Pheochromocytoma is a tumor which secretes catecholamine and produces remarkable hemodynamic changes during the perioperative period. It is reported that in cases where a patient with undiagnosed pheochromocytoma is operated on, the mortality rate can reach 25% to 50%. The subject in this study was a 55-year-old female patient who was diagnosed having a retroperitoneal mass which looked like a neurogenic tumor. During the manipulation, serious hypertension and tachycardia were developed. The authors at that time suspected a pheochromocytoma, interrupted the operation, and after insertion of arterial line and sodium nitroprusside infusion, the rest of the operation was restarted. After the extirpation of the tumor, as the patient suffered serious hypotension, the concentration of the inhalation agent was reduced, ephedrine was injected, the proper amount of fluid and blood were administered, and, as a result, the operation was carried out safely, and postoperative course was unremarkable.
Ephedrine ; Female ; Hemodynamics ; Humans ; Hypertension ; Hypotension ; Inhalation ; Middle Aged ; Mortality ; Nitroprusside ; Perioperative Period ; Pheochromocytoma* ; Tachycardia ; Vascular Access Devices

PURPOSE: The present study reviews the clinical features of orbital cellulitis in childhood for early diagnosis and proper treatment. METHODS: The authors performed a retrospective study by computed tomography (CT) on children under 14 years of age diagnosed with orbital cellulitis and admitted to Pusan National University Hospital from 2003 to 2010. RESULTS: In total, 27 patients were identified (range 4 months to 14 years). Periorbital swelling was the most common initiating symptom, followed by fever and conjunctival injection. Paranasal sinus disease was the most common predisposing factor. Preseptal cellulitis was the most common finding, followed by subperiosteal abscess, orbital cellulitis, and orbital abscess. All patients underwent a blood culture; none were positive. Intravenous antibiotics therapy was performed empirically and was effective in all cases. No patients suffered from permanent complications except recurrence. CONCLUSIONS: Orbital cellulitis in children presents with periorbital swelling, fever, conjunctival injection in association with sinusitis, and upper respiratory infection (URI). A CT study is a reliable diagnostic option for the early detection and localization in the pediatric orbital cellulitis. Early empirical antibiotic therapy is mandatory for successful treatment.
Abscess ; Anti-Bacterial Agents ; Cellulitis ; Child ; Early Diagnosis ; Fever ; Humans ; Orbit ; Orbital Cellulitis ; Paranasal Sinus Diseases ; Retrospective Studies ; Sinusitis

PURPOSE: To present a surgical result of Yokoyama procedure in myopic strabismus fixus. CASE SUMMARY: A 51-year-old female patient presented with progressive esotropia and diplopia. According to the Krimsky test, the patient showed 70 prism diopter esotropia and 30 prism diopter hypotropia in her left eye. The axial length was 34.97 mm in the right eye and 33.71 mm in the left eye. The patient was diagnosed with myopic strabismus fixus. The authors performed the Yokoyama procedure on her left eye. Surgical examination revealed each medial rectus muscle was recessed. Half of the muscle bellies of the superior and lateral rectus muscles were sutured together without muscle splitting 15 mm posterior from their insertion. At 1 year postoperatively, the patient showed 30 prism diopter esotropia and 20 prism diopter hypotropia in her right eye by alternative prism cover test. The authors performed the same procedure on her right eye. At 2 months after the second surgery, the patient showed orthotropia in the primary position and gaze limitation was improved. CONCLUSIONS: The Yokoyama procedure can be an effective method for improving deviation and ocular motility in esotropia caused by high myopia.
Diplopia ; Esotropia ; Eye ; Female ; Humans ; Muscles ; Myopia ; Strabismus

Although little attention has been paid to the less common rheumatoid involvement of the thoracic and lumbar regions, some studies have shown that rheumatoid synovitis with erosive changes can develop in these diarthrodial joints. We report a patient with seropositive rheumatoid arthritis (RA) involving the thoracic and lumbar vertebra with a collapse of the T12 vertebra, who was treated with percutaneous vertebroplasty. In this case of a painful pathological fracture due to RA, percutaneous vertebroplasty was found to be helpful in eliminating the pain. The paper presents the histological evidence, the pathogenesis and treatment of the thoracolumbar lesions affected by RA with a review of the relevant literature.
Arthritis, Rheumatoid/blood/complications/*pathology/radiography ; Female ; Fractures, Compression/etiology/radiography/surgery ; Humans ; Lumbar Vertebrae/*pathology/radiography ; Middle Aged ; Thoracic Vertebrae/*pathology/radiography ; Vertebroplasty

BACKGROUND: During the period from April to June 1996, an outbreak of typhoid fever occurred in SuYoung-Ku, Pusan city. We performed the molecular epidemiological analysis and drug susceptibility test for 48 isolates of Salmonella typhi from the outbreak. METHODS: Chromosomal DNA of S. typhi was digested with the restriction endonuclease Spe I and the resulting restriction polymorphism was observed on pulsed field gel electrophoresis (PFGE). Phage typing was performed using Vi-phages, and antimicrobial susceptibility test was done by Disc diffusion method. RESULTS: On phage typing, 2 isolates were M1 phage type, 2 E1 phage type and 44 untypable. The PFGE analysis on 14 to 16 chromosomal DNA restriction fragments ranged from 50 Kb to 1000kb showed 2 different patterns of restriction fragments, divided into group A and B. Forty-seven isolates belonged to group A that were allocated into A1 (42 strains), A2 (1 strain), A3 (3 strains), A4 (1 strain), and one strain was grouped into group B. In the F-value of genetic similarity of the epidemic S. typhi strains, there was low similarity (F value:0.2-0.258) between group A strains and group B strains. However, the subgroup strains (A1-A4) showed high similarity (F value:0.8-0.897) each other. The drug susceptibility test showed susceptibility to ampicillin, carbenicillin, cephalothin, chloramphenicol, tobramycin, gentamicin, kanamycin, nalidixic acid, neomycin, polymyxin B, streptomycin, tetracycline, trimethoprim-sulfamethoxazole, ciprofloxacin and norfloxacin. CONCLUSION: This study showed that phage typing and PFGE were very useful as a tool to investigate molecular analyses of epidemic S. typhi strains this study.
Ampicillin ; Bacteriophage Typing ; Bacteriophages* ; Busan* ; Carbenicillin ; Cephalothin ; Chloramphenicol ; Ciprofloxacin ; Diffusion ; DNA ; DNA Restriction Enzymes ; Electrophoresis, Gel, Pulsed-Field* ; Epidemics ; Gentamicins ; Kanamycin ; Nalidixic Acid ; Neomycin ; Norfloxacin ; Polymyxin B ; Salmonella typhi* ; Salmonella* ; Streptomycin ; Tetracycline ; Tobramycin ; Trimethoprim, Sulfamethoxazole Drug Combination ; Typhoid Fever

The incidence of traumatic rupture of the tracheobronchial tree has been increased considerably with advent of widespread mechanization and high speed era. Rupture of the bronchus is an unusual result of nonpenetrating trauma to chest. Early diagnosis and primary repair not only restore normal lung function but also avoid difficulties and complications associated with delayed diagnosis and repair. These complications are pneumonia, atelectasis and lung abscess secondary to the bronchial obtruction. We experienced a case of partial rupture on left main bronchus caused by nonpenetrating blunt chest trauma with rib fractures 1 year ago. He was suffered from progressively developing dyspnea on exercise and treated as bronchial asthma at other hospital. Bronchoscopic finding was the narrowed lumen of left main bronchus at 1cm from carina by web-like membrane. We confirmed by bronchogram and repaired by end to end anastomosis, which is rare delayed finding in bronchial rupture without pulmonary complications. We report a case of nonpenetrating traumatic bronchial rupture, manifested by bronchial web in bronchoscopy.
Asthma ; Bronchi ; Bronchoscopy* ; Delayed Diagnosis ; Dyspnea ; Early Diagnosis ; Incidence ; Lung ; Lung Abscess ; Membranes ; Pneumonia ; Pulmonary Atelectasis ; Rib Fractures ; Rupture* ; Thorax* ; Trees

PURPOSE: Nebulizers are commonly used to treat children with asthma. Some pulmonary infections associated with contaminated nebulizer units have been reported. The aims of this study were to determine whether home nebulizers are repositories of bacteria and to ascertain how asthmatic patients use and maintain their nebulizers at home. METHODS: Fifty-five children with asthma aged 2 to 6 years were enrolled in this study. The parents were asked to bring their child's nebulizer units to regular follow-up visits. Bacterial samples which were obtained from the masks(or mouthpieces), nebulizer chambers and throat swabs were inoculated to blood agar, chocolate agar, and McConkey agar. Cultures were incubated at 5 percent CO2 incubator and observed after 24 hours. Parents completed a questionnaire regarding nebulizer usage and care in their child. RESULTS: Bacterial contamination was found in samples from 27(49.1%) of the 55 masks(or mouthpieces) and 24(43.6%) of the 55 chambers. The predominant microorganisms isolated were Acinetobacter baumannii, Bacillus subtilis, Klebsiella pneumoniae, Staphylococcus aureus, and Candida albicans. The questionnaire revealed that 40 parents cleaned the nebulizer units with tap water(and soap) and dried then, as they had received cleaning and drying instructions from a medical staff member. Seven organisms from nebulizer units were indistinguishable from the patient's throat isolates. CONCLUSION: We have demonstrated that home nebulizers in these asthmatic children were frequently contaminated with aerobic bacteria. Aerosolization might transmit these bacteria to their upper respiratory tracts. The education and training of home caregivers should include the principles of cleaning and maintenance of their child's nebulizer units.
Acinetobacter baumannii ; Agar ; Asthma ; Bacillus subtilis ; Bacteria ; Bacteria, Aerobic ; Cacao ; Candida albicans ; Caregivers ; Child* ; Education ; Follow-Up Studies ; Humans ; Incubators ; Inhalation ; Klebsiella pneumoniae ; Medical Staff ; Nebulizers and Vaporizers* ; Parents ; Pharynx ; Surveys and Questionnaires ; Respiratory System ; Staphylococcus aureus

OBJECTIVES: We aimed to evaluate the efficacy of biofeedback-assisted autogenic training for chronic tension-type headache, and to determine the relationship among the changes in electromyography (EMG) activity, headache activity, and mood states according to the psychophysiological treatment. METHODS: Chronic tension-type headache patients aged from 20 to 40 years (n=35) were randomized to the treatment group receiving biofeedback-assisted autogenic training (8 sessions) or the monitoring-only control group. EMG activities, headache index, and various psychological variables were examined. RESULTS: We found greater treatment response rate (> or =50% reduction in headache index) in patients with biofeedbackassisted autogenic training than in the monitoring group (61% vs. 18%; chi-square=6.882, df=1, p=0.01). There were no significant changes in the mean values of the pretreatment EMG activities across the sessions in either group (all p's>0.1). Mood states including anxiety and depression improved over time in the both groups, with the improvements being more prominent in the treatment group. Moreover, the reduction in depression level predicted treatment outcome in terms of headache index (95% confidence interval: 0.272-0.966, p=0.039). CONCLUSION: These results show that biofeedback-assisted autogenic training is effective for the treatment of chronic tension-type headache in a Korean population. Changes in mood states may be closely associated with the clinical outcome in the treatment of chronic tension-type headache using biofeedback-assisted autogenic training.
Aged ; Anxiety ; Autogenic Training ; Biofeedback, Psychology ; Depression ; Electromyography ; Headache ; Humans ; Tension-Type Headache ; Treatment Outcome

PURPOSE: To report a case of multicentric Castleman disease that presented with scleritis. CASE SUMMARY: A 42-year-old male presented with decreased visual acuity in the left eye. Castleman disease had been diagnosed 21 months before and treated with systemic steroids and combined chemotherapy. Best-corrected visual acuity (BCVA) of the left eye was 0.02 and the intraocular pressure was 42 mmHg. Scleral edema and corneal edema were noted using a slit lamp examination. The anterior chamber cell was 2+ according to Standardization of Uveitis Nomenclature criteria. The fundus was invisible due to the anterior segment lesion. After one month, scleritis developed in the right eye and the patient complained of ocular pain. Topical steroids and non-steroidal anti-inflammatory drugs were prescribed. Due to recurrent scleritis and anterior uveitis, cataract extraction and laser iridectomy were performed on the left eye, and systemic steroids and the antimetabolite methotrexate were started. After 9 years of follow-up, all medications were stopped and there was no recurrence of inflammation, with a BCVA of 1.0 in both eyes. CONCLUSIONS: Treatment of a patient with scleritis accompanied with Castleman disease using systemic steroids and methotrexate resulted in a good prognosis.
Adult ; Anterior Chamber ; Cataract Extraction ; Corneal Edema ; Drug Therapy ; Edema ; Follow-Up Studies ; Giant Lymph Node Hyperplasia ; Humans ; Inflammation ; Intraocular Pressure ; Iridectomy ; Male ; Methotrexate ; Prognosis ; Recurrence ; Scleritis ; Slit Lamp ; Steroids ; Uveitis ; Uveitis, Anterior ; Visual Acuity

Purpose: We compared corneal higher-order aberration (HOA) measurements between the Pentacam® HR (PC), which uses the Scheimpflug principle, and the iTraceTM aberrometer (IT), which evaluates Placido disc topography. Methods: We retrospectively analyzed 109 eyes of 87 patients without a history of ocular surface disease during the period from January 2021 to December 2022; both devices were used on the same day. We calculated the root mean square values (μm) of corneal total HOA and of the corneal 3rd- and 4th-order HOA at a pupil diameter of 4 mm. Data were compared by Bland-Altman plots for agreement analysis and Pearson correlation coefficient for correlation analysis. Results: There was no significant difference in the total HOA (p = 0.145), coma (p = 0.309), or secondary astigmatism (p = 0.080) between the PC and IT measurements; all other HOAs significantly differed between devices (p < 0.001). In the correlation analysis, the total HOA (r = 0.605, p < 0.001) and coma (r = 0.634, p < 0.001) were moderately correlated between the two devices; the other HOAs showed low degree of correlations. In the Bland-Altman plot analysis, all HOAs showed low agreement between the two devices. Conclusions Corneal total HOA and coma measured by the two devices were significantly correlated between the two devices, but other HOAs showed significant differences in measurement and low correlations. Therefore, corneal HOA measurements cannot be interpreted interchangeably between the two devices.