PURPOSE: Epinephrine itself exhibits some cardiotoxicity. However, it rarely induces cardiomyopathy when used in standard doses during surgery for local hemostasis. This paper reports a rare case of stress-induced cardiomyopathy in a young woman after the local infiltration of epinephrine. METHODS: Corrective rhinoplasty was planned in a 20-year-old woman. Lidocaine mixed with epinephrine 1:100,000 was injected around the skin of the nose and nasal septum after inducing anesthesia, which resulted in sinus tachycardia and hypotension. Postoperative ECG showed a T wave inversion in the lead V2 and echocardiography revealed transient hypokinesia in the cardiac apex. Cardiac enzyme was mildly elevated. RESULTS: Symptoms and laboratory findings improved considerably, and the patient was discharged from hospital without complications on the sixth day after surgery. CONCLUSION: The prognosis of catecholamine-induced cardiomyopathy is generally favorable. However, it is important to be aware of the possible adverse effects of local epinephrine infiltration. This case highlights the need for caution when using epinephrine.
Anesthesia ; Cardiomyopathies ; Echocardiography ; Electrocardiography ; Epinephrine ; Female ; Hemostasis ; Humans ; Hypokinesia ; Hypotension ; Lidocaine ; Nasal Septum ; Nose ; Prognosis ; Rhinoplasty ; Skin ; Surgery, Plastic ; Tachycardia, Sinus ; Young Adult

PURPOSE: Malignant peripheral nerve sheath tumor without neurofibromatosis type 1 is very rare neoplasm. Development in the superficial soft tissue is exremely rare. Authors experienced one rare case of primary malignant peripheral nerve sheath tumor developed on abdomen. The clinical and histologic findings were described. METHODS: An 83-year-old man visited hospital with an 11x6.5x4.5 cm sized ulcerated and hemorrhagic mass on abdomen. The tumor was localized in abdominal skin and started growing 3 years ago. RESULTS: Wide excision with safety margin of 2cm and limberg flap was done. The postoperative biopsy revealed a malignant peripheral nerve sheath tumor. There was no evidence of recurrence of tumor for 16 months. CONCLUSION: Malignant peripheral nerve sheath tumor is an aggressive malignant tumor. An abrupt enlargement of size, ulceration and bleeding are suggestive of malignant chnages of the tumor. We recommand early wide excision with enough safety margin as treatment of malignant peripheral nerve sheath tumor.
Abdomen ; Aged, 80 and over ; Biopsy ; Hemorrhage ; Humans ; Neurofibromatosis 1 ; Peripheral Nerves ; Recurrence ; Skin ; Ulcer

so high that division of oral and maxillofacial surgery should be extablished immediately.]]>
Accidents, Traffic ; Emergencies ; Emergency Service, Hospital ; Facial Bones ; Female ; Humans ; Jeollanam-do ; Lacerations ; Male ; Mandible ; Surgery, Oral ; Tooth Injuries

This retrospective analysis describes the clinical characteristics, treatment, and outcome of 15 patients with C2 fracture. The Age of the patients varied from 28 to 71. There were only two female patients whose mean age was 25.5 while the mean age of 13 male patients was 44.6. Five patients showed odontoid process fracture, three had C2 body fracture and the remainder were traumatic spondylolisthesis of the axis. The fractures were caused by falls in two patients(13.3%) while in 11 patients(73.3%) they were associated with motor-vehicle accidents. The other two patients were injured by falling objects. No patients suffered a neurological injury associated with the fracture. Three patients are still hospitalized, and follow-up was lost for 2 patients. In 10 patients mean follow-up period was 7 months. External immobilization with halovest was done on all patients. Additionally, anterior interbody fusion was done on 1 patient(Case No. 3). All patients showed the union radiologically, and resumed routine activity. Only 4 of them complained minor limited range of motion of the neck.
Axis, Cervical Vertebra* ; Female ; Follow-Up Studies ; Humans ; Immobilization ; Male ; Neck ; Odontoid Process ; Range of Motion, Articular ; Retrospective Studies ; Spondylolisthesis

PURPOSE: To evaluate CT and MR findings of the intracranial schwannomas arising from variable cranial nerves. MATERIALS AND METHODS: The authors retrospectively analyzed CT (n=21) and MR(n=15) findings of 24 cases in 23 patients(M : 7, F : 16) who had suffered from surgically-proven intracranial schwannomas over the previous fiveyears. RESULTS: Schwannomas arose from the acoustic nerve(n=18), the trigeminal nerve(n=2), the glossopha-ryngeal-vagal-accessory nerve complex (n=2), and the olfactory nerve(n=1). Intracranial schwannomas were welldefined, lobulated and inhomogeneously or homogeneously enhancing masses on CT and MR, and were located along the course of the specific cranial nerve. Acoustic schwannomas involved both the internal auditory canal(IAC) and the cerebellopontine angle(CPA) in 14 cases, the IAC in three, and the CPA in two. Two trigeminal schwannomas involved both middle and posterior cranial fossa and were in the shape of a dumbbell. One of the two schwannomas that invelved lower cranial nerve complex(9-11th) was located in the medullary cistern and jugular foramen ; the other was located in the central posterior cranial fossa. A case of olfactory schwannoma was located in the right cribriform plate. The precontrast CT scan showed low density in 13 cases(62%), isodensity in seven(33%) and highdensity in one(5%). On postcontrast CT scan, enhancement was seen in 20 cases(95%). Of the 15 cases with MR, 12had low signal intensity on T1 weighted image and 14 had high signal intensity on T2 weighted image. MR imaging after Gd-DTPA infusion showed enhancement in 14 cases. Enhancement was inhomogeneous in 14 cases on CT and in 13 on MR. Of 24 cases, intratumoral necrosis was seen in 19, ring enhancement in five and severe cystic change inone. Other findings were intratumoral calcification(21%), hemorrhage(8%), pressure bony erosion(70.8%), midline shift(58%), peritumoral edema(29%) and hydrocephalus(33%). On MR, there was in all 15 cases a peritumoral lowsignal intensity rim on T1- and T2-weighted images and on a T1 weighted image following gadolium infusion. A caseof olfactory groove schwannoma was associated with neurofibromatosis type I and a case of bilateral acoustic schwannoma with neurofibromatosis II. CONCLUSION: Schwannomas can be easily diagnosed when a well defined, lobulated and inhomogeneously enhancing mass with intratumoral necrosis, cystic change, calcification orhemorrhage is seen along the course of a cranial nerve. Peritumoral low signal intensity rim on MR may be helpful in differentiating intracranial schwannomas from other tumors.
Acoustics ; Cranial Fossa, Posterior ; Cranial Nerves ; Gadolinium DTPA ; Necrosis ; Neurilemmoma* ; Neurofibromatosis 1 ; Neurofibromatosis 2 ; Neuroma, Acoustic ; Retrospective Studies ; Tomography, X-Ray Computed

PURPOSE: To evaluate the efficacy of CT imaging in differentiating pheochromocytoma from primary adrenalcarcinoma and metastasis. MATERIALS AND METHODS: The authors retrospectively reviewed CT imagings of 24 patients(9 males, 15 females, mean age 49) with 27 surgically or clinically proven adrenal neoplasms larger than 3cm indiameter. These neoplasms included pheochromocytomas(n=11), adrenal carcinomas(n=6), and adrenal metastases(n=10,bilateral : 3). Two radiologists visually inspected CT features with respect to tumor size, shape, intratumoral hypodensity, and calcification, and agreed upon their evalvation. These results were compared with the final histopathologic and clinical diagnosis. RESULTS: Ten of eleven pheochromocytomas(91%) were observed to be round or ovoid; this shape was rarely seen in primary carcinomas(0/6) or metastases(2/10). in contrast, mostcarcinomas(6/6, 100%) were lobulated or irregular in shape, as were most metastases(8/10, 80%). smooth, round orovoid intratumoral hypodensity was noted in all pheochromocytomas. Stellate or linear, irregular intratumoral hypodensity was present in all carcinomas and metastases. However, there were no significant differences in CTdensity of calcification. CONCLUSION: Tumor shape and intratumoral hypodensity are very useful CT findings for differentiating adrenal pheochromocytomas from primary carcinomas and metastases.
Adrenal Gland Neoplasms ; Diagnosis ; Female ; Humans ; Male ; Neoplasm Metastasis* ; Pheochromocytoma* ; Retrospective Studies

Diverticular bleeding is a common cause of lower gastrointestinal bleeding in adults. Most of colonic diverticular bleeding stop spontaneously without any treatment. But diverticular bleeding develops at arterial vessel, which results in massive bleeding in a short period of time and may shows recurrence. Acute lower intestinal bleeding has been treated with heater probe coagulation, injection therapy, bipolar coagulation and endoscopic hemoclips. We experienced a 67-year-old woman presented hematochezia. Emergency colonoscopy was performed and showed a diverticulum with a visible vessel at the cecum. Hemostasis with hemoclip was successfully done. We herein report a case of hemostasis by capping a diverticulum of the colon with hemoclips.
Adult ; Aged ; Cecum ; Colon* ; Colonoscopy ; Diverticulum ; Emergencies ; Female ; Gastrointestinal Hemorrhage ; Hemorrhage* ; Hemostasis ; Humans ; Recurrence

PURPOSE: We suspect there is a difference in the clinical manifestations and treatment response to antiviral drugs for influenza A and B. This study was conducted to investigate this difference. METHODS: We collected information on pediatric patients, infected with the influenza virus, admitted to Dongguk University Ilsan Hospital from October 2013 to May 2015. We investigated the clinical manifestations of influenza and differences in treatment response to oseltamivir treatment for the two types of influenza. RESULTS: A total of 138 patients were included. The mean age was 3.5±4.0 years. When comparing the diseases associated with influenza A and B, croup (19.2% vs. 1.7%, P=0.001) was more common with influenza A infection. Myositis (0% vs. 6.7%, P=0.021) and gastroenteritis (29.5% vs. 46.7%, P=0.038) were more common with influenza B infection. When comparing the total fever duration from the start of oseltamivir administration, patients treated with oseltamivir within 2 days of fever had the shortest duration. Among the patients treated with oseltamivir, the duration of fever, after the start of oseltamivir treatment, for was shorter for influenza A infection than for influenza B infection (16.0±19.1 hours vs. 28.9±27.9 hours, P=0.006). CONCLUSIONS: There appear to be differences in the accompanying diseases and antiviral medication responses between the two types of influenza. It is important to administer oseltamivir within 2 days of fever.
Antiviral Agents ; Child ; Croup ; Fever ; Gastroenteritis ; Humans ; Influenza, Human* ; Myositis ; Orthomyxoviridae ; Oseltamivir

Purpose: The coronavirus disease 2019 (COVID-19) pandemic disrupted the emergency medical care system worldwide. We analyzed the changes in the management of intracerebral hemorrhage (ICH) and compared the pre-COVID-19 and COVID-19 eras. Materials and Methods: From March to October of the COVID-19 era (2020), 83 consecutive patients with ICH were admitted to four comprehensive stroke centers. We retrospectively reviewed the data of patients and compared the treatment workflow metrics, treatment modalities, and clinical outcomes with the patients admitted during the same period of pre-COVID-19 era (2017–2019). Results: Three hundred thirty-eight patients (83 in COVID-19 era and 255 in pre-COVID-19 era) were included in this study. Symptom onset/detection-to-door time [COVID-19; 56.0 min (34.0–106.0), pre-COVID-19; 40.0 min (27.0–98.0), p=0.016] and median door to-intensive treatment time differed between the two groups [COVID-19; 349.0 min (177.0–560.0), pre-COVID-19; 184.0 min (134.0–271.0), p<0.001]. Hematoma expansion was detected more significantly in the COVID-19 era (39.8% vs. 22.1%, p=0.002). At 3-month follow-up, clinical outcomes of patients were worse in the COVID-19 era (Good modified Rankin Scale; 33.7% in COVID-19, 46.7% in pre-COVID-19, p=0.039). Conclusion During the COVID-19 era, delays in management of ICH was associated with hematoma expansion and worse outcomes.

Purpose: The coronavirus disease 2019 (COVID-19) pandemic disrupted the emergency medical care system worldwide. We analyzed the changes in the management of intracerebral hemorrhage (ICH) and compared the pre-COVID-19 and COVID-19 eras. Materials and Methods: From March to October of the COVID-19 era (2020), 83 consecutive patients with ICH were admitted to four comprehensive stroke centers. We retrospectively reviewed the data of patients and compared the treatment workflow metrics, treatment modalities, and clinical outcomes with the patients admitted during the same period of pre-COVID-19 era (2017–2019). Results: Three hundred thirty-eight patients (83 in COVID-19 era and 255 in pre-COVID-19 era) were included in this study. Symptom onset/detection-to-door time [COVID-19; 56.0 min (34.0–106.0), pre-COVID-19; 40.0 min (27.0–98.0), p=0.016] and median door to-intensive treatment time differed between the two groups [COVID-19; 349.0 min (177.0–560.0), pre-COVID-19; 184.0 min (134.0–271.0), p<0.001]. Hematoma expansion was detected more significantly in the COVID-19 era (39.8% vs. 22.1%, p=0.002). At 3-month follow-up, clinical outcomes of patients were worse in the COVID-19 era (Good modified Rankin Scale; 33.7% in COVID-19, 46.7% in pre-COVID-19, p=0.039). Conclusion During the COVID-19 era, delays in management of ICH was associated with hematoma expansion and worse outcomes.