An 18 month-old boy underwent endoscopic foreign body removal under anesthesia on an outpatient basis and the operation took approximately 5 minutes. Stridor developed in both lung fields 6 hours after emergence from anesthesia, and severe croup developed, with cyanosis of the lips and aggravated stridor 20 hours after the end of the procedure. The croup resolved with oxygen therapy, intravenous dexamethasone, and epinephrine nebulization therapy. In this report, we suggest that thorough investigations of the patient's past history, including history of any airway problems, and careful monitoring after emergence from anesthesia be done in order to decide the proper discharge time of the patient. Further, proper prophylaxis following risk stratification is important, especially in patients at high risk of postoperative airway obstruction.
Airway Obstruction ; Ambulatory Surgical Procedures* ; Anesthesia ; Croup* ; Cyanosis ; Dexamethasone ; Epinephrine ; Foreign Bodies ; Humans ; Lip ; Lung ; Male ; Outpatients ; Oxygen ; Respiratory Sounds

An 18 month-old boy underwent endoscopic foreign body removal under anesthesia on an outpatient basis and the operation took approximately 5 minutes. Stridor developed in both lung fields 6 hours after emergence from anesthesia, and severe croup developed, with cyanosis of the lips and aggravated stridor 20 hours after the end of the procedure. The croup resolved with oxygen therapy, intravenous dexamethasone, and epinephrine nebulization therapy. In this report, we suggest that thorough investigations of the patient's past history, including history of any airway problems, and careful monitoring after emergence from anesthesia be done in order to decide the proper discharge time of the patient. Further, proper prophylaxis following risk stratification is important, especially in patients at high risk of postoperative airway obstruction.
Airway Obstruction ; Ambulatory Surgical Procedures* ; Anesthesia ; Croup* ; Cyanosis ; Dexamethasone ; Epinephrine ; Foreign Bodies ; Humans ; Lip ; Lung ; Male ; Outpatients ; Oxygen ; Respiratory Sounds

Melioidosis, which is infection with the Gram-negative bacterium Burkholderia pseudomallei, is an important cause of sepsis in Southeast Asia and northern Australia and mainly affects diabetics who come into direct contact with wet soil. It presents as a febrile illness, ranging from an acute fulminant septicemia to a chronic debilitating localized infection. Only two cases of chronic infection have been reported in Korea. Both patients had lived in Southeast Asia for more than 1 year. We report a case of melioidosis presenting as acute fulminant septicemia and pneumonia in a 47-year-old diabetic male who had visited Cambodia for 4 days, 1 month before admission. He died of refractory septic shock and multi-organ failure within 10 hours of admission. Melioidosis should be suspected in any severely ill febrile patient with an underlying predisposing condition who lives in, or has travelled from, an endemic area.
Asia, Southeastern ; Australia ; Burkholderia pseudomallei ; Cambodia ; Humans ; Korea ; Male ; Melioidosis ; Middle Aged ; Pneumonia ; Sepsis ; Shock, Septic ; Soil

OBJECTIVE: Ultrasound-guided needle localization has been used prior to the surgical excision of nonpalpable breast lesions. The aim of the study was to assess the feasibility of the use of a saline immersion specimen ultrasound technique (immersion-US) to confirm the successful removal of breast lesions. MATERIALS AND METHODS: The devised immersion-US technique was used to examine the excised tissues of 72 ultrasound-guided needle localized breast lesions of 58 patients (34 benign lesions, 30 high-risk lesions and 8 malignant lesions). Freshly excised specimens were placed in a container filled with saline and one radiologist scanned the surgically excised specimens using a high-frequency linear transducer. We evaluated successful lesion removal and the qualities of the immersion-US images. Miss rates were determined by the use of postoperative ultrasound during follow-up. RESULTS: All 72 lesions were identified by the use of immersion-US and satisfactory or excellent quality images were obtained for most lesions (70/72, 97%). Five (7%) lesions were initially identified as incompletely excised, based on the immersion-US findings, and prompt re-excision was undertaken. Follow-up ultrasound examinations showed no residual mass in the surgical field in any patient. CONCLUSION: The immersion-US technique was found straightforward and efficient to perform. Immersion-US was able to determine whether nonpalpable breast lesions had been successfully excised after ultrasound-guided needle localization.
Adult ; Biopsy, Needle/methods ; Breast Neoplasms/*ultrasonography ; Female ; Humans ; Immersion ; Mammography ; Mastectomy ; Middle Aged ; Prospective Studies ; Ultrasonography/*methods ; Ultrasonography, Mammary/methods

PURPOSE: Here, our results from a prospective treatment protocol of concurrent radiochemotherapy (CRCT), which was conducted for locally advanced nasopharynx cancers, between April 1994 and May 2001, are reported. MATERIALS AND METHODS: A total of 52 consecutive eligible patients were accumulated for this protocol. The median radiation doses to the primary site, involved nodes and uninvolved neck were 72, 61.2 and 45 Gy, using a serial shrinking field technique. The boost techniques were 3-dimensional conformal radiation therapy in 45, intracavitary brachytherapy in 3 and 2-dimensional radiation therapy, with multiple small fields, in 2 patients. Two chemotherapy regimens were used: the first regimen, used in 8 patients during the earlier part of the study duration, consisted of 2 cycles of cisplatin plus 5- fluorouracil every 4 weeks, with concurrent radiation therapy, and 4 cycles with the same agents every 4 weeks, adjuvantly; the second regimen, used in 44 patients during the later part, consisted of 3 cycles of cisplatin every 3 weeks, with concurrent radiation therapy and 3 cycles of adjuvant cisplatin plus 5-fluorouracil every 3 weeks. RESULTS: The median follow-up period of the survivors was 32 months. The male to female ratio was 36/16, with a median age of 48 years. The stages, according to the new AJCC staging system (1997), were IIb in 6, III in 23, IVa in 14 and IVb in 9 patients. Fifty and 32 patients completed the planned radiation therapy and concurrent chemotherapy, respectively. Two patients died, 1 of septic shock during the CRCT and the other of malnutrition during the adjuvant chemotherapy. There were 12 failures in 11 patients: 7 locoregional recurrences, 1 within and 6 outside the radiation target volume, and 5 distant metastases. The locoregional control, disease-free survival and overall survival rates were 84.3, 78.8 and 92.8% at 3 years, respectively. CONCLUSION: High dose radiation therapy, coupled with concurrent chemotherapy, was judged a highly effective treatment for locally advanced nasopharynx cancers.
Brachytherapy ; Chemoradiotherapy ; Chemotherapy, Adjuvant ; Cisplatin ; Clinical Protocols ; Disease-Free Survival ; Drug Therapy* ; Female ; Fluorouracil ; Follow-Up Studies ; Humans ; Male ; Malnutrition ; Nasopharyngeal Neoplasms* ; Nasopharynx* ; Neck ; Neoplasm Metastasis ; Prospective Studies ; Recurrence ; Shock, Septic ; Survival Rate ; Survivors

PURPOSE: To report the results of curative treatment for patients with tonsil cancer by retrospective analysis. MATERIALS AND METHODS: From Jan. 1995 till Dec. 2000, 27 patients with squamous cell carcinoma of the tonsil received curative treatment at Samsung Medical Center. Therapeutic decision was made through multidisciplinary conference, and curative radiation therapy was favored when, (1) the patient's condition was not fit for general anesthesia and surgery, (2) the patient refused surgery, (3) complete resection was presumed impossible, or (4) too severe disability was expected after surgery. Surgery was the main local modality in 17 patients (S+/-RT group), and radiation therapy in 10 (RT+/-CT group). The median follow-up period was 41 months. RESULTS: AJCC stages were I/II in four, III in two, and Iv in 21 patients. The 5-year disease-free survival rate was 73.3% in all patients, 70.6% in the S+/-RT group, and 77.8% in the RT+/-CT group. Treatment failure occurred in seven patients, all with stage III/IV, and all the failures occurred within 24 months of the start of treatment. Five patients among the S CT group developed treatment failures; 2 local, 2 regional, and 1 distant (crude rate=29.4%). Two patients among the RT+/-CT group developed failures; 1 synchronous local and regional, and 1 distant (crude rate=20.0%). The 5-year overall survival rate was 77.0% in all patients, 80.9% in the S+/-RT group, and 70.0% in the RT+/-CT group. CONCLUSION: We could achieve favorable results that were comparable to previously reported data with respect to both the rates of local control and of survival by applying S+/-RT and RT+/-CT. RT+/-CT is judged to be an alternative option that can avoid the functional disability after surgical resection.
Anesthesia, General ; Carcinoma, Squamous Cell ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Palatine Tonsil ; Retrospective Studies ; Survival Rate ; Tonsillar Neoplasms* ; Treatment Failure

Purpose: Targeted next-generation sequencing (NGS) panels for solid tumors have been useful in clinical framework for accurate tumor diagnosis and identifying essential molecular aberrations. However, most cancer panels have been designed to address a wide spectrum of pan-cancer models, lacking integral prognostic markers that are highly specific to gliomas. Materials and Methods: To address such challenges, we have developed a glioma-specific NGS panel, termed “GliomaSCAN,” that is capable of capturing single nucleotide variations and insertion/deletion, copy number variation, and selected promoter mutations and structural variations that cover a subset of intron regions in 232 essential glioma-associated genes. We confirmed clinical concordance rate using pairwise comparison of the identified variants from whole exome sequencing (WES), immunohistochemical analysis, and fluorescence in situ hybridization. Results: Our panel demonstrated high sensitivity in detecting potential genomic variants that were present in the standard materials. To ensure the accuracy of our targeted sequencing panel, we compared our targeted panel to WES. The comparison results demonstrated a high correlation. Furthermore, we evaluated clinical utility of our panel in 46 glioma patients to assess the detection capacity of potential actionable mutations. Thirty-two patients harbored at least one recurrent somatic mutation in clinically actionable gene. Conclusion We have established a glioma-specific cancer panel. GliomaSCAN highly excelled in capturing somatic variations in terms of both sensitivity and specificity and provided potential clinical implication in facilitating genome-based clinical trials. Our results could provide conceptual advance towards improving the response of genomically guided molecularly targeted therapy in glioma patients.