The precise mechanism involved in DIC and delayed traumatic subarachnoid hemorrhage (DT-SAH) remains unclear in multiple-trauma patients. Hereby, we describe a polytraumatized patient with DIC who died due to DT-SAH. A 75-year-old female patient was admitted to our Emergency Department complaining of abdominal pain and drowsiness after a pedestrian accident. Her initial brain computerized tomography (CT) finding was negative for intracranial injury. However, her abdominal CT scan revealed a collection of retroperitoneal hematomas from internal iliac artery bleeding after a compressive pelvic fracture. This event eventually resulted in shock and DIC. An immediate angiographic embolization of the bleeding artery was performed along with transfusion and anti-thrombin III. Her vital signs were stabilized without neurological change. Fourteen hours after admission, she suddenly became comatose, and her follow-up brain CT scan revealed a dense DT-SAH along the basal cisterns with acute hydrocephalus. This event rapidly prompted brain CT angiography and digital subtraction angiography, which both confirmed the absence of any cerebrovascular abnormality. Despite emergency extraventricular drainage to reverse the hydrocephalus, the patient died three days after the trauma. This paper presents an unusual case of DT-SAH in a polytraumatized patient with DIC.
Abdominal Pain ; Aged ; Angiography ; Angiography, Digital Subtraction ; Arteries ; Brain ; Coma ; Dacarbazine ; Disseminated Intravascular Coagulation* ; Drainage ; Emergencies ; Emergency Service, Hospital ; Female ; Follow-Up Studies ; Hematoma ; Hemorrhage ; Humans ; Hydrocephalus ; Iliac Artery ; Multiple Trauma ; Shock ; Sleep Stages ; Subarachnoid Hemorrhage, Traumatic* ; Tomography, X-Ray Computed ; Vital Signs

Abstract: Ten cadavers were studied to compare the accessibility of cervical vertebral canal with conventional standard ventral slot and modified slanted ventral slot. One group performed standard ventral slot procedures at the C3-4, C5-6. The other group performed modified slanted ventral slot with inverted cone technique procedures at the C3-4, C5-6 computed tomography was performed before and after surgery. The accessibility of cervical vertebral canal with conventional standard ventral slot and modified slanted ventral slot using computed tomography in C3-4 and C5-6 intervertebral space was compared. Although smaller ostectomy was performed in the modified slanted ventral slot, some lesions were more accessible but limitations were obvious in C3-4 and C5-6 intervertebral disk space. After the disc material has been identified through accurate preoperative diagnostic imaging, less morbidity and complications can be expected if the appropriate surgical method is selected based on the lesion of compression.

Cutaneous squamous cell carcinoma is the second-most common skin cancer and represents 20% of all skin cancers. Cutaneous squamous cell carcinoma often spreads to the parotid gland through lymph nodes, but, direct invasion of an adjacent organ may also occur. We present the case of 78-year-old man with ulcerated mass on the right infra-auricular area. The histopathologic finding was squamous cell carcinoma. There was no evidence of distant metastasis, but the mass was found to invade the superficial lobe of the right parotid gland. The mass was widely excised and superficial parotidectomy was performed while preserving the facial nerve. The defect was covered by primary closure. Postoperative radiotherapy was performed. At 20 months after surgery, our patient had no facial palsy, local recurrence, or metastasis. Cutaneous squamous cell carcinoma involving the parotid gland is an aggressive, rapidly advancing lesion, which if not recognized and treated early will result in high morbidity and mortality. Squamous cell carcinoma of the parotid gland has shown that patients who receive adjuvant radiotherapy have a lower recurrence rate and a higher survival rate than patients treated with surgery alone. The role of elective neck dissection remains controversial.
Aged ; Carcinoma, Squamous Cell* ; Facial Nerve ; Facial Paralysis ; Humans ; Lymph Nodes ; Neck Dissection ; Neoplasm Metastasis ; Parotid Gland* ; Radiotherapy, Adjuvant ; Recurrence ; Skin Neoplasms ; Survival Rate ; Ulcer

Intrauterine devices (IUDs) are widely used for contraception in South Korea. However, several complications of IUDs have been reported, including inflammation, obstruction, perforation, and fistula. IUD perforation is the rarest of these complications but is also severe. Migrated IUDs can be retrieved through endoscopy, laparoscopy, or laparotomy. Presented below is an atypical case of an IUD perforating the sigmoid colon, which could not be removed endoscopically, and was subsequently incompletely removed through laparoscopic surgery. The present case underlines the importance of appropriate diagnosis and treatment approach in the management of IUD perforation.

Intrauterine devices (IUDs) are widely used for contraception in South Korea. However, several complications of IUDs have been reported, including inflammation, obstruction, perforation, and fistula. IUD perforation is the rarest of these complications but is also severe. Migrated IUDs can be retrieved through endoscopy, laparoscopy, or laparotomy. Presented below is an atypical case of an IUD perforating the sigmoid colon, which could not be removed endoscopically, and was subsequently incompletely removed through laparoscopic surgery. The present case underlines the importance of appropriate diagnosis and treatment approach in the management of IUD perforation.

PURPOSE: Sporadic excellent treatment results of intra-prostatic antibiotic injections against resistant chronic prostatitis were reported without sufficient background. So, for the scientific base of this effective treatment modality, we studied the tissue distribution and concentration of the ofloxacin after intraprostatic injection of formula which is designed for sustained release ofloxacin at least for four weeks. MATERIAL AND METHODS: 28 male dogs aged over 2 and ofloxacin designed to release over four weeks were used. The ofloxacin 12mg and poly(D,L-lactic) acid 28mg were prepared for sustained releasing formula and resolved in 1ml of 1.5% sodium carboxymethyl cellulose solution. Dogs were grouped into two, 8 control and 16 experiments for open injection. For control, oral ofloxacin 100mg was given twice a day for two and four weeks and for experimental groups, the new formula were injected at right lobe of prostate directly. The ofloxacin concentration was measured by high performance liquid chromatography(HPLC). RESULTS: Oral ofloxacin 2,800(2 weeks) and 5,600(4 weeks) were given for control and tissue concentration of ofloxacin were relatively even at all partitions of the prostate, 7.4+/-1.4(2 weeks) and 9.2+/-1.3mg/ml(4 weeks) and the blood level were 3.6-5.1mg/ml. In experimental groups, the only 12mg of ofloxacin was given and tissue concentration were 10.5+/-3.0(1 weeks), 13.8+/-4.5(2 weeks), 7.1+/-0.9(3 weeks) and 7.7+/-3.0mg/ml(4 weeks) in rights and 8.0+/-1.1(1 weeks), 10.2+/-4.2(2 weeks), 5.1+/-1.4(3 weeks) and 7.6+/-0.8(4 weeks)mg/ml in left lobes suggesting communication of blood between two lobes, and blood concentration were 0.16-0.59mg/ml. In histologic examination, the formula were localized between stroma and their size were reduced with time. CONCLUSIONS: Authors conclude that there are free communication of blood between two lobes of prostate and one direct injection of this sustained releasing formula ofloxacin into prostate can be a substitute with local effects without disturbing prostatic tissue level which reducing number or medication in future.
Animals ; Carboxymethylcellulose Sodium ; Dogs ; Human Rights ; Humans ; Male ; Microspheres* ; Ofloxacin* ; Prostate ; Prostatitis ; Sodium ; Tissue Distribution

Cutaneous Rosai-Dorfman disease (RDD) is a rare, benign condition mainly affecting the lymph nodes and sometimes involving the skin. RDD is notorious for its poor response to medication, and surgery is often the preferred treatment option for limited lesions. Herein, we present a case of cutaneous RDD in a 49-year-old woman with multiple facial nodules that showed minimal response to treatment with steroids, isotretinoin, and methotrexate.The diagnosis of cutaneous RDD was confirmed based on histopathological examination. The patient showed minimal response to medication; however, electrosurgery resulted in a relatively good cosmetic response. The present case demonstrates that electrosurgery can be an effective treatment option for cutaneous RDD, especially in case of patients with multiple lesions. The rarity of this disease and the limited reports on its management highlights the need for further research on the efficacy of different surgical modalities for cutaneous RDD.

Background: Risankizumab, human immunoglobulin G1λ monoclonal antibody, selectively blocks the p19 subunit of interleukin-23-mediated signaling pathway. Risankizumab has emerged as an effective and well-tolerated therapeutic option for moderate-to-severe psoriasis. However, real-world data on treatment outcomes of risankizumab in Korean patients with psoriasis are limited. Objective: To investigate the efficacy and safety of risankizumab in Korean patients with moderate-to-severe plaque psoriasis. Methods: We retrospectively reviewed patients with moderate-to-severe psoriasis who were treated with risankizumab in our hospital from July 2020 to December 2022. A total of 45 patients with psoriasis who were treated with risankizumab for at least 16 weeks were included in this study. Patient demographics, Psoriasis Area and Severity Index (PASI) scores, Investigator’s Global Assessment scores, and adverse events were assessed. Results: The mean baseline PASI score (13.1±7.7) was significantly decreased after 16 weeks of risankizumab treatment (0.9±1.4) (p＜0.05). Of the 45 patients, 40 showed a PASI 90 response at the last follow-up visit. No serious adverse events were observed. Three patients (6.7%) experienced mild adverse events such as injection site reaction, easy bruising, and headache. Conclusion Our real-world data demonstrated that risankizumab treatment is effective and safe in Korean patients with moderate-to-severe plaque psoriasis.

The precise mechanism involved in DIC and delayed traumatic subarachnoid hemorrhage (DT-SAH) remains unclear in multiple-trauma patients. Hereby, we describe a polytraumatized patient with DIC who died due to DT-SAH. A 75-year-old female patient was admitted to our Emergency Department complaining of abdominal pain and drowsiness after a pedestrian accident. Her initial brain computerized tomography (CT) finding was negative for intracranial injury. However, her abdominal CT scan revealed a collection of retroperitoneal hematomas from internal iliac artery bleeding after a compressive pelvic fracture. This event eventually resulted in shock and DIC. An immediate angiographic embolization of the bleeding artery was performed along with transfusion and anti-thrombin III. Her vital signs were stabilized without neurological change. Fourteen hours after admission, she suddenly became comatose, and her follow-up brain CT scan revealed a dense DT-SAH along the basal cisterns with acute hydrocephalus. This event rapidly prompted brain CT angiography and digital subtraction angiography, which both confirmed the absence of any cerebrovascular abnormality. Despite emergency extraventricular drainage to reverse the hydrocephalus, the patient died three days after the trauma. This paper presents an unusual case of DT-SAH in a polytraumatized patient with DIC.
Abdominal Pain ; Aged ; Angiography ; Angiography, Digital Subtraction ; Arteries ; Brain ; Coma ; Dacarbazine ; Disseminated Intravascular Coagulation ; Drainage ; Emergencies ; Emergency Service, Hospital ; Female ; Follow-Up Studies ; Hematoma ; Hemorrhage ; Humans ; Hydrocephalus ; Iliac Artery ; Multiple Trauma ; Shock ; Sleep Stages ; Subarachnoid Hemorrhage, Traumatic ; Tomography, X-Ray Computed ; Vital Signs

We developed age, gender and ethnic specific brain templates based on MR and Positron-Emission Tomography (PET) images of Korean normal volunteers. Seventy-eight normal right-handed volunteers (M/F=49/29) underwent 3D T1-weighted SPGR MR and F-18-FDG PET scans. For the generation of standard templates, an optimal target brain that has the average global hemispheric shape was selected for each gender. MR images were then spatially normalized by linear transformation to the target brains, and normalization parameters were reapplied to PET images. Subjects were subdivided into 2 groups for each gender: the young/midlife (<55 yr) and the elderly groups. Young and elderly MRI/PET templates were composed by averaging the spatially normalized images. Korean templates showed different shapes and sizes (mean length, width, and height of the brains were 16.5, 14.3 and 12.1 cm for man, and 15.6, 13.5 and 11.4 cm for woman) from the template based on Caucasian (18.3, 14.2, and 13.3 cm). MRI and PET templates developed in this study will provide the framework for more accurate stereotactic standardization and anatomical localization.
Adolescent ; Adult ; Age Factors ; Aged ; Brain/*radiography/*radionuclide imaging ; Comparative Study ; Female ; Fluorodeoxyglucose F18/diagnostic use ; Humans ; Korea ; Magnetic Resonance Imaging/methods ; Male ; Middle Aged ; Positron-Emission Tomography/methods ; Research Support, Non-U.S. Gov't ; Sex Factors