In the spring of 2011, a cluster of lung injuries caused by humidifier disinfectant (HD) usage were reported in Korea. Many patients required mechanical ventilation, extracorporeal membrane oxygenation, and even lung transplantation (LTPL). However, the long-term course of HD-associated lung injury remains unclear because the majority of survivors recovered normal lung function. Here we report a 33-year-old woman who underwent LTPL approximately four years after severe HD-associated lung injury. The patient was initially admitted to the intensive care unit and was supported by a high-flow nasal cannula. Although she had been discharged, she was recurrently admitted to our hospital due to progressive lung fibrosis and a persistent decline in lung function. Finally, sequential double LTPL was successfully performed, and the patient's clinical and radiological findings showed significant improvement. Therefore, we conclude that LTPL can be a therapeutic option for patients with chronic inhalation injury.
Adult ; Catheters ; Disinfectants ; Extracorporeal Membrane Oxygenation ; Female ; Fibrosis ; Humans ; Humidifiers* ; Inhalation ; Inhalation Exposure ; Intensive Care Units ; Korea ; Lung Injury* ; Lung Transplantation* ; Lung* ; Oxygen Inhalation Therapy ; Respiration, Artificial ; Survivors

Since cyanide poisoning is almost always fatal, reports of surviving patients to develop neurologic signs are rare. Systemic hypoxemia was not documented with arterial blood gases : however, significant tissue hypoxia most likely occurred from the action of cyanide. A38-year-old man ingested cyanide in a suicidal attempt. He was treated and survived the poisoning episode. But one week later, he showed classic extrapyramidal symptoms and signs, characterized by pit disturbance, bradykinesia, increased muscle tone, micrographia, tremor, apraxia of eyelid opening, palilalia. These symptoms and signs continued to progress, and response to levo-dopa and anticholinergics was poor, except apraxia of eyelid opening. About 3 months later, brain MRI showed abnormal signals (increas ed signal intensity on T2WI, decreased signal intensity on TIWI) in both globus pallidus and a part of putamen, but hippocompus and substantia nigra was normal. After 16 months, follow-up brain MRI showed the same findings. Although brainstem auditory evoked potential(BAEP) was normal, motor evoked potential(MEP) showed prolongation of central motor conduction time(CMCT) in right upper and lower extremities, then wecould suspect subtle changes in pyramidal tract. We report a patient as cyanide-induced parkinsonism by history, neuroimaging finding, and clinical parkinsonian symptoms and signs.
Anoxia ; Apraxias ; Brain ; Brain Stem ; Cholinergic Antagonists ; Eyelids ; Follow-Up Studies ; Gases ; Globus Pallidus ; Humans ; Hypokinesia ; Lower Extremity ; Magnetic Resonance Imaging ; Neuroimaging ; Neurologic Manifestations ; Parkinsonian Disorders* ; Poisoning ; Putamen ; Pyramidal Tracts ; Substantia Nigra ; Tremor

No abstract available.
Cell Proliferation* ; Female ; Humans ; Trophoblasts*

Otolaryngologists are sometimes confronted with various complications. They may be minor or sometimes they can be major, and rarely fatal. Some complications can be prevented, but some are unavoidable. Five cases of major complications, which occurred during or after routine rhinologic surgery, are presented. Two patients died of toxic shock syndrome: one patient after endoscopic sinus surgery (ESS) and the other patient after closed nasal bone reduction. One patient died of acute myocardial infarction during the recovery of anesthesia after uneventful ESS. One patient had a lidocaine shock, which required treatment in the intensive care unit. One patient had a transient unilateral blindness after intranasal steroid injection. Though the 3rd and 4th cases of complications were unavoidable, the others could have been prevented if precautions had taken place. The presumed pathophysiology, possible prevention measures, and their implications in routine otolaryngologic surgery are discussed.
Anesthesia ; Blindness ; Humans ; Intensive Care Units ; Lidocaine ; Myocardial Infarction ; Nasal Bone ; Shock ; Shock, Septic

The gastric polyps may be premalignant lesions and they should be removed as possible. The gastric polyps can be remoued by various endoscopic methods. The safety and therapeutic effectiveness of snare polypectomy, neodymium YAG laser therapy and electrocutery were compared in a total number of 106 patients who were diagnosed as benign polyps by means of endoscopic biopsy.Safety was evaluated by the rate of complications such as perforation and bleeding, and therapeutic effectiveness was evaluated by the average numbers of treatment session of each modality. Average numbers of treatment session of snare polypectomy, laser therapy and electrocautery were 1.04, 1.38 and l.44, respectively. Average numbers of treatment session of snare polypectomy were significantly (p<0.05) lower than those of other two methods. Perforation was not occurred in any group. Bleeding rates after snare polypectomy, laser therapy and electrocautery were 17.4%, 1.0% and 3.8%, respectively. Bleeding was significantly (p<0,05) more frequent after snare polypectomy than after other two methods. In conclusion therapeutic effectiveness was best in snare polypectomy but complication was most frequent after snare polypectomy. There was no difference between laser therapy and electrocautery for therapeutic effectiveness and safety. Therfore, laser therapy and electrocautery caa be used for the removal of flat adenoma, alternatively.
Adenoma ; Electrocoagulation ; Hemorrhage ; Humans ; Laser Therapy ; Lasers, Solid-State ; Neodymium ; Polyps ; SNARE Proteins

The gastric polyps may be premalignant lesions and they should be removed as possible. The gastric polyps can be remoued by various endoscopic methods. The safety and therapeutic effectiveness of snare polypectomy, neodymium YAG laser therapy and electrocutery were compared in a total number of 106 patients who were diagnosed as benign polyps by means of endoscopic biopsy.Safety was evaluated by the rate of complications such as perforation and bleeding, and therapeutic effectiveness was evaluated by the average numbers of treatment session of each modality. Average numbers of treatment session of snare polypectomy, laser therapy and electrocautery were 1.04, 1.38 and l.44, respectively. Average numbers of treatment session of snare polypectomy were significantly (p<0.05) lower than those of other two methods. Perforation was not occurred in any group. Bleeding rates after snare polypectomy, laser therapy and electrocautery were 17.4%, 1.0% and 3.8%, respectively. Bleeding was significantly (p<0,05) more frequent after snare polypectomy than after other two methods. In conclusion therapeutic effectiveness was best in snare polypectomy but complication was most frequent after snare polypectomy. There was no difference between laser therapy and electrocautery for therapeutic effectiveness and safety. Therfore, laser therapy and electrocautery caa be used for the removal of flat adenoma, alternatively.
Adenoma ; Electrocoagulation ; Hemorrhage ; Humans ; Laser Therapy ; Lasers, Solid-State ; Neodymium ; Polyps ; SNARE Proteins

OBJECTIVE : We investigated the relationship between the severity of the disease and the abnormality of some ocular movements in parkinson's disease. BACKGROUND: Disorders of eye movements have been described in diseases of the basal ganglia for over a century and ocular motor deficits of the saccadic and pursuit system have been reported in parkinsonian patients. METHOD : We studied the electro-oculography of the eye tracking and saccadic movement in 26 patients (11 males, 15 females) with Parkinson's disease. The severity of the disease was divided into two groups by Hoehn & Yahr(H-Y) staging, H-Y stage 1, 2(group A) and H-Y stage 3, 4 (Group B). Some patients antiparkinsonian drugs of L-dopa, dopamine agonist and anticholinergics. RESULT : The velocity of smooth pursuit and the velocity and latency of saccade were calculated and compared between two groups. Eye tracking test revealed decreased pursuit velocity leading to catch-up saccades, but normal phase relationship between eye and target movement, while saccadic eye movement had increased latency. These results showed more profound severity in more advanced stages of the disease. CONCLUSION : We suggest that ocular movement be often chosen as a simple but relevant example of general motor function, as well as criteria for staging of Parkinson's disease and basal ganglia play significant role in ocular movement.
Basal Ganglia ; Cholinergic Antagonists ; Dopamine Agonists ; Eye Movements ; Humans ; Levodopa ; Male ; Parkinson Disease* ; Pursuit, Smooth ; Saccades

We present a case of osteoma that was diagnosed incidentally in the middle ear. Osteomas are benign tumors and may occur as a solitary lesion in the squama, mastoid, middle ear and petrous pyramid. Even though osteomas in the middle ear are extremely rare, those lesions may be one of the causes of the conductive hearing loss by impinging upon the ossicular chain. There are only 22 cases of osteoma reported in the medical literature to date. In most patients, the diagnosis is confirmed by CT scan or at the time of surgery. CT scanning of these disorders is very useful, especially in examining the extent of the lesion and detailed bone destruction.
Diagnosis ; Ear, Middle ; Hearing Loss, Conductive ; Humans ; Incus* ; Malleus* ; Mastoid ; Osteoma* ; Petrous Bone ; Tomography, X-Ray Computed

BACKGROUND AND OBJECTIVES: Successful management of facial skin cancer needs complete removal of tumor with appropriate reconstruction of facial defect. A variety of methods have been used for the removal of tumor and reconstruction of the defect. The purpose of this study is to report our experience on management of facial skin cancer by surgical excision and immediate reconstruction. METHOD: Twenty-three cases of facial skin cancer which were treated by surgical excision and immediate reconstruction, were analyzed retrospectively. Basal cell carcinoma was the most common skin cancer and the nose was the most common site. Surgical excision was done with appropriate safety margin and the resection margin was confirmed with permanent sections. Immediate reconstruction was done using primary closure, skin graft, and local flaps according to the type, size, and location of the tumor. RESULTS: There were no recurrent cases during 13 months of follow up. There were no significant complications after the reconstruction except minor esthetic dissatisfaction. Local flap was the most efficient method for reconstruction with good esthetic outcome. CONCLUSION: Facial skin cancer can be successfully managed by surgical excision and immediate reconstruction.
Carcinoma, Basal Cell ; Follow-Up Studies ; Nose ; Retrospective Studies ; Skin Neoplasms* ; Skin* ; Transplants

BACKGROUND AND OBJECTIVES: In blowout fracture (BOF) of the medial orbital wall, the presence of significant enophthalmos indicates a need for surgery. In early post-traumatic period, it is usually difficult to measure the degree of enophthalmos due to orbital edema. So, in order to decide on the correct treatment method, it will be useful if we can predict the degree of enophthalmos according to the extent of fracture observed in computed tomography (CT). We studied the relationship between the extent of fracture measured in CT scans and the degree of enophthalmos in BOF of the medial orbital wall. MATERIALS AND METHODS: Nine patients with isolated BOF of the medial orbital wall confirmed by CT scans were studied. The severity of enophthalmos was measured by exophthalmometry. The area of fracture site and the volume of herniated orbital tissue were measured in CT scans. The statistical significance was analyzed using linear regression method. RESULTS: The degree of enophthalmos increased as the area of fracture site or the volume of herniated orbital tissue increased. The area of the fracture site and the volume of the herniated orbital tissue that caused enophthalmos of 2 mm were 1.9 cm2 and 0.9 ml, respectively. CONCLUSION: In BOF of the medial orbital wall, surgical intervention may be recommended to prevent significant enophthalmos when the area of fracture site is 1.9 cm2 or more, or the volume of herniated orbital tissue is 0.9 ml or more.
Edema ; Enophthalmos* ; Humans ; Linear Models ; Orbit* ; Tomography, X-Ray Computed