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

Cavernous hemangioma is the most common primary tumor occurred in adults' orbit. This tumor has symptoms characteristically developing over several years with slowly progressive proptosis, eyeball deviation, hyperopia, diplopia and optic nerve compression. It's removal, necessary when there is progressive exophthalmos and visual deficit, is best performed en bloc to avoid intraoperative vleeding, the risk of residue, and potential further growth. In principle, surgical approach to the orbit must provide maximum safety and optimal visualization. The noncompressibility of the globe imposes greater demand on the need for some removal of the osseous orbit for surgical approach. This also must permit immediate functional and aesthetic reconstruction. The authors have experienced a case of large cavernous hemangioma in the orbit inferomedially. The surgical treatment of tumor was achieved by inferomedial approach combined with inferolateral orbitotomy. This surgical approach allows better visualization of the tumor and greater protection of essential anatomic structures. This also permits immediate functional and aesthetic reconstruction. So we present our case with a brief review of the literature related to orbital cavernous hemangioma.
Diplopia ; Exophthalmos ; Hemangioma, Cavernous* ; Hyperopia ; Optic Nerve ; Orbit*

Many plastic surgeons have been tried to attain ultimate goal lies in restoring the original shape and function of the facial aesthetics, in reconstruction of deformities resulting from facial hypertrophic scar and skin defects. This would require consideration in terms of hanmony in color match, skin texture and thickness. Various forms of skin graft, local flap, distant flaps, free flap and tissue expander have been employed in restoring skin defects and deformities of the cheek and submental area, and the use of large local flaps utilizing the cervicofacial skin flaps or tissue expander have brought about improved aesthetic results. the authers have obtained satisfactory results in treating 2 cases of wide hypertrophic scar of the cheek and submental area with combination of wide cervical flap and intraoperative tissue expansion using foley catheter. the merits of this combined operative methods are as follows : 1. It is not necessory to keep tissue expander for a long period. 2. This technique is able to diminish the cost of multistage operation and using of tissue expander. 3. There is no psychologic problems due to undesirable facial appearance during tissue expansion period. 4. Rapid intraoperative tissue expansion by foley catheter during elevating wide cervical flap can allow to dissect one, preserving the perforators without bleeding in a short time. 5. Wide cervical flap and additional expanded tissue by means of intraoperative tissue expansion could brought into suturing avoiding tension of oral commissure and lip eversion. 6. Preservation of perforators of cervical flap above the platysma muscle raised flap's survival rate and then this result could prevent distal ischemic necrosis after flap coverage.
Catheters ; Cheek ; Cicatrix, Hypertrophic* ; Congenital Abnormalities ; Esthetics ; Free Tissue Flaps ; Hemorrhage ; Lip ; Necrosis ; Skin ; Survival Rate ; Tissue Expansion Devices ; Tissue Expansion* ; Transplants

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

BACKGROUND: NO (nitric oxide), derived from L-arginine through the action of nitric oxide synthase (NOS), is a short-lived free radical transmitting cellular signals for vasodilation, neurotransmission, and cytotoxicity. Recently, this molecule has been reported to be involved in the various glandular secretion. Although the relationship between NO and the pancreatic endocrine secretion has been widely investigated, the role of NO on insulin secretion has not been elucidated. Therefore, the present study was designed to reveal the precise action of NO on the secretion and synthesis of insulin following administration of NAME (L-NG -nitroarginine methyl ester) or L-arginine using immunocytochemistry and in situ hybridization techniques. METHODS: NAME or L-arginine was administered into jugular vein of the male Sprague-Dawley rat (180~200 g, b,w.) exhibiting normoglycemia (80~120mg/dL). Blood glucose concentrations were measured at intervals of 30 minutes for 2 hours after drug treatment. The pancreatic tissues were taken out at 30 and 90 minutes following drugs administration for insulin immunocytochemistry and in situ hybridization. RESULTS: Both NAME and L-arginine treatments diminished blood glucose levels. The decrease of blood glucose level was more prominent in NAME-treated rats than that of L-arginine. Insulin immunoreactivity in drugs-treated rat pancreas decreased compared to that in normal control, while the expression of insulin mRNA was significantly increased. CONCLUSION: On the basis of present study, it is concluded that the transient changes of NO con-centration, regardless of increase or decrease, in Langerhans islet might act as a potent stimulant in insulin secretion and its synthesis.
Animals ; Arginine ; Blood Glucose ; Humans ; Immunohistochemistry ; In Situ Hybridization ; Insulin* ; Jugular Veins ; Male ; Nitric Oxide Synthase ; Nitric Oxide* ; Pancreas* ; Rats* ; Rats, Sprague-Dawley ; RNA, Messenger ; Synaptic Transmission ; Vasodilation

Patients with pixie ear have an attached, tapering, and low-set earlobe. Traditional methods usually describe excision of the caudal portion of the lobule and reattachment in a more superior position. The present report suggests a simplified skin redraping method for correction of pixie ear. The procedure provides easy method to design and perform, which only requires elevation and trimming of the skin. Other ancillary procedures, such as flap design, anchoring, plication, and subdermal fixation, are not required. This method produces satisfactory results. Postoperative scar is invisible because the incision is on the retroauricular region, and the corrected earlobe has a more natural appearance than the repositioned earlobe. Moreover, skin redraping avoids tension, which contributes to minimization of the postoperative scar.

Coronary stent dislodgement is a rare complication of percutaneous coronary intervention. We report a rare case of dislodgement of two intracoronary stents. On withdrawal of two balloon catheters, one with a guide wire was mechanically distorted from the left main (LM) to the proximal left anterior descending artery (LAD) while the other was dislodged from the LM to the ostial left circumflex artery. The stent in the LAD could not be retrieved into the guide catheter using a Goose neck snare, because it was caught on a previously deployed stent at the mid LAD. A new stent was quickly deployed from the LM to the proximal LAD, because the patient developed cardiogenic shock. Both stents, including a distorted and elongated stent, were crushed to the LM wall. Stent deployment and crushing may be a good alternative technique to retrieving a dislodged stent.
Angioplasty, Balloon, Coronary/adverse effects/*instrumentation ; Cardiac Catheterization/adverse effects/*instrumentation ; Coronary Angiography ; Coronary Stenosis/diagnosis/*therapy ; Female ; Humans ; Middle Aged ; Prosthesis Failure ; Shock, Cardiogenic/etiology/therapy ; *Stents ; Treatment Outcome

No abstract available.
Catheters* ; Stents*

PURPOSE: We wanted to review the clinical results of staged reimplantation in patients who had candidal infection after total knee arthroplasty. MATERIALS AND METHODS: We reviewed five patients who had a candidal prosthetic knee infection, as was assessed by synovial fluid culture. Amphotericin B was intravenously administrated to all five patients during the postoperative period for six weeks and followed for at least twelve months. We carried out two-stage re-implantations with using antifungal agent-impregnated bone cement. Whether or not infection recurred was evaluated according to the symptoms and radiologic and hematologic studies. The clinical results were analyzed on the basis of the range of motion and hospital for special surgery (HSS) score. RESULTS: The final review showed that all of the symptoms disappeared. We could not find any loosening on the radiologic studies and all five patients had normal C-reactive protein values on serological exams. The mean postoperative range of motion was 1degrees (range: 0~5)~99degrees (range: 70~130) and the mean HSS score improved from 49.4 (range: 44~64) points to 73 (range: 65~90) after the re-implantation. CONCLUSION: We successfully controlled five candidal prosthetic knee infections by removing the components in conjunction with using an antifungal- impregnated bone cement and staged re-implantation after a 6 week course of intravenous antifungal drugs.
Amphotericin B ; Arthroplasty ; C-Reactive Protein ; Candida ; Humans ; Knee ; Postoperative Period ; Range of Motion, Articular ; Replantation ; Synovial Fluid

BACKGROUND/AIMS: Pancreatic acini of streptozotocin (STZ)-induced diabetic rats release amylase less than normal acini on cholecystokinin (CCK) stimulation. Pancreatic enzyme secretion has been closely related to the intracellular calcium concentration ([Ca2+]i) of the acinar cell. In the present study, sequential changes of the intracellular calcium signal which probably underlie the altered enzyme secretion in response to CCK-8 were investigated using pancreatic acini from diabetic rats. METHODS: Diabetic rats were prepared by single intravenous injection of STZ (70 mg/kg). Stimulating experiments with CCK-8 were performed 7 days later. Pancreatic acini were isolated by collagenase digestion. Amylase release and [Ca2+]i were measured by colorimethod and calcium imaging, respectively. The geometry of intracellular calcium signal was analyzed. RESULTS: Normal acini exhibited concentration-dependent [Ca2+]i increase and regular oscillatory calcium signal on CCK-8 stimulation. Amylase release was also concentration-dependent. However, diabetic acini showed significantly less [Ca2+]i increase, prolonged time to peak [Ca2+]i, decreased calcium spikes number, and decreased amylase release compared with normal acini. The decreased [Ca2+]i in diabetic acini was restored significantly by insulin treatment. CONCLUSIONS: Relatively decreased amylase release in diabetic pancreatic acini in response to CCK, appears to be associated with altered calcium signal due to insulin deficiency.
Amylases/*secretion ; Animals ; Calcium Signaling/*drug effects ; Diabetes Mellitus, Experimental/*physiopathology ; Pancreas/cytology/metabolism/*secretion ; Rats ; Rats, Sprague-Dawley ; Sincalide/*pharmacology