A 74-year-old man presented with recurrent vomiting and aspiration pneumonia in the left lower lobe. He entered the intensive care unit to manage the pneumonia and septic shock. Although a percutaneous endoscopic gastrostomy tube was implanted for recurrent vomiting, vomiting and aspiration recurred frequently during admission. Subsequently, he complained of neck pain when in an upright position. A videofluoroscopic swallowing study showed compression of the esophagus by cervical osteophytes and tracheal aspiration caused by an abnormality at the laryngeal inlet. Cervical spine X-rays and computed tomography showed anterior cervical osteophytes at the C3-6 levels. Surgical decompression was scheduled, but was cancelled due to his frailty. Unfortunately, further recurrent vomiting and aspiration resulted in respiratory arrest leading to hypoxic brain damage and death. Physicians should consider cervical spine disease, such as diffuse skeletal hyperostosis as an uncommon cause of recurrent aspiration pneumonia.
Aged ; Bays ; Decompression, Surgical ; Deglutition ; Esophagus ; Gastrostomy ; Humans ; Hyperostosis ; Hypoxia, Brain ; Intensive Care Units ; Neck Pain ; Osteophyte* ; Pneumonia ; Pneumonia, Aspiration* ; Shock, Septic ; Spine ; Vomiting

Cavernous hemangioma is the most common primary tumor occurred in adults' orbit. This tumor has symptoms characteristically developing over several years with slowly progressive proptosis, eyeball deviation, hyperopia, diplopia and optic nerve compression. It's removal, necessary when there is progressive exophthalmos and visual deficit, is best performed en bloc to avoid intraoperative vleeding, the risk of residue, and potential further growth. In principle, surgical approach to the orbit must provide maximum safety and optimal visualization. The noncompressibility of the globe imposes greater demand on the need for some removal of the osseous orbit for surgical approach. This also must permit immediate functional and aesthetic reconstruction. The authors have experienced a case of large cavernous hemangioma in the orbit inferomedially. The surgical treatment of tumor was achieved by inferomedial approach combined with inferolateral orbitotomy. This surgical approach allows better visualization of the tumor and greater protection of essential anatomic structures. This also permits immediate functional and aesthetic reconstruction. So we present our case with a brief review of the literature related to orbital cavernous hemangioma.
Diplopia ; Exophthalmos ; Hemangioma, Cavernous* ; Hyperopia ; Optic Nerve ; Orbit*

Many plastic surgeons have been tried to attain ultimate goal lies in restoring the original shape and function of the facial aesthetics, in reconstruction of deformities resulting from facial hypertrophic scar and skin defects. This would require consideration in terms of hanmony in color match, skin texture and thickness. Various forms of skin graft, local flap, distant flaps, free flap and tissue expander have been employed in restoring skin defects and deformities of the cheek and submental area, and the use of large local flaps utilizing the cervicofacial skin flaps or tissue expander have brought about improved aesthetic results. the authers have obtained satisfactory results in treating 2 cases of wide hypertrophic scar of the cheek and submental area with combination of wide cervical flap and intraoperative tissue expansion using foley catheter. the merits of this combined operative methods are as follows : 1. It is not necessory to keep tissue expander for a long period. 2. This technique is able to diminish the cost of multistage operation and using of tissue expander. 3. There is no psychologic problems due to undesirable facial appearance during tissue expansion period. 4. Rapid intraoperative tissue expansion by foley catheter during elevating wide cervical flap can allow to dissect one, preserving the perforators without bleeding in a short time. 5. Wide cervical flap and additional expanded tissue by means of intraoperative tissue expansion could brought into suturing avoiding tension of oral commissure and lip eversion. 6. Preservation of perforators of cervical flap above the platysma muscle raised flap's survival rate and then this result could prevent distal ischemic necrosis after flap coverage.
Catheters ; Cheek ; Cicatrix, Hypertrophic* ; Congenital Abnormalities ; Esthetics ; Free Tissue Flaps ; Hemorrhage ; Lip ; Necrosis ; Skin ; Survival Rate ; Tissue Expansion Devices ; Tissue Expansion* ; Transplants

Generalized plane xanthoma is less common and usually involves the eyelids, lateral side of the neck, upper trunk, and extremities. Lesions, however, may appear on any portion of the body. Cutaneous xanthomas may occur in hyperlipidemic and in normolipidemic states. Generalized normolipidemic plane xanthoma is often associated with multiple myeloma, other reticulo-endothelial malignancies and monoclonal gammopathy with unknown significance(MGUS). We wish to report two eases of generalized plane xanthoma associated with IgG monoclonal gammopathy of unknown significance.
Extremities ; Eyelids ; Immunoglobulin G ; Multiple Myeloma ; Neck ; Paraproteinemias* ; Xanthomatosis*

Various remedies have been developed for broad damage to soft tissue in limbs by traffic accidents and mechanical mishaps that have greatly increased in modern society. If the damaged part is trivial, it may be generally treated with local flap or skin graft. However, this has been limited by the ability to choose the flap available depending on the condition of the wounded part, so that, if it is rather large or severly inflamed, or if it occurred with a bone-fracture, it is inevitable to practice the free flap. In the past, the focus was on whether the free flap would survive or not. However, the function of donor the and recipient, as well as the problem of aesthetic appearance, gas become a matter of increqsing interest and concern as the survival rate of the flap has greatly improved due to the development of precise operations. In thes study, therefore, some complications were analyzed which may develop in a donor by a variety of free flaps. Preoperative plans, as well as intraoperative and postoperati-ve treatment were also studied to minimize the cause of complications. To investigate these questions, we undertook a clinical analysis of 91 followed patients from 1990 to 1997. There were 68 male and 23 female patients ranging in age from 6 to 67 years, with an average of 34.7 years. The length of follow-up ranged from 8 months to 6 years. The results of this study were as follows: Sufficient plans must be made on the donor before operation, single textures like muscle or fascia should be used if possible, and incision should be arranged along Langer`s line. Some measures to reduce wound tension should be pursued, and plans must be made to immobilize the site for an ample period after the operation. Some precautious should also be considered during the operation, such as avoiding traction surrounding nerves and vessels, preserving paratenon, practicing osteotomy with great care and properly stopping any bleeding. In addition, formation of a hematoma or seroma should be preventcd and the donor must be sutur-ed as soon as possible to reduce infection. With the application of the basic operational principles on the treatment of donors, the complications which might be caused by each free flap can be reduced, and furthermore, be protected against.
Accidents, Traffic ; Extremities ; Fascia ; Female ; Follow-Up Studies ; Free Tissue Flaps* ; Hematoma ; Hemorrhage ; Humans ; Male ; Osteotomy ; Seroma ; Skin ; Survival Rate ; Tissue Donors* ; Traction ; Transplants ; Wounds and Injuries

No abstract available.
Aneurysm* ; Renal Artery*

A 74-year-old man presented with recurrent vomiting and aspiration pneumonia in the left lower lobe. He entered the intensive care unit to manage the pneumonia and septic shock. Although a percutaneous endoscopic gastrostomy tube was implanted for recurrent vomiting, vomiting and aspiration recurred frequently during admission. Subsequently, he complained of neck pain when in an upright position. A videofluoroscopic swallowing study showed compression of the esophagus by cervical osteophytes and tracheal aspiration caused by an abnormality at the laryngeal inlet. Cervical spine X-rays and computed tomography showed anterior cervical osteophytes at the C3-6 levels. Surgical decompression was scheduled, but was cancelled due to his frailty. Unfortunately, further recurrent vomiting and aspiration resulted in respiratory arrest leading to hypoxic brain damage and death. Physicians should consider cervical spine disease, such as diffuse skeletal hyperostosis as an uncommon cause of recurrent aspiration pneumonia.
Aged ; Bays ; Decompression, Surgical ; Deglutition ; Esophagus ; Gastrostomy ; Humans ; Hyperostosis ; Hypoxia, Brain ; Intensive Care Units ; Neck Pain ; Osteophyte ; Pneumonia ; Pneumonia, Aspiration ; Shock, Septic ; Spine ; Vomiting

BACKGROUND: External ventricular drainage (EVD) is an important procedure for draining excessive cerebrospinal fluid (CSF) and monitoring intracranial pressure. Generally, EVD is performed in the operating room (OR) under aseptic conditions. However, in emergency circumstances, the operation may be performed in the intensive care unit (ICU) to save neuro-critical time and to avoid the unnecessary transfer of patients. In this study, we retrospectively analyzed the risk of EVD-induced CNS infections and their outcomes according to the operating place (ICU versus OR). In addition, we compared mortalities as well as hospital and ICU days between the CNS infection and non-CNS infection groups. METHODS: We reviewed medical records, laboratory data and radiographic images of patients who had received EVD operations between January, 2013 and March, 2015. RESULTS: A total of 75 patients (45 men and 30 women, mean age: 58.7 +/- 15.6 years) were enrolled in this study. An average of 1.4 catheters were used for each patient and the mean period of the indwelling catheter was 7.5 +/- 5.0 days. Twenty-six patients were included in the ICU group, and EVD-induced CNS infection had occurred in 3 (11.5%) patients. For the OR group, forty-nine patients were included and EVD-induced CNS infection had occurred in 7 (14.3%) patients. The EVD-induced CNS infection of the ICU group did not increase above that of the OR group. The ICU days and mortality rate were higher in the CNS infection group compared to the non-CNS infection group. The period of the indwelling EVD catheter and the number of inserted EVD catheters were both higher in the CNS infection group. CONCLUSIONS: If the aseptic protocols and barrier precautions are strictly kept, EVD in the ICU does not have a higher risk of CNS infections compared to the OR. In addition, EVD in the ICU can decrease the hospital and ICU days by saving neuro-critical time and avoiding the unnecessary transfer of patients. Therefore, when neurosurgeons decide upon the operating place for EVD, they should consider the benefits of ICU operation and be cautious of EVD-induced CNS infection.
Catheter-Related Infections ; Catheters ; Catheters, Indwelling ; Cerebrospinal Fluid ; Drainage* ; Emergencies ; Female ; Humans ; Intensive Care Units* ; Critical Care* ; Intracranial Pressure ; Male ; Medical Records ; Mortality ; Operating Rooms* ; Retrospective Studies ; Ventriculostomy

Recent studies suggest the flow cytometric DNA ploidy analysis may be useful in defining the biologic behavior and prognosis in prostatic adenocarcinoma. Flow cytometric nuclear DNA ploidy analysis was used to study the relationship between DNA ploidy, clinical stage and histopathological grade in thirty two patients with prostatic adenocarcinomas diagnosed from 1987 to 1990. The incidence of aneuploidy in the total population was 18 of 32 (56.3%). The frequency of aneuploidy increased with advancing stage and 63.2% of carcinomas with distant metastases were aneuploidy. Aneuploidy was more frequent in high Gleason sum carcinomas than in low. The incidence of aneuploidy in carcinomas with high Gleason grade (Gleason sum 8 to 10) was 77.8%. comparing to 33.3% in low Gleason grade (Gleason sum 2 to 4). When carcinomas classified according to both DNA ploidy and degree of glandular differentiation, then subgroups with the highest and lowest degree of malignant potential became apparent. None of diploid tumors with low Gleason grade (Gleason sum 2 to 4) formed metastasis, but 71.4% of aneuploidy tumors with high Gleason grade (Gleason sum 8 to 10) formed metastases. The influence of DNA ploidy on survival was examined with Kaplan-Meier method and the generalized Wilcoxon test. Overall, the patients with diploid tumor had a survival advantage over patients with aneuploid tumor (p<0.05). In patients with stage C and D, there was increasing tendency of survival in diploid group. In conclusion flow cytometric determination of DNA ploidy in prostatic adenocarcinoma is correlated strongly with clinical stage and Gleason sum and can be expected to be a valuable adjunct b clinical stage and histopathological grade in the assessment of malignant potential of prostatic adenocarcinoma.
Adenocarcinoma* ; Aneuploidy ; Diploidy ; DNA* ; Humans ; Incidence ; Neoplasm Metastasis ; Ploidies* ; Prognosis

To investigate retinal hemodynamics in diabetic retinopathy, the perifoveral capillary leukocyte velocity for retinal microcirculation was measured in eyes of 16 control. 12 non-proliferative diabetic retinopathy(NPDR) and 10 proliferative diabetic retinopathy(PDR) on the video fluorescein angiogram using a scanning laser ophthalmoscope(SLO 101, Rod-enstock, Munich, Germany) in 20 degrees retinal field. And the times of arm to retinal circulation, arterio-venous circulation and venous lamina flow for retinal macrocirculation were also measured in eyes of 18 control, 16 NPDR and 10 PDR in 40 degrees retinal field. There was not any statistically significant difference between control eyes(140.62 +/- 34.11 pixels/see, 1.21 +/- 0.29 mm/sec) and NPDR eyes(133.98 +/- 31.85 pixels/sec, 1.15 +/- 0.27 mm/sec) in mean perifoveal capillary leukocyte velocity(p=0.60). But it was significantly decreased in PDR eyes(108.80 +/- 26.19 pixels/see, 0.94 +/- 0.23 mm/sec) compared with control(p=0.01) and NPDR eyes(p=0.05). The were not any significant differences in the times of arm to retinal and arterio-venous circulation respectively(p>0.05) among the eyes of control(12.09 +/- 1.41 sec, 2.41 +/- 0.86 sec), NPDR(12.66 +/- 1.42 see, 2.32 +/- 0.96 sec) and PDR(12.90 +/- 1.51 see, 2.54 +/- 0.94 sec). But the venous lamina flow time was significantly decreased in eyes of NPDR(6.91 +/- 2.32 see, p=0.02) and PDR(7.03 +/- 1.89 sec, p=0.01) compared with that of control(5.46 +/- 1.18 see). These results indicate that a significant retinal microcirculatory deficit exists in the eyes of PDR, and venous lamina flow time may be a good index of retinal macrocirculatory deficit in diabetic retinopathy.
Arm ; Capillaries ; Diabetic Retinopathy ; Fluorescein ; Hemodynamics* ; Leukocytes ; Microcirculation ; Ophthalmoscopes* ; Retinaldehyde*