Purpose: To present a case of sinonasal neuroendocrine cancer initially manifesting with orbital involvement.Case summary: A 63-year-old female patient visited a neuro-ophthalmologic clinic due to a 3-week history of decreased visual acuity (VA), color vision abnormalities, and swelling of the upper eyelid in right eye. Best-corrected VA (BCVA) in the right eye was 0.8. Clinical findings included a relative afferent pupillary defect, restricted eye movement in lateral, superior, and medial gaze, and exophthalmos in the right eye. Wide-field fundus photography and optical coherence tomography indicated swelling of right optic disc. Magnetic resonance imaging was performed revealing a mass invading nasal cavity, sinus, and right orbital apex, and compressing the medial rectus, inferior rectus, superior oblique, and optic nerve. An otolaryngological nasal biopsy was conducted and immunohistochemical staining showed positive results for Ki-67, NSE, p16, P-53, and CD56, leading to a diagnosis of small cell neuroendocrine carcinoma with an irreducible tumor stage. Prior to initiation of treatment (concurrent chemoradiotherapy, CCRT), there was rapid worsening of VA and eye movement in the right eye. CCRT commenced alongside high-dose steroid treatment. One month following treatment, the BCVA of the right eye improved and protrusion of the right eye resolved. Six months after starting CCRT, a contrast-enhanced orbital computed tomography scan showed no residual lesion. The BCVA of the right eye stabilized at 0.3 with complete recovery of color vision and eye movement. Conclusions Neuroendocrine cancer should be considered as a possible diagnosis in cases of rapidly progressing compressive optic neuropathy.

BACKGROUND: The patient-controlled sedation (PCS) allows for rapid individualized titration of sedative drugs. Propofol has been the most widely used IV adjuvant, during the monitored anesthesia care (MAC). This study was designed to compare the sedation quality, side effect and recovery of the propofol alone, and propofol-remifentanil combination, using PCS for breast biopsy. METHODS: Seventy five outpatients, undergoing breast biopsy procedures with local anesthesia, were randomly assigned to receive propofol alone (group P), propofol-25 ug/ml of remifentanil (group PR25), and propofol-50 ug/ml of remifentanil (group PR50), using PCS. Pain visual analogue scores (VAS) and digit symbol substitution test (DSST), Vital signs, bi-spectral index (BIS) and observer assessment of alertness and sedation (OAA/S) score were recorded. RESULTS: Apply/Demand ratio in the group PR50 had a significant increase over the other groups (P < 0.05). The incidence of excessive sedation and dizziness were significantly more frequent in the group PR50 (P < 0.05). BIS and OAA/S score significantly decreased in the group PR25, PR50 at 15 min after the operation, the end of surgery (P < 0.05). At 5 min after the start of PCS, patients in the group PR25 and PR50 gave significantly less correct responses on the DSST than that of the group P (P < 0.05). CONCLUSIONS: Compared with the propofol alone, intermittent bolus injection of propofol-remifentanil mixture could be used, appropriately, for the sedation and analgesia during MAC. The group PR25 in a low dose of remifentanil has more advantages in terms of sedation and satisfaction because of the group PR50's side effects.
Analgesia ; Anesthesia ; Anesthesia, Local ; Biopsy ; Breast ; Dizziness ; Humans ; Incidence ; Outpatients ; Piperidines ; Propofol ; Vital Signs

A 69-year-old female patient presented with a huge liver mass at another hospital. Computed tomography (CT) revealed a huge, well-demarcated, low-attenuated mass in the right lobe of the liver and multiple nodules in both lungs. The liver mass invaded the colon at the hepatic flexure and infiltrated into the retroperitoneum. Spiral CT revealed a huge tumor thrombus in the right ventricle (RV). The enhancement pattern of the right ventricular mass was identical to that of the liver mass. After ultrasonography-guided needle biopsy of the liver mass, the patient was diagnosed with intrahepatic sarcomatoid cholangiocarcinoma. Although we recommended debulking open-heart surgery for the prevention of sudden death caused by massive pulmonary embolism, the patient and her family opted against surgery due to high operation-related mortality and old age. The patient later died of massive pulmonary embolism at another hospital a few weeks later.
Aged ; Biopsy, Needle ; Cholangiocarcinoma ; Colon ; Death, Sudden ; Female ; Heart Ventricles ; Humans ; Liver ; Lung ; Pulmonary Embolism ; Thrombosis ; Tomography, Spiral Computed

Intracapsular and paraarticular chondroma is a rare benign lesion of the large joints (mostly the knee). We report a case of intracapsular and paraarticular chondroma in the infrapatellar Hoffa's fat pad that presented as a painful palpable mass in 15-yearold woman. A physical examination revealed a firm, movable and tender mass in the infrapatellar area. Magnetic resonance images showed an ovoid, well-defined, soft tissue mass with focal calcification in the infrapatellar fat pad. The final pathology revealed an intracapsular and paraarticular chondroma.
Adipose Tissue ; Chondroma ; Female ; Humans ; Joints ; Knee ; Lower Extremity ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Physical Examination

Secondary aneurysmal bone cysts (ABCs) associated with Langerhans cell histiocytosis are rare. Although cases of ABCs arising from Langerhans cell histiocytosis in the skull have been reported in several studies, to the best of our knowledge, only two femur cases have been reported. In this case study, we described a 9-year-old boy with Langerhans cell histiocytosis of the femur. Magnetic resonance findings indicated internal multilocular cysts and multiple fluid–fluid levels, which are typical of ABCs. ABCs rarely occur in conjunction with Langerhans cell histiocytosis. Our findings may be helpful in the differential radiological diagnosis of pediatric bone tumors.

BACKGROUND: Carpal tunnel syndrome(CTS) is a long-term complication in dialysis patients which results from compression of the median nerve within the carpal tunnel. It has been reported to occur with increased frequency in the hemodialysis population, but, there are few reports concering long-term complications in CAPD because of the relatively shorter duration of dialysis in most CAPD patients. The aim of this study was to determine the incidence of CTS in patients undergoing CAPD. METHODS: We analyzed 21 chronic renal failure (CRF) patients(males 14, females 7; age range 19-79 yr) undergoing CAPD. The patients were evaluated by questionnare, physical examination, and nerve conduction test(NCT). Age, gender, duration of CRF before CAPD, duration of CAPD, diabetic history were determined. RESULTS: Among the total 21 patients undergoing CAPD, only 5 patients(24%) were CTS, diagnosed by NCT. Two of these patients were symptomatic CTS, three patients were non-symptomtic CTS. So, there were no relationship between the incidence of CTS and clinical symptoms. Among the diabetic dialysis patients, the incidence of CTS was 28.57%. Also there was no increase in the number of diatetic patients with CTS. CONCLUSION: It is concluded that the incidence of CTS in CAPD patients was similar with the previous reported incidence(2-31%) of hemodialysis patients. Since CTS is treatable, annual or even semiannual nerve conduction tests is indicated all CRF patients on chronic dialysis.
Carpal Tunnel Syndrome* ; Dialysis ; Female ; Humans ; Incidence ; Kidney Failure, Chronic* ; Median Nerve ; Neural Conduction ; Peritoneal Dialysis, Continuous Ambulatory ; Physical Examination ; Renal Dialysis

No abstract available.
Cavernous Sinus* ; Dura Mater ; Meningitis ; Tuberculosis*

To compare the effects of ketamine and tiletaminezolazepam (TZ) drugs widely used for the chemical restraint and immobilization of primates, on various physiological parameters and blood gas values in cynomolgus monkeys (Macaca facicularis). Rectal temperature, heart rate, respiration rate and blood gas analysis were measured before treatment and at 1, 10, 20, 30, 40, 50 and 60 min after administration. Additionally, in both groups, induction and maintenance times were compared. Heart rate, respiration rate, rectal temperature, pH and pCO2 were not significant different in the two groups. However, pO2 in the ketamine-treated group was significantly lower at 30 and 40 min than in the TZ-treated group. The induction time was short in both groups, and the maintenance time was longer in the TZ-treated group (67.8+/-6.5 min) than in the ketamine-treated group (42.3+/-6.7 min). However, decreased rectal temperatures must be watched and prevented following TZ administration to cynomolgus monkeys. It was considered that ketamine may be useful for short duration anesthesia including handling, physical examination, blood sampling and TZ may be useful for prolonged anesthesia including minor surgery and other surgical procedure.
Animals ; Body Temperature/drug effects ; Carbon Dioxide/blood ; Excitatory Amino Acid Antagonists/*pharmacology ; Female ; Heart Rate/drug effects ; Hydrogen-Ion Concentration ; Immobilization/*physiology ; Ketamine/*pharmacology ; Macaca fascicularis ; Male ; Partial Pressure ; Respiratory Mechanics ; Restraint, Physical/*methods ; Tiletamine/*pharmacology ; Time Factors

OBJECTIVE: Osteoporotic compression fracture is an increasing issue in this community and its diagnosis depends on the magnetic resonance images (MRI). Although T1- and T2-weighted images (T1WI and T2WI) have high sensitivity and specificity, the fat suppression technique gives more clear delineation of this abnormalities. Accordingly, we re-evaluated its exact sensitivity and specificity for the imaging diagnosis of osteoporotic compression fractures in our cases. For additional information about the osteoporotic compression fractures, we evaluate the fracture lines, fluid sign and adjacent discs change on the MRI. METHODS: Retrospectively, total 85 patients who had been diagnosed with acute osteoporotic compression fracture were enrolled. They all had been underwent MRI including T1WI, T2WI and T2- Spectral Adiabatic Inversion Recovery (SPAIR) sequence. RESULTS: In this study, the incidence of high signal intensity on T2-SPAIR image was very high (0.9917). The fluid sign was seen in 56.7% on the SPAIR image. The fracture lines were more observed on the T2WI than T1WI (p=0.0062). The adjacent discs change on T2WI and T2-SPAIR image were higher than T1WI (p<0.001). CONCLUSION: For the acute osteoporotic compression fracture, T2-SPAIR image is the most specific sequence of the all sequences. The fluid sign is another suggestive finding when considered other studies. T2WI is more useful to find the fracture line than T1WI. Abnormal signal intensity on the adjacent discs may provide additional information for the acute osteoporotic compression fractures.
Fractures, Compression ; Humans ; Incidence ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets ; Osteoporosis ; Retrospective Studies ; Sensitivity and Specificity

An emphysematous pancreatitis is a rare, but fatal subtype of acute pancreatitis. Gas-forming bacteria from the bowel may penetrate the pancreas to cause emphysematous pancreatitis. It is characterized by the presence of gas within pancreas bed or retroperitoneal cavity at computed tomographic image and carries a high mortality rate. It requires fluid resuscitation and anti-bacterial therapy to control infection, and needs to consider percutaneous drainage or surgical management depending on the clinical condition. We report a case of 73-year-old patient presented with an emphysematous pancreatitis which developed fulminant multi-organ failure in spite of intensive medical treatment along with a review of the related literatures.
Aged ; Bacteria ; Drainage ; Humans ; Mortality ; Multiple Organ Failure ; Pancreas ; Pancreatitis* ; Pancreatitis, Acute Necrotizing ; Resuscitation ; Retroperitoneal Space