No abstract available.

The mucocele of paranasal sinuses is a mucus-filled, epithelial-lined cystic structure resulting from the destruction of the sinus ostia secondary by recurrent inflammation, trauma or intrinsic disease. A 42-year-old man was presented with a left periorbital swelling that developed 7 days ago. CT scan revealed mass lesions with soft tissue density in the left anterior ethmoid and frontal sinus. MRI showed a well- demarcated cystic mass in the left anterior ethmoid sinus with a high signal on both the T1-weighted and T2-weighted images as well as in the left frontal sinus with a low signal on the T1-weighted images and a high signal on the T2- weighted images. The patient subsequently underwent the removal of the left anterior ethmoid and frontal mucocele via a Lynch's approach and a left endoscopic anterior ethmoidectomy. He has no recurrence 6 months after surgery.
Adult ; Ethmoid Sinus ; Frontal Sinus ; Humans ; Inflammation ; Mucocele ; Paranasal Sinuses ; Recurrence

Cholesterol granuloma is usually found in chronic middle ear disease. However, it rarely occurs in the sinonasal regions and only a few cases have been reported in the literature. The etiology of the sinonasal cholesterol granuloma is not known yet, and the clinical manifestations are variable. The 78-year-old man complained of facial pain and toothache at first visit. The PNS CT had a homogenous isodense mass occupying right spenoid sinus and extending to right pterygopalatine fossa, infratemporal fossa and masticator space. The PNS MRI had characteristically high signal lesion at both T1- and T2-weighted images. The tumor was completely excised via transantral approach. Pathological confirmation was the cholesterol granuloma with fungal infection consistent with Aspergillus species. This patient is followed up without recurrence.
Aged ; Aspergillus ; Cholesterol ; Ear, Middle ; Facial Pain ; Granuloma ; Humans ; Pterygopalatine Fossa ; Recurrence ; Sphenoid Sinus ; Toothache

Intervertebral disc herniation is rare in children and is reportedly related with disc calcification and traumatic injury. We report an 8 years old girl, who complained of tingling sensation in both arms and intentional tic like neck stretching for about 1 month. She had got unnoticed whiplash Injury 2 weeks before symptoms. She also had been taking lessons for taekwondo for one and half year. Physical examination was unremarkable. Her symptoms got aggravated over the next 4 weeks. Plain vertebral x-ray showed no abnormalities, but cervical spinal MRI revealed disc central herniations at C 5-6 and C 6-7 levels. We concluded that her paresthesia and tic like motion were related with cervical disc herniation from hyperflexion neck injury.
Arm ; Child ; Humans ; Intervertebral Disc ; Neck ; Neck Injuries ; Paresthesia ; Physical Examination ; Sensation ; Tic Disorders ; Tics ; Whiplash Injuries

BACKGROUND: Evaluation of coronary artery disease(CAD) by radionuclide myocardial perfusion scintigraphy is safe, convenient and informative for diagnosis of CAD & assessment of functional significance of stenotic lesions. We tried to evaluate the characteristics of CAD in dibetics by intravenous dipyridamloe (99m)Tc-MIBI(methoxy isobutyl isonitrile) SPECT(Single Photon Emission Computed Tomography). METHOD: (99m)Tc-MIBI SPECT and coronary arteriography(CAG) were performed simultaneously in less than 2 week interval in 41 diabetics(diabetic group) and 103 non-diabetics(non-diabetic group) with clinical suspicion of CAD. The sensitivity and specificity of (99m)Tc-MIBI SPECT for detection of CAD were compared between two groups. The site and number of involved vessels, the extent of perfusion defect and redistribution pattern were compared between two groups. RESULT: 1) The sensitivity and specificity of (99m)Tc-MIBI SPECT for detection of CAD were 97% and 80% in diabetics, these were comparable to those in non-diabetics(97% and 78%). 2) Three vessel disease were common(p<0.01)in diabetics(SPECT 28.1%, CAG 32.3%) than in non-diabetics(SPECT 11.4%, CAG 7.5%). Distal lesions were also more common(p<0.005) in diabetics(CAG 40.3%) than in non-diabetics(CAG 15.7%). 3) On stress SPECT, the extent of perfusion defect was not different in individual vessel areas between diabetics and non-diabetics. However the perfusion defect of left ventricle as a whole was significantly higher(p<0.05) in diabetics(35.2+/-16.2%) than in non-diabetics(26.4+/-15.5%). 4) On rest SPECT, the percent redistribution was significantly lower in diabetics than in non-diabetics(left anterior descending artery area ; diabetic group 31.1+/-22.5% vs non-diabetic group ; 49+/-28.5%, p<0.05, left ventricle as a whole ; diabetic group 30.6+/-21.2% vs non-diabetic group 48.2+/-27.6%, p<0.02). CONCLUSION: Quantitative (99m)Tc-MIBI SPECT provided high sensitivity and specificity for detection of CAD in diabetics. Multiple vessel disease, distal lesion and fixed lesions were more common in diabetics than in non-diabetics, (99m)Tc-MIBI SPECT is useful noninvasive test for diagnosis of CAD & important prognostic implications.
Arteries ; Coronary Artery Disease* ; Coronary Vessels* ; Diagnosis ; Heart Ventricles ; Perfusion ; Perfusion Imaging ; Sensitivity and Specificity ; Tomography, Emission-Computed, Single-Photon*

Sialolipoma is a new variant of salivary gland lipoma containing secondary entrapment of acini and ducts of normal salivary gland, first described by Nagao et al. in 2001. We present the clinicopathologic features of two cases, with a review of 18 cases of sialolipoma reported in the literature so far. In our cases, both 59-year-old and 74-year-old men had painless, movable, and soft mass. The finding of neck enhanced computed tomography was a well-demarcated hypodense mass within the superficial lobe of left parotid gland in both cases. So we performed a superficial parotidectomy with preservation of the facial nerve. Grossly, this tumor was a well-demarcating, soft, greasy, yellowish mass, and microscopically, it consisted of mature adipose tissues and normal entrapped glandular epithelium of acini and ducts. This had been recently recognized as a separate entity under the term, "sialolipoma". We report two cases with a review of the literature.
Aged ; Epithelium ; Facial Nerve ; Humans ; Lipoma ; Male ; Middle Aged ; Neck ; Parotid Gland ; Salivary Glands

We present a case of scalp metastasis from papillary thyroid carcinoma which developed on the scalp of a 57-year-old man. The lesion was noticed at the scalp of left parietal area and a biopsy from the nodule showed mostly metastatic papillary form structures with colloidal structure. We performed immunohistochemistry stain using antithyroglobulin antibody, which established the diagnosis of a metastatic lesion from thyroid papillary carcinoma. Total thyroidectomy, excision of scalp nodule, and 131I radiotherapy were performed. No further metastasis has been discovered during the last 12 months.
Biopsy ; Carcinoma, Papillary ; Colloids ; Diagnosis ; Humans ; Immunohistochemistry ; Middle Aged ; Neoplasm Metastasis* ; Rabeprazole ; Radiotherapy ; Scalp* ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

Purpose: We investigated the effects of upper eyelid surgery on corneal higher-order aberrations and astigmatism. Methods: We enrolled 38 patients (66 eyes) who underwent blepharoplasty and 48 (81 eyes) who underwent levator resection. The marginal reflex distance1 (MRD1), corneal astigmatism, and corneal higher-order aberrations were measured preoperatively, and at 6 months postoperatively, and the two groups were compared. Results: Corneal astigmatism decreased significantly in the ptosis repair group (p < 0.001) but there was no significant change in the axis of astigmatism. Preoperative third-order and coma-like aberrations were significantly more common in the ptosis repair group than in the other group (p = 0.027 and p = 0.044, respectively); both decreased significantly after the operation (p = 0.030 and p = 0.006, respectively). The decrease in MRD1 and changes in the two aberrations showed a significantly stronger negative correlation in the ptosis repair group than in the other group (b = -0.186; p < 0.001 and b = -0.159; p < 0.001, respectively). Conclusions For patients with both cataract and ptosis, it is best to perform levator resection surgery before cataract surgery, because corneal higher-order aberrations and astigmatism are improved by levator resection. In turn, this reduces postoperative refractive error and improve vision quality.

Background: and Purpose: The importance of the specialized management of neurocritical patients is being increasingly recognized. We evaluated the impact of neurointensivist comanagement on the clinical outcomes (particularly the mortality rate) of neurocritical patients admitted to a semiclosed neurocritical-care unit (NCU). Methods: We retrospectively included neurocritical patients admitted to the NCU between March 2015 and February 2018. We analyzed the clinical data and compared the outcomes between patients admitted before and after the initiation of neurointensivist co-management in March 2016. Results: There were 1,785 patients admitted to the NCU during the study period. Patients younger than 18 years (n=28) or discharged within 48 hours (n=200) were excluded. The 1,557 remaining patients comprised 590 and 967 who were admitted to the NCU before and after the initiation of co-management, respectively. Patients admitted under neurointensivist co-management were older and had higher Acute Physiologic Assessment and Chronic Health Evaluation II scores. The 30-day mortality rate was significantly lower after neurointensivist co-management (p=0.042). A multivariate logistic regression analysis demonstrated that neurointensivist co-management significantly reduced mortality rates in the NCU and in the hospital overall [odds ratio=0.590 (p=0.002) and 0.585 (p=0.001), respectively]. Conclusions Despite the higher severity of the condition during neurointensivist co-management, co-management significantly improved clinical outcomes (including the mortality rate) in neurocritical patients.

BACKGROUND AND OBJECTIVES: Tinnitus is the conscious experience of sound that originates in the head or neck, and without voluntary origin obvious to that person. The aim of this study was to evaluate the prevalence of dyslipoproteinemias and its correlation with subjective tinnitus in the healthy elderly men (especially in men older than 60 years). SUBJECTS AND METHOD: From January 2007 to January 2008, we randomly selected 150 men at our office visit. Of these men, only 102 complained of subjective tinnitus. All men underwent pure tone audiogram, pitch-match and loudness-balance test for tinnitus, simple X-ray (mastoid series), blood sampling such as total cholesterol, LDL cholesterol, HDL cholesterol, triglyceride and lipoprotein(a) etc, and if necessary, temporal bone imaging study, and vestibular function test. Statistical analyses were performed using the SPSS version 15.0, and the p-value was considered significant when less than 5%. RESULTS: The prevalence of hyperlipoproteinemia had no significant difference between the tinnitus group and the control group. Although there was no correlation between loudness (r=0.008, p>0.05) and pitch (r=0.026, p>0.05) for tinnitus with the serum lipoprotein(a) level, the mean value of serum lipoprotein(a) was significantly different between the two groups (p<0.05). CONCLUSION: The high level of serum lipoprotein(a) may have influence on the subjective tinnitus as a risk or aggravation factor in the healthy elderly men.
Aged ; Cholesterol ; Cholesterol, HDL ; Cholesterol, LDL ; Dyslipidemias ; Head ; Humans ; Hyperlipoproteinemias ; Lipoprotein(a) ; Lipoproteins ; Male ; Neck ; Office Visits ; Prevalence ; Temporal Bone ; Tinnitus ; Vestibular Function Tests