Leiomyoma is a tumor rarely occurring in the nose and the paranasal sinus. It constitutes about 1% of all benign tumors arising in the head and neck area. This is probably due to the paucity of smooth muscle in the nose. We experienced a case of leiomyoma originating in the right side of the nasal septum in a 50-year- man. It was successfully removed by endoscopic surgery, and we report this case with literature.
Head ; Leiomyoma* ; Muscle, Smooth ; Nasal Septum* ; Neck ; Nose

Postoperative pancreatic fistula (POPF) combined with postoperative fluid collection, bleeding and abscess formation is one of the most critical morbidities after distal pancreatectomy or pancreaticoduodenectomy. Percutaneous catheter drainage has been commonly used for managing for the postoperative management of abnormal fluid collection. Removal of the catheter is rarely associated with occurrence of life-threatening complication such as serious liver damage. Herein, we report a case of unexpected fatal liver injury complicated by percutaneous catheter drainage treatment after distal pancreatosplenectomy in a patient with pancreatic cancer. We suggest that prudent decision for timing of catheter removal and meticulous care during procedure can reduce the possibility of major liver injury in patients with percutaneous transhepatic catheter drainage.
Abscess ; Catheters* ; Drainage* ; Hemorrhage ; Humans ; Liver* ; Pancreatectomy ; Pancreatic Fistula ; Pancreatic Neoplasms* ; Pancreaticoduodenectomy

PURPOSE: Hypocalcemia is the most common complication after total thyroidectomy. The purpose of this study was to determine whether measurement of intact parathyroid hormone (i-PTH) level in thyroidectomy patients could predict hypocalcemia. MATERIALS AND METHODS: We performed a prospective study of patients undergoing total thyroidectomy. Serum concentration of i-PTH, total calcium (Ca), ionized calcium (Ca2+), phosphate (P), magnesium (Mg), and albumin were measured preoperatively and at 0 hour, 6 hours, 12 hours, 24 hours, 48 hours, and 72 hours postoperatively. RESULTS: 108 patients were recruited to the study. A total of 50 patients (46%) experienced hypocalcemia. The serum i-PTH concentration was linearly related to the time of measurement, while concentrations of P, Mg, albumin, Ca, and Ca2+ were not. We compared odds ratios, and found that the concentration of i-PTH at 6 hours post operation was the most closely related to the occurrence of hypocalcemic symptom. On ROC analysis using i-PTH level at 6 hours, an i-PTH level of 10.6 mg/dL was found to maximize both sensitivity and specificity at the same time point. CONCLUSION: We found that i-PTH was a predictor of hypocalcemia, and that the earliest predictor of hypocalcemic symptoms was an i-PTH concentration lower than 10.6 mg/dL obtained 6 hours after total thyroidectomy.
Calcium/blood ; Humans ; Hypocalcemia/*diagnosis ; Magnesium/blood ; Odds Ratio ; Parathyroid Hormone/*blood ; Phosphates/blood ; Postoperative Complications/blood/*diagnosis ; Prospective Studies ; Serum Albumin ; Thyroidectomy/*adverse effects

Septic thrombophlebitis results from extensive infection of the lateral pharyngeal space to the jugular vein and generally occurs in healthy adolescents and young adults. This disease can disseminate to multiple distant sites such as joint, liver, kidney, eye, bone, and especially lung, and can lead patients into fatal condition. Contrast enhanced computed tomography and ultrasonography are good diagnostic methods for external jugular vein thrombophlebitis (EJVT). Treatment of EJVT includes intravenous antibiotics and surgical drainage of abscess, ligation or excision of the jugular vein, in addition to fibrinolytic agents and anticoagulants. With a review of literature, authors report a case of external jugular vein thrombophlebitis with sepsis which has successfully been managed by ligation and excision of the vein.
Abscess ; Adolescent ; Anti-Bacterial Agents ; Anticoagulants ; Drainage ; Fibrinolytic Agents ; Humans ; Joints ; Jugular Veins* ; Kidney ; Ligation ; Liver ; Lung ; Sepsis* ; Thrombophlebitis* ; Ultrasonography ; Veins ; Young Adult

Cholesterol granuloma is usually described in association with middle ear diseases, but has also been reported to be found in the paranasal sinuses and orbit. It is currently thought that impaired drainage, hemorrhage and inadequate ventilation play significant roles in its pathogenesis. Histopathologic examination of cholesterol granuloma shows abundant foreign body giant cells, cholesterol crystal clefts, histiocytes surrounded by a dense fibrous capsule. We report our endoscopic surgical experience in one female patient with a large cholesterol granuloma of the sphenoid sinus presenting bilateral visual involvement and brain invasion.
Brain ; Cholesterol* ; Drainage ; Ear, Middle ; Female ; Giant Cells, Foreign-Body ; Granuloma* ; Hemorrhage ; Histiocytes ; Humans ; Orbit ; Paranasal Sinuses ; Sphenoid Sinus* ; Ventilation

Background/Aims: Gallbladder cancer is fatal, but fluorescent imaging technology can facilitate timely diagnosis and improve patient outcomes. Fluorophore-conjugated insulin-like growth factor-1 receptor (IGF-1R) targeted antibodies were used to visualize gallbladder cancer in orthotopic tumor mouse models. Methods: Western blotting, flow cytometric analysis, and confocal microscopy detected the expression of IGF-1R in SNU-308, SNU-478, and SNU-1196 bile duct cancer cells. In vivo imaging of SNU-478 and SNU-1196 subcutaneous tumors and orthotopic gallbladder tumor models of SNU-478 were performed after injection with DyLight 650-conjugated IGF-1R antibody. Results: Western blotting and flow cytometric analysis showed that IGF-1R was expressed in bile duct cancer cells, and confocal microscopy demonstrated that IGF-1R antibody was able to bind to IGF-1R on the cell membrane. Fluorescent IGF-1R antibody injected into the mouse tail vein made subcutaneous tumors and orthotopic tumors become fluorescent. The intensity of fluorescence from the tumor was stronger than that from surrounding normal tissues. Histochemical examination confirmed that the tumor was located inside the gallbladder and adjacent liver parenchyma of mice. Conclusions Our study showed that a fluorescent IGF-1R-targeted antibody could help detect gallbladder tumors. Tumor-specific imaging technology can be applied to endoscopy, laparoscopy, and robotic surgery for better management of gallbladder cancer.

BACKGROUND: The best way of delivering drugs for the treatment of asthma and chronic obstructive pulmonary disease (COPD) is via the inhaled route of administration. However, many patients use inhaler devices incorrectly. To augment the proper use of inhalation medicine and to improve knowledge of the disease and compliance, we have developed a "Computerized Respiratory Service Program" and applied the use of this program to educate patients. METHODS: Prospectively, this study was performed in 164 patients with asthma or COPD prescribed with inhaled medication. When inhalation medication was first prescribed, education using a drug model was conducted two times and thereafter every month. In addition, education using a drug model was conducted and the ability of the patient to use inhalation medicine properly was evaluated. RESULTS: A total of 164 patients participated in the sessions more than two times and received education. Fifty-seven patients participated in three sesions. After the patients received education one time, the ability of these patients to use an inhaler had an average score of 20.6. After the patients received education two times, the average score was 21.9. After the patients received education three times, the average score was 22.3, a further increase. The compliance of using the inhaler was 70.1% at the second session and increased to 81.8% at the third session. CONCLUSION: Feedback education using the "Computerized Respiratory Service Program" will increase the ability of the patient to use an inhaler and consistent education can maintain patient compliance with inhaler use.
Asthma ; Compliance ; Education* ; Humans ; Inhalation* ; Nebulizers and Vaporizers ; Patient Compliance ; Prospective Studies ; Pulmonary Disease, Chronic Obstructive

BACKGROUND: Impulse oscillometry (IOS) is a valuable method for evaluating respiratory func- tion in a patient with bronchial asthma. There have been no reports on compliance assessment of the remodeled airway by estimation of the relationship between resistance and breathing volume in asymptomatic asthma using IOS. OBJECTIVE: This study was performed to evaluate whether IOS could distinguish asymptomatic asthma from healthy control and detect altered physiology of the airway due to airway remodeling in asymptomatic asthmatic patients with normal pulmonary function. METHOD: 16 healthy and 16 asymptomatic patients with bronchial asthma were asked to breathe with the usual tidal volume (Vt) and with twice the amount of Vt. Using IOS, impedance, resistance for frequency at 5Hz and 20 Hz, reactance, and resonant frequency were measured. RESULTS: Resonant frequency was significantly higher in asymptomatic asthma than in healthy control for breathing with both usual Vt and twice the amount of Vt (mean+/-S.E.M. 16.35+/-1.44 Hz vs 13.34+/-0.66 Hz, 16.27+/-0.72 Hz vs 13.68+/-0.66 Hz, p<0.05 respectively), but the discriminant power of resonant frequency for distinguishing asymptomatic asthma from healthy control was low. There were no significant differences of other IOS parameters between asthma and control groups. Compared with control group, asymptomatic asthma group showed no significant change of IOS parameters according to breathing volume change. CONCLUSION: In this study, we could not find any IOS parameters sensitive enough to detect altered physiology of the remodeled airway in patients with asymptomatic bronchial asthma. Further studies are recommended to improve sensitivity of IOS method for investigating airway physiology in bronchial asthma.
Airway Remodeling ; Asthma* ; Compliance ; Electric Impedance ; Humans ; Oscillometry* ; Physiology ; Respiration ; Tidal Volume

BACKGROUND: Impulse oscillometry(IOS) is a method to characterize the mechanical properties of respiratory system over wide range of frequency. It's most important advantage is to require minimal cooperations from subject. Therefore it is used to estimate pulmonary function of young children and to study epidemiology of occupational asthma. This study was performed to evaluate the usefulness for the clinical applications of IOS in bronchial asthmatics by estimating the associations between asthma severity and IOS parameters, and the relationships between IOS parameters and conventional spirometry. METHODS: 216 subjects with bronchial asthma were enrolled in this study. Subjects were grouped to 3 different groups according to their symptoms and pulmonary functions. Respiratory impedance, resistance (at 5Hz, 20Hz, 35Hz) and resonant frequency were measured by IOS. FEV1, FVC and MMEF were measured with conventional spirometry. RESULTS: There were significant difference of resonant frequency, resistance at 5Hz and 20Hz, resistance difference at 5Hz and 20Hz according to asthma severity(p<0.05, respectively). Resonant frequency, resistance at 5Hz, impedance were significantly correlated with FEV1 (r= -0.55, 0.48, 0.49, p<0.05, respectively). And resistance at 5Hz had similar reproducibility compared to FEV1 (resistance at 5Hz, r= 0.78 vs FEV1, r= 0.79). CONCLUSION: IOS is an useful and alternative method to evaluate clinical status of brnochial asthmatics. And further studies will be needed to clarify its values for wide range of clinical applications.
Asthma* ; Asthma, Occupational ; Child ; Electric Impedance ; Epidemiology ; Humans ; Oscillometry ; Respiratory System ; Spirometry

We report a case of a 46-year-old male patient who presented with sudden abdominal pain and hypovolemic shock. The initial hemoglobin level was 11.9 g/dl, which fell to 6.9 g/dl after hydration. The emergent CT showed a large amount of hemoperitoneum and dye leakage. Emergent angiography and gell foam embolization were performed under the diagnosis of right gastric artery aneurysm rupture.
Abdominal Pain ; Aneurysm* ; Angiography ; Arteries* ; Diagnosis ; Hemoperitoneum* ; Humans ; Male ; Middle Aged ; Rupture ; Rupture, Spontaneous* ; Shock