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*

Injection medialization laryngoplasty is a procedure that has many advantages in treating vocal fold paralysis; however, undesired complications can occur. We experienced a case of a pulmonary embolism, suspected in a patient who had undergone an injection laryngoplasty with calcium hydroxylapatite (CaHA). The patient suffered dyspnea after undergoing the injection laryngoplasty. Chest embolism computed tomography (CT) scan revealed a new lesion of enhancing materials at the pulmonary vasculature in the right upper lobe. The CaHA embolism was suspected, and the patient was treated with warfarin for 12 months. The patient's symptom of dyspnea nearly disappeared and a follow up chest embolism CT scan revealed no signs of the previous lesion. Thus, we would like to report this rare case along with a review of the literature.
Calcium* ; Durapatite* ; Dyspnea ; Embolism ; Follow-Up Studies ; Humans ; Laryngoplasty* ; Paralysis ; Pulmonary Embolism* ; Thorax ; Tomography, X-Ray Computed ; Vocal Cord Paralysis ; Vocal Cords ; Warfarin

No abstract available.
Allografts* ; Fibroblasts*

Actinomycosis, in which the principal causative agent in man is known to Actinomyces israelii, is a chronic, suppurative diseases characterized by extensive fibrosis, multiple abscesses, and formation of sinus tracts that drain suppurative exudates. On the basis of the anatomical sites involved; it can be subclassified into the cervicofacial form, which is the most common form, pulmonary form and abdominal form. Kidneys are rarely affected. Clinically, radiologically, and at operation it is difficult to differentiate the renal actinomycosis from renal tuberculosis and renal carcinoma. The prognosis is excellent after nephrectomy followed by appropriate antibiotic therapy. We presented a case of renal actinomycosis with a brief review of the literatures.
Male ; Humans

As population ages, much more elderly patients have been diagnosed with head and neck cancer especially in Korea. Diverse factors such as comorbidities and disabilities make the establishment of evidence-based guidance more challenging. Chronological age, literally measured in days, months and years from the time the individual was born, is not an ideal predictor in determining personal health condition; individualization of treatment protocols with identifying the concept of frailty is the key to produce an advanced treatment plan of elderly patients suffering from head and neck malignancy. Frailty is a type of geriatric syndrome which refers to the status with age-associated declines in physiologic function and increased vulnerability to stress conditions independent of age. Therefore, screening the status of frailty may be beneficial for the elderly patients to determine decent treatment option and maximize the efficiency. In order to provide otolaryngologists prognostic information adapting the concept of frailty, research papers published from 2000 to 2018 are comprehensively reviewed in this article. For optimal care of elderly patients with head and neck cancer, frailty is definitely required to be assessed in order to establish an ideal treatment option and increase the efficacy of the treatment.
Aged ; Clinical Protocols ; Comorbidity ; Diagnosis ; Head and Neck Neoplasms ; Head ; Humans ; Korea ; Mass Screening ; Neck

As population ages, much more elderly patients have been diagnosed with head and neck cancer especially in Korea. Diverse factors such as comorbidities and disabilities make the establishment of evidence-based guidance more challenging. Chronological age, literally measured in days, months and years from the time the individual was born, is not an ideal predictor in determining personal health condition; individualization of treatment protocols with identifying the concept of frailty is the key to produce an advanced treatment plan of elderly patients suffering from head and neck malignancy. Frailty is a type of geriatric syndrome which refers to the status with age-associated declines in physiologic function and increased vulnerability to stress conditions independent of age. Therefore, screening the status of frailty may be beneficial for the elderly patients to determine decent treatment option and maximize the efficiency. In order to provide otolaryngologists prognostic information adapting the concept of frailty, research papers published from 2000 to 2018 are comprehensively reviewed in this article. For optimal care of elderly patients with head and neck cancer, frailty is definitely required to be assessed in order to establish an ideal treatment option and increase the efficacy of the treatment.

A rare case of giant invasive intraosseous schwannoma in lumbar vertebra with no neurologic deficit is reported. This tumor had vertebral body, left paravertebral tissue and lamina invasion and thus classified as type V giant invasive schwannoma according to Sridhar's classification of benign nerve sheath tumor. Because intraosseous portion was significantly larger than extraosseous portion, this tumor was mentioned as intraosseous schwannoma. Tumor was successfully resected using corpectomy, mesh cage insertion and posterior fixation. Pathological diagnosis was benign schwannoma.
Neurilemmoma ; Neurologic Manifestations ; Spine

OBJECTIVES: Working at other times than the regular day shift has been reported to be a stressor associated with health consequences and mental disorders as well as disturbance of sleep. In current study, we aimed at investigating the relationship between work schedule, sleep quality and depression among police officers. METHODS: Eleven hundreds and forty five police officers (male:1040, female:105) completed questionnaires of basic socio-demographic data, Pittsburgh Sleep Quality Index (PSQI), Korean Scale of Occupational Stress (KOSS), Impact of Event Scale - Revised (IES-R) and Center for Epidemiologic Study-Depression (CES-D). RESULTS: After controlling for age, sex and educational level, score of CES-D was correlated positively with the score of KOSS, PSQI and IES-R on partial correlation analysis (r=-0.077;p=0.009, r=0.262;p<0.000 and r=0.421, p<0.000, respectively). Logistic regression analysis revealed that female sex, age, the score of KOSS and IES-R and schedule of rotating shift work predicted higher score than 16 score of CES-D significantly in total subjects (p=0.023, p=0.015, p=0.000, p=0.000 and p=0.022, respectively). CONCLUSION: Current result suggested that not only female sex, age, higher occupational stress and impact of event scale but also rotating shift work schedule might be related to depression among police officers.
Appointments and Schedules ; Depression ; Female ; Humans ; Logistic Models ; Mental Disorders ; Police ; Surveys and Questionnaires ; Risk Factors

Orientia tsutsugamushi is obligate intracellular bacterium that grows within the cytoplasm of the eukaryotic host cells. Therefore capability of the attachment, entry into the host cell and intracellular survival should be critical process for oriential infection. In this study we investigated the cellular invasion mechanism of Orientia tsutsugamushi and the role of transmembrane heparan sulfate proteoglycan, which binds diverse components at the cellular microenvironment and is implicated as host cell receptors for a variety of microbial pathogens. First of all Orientia tsutsugamushi can invade a wide range of nonprofessional phagocytic cells including fibroblast, epithelial cells a#nd endothelial cells of various host species, including B and T lymphocytes. Thus, it was postulated that the attachment of O. tsutsugamushi requires the recognition of ubiquitous surface structures of many kinds of host cells. Treatments with heparan sulfate and heparin inhibited the infection of Orientia tsutsugamushi in dose-dependent manner for L cell, mouse fibroblast, whereas other glycosaminoglycans such as chondroitin sulfate had no effect. Collectively, these findings provide strong evidence that initial interaction with heparan sulfate proteoglycan is required for the oriential invasion into host cells.
Animals ; Cellular Microenvironment ; Chondroitin Sulfates ; Cytoplasm ; Endothelial Cells ; Epithelial Cells ; Eukaryotic Cells* ; Fibroblasts ; Glycosaminoglycans ; Heparan Sulfate Proteoglycans ; Heparin ; Heparitin Sulfate ; Mice ; Orientia tsutsugamushi* ; Phagocytes ; T-Lymphocytes

INTRODUCTION: There has been an increasing interest in the relationship between sleep and suicidality. In addition, suicidal patients habitually report their sleep problems. Although sleep-related complaints and electroencephalographic changes are generally encountered in psychiatric disorders, sleep complaints such as insomnia, hypersomnia and nightmares are more common in suicidal patients. In current study, we aimed at investigating the relationship between self-reported sleep duration and suicidality in general population. METHODS: One thousand general population (male : female=500 : 500, mean age=39.6+/-11.6 years, ranged age=20-77 years) completed Center for Epidemiologic Study-Depression (CES-D), Beck Suicide Intent scale (BSI), Spielberger State-Trait Anger Expression Inventory (STAXI), Barratt Impulsiveness Scale (BIS), Morningness-Eveningness Scale (MES) and brief questionnaire of sleep habits. RESULTS: After controlling for age and sex, score of BSI was correlated positively with the score of CES-D, STAXI and BIS on partial correlation analysis (r(p)=0.251 ; p<0.001, r(p)=0.352 ; p<0.001, and r(p)=0.175 ; p<0.001, respectively). In addition, score of BSI was inversely correlated with the score of MES (r(p)=-0.066; p=0.037). However, score of BSI showed no significant correlation with sleep duration. However, regression analysis revealed that short (<6 hrs) or long (>10 hrs) sleep duration, the family history of psychiatric illness, the score of CES-D, and the score of STAXI predicted higher score of BSI significantly in total subjects (F=17.837, adjusted R2 =0.166 ; p=0.003, p=0.003, p<0.001, and p=0.003, respectively). This model was explained better in depressed subjects with 16 or higher score of CES-D (F=9.920, adjusted R2=0.298). CONCLUSION: Current result suggested that not only short sleep duration (<6 hrs) but also long sleep duration (>10 hrs) might be related to suicidality.
Anger ; Depression ; Disorders of Excessive Somnolence ; Dreams ; Humans ; Surveys and Questionnaires ; Republic of Korea ; Sleep Initiation and Maintenance Disorders ; Suicide