Subcutaneous emphysema is one of the rare complication of tracheal intubation and it's mechanism has been known as airleakage to subcutaneous tissue from the perforated site of larynx, trachea and esophagus by the trauma of laryngoscopic blade, stylet and endotracheal tube. We experienced a case of subcutaneous emphysema during unexpected difficult endotracheal intubation. At the initial laparoscopic examination, the patient's laryngeal view was grade IV of Cormack and Lehane's calssification. After several trial of the intubation, cervical subcutaneous emphysema developed by the trauma of laryngoscopic blade, stylet and endotracheal tube, even though failed to confirm the perforated site at postanesthesia one day.
Esophagus ; Intubation ; Intubation, Intratracheal* ; Larynx ; Subcutaneous Emphysema* ; Subcutaneous Tissue ; Trachea

A clinical analysis was made of 18 cases of traumatic diaphragmatic rupture which had been treated during the 8 years from January 1989 to December 1997 at the Department of Surgery & Chest Surgery, Dae Rim Saint Mary's Hospital. The results are as follows: 1) The most common ages were 3rd and 4th decades (61.1%).There were 14 males and 4 females (M : F = 3.5 : 1) 2) The traumatic diaphragmatic ruptures were due to blunt trauma in 13 (72.2%) patients (left 10, right 3) and penetrating trauma in 5 (27.8%) patients (left 5). 3) The common symptoms were dyspnea (77.8%), abdominal pain (66.7%), and chest pain (55.6%). 4) 12 of the 18 patients were diagnosed before operation. Six patients were diagnosed during operation. 5) 15 of the 18 patients were operated on within 24 hours (83.3%). 6) The most common associated intraabdominal injured organ was spleen (44.4%). The most common herniated organ was colon (27.8%). 7) Most of the injuries ranged in size from 6 to 10 cm in the blunt trauma patients (53.8%) and less than 5 cm in penetrating trauma patients (100%). 8) The operations were done using a laparotomy alone in 11 patients, a thoracotomy in 5 patients, and a thoracoabdominal incision in 2 patients. 9) Postoperative complications were developed in 8 patients (44.4%). 10) The perioperative mortality was 11.1%, and the causes of deaths were hypovolemic shock and septic shock. In conculusion, traumatic diaphragmatic rupture without severe associated organ injury could reveal a good outcome, if early diagnosis and proper treatment was performed.
Abdominal Pain ; Cause of Death ; Chest Pain ; Colon ; Dyspnea ; Early Diagnosis ; Female ; Humans ; Laparotomy ; Male ; Mortality ; Postoperative Complications ; Rupture* ; Saints ; Shock ; Shock, Septic ; Spleen ; Thoracotomy ; Thorax

We experienced a rare clinical manifestation of a digoxin induced catatonic stupor without other features of digoxin toxicity. This case suggests that the neurological manifestation of digoxin toxicity can occur without the usual side effects. Also, a serum digoxin level should be checked in any elderly patient presenting with abnormal cerebral func-tions, irrespective of whether or not the dose of digoxin has been changed. (J Korean Neurol Assoc 19(4):438~439, 2001)
Aged ; Digoxin ; Humans ; Neurologic Manifestations ; Stupor*

BACKGROUND: The pathogenesis of silicosis has been focused on the interaction between alveolar macrophages and silica particle. Although fibrosis in silicosis has been studied extensively, the mechanism is still not fully understood. There is increasing evidence that monokines and arachidonic acid metabolites produced by macrophage are involved in pathogenesis of silicosis. Recently, it was reported that prostaglandin E2 produced from macrophage counteracts the stimulatory effects of other monokines on fibroblast proliferation or collagen production. Until now, it was remained uncertain by which mechanism silica particle may activate alveolar macrophage to an enhanced release of prostaglandin E2. METHODS: In order to investigate the relationship between the activity of alveolar macrophage and the production of PGE2 from activated alveolar macrophage, the authors measured hydrogen peroxide and PGE2 from alveolar macrophages activated by silica in vitro and from alveolar macrophages in the silicotic nodules from rat. Experimental silicosis was induced by intratracheal infusion of silica(SiO2) suspended in saline (50 mg/ml) in Sprague-Dawley rats. RESULTS: 1) The silicotic nodules with fibrosis were seen from the sections of rat lung at 60 days after intratracheal injection with 50 mg aqueous suspension of silica. 2) In vitro, silica caused the dose dependent increase of hydrogen peroxide(p<0.05) and PGE2(p>0.05) release from alveolar macrophages. Alveolar macrophages from rats with silicotic nodules released more hydrogen peroxide and PGE2 than those of control group(p<0.05). CONCLUSION: These results suggest that silica particle could activate macrophage directly and enhanced the release of PGE2 and hydrogen peroxide from the alveolar macrophage.
Animals ; Arachidonic Acid ; Collagen ; Dinoprostone* ; Fibroblasts ; Fibrosis ; Hydrogen ; Hydrogen Peroxide ; Lung ; Macrophages ; Macrophages, Alveolar* ; Monokines ; Rats ; Rats, Sprague-Dawley ; Silicon Dioxide* ; Silicosis

Rhinoliths result from calcification of an endogenous or exogenous nidus within the nasal cavity. Patients typically present symptoms of long-standing unilateral nasal obstruction, pain and foul-smelling discharge. Rhinoliths are most often found on the floor of the nose and maxillary antrum. Rhinoliths are most often found on the floor of the nose and maxillary antrum. Rhinoliths present complications involving erosion or perforation of nasal mucosa, septum and palate. Sinusitis is a rare complication of rhinoliths. The authors experienced a case of frontal sinus rhinoliths in 36 years old man who complained of a headache and had a history of a frontal area trauma. At first we suspected it to be fungal sinusitis or mucocele, but finally confirmed it to be frontal sinus rhinolith after carrying out a frontal sinus osteoplastic operation.
Adult ; Frontal Sinus* ; Headache ; Humans ; Maxillary Sinus ; Mucocele ; Nasal Cavity ; Nasal Mucosa ; Nasal Obstruction ; Nose ; Palate ; Sinusitis

Background: This study aimed to evaluate the co-administration effect of atelocollagen combined with hyaluronic acid (HA) injections fortreatment of full-thickness rotator cuff tear (RCT). Methods: Eighty patients who underwent arthroscopic rotator cuff repair for full-thickness RCT from March 2018 to November 2019 wereenrolled. The patients were randomly allocated to the following groups: combined atelocollagen and HA injection (group I, n=28), only HAinjection (group II, n=26), and no injection (group III, n=26). Clinical outcomes were assessed at 3, 6, and 12 months after surgery usingthe American Shoulder and Elbow Surgeons score, visual analog scale pain score, functional scores (pain visual analog scale, function visualanalog score), and range of motion. Magnetic resonance imaging was performed 12 months after surgery to evaluate rotator cuff integrity. Results: Preoperative demographic data and postoperative clinical outcomes did not differ significantly among the three groups (p>0.05).However, in group I, the number of steroid injections after surgery was significantly lower than that in the other groups (p=0.011). The retear rate on follow-up magnetic resonance imaging was significantly higher in group II (9.5%, n=2) and group III (13.6%, n=3) than ingroup I (0%, p=0.021). Conclusions Co-administration of atelocollagen and HA improves healing of the rotator cuff and increases the integrity of the rotator cuffrepair site. This study provides encouraging evidence for use of combined atelocollagen-HA injections to treat patients with full-thicknessRCT.

Background: This study aimed to evaluate the co-administration effect of atelocollagen combined with hyaluronic acid (HA) injections fortreatment of full-thickness rotator cuff tear (RCT). Methods: Eighty patients who underwent arthroscopic rotator cuff repair for full-thickness RCT from March 2018 to November 2019 wereenrolled. The patients were randomly allocated to the following groups: combined atelocollagen and HA injection (group I, n=28), only HAinjection (group II, n=26), and no injection (group III, n=26). Clinical outcomes were assessed at 3, 6, and 12 months after surgery usingthe American Shoulder and Elbow Surgeons score, visual analog scale pain score, functional scores (pain visual analog scale, function visualanalog score), and range of motion. Magnetic resonance imaging was performed 12 months after surgery to evaluate rotator cuff integrity. Results: Preoperative demographic data and postoperative clinical outcomes did not differ significantly among the three groups (p>0.05).However, in group I, the number of steroid injections after surgery was significantly lower than that in the other groups (p=0.011). The retear rate on follow-up magnetic resonance imaging was significantly higher in group II (9.5%, n=2) and group III (13.6%, n=3) than ingroup I (0%, p=0.021). Conclusions Co-administration of atelocollagen and HA improves healing of the rotator cuff and increases the integrity of the rotator cuffrepair site. This study provides encouraging evidence for use of combined atelocollagen-HA injections to treat patients with full-thicknessRCT.

The management of the third molar tooth in mandibular angle fracture is still controversial. Retrospective analysis of 197 cases of mandibular angle fractures associated with third molar tooth was undertaken. Selective prophylactic extraction of the third molar teeth were undertaken in 66 cases. The third molar teeth were retained in 131 fractures. The indication of extraction of the third molar teeth in mandibular angle fracture were as follows: 1) interfering with reduction of the fracture; 2) excessive mobility; 3) exposure of tooth root due to distraction of the fracture; 4) fractured teeth; 5) severely carious tooth 6) infected supporting structure. There were no significant differences between the complication rate in the "tooth removed" group and "tooth retained" group. Complications were minimal. Therefore proper management of the third molar tooth in mandibular angle fracture will minimize complication.
Molar, Third* ; Retrospective Studies ; Tooth Root ; Tooth*

OBJECTIVE: To assess the current practice patterns of radiologists who perform transthoracic needle biopsy (TNB). MATERIALS AND METHODS: An email survey of 71 questions on TNB was sent to 240 members of the Korean Society of Thoracic Radiology. The answers to multiple-choice questions (n = 56) were analyzed. RESULTS: Of 60 respondents, 45% had 10 or more years of experience in chest radiology, and 70% had 5 or more years of experience in TNB. For the question on the most frequently used diagnostic method for lesions with high probability of being resectable-stage lung cancer, 70% of respondents answered that TNB is initially used, with or without bronchoscopy. In patients at high-risk of TNB-related complications, the proportion of the respondents who consistently declined TNB was only 5%. The number of rebiopsies was said to be increased; molecular analysis for an established target therapy (43.6%) and clinical trial of a new drug (28.2%) were the two most common reasons for it. The most popular needle type was the coaxial cutting needle (55%), and the popular guiding modality was conventional computed tomography (CT) (56.7%). In addition, 15% of respondents have encountered air embolism. CONCLUSION: Despite high variation in how TNB is being performed in Korea, some patterns were noted. It is common for patients with resectable-stage lung cancer to undergo TNB prior to surgery. Rebiopsy is now more common than before, with personalized medicine as the most important reason for it. The most popular type of needle is the coaxial system; the most popular modality for guidance is still CT.
Biopsy, Needle* ; Bronchoscopy ; Electronic Mail ; Embolism, Air ; Humans ; Korea ; Lung Neoplasms ; Methods ; Needles* ; Precision Medicine ; Surveys and Questionnaires ; Thorax

We developed the standard digital images (SDIs) to be used in the classification and recognition of pneumoconiosis. From July 3, 2006 through August 31, 2007, 531 retired male workers exposed to inorganic dust were examined by digital (DR) and analog radiography (AR) on the same day, after being approved by our institutional review board and obtaining informed consent from all participants. All images were twice classified according to the International Labour Office (ILO) 2000 guidelines with reference to ILO standard analog radiographs (SARs) by four chest radiologists. After consensus reading on 349 digital images matched with the first selected analog images, 120 digital images were selected as the SDIs that considered the distribution of pneumoconiosis findings. Images with profusion category 0/1, 1, 2, and 3 were 12, 50, 40, and 15, respectively, and a large opacity were in 43 images (A = 20, B = 22, C = 1). Among pleural abnormality, costophrenic angle obliteration, pleural plaque and thickening were in 11 (9.2%), 31 (25.8%), and 9 (7.5%) images, respectively. Twenty-one of 29 symbols were present except cp, ef, ho, id, me, pa, ra, and rp. A set of 120 SDIs had more various pneumoconiosis findings than ILO SARs that were developed from adequate methods. It can be used as digital reference images for the recognition and classification of pneumoconiosis.
Adult ; Aged ; Aged, 80 and over ; Dust ; Humans ; Lung/*pathology/*radiography ; Male ; Middle Aged ; Occupational Exposure ; Pleura/radiography ; Pneumoconiosis/*radiography ; Radiographic Image Enhancement/*standards