Cerebral Venous Sinus Thrombosis Associated with Dutasteride Use

Cerebral venous thrombosis (CVT) is an uncommon cause of stroke that mainly affects young adults with known risk factors of prothrombotic conditions, pregnancy, infection, malignancy, and drugs. Dutasteride is a 5α-reductase inhibitor that is used for benign prostate hypertrophy and androgenetic alopecia. To date, CVT caused by dutasteride use has not been reported. A 25-yearold male presented with headache and diplopia. He had taken 0.5 mg of dutasteride every other day for 9 months to treat alopecia. A headache developed 7 months after he started taking medication, and horizontal diplopia occurred 1 month after the onset of headache. Fundus examination showed bilateral papilledema. Brain magnetic resonance imaging showed thrombosis in the left sigmoid and transverse sinuses. Headache and diplopia improved after discontinuing dutasteride and starting anticoagulation. The results from this case report indicated dutasteride as a potential cause of CVT. Presumably, the increased estrogen level due to dutasteride use caused the formation of a thrombus.

Patient-specific Guides Using 3-dimensional Reconstruction Provide Accuracy and Reproducibility in Reverse Total Shoulder Arthroplasty

BACKGROUND: We aimed to evaluate whether the use of our novel patient-specific guide (PSG) with 3-dimensional reconstruction in reverse total shoulder arthroplasty (RTSA) would allow accurate and reliable implantation of the glenoid and humeral components. METHODS: 20 fresh-frozen cadaveric shoulders were used. The PSG group (n=10) and conventional group (n=10) was evaluated the accuracy and reproducibility of implant positioning between before and after surgery on the computed tomography image. RESULTS: The superoinferior and anteroposterior offset in the glenoid component were 0.42 ± 0.07, 0.50 ± 0.08 in the conventional group and 0.45 ± 0.03, 0.46 ± 0.02 in the PSG group. The inclination and version angles were −1.93° ± 4.31°, 2.27° ± 5.91° and 0.46° ± 0.02°, 3.38° ± 2.79°. The standard deviation showed a smaller difference in the PSG group. The anteroposterior and lateromedial humeral canal center offset in the humeral component were 0.45 ± 0.12, 0.48 ± 0.15 in the conventional group and 0.46 ± 0.59 (p=0.794), 0.46 ± 0.06 (p=0.702) in the PSG group. The PSG showed significantly better humeral stem alignment. CONCLUSIONS: The use of PSGs with 3-dimensional reconstruction reduces variabilities in glenoid and humerus component positions and prevents extreme positioning errors in RTSA.

Multiple Embolic Infarcts Caused by Infective Endocarditis Associated with Atrioesophageal Fistula after Percutaneous Radiofrequency Catheter Ablation for Atrial Fibrillation

Infective endocarditis (IE) is not a common cause of stroke. Considering the high mortality rates, however, IE should always be considered as a possible cause of stroke even when the chances are low. Atrioesophageal fistula is a life-threatening condition that can cause IE and subsequent stroke, but the diagnosis is often delayed due to its rarity. We report a case of multiple embolic infarcts caused by infective endocarditis associated with atrioesophageal fistula after radiofrequency catheter ablation for atrial fibrillation.

Clinical and Radiological Results of Hook Plate Fixation in Acute Acromioclavicular Joint Dislocations and Distal Clavicle Fractures

BACKGROUND: The purpose of this study was to evaluate the clinical outcomes and complications of hook plate fixation in acromioclavicular (AC) joint dislocations and distal clavicle fractures. METHODS: We retrospectively reviewed a series of 60 consecutive patients with hook plate fixation for AC joint dislocation (group I) and distal clavicle fracture (group II). Groups I and II had 39 and 21 patients, respectively. Clinical results were evaluated using the pain visual analogue scale (VAS), simple shoulder test, and Constant-Murley scores. In addition, subacromial erosion and stiffness were evaluated as complications. RESULTS: At the removal, the pain VAS was 2.69 ± 1.30 and 4.10 ± 2.14 in groups I and II, respectively, which were significantly different (p=0.003). The simple shoulder test score was 9.59 ± 1.60 and 7.81 ± 2.67 in groups I and II, respectively, which were also significantly different (p=0.002). Subacromial erosion was significantly more frequent in group II (14/21 patients, 66.7%) than in group I (15/39 patients, 38.5%) (p=0.037), and stiffness was also higher in group II (17/21 patients, 81.0%) than in group I (22/39 patients, 56.4%), but it was not significant. CONCLUSIONS: Hook plate fixation showed good clinical and functional results for the treatment of acute unstable AC joint dislocation and distal clavicle fracture. But, in distal clavicle fractures, there are more subacromial erosion and stiffness compare with acute unstable AC joint dislocation.

Cardiac arrest after sugammadex administration in a patient with variant angina: a case report / 대한마취과학회지

A 76-year-old man with no notable medical history was scheduled for a robot-assisted radical prostatectomy. After the operation, he was given sugammadex. Two minutes later, ventricular premature contraction bigeminy began, followed by cardiac arrest. Cardiac arrest occurred three times and cardiopulmonary resuscitation was done. The patient recovered after the third cardiopulmonary resuscitation and was transferred to the intensive care unit. Coronary angiography was done on postoperative day 1. The patient was diagnosed with variant angina and discharged uneventfully on postoperative day 8.

Spinal Cord Stimulation for Intractable Visceral Pain Due to Sphincter of Oddi Dysfunction

Sphincter of Oddi dysfunction (SOD) is a syndrome of chronic biliary pain or recurrent pancreatitis due to the functional obstruction of the pancreaticobiliary flow. We report a case of spinal cord stimulation (SCS) for chronic abdominal pain due to SOD. The patient had a history of cholecystectomy and had suffered from chronic right upper quadrant abdominal pain. The patient had been diagnosed as having SOD. The patient was treated with opioid analgesics and nerve blocks, including a splanchnic nerve block. However, two years later, the pain became intractable. We implanted percutaneous SCS at the T5-7 level for this patient. Visual analog scale (VAS) scores for pain and the amount of opioid intake decreased. The patient was tracked for more than six months without significant complications. From our clinical case, SCS is an effective and alternative treatment option for SOD. Further studies and long-term follow-up are necessary to understand the effectiveness and the limitations of SCS on SOD.

Epidural anesthesia for permanent spinal cord stimulation with a cylindrical type lead: a case series / 대한마취과학회지

Spinal cord stimulation (SCS) in trials involving external stimulation are easily conducted under local anesthesia. However, implantation of a permanent SCS system is painful, and can be intolerable in some patients. Epidural anesthesia can be used to perform the SCS implantation without discomfort if the patient can localize the area of paresthesia. However, little is known about epidural anesthesia for SCS. This paper reports 23 cases of permanent SCS with a cylindrical type lead implanted under the epidural anesthesia. Epidural anesthesia was sufficient in 22 patients without discomfort and significant complications. The remaining patient experienced incomplete epidural anesthesia and required additional analgesics to blunt the pain. All the leads were placed consistent with the patient's report of paresthesia area under epidural anesthesia. Thus, epidural anesthesia is an effective and safe method for the optimal placement of SCS to minimize the discomfort for patients without impairing patients' response to the intraoperative stimulation test.

Successful use of caudal anesthesia and light sevoflurane mask ventilation for inguinal hernia repair in an infant with multiple large intrapulmonary cysts / 대한마취과학회지

No abstract available.

Two Cases of Onycholysis Treated with Long-Pulse Nd:YAG 1064-nm Laser / 대한피부과학회지

No abstract available.

A Case of Hydroxyurea-induced Melanonychia with Mucocutaneous Hyperpigmentation / 대한피부과학회지

No abstract available.

Tinea Incognito due to Trichophyton rubrum in Atopic Dermatitis Patient / 대한의진균학회지

Tinea incognito is a dermatophytic infection with an atypical clinical presentation caused by previous treatment with topical or systemic steroids, as well as by the topical application of calcineurin inhibitors such as pimecrolimus and tacrolimus. The diagnosis of tinea incognito is frequently delayed or missed due to loss of typical appearance. Nowadays, as the use of steroid and topical calcineurin inhibitor has been increasing, the incidence of tinea incognito has also increased. Here we report a case of tinea incognito in a 19-year-old girl initially misdiagnosed as irritant contact dermatitis who also had atopic dermatitis and onychomycosis on the left 3rd finger nail. On the basis of the detection of hyphae on KOH examinations and isolation of Trichophyton rubrum by fungus culture, she was successfully treated with oral terbinafine 250 mg/day and topical terbinafine for 12 weeks.

A Case of Merkel Cell Carcinoma with Metastasis to Sentinel Lymph Node and Regional Lymph Node Confirmed by Lymphoscintigraphy / 대한피부과학회지

No abstract available.

Identification of Dermatophytes by Polymerase Chain Reaction-Restriction Fragment Length Polymorphism Analysis of Metalloproteinase-1

BACKGROUND: Transgenic research on metalloproteinase-1 is an emerging field in the area of plant molecular biology. The new method reported here can similarly be applied in fungal molecular biology to identify different dermatophytes. Our method is more accurate than traditional methods such as molecular analyses. OBJECTIVE: To identify Trichophyton rubrum, T. mentagrophytes var. mentagrophytes, T. tonsurans, T. mentagrophytes var. interdigitale, Microsporum canis and M. gypseum, by using the restriction fragment length polymorphism (RFLP) analysis and polymerase chain reaction (PCR) to detect polymorphisms in the metalloproteinase-1 gene (MEP1). METHODS: From each fungal strain, we isolated genomic DNA and performed PCR to amplify the region coding for metalloproteinase-1. Primers for the metalloproteinase-1 gene were designed based on the sequence in NCBI GenBank. Subsequently, we purified the amplified PCR product and performed RFLP analysis. After restriction enzyme digestion, BsrDI (NEB, England), the samples were subjected to electrophoresis. Four different patterns of DNA fragments were observed among 6 fungal species. RESULTS: The DNA fragments for T. mentagrophytes var. mentagrophytes, T. mentagrophytes var. interdigitale and T. tonsurans showed similar patterns on electrophoresis and were not distinguishable, whereas T. rubrum, M. canis, and M. gypseum showed different patterns. CONCLUSION: To our knowledge, it is the first study to introduce the analysis of the nucleotide sequence of metalloproteinase-1 enzyme to study differentiation in dermatophytes. Based on our results, more accurate differentiation and subtyping of T. rubrum and T. mentagrophytes var. interdigitale might be possible. This might contribute to better understanding of the epidemiology and pathogenesis of dermatophyte.

Diurnal variation of extremely low frequency electromagnetic field in an empty operating room

Extremely low frequency electromagnetic field [ELF-EMF] is harmful to human body and causes various diseases like cancer. ELF-EMF is mainly produced by surgical or anesthetic equipment in operating room. However, it can be made by surrounding electricity without electric device. We measured it in an empty operating room of our hospital over two days and nights. The intensity of ELF-EMF was measured as two-second interval for two days in an empty operating room. One day was divided to three groups; night, morning, and afternoon. Each group continued for three hours due to capacity of ELF-EMF instrument. All of electrical devices were off including lamp, computer and air conditioner. Groups were compared using one-way ANOVA. P<0.05 was considered significant. Mean value of ELF-EMF during 1st and 2nd night was 1.9459 and 1.9486 respectively. It was lower than data of morning and afternoon [P<0.001]. All values [100%] were above 2 mG [micro-Gauss] in daytime. In night time, most of ELF-EMF [99.9%] was below 2 mG. The intensity of ELF-EMF is higher in an empty daytime operating room than at night time

Use of the i-gel(TM) supraglottic airway device in a patient with subglottic stenosis: a case report / 대한마취과학회지

The airway management of patients with subglottic stenosis poses many challenges for the anesthesiologists. Many anesthesiologists use a narrow endotracheal tube for airway control. This, however, can lead to complications such as tracheal mucosal trauma, tracheal perforation or bleeding. The ASA difficult airway algorithm recommends the use of supraglottic airway devices in a failed intubation/ventilation scenario. In this report, we present a case of failed intubation in a patient with subglottic stenosis successfully managed during an i-gel(TM) supraglottic airway device. The device provided a good seal, and allowed for controlled mechanical ventilation with acceptable peak pressures while the patient was in the beach-chair position.

A Case of Psoriasiform Dermatitis Following Adalimumab Injection for Treatment of Ankylosing Spondylitis / 대한피부과학회지

Adalimumab (Humira(TM)) is the first fully humanized monoclonal TNF-alpha antibody that antagonizes the effects of TNF-alpha. Its use has been found in the treatment of various rheumatologic disorders, namely rheumatoid arthritis, Crohn's disease, and ankylosing spondylitis, as well as for various skin conditions such as psoriasis. As the use of this particular biologic agent is becoming more widespread, cutaneous adverse effects of the drug is now being reported at a steady rate. The authors herein report a case of 32 year-old female who presented with multiple psoriasiform eruptions on her trunk, back and lower extremities. She had a four-year history of ankylosing spondylitis, for which she was started on subcutaneous adalimumab injection monthly, three and a half years prior to her initial visit.

Dexmedetomidine and remifentanil in the perioperative management of an adolescent undergoing resection of pheochromocytoma: A case report / 대한마취과학회지

A 15-year-old adolescent with unilateral multiple adrenal pheochromocytoma had an episode of subcortical intracerebral hemorrhage and seizure 6 weeks before the surgery. He was pretreated with terazosin, losartan, atenolol and levetiracetam for 2 weeks. Dexmedetomidine was started in the preoperative waiting area, and a combination of dexmedetomidine and remifentanil was continuously infused for most of anesthetic time. To control blood pressure, bolus injection of remifentanil and low-dose infusion of sodium nitroprusside, nicardipine, and esmolol were administered during three adrenergic crises. There was minimal post-resection hypotension, and his trachea was extubated safely 20 min after the surgery. He was discharged without noticeable complication. His catecholamine levels showed the steadily decreasing pattern during the operation in this case. Though a combination of dexmedetomidine and remifentanil may not prevent the hemodynamic instability impeccably during the tumor manipulation, this combination seems to be the way of interrupting release of catecholamines and minimizing hemodynamic fluctuations.

A Comparison Study between Culture Based Technique and Op-site Non-Culture Based Technique for Identifying Malassezia Yeasts on Normal Skin / 대한의진균학회지

BACKGROUND: Culture based technique, a traditional method for extraction of DNA from a cultured colony, was complex in culture conditions and was associated with a lower chance of successful culture. Recently, non-culture based technique, which skipped the culture process and directly extracted fungal DNA and differentiated Malassezia species, has been introduced. OBJECTIVE: Using 26S rDNA PCR-RFLP, the authors identified Malassezia yeasts and compared the yield of Malassezia DNA by the traditional culture based technique and the non-culture based technique via Op-site adhesive tape. METHODS: DNA of Malassezia yeasts were extracted using the culture based technique and the non-culture based technique from normal adults. Comparison was performed in order to clarify the differences between these two techniques. RESULTS: Use of the culture based technique resulted in a culture rate of 57.8% (78 out of 135 samples). On the other hand, using the non-culture based technique, fungal species were identified from all 135 samples. Using both techniques, M. globosa was the most identified species. The identification rate of the non-culture based technique was 100%; however, 7 repeats of PCR were required to reach 100% identification. Among samples from five body sites, those from the thigh required 5.5 repeats of PCR. CONCLUSION: The non-culture based technique was better than the culture based technique. However, due to the low amount of DNA extracts from the body sites with low habitation of Malassezia yeasts, repeated PCR was required for differentiation of Malassezia species.

Subtrochanteric Femur Fracture after Multiple Drilling for Treatment of Nontraumatic Osteonecrosis of the Femoral Head: A Case Report

Multiple drilling of the femoral head is a commonly-used surgical technique for the treatment of osteonecrosis. Several holes are drilled into the femoral head using a small-diameter Steinmann pin. This decompression technique promotes revascularization and regeneration of necrotic tissue in the femoral head. Known complications are heterotopic ossification and femoral subtrochanteric fractures, although these have only been rarely reported. Our case study focuses on a subtrochanteric fracture 6 weeks after a multiple drilling operation.