Post-traumatic pseudoaneurysm of the carotid artery is extremely rare but present with progressively severe, often fatal epistaxis. Because temporal course of epistaxis in patients with traumatic pseudoaneurysm of the carotid artery commonly demonstrates a variable latency period, pseudoaneurysm is often a clinical challenge. Optimal management for this diseases demands rapid recognition and treatment to give the best functional outcome. The authors have experienced three cases of traumatic pseudoaneurysm of the carotid artery resulting in massive epistaxis and showing unusual clinical course that were successfully treated with endovascular techniques. In two patients, pseudoaneurysm formation resulted from hemorrhage of the internal carotid artery (ICA). The other one case resulted from the external carotid artery (ECA).
Aneurysm, False* ; Carotid Arteries ; Carotid Artery, External ; Carotid Artery, Internal* ; Endovascular Procedures ; Epistaxis* ; Hemorrhage ; Humans ; Latency Period (Psychology)

BACKGROUND: Malnutrition-inflammation complex syndrome (MICS) is common in maintenance hemodialysis (MHD) patients and may be related to a poor outcome. However, there is little evidence showing MICS to be a risk factor for atherosclerosis. The aim of this study was to determine if MICS is associated with the atherosclerotic markers such as abdominal aortic calcification (AAC) and pulse wave velocity (PWV) in MHD patients. METHODS: Eighty MHD patients were selected in Kangbuk Samsung Hospital (male: female=50:30, age 58+/-14 years). The nutritional status was assessed by the Subjective Global Assessment (SGA), biochemical measurement and the normalized protein equivalent of the total nitrogen appearance (nPNA). The presence of inflammatory reaction was assessed by the C-reactive protein (CRP). The malnutrition-Inflammation Score (MIS) was used to assess MICS. A lateral lumbar radiogram was used to evaluate the AAC index. Brachial-ankle (ba) PWV using automatic device was performed. RESULTS: Malnourished patients had a higher MIS than the well nourished patients (8.7+/-3.6 vs. 4.0+/-1.8, p<0.001). Patients with inflammation (CRP3 mg/L) showed a higher MIS than patients without inflammation (7.6+/-4.6 vs. 5.7+/-3.3, p=0.045). There was no correlation between the MIS and the AAC index (r=0.157, p=0.191) and baPWV (r= 0.144, p=0.323). CONCLUSION: These results suggest that the MIS is a useful marker of MICS in MHD patients. However, the MIS was not directly related to the AAC index and baPWV. This report highlights the importance of assessing the MICS and atherosclerosis in MHD patients.
Atherosclerosis* ; C-Reactive Protein ; Humans ; Inflammation ; Malnutrition ; Nitrogen ; Nutritional Status ; Pulse Wave Analysis ; Renal Dialysis* ; Risk Factors

BACKGROUND AND OBJECTIVES: Anterior attic bony plate (cog) is a coronally oriented bony septum which is suspended from the anterior petrosal tegmen, and the anterior epitympanic recess is partitioned from epitympanum by this bony plate. It is an important pathway for anterior drainage which can cause inflammation in obstructed conditions; therefore, it needs appropriate procedure to eradicate the lesions without recurrence. We aimed to classify types of the anterior attic bony plates on the temporal bone CT and to find correlation between the types of the anterior attic bony plates and the development of chronic otitis media and cholesteatoma. MATERIALS AND METHODS: We reviewed 264 cases of the temporal bone CT of the normal and the chronic otitis media patients, of which 64 cases were excluded as lesions could not be identified due to severe destruction and obscurity of the figure. RESULTS: In normal ears, the incidence of the anterior attic bony plate was 67% in the plate type, 28% in the pyramid type, and 5% in the anterior type. In the diseased ear, the incidences were 40%, 44%, 16%, in the plate type, pyramid type, and anterior type, respectively and in the cholesteatoma ear, 30%, 43%, 27%, respectively. The difference of incidence was statistically significant. CONCLUSION: We assumed that the development of the chronic otitis media is related to the type of the anterior attic bony plate in some degree. Especially, the anterior type was more prominent in cholesteatoma than in noncholesteatoma with a statistical significance. Further studies are needed to figure out the correlation between the type of the anterior attic bony plate and it's clinical importance.
Cholesteatoma ; Classification* ; Drainage ; Ear ; Humans ; Incidence ; Inflammation ; Otitis Media ; Recurrence ; Temporal Bone* ; Ventilation

BACKGROUND AND OBJECTIVES: An isolated sphenoid sinus lesion is a rare disorder and is difficult to diagnose for several reasons. This lesion can easily spread to the adjacent structures and lead to severe complications. Thus, early diagnosis and treatments are needed. We experienced 17 cases of isolated sphenoid sinus lesions, including inflammatory, neoplastic, and vascular lesions, and reviewed the clinical findings, radiologic features, treatments and complications of these cases. MATERIALS AND METHOD: Isolated sphenoid sinus lesions were reviewed retrospectively of patients from January 1995 to July 2001. Patients were identified with radiologic findings and intraoperative endoscopic findings excluding other paranasal sinus involvements. RESULTS: The most common symptom was headache, and 13 patients (76%) complained. Nasal symptoms appeared only 4 patients (23%). Pathologic reviews showed 9 cases of acute and chronic sinusitis were 9 cases, 4 fungal sinusitis, 2 neoplastic diseases, 1 polyp, and 1 vascular disease. We carried out medical treatment in 5 cases, and diagnostic biopsy in 3 cases, and therapeutic surgery in 10 cases. In 7 cases, complications including cranial nerve palsy were observed, and 1 patient was expired due to meningitis. CONCLUSION: We can diagnose isolated sphenoid sinus lesions exactly with the use of radiologic findings and endoscopic examinations. With endoscopy, we can operate relatively less invasively and more effectively. It is apparent that early recognition and rapid treatment are essential if complications are to be avoided.
Biopsy ; Cranial Nerve Diseases ; Early Diagnosis ; Endoscopy ; Headache ; Humans ; Meningitis ; Polyps ; Retrospective Studies ; Sinusitis ; Sphenoid Sinus* ; Vascular Diseases

Autosomal dominant polycystic kidney disease (ADPKD) is one of most common hereditary disorders that is potentially fatal. To elucidate clinical and genetic characteristics of ADPKD in Korea, 166 patients were analyzed retrospectively. The results were as follows ; 1) The male-to-female ratio was 83: 83, and age of patients was 4813(meanSD) years. 6496 of patients have a family history of the ADPKD. 2) Most common symptom was flank and ab- dominal pain. In urinalysis, proteinuria(42%), hematuria(18%) were found. Other organ involvement included hepatic cysts(58%), pancreatic cysts(8%) and splenic cyst(296). 3) The age at diagnosis was 44% 12 years. Hypertension was observed in 65%, the age of detection was 45% 11 years. Azotemia was observed in 36%, the age of detection was 52 +/- 11 years. 4) Echocardiography showed left ventricular hypertrophy 5896(19/33), valve regurgitation 1596(5/33) and mitral valve prolapse 3%(1/33). Cerebrovascular events occurred in 14 patients(8.4%), and 6 patients confirmed cerebral aneurysm rupture. 5) 29 patients(17%) reached end stage renal fail- ure(ESRD), the age was 53 +/- 10 years. The provability of being alive and not having ESRD was 88% by age 50, 76% by age 58, and 48% by age 65. Sex and hepatic cyst were not associated significantly with the course of renal function(p>0.05). 6) 15 patients(9%) died, the age of death was 55 +/- 12 years. 6 patients died after reaching ESRD. The cause of death were was cancer(4), cerebrovascular event(3), cessation of dialysis(2), sudden death (2), liver cirrhosis(1), sepsis(1), suicide(1) and unknown(1). Results of our study revealed the complications of ADPKD in Korea, hypertension 6596, ESRD 17% and cerebrovascular event 8%. Functional survival was 88M by age 50, 76% by age 58, and 48M by age 65. The extrarenal manifestations are more important contributors to mortality than renal manifestations of ADPKD.
Azotemia ; Cause of Death ; Death, Sudden ; Diagnosis ; Echocardiography ; Humans ; Hypertension ; Hypertrophy, Left Ventricular ; Intracranial Aneurysm ; Kidney Failure, Chronic ; Korea* ; Liver ; Mitral Valve Prolapse ; Mortality ; Polycystic Kidney, Autosomal Dominant ; Retrospective Studies ; Rupture ; Urinalysis