BACKGROUND: The risk of bleeding during extracorporeal membrane oxygenation (ECMO) is a potential deterrent in performing tracheostomy at many centers. To evaluate the safety of surgical tracheostomy (ST) in critically ill patients supported by ECMO, we reviewed the clinical correlation between preoperative coagulation status and bleeding complication-related ST during ECMO. METHODS: From April 1, 2012 to March 31, 2016, ST was performed on 38 patients supported by ECMO. We retrospectively reviewed and analyzed the medical records including complications related to ST. RESULTS: Heparin was administered to 23 patients (60.5%) for anticoagulation during ECMO, but 15 patients (39.5%) underwent ECMO without anticoagulation. Of the 23 patients administered anticoagulation therapy, heparin infusion was briefly paused in 13 prior to ST. The median platelet count, international normalized ratio, and activated partial thromboplastin time before ST were 126 ×109/L (range, 46 to 434 ×109/L), 1.2 (range, 1 to 2.3) and 62 seconds (27 to 114.2 seconds), respectively. No peri-procedural clotting complications related to ECMO were observed. Two patients (5.3%) suffering from ST-related major bleeding required surgical hemostasis. Minor bleeding after ST occurred in two cases (5.3%). No significant difference was found according to anticoagulation management (P = 0.723). No fatality was attributable to ST. CONCLUSIONS: The complication rates of ST in the patients supported by ECMO were low. Therefore, ST performed by an experienced operator, and with careful optimization of coagulation status, is a relatively safe procedure; the use of ST with ECMO should thus not be dismissed on account of the potential for bleeding caused by the administration of anticoagulants.
Anticoagulants ; Critical Illness ; Extracorporeal Membrane Oxygenation* ; Hemorrhage ; Hemostasis, Surgical ; Heparin ; Humans ; International Normalized Ratio ; Medical Records ; Partial Thromboplastin Time ; Platelet Count ; Retrospective Studies ; Tracheostomy*

Spinal fusion has performed for instability and anatomical reconstruction since 1985 by Barthe. Bone grafts and synthetic materials has been used for spinal fusion, but they have several limitations and complications. Recently a new synthetic polymer B.O.P.(Biocompatible Osteoconductive Polymer) was developed and it overcome the limitations of other materials. The B.O.P. showed no foreign body reaction and gave scaffolding for the osteoconduction and osteointegration. Authors operated 35 cases of spinal fusion with B.O.P. and the results and literature reviews were discussed.
Bone Regeneration ; Bone Substitutes ; Foreign-Body Reaction ; Polymers ; Spinal Fusion* ; Transplants

Anterior interbody fusion has used for instability and anatomical reconstruction in various cervical diseases since 1958 by cloward. Bone grafts such as autograft, allograft, xenograft and synthetic materials were utilized in fusion as a graft material. But conventional fusion materials have problems including postoperative morbidity, transmission of diseases, foreign body reaction, collapse, prolongation of operation time. A new synthetic material, Biocompatible Osteoconductive Polymer(B.O.P) is developed and it was useful for cervical anterior interbody fusion as a substitute for other fusion materials.
Allografts ; Autografts ; Foreign-Body Reaction ; Heterografts ; Transplants

PURPOSE: To compare the outcomes of indocyanine green (ICG) and triamcinolone (TA) assisted internal limiting membrane (ILM) peeling during idiopathic macular hole surgery. METHODS: Fifty-four eyes of 54 patients with idiopathic macular hole underwent pars plana vitrectomy including peeling of the posterior cortical hyaloid and peeling of the internal limiting membrane. For enhanced visualization of ILM, ICG was used in 25 eyes and TA in the remaining 29 eyes. Postoperative visual acuity was measured and OCT was performed. RESULTS: Anatomical closure was achieved in 25 eyes (100%) in ICG group and 28 eyes (97%) in TA group, Best corrected visual acuity improvement by > or =2 lines was in 15 eyes (60%) in ICG group and 18 eyes (62%) in TA group. Postoperative visual improvement rates by > or =20/50 were 10 eyes (40%) in ICG group and 9 eyes (31%) in TA group. CONCLUSIONS: Peeling of the internal limiting membrane using triamcinolone and indocyanine green was safe and effective for anatomic and functional success in idiopathic macular hole surgery. Further studies of the toxicity of TA, ICG and the result of internal limiting membrane peeling is needed.
Humans ; Indocyanine Green* ; Membranes ; Retinal Perforations* ; Triamcinolone* ; Visual Acuity ; Vitrectomy

Pigmented extraadrenal paraganglioma is an unusual neoplasm that has rarely been reported in the literature. Based on histochemical staining or electron microscopy, pigment has been classified as lipofuscin, neuromelanin or true melanin. We report a case of pigmented extraadrenal paraganglioma in the posterior mediastinum of a 70-year-old woman. Histologically, the tumor had a characteristic organoid architecture of "zellballen" pattern with rich delicate microvasculature. Tumor cells contained numerous coarse brown-black pigment granules. Ultrastructurally, the tumor showed abundant large electron-dense pigment granules that vary in size and shape and smaller membrane-bound neurosecretory granules. The larger granules were consistent with neuromelanin or lipofuscin. Histochemically, the pigment is most likely neuromelanin, which is a waste product of catecholamine metabolism.
Aged ; Female ; Humans ; Lipofuscin ; Mediastinum ; Melanins ; Metabolism ; Microscopy, Electron ; Microvessels ; Organoids ; Paraganglioma* ; Waste Products

PURPOSE: To evaluate the effects of intravitreal aflibercept injection in the treatment of submacular hemorrhage secondary to neovascular age-related macular degeneration (nAMD). METHODS: This retrospective, observational study included patients diagnosed with nAMD with submacular hemorrhage treated with intravitreal aflibercept monotherapy. A total of 54 eyes of 54 patients were treated with an initial series of three monthly intravitreal aflibercept injections followed by as-needed injections. At the 6 month follow-up, changes in best-corrected visual acuity (BCVA), central macular thickness (CMT), and submacular hemorrhage area (SMH) were evaluated. RESULTS: The mean preoperative BCVA was 0.79 ± 0.59 logMAR, which improved significantly to 0.53 ± 0.46 logMAR at 3 months and 0.48 ± 0.50 logMAR at 6 months (p < 0.001, in both). The CMT significantly decreased in all eyes: preoperative, 454.4 ± 131.5 µm, to 242.6 ± 39.7 µm at 6 months. The SMH was also reduced in all eyes: preoperative, 6.4 ± 4.8 disc areas (DAs) to 0.8 ± 1.4 DAs at 6 months. Ten eyes were diagnosed with typical nAMD (18.5%) and 44 eyes were diagnosed polypoidal choroidal vasculopathy (81.5%). There was no significant difference at 6 months in the visual outcomes of the subgroups. CONCLUSIONS: Intravitreal aflibercept monotherapy is well-tolerated as a treatment in maintaining or improving vision in patients with SMH secondary to nAMD.
Choroid ; Follow-Up Studies ; Hemorrhage ; Humans ; Macular Degeneration ; Observational Study ; Retrospective Studies ; Visual Acuity

PURPOSE: To determine risk factors contributing to the development of an epiretinal membrane after retinal detachment surgery. METHODS: The authors retrospectively reviewed the records of 294 eyes which underwent retinal detachment surgery between 2001 and 2004. Parameters including numbers and locations of retinal breaks, operation methods and associated abnormalities were compared between the eyes from which a postoperative epiretinal membrane was removed and the eyes from which the membrane was not removed. RESULTS: Fourteen eyes (4.8%) underwent epiretinal membrane removal during the follow-up period. The mean interval between the retinal reattachment surgery and the vitrectomy for epiretinal membrane was 184 days (range: 50~546 days). Retinal breaks were located superiorly in 12 eyes and inferiorly in 2 eyes. Regarding the number of breaks, 1 break was observed in 9 eyes, 2 breaks in 2 eyes, 3 breaks in 2 eyes and no breaks in 1 eye. Vitreous hemorrhages presented in 7 eyes (50%). Twelve eyes were phakic eyes and 2 were pseudophakic. The macula was detached in 9 eyes (64.3%). Procedures for retinal detachment were vitrectomy with gas tamponade in 8 eyes (57.1%) and scleral buckling with cryoretinopexy in 6 eyes (42.9%). CONCLUSIONS: Preoperative vitreous hemorrhage, superior location of retinal breaks, old age and scleral buckling with cryotherapy were determined to be significant factors for the postoperative development of an epiretinal membrane. Postoperative visual acuity increased in all cases. This study demonstrates that vitrectomy for epiretinal membrane results in an overall favorable functional outcome.
Cryotherapy ; Epiretinal Membrane ; Eye ; Follow-Up Studies ; Membranes ; Retinal Detachment ; Retinal Perforations ; Retinaldehyde ; Retrospective Studies ; Risk Factors ; Scleral Buckling ; Visual Acuity ; Vitrectomy ; Vitreous Hemorrhage

Retroperitoneal teratoma is comparatively rare and yet difficult to treat and predict the prognosis. Recently we experienced 2 cases of retroperitoneal teratoma in the infancy, which was suspected by radiologic investigation and confirmed by exploration and microscopic examination.
Prognosis ; Teratoma*

Syphilitic granulomatous pancreatitis is an extremely rare condition,and can occur in the generalized acquired syphilitic patient in tertiary or secondary phase. The most serious problem with granulomatous pancreatic lesion is clinical or radiological misdiagnosis as cancer. We experienced a case of syphilitic granulomatous pancreatitis arising in 54 year old female patient. She was treated for syphilis 20years ago. But she and her husband are still strong positive to VDRL and TPHA. On abdominal computed tomography and endoscopic pancreatico- duodenography, there was an obstructive mass of low density in the distal common bile duct or pancreatic head. Under the preoperative diagnosis of pancreatic head carcinoma, Whipple's operation was done. On gross examination, the pancreas was fibrotic, and the common bile duct was well preserved without tumor mass. Microscopically, numerous intralobular noncaseating epithelioid cell granulomas with multinucleated giant cells are identified. They surround thick-walled, small to medium sized arteries and involve vascular wall with luminal narrowing or obliteration, which are characteristic findings of the syphilitic granuloma. The remaining parenchyme shows fibrosis, acinar atrophy or destruction with dense infiltration of lymphohistiocytes, plasma cells with granuloma formation. Although the Warthin-Starry stain reveals no spirochetes, the serologic result and pathologic findings are compatible with syphilitic granulomatous pancreatitis.
Female ; Humans

Being described first 1912 by Hashimoto, Chronic lymphocytic thyroiditis has been most commonly diagnosed as inflammatory thyroid disease. Despite of worldwide reports about the concomitant malignancy with Hashimoto's thyroiditis, the definite incidence of coexsiting malignancy and the etiologic relationship between these different pathologic conditions remains to be brought out. Analyzing 18 cases of coexisting thyroid carcinoma among 80 cases of Hashimoto's thyroiditis, confirmed by pathologic study at Presbyterian medical center in Chonju between 1991 and 1995, the authors intended to make guideline of management for them. The results are as follows: 1. The incidence of coexisting carcinoma with HT was 18/80(22.5%). 2. The average age of patients with coexisting carcinoma was 44.1 years and all of them were female.3. Cold nodules on thyroid scan were noticed in 23 cases(22.7%) of HT and 7 cases(33.8%) of coexisting carcinoma with HT. 4. Calcified lesions on thyroid sonography were detected in 0 cases of HT and 4 cases(50%) of coexisting carcinoma. 5. The pathologic types of carcinoma were papillary(17/18, 94.4%) and follicular(1/18, 5.6%). 6. 3 cases of coexisting carcinoma had metastatic lesions on peritracheal lymph nodes and another 3 cases had on ipsilateral jugular nodes. 7. The carcinoma of smaller than 0.5cm were 7 cases, of 0.6-1.0cm were 3 cases, of 1.1-1.5cm were 5 cases, and so 15 cases(83.3%) were occult carcinoma. Only 3 cases were larger than 1.6cm. 8. Coexisting carcinoma patients with HT underwent subtotal thyroidectomy (4 cases), subtotal thyroidectomy & anterior compartment dissection (ACD, 6 cases), subtotal thyroidectomy & modified RND (2 cases), thyroid lobectomy & ACD (4 cases), thyroid lobectomy & modified RND (1 cases), or near total thyroidectomy & ACD (1 case).
Hashimoto Disease ; Humans ; Incidence ; Jeollabuk-do ; Lymph Nodes ; Protestantism ; Thyroid Diseases ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy ; Thyroiditis*