Transfusion of RhD-Positive Blood Products to Asia Type DEL Patients:A Report of Two Cases / 대한수혈학회지

Individuals with Asia type DEL blood group, the RhD-variant that classified as serologically RhD-negative, do not produce anti-D even when exposed to the D-antigen. Therefore, it is considered safe to transfuse RhD-positive blood products to them. However, such transfusions are still rare in medical institutions, with only two cases reported in Korea. Here, we present cases of two additional patients based on our experience. A 60-year-old female patient undergoing extra corporeal membrane oxygenation (ECMO) for myocarditis presented with severe anemia.The patient was serologic RhD-negative. Due to the lack of RhD-negative RBC inventory for emergency transfusion, RhD-positive blood was transfused. After confirming the patient’s RHD genotype as Asia type DEL, the planned RhD-positive blood transfusion was continued. A total of 13 units of RhD-positive RBCs and 26 units of single donor platelets (SDPs) were transfused over 25 days. Throughout this period, all unexpected antibody tests were negative. The second patient, a 50-year-old male diagnosed with myelodysplastic syndrome (MDS), was serologic RhD-negative, and the RHD genotyping confirmed Asia type DEL. During the hospitalization period, a total of 113 units of RhD-positive SDPs and 10 units of fresh frozen plasma (FFP) were transfused over 64 days, and all unexpected antibody tests were negative. These two cases suggest the transfusion of RhD-positive blood products to patients with Asia type DEL is safe.

Incidence and Clinical Characteristics of Patients with Tinnitus According to Diagnostic Classification / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Knowledge about the incidence and clinical characteristics of tinnitus can be useful for diagnostic approach and treatment plan. We analyzed the incidence and clinical characteristics of each case of tinnitus according to the classification of tinnitus. SUBJECTS AND METHOD: The study recruited 211 tinnitus patients who visited tinnitus clinic from March 2009 to August 2009. First, patients were diagnosed and classified as sensorineural tinnitus and somatosounds. Somatosounds were subdivided to vascular tinnitus, muscle origin tinnitus and patulous Eustachian tube. Patients were evaluated by history taking by means of having them fill out tinnitus questionnaires and psychoacoustic questionnaires. Audiologic findings of each type of tinnitus have also been analyzed. RESULTS: Incidences of sensorineural tinnitus and somatosounds were 82.9% and 17.1% respectively. Among somatosounds, vascular tinnitus occupied 7.6%, muscle origin tinnitus, 4.3% and patulous Eustachian tube, 5.2%. The mean age of the patients with sensorineural tinnitus was older than somatosounds. Patients with muscle origin tinnitus had higher scores of tinnitus loudness, effect on life, tinnitus handicap inventory, stress and depression than those with other types of tinnitus. Overall compliance of the treatment was 66.7% and their tinnitus had been significantly improved after treatment. CONCLUSION: With the knowledge of incidence, clinical characteristics and treatment approach for each tinnitus, clinicians can be more confident in providing proper diagnosis and management of patients with tinnitus. Somatosounds, which showed relatively high incidence in this study, should not be neglected but properly treated with early diagnosis.

A Case of Isolated Abducens Nerve Palsy Caused by Primary Sphenoid Sinus Mucocele / 대한이비인후과학회지

Mucoceles of the sphenoid sinus are relatively rare and can lead to visual impairment, diplopia and external ophthalmoplegia. The ophthalmic symptoms seem to be caused mainly by compression or inflammatory changes. It is difficult to diagnose mucocele of the sphenoid sinus just on the basis of patient history or physical examination alone. CT scans and MRI help in the correct assessment of this lesion. We experienced one patient with a sphenoid sinus mucocele who presented simply with diplopia. The mucocele was managed successfully by endoscopic marsupialization.

A Case of Spontaneous Extracapsular Hemorrhage of Intrathyroidal Parathyroid Adenoma / 대한이비인후과학회지

Intrathyroidal parathyroid adenoma is an infrequent lesion which can be explained by abnormalities during embryonic migration of the parathyroid glands. Extracapsular hemorrhage from a intrathyroidal parathyroid adenoma is extremely rare, however, due to its location near upper airway, it might cause a life-threatening situation. Therefore, if patients presented with anterior neck painful swelling, skin ecchymosis associated with dysphagia and/or hoarseness, extracapsular hemorrhage from parathyroid adenoma should be considered as a possible diagnosis. Estimation of serum calcium level is essential as the presence of hypercalcemia can help to make the diagnosis pre-operatively. As rupture of a parathyroid adenoma and cyst may lead to local dissemination of tumor cells and an increased risk of recurrent hyperparathyroidism, careful longterm follow-up is required. We report an unusual case of spontaneous rupture of intrathyroidal parathyroid adenoma with a review of literature.

Ruptured Infectious Internal Carotid Artery Aneurysm Presenting with Epistaxis: A Case Report

Cavernous carotid aneurysms represent fewer than 2% of all intracranial aneurysms and are a rare cause of epistaxis, but rupture of an aneurysm into the sphenoid sinus may result in a massive hemorrhage. Infectious intracranial aneurysms are rare, but can develop as a result of direct extension from bacterial endocarditis or local infection of the head, neck, face, and paranasal sinus. The incidence of infectious intracavernous aneurysm is much lower. Because the sphenoid sinus is located adjacent to the cavernous sinus, sphenoid sinusitis may cause an infectious carotid aneurysm. We have experienced a case of ruptured infectious carotid aneurysm following sphenoid sinusitis presenting with epistaxis. We describe several aspects of the diagnosis and management of this rare case with a review of the literature.

Clinical Outcome of Squamous Cell Carcinoma of the Tongue in Young Patients: A Stage-Matched Comparative Analysis

OBJECTIVES: The reported incidence of tongue cancer in young patients has recently increased. The aim of this study was to analyze the clinical characteristics of tongue cancer in a young group of patients, and to compare them with those of an older group of tongue cancer patients. METHODS: We retrospectively reviewed the records of 85 patients who were diagnosed with squamous cell carcinoma of the tongue. They were divided into two age groups: over 45 years of age and under 45 years. To compare the prognosis of similarly staged patients in the group, each age group was divided into the early (stage I, II) and advanced stage groups (stage III, IV), and then they were compared. The young group consisted of 23 patients and the older group had 62 patients. RESULTS: At the early stage, the clinical prognosis of the patients in both age groups was good, and no significant difference was observed. However, at the advanced stage, the overall and regional recurrence rates were significantly higher in the younger age group as compared to that in the old age group (P=0.007, P=0.001, respectively). The disease-specific survival rate of the patients in the young group was significantly lower than that in the old age group (P=0.025). CONCLUSION: Tongue cancer in young subjects has significantly different clinical outcomes according to the stage. The clinical outcome of the advanced-stage tongue cancer in young subjects was poorer than that in the older subjects. Regional recurrence seemed to be the main cause of the poor prognosis.