A 74-year-old man presented with recurrent vomiting and aspiration pneumonia in the left lower lobe. He entered the intensive care unit to manage the pneumonia and septic shock. Although a percutaneous endoscopic gastrostomy tube was implanted for recurrent vomiting, vomiting and aspiration recurred frequently during admission. Subsequently, he complained of neck pain when in an upright position. A videofluoroscopic swallowing study showed compression of the esophagus by cervical osteophytes and tracheal aspiration caused by an abnormality at the laryngeal inlet. Cervical spine X-rays and computed tomography showed anterior cervical osteophytes at the C3-6 levels. Surgical decompression was scheduled, but was cancelled due to his frailty. Unfortunately, further recurrent vomiting and aspiration resulted in respiratory arrest leading to hypoxic brain damage and death. Physicians should consider cervical spine disease, such as diffuse skeletal hyperostosis as an uncommon cause of recurrent aspiration pneumonia.
Aged ; Bays ; Decompression, Surgical ; Deglutition ; Esophagus ; Gastrostomy ; Humans ; Hyperostosis ; Hypoxia, Brain ; Intensive Care Units ; Neck Pain ; Osteophyte* ; Pneumonia ; Pneumonia, Aspiration* ; Shock, Septic ; Spine ; Vomiting

A 74-year-old man presented with recurrent vomiting and aspiration pneumonia in the left lower lobe. He entered the intensive care unit to manage the pneumonia and septic shock. Although a percutaneous endoscopic gastrostomy tube was implanted for recurrent vomiting, vomiting and aspiration recurred frequently during admission. Subsequently, he complained of neck pain when in an upright position. A videofluoroscopic swallowing study showed compression of the esophagus by cervical osteophytes and tracheal aspiration caused by an abnormality at the laryngeal inlet. Cervical spine X-rays and computed tomography showed anterior cervical osteophytes at the C3-6 levels. Surgical decompression was scheduled, but was cancelled due to his frailty. Unfortunately, further recurrent vomiting and aspiration resulted in respiratory arrest leading to hypoxic brain damage and death. Physicians should consider cervical spine disease, such as diffuse skeletal hyperostosis as an uncommon cause of recurrent aspiration pneumonia.
Aged ; Bays ; Decompression, Surgical ; Deglutition ; Esophagus ; Gastrostomy ; Humans ; Hyperostosis ; Hypoxia, Brain ; Intensive Care Units ; Neck Pain ; Osteophyte ; Pneumonia ; Pneumonia, Aspiration ; Shock, Septic ; Spine ; Vomiting

We report 23 cases of silicone stents intubation for obstruction of lacrimal drainage system in 23 patients with tearing and mucopurulent material discharge from January 1985 to April 1988. The success rate of silicone stents intubation was 47.4% and the most common site of obstruction was nasolacrimal duct(56.5%). 30.3% of patients had complications related to silicone stents, conjunctivitis, punctal erosion etc. With these results, we consider that congenital dacryostenosis, partical and complete nasolacrimal duct obstruction is mainly indicated for silicone stents intubation and better results will be gained if be done with acryocystorhinostomy to prevent complications related to silicone stents.
Conjunctivitis ; Drainage* ; Humans ; Intubation* ; Nasolacrimal Duct ; Silicones* ; Stents

A cadaveric study was performed to investigate the relationship between disc degeneration and morphological changes in the intervertebral foramen of cervical spine, including the effect on the nerve root. Seven fresh frozen human cadavers were dissected from C1 to T1, preserving the ligaments, capsules, intervertebral disc and the neural structures. The specimens were scanned with MRI and then scanned through CT scan in the upright position. Direct mid-sagittal and 45 degree oblique images were obtained to measure the dimension of the intervertebral disc height, foraminal height, width, area and segmental angles. Disc degeneration was inversely correlated with disc height. There was a significant correlation between disc degeneration and foraminal width (p<0.005) and foraminal area (p< 0.05), but not with foraminal height. Disc height was correlated with foraminal width but not with height. The segmental angles were decreased more in advanced degenerated discs. There was a correlation between nerve root compression and decreased foraminal width and area (p<0.005). This information and critical dimensions of the intervertebral foramen for nerve root compression should help in the diagnosis of foraminal stenosis of the cervical spine in patients presenting with cervical spondylosis and radiculopathy.
Adult ; Aged ; Aged, 80 and over ; Cadaver ; Female ; Human ; Intervertebral Disk/*pathology/radiography ; Magnetic Resonance Imaging/*methods ; Male ; Middle Aged ; Spine/*pathology/radiography ; Support, Non-U.S. Gov't ; Tomography, X-Ray Computed/*methods

PURPOSE: To report the efficacy of intravitreal bevacizumab injection in adult patients with Coats' disease. CASE SUMMARY: Vascular telangiectasia, microaneurysms, circinate hard exudates, and macular edema were shown in the macula of two patients. Vascular abnormality was limited to < or =6 clock hours in both cases. In case 1, the temporal retina demonstrates filigree-like vessels and capillary nonperfusion. In case 2, the nasal retina demonstrates aneurysmal dilatation and multiple microaneurysms. Intravitreal bevacizumab injection was administered in both cases. After 1 month, macular edema decreased. Laser photocoagulation was performed for vascular telangiectasia, microaneurysms, and capillary nonperfusion area. Then an additional decrease of macular edema was observed. Fluorescein leakage decreased, as well. After 1 month (case 1) and 2 months (case 2), macular edema increased. The second and third intravitreal reinjections were administered to each patient. Macular edema decreased. CONCLUSIONS: We report two rare cases of Coats' disease in adult patients. Intravitreal bevacizumab injection in patients with Coats' disease can result in a rapid decrease of macular edema, which will then lead to rapid visual recovery and an opportunity for effective laser photocoagulation. We recommend that intraviteal bevacizumab injection be used in combination with laser photocoagulation for the treatment of Coats' disease.
Adult ; Aneurysm ; Antibodies, Monoclonal, Humanized ; Capillaries ; Dilatation ; Exudates and Transudates ; Fluorescein ; Humans ; Light Coagulation ; Macular Edema ; Retina ; Telangiectasis ; Bevacizumab

PURPOSE: To report a case of endogenous Nocardia endophthalmitis developed in an immunocompromized patient. METHODS: Case report. RESULTS: A 25 year-old man with terminal stage renal disease who was treated with renal transplantation and immunosuppressive medications, presented with reduced vision in his right eye. Ocular examination showed inflammation of anterior chamber, vitreous opacity and subretinal abscess. Prior to ocular symptom, he had been diagnosed to have Nocarida abscess in the lung, brain and soft tissue. He was treated with systemic antibiotics (Imipenam, TMP/SMX). Retinal lesion was improved to achieve 20/200 vision. CONCLUSIONS: We experienced a case of endogenous endophthalmitis due to systemic Nocardia infection in an immunocompromised patient. To our knowledge, this case was the first report of endogenous Nocardia endophthalmitis in Korea.
Abscess ; Adult ; Anterior Chamber ; Anti-Bacterial Agents ; Brain ; Endophthalmitis* ; Humans ; Immunocompromised Host ; Inflammation ; Kidney Transplantation ; Korea ; Lung ; Nocardia ; Nocardia Infections ; Retinaldehyde ; Transplantation* ; Vision, Low

As extra-mammary Paget's disease is rare and usually diagnosed at early stage when it is highly curable with surgical resection, it is much rarer to see patients with recurrent metastatic disease. Thrombotic thrombocytopenic purpura in patients with metastatic solid cancer is also a rare disease and may result from bone marrow metastasis or bone marrow necrosis. For the latter, the majority of cases are not eligible for systemic chemotherapy for rapid disease progression and poor performance status. Herein, authors report a patient with thrombotic thrombocytopenic purpura associated with bone marrow necrosis complicating extra-mammary Paget's disease who was successfully treated with docetaxel and carboplatin combination chemotherapy.
Bone Marrow* ; Carboplatin ; Disease Progression ; Drug Therapy ; Drug Therapy, Combination ; Humans ; Necrosis* ; Neoplasm Metastasis ; Paget Disease, Extramammary* ; Purpura, Thrombotic Thrombocytopenic* ; Rare Diseases

PURPOSE: To evaluate the neuroprotective effect of combination therapy of polyethylene glycol (PEG) and magnesium sulfate (MgSO4) after a spinal cord injury. MATERIALS AND METHODS: Twenty Sprague Dawley male rats (300-350 gm) had a spinal cord injury after T9/10 laminectomy using an Ohio State University (OSU) impactor under intraperitoneal anesthesia. The animals were randomized to receive either PEG (1 g/kg)+MgSO4 (300 mg/kg) or saline (2 ml) via carotid vein after 2 hours of injury and then every 6 hours for 5 times. The behavioral outcome assessments were performed on days 2, 4 and 7, and then every week using the Basso, Bresnahan, and Beattie (BBB) score and subscore. The animals also underwent sensory threshold testing using a von Frey monofilament device and gait analysis with Catwalk program before and 6 weeks after cord injury. The animals were sacrificed at the end of 6 weeks and histologic assessment was performed to measure the areas of white and gray matter. RESULTS: For the animals treated with PEG+MgSO4 and saline, the mean BBB scores at 6 weeks post-injury were 13.3+/-0.3, 11.4+/-0.2 and the BBB subscores were 9.1+/-1.1, 4.4+/-1.2 respectively (p<0.05). No significant differences were found in sensory testing and gait analysis between the two groups. Histologic assessment revealed no significant difference in gray matter sparing but the areas of white matter at the lesion epicenter were 0.68+/-0.2, 0.41+/-0.04 mm2 in the PEG+MgSO4 and saline groups respectively, which indicated significant sparing of white matter in PEG+MgSO4 group (p<0.05). CONCLUSION: The combination therapy of polyethylene glycol and magnesium sulfate improved the motor function and showed significant histological sparing of the spinal cord after an acute spinal cord injury in rats.
Anesthesia ; Animals ; Gait ; Humans ; Laminectomy ; Magnesium ; Magnesium Sulfate ; Male ; Neuroprotective Agents ; Ohio ; Polyethylene ; Polyethylene Glycols ; Rats ; Sensory Thresholds ; Spinal Cord ; Spinal Cord Injuries ; Veins

PURPOSE: Retrograde intramedullary nailing has been recommended as one of the treatment options for the distal femoral fracture, particularly in patients who are obese, are pregnant, has sustained ipsilateral femoral neck fracture, have multiple injuries. However there are some disadvantage such as post-arthrotomy infection, knee joint stiffness. This paper is to evaluate the result and complication of treatment of distal femoral fracture with a retrograde intramedullary nailing. MATERIALS AND METHODS: We reviewed 13 cases (distal femoral shaft fracture: 6 cases, supracondylar fracture: 7 cases) of the distal femoral fracture who had been treated with retrograde intramedullary nailing and follow up for more than 12 months from January 1999 to December 2001. The rate of bony union, range of motion of the knee, complications were evaluated. RESULTS: The mean duration of bony union was 20 weeks (range, 16~25 weeks). A case of delayed union was developed. In 4 cases of 13 cases showed posterior angulation below 6 degree, which did not need further treatment. According to Saunder's criteria, excellent result was achieved in 8 patients, good result in 5 patients, respectively. CONCLUSION: This study showed good clinical and radiological results of union with retrograde intramedullary nailing at the distal femoral fracture and ipsilateral multiple fracture
Femoral Fractures ; Femoral Neck Fractures ; Follow-Up Studies ; Fracture Fixation, Intramedullary* ; Humans ; Knee ; Knee Joint ; Multiple Trauma ; Range of Motion, Articular

New surgical techniques utilizing computer-aided engineering have been recently developed to improve the quality of surgery and reduce the risk to patients. This paper reports the surgical cases using rapid prototyping assisted orthopeadic fracture surgery (RPAOFS). RPAOFS utilizes the symmetric characteristics of the human body, and the potential for RE and RP in which the physical shape is manufactured repidly from the CT data. The physical shape before the injury was manufactured from the RP using the mirror transformed CAD data of the uninjured extents. Subsequently, pre-operative planning, such as the selection of the proper implant, preforming of the implant, selection of the fixation positions, and surgery are performed utilizing the physical shape. RPAOFS was applied to two cases such as a distal tibia communited fracture and a proximal tibia plateau fracture. The surgical results showed that RPAOFS is an effective surgical tools.
Human Body ; Humans ; Surgery, Computer-Assisted ; Tibia