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Traumatic rupture of the superior oblique muscle is rare. We report a case of a 54-year-old man injured by the metal hook of a hanger, resulting in a rupture of the superior oblique muscle tendon. He complained of torsional diplopia when in the primary position. The distal margin of the superior oblique muscle was reattached to sclera 5 and 9 mm apart from the medial insertion of the superior rectus muscle. One week after the operation, torsional diplopia disappeared. However, a 4-prism diopter ipsilateral hypertropia was observed. Three months later, hypertropia gradually increased to 20 prism dioptors and the second operation was done to correct vertical diplopia.
Diplopia/etiology/physiopathology/surgery ; Eye Injuries/complications/*diagnosis/surgery ; *Eye Movements ; Humans ; Male ; Middle Aged ; Oculomotor Muscles/*injuries/physiopathology/surgery ; Ophthalmologic Surgical Procedures/*methods ; Strabismus/etiology/physiopathology/surgery ; Tendon Injuries/complications/*diagnosis/surgery

Cronkhite-Canada Syndrome (CCS) is a rare, non-inherited hamartomatous polyposis syndrome. It is characterized by diffuse gastrointestinal polyposis, diarrhea, weight loss and unique ectodermal manifestations such as alopecia, onychodystrophy and cutaneous hyperpigmentation. The etiology of CCS remains unknown, but an autoimmue contribution to the pathogenesis has been postulated. We report here on a 79-year-old male who has been diagnosed with CCS. He had been taking levothyroxine sodium after total thyroidectomy. To the best of our knowledge, this is the first case report of CCS in association with hypothyroidism and supplementation with levothyroxine sodium in the Korean medical literature.
Aged ; Alopecia ; Diarrhea ; Ectoderm ; Humans ; Hyperpigmentation ; Hypothyroidism ; Intestinal Polyposis ; Male ; Thyroidectomy ; Thyroxine ; Weight Loss

This study highlights a new case of an infant death caused by mechanical asphyxia, who was found dead after being wrapped and pressed by a daycare center teacher with the body and beddings. Moreover, we present a comparative review of four similar previously reported cases and the implications for forensic pathologists in the management of such cases from the perspectives of judicial verdicts of the cases. The previous report commented that the four cases could be considered as overlaying as a type of accidental asphyxia. However, a contextual comprehensive review including the whole scenarios of the cases and negative postmortem findings concluded that all the cases were explicitly different from overlaying cases. Furthermore, we followed up the judicial processes and verdicts in all five cases, including the present case and the four previously reported cases. In the four cases, the defendants were incarcerated for violation of ‘Act on Special Cases Concerning the Punishment of Child Abuse Crimes.’ The ruling trend revealed that the prison sentence durations had been prolonged from 4 to 19 years. Therefore, for a pediatric death suspecting mechanical asphyxia involving a daycare center, contextual comprehensive approach is essential to determine the cause of death and to provide appropriate medicolegal interpretation.

Few studies have examined the clinical features and long-term outcomes of isolated pituitary hormone deficiencies after traumatic brain injury (TBI). Such deficiencies typically present at time intervals after TBI, especially after mild injuries such as concussions, which makes their diagnosis difficult without careful history taking. It is necessary to improve diagnosis and prevent life threatening or morbid conditions such as those that may occur in deficiencies of adrenocorticotropic hormone (ACTH) or thyroid-stimulating hormone (as known as thyrotropin, TSH), the two most important pituitary hormones in hypopituitarism treatment. Here, we report two cases of isolated ACTH deficiency and one case of isolated TSH deficiency. These patients presented at different time points after concussion and underwent long-term follow-ups.
Adrenocorticotropic Hormone* ; Brain Injuries* ; Diagnosis ; Follow-Up Studies* ; Humans ; Hypopituitarism ; Pituitary Hormones ; Thyrotropin*

Background: The direct entry of the camera under the epiglottis may provide a better view of the glottis than the indirect lifting of the epiglottis by placing the Macintosh blade tip on the vallecula when using the video laryngoscope. This study aimed to compare the efficiency of two different methods of lifting the epiglottis during the visualization of glottis using video laryngoscopy in the same patient. Methods: This prospective study enrolled 60 patients who underwent general anesthesia with tracheal intubation. In each patient, glottic views were obtained by directly (group DE) and indirectly lifting the epiglottis (group IE). These two methods were compared using the modified Cormack and Lehane grade and the percentage of glottis opening (POGO) score as assessment parameters. Results: Modified Cormack and Lehane grade showed a significant difference between the groups DE and IE (P = 0.004). The difference in the POGO score between the groups DE and IE was also statistically significant (87.5% and 64.4%, respectively; P < 0.001). Conclusions Our results, therefore, revealed that the method of directly lifting epiglottis was better at exposing glottis than the method of indirectly lifting epiglottis using a video laryngoscope.

Background: The direct entry of the camera under the epiglottis may provide a better view of the glottis than the indirect lifting of the epiglottis by placing the Macintosh blade tip on the vallecula when using the video laryngoscope. This study aimed to compare the efficiency of two different methods of lifting the epiglottis during the visualization of glottis using video laryngoscopy in the same patient. Methods: This prospective study enrolled 60 patients who underwent general anesthesia with tracheal intubation. In each patient, glottic views were obtained by directly (group DE) and indirectly lifting the epiglottis (group IE). These two methods were compared using the modified Cormack and Lehane grade and the percentage of glottis opening (POGO) score as assessment parameters. Results: Modified Cormack and Lehane grade showed a significant difference between the groups DE and IE (P = 0.004). The difference in the POGO score between the groups DE and IE was also statistically significant (87.5% and 64.4%, respectively; P < 0.001). Conclusions Our results, therefore, revealed that the method of directly lifting epiglottis was better at exposing glottis than the method of indirectly lifting epiglottis using a video laryngoscope.

PURPOSE: Little data is currently available on the use of the impulse oscillometry system (IOS) parameter in analyzing the lung function of young children with cough-variant asthma (CVA) and classic asthma. The aims of this study were to evaluate the bronchial responsiveness between patients with CVA and those with classic asthma using dose-response slope and various cutoff values. METHODS: A methacholine challenge test and a pulmonary function test were performed in 43 children with classic asthma and 26 children with CVA using IOS, and the respiratory resistance (Rrs) and reactance (Xrs) were obtained. The bronchial responsiveness were assessed by provocative concentration causing an 80% fall from baseline in reactance at 5 Hz (PC80_Xrs5) and a 40% increase in resistance at 5 Hz (PC40_Rrs5) and calculating from the degree of dose-response slope (DRS) for airway resistance and reactance. RESULTS: There was no significant difference in base lung function between the two groups. However, the mean DRS_Xrs5 and the number who showed more than an 80% fall in reactance were significantly higher in classic asthma group than those in CVA group (P=0.040 and P=0.040, respectively). CONCLUSION: The use of DRS in oscillatory reactance at 5 Hz is useful for the differential diagnosis of classic asthma and CVA based on bronchial hyperresponsiveness.
Airway Resistance ; Asthma* ; Bronchial Hyperreactivity ; Child* ; Cough ; Diagnosis, Differential ; Humans ; Lung ; Methacholine Chloride ; Oscillometry ; Respiratory Function Tests

PURPOSE: Bronchial asthma is an inflammatory respiratory disease characterized by the activation of inflammatory cells and its infiltration. It has been recently reported that MMP- 9 dose an importance role in the movement of inflammatory cells through basal membrane, that the function may be suppressed by TIMP-1. We studied to know the change of MMP-9 and TIMP-1 in sputum before and after corticosteroid (CS) therapy, and the relation with MMP-9/TIMP-1 ratio and improvement of FEV1. METHODS: Seventeen acute moderate to severe asthmatics were selected as was a control group of 17 healthy children. MMP-9 and TIMP-1 in sputum were measured on the 0 day, 7 days and 3 months later and observed as to the flow of time. FEV1 was measured before the CS therapy and 3 months later, and the change of FEV1 & FEV1 at 3 months were compared with the relation of MMP-9/TIMP-1 ratio. RESULTS: Sputum MMP-9 was lowered more at 7 days and 3 months compared with 0 day (P< 0.05). Sputum TIMP-1 was significantly high on 7 days (P< 0.05) and then had a tendency to decrease until 3 months (P< 0.05). MMP-9/TIMP-1 ratio decreased according to the flow of time (P< 0.05). MMP-9/TIMP-1 ratio at 3 months closely correlated with the change of FEV1 (r=0.65, P< 0.05). CONCLUSION: These data suggest that the overproduction of MMP-9 after asthma exacerbation correlates with airway inflammation and TIMP-1 production might contribute to airway fibrosis. MMP-9/TIMP-1 ratio at 3 months correlates with improvement of pulmonary function after CS therapy.
Asthma* ; Child ; Fibrosis ; Gelatinases ; Humans ; Inflammation ; Matrix Metalloproteinase 1* ; Matrix Metalloproteinase 9* ; Membranes ; Prednisolone ; Sputum* ; Tissue Inhibitor of Metalloproteinase-1

Pulmonary mucormycosis is a relatively rare but highly virulent and rapidly progressive disease that occurs after inhalation of spores of the fungi that belong to class Zygomycetes. This infection occasionally occurs in seriously immunocompromised patients, but also in patients with uncontrolled diabetes or diabetic ketoacidosis. Diagnosis is pathologic demonstration of typical hyphae within lung tissue, and requires aggressive treatments including surgical and medical approach for reducing the overall mortality. In Korea, pulmonary mucormycosis complicated with diabetes has been reported in only five cases. Recently, we experienced a case of pulmonary mucormycosis in 32-year-old poorly controlled diabetic man, who had nonspecific pulmonary symptoms, a lobar consolidation on chest radiograph, and endobronchial lesions on bronchoscopic finding. We reported here our case and reviewed characteristics of other five previous cases.
Adult ; Diabetes Mellitus* ; Diabetic Ketoacidosis ; Diagnosis ; Fungi ; Humans ; Hyphae ; Immunocompromised Host ; Inhalation ; Korea ; Lung ; Mortality ; Mucormycosis* ; Radiography, Thoracic ; Spores