Follicular bronchiolitis is an uncommon bronchiolar disorder that is characterized by the presence of hyperplastic lymphoid follicles with reactive germinal centers. The condition is associated with connective tissue diseases such as rheumatoid arthritis, Sjögren’s syndrome, and immunodeficiency disorders. A 56-year-old man with rheumatoid arthritis was admitted to hospital with a progressively enlarging pulmonary nodule in the left upper lobe. A follow-up contrast tomography scan showed that the nodule had increased in size from 4.2 mm to 6.3 mm over a 3 month period. An open lung biopsy was performed to establish a definite pathologic diagnosis of the pulmonary nodule, which was suspected to be a lung malignancy. The nodule was diagnosed as follicular bronchiolitis based on the histopathology findings. We describe a patient with follicular bronchiolitis that was confirmed by an open lung biopsy, and is believed to have had rheumatoid involvement.
Arthritis, Rheumatoid* ; Biopsy ; Bronchiolitis* ; Connective Tissue Diseases ; Diagnosis ; Follow-Up Studies ; Germinal Center ; Humans ; Lung ; Middle Aged ; Solitary Pulmonary Nodule

Background and Objectives: The purpose of this study was to investigate the prevalence of incidental paranasal sinus (PNS) opacification in nasal septal deviation (NSD) using computed tomography (CT) and to identify contributing factors.Subjects and Method: We analyzed 216 patients who underwent septoplasty for the correction of NSD and who underwent preoperative PNS CT. We assessed the prevalence of incidental PNS opacification in these patients and determined the type of NSD according to Mladina classification. We also evaluated whether the direction of NSD affected the presence of PNS opacification on CT, and whether the presence of PNS opacification was associated with other rhinologic symptoms. Results: Of 216 patients with NSD, 86 showed opacified PNS on CT. According to Mladina classification, NSD patients were classified as type I (24.1%), type II (36.1%), type III (20.8%), type IV (5.6%), type V (9.7%), type VI (2.3%), or type VII (1.4%). Patients with type II NSD showed a significantly higher incidence of PNS opacification compared with other types of NSD (p=0.001). However, the direction of NSD did not significantly influence the presence of incidental PNS opacification. Furthermore, regardless of the presence of PNS opacification, there was no significant difference in rhinologic symptoms such as olfactory dysfunction, among others. Conclusion We found that incidental PNS opacification on CT was common in NSD patients, especially in patients with type II NSD. Thus, we suggest that CT evaluation of patients with NSD may be helpful for assessing comorbid PNS pathologies as well as objectively identifying nasal septal deformities.

Conjoined twinning is a rare congenital malformation, accounting for 1% monozygotic twins. Conjoined twins result if twining is initiated after the embryonic disc and rudimentary amniotic sac have been formed and if division of the embryonic disc is incomplete. Recently we experienced a case of conjoined twins, dicephalus dipus dibrachius, who had died at 3 hours of life, and performed autopsy. Autopsy revealed a total duplication of the heads, spines up to sacrum, small bowels, thymus and lungs. Two hearts existed within a common pericardium.
Autopsy ; Head ; Heart ; Humans ; Lung ; Pericardium ; Sacrum ; Spine ; Thymus Gland ; Twins, Conjoined* ; Twins, Monozygotic

PURPOSE: To evaluate the use of prophylactic antibiotics in glaucoma surgery and the prevalence of postoperative endophthalmitis. METHODS: Retrospective medical record review was performed on 136 eyes which underwent glaucoma operation by one surgeon from March 2008 to February 2010 and were followed at least till 6 months postoperatively (glaucoma drainage device implantation; 95 eyes, trabeculectomy; 41 eyes). RESULTS: For intravenous antibiotics injection, 10 eyes used 3rd generation cephalosporin, 54 eyes used 4-fluoroquinolone, 72 eyes used 2nd generation cephalosporin. For oral antibiotics, 125 eyes used 3rd generation cephalosporin, 1 case used 4-fluoroquinolone, and other 10 cases did not use oral antibiotics after the surgery. Total period of systemic antibiotics use showed various distributions with 14 eyes more than 5 days, 115 eyes 4-5 days, and 8 cases less than 4 days. Six eye which used 4-fluoroquinolone and 3 eyes which used cephalosporin showed side effect such as skin lesion and nausea. There has been no single occurrence of endophthalmitis. CONCLUSIONS: Various kinds of prophylactic antibiotics were used for glaucoma surgery and the period of antibiotics use was different among patients. However, there has been no single occurrence of endophthalmitis till 6 months postoperative follow up.
Anti-Bacterial Agents ; Drainage ; Endophthalmitis ; Eye ; Follow-Up Studies ; Glaucoma ; Humans ; Medical Records ; Nausea ; Prevalence ; Retrospective Studies ; Skin

PURPOSE: To compare the clinical characteristics of unilaterally progressing glaucoma (UPG) and simultaneously bilaterally progressing glaucoma (BPG) in medically treated cases. METHODS: Primary open angle glaucoma patients were classified as having UPG or BPG according to an assessment of optic disc and retinal nerve fiber layer photographs and visual field analysis. Risk factors including the presence of systemic diseases (hypertension, diabetes, cerebrovascular accident, migraine, and dyslipidema) were compared between the UPG and BPG groups. Baseline characteristics and pre- and post-treatment intraocular pressure (IOP) were compared between the progressing eye (PE) and the non-progressing eye (NPE) within the same patient in the UPG group and between the faster progressing eye and the slower progressing eye in the BPG group. RESULTS: Among 343 patients (average follow-up period of 4.2 years), 43 were categorized into the UPG group and 31 into the BPG group. The prevalence of all analyzed systemic diseases did not differ between the two groups. PEs in the UPG group had more severe pathology in terms of baseline visual field parameters than NPEs (mean deviation -6.9 ± 5.7 vs. -2.9 ± 3.9 dB, respectively; p < 0.001). However, baseline IOP, mean follow-up IOP, and other clinical characteristics were not significantly different between the PE and the NPE in the UPG group. The progression rate was significantly higher in the faster progressing eye in patients with BPG than in the PE for patients with UPG (-3.43 ± 3.27 vs. -0.70 ± 1.26 dB/yr, respectively; p = 0.014). CONCLUSIONS: There were no significant differences in the prevalence of systemic diseases between the UPG and BPG groups. Simultaneously bilaterally progressing patients showed much faster progression rates than those with a unilaterally progressing eye.
Disease Progression ; Female ; Follow-Up Studies ; Glaucoma, Open-Angle/*diagnosis/physiopathology ; Humans ; Intraocular Pressure/*physiology ; Male ; Middle Aged ; Optic Disk/*pathology ; Retina/*pathology ; Retrospective Studies ; Time Factors ; Visual Fields/*physiology

PURPOSE: The aim of this study was to investigate factors associated with the signal strengths (SS, image quality scores) of optic disc and macular images obtained using Cirrus spectral domain optical coherence tomography (OCT). METHODS: Ninety-two glaucomatous eyes were imaged using the Cirrus OCT macular and optic disc cube modes after pupil dilation. The influences of patient age, spherical equivalent, cataract presence, and cataract and glaucoma severity (visual field mean deviation), on the SS of images obtained using the two cube modes were compared between patients whose images showed high SS (SS > or =7) and low SS (SS <7). RESULTS: The signal strength was significantly higher in images obtained using the macular cube compared to the optic disc cube mode (7.8 +/- 1.3 vs. 6.9 +/- 1.1, respectively; p = 0.001). Age and visual acuity of patients differed significantly between the high- and low-SS groups when data acquired using the optic disc (p = 0.027 and 0.012, respectively) and macular cube modes (p = 0.046 and 0.014, respectively) were analyzed. When the optic disc cube mode was employed, the extent of cataracts was significantly related to SS, whereas when the macular cube mode was used, none of the factors analyzed was significantly associated with SS. CONCLUSIONS: Age, visual acuity, and the extent of cataracts were significantly associated with images of higher SS when the Cirrus OCT optic disc cube mode was employed.
Cataract/complications/pathology ; Female ; Glaucoma/complications/*pathology ; Humans ; Macula Lutea/*pathology ; Male ; Middle Aged ; Nerve Fibers/*pathology ; Reproducibility of Results ; Retinal Ganglion Cells/*pathology ; Retrospective Studies ; Tomography, Optical Coherence/methods

PURPOSE: To characterize the features of peripapillary atrophy (PPA), as imaged by spectral-domain optical coherence tomography (SD-OCT). METHODS: SD-OCT imaging of the optic disc was performed on healthy eyes, eyes suspected of having glaucoma, and eyes diagnosed with glaucoma. From the peripheral beta-zone, the retinal nerve fiber layer (RNFL), the junction of the inner and outer segments (IS/OS) of the photoreceptor layer, and the Bruch's membrane/retinal pigment epithelium complex layer (BRL) were visualized. RESULTS: Nineteen consecutive eyes of 10 subjects were imaged. The RNFL was observed in the PPA beta-zone of all eyes, and no eye showed an IS/OS complex in the beta-zone. The BRL was absent in the beta-zone of two eyes. The BRL was incomplete or showed posterior bowing in the beta-zone of five eyes. CONCLUSIONS: The common findings in the PPA beta-zone were that the RNFL was present, but the photoreceptor layer was absent. Presence of the BRL was variable in the beta-zone areas.
Adult ; Aged ; Bruch Membrane/pathology ; Female ; Glaucoma/*complications ; Humans ; Male ; Middle Aged ; Nerve Fibers/pathology ; Optic Atrophy/*diagnosis/*etiology ; Optic Disk/*pathology ; Photoreceptor Cells, Vertebrate/pathology ; Retina/pathology ; Retinal Pigment Epithelium/pathology ; Tomography, Optical Coherence/*methods

Tracheal intubation for general anesthesia is usually performed using a rigid laryngoscope and reguires the mandible to be opened with forward and upward traction of the patient's jaw which may at times result in the inadvertant injury to temporomandibular joint(TMJ). The injury may include internal derangement, dislocation and hematoma of TMJ; subsequent intraarticular adhesion formation ; dislocation of the meniscus, and rarely auriculotemporal nerve damage from traumatic TMJ dislocation. We studied in 200 patients the size of mouth opening during intubation, the change of mouth opening by tracheal intubation evaluated after operation, and any TMJ disorder arising after tracheal intubation. The results were as follows; 1) The mean size of mouth opening before operation was 42.7+/-7.0 and 40.6+/-6.2mm in male and female patients, respectively. 2) The mean size of mouth opening during intubation was 24.7+/-2.6 and 23.4+/-2.7mm in male and female patients, respectively. When vecuronium was used to prevent fasciculation, the mean was 24.3+/-3.1 and 25.2+/-2.0mm in male and female patients, respectively. 3) One week following operation The mean size of mouth opening one week postoperation was 48.3+/-8.9 and 42.2+/-6.3mm in male and female patients, respectively. When vecuronium was used to prevent fasciculation, the mean size of mouth opening was 55.5+/-5.3 and 43.2+/-6.2mm in male and female patients, respectively. 4) Five patients complained of discomfort around TMJ after tracheal intubation. It seems that upward 45 mandibule lifting by laryngoscope caused trauma to TMJs.
Anesthesia, General ; Dislocations ; Fasciculation ; Female ; Hematoma ; Humans ; Intubation ; Intubation, Intratracheal* ; Jaw ; Laryngoscopes ; Lifting ; Male ; Mandible ; Mouth ; Temporomandibular Joint Disorders ; Temporomandibular Joint* ; Traction ; Vecuronium Bromide

BACKGROUND: Epidural pain control has been used extensively for postoperative pain management, but nausea, vomiting and pruritus associated with morphine and fentanyl administration remain intractable problems. The aim of this study is to find the optimal epidural droperidol dosage for reducing the side effects of epidural morphine and fentanyl. METHODS: 140 patients randomly sampled and undergoing vaginal total hysterectomy were divided into 7 groups. Groups I and IV, and groups II and V, and groups III and VI, received 5 mg, 3.75 mg, 2.5 mg of droperidol by 2-day infusion pump through the indwelling epidural catheter, respectively. Group IV, V, VI patients received 1.25 mg of bolus droperidol through the indwelling epidural catheter at the time of peritoneal closure. As group VII was the control group, these patients received only epidural analgesics (morphine 10 mg, fentanyl citrate 300 microgram and 0.05% bupivacaine 100 ml) by 2-day infusion pump. RESULTS: Droperidol significantly reduced the incidence and severity of postoperative nausea, vomiting and itching sensation compared with the control group but verbal rating scale (VRS) of sedation was increased with the dosage of droperidol. There was no significant difference in the intensity of analgesia between the there groups. CONCLUSIONS: An effective epidural droperidol dosage for reducing postoperative nausea, vomiting and pruritus due to epidural pain control is 2.5 mg by 2-day infusion pump.
Analgesia ; Analgesics ; Bupivacaine ; Catheters ; Droperidol* ; Fentanyl* ; Humans ; Hysterectomy* ; Incidence ; Infusion Pumps ; Morphine* ; Nausea* ; Pain Management* ; Pain, Postoperative ; Postoperative Nausea and Vomiting ; Pruritus* ; Sensation ; Vomiting*

BACKGROUND: Epidural pain control has been used extensively for postoperative pain management, but nausea, vomiting and pruritus associated with morphine and fentanyl administration remain intractable problems. The aim of this study is to find the optimal epidural droperidol dosage for reducing the side effects of epidural morphine and fentanyl. METHODS: 140 patients randomly sampled and undergoing vaginal total hysterectomy were divided into 7 groups. Groups I and IV, and groups II and V, and groups III and VI, received 5 mg, 3.75 mg, 2.5 mg of droperidol by 2-day infusion pump through the indwelling epidural catheter, respectively. Group IV, V, VI patients received 1.25 mg of bolus droperidol through the indwelling epidural catheter at the time of peritoneal closure. As group VII was the control group, these patients received only epidural analgesics (morphine 10 mg, fentanyl citrate 300 microgram and 0.05% bupivacaine 100 ml) by 2-day infusion pump. RESULTS: Droperidol significantly reduced the incidence and severity of postoperative nausea, vomiting and itching sensation compared with the control group but verbal rating scale (VRS) of sedation was increased with the dosage of droperidol. There was no significant difference in the intensity of analgesia between the there groups. CONCLUSIONS: An effective epidural droperidol dosage for reducing postoperative nausea, vomiting and pruritus due to epidural pain control is 2.5 mg by 2-day infusion pump.
Analgesia ; Analgesics ; Bupivacaine ; Catheters ; Droperidol* ; Fentanyl* ; Humans ; Hysterectomy* ; Incidence ; Infusion Pumps ; Morphine* ; Nausea* ; Pain Management* ; Pain, Postoperative ; Postoperative Nausea and Vomiting ; Pruritus* ; Sensation ; Vomiting*