Hypervirulent Klebsiella pneumoniae (hvKp) infections are being increasingly reported globally, and cause severe central nervous system (CNS) and multiorgan infections even in immunocompetent individuals. The recent emergence of hvKp antibiotic resistance has generated escalating concern about effective infection control for this potentially neuroinvasive pathogen. Herein, we report two cases of Klebsiella pneumoniae-related CNS infection, including one patient with antimicrobial-resistant hvKp, confirmed by string test that demonstrated a hypermucoviscous phenotype.

OBJECTIVES: To find the main cause of facial nerve dysfunction in vestibular schwannoma (VS) surgery and review the prognosis of facial function in relation to tumor size, preoperative facial function and surgical approach. METHODS: We reviewed the surgical outcome of 134 patients with VS treated in our department between 1994 and 2008. All patients included in the study had postoperative facial paralysis after surgical management of their VS. There were 14 women and 7 men. The mean age was 48.5 years, with a mean follow-up period of 57 months. RESULTS: Twenty-one patients (sustained facial palsy, 4; newly developed facial palsy, 17) had facial nerve paralysis after surgery: ten patients in large VS and eleven patients in small VS. In large VS group, 4 patients had facial nerve function of HB grade II, 3 patients had HB grade III, and 3 patients had HB grade IV. In small VS group, 9 patients had HB grade II and 2 patients had HB grade IV. Middle cranial fossa approach rather than translabyrinthine approach for the preservation of hearing, led to facial nerve deterioration and the patients who had facial nerve paralysis perioperatively, had resulted in permanent facial paralysis. CONCLUSION: The tumor size in VS is certainly one of the most important prognostic factors. However, VS tumor size alone should not be considered a unique prognostic indicator. The surgical approach used, which may be related to tumor size, based on the surgeon's experience, can be a deciding factor, and the status of the facial nerve injured by the tumor can influence postoperative facial nerve function.
Cranial Fossa, Middle ; Facial Nerve ; Facial Paralysis ; Female ; Follow-Up Studies ; Hearing ; Humans ; Male ; Neuroma, Acoustic ; Paralysis ; Prognosis

PURPOSE: The purpose of this study is to investigate peculiar patterns of facial asymmetry following incomplete recovery from facial paralysis that require optimal physical therapy for effective facial rehabilitation, and to decrease the incidence of avoidable facial sequelae. MATERIALS AND METHODS: This study involved 41 patients who had facial sequelae following the treatment of various facial nerve diseases from March 2000 to March 2007. All patients with a follow-up of at least 1 year after the onset of facial paralysis or hyperactive function of the facial nerve were evaluated with the global and regional House-Brackmann (HB) grading systems. The mean global HB scores and regional HB scores with standard deviations were calculated. Other factors were also analyzed. RESULTS: Four patterns of facial asymmetry can be observed in patients with incomplete facial recovery. The most frequently deteriorated facial movement is frontal wrinkling, followed by an open mouth, smile, or lip pucker in patients with sequelae following facial nerve injury. The most common type of synkinesis was unintended eye closure with an effort to smile. CONCLUSION: We described common configurations of facial asymmetry seen in incomplete recovery following facial nerve injury in an attempt to develop an optimal strategy for physical therapy for complete and effective facial recovery, and to decrease the incidence of avoidable sequelae.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Face/physiopathology ; Facial Asymmetry/*physiopathology ; Facial Nerve/pathology ; Facial Nerve Injuries/physiopathology/therapy ; Facial Paralysis/physiopathology/*therapy ; Female ; Humans ; Male ; Middle Aged ; Reproducibility of Results ; Treatment Outcome

In the management of advanced maxillary sinus cancer, sometimes it requires an extensive ablation and orbital exenteration that results in large and full defects of the cheek and orbital regions. Reconstruction of large orbital-maxillary defects can be accomplished in one stage by microsurgical free transfer of rectus abdominis myocutaneous flap. The muscle component is suitable to fill the orbital and maxillary cavities, and the skin components are used for cheek, palate and lateral nasal cavity wall reconstruction as a three-dimentional folded free flap. Major problems with this flap are the bulkiness, the possibility of abdominal hernia and muscle weakness following the removal of the rectus abdominis muscle. Free deep inferior epigastric artery skin flap without rectus abdominis muscle is available in the reconstruction of large orbital-maxillary defect without the problems of the rectus abdominis myocutaneous free flap. We experienced one case of rectus abdominis myocutaneous free flap, and one other case of inferior rectus abdominis free flap for the reconstruction of huge surgical defects due to radical maxillectomy with orbital excenteration. Both of the patients were satisfied and there have been no severe complication associated with these technique.
Cheek ; Epigastric Arteries ; Free Tissue Flaps* ; Hernia, Abdominal ; Humans ; Maxillary Sinus Neoplasms* ; Maxillary Sinus* ; Muscle Weakness ; Myocutaneous Flap ; Nasal Cavity ; Orbit ; Palate ; Rectus Abdominis* ; Skin

Mucocele is a benign, encapsulated lesion, lined by epithelium and filled with mucus. Found mostly in the frontal and ethmoid sinus, sinonasal mucoceles cause several symptoms depending on the location. We report a case of mucocele found in the petrous apex that caused ear fullness. It was completely treated with endoscopic sphenoid marsupialization.
Ear ; Epithelium ; Ethmoid Sinus ; Mucocele ; Mucus ; Petrous Bone ; Sphenoid Sinus

Hypernatremia, defined as a rise in the serum sodium concentration to a value exceeding 145 mM/L, is a common electrolyte disorder. Diabetes insipidus is a common cause of hypernatremia, caused by impaired production or reduced responses to vasopressin. The resultant morbidity may be inconsequential, serious, or even life-threatening. However, hypernatremia rarely occurs during anesthesia and surgery. A 45-year-old female patient with craniopharyngioma was scheduled for tumor resection. Hypernatremia (serum sodium, 170 mM/L) occurred suddenly at the end of the surgery. To treat hypernatremia, 0.45% normal saline was used. Although serum sodium concentration was reduced faster than expected, the patient did not have any complications.
Anesthesia ; Anesthesia, General ; Craniopharyngioma ; Diabetes Insipidus ; Female ; Humans ; Hypernatremia ; Sodium ; Vasopressins

Medial femoral cutaneous nerve(MFCN), a sensory branch of the femoral nerve, supplies the skin over the anteromedial aspect of the thigh and knee. Posterior femoral cutaneous nerve(PFCN), comprised of fibers originating from the anterior and posterior divisions of the first three sacral segments, supplies the skin over the posterior aspect of the thigh. Forty nerves of twenty healthy adults, ages from 20 to 58, were tested. The onset and peak latencies of MFCN were 2.3+/-0.2 ms and 2.9+/-0.2 ms respectively. The baseline to peak amplitude was 6.5+/-2.3 V. The onset and peak latencies of PFCN were 2.4+/-0.2 ms and 2.9+/-0.2 ms respectively. The baseline to peak amplitude was 7.1+/-1.7 V.
Adult ; Equipment and Supplies ; Femoral Nerve ; Humans ; Knee ; Skin ; Thigh

Achieving periodontal regeneration in class III furcation defects is challenging. Many studies have applied growth factors to periodontal defects, including fibroblast growth factors (FGFs), which demonstrate angiogenic activity and mitogenic ability. This study aimed to evaluate periodontal regeneration following the application of FGF-2 to deproteinized bovine bone mineral (DBBM) in surgically created supra-alveolar class III furcation defects of the mandibular premolars of beagles. The defects were divided into the control, DBBM, and FGF/DBBM groups. For the control group, only root planing was performed. For the DBBM group, only DBBM particles were implanted into the furcation. For the FGF/DBBM group, DBBM was soaked with 0.3% FGF-2 solution, and FGF-2/ DBBM was then positioned into the furcation. After 8 weeks, the dogs were euthanized. The micro-computed tomography analysis revealed that the changes in the bone volume of the furcation area were significantly greater in the FGF/DBBM group than in the DBBM group. In the histomorphometric analysis, the area of the newly formed bone was significantly greater in the FGF/DBBM group than in the DBBM or control group. The cementum extension was significantly longer in the FGF/DBBM or DBBM group than in the control group. The epithelial area was significantly less in the FGF/DBBM group than in the DBBM or control group. The application of FGF combined with DBBM to a class III defect enhanced the regeneration of periodontal tissues and increased the healing rate. This finding indicates that FGF-2 combined with DBBM can be applied to class III defects clinically.

PURPOSE: Multiple trauma is one of the major causes of deaths and physical disabilities of the young. Thus, a trauma scoring system which is easy, fast, and accurate is the most important factor for reducing the mortality due to multiple trauma. As studies have shows the systemic inflammatory response syndrome (SIRS) score is useful in estimating the severity of and determining the prognosis of the disease, so we investigated the usefulness of the SIRS score as a trauma score. METHODS: This study was a retrospective analysis of data collected from January 2002 to December 2002. Three hundred sixity nine trauma patients who were admitted to the emergency department were included. Patients who were transferred from other hospitals, children under the age of 15 years and patients transferred to other hospitals for ICU care and emergency operations were excluded. The SIRS score was defined according to the criteria of the American College of Chest Physicians and the Society of Critical Care Medicine (ACCP/SCCM). Patients were grouped by using the SIRS score(0 to 4) calculated at admission. RESULTS: Among the 369 trauma patients, 174 patients (47.2%) had a SIRS score > or =2 at admission, and 30 of the 369 patients expired. The admission SIRS score was significantly correlated with the injury severity score (ISS). The mortality rate and the length of stay (LOS) significantly increased as the admission SIRS score increased. Analysis of the variance, adjusting for age and ISS, should that are SIRS score> or =2 was a significant predictor of mortality and LOS. CONCLUSION: The admission SIRS score has been shown to be useful in estimating the severity of and the prognosis for a trauma. If we apply it to the trauma patients who visit ED, it should provide a more useful means for determining the severity of the trauma and the prognosis for the patient.
Cause of Death ; Child ; Critical Care ; Emergencies ; Emergency Service, Hospital ; Humans ; Injury Severity Score ; Length of Stay ; Mortality ; Multiple Trauma ; Prognosis ; Retrospective Studies ; Systemic Inflammatory Response Syndrome* ; Thorax

BACKGROUND AND OBJECTIVES: Pediatric otitis media is closely related to upper respiratory illness and is one of the most common causes of hospital visiting and antibiotic prescription. Although there are many studies of asthma with other upper respiratory tract infections, few studies have investigated the relationship between asthma and otitis media. This study estimated whether pediatric otitis media is associated with the risk of asthma using the Korean National Health Insurance Service National Sample Cohort (NHIS-NSC 2002-2013) data. SUBJECTS AND METHOD: In using the NHIS-NSC 2002-2013 data, children diagnosed as otitis media or bronchial asthma in 2002 were excluded from children from 1 to 8 years old in 2003. The patients who were diagnosed and treated as otitis media (n=8506) and the comparison group (n=65886) were enrolled in 2003. During a 10-year follow-up period until December 2013, the incidence of asthma between two groups was analyzed and the result was adjusted for the impact of comorbidities such as atopic dermatitis, allergic rhinitis with multivariate linear regression analyses. RESULTS: In 2003, 20.88% of first-year-old children were treated with otitis media. The prevalence of otitis media was maintained at 15% until age 4 and decreased rapidly after 5 years of age. Asthma incidence was reported higher in patients with otitis media compared to the comparison group, with an adjusted odds ratio of 1.196 [95% confidence interval (CI) 1.127-1.269] followed by patients with atopic dermatitis [hazard ratio (HR) 1.261, 95% CI 1.196-1.33], allergic rhinitis (HR 1.473, 95% CI 1.409-1.54). CONCLUSION: Pediatric otitis media appeared to be associated with an increased risk of developing bronchial asthma after adjusting for other risk factors.
Asthma* ; Child ; Cohort Studies ; Comorbidity ; Dermatitis, Atopic ; Follow-Up Studies ; Humans ; Incidence ; Linear Models ; Methods ; National Health Programs ; Odds Ratio ; Otitis Media* ; Otitis* ; Prescriptions ; Prevalence ; Respiratory Tract Infections ; Rhinitis, Allergic ; Risk Factors