Arytenoid subluxation or recurrent laryngeal nerve paralysis may result from injury to the larynx following endotracheal intubation or blunt laryngeal trauma. Early diagnosis is important for appropriate treatment and better prognosis. A 62-years-old man was admitted for cholecystectomy. He was intubated without any difficulty and nasogastric tube was inserted with the help of laryngoscope and Magill forcep before surgery. He had a weak voice and hoarseness after atraumatic extubation and those symptoms did not improve even 2 days after. Indirect laryngoscopy, videolaryngotelescopy, electromyography(EMG) and computed tomographic findings revealed anterior, inferior subluxation of left cricoarytenoid cartilage associated with left thyroarytenoid muscle denervation and resultant unilateral vocal cord palsy. Conservative treatment for 40 days after the operation and follow-up examination was done. The voice quality was improved and indirect laryngoscopy examination showed that right vocal cord crossed midline in a attempt to meet its paralyzed counterpart on phonation.
Anesthesia, General* ; Cartilage ; Cholecystectomy ; Denervation ; Early Diagnosis ; Follow-Up Studies ; Hoarseness ; Intubation, Intratracheal ; Laryngeal Muscles ; Laryngoscopes ; Laryngoscopy ; Larynx ; Paralysis* ; Phonation ; Prognosis ; Recurrent Laryngeal Nerve* ; Surgical Instruments ; Vocal Cord Paralysis ; Vocal Cords ; Voice ; Voice Quality

Bronchogenic cyst is an uncommon congenital lesion which is derived from the primitive foregut. Most bronchogenic cyst may develope at the tracheal bifurcation, both main bronchi, the lung parenchymeand the mediastinum. A 40-year old male was evaluated for dyspnea and chest tightness. Computed tomography revealed a well dermarcated, 7.2 x 7.9 cm sized, homogeneous mass compressing the left atrium. 2D-echo showed grade III mitral regurgitation. We completely removed the cystic mass and then confirmed the bronchogenic cyst in the pathological diagnosis. During the follow up period, the patient progressed well without any symptoms and showed grade I mitral regurgitation on the 2D-Echo. Therefore, we report a case of the bronchogenic cyst causing grade III mitral regurgitation.
Adult ; Bronchi ; Bronchogenic Cyst* ; Diagnosis ; Dyspnea ; Follow-Up Studies ; Heart Atria ; Humans ; Lung ; Male ; Mediastinum ; Mitral Valve Insufficiency* ; Thorax

BACKGROUND: This study was conducted to compare the accuracy of computered tomography(CT) and sonography(US) in diagnosing acute appendicitis and to analyze the radiologic factors which influence the result. METHODS: We retrospectively studied the cases of 53 patients who were suspected of having appendicitis and who were examined by CT and US covered a three-year period. The final diagnosis was determined from the surgico-pathologic diagnosis and clinical follow-up for two months, as well as from the discharge diagnosis. RESULTS: Thirty-eight(38) patients had acute appendicitis; 15 patients did not. In the analysis, CT and US, respectively, revealed sensitivities of 89.5% and 73.7%, specificities of 93.3% and 60.0%, positive predictive values of 97.1% and 82.4%, negative predictive values of 77.8% and 47.4%. Among patients diagnosed with acute appendicitis, 10 patients were discordant in the US and the CT examinations; CT findings were correct in 8 and US findings in 2. Among non-appendicitis patients, 5 patients were discordant in the US and the CT examinations; CT was correct in 5 and US in 0. Nighteen(19) patients had complications such as an abscess or a perforation. Among these patients, the degree and the extent of the complication were accurately evaluated by CT in 15 patients and by US in 5 patients. CONCLUSION: CT is more accurate than US in diagnosing and excluding acute appendicitis. The use of CT will substantially decrease unnecessary laparotomies and post-operation complications.
Abscess ; Appendicitis* ; Diagnosis ; Follow-Up Studies ; Humans ; Laparotomy ; Retrospective Studies

A case changing blood pressure severely by manipulation of the huge tumor mass during the brain tumor surgery was observed. Decreased blood pressure (55/35 mmHg) might be caused by the stimulation of the brain increased to 150/75 mmHg after a neurosurgeon undermined and elevated the tomor mass, and blood pressure decreased again to 55/35 mmHg when he put it on the same position. Removing the mass completely, blood pressure was stabilized (about 130/70 mmHg). There are central vasomotor centers of autonomic nervous organization in the hypothalamus, midbrain, pons or medulla oblongata of the brain. By the stimulation of specific region in the above area, various features of responses were anatomically defined. The supratentorial contents may herniate through the tentorial incisura into the infratentorial spaces and posterior fossa, when intracranial pressure gradients become large enough to overcome the resistance of the brain tissue, and they can affect vital changes.
Blood Pressure* ; Brain Neoplasms* ; Brain* ; Hypothalamus ; Intracranial Pressure ; Medulla Oblongata ; Mesencephalon ; Pons

The congenital absence of the left circumflex artery and a compensatory super-dominant right coronary artery (RCA) is a very rare benign coronary anomaly in the clinic. The presence of a massive thrombus in the super-dominant RCA can lead to fatal results in cases of acute myocardial infarction, unless the thrombus is mechanically removed. Aspiration of the thrombus using a 6 Fr right Judkins guide catheter is useful to extract a massive thrombus and is both safe and effective. We report a case of complete revascularization of the super-dominant RCA after thrombus aspiration using a 6 Fr Judkins right catheter in a patient with acute inferior and inferolateral wall myocardial infarction.
Catheters ; Coronary Thrombosis ; Coronary Vessel Anomalies ; Coronary Vessels* ; Humans ; Inferior Wall Myocardial Infarction ; Lung Neoplasms* ; Myocardial Infarction ; Thrombosis*

During percutaneous coronary intervention, guidewire fractures are very exceptionally encountered in medical practice, but can cause fatal complications such as intracoronary thrombus formation, embolization and perforation. Removal of the remnant segments of guidewire is important for the prognosis. There are several methods being recommended for the treatment of fractured guidewire remnants. However, the best treatment of remnant guidewire filament is still unclear. Herein, we present a case where we did not completely remove remnant guidewire filaments that caused fatal coronary thrombosis.
Coronary Thrombosis ; Coronary Vessels* ; Methods ; Percutaneous Coronary Intervention ; Prognosis ; Stents* ; Thrombosis*

BACKGROUND: Iron deficiency anemia (IDA) is the most common anemia followed by anemia of chronic disease (ACD). Reticulocyte indices have been shown to be helpful indicators for detecting IDA. We investigated whether RBC and reticulocyte indices can be used to differentiate ACD from IDA. METHODS: A total of 85 women showing microcytic hypochromic anemia (38 IDA and 47 ACD cases) were enrolled. IDA was defined as those with ferritin level of <6 microg/dL and total iron binding capacity (TIBC) of >450 microg/dL. ACD was defined as ferritin level of > or =6 microg/dL, TIBC of < or =450 microg/dL, and presence of underlying diseases. We measured complete blood count, TIBC, iron, ferritin, and RBC and reticulocyte indices. The mean values of each item were compared between the two groups and sensitivity and specificity of each item in the differential diagnosis of ACD from IDA were determined by ROC curve analysis. RESULTS: In ACD, most of the RBC and reticulocyte indices were significantly higher than in IDA: mean cell volume (MCV), mean cell hemoglobin (MCH), mean cell hemoglobin concentration (MCHC), cellular hemoglobin concentration mean (CHCM), cellular hemoglobin content (CH), red cell distribution width (RDW), reticulocyte hemoglobin content (CHr), and mature RBC cellular hemoglobin content (CHm). All these indices, except MCV showed significant correlations with ferritin and/or TIBC. CHr level of > or =24.6 pg could be used to differentiate ACD from IDA with 85.1% sensitivity and 81.6% specificity. CONCLUSIONS: The reticulocyte indices, especially CHr, are useful for the differential diagnosis of microcytic hypochromic anemias, ACD and IDA.
Adult ; Anemia ; Anemia, Hypochromic ; Anemia, Iron-Deficiency ; Blood Cell Count ; Chronic Disease ; Diagnosis, Differential ; Erythrocyte Indices ; Female ; Ferritins ; Hemoglobins ; Humans ; Iron ; Reticulocytes ; ROC Curve ; Sensitivity and Specificity

Crystal-storing histiocytosis (CSH) is a rare event observed in association with lymphoproliferative diseases, and mainly occurrs in plasma cell dyscrasias. It is presumed to be an intra-lysosomal accumulation of the secreted paraproteins. Crystal formation can be seen inside histiocyte-like cells with phagocytosed crystalline inclusions in the bone marrow and extramedullary sites. CSH is a rare morphological entity with poor prognostic implications and may be confused with Gaucher or pseudo-Gaucher cells. Herein we report a case of non-secretory myeloma associated with CSH showing a poor clinical course. A 79-yr-old male presenting with dizziness was evaluated in hematology department for anemia. Laboratory tests revealed Hb of 4.9 g/dL and beta2-microglobulin of 21,000 ng/mL (reference range, 0-370). Presence of monoclonal protein was not detected on protein electrophoresis and immunofixation in serum and urine. However, serum free light chain assay showed an increased kappa-light chain level of 126 mg/L (reference range, 3.3-19.4) resulting in an increased kappa/lambda ratio. The bone marrow touch print showed numerous plasma cells and crystal-laden histiocytes and immunohistochemical stainings on bone marrow biopsy revealed positivity for CD38, CD56 and kappa in the plasma cells and CD68 and kappa in crystal-laden histiocytes.
Aged ; Antigens, CD/metabolism ; Antigens, CD38/metabolism ; Antigens, Differentiation, Myelomonocytic/metabolism ; Bone Marrow Cells/pathology ; Histiocytosis/complications/*diagnosis/radiography ; Humans ; Immunoglobulin kappa-Chains/analysis ; Male ; Multiple Myeloma/complications/*diagnosis/radiography ; Tomography, X-Ray Computed

PURPOSE: The clinical utility of brain computed tomography (CT) in detecting temporal bone fracture is not well established. We performed this study to determine the utility of brain computed tomography (CT) in detecting fractures of the temporal bones in correlation with fracture patterns. We used high resolution computed tomography (HRCT) as the gold standard for diagnosing temporal bone fracture and its pattern. METHODS: From January 2007 to December 2009, patients who underwent both brain CT and HRCT within 10 days of head trauma were investigated. Among them, 58 cases of temporal bone fracture confirmed by HRCT were finally included. Fracture patterns (transverse or non-transverse, otic capsule sparing or otic capsule violating) were determined by HRCT. Brain CT findings in correlation with fracture patterns were analyzed. RESULTS: Among 58 confirmed cases of temporal bone fracture by HRCT, 14 cases (24.1%) were not detected by brain CT. Brain CT showed a significantly lower ability to detect temporal bone fracture with transverse component than without transverse component (p=0.020). Moreover, brain CT showed lower ability to detect otic capsule violating pattern than otic capsule sparing pattern (p=0.015). Among the 14 cases of temporal bone fracture that were not detected by brain CT, 4 cases lacked any objective physical findings (facial palsy, hemotympanum, external auditory canal bleeding) suggesting fractures of the temporal bones. CONCLUSION: Brain CT showed poor ability to detect temporal bone fracture with transverse component and otic capsule violating pattern, which is associated with a poorer clinical outcome than otic capsule sparing pattern. Routine use of HRCT to identify temporal bone fracture is warranted, even in cases without evidence of temporal bone fracture on brain CT scans or any objective physical findings suggestive of temporal bone fracture.
Brain ; Craniocerebral Trauma ; Ear Canal ; Humans ; Paralysis ; Skull Fractures ; Temporal Bone

No abstract available.
Brain Abscess* ; Humans ; Lupus Erythematosus, Systemic* ; Nocardia*