Inverted papilloma is a rare form of a benign sinonasal tumor characterized by a potentially invasive nature. The lateral nasal wall represents the most common site of origin. In contrast, involvement of sphenoid sinus is exceedingly rare. The present study describes a case of a 52-years-old patient with an inverted papilloma which originated from the sphenoid sinus. The patient complained mainly of headache, ptosis and diplopia. Radiologic study revealed that the sphenoid sinus was completely occupied by the tumor. Additionally, the ethmoid sinus, cavernous sinus and intracranial fossa have been invaded by the tumor. Endoscopic sinus surgery and postoperative radiotherapy were performed. Two months after the operation, the patient has not revealed any new symptom. However, a remnant of the inverted papilloma still remains. The clinical presentation of the inverting papillomas confined to the sphenoid sinus is often non-specific and insidious, with ptosis and diplopia being predominant. The rhinologic surgeon has to rule out this condition.
Cavernous Sinus ; Diplopia ; Ethmoid Sinus ; Headache ; Humans ; Papilloma ; Papilloma, Inverted ; Sphenoid Sinus

Primary Pulmonary leiomyosarcomas are rare tumors. These tumors may arise at any level of the lung in which smooth muscle fibers are found. The highest incidence of sarcoma is during the fourth decade whereas for bronchogenic carcinoma the maximum incidence is during the sixth and seventh decades. Leiomyosarcomas are aggressive and progressive. Treatment is mainly surgical. The chemotherapy is ineffective and the effectiveness of radiotherapy depends on the total dose of irradiation. Prognosis and significant survival rate are related to the size of the lesion. We report one patient with primary pulmonary leiomyosarcoma involving the right lower lung.
Carcinoma, Bronchogenic ; Drug Therapy ; Humans ; Incidence ; Leiomyosarcoma* ; Lung ; Muscle, Smooth ; Prognosis ; Radiotherapy ; Sarcoma ; Survival Rate

Purpose: Intensive IV insulin infusion therapy has been applied widely to critically ill patients. However, IV insulin protocols are complex, and require repeated calculations. The purpose of this study was to evaluate the safety and efficiency of a computerized insulin infusion (CII) protocol to replace manual insulin infusion protocols, for glucose control in critically ill patients. Methods: This was an observational study (September 2016 to January 2017) of 43 patients in ICU whose blood glucose level was between 140-180 mg/mL and could not be controlled by the conventional manual insulin protocol. The CII protocol was integrated in to the electronic medical record order system, and automatically calculated the insulin infusion dose and blood sugar test (BST) interval. BSTs were taken 48 hours pre- and post-initiation of the CII protocol. The proportion of BSTs in the normal (70-180 mg/mL), hypoglycemic (70 mg/mL), and severe hyperglycemic (> 250 mg/mL) range were recorded. Results: The mean number of BSTs performed before using the CII protocol was 10.3/person and 0.4/hour, and after implementing the protocol, increased to 21.7/person and 0.7/hour. The mean glucose level (281.4 mg/mL) decreased after using the CII protocol (195.5 mg/mL; p < 0.001). The percentage of BSTs within normal range increased from 22.5% to 44.9% after implementing the protocol (p < 0.001). Severe hyperglycemia (> 250 mg/mL) decreased from 47.3% to 17.9% after protocol implementation (p = 0.020). Conclusion The CII protocol safely and successfully maintained a normal glucose range, and decreased severe hyperglycemia in intensive care patients.

Purpose: Intensive IV insulin infusion therapy has been applied widely to critically ill patients. However, IV insulin protocols are complex, and require repeated calculations. The purpose of this study was to evaluate the safety and efficiency of a computerized insulin infusion (CII) protocol to replace manual insulin infusion protocols, for glucose control in critically ill patients. Methods: This was an observational study (September 2016 to January 2017) of 43 patients in ICU whose blood glucose level was between 140-180 mg/mL and could not be controlled by the conventional manual insulin protocol. The CII protocol was integrated in to the electronic medical record order system, and automatically calculated the insulin infusion dose and blood sugar test (BST) interval. BSTs were taken 48 hours pre- and post-initiation of the CII protocol. The proportion of BSTs in the normal (70-180 mg/mL), hypoglycemic (70 mg/mL), and severe hyperglycemic (> 250 mg/mL) range were recorded. Results: The mean number of BSTs performed before using the CII protocol was 10.3/person and 0.4/hour, and after implementing the protocol, increased to 21.7/person and 0.7/hour. The mean glucose level (281.4 mg/mL) decreased after using the CII protocol (195.5 mg/mL; p < 0.001). The percentage of BSTs within normal range increased from 22.5% to 44.9% after implementing the protocol (p < 0.001). Severe hyperglycemia (> 250 mg/mL) decreased from 47.3% to 17.9% after protocol implementation (p = 0.020). Conclusion The CII protocol safely and successfully maintained a normal glucose range, and decreased severe hyperglycemia in intensive care patients.

OBJECTIVES: The present study examined the impact of the coronavirus disease 2019 (COVID-19) pandemic on mental health service utilization through a comparative analysis of nationwide data regarding inpatient care users, outpatient visits, emergency department (ED) visits, and admissions via the ED before and during the pandemic. METHODS: Data from approximately 350,000 Koreans diagnosed with mental illness were analyzed in terms of hospitalization, outpatient visits, and ED visits between January 2018 and June 2021. An interrupted time series analysis was conducted to determine the significance of changes in mental health service utilization indicators. RESULTS: The number of hospital admissions per patient decreased by 1.2% at the start of the pandemic and 0.7% afterward. The length of hospital stay increased by 1.8% at the outbreak of the pandemic, and then decreased by 20.2%. Although the number of outpatients increased, the number of outpatient visits per patient decreased; the number of outpatient visits for schizophrenia (3.4%) and bipolar disorder (3.5%) significantly decreased immediately post-outbreak. The number of ED visits per patient decreased both immediately post-outbreak and afterward, and ED visits for schizophrenia (19.2%), bipolar disorder (22.3%), and depression (17.4%) decreased significantly immediately post-outbreak. Admissions via the ED did not show a significant change immediately post-outbreak. CONCLUSIONS Mental health service utilization increased during the pandemic, but medical service use decreased overall, with a particularly significant decrease in ED utilization. As the pandemic worsened, the decline in outpatient visits became more pronounced among those with severe mental illness.

BACKGROUND: Toxic epidermal necrolysis(TEN) is the most dramatic and life-threatening cutaneous drug reaction. However, specific and effective treatment for TEN have not yet been identified. Recently several reports suggested that high dose intravenous immunoglobulin(IV Ig) treatment has produced good results in patients with TEN. OBJECTIVE: To analyze the efficacy and side effects of IV Ig in treatement of TEN. METHODS: Ten patients with clinicopathological diagnosis of TEN were treated with IV Ig(1.6-3.4g/kg), and clinical efficacy and side effects were observed. RESULTS: Nine patients were healed and one died of sepsis. Interruption of further epidermal detachment occurred after an average 3 days from the onset of IV Ig therapy. Complete wound healing occurred after an average of 14.3 days. The side effects of IV Ig including headache, myalgia, nausea, transient neutropenia, and coombs positive hemolytic anemia were observed in 4 patients but normalized after cessation of IV Ig therapy. Three of them showed complete healing of detached skin but died with aggravation of underlying disease. CONCLUSION: IV Ig therapy represents a safe and very effective treatment for TEN. Furthermore, intensive care for underlying diseases is also very important for reducing the mortality rate in patients with TEN.
Anemia, Hemolytic ; Diagnosis ; Headache ; Humans ; Immunoglobulins* ; Critical Care ; Mortality ; Myalgia ; Nausea ; Neutropenia ; Sepsis ; Skin ; Stevens-Johnson Syndrome* ; Wound Healing

Hypersensitivity reactions to antituberculosis medicine are obstacles to the treatment of tuberculosis. However, rapid drug desensitization can secure successful treatment with essential antituberculosis medicines in pediatric patients. A 17-year-old boy with active pulmonary tuberculosis complained of generalized erythematous rashes, pruritus on the 11th day of tuberculosis treatment. He was diagnosed with hypersensitivity reactions to isoniazid and rifampin by the oral provocation test. After desensitization, the patient continued to take antituberculosis treatment with isoniazid, rifampin, pyrazinamide, and ethambutol. We report here a case of successful desensitization in an adolescent with hypersensitivity to isoniazid and rifampin.
Adolescent* ; Antitubercular Agents ; Desensitization, Immunologic ; Drug Hypersensitivity ; Ethambutol ; Exanthema ; Humans ; Hypersensitivity ; Isoniazid* ; Male ; Pruritus ; Pyrazinamide ; Rifampin* ; Tuberculosis ; Tuberculosis, Pulmonary*

OBJECTIVES: The Korean version of the Sniffin' stick (KVSS) test is widely used in Korea to evaluate olfactory function. However, its validity and reliability have not been studied well. In this study, the authors administered the KVSS and the T%T olfactometer test to evaluate olfactory function and to establish relationships between these two test measures. METHODS: Two hundred and eleven patients participated in this prospective randomized study. One hundred and nine patients with no olfactory symptoms and 102 patients with decreased olfaction participated. All participants were underwent KVSS II and T&T olfactometer testing. RESULTS: The mean recognition threshold of the T&T olfactometer was -1.8+/-0.9 for patients with normal olfaction and 4.0+/-2.6 for patients with decreased olfaction. The mean Threshold-Discrimination-Identification score of the KVSS II was 30.0+/-3.8 for patients with normal olfaction and 15.9+/-7.1 for patients with decreased olfaction. Correlation coefficient between the two tests was significantly high (r(s)=-0.725, P<0.01). CONCLUSION: The KVSS and T&T olfactometry test are both reliable tests of olfactory function and their results are well correlated with each other.
Humans ; Korea ; Prospective Studies ; Reproducibility of Results ; Smell

Esophageal cancer is easy to infiltrate and metastasize because esophagus does not have serosa, and is difficult to remove it because esophagus is in the middle of the chest. Because of this, treatments of esophageal cancer do not always follow the guideline. In this situation, efforts to increase treatment efficiency and improve survival rate through multidisciplinary treatment are increasing. In this case, we report the patient with three superficial esophageal cancers (one in cervical esophagus and two in thoracic esophagus). The patient was treated with concurrent chemoradiotherapy instead of surgery through multidisciplinary discussion. The patient reached a complete remission through this discussion. This case is intended to inform the usefulness of multidisciplinary treatment in patients with esophageal cancer.

Esophageal cancer is easy to infiltrate and metastasize because esophagus does not have serosa, and is difficult to remove it because esophagus is in the middle of the chest. Because of this, treatments of esophageal cancer do not always follow the guideline. In this situation, efforts to increase treatment efficiency and improve survival rate through multidisciplinary treatment are increasing. In this case, we report the patient with three superficial esophageal cancers (one in cervical esophagus and two in thoracic esophagus). The patient was treated with concurrent chemoradiotherapy instead of surgery through multidisciplinary discussion. The patient reached a complete remission through this discussion. This case is intended to inform the usefulness of multidisciplinary treatment in patients with esophageal cancer.