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

No abstract available.
Endoderm* ; Endodermal Sinus Tumor*

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

No abstract available.
Ear Cartilage ; Ectropion ; Eyelids ; Transplants

No abstract available.
Humans ; Plasma* ; Tranexamic Acid* ; Urticaria*

No abstract available.
Breast Neoplasms* ; Breast*

Segmentally distributed cutaneous eruptions and neuralgia are common manifestations of herpes zoster. However, motor loss is another aspect of this manifestation, which is less well known and considered a rare finding. In many cases the loss of motor function may be easily overlooked because the pain is the more prominent feature and the weakness probably goes unrecognized with only a mild impairment of the motor function. We experienced a 71-year-old male patient with a herpes zoster-related motor paralysis of right arm whose clinical features of a weak limb mimicked other spinal motor diseases and confirmed motor involvement using electromyographic (EMG) and motor nerve conduction velocity (MNCV) studies.
Aged ; Arm ; Extremities* ; Herpes Zoster* ; Humans ; Male ; Neural Conduction ; Neuralgia ; Paralysis*

BACKGROUND: Tourniquet pain is probably mediated by C-fiber. The ability of fentanyl to interrupt this nociceptive conduction was studied by administering either fentanyl or saline intrathecally along with hyperbaric bupivacaine for spinal anesthesia. METHOD: The incidence of tourniquet pain was evaluated in 60 patients having orthopedic surgery of the lower extremities during spinal anesthesia by administering either 30 mcg fentanyl (group 2) or saline (group 1) along with 0.5% hyperbaric bupivacaine 10 mg. We measured the maximal sensory spread of analgesia to pinprick, the incidence of tourniquet pain, and the sensory anesthesia to pinprick at the onset of tourniquet pain. RESULTS: The average maximal sensory spread of analgesia was the same in both groups (T9). The incidence of tourniquet pain was significantly greater in group 1 (33%) than in group 2 (10%). The sensory levels of anesthesia at the onset of tourniquet pain were not different in two groups. CONCLUSIONS: Intrathecal fentanyl was effective against tourniquet pain for 2 hours of the orthopedic surgery of the lower extremities.
Analgesia ; Anesthesia ; Anesthesia, Spinal* ; Bupivacaine* ; Fentanyl* ; Humans ; Incidence ; Lower Extremity ; Orthopedics ; Tourniquets*

OBJECTIVE: We analyzed the frequency, clinical symptom, physical exam, site and the degree of torsion, ultrasound findings, histological aspects and the relationship between the pregnancy of ovarian torsion in order to help the early detection of the disease and conservation of the ovary. METHODS: Out of 510 operative cases of adnexal mass patients in Dongguk university hospital from March 1993 to March 2003, 50 histologically confirmed cases of ovarian torsion were selected and retrospectively analyzed. RESULTS: Operative cases of adnexal mass were 510 including the 42 complicated by pregnancy and out of these, torsion occurred in 50 cases (10%) with 16 pregnancy complication. Clinical features of 50 torsion cases are as follows. The frequencies of uterine adnexal tumor torsion were reported by age, 36 cases (72%) in their twenties and thirties, with 21 (42%) nulliparous women at the highest. 42 (84%) had no previous operative history. On the clinical features and physical exam, in the order of frequency, 48 cases (96%) of lower abdominal pain were the highest, and 42 (84%) of GI symptoms, 11 (22%) of urogenital symptoms, and 4 cases (8%) of vaginal bleeding was noted. Under CBC study, 28 (56%) leukocytosis were reported. And on the ultrasound findings, 46 cases (90%) of tumor with hypertrophic wall were noted, septum existed in 12 cases (24%), and 40 (78%) represented internal shadow of the solid portion. The tumor size between 5 to 9 centimeters were the most with 30 cases (58%), and the sum of torsions with 360 and 720 degrees consisted of 40 (78%), occupying for the most of the cases. 27 (55%) of right side existed compared to the 22 (45%) of left. 42 had no previous transabdominal surgery. In the method of operation, 41 (82%) explorative surgeries and 9 cases (18%) of laparoscopic surgery was done, and 5 of these were conservative (12%). The necrosis was noted in 44 cases, and internal bleeding was present in 39 cases. Histologically, functional cyst consisted highest in numbers with 25 (49%), where benign neoplasm with 22, and one malignant neoplasm. About relationship with pregnancy, 9 cases (56%) of corpus luteal cyst were the most. Outcome of the pregnancy was 9 (56%) full term deliveries, 2 abortions (12%), and 1 (6%) preterm delivery. CONCLUSION: Ovarian torsion should be considered when women in between their twenties and thirties with abrupt onset of lower abdominal pain along with nausea and vomiting, leukocytosis, and 5 to 9 cm sized cystic mass with the wall hypertrophy present in ultrasound. Immediate and accurate diagnosis and treatment should follow.
Abdominal Pain ; Diagnosis ; Female ; Hemorrhage ; Humans ; Hypertrophy ; Laparoscopy ; Leukocytosis ; Nausea ; Necrosis ; Ovary ; Pregnancy ; Pregnancy Complications ; Retrospective Studies ; Ultrasonography ; Uterine Hemorrhage ; Vomiting

OBJECTIVE: We analyzed the frequency, clinical symptom, physical exam, site and the degree of torsion, ultrasound findings, histological aspects and the relationship between the pregnancy of ovarian torsion in order to help the early detection of the disease and conservation of the ovary. METHODS: Out of 510 operative cases of adnexal mass patients in Dongguk university hospital from March 1993 to March 2003, 50 histologically confirmed cases of ovarian torsion were selected and retrospectively analyzed. RESULTS: Operative cases of adnexal mass were 510 including the 42 complicated by pregnancy and out of these, torsion occurred in 50 cases (10%) with 16 pregnancy complication. Clinical features of 50 torsion cases are as follows. The frequencies of uterine adnexal tumor torsion were reported by age, 36 cases (72%) in their twenties and thirties, with 21 (42%) nulliparous women at the highest. 42 (84%) had no previous operative history. On the clinical features and physical exam, in the order of frequency, 48 cases (96%) of lower abdominal pain were the highest, and 42 (84%) of GI symptoms, 11 (22%) of urogenital symptoms, and 4 cases (8%) of vaginal bleeding was noted. Under CBC study, 28 (56%) leukocytosis were reported. And on the ultrasound findings, 46 cases (90%) of tumor with hypertrophic wall were noted, septum existed in 12 cases (24%), and 40 (78%) represented internal shadow of the solid portion. The tumor size between 5 to 9 centimeters were the most with 30 cases (58%), and the sum of torsions with 360 and 720 degrees consisted of 40 (78%), occupying for the most of the cases. 27 (55%) of right side existed compared to the 22 (45%) of left. 42 had no previous transabdominal surgery. In the method of operation, 41 (82%) explorative surgeries and 9 cases (18%) of laparoscopic surgery was done, and 5 of these were conservative (12%). The necrosis was noted in 44 cases, and internal bleeding was present in 39 cases. Histologically, functional cyst consisted highest in numbers with 25 (49%), where benign neoplasm with 22, and one malignant neoplasm. About relationship with pregnancy, 9 cases (56%) of corpus luteal cyst were the most. Outcome of the pregnancy was 9 (56%) full term deliveries, 2 abortions (12%), and 1 (6%) preterm delivery. CONCLUSION: Ovarian torsion should be considered when women in between their twenties and thirties with abrupt onset of lower abdominal pain along with nausea and vomiting, leukocytosis, and 5 to 9 cm sized cystic mass with the wall hypertrophy present in ultrasound. Immediate and accurate diagnosis and treatment should follow.
Abdominal Pain ; Diagnosis ; Female ; Hemorrhage ; Humans ; Hypertrophy ; Laparoscopy ; Leukocytosis ; Nausea ; Necrosis ; Ovary ; Pregnancy ; Pregnancy Complications ; Retrospective Studies ; Ultrasonography ; Uterine Hemorrhage ; Vomiting