STUDY DESIGN: Two case reports. OBJECTIVES: We present two cases of quadriplegia after posterior decompression with fusion caused by a suspicious reperfusion injury of spinal cord without remarkable surgical insult. SUMMARY OF LITERATURE REVIEW: Posterior decompression and posterolateral fusion have been reported as effective procedures in patients with multilevel myelopathy. However, postoperative spinal cord injury without remarkable intraoperative technical damage has been reported in a few articles. Reperfusion mechanism was suggested as one of the leading causes and reported in some animal models. MATERIALS AND METHODS: There was one case of ossification of the posterior longitudinal ligament and one developmental multilevel stenosis that underwent laminectomy with lateral mass instrumentation. After surgery, the patients presented with quadriplegia; MRI demonstrated swelling of the spinal cord and intramedullary lesion in two cases. RESULTS: After surgery, the patients presented with quadriplegia; MRI demonstrated swelling of the spinal cord and intramedullary lesion in two cases. CONCLUSION: Although patients with such a medical condition are rare, it is difficult to predict postoperative swelling of the spinal cord before surgery. The surgeon should thus be aware of such rare disease conditions involving the spinal cord before the surgical procedure.
Constriction, Pathologic ; Decompression* ; Humans ; Laminectomy ; Longitudinal Ligaments ; Magnetic Resonance Imaging ; Models, Animal ; Quadriplegia ; Rare Diseases ; Reperfusion ; Reperfusion Injury* ; Spinal Cord Diseases ; Spinal Cord Injuries ; Spinal Cord*

PURPOSE: Mechanical thrombectomy using a Solitaire stent has been associated with a high recanalization rate and favorable clinical outcome in intra-arterial thrombolysis. To achieve a higher recanalization rate for mechanical Solitaire thrombectomy, we used an intra-arterial low-dose booster tirofiban injection into the occluded segment after stent deployment. We report the safety and recanalization rates for mechanical Solitaire thrombectomy with a low-dose booster tirofiban injection. MATERIALS AND METHODS: Between February and March 2013, 13 consecutive patients underwent mechanical Solitaire thrombectomy with low-dose booster tirofiban injection. The occlusion sites included the proximal middle cerebral artery (5 patients), the internal carotid artery (5 patients), the top of the basilar artery (2 patients) and the distal middle cerebral artery (M2 segment, 1 patient). Six patients underwent bridge treatment, including intravenous tissue plasminogen activator. Tirofiban of 250 µg was used in all patients except one (500 µg). All occluded vessels were recanalized after 3 attempts at stent retrieval (1 time, n=9; 2 times, n=2; 3 times, n=2). RESULTS: Successful recanalization was achieved in all patients (TICI 3, n=8; TICI 2b, n=5). Procedural complications developed in 3 patients (subarachnoid hemorrhage, n=2; hemorrhagic transformation, n=1). Mortality occurred in one patient with a basilar artery occlusion due to reperfusion brain swelling after mechanical Solitaire thrombectomy with low-dose booster tirofiban injection. Favorable clinical outcome (mRS≤2) was observed in 8 patients (61.5%). CONCLUSION: Our modified mechanical Solitaire thrombectomy method using a low-dose booster tirofiban injection might enhance the recanalization rate with no additive hemorrhagic complications.
Basilar Artery ; Brain Edema ; Carotid Artery, Internal ; Hemorrhage ; Humans ; Methods ; Middle Cerebral Artery ; Mortality ; Reperfusion ; Stents ; Thrombectomy* ; Tissue Plasminogen Activator

Myxoma is a relatively rare tumor of mesenchymal origin that can be found in numerous sites throughout the body including heart, skin, and subcutaneous tissue along with various sites in the head and neck. It is presumed to be originated from dental malformation or missing teeth, but occasionally myxoma without dental abnormalities is found giving arguments for its embryogenesis. Myxoma in the head and neck is usually managed by radical operation in order to prevent the possible recurrence. A case of recurrent myxoma of maxilla is described, which was treated with en-bloc removal via lateral rhinotomy incision. The purpose of this article is to present a case of myxoma of maxilla with a review of the literature and is to give a special emphasis on the proper modalities of treatment which minimizes recurrence and functional deficit.
Embryonic Development ; Female ; Head ; Heart ; Maxilla* ; Myxoma* ; Neck ; Pregnancy ; Recurrence ; Skin ; Subcutaneous Tissue ; Tooth

OBJECTIVE: Unexpected Solitaire stent detachment can occur during mechanical Solitaire thrombectomy. The purpose of this study was to retrospectively evaluate the influencing factors causing unexpected Solitaire stent detachment and the clinical outcomes. METHODS: Between October 2011 to December 2013, 232 cases of mechanical Solitaire thrombectomy for acute ischemic stroke were performed in 3 stroke centers. During this period, we encountered unexpected Solitaire stent detachments during mechanical Solitaire thrombectomies in 9 cases. RESULTS: Solitaire stents unexpectedly detached in 9 cases (3.9%) during the retrieval of Solitaire stents. The median patient age was 76 years. The occlusion sites of the unexpected stent detachment were the proximal middle cerebral artery (MCA) in 7 cases and the internal carotid artery in 2 cases. The sizes of the stents that unexpectedly detached were 6x30 mm in 7 cases, 5x30 mm in 1 case, and 4x20 mm in 1 case. Four patients had unexpected detachment at the first retrieval, 1 patient at the second, 3 patients at the third, and 1 patient at the fifth. In all of the cases of unexpected detachment at the first retrieval, the stent deployment site was the proximal MCA. After detachment, a proximal marker of the Solitaire stent was observed in 3 patients. However, no marker was visible in the remaining 6 patients. CONCLUSION: Unexpected Solitaire stent detachment should be considered in the first instance of stent retrieval for a relatively large-diameter stent, especially in elderly patients with MCA occlusions.
Aged ; Carotid Artery, Internal ; Humans ; Middle Cerebral Artery ; Retrospective Studies ; Stents* ; Stroke ; Thrombectomy*

BACKGROUND: Inhaled nitric oxide therapy causes selective pulmonary vasodilation in congenital heart diseases with pulmonary hypertension. However discontinuation of inhaled nitric oxide therapy may be complicated by abrupt life-threatening rebound pulmonary hypertension(RPH) The purpose of this study was to prevent by comparing group I(without RPH n=13) and group II(with RPH n=6) to determine the risk factors involved inthe development of the RPH. MATERIAL AND METHOD: Between Januarty 6, 1998 and April 14, 1999. we studied 19 consecutive children who were treated with inhaled nitric oxide for clinically significant pulmonary hypertension after an open heart surgery for congenital heart disease. the ratio of males and females was 12:7 ranging in age from 10 days to 6040 days(16 years) To identify the effects of nitric oxide between two groups we measured heart rate mean and systolic pulmonary arterial pressure mean and systolic systemic arterial pressure central venous pressure pH paO2/FiO2 and O2 saturation before and after the initiation and just before the withdrawal of the inhaled nitric oxide. RESULT: In 6 of 19 patients(32%) withdrawal of inhaled nitric oxide caused RPH. In the two groups inhaled nitrix oxide decreased in pulmonary arterial pressure(PAP) without decreasing the systemic arterial pressure(SAP) and increased PaO2/FiO2 Compared with patients who had no RPH(group I) patients who had RPH(group II) were older in age (1204+/-1688 versus 546+/-1654 days p<0.05) received less nitric oxide therapy(34+/-18 versus 67+/-46 hours p<0.05) has shorter weaning process(5+/-3 versus 15-13 hours p<0.05) and received lowerconcentration of initial nitric oxide supply(11+/-8 versus 17+/-8 ppm p>0.05) and lower concentration just before the withdrawal nitric oxide(4.2+/-2.6 versus 5.6+/-2.6 ppm, p>0.05) CONCLUSION: We speculate that older age shorter of nitric oxide therapy shorter weaning process are the risk factors of RPH.
Arterial Pressure ; Central Venous Pressure ; Child ; Female ; Heart Defects, Congenital ; Heart Diseases ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Hypertension, Pulmonary* ; Male ; Nitric Oxide* ; Risk Factors ; Thoracic Surgery ; Vasodilation ; Weaning

BACKGROUND AND OBJECTIVES: he purpose of this study was to determine the relationship between cyclic changes of unilateral nasal obstruction and nasal geometry in patients with septal deviation. MATERIAL AND METHODS: Twenty-one young adults with anteriorly located septal deviation were selected. With acoustic rhinometry, we measured minimum cross-sectional area (MCA) and nasal volume (NV) in 20 minutes interval for 7 hours. The patients were required to assess their own unilateral nasal obstruction on a linear visual analogue scale immediately prior to acoustic rhinometric measurements. After plotting of MCA and VAS as a function of time, we determined whether cyclic changes were present or not. Correlation between subjective scores and objective measurements were calculated using Pearsons correlation coefficient. We calculated delta (sigma) value in patients with cyclic changes of MCA and VAS to compare the unilateral MCA changes to corresponding VAS changes of each nasal cavity. The formula for calculating Delta value was Delta value=m(Npeak-Wtrough)/m(Wpeak-Wtrough): where m is the sample mean, Npeak the peak of narrow side, Wpeak the peak of wide side, Wtrough the nadir of wide side. RESULTS: Fifteen subjects showed classic alternating nasal cycle in MCA and ipsilateral VAS with significant positive linear correlation. Despite the diverse distribution of delta value of MCA cycle (sigma(M)), the mean delta value of VAS cycle (sigmaV) was about 0.8, thus representing a small difference of patency of each nasal cavities in patients with septal deviation. CONCLUSION: In most patients, nasal sensation of patency fluctuated with a similar amplitude with each other regardless of the degree of septal deviation.
Acoustics ; Humans ; Nasal Cavity ; Nasal Obstruction* ; Rhinometry, Acoustic ; Sensation ; Young Adult

Extramedullary plasmacytoma involving the head and neck region is rare. Among the sites of involvement, nasopharynx, nasal cavity, paranasal sinus were the most frequent sites in descending order. Maxillary sinus is the most prevalent site of the paranasal sinuses with occasional involvement of the ethmoid and sphenoid sinus. However, the frontal sinus has not been reported to be the site of involvement as far as we know. Recently we experienced an extramedullary plasmacytoma of the frontal sinus in a 54 year-old male patient and report with literature review.
Frontal Sinus* ; Head ; Humans ; Male ; Maxillary Sinus ; Middle Aged ; Nasal Cavity ; Nasopharynx ; Neck ; Paranasal Sinuses ; Plasmacytoma* ; Sphenoid Sinus

A 52-year-old woman with a gastric outlet obstruction (GOO) caused by pyloric cancer underwent pyloric endoscopic self-expandable metal stent (SEMS) insertion. She presented with abdominal distension 40 days later. The SEMS was dysfunctional, and endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ) was performed using an endoscopic nasobiliary drainage tube. A 16 mm×31 mm Niti-S ™ HOT SPAXUS™ (TaeWoong Medical, Gimpo, Korea) was inserted successfully between the stomach and the adjacent jejunum. After the procedure, the patient had a good oral intake for more than seven months. GOO is a mechanical obstructive condition caused by various benign and malignant conditions. Traditionally, surgical GJ and SEMS insertion have been used to treat GOOs. EUS-GJ is a feasible treatment option for patients with GOO and a pyloric metal stent dysfunction.

Pulmonary arteriovenous fistula can occur in a variety of clinical situations including liver diseases, infections, metastatic carcinomas, systemic disorders, and after the palliation of congenital heart diseases. A 72-day-old male infant with Tetralogy of Fallot and pulmonary atresia underwent surgical correction without difficulty. However, ventilator weaning in the ICU failed initially because of an unexplained postoperative hypoxemia(FiO2: 0.8, PaO2: 40 mmHg, SaO2: 80~90%). Postoperative follow-up lung perfusin scan at postoperative 15 days showed right-to-left shunt(33.6%) and ventilator weaning was performed on the 20th day after the operation (FiO2: 0.4, PaO2, 50mmHg, SaO2: 86.9%). Arterial oxygen saturation under room air was 80~85% at 7 months postoperatively. One and half year follow-up lung perfusion scan showed decreased amount of right-to-left shunt (11.2%). We report a case with a review of the literatures.
Arteriovenous Fistula* ; Follow-Up Studies ; Heart Diseases ; Humans ; Infant ; Liver Diseases ; Lung ; Male ; Oxygen ; Perfusion ; Pulmonary Atresia ; Tetralogy of Fallot* ; Ventilator Weaning

A 61-year-old man was diagnosed with aortic stenoinsufficiency with periannular abscess, which involved the aortic root of noncoronary sinus (NCS) that invaded down to the central fibrous body, whole membranous septum, mitral valve (MV), and tricuspid valve (TV). The open complete debridement was executed from the aortic annulus at NCS down to the central fibrous body and annulus of the MV and the TV, followed by the left ventricular outflow tract reconstruction with implantation of a mechanical aortic valve by using a leaflet of the half-folded elliptical bovine pericardial patch. Another leaflet of this patch was used for the repair of the right atrial wall with a defect and the TV.
Abscess* ; Aortic Valve ; Debridement ; Endocarditis ; Humans ; Middle Aged ; Mitral Valve* ; Tricuspid Valve*