BACKGROUND AND OBJECTIVES: Pulmonary thromboembolism (PTE) after surgery is one of the rare but fatal complications causing sudden respiratory failure. This study was performed to evaluate PTE after head and neck surgery and to report our recent experience with review of the literature. SUBJECTS AND METHOD: We retrospectively analyzed 1096 patients who underwent head and neck surgery from January 2011 to June 2013 in a tertiary hospital. We evaluated the incidence and characteristics of PTE and risk factors of PTE such as smoking, body mass index, comorbidities, coronary artery disease, coagulation disorder and Caprini risk assessment model. RESULTS: PTE occurred in five of 1096 patients (0.46%; two were male and three were female, with a mean age of 56.2 year). All patients with PTE were categorized into high risk group of PTE by Caprini model. The mean Caprini risk score were 6.6 and 4.6 in the PTE patients and non-PTE patients, respectively. The significant risk factors were long operative time, cancer patients and high Caprini score in this study. One PTE patient underwent cardiopulmonary resuscitation due to respiratory arrest, afterwards received thromboembolectomy by thoracotomy. Four patients received anticoagulation therapy only. CONCLUSION: Risk stratification for PTE is necessary in patients who receive long operation for head and neck cancer or have high Caprini score.
Body Mass Index ; Cardiopulmonary Resuscitation ; Comorbidity ; Coronary Artery Disease ; Female ; Head and Neck Neoplasms ; Head* ; Humans ; Incidence ; Male ; Neck* ; Operative Time ; Pulmonary Embolism* ; Respiratory Insufficiency ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Smoke ; Smoking ; Tertiary Care Centers ; Thoracotomy ; Venous Thrombosis

Newborn hearing screening test is very important in the early diagnosis of childhood hearing loss because it affects language development. Auditory neuropathy is a spectrum disorder characterized by abnormal auditory brainstem response but preserved otoacoustic emission and cochlear microphonics. In general, auditory neuropathy patients have poor word discrimination and variable patterns of pure tone audiometry. We report on a patient with auditory neuropathy diagnosed at 16 months of age and started wearing hearing aids, but showed normal pure tone and speech audiometric findings 3 years later. Close follow-up for patients with auditory neuropathy is recommended.
Audiometry ; Discrimination (Psychology) ; Early Diagnosis ; Evoked Potentials, Auditory, Brain Stem ; Hearing Aids ; Hearing Loss ; Hearing* ; Humans ; Infant, Newborn ; Language Development ; Mass Screening

PURPOSE: This study attempted to investigate the effects of supply of highly concentrated (30%) oxygen on human ability of visuospatial cognition using time course data analysis of functional Magnetic Resonance Imaging (fMRI). MATERIALS AND METHODS: To select an item set in the visuospatial performance test, two questionnaires with similar difficulty were developed through group testing. A group test was administered to 263 college students. Two types of questionnaire containing 20 questions were developed to measure the ability of visuospatial cognition. Eight college students (right-handed male, average age of 23.5 yrs) were examined for fMRI study. The experiment consisted of two runs of the visuospatial cognition testing, one with 21% level of oxygen and the other with 30% oxygen level. Each run consisted of 4 blocks, each containing control and visuospatial items. Functional brain images were taken from 3T MRI using the single-shot EPI method. Using the subtraction procedure, activated areas in the brain during visuospatial tasks were col-orcoded by t-score. To investigate the time course data in each activated area from brain images, 4 typical regions (cerebellum, occipital lobe, parietal lobe, and frontal lobe) were selected. RESULTS: The average accuracy was 50.63 +/-8.63 and 62.50 +/-9.64 for 21% and 30% oxygen respectively, and a statistically significant difference was found in the accuracy between the two types of oxygen (p<0.05). There were more activation areas observed at the cerebellum, occipital lobe, parietal lobe and frontal lobe with 30% oxygen administration. The rate of increase in the cerebellum, occipital lobe and parietal lobe was 17% and that of the frontal lobe, 50%. Especially, there were increase of intensity of BOLD signal at the parietal lobe with 30% oxygen administration. The increase rate of the left parietal lobe was 1.4% and that of the right parietal lobe, 1.7%. CONCLUSION: It is concluded that while performing visuospatial tasks, high concentrations of oxygen administration make oxygen administration sufficient, thus making neural network activate more, and the ability to perform visuospatial tasks increase.
Brain ; Cerebellum ; Cognition ; Frontal Lobe ; Humans ; Magnetic Resonance Imaging* ; Male ; Occipital Lobe ; Oxygen* ; Parietal Lobe ; Surveys and Questionnaires ; Statistics as Topic*

PURPOSE: This study attempted to investigate the effects of supply of highly concentrated (30%) oxygen on human ability of visuospatial cognition using time course data analysis of functional Magnetic Resonance Imaging (fMRI). MATERIALS AND METHODS: To select an item set in the visuospatial performance test, two questionnaires with similar difficulty were developed through group testing. A group test was administered to 263 college students. Two types of questionnaire containing 20 questions were developed to measure the ability of visuospatial cognition. Eight college students (right-handed male, average age of 23.5 yrs) were examined for fMRI study. The experiment consisted of two runs of the visuospatial cognition testing, one with 21% level of oxygen and the other with 30% oxygen level. Each run consisted of 4 blocks, each containing control and visuospatial items. Functional brain images were taken from 3T MRI using the single-shot EPI method. Using the subtraction procedure, activated areas in the brain during visuospatial tasks were col-orcoded by t-score. To investigate the time course data in each activated area from brain images, 4 typical regions (cerebellum, occipital lobe, parietal lobe, and frontal lobe) were selected. RESULTS: The average accuracy was 50.63 +/-8.63 and 62.50 +/-9.64 for 21% and 30% oxygen respectively, and a statistically significant difference was found in the accuracy between the two types of oxygen (p<0.05). There were more activation areas observed at the cerebellum, occipital lobe, parietal lobe and frontal lobe with 30% oxygen administration. The rate of increase in the cerebellum, occipital lobe and parietal lobe was 17% and that of the frontal lobe, 50%. Especially, there were increase of intensity of BOLD signal at the parietal lobe with 30% oxygen administration. The increase rate of the left parietal lobe was 1.4% and that of the right parietal lobe, 1.7%. CONCLUSION: It is concluded that while performing visuospatial tasks, high concentrations of oxygen administration make oxygen administration sufficient, thus making neural network activate more, and the ability to perform visuospatial tasks increase.
Brain ; Cerebellum ; Cognition ; Frontal Lobe ; Humans ; Magnetic Resonance Imaging* ; Male ; Occipital Lobe ; Oxygen* ; Parietal Lobe ; Surveys and Questionnaires ; Statistics as Topic*

BACKGROUND AND OBJECTIVES: Various drugs can be used for treatment of laryngopharyngeal reflux disease (LPRD). However, the optimal medical treatment regimen is still controversial. This study was performed to determine the optimal medical treatment regimen and duration for LPRD. SUBJECTS AND METHOD: We studied 172 patients who were diagnosed as LPRD by reflux symptom index (RSI) or reflux finding scores (RFS). The study group was divided into 4 groups according to the medication regimen: proton pump inhibitor (PPI), PPI and prokinetics, PPI and H2 blocker, and double dose PPI groups. All patients took medicines for 3 months or more. Clinical remission was defined as 70% improvement of initial RSI scores. RESULTS: 36 (20.9%) patients were prescribed PPI only, 65 (37.8%) patients PPI with prokinetics, 51 (29.6%) patients PPI with H2 blocker, 20 (11.6%) patients double dose PPI. Pretreatment with RSI and RFS did not differ among the four groups. RSI was improved after one month of medication in all of the groups. RSI and RFS tended to decrease during the treatment in all groups (p for trend <0.001). The mean clinical remission time was 2.3 months in patients receiving PPI alone, 2.6 months in PPI and prokinetics group, 2.5 months in the PPI and H2 blocker group and 1.8 months in the double dose PPI group. About 70% of patients reached clinical remission within 3 months. CONCLUSION: PPI with or without prokinetics or H2 blocker is effective treatment for LPRD, and the appropriate duration of medication seems to be about 3 months. Double dose PPI can be used for those whom normal dose PPI is ineffective.
Humans ; Laryngopharyngeal Reflux* ; Proton Pumps

Infliximab is a chimeric antibody against tumor necrosis factor-alpha and it can be used in the treatment of ankylosing spondylitis. Tumor necorosis factor-alpha is a potent proinflammatory cytokine and plays a key role in the host response against tuberculosis. Infliximab is known to be effective on active ankylosing spondylitis but it can also cause reactivation of latent tuberculosis. Physicians should screen patients for latent tuberculous infection or disease before prescribing the drug. We experienced a case of tuberculous pleurisy after taking infliximab in a patient suffering from ankylosing spondylitis. We present the case with a review of literature.
Humans ; Latent Tuberculosis ; Spondylitis, Ankylosing ; Tuberculosis ; Tuberculosis, Pleural* ; Tumor Necrosis Factor-alpha ; Infliximab

OBJECTIVE: To evaluate the diagnostic accuracy of a new ultrasound (US) classification system for differentiating between benign and malignant solid thyroid nodules. MATERIALS AND METHODS: In this study, we enrolled 191 consecutive patients who received real-time US and subsequent US diagnoses for solid thyroid nodules, and underwent US-guided fine-needle aspiration. Each thyroid nodule was prospectively classified into 1 of 5 diagnostic categories by real-time US: "malignant," "suspicious for malignancy," "borderline," "probably benign," and "benign". We evaluated the diagnostic accuracy of thyroid US and the cut-off US criteria by comparing the US diagnoses of thyroid nodules with cytopathologic results. RESULTS: Of the 191 solid nodules, 103 were subjected to thyroid surgery. US categories for these 191 nodules were malignant (n = 52), suspicious for malignancy (n = 16), borderline (n = 23), probably benign (n = 18), and benign (n = 82). A receiver-operating characteristic curve analysis revealed that the US diagnosis for solid thyroid nodules using the 5-category US classification system was very good. The sensitivity, specificity, positive and negative predictive values, and accuracy of US diagnosis were 86%, 95%, 91%, 92%, and 92%, respectively, when benign, probably benign, and borderline categories were collectively classified as benign (negative). CONCLUSION: The diagnostic accuracy of thyroid US for solid thyroid nodules is high when the above-mentioned US classification system is applied.
Biopsy, Fine-Needle ; Cytodiagnosis ; Diagnosis, Differential ; Female ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Sensitivity and Specificity ; Thyroid Neoplasms/classification/congenital/pathology/*ultrasonography ; Thyroid Nodule/classification/pathology/*ultrasonography ; Ultrasonography, Interventional

BACKGROUND: There are several different opinions regarding the improvements seen on the transverse plane after soft tissue surgery alone in independently ambulant patients with cerebral palsy. We performed a meta-analysis using data from previous studies to identify the effects of soft tissue surgery alone on pelvic and hip rotation in children with spastic diplegia. METHODS: We conducted a pilot study to evaluate the improvement in pelvic and hip rotation after muscle-tendon lengthening surgery in children with spastic diplegia. We also searched EMBASE and PubMed and selected 2 previous studies using the same test conditions with kinematic data on the pelvis and hip joints. A meta-analysis of the results of these 3 studies, including this pilot study, was then performed. RESULTS: The meta-analysis results showed an external rotation decrease (p = 0.005) in the mean difference of pelvic rotation of -3.61 (95% confidence interval [CI], -6.13 to -1.09) and a mean difference in hip rotation of 6.60 (95% CI, 3.34 to 9.86), indicating a significant increase in the hip external rotation after surgery (p < 0.001). CONCLUSIONS: In independently community-ambulant pediatric patients with spastic diplegia, pelvic retraction and hip internal rotation could be improved after soft tissue surgery.
Cerebral Palsy* ; Child ; Hip Joint ; Hip* ; Humans ; Muscle Spasticity* ; Pelvis ; Pilot Projects

BACKGROUND: There are several different opinions regarding the improvements seen on the transverse plane after soft tissue surgery alone in independently ambulant patients with cerebral palsy. We performed a meta-analysis using data from previous studies to identify the effects of soft tissue surgery alone on pelvic and hip rotation in children with spastic diplegia. METHODS: We conducted a pilot study to evaluate the improvement in pelvic and hip rotation after muscle-tendon lengthening surgery in children with spastic diplegia. We also searched EMBASE and PubMed and selected 2 previous studies using the same test conditions with kinematic data on the pelvis and hip joints. A meta-analysis of the results of these 3 studies, including this pilot study, was then performed. RESULTS: The meta-analysis results showed an external rotation decrease (p = 0.005) in the mean difference of pelvic rotation of -3.61 (95% confidence interval [CI], -6.13 to -1.09) and a mean difference in hip rotation of 6.60 (95% CI, 3.34 to 9.86), indicating a significant increase in the hip external rotation after surgery (p < 0.001). CONCLUSIONS: In independently community-ambulant pediatric patients with spastic diplegia, pelvic retraction and hip internal rotation could be improved after soft tissue surgery.
Cerebral Palsy* ; Child ; Hip Joint ; Hip* ; Humans ; Muscle Spasticity* ; Pelvis ; Pilot Projects

A 10-year-old castrated male papillon presented with nasal discharge, coughing and chronic dysphagia. On physical examination, the dog exhibited sneezing, gurgling and movement of the throat with repeated attempts to swallow fluids. A diagnosis of cricopharyngeal achalasia (CPA) was made based on video fluoroscopic demonstration of failure of relaxation of the upper esophageal sphincter. This report describes the diagnosis of CPA in an old dog, which is rarely diagnosed in older animals.
Animals ; Child ; Cough ; Deglutition Disorders ; Diagnosis ; Dogs* ; Esophageal Achalasia* ; Esophageal Sphincter, Upper ; Humans ; Male ; Pharynx ; Physical Examination ; Relaxation ; Sneezing