Delayed diagnosis of postintubation tracheal laceration in a patient who underwent septorhinoplasty including osteotomy: A case report

Iatrogenic postintubation tracheal injury is a rare but potentially fatal complication associated with anesthesia. However, as signs of tracheal injury including subcutaneous emphysema, pneumomediastinum, pneumothorax, and respiratory distress may also be related to surgical technique, diagnosis may be confused and treatment of tracheal injury can be delayed. We report a case of postintubation tracheal laceration, whose diagnosis was delayed because of symptoms were confused with subcutaneous emphysema after septorhinoplasty including osteotomy. As symptoms deteriorated in spite of conventional management, patient underwent evaluation to determine other causes and eventually postintubation tracheal injury was detected. Therefore, even if there is no problem during tracheal intubation, it is necessary to consider postintubation tracheal injury in patients with subcutaneous emphysema that worsens despite appropriate treatment after septorhinoplasty including osteotomy.

Perioperative anesthetic management of a patient with catecholamine-secreting paraganglioma: A case report

Paraganglioma is an uncommon neuroendocrine tumor of cells that originate in the autonomic nervous system. Some paragangliomas have the ability to secrete catecholamines, similar to secretions in pheochromocytoma. For this reason, paragangliomas may cause malignant hypertension in patient, upon being administered anesthesia, or during surgery, this may lead to a life-threatening condition, despite the tumor having been diagnosed before conducting the procedure. Therefore, it is important to take adequate actions for reducing the occurrence of morbidity and mortality during surgery. Here, we describe a successful anesthetic management in a patient diagnosed with retroperitoneal paraganglioma invading the iliac bone.

A Case of Idiopathic Mesenteric Phlebosclerosis / 대한소화기학회지

Idiopathic mesenteric phlebosclerosis, rare disease entity causing chronic mesenteric ischemia is a member of non-thrombotic, non-inflammatory stenosis or occlusion of the mesenteric veins. The histologic hallmark is marked fibrous mural thickening and sclerosis of the vessel wall. It is frequently accompanied by calcification in the vessel wall. We report the case of a 61-year-old woman with idiopathic mesenteric phlebosclerosis. To our knowledge, this is the first case reported in Korea.

A Case of Idiopathic Mesenteric Phlebosclerosis / 대한소화기학회지

Idiopathic mesenteric phlebosclerosis, rare disease entity causing chronic mesenteric ischemia is a member of non-thrombotic, non-inflammatory stenosis or occlusion of the mesenteric veins. The histologic hallmark is marked fibrous mural thickening and sclerosis of the vessel wall. It is frequently accompanied by calcification in the vessel wall. We report the case of a 61-year-old woman with idiopathic mesenteric phlebosclerosis. To our knowledge, this is the first case reported in Korea.

Comparison of Early and Six Month Outcomes of Direct Stenting vs. Conventional Stenting in Patients with Angina Pectoris

BACKGROUND AND OBJECTIVES: Direct stenting (DS) has been shown to be safe and feasible, with demonstrable reductions in cost, procedural time and radiation exposure, and may also result in less vessel injury. The aim of this study was to compare the immediate and six month clinical and angiographic outcomes of direct stent (DS) with stent implantation implantation following balloon predilatation (conventional stenting, CS). SUBJECTS AND METHODS: Between July 2001 and June 2004, 266 patients (293 lesions) with angina pectoris were included in this study. Patients having lesion characteristics with excessive calcification, left main lesion, chronic total occlusion, severe proximal tortuosity and a bifurcated lesion were excluded. Follow up angiography was performed about six months after the initial procedure. RESULTS: Direct (73 lesions) and conventional stenting (220 lesions) were performed respectively. In the DS group, the minimal luminal diameter was larger (0.36+/-0.18 vs. 0.31+/-0.19 mm, p=0.036) and diameter stenosis lower than in the CS group (89.1+/-5.1 vs. 90.6+/-3.9%, p=0.026). However, no difference was found in the reference vessel diameter between the two groups. From the immediate angiographic results, the CS group showed a longer stent length than the DS group (18.84+/-5.61 vs. 16.16+/-3.67 mm, p=0.000), but the DS group had a higher balloon inflation pressure than the CS group (12.25+/-1.71 vs. 11.35+/-1.72 atm, p=0.000). However, no difference was found in the post-stent minimal luminal diameter, acute gain and angiographic success rates. Follow up angiography was performed in 68.6% (201/293) of lesions. The angiographic restenosis rate was similar between the two groups (DS, 19.6 vs. CS, 19.3%, p=0.966), as were the other angiographic findings. The rates of in-hospital and 6 month follow up major adverse cardiovascular events (MACE) were similar between the two groups. CONCLUSION: Direct stenting showed similar rates of angiographic restenosis as well as inhospital and 6 months MACE (death, myocardial infarction, target lesion revascularization, cerebrovascular accident) compared with conventional stenting.

A Case of Splenic Non-Hodgkin's Lymphoma in Rheumatoid Arthritis / 대한류마티스학회지

Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disorder of unknown etiology. Inflammation may usually extend beyond the joints and involve other organs. Clinically detectable splenomegaly is present in 5~10% of RA. Methotrexate (MTX) is a structural analog of folic acid that inhibits the enzyme dihydrofolate reductase, so cellular proliferation is reduced. MTX has been proven to be effective in treating RA and is believed to be nononcogenic at low, weekly dose employed in the patients with RA. However, recently there has been increased concern about the oncogenic potential of MTX because of several case reports describing the occurrence of non-Hodgkin's Lymphoma (NHL) in the patients with RA treated with MTX. A 65-year-old woman with RA was treated with low dose MTX (i.e. 10 mg/week) for 3 years. Because of prolonged left upper abdominal pain and thrombocytopenia associated with huge splenomegaly, splenectomy was performed. Biopsy revealed splenic B-cell NHL. We report a case of RA with splenomegaly who developed B-cell NHL in spleen during low dose MTX therapy.