Ultrasound-guided treatment of common peroneal neuropathy caused by Baker’s cyst: a clinical note - A case report -

Baker’s cysts are usually located in the posteromedial side of the knee and seldom cause neuropathy. We describe the rare case of a 57-year-old woman with a popliteal cyst who presented with limping gait and pain in her lower leg. She was electronically diagnosed with common peroneal neuropathy and transferred to our pain clinic. On ultrasound examination, about 2.0 × 1.2 cm sized popliteal cyst was found to extend to the fibular head, compressing the common peroneal nerve. Therefore, ultrasound-guided aspiration of the cyst and a common peroneal nerve block were performed. Immediately after the procedure, the pain, dysesthesia, and limping gait were relieved. Although her pain and dysesthesia were relieved, she underwent the surgery because of limping gait. In this case, we found the Baker’s cyst, the cause of the common peroneal neuropathy, and treated it immediately by just simple ultrasound examination and aspiration.

Accidental middle turbinectomy by nasotracheal intubation: A case report

Nasotracheal intubation is an anesthetic technique widely used for maxillofacial surgery. It has the advantage of easier access to the surgical site to surgeon. However, when the nasothracheal intubation is performed a few complications may occur, such as nasal mucosa damage, epistaxis, sinusitis by sinus drainage occlusion and transient bacteremia. In addition, concha bullosa is a common anatomic variant of the middle turbinate, which is pneumatized, and very susceptible to trauma. We report a case of accidental middle turbinectomy by nasotracheal intubation, in the patient who had bilateral concha bullosa.

Clinical Study of the Pheochromocytoma / 대한내분비학회지

BACKGROUND: Pheochromocytoma may arise within the adrenal medulla, or in other locations where sympathetic ganglia or chromaffin tissues are known to exist. Approximately 0.1% of hypertensive patients have pheochromocytoma. Most of this hypertension can be cured by surgical removal of the tumor, but lethal complication can develop if proper treatment is not prepared. Therefore, accurate diagnosis and preoperative preparation is very important. The objective of this study was to evaluate the clinical characteristics of pheochromocytoma and the blood pressure change following tumor removal. METHOD: The medical records of 45 patients [29 cases of intra-adrenal, 16 cases of extra-adrenal (paraganglioma)] diagnosed with of pheochromocytoma at Korea University Medical Center between 1991 and 2001 were reviewed. RESULTS: Twenty of the cases were male and 25 were female. The mean age of these patients was 43 years old. Hypertension, headaches, palpitations and impaired glucose tolerance were observed more frequently in cases of intra-adrenal tumor than in those of extra-adrenal. In the extra-adrenal group, abdominal pain, hypertension and nausea were more frequently observed. A biochemical study showed that the sensitivity of the test for catecholamines and metabolites in 24 hours urine was over 80%. For the localization of tumors we used abdominal CT and MIBG. The sensitivities of the CT and MIBG for the tumor localization were 97 and 91%, respectively. Blood pressures during the operations were effectively controlled by preoperative treatment with phenoxybenzamine (non-competitive, non-selective -adrenoreceptor antagonists). CONCLUSION: Surgical treatment cured 23 of the 30 cases of hypertension with pheochromocytoma. We have to take careful approaches in the care of the patient who may have pheochromocytoma, due to the various clinical signs and symptoms.

The relationship of smoking and alcohol consumption to blood pressure and lipid concentrations in male elderly living in Seoul, Korea / 대한내과학회지

BACKGROUND: It is known that the effects of cigarette smoking and alcohol consumption on cardiovascular disease are very diverse. We investigated the effects of cigarette smoking and alcohol consumption on cardiovascular risk factors such as hypertension and dyslipidemia in male elderly living in Seoul, Korea. METHODS: We examined the relationship of smoking and alcohol consumption to cardiovascular risk factors in 236 Korean men aged over 60 years in the community-based cross-sectional study from August 1999 to October 1999. RESULTS: Alcohol users had higher systolic blood pressure, HDL cholesterol and lower LDL cholesterol, total cholesterol compared with non-users. After adjustment with age, body mass index and amount of smoking, partial correlation analysis showed that amount of alcohol consumption positively correlated with systolic blood pressure (r=0.1479, p<0.05) and negatively correlated with LDL cholesterol (r=0.2704, p<0.01) and total cholesterol (r=0.1800, p<0.05). But smokers didn't show any difference of body mass index, blood pressure, and lipid profile compared with non-smokers. CONCLUSION: In Korean male elderly, alcohol consumption was associated with increased systolic blood pressure. Also alcohol consumption was confirmed to be associated with decreased LDL cholesterol and total cholesterol, which might have a protective effect on coronary heart disease. We couldn't find the correlation between blood pressure, lipid profile and cigarette smoking.

Prevalence of Obesity and Correlation Between Obesity and Dyslipidemia in Elderly Population in South-West Seoul

BACKGROUND: Recently obese people have increased in Korea due to change of diet and life style. Obesity itself is an independent risk factor of cardiovascular disease. Also, obesity is associated with hyper tension, dyslipidemia, and diabetes as a componet of insulin resistance syndrome. To assess the health implications of obesity, we investigated the prevalence of obesity and the correlation between obesity and dyslipidemia. METHOD: The study was conducted in 1,733 elderly Korean(male 346, female 1,387) who lived in southwest Seoul area. Subjects were checked sex, age, height, weight, waist circumference, hip circumference blood pressure, serum total cholesterol, triglyceride, HDL cholesterol and LDL cholesterol. Overall obesity was measured by BMI(body mass index) and abdominal obesity was evaluated by WHR(waist-to-hip ratio). Subjects were divided according to their BMI(<25.0, > or = 25.0) and WHR(male< or =0.90, > or =0.90/female< or =0.85, > or =0.85). RESULT: The prevalence of obesity according to BMI was 32.1% in men and 46.4% in women. Systolic and diatolic blood pressure, total cholesterol, triglyceride, LCD cholesterol in the obese group revealed significantly higher than those in the nonobese group. In the abdominal obesity male group according to WHRl, the serum tiglyceride level was increased and the serum cholesterol level was decrea- sed but blood pressure, total cholesterol and LDL cholesterol were not different compared with the non-obese group. In the abdominal obesity female group, sys- tolic and diastolic blood pressure was significantly different in addition to triglyceride and HDL cholesterol compared with the non-obese group. CONCLUSION: Obese Korean elderly population had a characteristics like higher levels of blood pressure, serum total cholesterol, triglyceride and lower level of HDL cholesterol. which were known as cardiovascular risk factors. To evaluate the correla- tion between obesity and cardiovascular risk, prospective study for the difference of incidence of cardiovascular disease between obese and non-obese group will be continued.

A Case of Endocarditis Related to Pacemaker-Lead Infection / 감염

Endocarditis related to pacemaker-lead infection is a rare complication characterized by infection on the pacemaker electrode tip, tricuspid valve, or the fibrotic endocardial areas that are in contact with the electrode tip. However, it is a serious, potentially life-threatening complication. We experienced a case of pacemaker endocarditis in a 39-year old male patient in whom a permanent pacemaker had been inserted four years before. The diagnosis was made by the demonstration of vegetations on the electrode tip of the pacemaker, that was detected by transthoracic echocardiography and isolation of methicillin-resistant Staphylococcus epidermidis from blood culture. The patient was managed with antibiotics for six weeks and the infected electrode was removed by open heart surgery.

A Case of Endocarditis Related to Pacemaker-Lead Infection / 감염

Endocarditis related to pacemaker-lead infection is a rare complication characterized by infection on the pacemaker electrode tip, tricuspid valve, or the fibrotic endocardial areas that are in contact with the electrode tip. However, it is a serious, potentially life-threatening complication. We experienced a case of pacemaker endocarditis in a 39-year old male patient in whom a permanent pacemaker had been inserted four years before. The diagnosis was made by the demonstration of vegetations on the electrode tip of the pacemaker, that was detected by transthoracic echocardiography and isolation of methicillin-resistant Staphylococcus epidermidis from blood culture. The patient was managed with antibiotics for six weeks and the infected electrode was removed by open heart surgery.

Rectal Surveillance Culture of Vancomycin-resistant Enterococci (VRE) Colonization among Patients Hospitalized in the Intensive Care Unit (ICU) / 감염

BACKGROUND: VRE (vancomycin-resistant enterococci) have been an important nosocomial pathogen in the United States in the 1990s. VRE are usually multidrug-resistant and currently there is no effective antimicrobial agent for the treatment of such organisms. Recently, VRE have become an emerging nosocomial pathogen in Korea, but there have been few studies on the epidemiologic investigation of the infection or colonization of VRE among hospitalized patients with high risk factors. The purpose of this study was to determine the prevalence of rectal colonization of VRE among patients hospitalized in the intensive care unit (ICU), to study the risk factors for nosocomial acquisition of VRE, and to obtain the baseline data for controlling the spread of VRE infection within the hospital. METHODS: Between August 1 and October 12 (10 weeks) 1998, a prospective surveillance study was conducted in the ICU at Korea University, Guro Hospital. Surveillance rectal swab cultures for detecting VRE were obtained at weekly intervals among 93 patients admitted to the ICU during the study period. To obtain the VRE, rectal swab cultures were performed on Enterococcosel agar (BBL Microbiology Systems, Cockeysville, Md., USA) containing 6 microgram/mL of vancomycin. Minimal inhibitory concentrations (MICs) of vancomycin and teicoplanin were determined by agar dilution method. For the genotyping of isolated VRE, detection of vanA, vanB, vanC1 and vanC2 gene by polymerase chain reaction was done. Patients harboring VRE were compared to patients who were not colonized with this organism to identify the risk factors associated with rectal colonization. RESULTS: The rectal colonization rate of VRE was 23.7% (22/93 patients), but no patients had VRE infection during the study period. Twenty-six strains of VRE, which were isolated from 22 patients, included 2 E. faecium, 18 E. gallinarum and 6 E. casseliflavus isolates. Two vancomycin-resistant E. faecium (VREF) isolates were vanA genotype. All E. gallinarum, and all E. casseliflavus isolates demonstrated vanC1 and vanC2 genotype, respectively. Risk factors for rectal colonization of VRE included diabetes, catheterization of arterial and central venous lines, and vancomycin usage. CONCLUSION: This study demonstrated the low rectal colonization rate of clinically significant VREF (2.2%:2/93 patients) isolates among patients admitted to the ICU. This study suggests that maintaining HICPAC guidelines, restricted vancomycin usage and periodic surveillance in patients with high risk factors are important in preventing the emergence and spread of VRE infection among ICU patients in a university- affiliated hospital.

A Case of Recurrent Bacterial Meningitis associated with Traumatic Cerebrospinal Fluid Fistula / 감염

Recurrent bacterial meningitis in adults is a rare disease mostly due to traumatic cerebrospinal fluid (CSF) fistula and usually occurs within 2 weeks after head trauma. Recurrent bacterial meningitis shows high mortality and requires prompt diagnosis and proper treatment. However, diagnostic problems often arise when there may be no recent history of head injury, no direct radiologic evidence, and no CSF rhinorrhea or otorrhea. A 43-year-old man who had head trauma 2 years ago was admitted two times during 3 months due to acute bacterial meningitis. Culture of CSF grew Streptococcus pneumoniae during the second admission. The temporal bone CT scan revealed the transverse fracture on the right temporal bone. CSF leakage through the fracture was corrected by the open cavity mastoidectomy with middle ear obliteration. After the operation further recurrence of bacterial meningitis has not occurred.