De Quervain's disease is the most common form of tenosynovitis, which causes disability in daily living and occupational activity. Anatomical variations in the first extensor compartment including separate comparment influenced the effects of treatment. A 45-year-old woman had severe pain on wrist and suffered in activity of daily living after motor vehicle accident. She had swelling and tenderness upon the radial styloid process, and more aggravated pain by Finkelstein's maneuver test. The magnetic resonance imaging (MRI) scans showed severe peritendinous edema within the synovial sheath, increased signal intensity within the tendons. Also, the images revealed a thickened septum between abductor pollicis longus and extensor pollicis brevis. Corticosteroid was injected on both sides of the septum. We report a case of definite septum of de Quervain's disease via MRI scans.
De Quervain Disease* ; Edema ; Female ; Humans ; Magnetic Resonance Imaging* ; Middle Aged ; Motor Vehicles ; Tendons ; Tenosynovitis ; Wrist

Sudden sensorineural hearing loss has been reported to occur following anesthesia and various non-otologic surgeries, mostly after procedures involving cardiopulmonary bypass. Unilateral sensorineural hearing loss resulting from microembolism is an infrequent complication of cardiopulmonary bypass surgery that has long been acknowledged. Moreover, there are few reports on the occurrence of bilateral sensorineural hearing loss without other neurologic deficits and its etiology has also not been determined. We describe here a rare case of bilateral hearing loss without other neurologic deficits in an otherwise healthy 27-year-old woman who underwent cardiopulmonary bypass surgery for repair of severe mitral valve stenosis. The patient suffered from profound sensorineural hearing loss in both ears that was recognized immediately upon extubation, and audiometry tests confirmed the diagnosis. Without any treatment, her hearing recovered almost completely by the time of her discharge one week after surgery.
Adult ; Anesthesia ; Audiometry ; Cardiopulmonary Bypass ; Ear ; Female ; Hearing ; Hearing Loss ; Hearing Loss, Bilateral ; Hearing Loss, Sensorineural ; Humans ; Mitral Valve Stenosis ; Neurologic Manifestations ; Postoperative Complications

65-year-old woman was admitted to our hospital with acute decompensated heart failure with reduced left ventricular ejection fraction and severe mitral regurgitation. Electrocardiography revealed a typical left bundle branch block and atrial fibrillation. Her condition deteriorated despite administering high-doses of inotropes and vasopressors. Pending a decision to therapy, venoarterial extracorporeal membrane oxygenation (ECMO) was performed when the patient underwent a cardiogenic shock. Although the hemodynamic status stabilized with ECMO support, weaning the patient from ECMO was not possible. Thus, we decided to perform cardiac resynchronization with defibrillator implantation as a “rescue” therapy. Five days post-implantation, the patient was successfully weaned from ECMO.
Aged ; Atrial Fibrillation ; Bundle-Branch Block ; Cardiac Resynchronization Therapy* ; Defibrillators ; Electrocardiography ; Extracorporeal Membrane Oxygenation ; Female ; Heart Failure ; Hemodynamics ; Humans ; Mitral Valve Insufficiency ; Shock, Cardiogenic* ; Stroke Volume ; Weaning

PURPOSE: As a common and dangerous disease, an abdominal aortic aneurysm (AAA) occurs in approximately 2-4% of the general population and recently the incidence of AAA has been gradually increasing in Korea. Since rupture of an AAA is recognized as a lethal event, a more aggressive policy of early diagnosis and of an elective repair of the AAA are that can be performed with a mortality rate of less than 5 percent is the approach of choice for treating an AAA nowadays. METHODS: This retrospective study reports our experience managing forty-two patients with an AAA who had been operated on between January 1993 and December 1999 at Korea University hospitals. RESULTS: Thirty- seven of the patients were male, and five were female. The mean age was 67.1 years. The most common clinical manifestation was abdominal pain in 26 cases (61.9%), followed by abdominal pulsatile mass in 20 cases (47.6%), and back pain in 12 cases (28.5%). The most common associated disease was hypertension in 24 cases (57.1%). An abdominal CT scan was performed in 26 cases (61.9%) and was the most commonly used method for diagnosis. Emergency repair of the AAA was performed in 10 cases; the repair was performed electively in the other cases. Among the 42 aortic grafts implanted for AAA repair, 37 were bifurcated Y grafts and 4 were straight tube grafts. Axillobifemoral bypass surgery was performed in the case of one infected aneurysm. Among the 42 cases, 10 cases (23.8%) experienced ruptures, requiring 4 urgent operation and 6 emergency procedures. Among the 42 cases, 6 patients (14.2%) expired. In the elective cases, one (3.1%) expired. In the urgent cases, one (25.0%) expired, and in the emergency cases, four (66.6%) expired. CONCLUSION: This study showed that an AAA should be considered as a possible cause of unexplained abdominal pain in aged patients. In such patients, various diagnostic tools must be used to eliminate the possibility of an abdominal aortic aneurysm. Early diagnosis and elective surgery are crucial for a better outcome in the management of patients with an abdominal aortic aneurysm.
Abdominal Pain ; Aneurysm, Infected ; Aortic Aneurysm ; Aortic Aneurysm, Abdominal* ; Aortic Rupture ; Back Pain ; Diagnosis ; Early Diagnosis ; Emergencies ; Female ; Hospitals, University ; Humans ; Hypertension ; Incidence ; Korea ; Male ; Mortality ; Retrospective Studies ; Rupture ; Tomography, X-Ray Computed ; Transplants

Myotonic dystrophy is a rare genetic disorder characterized by muscle atrophy and weakness. Surgical treatment of this condition poses various problems for the anesthesiologist. We describe the anesthetic management of a 10-month-old infant with congenital myotonic dystrophy, who was scheduled for endoscopic third ventriculostomy under general anesthesia. Anesthesia was induced with thiopental sodium, fentanyl, and vecuronium, and thereafter maintained via continuous infusion of propofol and remifentanil. The train-of-four ratio was monitored throughout the operation, and muscle relaxation was reversed with pyridostigmine and glycopyrrolate at the end of the procedure. We show that total intravenous anesthesia using propofol and remifentanil is a satisfactory anesthetic technique in very young patients with congenital myotonic dystrophy.
Anesthesia ; Anesthesia, General ; Anesthesia, Intravenous ; Fentanyl ; Glycopyrrolate ; Humans ; Infant ; Muscle Relaxation ; Muscular Atrophy ; Myotonic Dystrophy ; Piperidines ; Propofol ; Pyridostigmine Bromide ; Thiopental ; Vecuronium Bromide ; Ventriculostomy

Bronchial invasion of tuberculous lymphadenitis in children has been reported in areas of high tuberculosis (TB) prevalence as a complication due to primary pulmonary tuberculosis. However, it is rare in immunocompetent adults. When it appears, it often presents as a consequence of the reactivation of TB in the lung parenchyma. Primary TB occurs more frequently in patients with human immunodeficiency virus (HIV), with a history of organ transplants, or undergoing immunosuppressive treatments such as steroids. Furthermore, bronchial invasion of the bronchus by tuberculous lymphadenitis is considered to be very rare even among immunocompromised adults with primary TB, and has never before been reported in Korea. The authors report a case of bronchial invasion of the bronchus by tuberculous lymphadenitis, confirmed by bronchoscopy, in an Acquired Immunodeficiency Syndrome (AIDS) patient.
Acquired Immunodeficiency Syndrome ; Adult ; Bronchi ; Bronchoscopy ; Child ; Fistula ; HIV ; Humans ; Korea ; Lung ; Lymph Nodes ; Prevalence ; Steroids ; Transplants ; Tuberculosis ; Tuberculosis, Lymph Node ; Tuberculosis, Pulmonary

BACKGROUND: From May to July 2015, the Republic of Korea experienced the largest outbreak of Middle East respiratory syndrome (MERS) outside the Arabian Peninsula. A total of 186 patients, including 36 deaths, had been diagnosed with MERS-coronavirus (MERS-CoV) infection as of September 30th, 2015. MATERIALS AND METHODS: We obtained information of patients who were confirmed to have MERS-CoV infection. MERS-CoV infection was diagnosed using real-time reverse-transcriptase polymerase chain reaction assay. RESULTS: The median age of the patients was 55 years (range, 16 to 86). A total of 55.4% of the patients had one or more coexisting medical conditions. The most common symptom was fever (95.2%). At admission, leukopenia (42.6%), thrombocytopenia (46.6%), and elevation of aspartate aminotransferase (42.7%) were observed. Pneumonia was detected in 68.3% of patients at admission and developed in 80.8% during the disease course. Antiviral agents were used for 74.7% of patients. Mechanical ventilation, extracorporeal membrane oxygenation, and convalescent serum were employed for 24.5%, 7.1%, and 3.8% of patients, respectively. Older age, presence of coexisting medical conditions including diabetes or chronic lung disease, presence of dyspnea, hypotension, and leukocytosis at admission, and the use of mechanical ventilation were revealed to be independent predictors of death. CONCLUSION: The clinical features of MERS-CoV infection in the Republic of Korea were similar to those of previous outbreaks in the Middle East. However, the overall mortality rate (20.4%) was lower than that in previous reports. Enhanced surveillance and active management of patients during the outbreak may have resulted in improved outcomes.
Antiviral Agents ; Aspartate Aminotransferases ; Coronavirus Infections* ; Disease Outbreaks ; Dyspnea ; Extracorporeal Membrane Oxygenation ; Fever ; Humans ; Hypotension ; Leukocytosis ; Leukopenia ; Lung Diseases ; Middle East Respiratory Syndrome Coronavirus ; Middle East* ; Mortality ; Pneumonia ; Polymerase Chain Reaction ; Republic of Korea* ; Respiration, Artificial ; Thrombocytopenia