An intraneural ganglion in the peripheral nerve and the resulting ulnar neuropathy at the elbow are uncommon and may show various symptoms ranging from local pain to motor and sensory impairment. We report a case of a 76-year-old man who was diagnosed with ulnar neuropathy caused by an intraneural ganglion derived from the elbow. We also discuss the pathophysiology, treatment, prognosis, and diagnostic value of ultrasonography in neuropathy caused by a ganglion.

The aortic arch normally causes no symptomatic physiological constriction of the esophagus. Symptoms of dysphagia are generally observed in the presence of specific conditions, such as an aortic aneurysm. In the present case, during a videofluoroscopic swallowing study (VFSS), the authors incidentally found that despite the absence of an aortic lesion, the dysphagia observed in a stroke patient was caused by compression from the aortic arch. The patient complained of discomfort when swallowing, similar to a bolus lodged in the chest, which was consistent with compression by the aortic arch found on the VFSS and chest computed tomography (CT). After undergoing dysphagia therapy, the VFSS after 52 days revealed improved swallowing function; however, the sensation of food lodging in the chest due to compression by the aortic arch persisted. We conclude that although the physiological constriction of the esophagus by the aortic arch is usually asymptomatic, the constriction can be a factor that exacerbates the swallowing function in patients with dysphagia, and should therefore be considered during the differential diagnosis.

An intraneural ganglion in the peripheral nerve and the resulting ulnar neuropathy at the elbow are uncommon and may show various symptoms ranging from local pain to motor and sensory impairment. We report a case of a 76-year-old man who was diagnosed with ulnar neuropathy caused by an intraneural ganglion derived from the elbow. We also discuss the pathophysiology, treatment, prognosis, and diagnostic value of ultrasonography in neuropathy caused by a ganglion.

The aortic arch normally causes no symptomatic physiological constriction of the esophagus. Symptoms of dysphagia are generally observed in the presence of specific conditions, such as an aortic aneurysm. In the present case, during a videofluoroscopic swallowing study (VFSS), the authors incidentally found that despite the absence of an aortic lesion, the dysphagia observed in a stroke patient was caused by compression from the aortic arch. The patient complained of discomfort when swallowing, similar to a bolus lodged in the chest, which was consistent with compression by the aortic arch found on the VFSS and chest computed tomography (CT). After undergoing dysphagia therapy, the VFSS after 52 days revealed improved swallowing function; however, the sensation of food lodging in the chest due to compression by the aortic arch persisted. We conclude that although the physiological constriction of the esophagus by the aortic arch is usually asymptomatic, the constriction can be a factor that exacerbates the swallowing function in patients with dysphagia, and should therefore be considered during the differential diagnosis.

In cases of inadequate nutrition among individuals with dysphagia, nasogastric tube insertion is considered for nutritional supplementation. Typically, the complications of nasogastric tube insertion are not severe. In rare cases, however, nasal or nasopharyngeal injury caused by the self-knotting of nasogastric tubes can occur. This paper presents a case of spontaneous knotting of a nasogastric tube and its removal in a patient with aspiration pneumonia caused by dysphagia. This case shows that self-knotting must be considered when there is strong resistance during the removal of a nasogastric tube.

Since dysphagia is a common occurrence after a stroke, assessing the swallowing function in stroke patients is important. Killian-Jamieson diverticulum is a rare esophageal diverticulum that leads to various complications.However, few studies have reported the presence of the Killian-Jamieson diverticulum subsequent to a cerebral infarct. A 66-year-old woman diagnosed with left periventricular white matter infarction complained of dysphagia.A suspected diverticulum observed in the first videofluoroscopic swallowing study (VFSS) was thought to be unrelated to the patient’s symptoms. However, since the patient continued to complain of dysphagia, computed tomography was performed to detect any anatomical abnormalities that could cause dysphagia. An approximately 12 mm-sized Killian-Jamieson diverticulum was found on the left side of the esophagus at the C5-6 level. A reversed flow from the diverticulum was observed in the following VFSS. No treatment was administered as the caregiver disagreed with the patient’s aggressive treatment options, which included surgical procedures such as diverticulectomy and cricopharyngeal myotomy. Only periodic VFSS follow-up was continued. The association between Killian-Jamieson diverticulum and cerebral infarction remains unclear. This case underlines the importance of considering an esophageal diverticulum in patients with aggravated swallowing difficulties after cerebral infarction.

The cricopharyngeus muscle (CPM), an important anatomical component of the upper esophageal sphincter (UES), is controlled by reflexive contraction and relaxation movements that are coordinated with swallowing and breathing.In cricopharyngeal dysfunction (CPD) the CPM does not relax to allow food to enter the esophagus or it relaxes in an uncoordinated manner, causing dysphagia. Prolonged CPD may lead to malnutrition, dehydration, weight loss, or aspiration, and therefore, prompt treatment is essential. A 41-year-old female diagnosed with left lateral medullary infarction demonstrated relative improvement in cognitive, language, and motor dysfunctions following acute treatment. However, her swallowing disorder continued from time of onset of symptoms. Balloon dilatation was performed at various frequencies, and gradually the patient was trained to perform the procedure on her own. The effects of balloon dilatation were evaluated continuously through repetitive videofluoroscopic swallowing studies. While balloon dilatation is a widely used method for treating CPD, its use has not yet been standardized. The diameter, pressure, and extension time of the balloon depend greatly on the operator’s personal experience. This case is valuable because we determined the optimal frequency of balloon dilatation for the patient through a series of attempts at various frequencies. Furthermore, performing balloon dilatation on her own helped with her early recovery and discharge. Due to this individualized treatment, the patient could safely progress to a regular diet from being fed through a tube.

BACKGROUND/AIMS: Blood loss and blood transfusion are extremely important determinants of morbidity and mortality following hepatic resection. This is attributed to increased risks of coagulopathy, acute respiratory distress syndrome and multiorgan failure. The hypothesis is that a low pressure in the central veins would be accompanied by a low pressure in the hepatic veins and sinusoids, thereby decreasing blood loss during hepatic resection. This study evaluates the effectiveness of continuing low central venous pressure comparing with high central venous pressure during major hepatic resection. METHODS: 20 consecutive major hepatic resections between March 2000 and August 2000 were studied prospectively concerning central venous pressure which was analysed for 10 cases with a central venous pressure less than 10 mmHg, and greater than or equal to 10 mmHg. The central venous pressure was monitored continuously using a Narkomed Anaesthetic Component Monitoring System (Drager Inc., USA). RESULTS: Low central venous pressure allowed a smaller intraoperative blood loss (<10 mmHg: 1010+/-465.3 ml vs. > or =10 mmHg: 1770+/-916.5 ml, p<0.05), a smaller perioperative transfusion (<10 mmHg: 139+/-276.2 ml vs. > or =10 mmHg: 807+/-799.2 ml, p<0.05), a lower postoperative peak AST (<10 mmHg: 167.4+/-53.2 IU/L vs. > or =10 mmHg: 293.0+/-123.2 IU/L, p<0.05), a lower postoperative peak ALT (<10 mmHg: 96.1+/-55.3 IU/L vs. > or =10 mmHg: 193.2+/-103.5 IU/L, p<0.05), and a earlier resumption of a normal hepatic enzyme (<10 mmHg: 6.4+/-0.9 days vs. > or =10 mmHg: 8.7+/-1.6 days, p<0.05) in comparison to high central venous pressure. There was no postoperative mortality in both group. CONCLUSIONS: Maintaining a low central venous pressure throughout major hepatic resection reduced blood loss, blood transfusion requirements and enzyme recovery periods. Lowering the central venous pressure is a simple and effective way during hepatic resection.
Blood Transfusion ; Central Venous Pressure* ; Hepatic Veins ; Mortality ; Prospective Studies ; Respiratory Distress Syndrome, Adult ; Veins

OBJECTIVE: To investigate the characteristics and risk factors of dysphagia using the videofluoroscopic dysphagia scale (VDS) with a videofluoroscopic swallowing study (VFSS) in patients with acute cerebral infarctions. METHODS: In this retrospective study, the baseline VFSS in 275 stroke patients was analyzed. We divided patients into 8 groups according to lesion areas commonly observed on brain magnetic resonance imaging. Dysphagia characteristics and severity were evaluated using the VDS. We also analyzed the relationship between clinical and functional parameters based on medical records and VDS scores. RESULTS: In comparison studies of lesions associated with swallowing dysfunction, several groups with significant differences were identified. Apraxia was more closely associated with cortical middle cerebral artery territory lesions. Vallecular and pyriform sinus residue was more common with lesions in the medulla or pons. In addition, the results for the Korean version of the Modified Barthel Index (K-MBI), a functional assessment tool, corresponded to those in the quantitative evaluation of swallowing dysfunctions. CONCLUSION: A large cohort of patients with cerebral infarction was evaluated to determine the association between brain lesions and swallowing dysfunction. The results can be used to establish a specific treatment plan. In addition, the characteristic factors associated with swallowing dysfunctions were also confirmed.
Apraxias ; Brain* ; Cerebral Infarction* ; Cohort Studies ; Deglutition ; Deglutition Disorders* ; Evaluation Studies as Topic ; Fluoroscopy ; Humans ; Magnetic Resonance Imaging ; Medical Records ; Middle Cerebral Artery ; Pons ; Pyriform Sinus ; Retrospective Studies ; Risk Factors ; Stroke

This retrospective case-control study investigated the prevalence and risk factors of carbapenem-resistant Enterobacteriaceae (CRE) colonization in stroke patients within 6 months of onset. Forty-three patients confirmed to have CRE colonization in our hospital from January 2017 to December 2018 were included in this study. The control group included 44 stroke patients who had carbapenem-susceptible Enterobacteriaceae colonization. The patients were age- (± 3 years) and sex-matched. Their demographic and clinical characteristics were analyzed to identify the risk factors for CRE colonization using multivariate logistic regression analysis. During the study period, the prevalence of CRE was 2.9% (105/3,657). In the univariate analysis, factors associated with CRE colonization included the use and duration of antibiotic intake; admission to intensive care unit (ICU); and use of enteral feeding tube, urethral Foley catheter, tracheostomy, and central venous catheter. In the multivariate analysis, use and duration of antibiotic intake and admission to ICU persisted as independent factors. CRE should be considered when antibiotics are administered to a stroke patient, especially if the administration period is more than 2 weeks, and if the stroke patient has been admitted to the ICU. This study suggests preventing post-stroke infections and, if possible, reducing ICU admissions and preventing CRE transmission in all stroke patients admitted to the ICU.
Anti-Bacterial Agents ; Case-Control Studies ; Catheters ; Central Venous Catheters ; Colon ; Enteral Nutrition ; Enterobacteriaceae ; Humans ; Intensive Care Units ; Logistic Models ; Multivariate Analysis ; Prevalence ; Retrospective Studies ; Risk Factors ; Stroke ; Tracheostomy