No abstract available.
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Diffuse alveolar hemorrhage is life-threatening situation which is rarely caused by paraganglioma or pheochromocytoma. Here, we describe anesthetic management of 64-year-old man underwent laparoscopic pararenal mass excision and later on this mass diagnosed as paraganglioma. We induced anesthesia with propofol 120 mg, sufentanil 12.5 μg, and rocuronium 50 mg. Anesthesia was maintained with sevoflurane administration. Patient position was changed to right lateral decubitus position for laparoscopic approach. Vital signs were stable until direct stimulation of mass. When surgeon started to manipulate pararenal mass, blood pressure suddenly increased to 274/169 mmHg and heart rate also increased to 140 beat/minute. SpO2 dropped to 69% and bilateral lung sounds decreased. We used intravenous esmolol to control blood pressure and heart rate. In doubt for bronchial spasm, we used intravenous hydrocortisol and chlorpheniramine maleate. Discharge of bloody fluid was obtained from endotracheal tube. Immediate postoperative chest x-ray showed diffuse air space consolidation in right lung field. We assessed as unilateral alveolar hemorrhage and patient was transferred to intensive care unit (ICU) without endotracheal extubation. The patient was followed up with ventilator care and antibiotic treatment in ICU, and daily chest x-ray was taken. He was extubated after showing favorable prognosis on postoperative day (POD) 4, and discharged on POD 7. Anesthesiologist should be aware that incidental manipulation of undiagnosed catecholamine producing tumor can lead to fatal consequences, and should know the management of hypertensive crisis and bronchial spasm.

BACKGROUND: Postherpetic neuralgia (PHN) is usually managed pharmacologically. It is not uncommon for patients with chronic kidney disease (CKD) to suffer from PHN. It is difficult to prescribe a sufficient dose of anticonvulsants for intractable pain because of the decreased glomerular filtration rate. If the neural blockade and pulsed radiofrequency ablation provide only short-term amelioration of pain, spinal cord stimulation (SCS) with a low level of evidence may be used only as a last resort. This study was done to evaluate the efficacy of spinal cord stimulation in the treatment of PHN in patients with CKD. METHODS: PHN patients with CKD who needed hemo-dialysis who received insufficient relief of pain over a VAS of 8 regardless of the neuropathic medications were eligible for SCS trial. The follow-up period was at least 2 years after permanent implantation. RESULTS: Eleven patients received percutaneous SCS test trial from Jan 2003 to Dec 2007. Four patients had successfully received a permanent SCS implant with their pain being tolerable at a VAS score of less than 3 along with small doses of neuropathic medications. CONCLUSIONS: SCS was helpful in managing tolerable pain levels in some PHN patients with CKD along with tolerable neuropathic medications for over 2 years.
Anticonvulsants ; Electric Stimulation Therapy ; Follow-Up Studies ; Glomerular Filtration Rate ; Health Resorts ; Humans ; Kidney ; Kidney Diseases ; Neuralgia, Postherpetic ; Pain, Intractable ; Renal Insufficiency, Chronic ; Spinal Cord ; Spinal Cord Stimulation

Radiofrequency ablation (RFA) is a new, minimally invasive modality that serves as an alternative to surgery in patients with thyroid tumors. The Task Force Committee of the Korean Society of Thyroid Radiology developed recommendations for the optimal use of RFA for thyroid tumors in 2012 and revised them in 2017. Herein, we review and summarize the 2017 thyroid RFA guideline and compare it with the 2012 thyroid RFA guideline.
Advisory Committees ; Catheter Ablation ; Humans ; Thyroid Gland ; Thyroid Neoplasms ; Thyroid Nodule ; Ultrasonography

BACKGROUND: The single radius total knee prosthesis was introduced with the advantage of reduced patellar symptoms; however, there is no long-term follow-up study of the same. The purpose of this study was to determine the survival rate of single radius posterior-stabilized total knee arthroplasty and patellofemoral complication rates in a consecutive series. METHODS: Seventy-one patients (103 knees) who underwent arthroplasty without patellar resurfacing using a single radius posterior-stabilized total knee prosthesis were followed up for a minimum 10 years. Clinical evaluation using Knee Society knee and function scores and radiologic evaluation were performed at regular intervals. Anterior knee pain as well as patellofemoral complications were evaluated with a simple questionnaire. The Kaplan-Meier product-limit method was used to estimate survival. RESULTS: Seventeen patients (23 knees) were excluded due to death (12 knees) or lost to follow-up (11 knees). Of the 80 knees enrolled, all femoral components and 78 tibial components were well fixed without loosening at final follow-up. Two revisions were performed because of tibial component loosening and periprosthetic joint infection. One patient with tibial component loosening refused to have revision surgery. No obvious tibial insert polyethylene wear was observed. The survivorships at 132 months were 96.7% using revision or pending revision as end points. Anterior knee pain was present in 6 patients (6 knees, 7.5%) at the latest follow-up. No patellofemoral complication requiring revision was encountered. CONCLUSIONS: The single radius posterior-stabilized total knee prosthesis demonstrated an excellent minimum 10-year survivorship. The low rates of implant loosening and 7.5% of anterior knee pain as a patellofemoral complication are comparable with those reported for other modern total knee prosthesis.
Aged ; Arthralgia/*surgery ; Arthroplasty, Replacement, Knee/*instrumentation/*methods ; Cementation ; Female ; Follow-Up Studies ; Humans ; Knee Joint/*surgery ; Knee Prosthesis ; Male ; Middle Aged ; Patella/surgery ; Prosthesis Failure ; Retrospective Studies ; Treatment Outcome

PURPOSE: To review the mechanisms and clinical patterns of spontaneous resolution of vitreoretinal interface disorders by analyzing cases and available literature on macular hole (MH), vitreoretinal traction (VMT), and epiretinal membrane (ERM). METHODS: Medical records and optical coherence tomography (OCT) images of patients with spontaneous resolution of MH, VMT, and ERM were reviewed. RESULTS: Two eyes with VMT, 3 eyes with idiopathic MH, 3 eyes of traumatic MH (including 1 eye with electrical burn), and 2 eyes with ERM showed spontaneous resolution. All eyes except traumatic MH reached a visual acuity better than 0.5 after resolution. All idiopathic MHs achieved anatomic closure in 6 months, and traumatic MHs in 1 month except for the electrical burn case. Seven out of 10 eyes experienced complete posterior vitreous detachment (PVD) during resolution. CONCLUSIONS: Some cases of vitreoretinal interface disorders can resolve spontaneously with complete PVD or other mechanisms. Indicators predicting spontaneous resolution should be considered in patients with vitreoretinal interface disorder.
Burns ; Epiretinal Membrane ; Eye ; Humans ; Medical Records ; Retinal Perforations ; Tomography, Optical Coherence ; Traction ; Visual Acuity ; Vitreous Detachment

Neurofibromas are spindle cell tumors of peripheral nerves that may be solitary or multiple. Usually neurofibromas may occur on any part of the body, but seldom involve the palms and soles. There have been no reports of neurofibromas developing on the sole in the Korean dermatologic literature. We report a 34-year-old woman with neurofibromas occurring on both soles.
Adult ; Female ; Humans ; Neurofibroma ; Peripheral Nerves

OBJECTIVE: To test whether the impact of thyroid-nodule size on the malignancy risk differs according to the ultrasonography (US) patterns of nodules. MATERIALS AND METHODS: This study is a post hoc analysis using data from the Thyroid Imaging Reporting and Data System (TIRADS) multicenter retrospective study which included 2000 consecutive thyroid nodules (≥ 1 cm) with final diagnoses. A total of 2000 consecutive thyroid nodules from 1802 patients (1387 women and 613 men; mean age, 51.2 ± 12.2 years) were enrolled in this study. The malignancy risk of the nodules was assessed according to the nodule size and US patterns (Korean-TIRADS). RESULTS: Overall, the malignancy risk did not increase as nodules enlarged. In high-suspicion nodules, the malignancy rate had no association with nodule size (p = 0.467), whereas in intermediate- or low-suspicion nodules there was a trend toward an increasing malignancy risk as the nodule size increased (p = 0.004 and 0.002, respectively). The malignancy rate of large nodules (≥ 3 cm) was higher than that of small nodules (< 3 cm) in intermediate-suspicion nodules (40.3% vs. 22.6%, respectively; p = 0.001) and low-suspicion nodules (11.3% vs. 7.0%, respectively; p = 0.035). There was a trend toward a decreasing risk and proportion of papillary carcinoma and an increasing risk and proportion of follicular carcinoma or other malignant tumors as nodule size increased (p < 0.001, respectively). CONCLUSION: The impact of nodule size on the malignancy risk differed according to the US pattern. A large nodule size (≥ 3 cm) showed a higher malignancy risk than smaller nodules in intermediate- and low-suspicion nodules.
Carcinoma, Papillary ; Diagnosis ; Female ; Humans ; Information Systems ; Male ; Retrospective Studies ; Thyroid Gland* ; Thyroid Nodule* ; Ultrasonography*

Hamartomatous polyp is an uncommon lesion. Most of the gastric hamartomatous polyps occur in patients in their 40s because of polyposis coli. Gastric hamartomaotus polyps are usually asymptomatic, but they occasionally manifest with hematemesis or anemia. If they are congenital, then sessile polyps in children should be observed with some measurable frequency. However, many reports have revealed that if the polyp size is big and the risk of rebleeding is high, then ESD or surgical resection can be used to completely remove them. An inverted gastric hamartomatous polyp may have an early gastric cancer component. We report here on an unusual polyp in a 14-years male who presented with hematemesis. Those were about two 3 cm sized large polyps at the proximal antrum and mid body of the stomach, respectively. The polyps were successfully removed by an endoscopic mucosal resection and the lesions were diagnosed as gastric harmatomas.
Anemia ; Child ; Hematemesis ; Hemorrhage ; Humans ; Male ; Polyps ; Stomach ; Stomach Neoplasms

No abstract available.
Blepharoplasty*