BACKGROUND: Deep neck infections (DNI) can originate from infection in the potential spaces and fascial planes of the neck. DNI can be managed without surgery, but there are cases that need surgical treatment, especially in the case of mediastinal involvement. The aim of this study is to identify clinical features of DNI and analyze the predisposing factors for mediastinal extension. MATERIALS AND METHODS: We reviewed medical records of 56 patients suffering from DNI who underwent cervical drainage only (CD group) and those who underwent cervical drainage combined with mediastinal drainage for descending necrotizing mediastinitis (MD group) from August 2003 to May 2009 and compared the clinical features of each group and the predisposing factors for mediastinal extension. RESULTS: Forty-four out of the 56 patients underwent cervical drainage only (79%) and 12 patients needed both cervical and mediastinal drainage (21%). There were no differences between the two groups in gender (p=0.28), but the MD group was older than the CD group (CD group, 44.2+/-23.2 years; MD group, 55.6+/-12.1 years; p=0.03). The MD group had a higher rate of co-morbidity than the CD group (p=0.04). The CD group involved more than two spaces in 14 cases (32%) and retropharyngeal involvement in 12 cases (27%). The MD group involved more than two spaces in 11 cases (92%) and retropharyngeal involvement in 12 cases (100%). Organism identification took place in 28 cases (64%) of the CD group and 3 cases of (25%) the MD group (p=0.02). The mean hospital stay of the CD group was 21.5+/-15.9 days and that of the MD group was 41.4+/-29.4 days (p=0.04). CONCLUSION: The predisposing factors of mediastinal extension in DNI were older age, involvement of two or more spaces, especially including the retropharyngeal space, and more comorbidities. The MD group had a longer hospital stay, higher mortality, and more failure to identify causative organisms of causative organisms than the CD group.
Comorbidity ; Drainage ; Humans ; Hypogonadism ; Length of Stay ; Mediastinitis ; Medical Records ; Mitochondrial Diseases ; Neck ; Ophthalmoplegia ; Stress, Psychological

A 39-year-old woman was admitted to the hospital due to a pulsatile mass on her right inner thigh that was evident for two months. She did not exhibit any risk factors of atherosclerosis, no evidence of vasculitis, or any signs of previous trauma history. Ultrasound and computed tomography revealed an adult fist-sized aneurysm on the distal superficial femoral artery. The aneurysm was resected and peripheral circulation was restored with the interposition of a saphenous vein graft. The resected aneurysm had three layers that showed atherosclerosis on histological examination.
Adult ; Aneurysm ; Arteries ; Atherosclerosis ; Female ; Femoral Artery ; Humans ; Risk Factors ; Saphenous Vein ; Thigh ; Transplants ; Vasculitis

Schwannoma is a benign neoplasm of the Schwann cells of the neural sheath. Most schwannomas occur in the head and neck, and extremities and rarely in the retroperitoneal space. The differentiation of a schwannoma from other malignant tumor or benign tumor is very difficult on a preoperative examination with ultrasonography, computed tomography or magnetic resonance imaging. Furthermore, the lesion with increased fluorodeoxyglucose uptake in PET-CT cannot exclude malignant tumor. Therefore, this lesion needs surgical excision and a histological examination with immunohistochemical staining. We report a case of schwannoma occuring in the retroperitoneal space that incidentally discovered by PET-CT for health-check up. Pathologic confirmation by laparoscopic excision was done.
Aged ; Diagnosis, Differential ; Fluorodeoxyglucose F18/diagnostic use ; Humans ; Male ; Neurilemmoma/*diagnosis/pathology/surgery ; Positron-Emission Tomography ; Retroperitoneal Neoplasms/*diagnosis/pathology/surgery ; Tomography, X-Ray Computed

Hyaluronidase is an enzyme that has temporary and reversible enzymatic effects on the matrix of connective tissue. When added to local anesthetics in pain treatments, it enhances their infiltration and dispersal into tissues. It is widely used in anesthesia for ocular, dental, and plastic surgery. Reports of drug hypersensitivity to hyaluronidase are rare and are usually confined to peribulbar or retrobulbar anesthesia during ophthalmic surgery. However, few reports exist on adverse drug reaction after epidural injection. We have observed two patients experiencing anaphylactic shock caused by hyaluronidase following epidural injection. Most of the patients with a hypersensitivity to hyaluronidase had one previous uneventful injection containing hyaluronidase, implying that sensitization had taken place. However, hypersensitivity occurring at the first administration is possible. A positive skin test can help establish the diagnosis. Although rare, the possibility of an allergic reaction to hyaluronidase should be considered even in patients with no known previous exposure.
Anaphylaxis ; Anesthesia ; Anesthetics, Local ; Connective Tissue ; Drug Hypersensitivity ; Drug Toxicity ; Humans ; Hyaluronoglucosaminidase ; Hypersensitivity ; Hypogonadism ; Injections, Epidural ; Mitochondrial Diseases ; Ophthalmoplegia ; Skin Tests ; Surgery, Plastic

Stress-induced cardiomyopathy is caused by emotional or physical stressors and mimics acute myocardial infarction, though Stress-induced cardiomyopathy is characterized by reversible left ventricular (LV) apical ballooning in the absence of significant coronary artery disease. We describe a 51-year-old male who underwent left upper lobectomy for non-small cell lung cancer, and during which cardiogenic arrest occurred due to stress-induced cardiomyopathy, successfully managed by intra-aortic balloon pumping and extracorporeal membrane oxygenation.
Carcinoma, Non-Small-Cell Lung ; Cardiomyopathies ; Coronary Artery Disease ; Extracorporeal Membrane Oxygenation ; Humans ; Intra-Aortic Balloon Pumping ; Male ; Middle Aged ; Myocardial Infarction

Stress-induced cardiomyopathy is caused by emotional or physical stressors and mimics acute myocardial infarction, though Stress-induced cardiomyopathy is characterized by reversible left ventricular (LV) apical ballooning in the absence of significant coronary artery disease. We describe a 51-year-old male who underwent left upper lobectomy for non-small cell lung cancer, and during which cardiogenic arrest occurred due to stress-induced cardiomyopathy, successfully managed by intra-aortic balloon pumping and extracorporeal membrane oxygenation.
Carcinoma, Non-Small-Cell Lung ; Cardiomyopathies ; Coronary Artery Disease ; Extracorporeal Membrane Oxygenation ; Humans ; Intra-Aortic Balloon Pumping ; Male ; Middle Aged ; Myocardial Infarction

No abstract available.
Carotid Artery, Internal ; Carotid Artery, Internal, Dissection ; Osteogenesis Imperfecta

A pancreatico-pleural fistula (PPF), caused by rupture of a pancreatic pseudocyststectomy or obstruction of the pancreatic duct, is a rare condition. A 48-year-old man with chronic alcoholism was admitted with a massive pleural effusion. Pleural fluid studies revealed elevated amylase and lipase. A PPF complicated by a ruptured pancreatic pseudocyststectomy was diagnosed by computerized tomography scan. Although the symptoms improved with conservative management, (chest tube drainage, NPO, total parenteral nutrition, and a pancreatic secretion inhibitor), a distal pancreatectomy, including a pseudocystectomy and thoracotomy, were performed for an increasing size of the hemorrhagic pancreatic pseudocyststectomy and a recurrent hemorrhagic pleural effusion. There were no post-operative complications and the patient was discharged on post-operative day 27.
Alcoholism ; Amylases ; Drainage ; Fistula ; Humans ; Lipase ; Middle Aged ; Pancreatectomy ; Pancreatic Cyst ; Pancreatic Ducts ; Parenteral Nutrition, Total ; Pleural Effusion ; Rupture ; Thoracotomy

A left atrial appendage aneurysm is a very rare medical condition which can develop by an inflammatory reaction or a degenerative change. If there is no accompanying anomaly, a left atrial appendage is considered a congenital disease. The majority of left atrial appendage aneurysms are detected incidentally because they usually do not cause any symptoms. Surgery is indicated, even for asymptomatic patients, because of the risk of life-threatening complications, such as atrial fibrillation, supraventricular tachycardia, systemic embolization, and cardiac arrest. Left atrial appendage aneurysms are usually treated by a median sternotomy with extracorporeal circulation, especially if the aneurysm has a broad base or contains a thrombus, but can treated by thoracotomy without extracorporeal circulation. We report a case of a successfully treated left atrial appendage aneurysm that was misdiagnosed as a partial pericardial defect without extracorporeal circulation in a 13-year old child.
Aneurysm ; Atrial Appendage ; Atrial Fibrillation ; Extracorporeal Circulation ; Heart Arrest ; Heart Atria ; Humans ; Sternotomy ; Tachycardia, Supraventricular ; Thoracotomy ; Thrombosis

BACKGROUND/AIMS: To evaluate the effect and prognostic factors related to curative surgical resection and adjuvant radiotherapy in patients with extrahepatic bile duct cancer. METHODS: The authors performed a retrospective analysis of 53 patients with extrahepatic bile duct cancer who were treated at Chungnam National University Hospital between 1998 and 2005. 18 patients (Group 1) were managed with percutaneous bile drainage (n=13) or endoscopic bile drainage (n=5), 17 patients (Group 2) underwent only curative resection, and 18 patients (Group 3) received radiotherapy after curative resection. The radio-sensitizer used in these patients was 5-FU. RESULTS: Three-year overall survival was 5.6% in group 1, 64.7% in group 2, and 61.1% in group 3, with no significant difference noted between group 2 and group 3. The disease-free survival rate was 64.7% in group 2 and 66.7% in group 3, with no significant difference noted between the two groups. We evaluated age, sex, differentiation, tumor location, perineural invasion, operative method, lymphovascular tumor emboli, T stage, and N stage as possible prognostic factors. T stage, N stage, and operative method were significant factors in group 2, but age was the only significant factor in group 3. Group 2 patients had longer overall survival than did group 3 patients with well-differentiated cancer, but group 3 patients had longer survival than did group 2 patients with lymph node metastasis. The recurrence rate was 34.3% (mean value) and was no different between group 2 and group 3. Recurrence sites included local tissue, such as liver, and regional lymph nodes. There were no serious complications during radiotherapy. CONCLUSIONS: Patients who underwent curative surgical resection and adjuvant radiotherapy after surgery had no statistically significant difference in survival or recurrent rates. However, curative surgery is considered to be the only method to improve survival. Our results suggest that radiotherapy after curative resection may improve survival in patients with lymph node metastasis.
Bile ; Bile Ducts, Extrahepatic ; Disease-Free Survival ; Drainage ; Humans ; Liver ; Lymph Nodes ; Neoplasm Metastasis ; Radiotherapy, Adjuvant ; Recurrence ; Retrospective Studies