pneumomediastinum During Asthma Exacerbation

Pneumomediastinum, a condition in which air is present in the mediastinum, is generally regarded as a benign, self-limited process. Rare life-threatening causes such as esophageal rupture must be excluded. A 26-year-old woman with allergic rhinitis presented with a 3-day history of increasing dyspnea, wheezing, and chest pain. Her high resolution CT (HRCT) showed extensive pneumomediastinum and subcutaneous emphysema without visible airway injury on the CT scan. With application of oxygen through a nasal cannula, bronchodilator inhalation, and systemic steroids, her pneumomediastinum and asthma symptoms were improved. A 30-year-old man with acute exacerbation of newly diagnosed asthma and spontaneous pneumomediastinum was treated with application of oxygen and asthma medication. Here, we reported two cases of newly diagnosed asthma with spontaneous pneumomediastinum during asthma exacerbation.

Comparison of the Effectiveness of Monitoring Cisplatin-Induced Ototoxicity with Extended High-Frequency Pure-Tone Audiometry or Distortion-Product Otoacoustic Emission

BACKGROUND AND OBJECTIVES: To compare the effectiveness of monitoring cisplatin-induced ototoxicity in adult patients using extended high-frequency pure-tone audiometry (EHF-PTA) or distortion-product otoacoustic emission (DP-OAE) and to evaluate the concurrence of ototoxicity and nephrotoxicity in cisplatin-treated patients. SUBJECTS AND METHODS: EHF-PTA was measured at frequencies of 0.25, 0.5, 1, 2, 3, 4, 6, 8, 9, 11.2, 12.5, 14, 16, 18, and 20 kHz and DP-OAE at frequencies of 0.5, 0.75, 1, 1.5, 2, 3, 4, 6, and 8 kHz in cisplatin-treated patients (n=10). Baseline evaluations were made immediately before chemotherapy and additional tests were performed before each of six cycles of cisplatin treatment. Laboratory tests to monitor nephrotoxicity were included before every cycle of chemotherapy. RESULTS: Four of 10 patients showed threshold changes on EHF-PTA. Five of 10 patients showed reductions in DP-OAE, but one was a false-positive result. The results of EHF-PTA and DP-OAE were consistent in two patients. Only one patient displayed nephrotoxicity on laboratory tests after the third cycle. CONCLUSIONS: In our study, the incidence rate of cisplatin-induced ototoxicity was 40% with EHF-PTA or DP-OAE. Although both EHF-PTA and DP-OAE showed the same sensitivity in detecting ototoxicity, they did not produce the same results in all patients. These two hearing tests could be used to complement one another. Clinicians should use both tests simultaneously in every cycle of chemotherapy to ensure the detection of ototoxicity.

The Effects of Unilateral Tinnitus on Auditory Temporal Resolution: Gaps-In-Noise Performance

BACKGROUND AND OBJECTIVES: The Gaps-In-Noise (GIN) test is a measure to assess auditory temporal resolution, which is the ability to follow rapid changes in the envelope of a sound stimulus over time. We investigated whether unilateral tinnitus affects temporal resolution by the GIN performance. SUBJECTS AND METHODS: Hearing tests including the GIN test were performed in 120 ears of 60 patients with unilateral tinnitus who showed symmetric hearing within 20 dB HL difference up to 8 kHz (tinnitus-affected ears, 14.6+/-11.2 dB HL; non-tinnitus ears 15.1+/-11.5 dB HL) and 60 ears of 30 subjects with normal hearing. Comparisons were made between tinnitus and non-tinnitus side of patients and normal ears of controls. RESULTS: There was no significant difference of the mean GIN thresholds among tinnitus-affected ears (5.18+/-0.6 ms), non-tinnitus ears (4.98+/-0.6 ms) and normal ears (4.97+/-0.8 ms). The mean percentage of correct answers in tinnitus side (67.3+/-5.5%) was slightly less than that in non-tinnitus side (70.0+/-5.5%) but it was not significantly different from that in normal ears (69.4+/-7.5%). Neither the GIN threshold nor the GIN perception level in tinnitus ears has relation to sex, frequency and loudness of tinnitus, and audiometric data. Age only showed a significant correlation with the GIN performance. CONCLUSIONS: We found no evidence which supported the influence of unilateral tinnitus on auditory temporal resolution. These results imply that tinnitus may not simply fill in the silent gaps in the background noise.

Time Course of the Suppression Effect on Transient Evoked Otoacoustic Emissions by Prolonged Contralateral Acoustic Stimulation

BACKGROUND AND OBJECTIVES: Although the suppressive effect of the medial efferent acoustic reflex is well known, the time course of this effect over prolonged periods has yet to be fully evaluated. We assessed time-dependent change in the suppression of transient evoked otoacoustic emissions (TEOAEs) by the medial efferent acoustic reflex over a relatively long period. SUBJECTS AND METHODS: We measured TEOAEs in the right ear before contralateral acoustic stimulation (CAS), and then measured serial TEOAEs in the right ear at four intervals during a total of 16 minutes of continuous CAS, followed by three more recordings after termination of CAS. RESULTS: TEOAE amplitudes were reduced with CAS during a certain period (from the immediate period to 10 minutes depending on frequency) and subsequently recovered. TEOAE suppression values in the mean amplitudes for overall frequency were 0.76 dB at the initial recording, 0.35 dB at 5 minutes, 0.44 dB at 10 minutes, and 0.33 dB at 15 minutes during CAS. The initial suppression value was significantly larger than other suppression values of 5, 10, and 15 minutes (p<0.05). In recordings obtained after CAS, TEOAE amplitude exceeded pre-acoustic amplitudes at 1 kHz, 1.5 kHz, and 2 kHz. CONCLUSIONS: The present results show the existence of the medial efferent acoustic reflex and demonstrate the time course that TEOAE suppressions present initially after CAS, showing fatigue over time. Overshooting of TEOAE was observed in recordings at several frequencies after termination of CAS.

Time Course of the Suppression Effect on Transient Evoked Otoacoustic Emissions by Prolonged Contralateral Acoustic Stimulation

BACKGROUND AND OBJECTIVES: Although the suppressive effect of the medial efferent acoustic reflex is well known, the time course of this effect over prolonged periods has yet to be fully evaluated. We assessed time-dependent change in the suppression of transient evoked otoacoustic emissions (TEOAEs) by the medial efferent acoustic reflex over a relatively long period. SUBJECTS AND METHODS: We measured TEOAEs in the right ear before contralateral acoustic stimulation (CAS), and then measured serial TEOAEs in the right ear at four intervals during a total of 16 minutes of continuous CAS, followed by three more recordings after termination of CAS. RESULTS: TEOAE amplitudes were reduced with CAS during a certain period (from the immediate period to 10 minutes depending on frequency) and subsequently recovered. TEOAE suppression values in the mean amplitudes for overall frequency were 0.76 dB at the initial recording, 0.35 dB at 5 minutes, 0.44 dB at 10 minutes, and 0.33 dB at 15 minutes during CAS. The initial suppression value was significantly larger than other suppression values of 5, 10, and 15 minutes (p<0.05). In recordings obtained after CAS, TEOAE amplitude exceeded pre-acoustic amplitudes at 1 kHz, 1.5 kHz, and 2 kHz. CONCLUSIONS: The present results show the existence of the medial efferent acoustic reflex and demonstrate the time course that TEOAE suppressions present initially after CAS, showing fatigue over time. Overshooting of TEOAE was observed in recordings at several frequencies after termination of CAS.

Intracavernous Sinus Arachnoid Cyst Confused with the Complication of Mycotic Sphenoidal Sinusitis / 대한이비인후과학회지

The arachnoid cyst is a rare disease that accounts for about 1% of the intracranial mass. The etiology of arachnoid cyst is due to either congenital compromise of arachnoidal development or acquired inflammatory reaction or trauma in the subarachnoid space. Computed tomography of arachnoid cyst demonstrates well-marginated low density lesions, whereas magnetic resonance image shows identical signal intensities of cerebrospinal fluid on T1 and T2 weighted image and low signal intensity on diffuse weight imaging without contrast-enhancement. The treatment of intracavernous sinus arachnoid cyst must be tailored to each patient according to the location of the lesion within cavernous sinus and the patient's symptoms. We experienced a case of arachnoid cyst of the cavernous sinus accompanying mycotic sphenoidal sinusitis. There are no previously reported cases of patients with an intracavernous sinus arachnoid cyst accompanying mycotic sphenoidal sinusitis.

A Case of Schwannoma Arising from the Sphenoid Sinus / 대한이비인후과학회지

Schwannomas are neurogenic tumors that arise from the Schwann cells of the nerve sheath. Although up to 45% of all schwannomas occur in the head and neck region, only 4% involve the nasal cavity and paranasal sinuses. A 56-year-old female presented with an incidentally discovered lesion in the left posterior ethmoid and sphenoid sinuses on the brain magnetic resonance imaging. Magnetic resonance imaging showed a well demarcated mass without bony destruction with isointensity in T1 and hyperintensity in T2 weighted scans. Eighteen months later, repeated computed tomography showed an enlargement of the mass with the erosion of the adjacent sinus wall and left vidian canal. She underwent an endoscopic mass removal, which revealed a pale yellowish, firm mass in the left posterior ethmoid and sphenoid sinuses. Final histopathology confirmed the diagnosis of a schwannoma. There has been no evidence of recurrence during the two-year follow-up.

Infraoptic Course of the Anterior Cerebral Artery: Case Report / 대한뇌혈관외과학회지

An infraoptic course of the anterior cerebral artery (ACA) is a rare anomaly of the anterior part of the circle of Willis. About 56 cases have been reported, often in association with cerebral aneurysm. We describe a case involving an infraoptic ACA in which a ruptured middle cerebral artery aneurysm was also present. A 52-year-old man experienced a sudden onset of severe headache without focal neurological deficits. Computed tomography demonstrated diffuse subarachnoid hemorrhage. Three-dimensional computed tomographic angiography and conventional angiography revealed a saccular aneurysm in the left middle cerebral artery. An anomalous arterial branch, originating from the right internal carotid artery at the level of the ophthalmic artery was also visible. This vessel followed an infraoptic course. The aneurysm was successfully embolized with coils. We review the literature for the possible genesis of this anomaly and consider treatment of the associated aneurysm.