A one-year-old female sika deer died suddenly with no preliminary signs during exhibition at a zoo. At necropsy, the carcass was emaciated and had dried fur. Examination of the thoracic cavity revealed a diaphragmatic rupture measuring 2 cm in diameter and a fracture in the middle of the right eighth rib. The liver and lungs had irregular circular discolorations caused by diaphragmatic rupture and subsequent herniation. Dark-brown-colored ascitic fluid, hydrothorax, and yellowish hydropericardium were also observed. The cause of death was determined to be diaphragmatic rupture caused by a rib fracture, which led to respiratory imbalance and circulatory disorders.

Dermatophytosis was found on the right front leg of a 4-month-old female African lion cub (Panthera leo) kept at a zoo with locally marginal alopecia. For diagnosis, culturing on sabouraud dextrose agar was performed and skin scrapings from the lesion were analyzed. The ones from the culture and skin scrapings were identified as Trichophyton mentagrophytes. A zookeeper that had been in contacted with the lion for artificial rearing developed skin lesions with well-defined erythematous plaques on the right arm about 1 month after the lesion in the lion was observed. The ringworm was probably transmitted from the lion through continuous contact.
Agar ; Alopecia ; Arm ; Diagnosis ; Female ; Glucose ; Humans ; Infant ; Leg ; Lions* ; Skin ; Tinea ; Trichophyton*

Intestinal rupture caused by small bowel volvulus was diagnosed in a captive 13-year-old male American black bear. The animal presented with decreased appetite, depression, lethargy, and mild abdominal distention for 3 days. The animal was treated with antibiotics, hypermetabolites, and digestive medicine daily; however, it died on the third day of treatment. The clinical symptoms included hemorrhagic ascites, gaseous extension of the small intestine, and intestinal rupture caused by small bowel volvulus. Hemorrhagic signs were observed in the lungs and heart. This is the first case to describe small bowel volvulus in mammals of the family Ursidae.
Adolescent ; Animals ; Anti-Bacterial Agents ; Appetite ; Ascites ; Depression ; Heart ; Humans ; Intestinal Volvulus* ; Intestine, Small ; Lethargy ; Lung ; Male ; Mammals ; Rupture* ; Ursidae*

PURPOSE: The purpose of this study was to compare the curative effect of Proximal Femoral Nail Antirotation (PFNA) with a Proximal Femoral Nail (PFN) for the treatment of intertrochanteric fracture of the femur. MATERIALS AND METHODS: This study compared 58 cases of 57 patients who were treated by PFNA from June 2007 to February 2009 with 60 cases of 58 patients who were treated by PFN from July 2005 to May 2007. The mean duration of follow-up was 17.2 months (range: 12-31 months). All the fractures were classified according to the AO/ASIF systems. The operative time, the average number of days of hospitalization, the amount of bleeding, the incidence of complications, the union time as assessed on radiologic examinations, the tip apex distance (TAD), the outcome according to the Cleveland index, the change of the neck shaft angle and the amount of sliding at the end of follow-up were compared between the two groups. The clinical outcomes were compared according to the mobility score of Parker, Palmer, Jensen. The results were analyzed using the Student T-test and chi-square tests. RESULTS: There was no significant difference in blood loss during surgery, the number of hospitalization days, radiographic bone union and TAD (p>0.05). Compared with PFN, the operation time, the postoperative sliding and the neck shaft angle change were significantly less in the PFNA group (p<0.05). For the postoperative complications, there was 1 case of cutting out and 1 case of superficial infection in the PFNA group, and there were 4 cases of cutting out, 2 cases of back out, 2 cases of varus collapse, 1 case of nonunion and 1 case of superficial infection in the PFN group. CONCLUSION: Using the PFNA had relatively satisfying clinical results for the treatment of intertrochanteric fracture, as compared with those of using PFN.
Follow-Up Studies ; Hemorrhage ; Hip Fractures ; Hospitalization ; Humans ; Incidence ; Nails ; Neck ; Operative Time ; Postoperative Complications

Myasthenia gravis, a disease characterized by weakness and easy fatigue of skeletal muscles, has been associated with other diseases of presumed autoimmune nature. These include rheumatoid arthritis, systemic lupus erythematosus, thyroid dysfunction, hematologic disease, gammopathy, infection, cancer, inflammatory myopathy, etc. In some cases of myasthenia gravis, an inflammatory myopathy develops and adds to the weakness already caused by the transmission defect. We report a 31-year-old female who had the manifestations of myasthenia gravis and polymyositis with the brief review of literatures.
Adult ; Arthritis, Rheumatoid ; Fatigue ; Female ; Hematologic Diseases ; Humans ; Lupus Erythematosus, Systemic ; Muscle, Skeletal ; Myasthenia Gravis* ; Myositis ; Polymyositis* ; Thyroid Gland

PURPOSE: After intubation, it is recommended that, to sustain airway patency, about 10ml of air be infused to seal the airway and to prevent complications. At this step, sustaining a proper pressure level (18~24 mmHg) is most important because excessive pressure can cause diverse complications. We carried out a series of investigations to find a way to sustain a constant pressure level. METHODS: We gathered the cases of intubated patients for 6 randomly selected days during 2003 at HanGang Sacred Heart Hospital. Included were cases from emergency room, the intensive care unit, and the operating rooms; 30 cases were enrolled for this investigation. We used a cuff pressure control REF 701 (Tracoe(r), Mainz, Germany) to trace the cuff pressure. First, we measured the amount of air that was infused into the cuff and the cuff pressure. Then, we measured the amount of air after a proper level of cuff pressure had been achieved. RESULTS: We have found that out of the 30 cases investigated the recommended pressure level was maintained in 4 cases. The average cuff pressure was 40.9 mmHg with 10.2 cc of air and 69.0 mmHg, the largest value, was reported in one case. However, when recommended pressure level was maintained (18 mmHg), the average amount of air was reduced to 7.9 cc. CONCLUSION: The results reveal that it may not be possible to sustain the recommended pressure level by "infusing about 10 ml of air,"and that may cause complications.
Emergency Service, Hospital ; Heart ; Humans ; Intensive Care Units ; Intubation ; Operating Rooms

OBJECTIVES: P1 is a robust positivity at a latency of 50-150 msec in the auditory evoked potential of young children. It has been reported that over the first 2-3 years of life, there is a rapid decrease of the latency and the mean P1 latency in adults with normal hearing is approximately 60 msec. This study was designed to evaluate the change of the P1 latency in Koreans with normal hearing according to age and to compare this with the P1 latency of young patients with profound sensorineural hearing loss before and/or after cochlear implantation. METHODS: Among the patients who visited the Department of Otorhinolaryngology at Seoul National University Hospital from June 2007 to September 2009, the P1 response was recorded in 53 patients in the normal hearing group, in 13 patients in the pre-cochlear implantation (CI) group and in 10 patients in the post-CI group. A synthesized consonant-vowel syllable /ba/ was used to elicit the evoked responses. The evoked responses were collected using the center of the frontal head. For each subject, an individual grand average waveform was computed by averaging the ten recordings. The P1 latency was visually identified as a robust positivity in the waveform. RESULTS: For the normal hearing group, the P1 latency showed the pattern of shortening as the age increased (coefficient, -0.758; P<0.001). For the pre-CI group, 10 cases showed delayed latencies and 3 cases did not show the P1 wave. For the post-CI group, the P1 latencies showed a less delayed tendency than those of the pre-CI group, but this was not statistically different. CONCLUSION: This report provides the standard value of the P1 latency at each age in Koreans for the first time and the findings support that the maturation of the central auditory pathways could be measured objectively using the P1 latency.
Adult ; Auditory Pathways ; Child ; Cochlear Implantation ; Evoked Potentials, Auditory ; Head ; Hearing ; Hearing Loss, Sensorineural ; Humans ; Otolaryngology

This study compared long-term speech performance after cochlear implantation (CI) between surgical strategies in patients with chronic otitis media (COM). Thirty patients with available open-set sentence scores measured more than 2 yr postoperatively were included: 17 who received one-stage surgeries (One-stage group), and the other 13 underwent two-stage surgeries (Two-stage group). Preoperative inflammatory status, intraoperative procedures, postoperative outcomes were compared. Among 17 patients in One-stage group, 12 underwent CI accompanied with the eradication of inflammation; CI without eradicating inflammation was performed on 3 patients; 2 underwent CIs via the transcanal approach. Thirteen patients in Two-stage group received the complete eradication of inflammation as first-stage surgery, and CI was performed as second-stage surgery after a mean interval of 8.2 months. Additional control of inflammation was performed in 2 patients at second-stage surgery for cavity problem and cholesteatoma, respectively. There were 2 cases of electrode exposure as postoperative complication in the two-stage group; new electrode arrays were inserted and covered by local flaps. The open-set sentence scores of Two-stage group were not significantly higher than those of One-stage group at 1, 2, 3, and 5 yr postoperatively. Postoperative long-term speech performance is equivalent when either of two surgical strategies is used to treat appropriately selected candidates.
Adult ; Aged ; Cholesteatoma, Middle Ear/epidemiology ; Chronic Disease/therapy ; Cochlear Implantation/*adverse effects ; Cochlear Implants/*adverse effects ; Female ; Hearing Loss, Sensorineural/*surgery ; Humans ; Inflammation/epidemiology ; Male ; Middle Aged ; Otitis Media/*surgery ; Retrospective Studies ; *Speech Articulation Tests ; Treatment Outcome ; Young Adult

Acute fulminant invasive fungal sinusitis in an immunocompromised host and bacterial rhinosinusitis with intracranial or orbital extension is challenging to manage. And it sometimes constitutes true otolaryngologic emergencies. In the absence of rapid diagnosis and treatment, these diseases can be fatal. A 57-year-old female was admitted for chills and headache, who received a deceased donor renal transplantation 3 months ago. Paranasal sinus CT showed enhanced soft tissue density and MRI showed low-signal with hyperintense signal of around paranasal sinus cavity. The histological investigation revealed invasive aspergillosis of paranasal sinuses. Clinical improvement occurred after endoscopic sinus surgery and post-operative systemic antifungal therapy with amphotericin B and voriconazole.
Amphotericin B ; Aspergillosis ; Chills ; Emergencies ; Female ; Headache ; Humans ; Immunocompromised Host ; Kidney ; Kidney Transplantation ; Middle Aged ; Orbit ; Paranasal Sinuses ; Pyrimidines ; Sinusitis ; Tissue Donors ; Triazoles

PURPOSE: It is important that the internal pressure of a cuff be sustained at a constant level (18~25 mmHg). If not, complications may result. Because the space for the intrusion of the cuff is limited, the pressure should be determined by the amount of air in the cuff and the tracheal luminal diameter. Since very limited studies of the tracheal luminal diameter in Korea exist, in this study, we report the relationships between the tracheal luminal diameter and other variables such as age, gender, pulmonary disease, and chronic obstructive pulmonary disease. METHODS: This study was based on chest CT cases at HanGang Sacred Heart Hospital in 2002. We retrospectively reviewed the charts of the 102 patients included in this study. The mean luminal diameter of the anterior-posterior(AP) and the transverse diameters were our dependent variables, and those diameters were checked by two investigators in each case. RESULTS: The average mean luminal diameter was 17.0mm, and the range of the mean luminal diameter was from 9.0 mm to 27.5 mm. The mean value for men was 18.3mm, and that for women was 15.1 mm, and the difference proved to be statistically different from zero (p<0.01). The luminal diameter is significantly different between COPD (m=19.0 mm) and non-COPD (m=17.0 mm) cases and the difference was statistically different from zero for all the statistics adopted in this study. CONCLUSION: This study found that the size of the luminal diameter was significantly different between two groups: men and women, and COPD and non-COPD cases. Despite the seminal findings of the present study, this study has several limitations.
Female ; Heart ; Humans ; Intubation ; Korea ; Lung Diseases ; Male ; Phenobarbital* ; Pulmonary Disease, Chronic Obstructive ; Research Personnel ; Retrospective Studies ; Thorax* ; Tomography, X-Ray Computed ; Trachea