We experienced a case of unilasteral vocal cord paralysis following cuffed endotracheal intubation for abdominal surgery. The patient had have no laryngotracheal symptoms prior to the operation and anesthesia was uneventful. He complained of hoarseness post-operatively but no visible evidence of trauma secondary to the intubation was mainfested on the indirect laryngoscopic examination, except left vocal cord paralysis. There were no obvious causes for the vocal cord paralysis and possible etiologic factors. Therefore, no specific treatment was done except for the bed rest, humidification and gurgling. Vocal cord function returned nearly normal after six months.

A 44-year-old man had Sweet's syndrome (acute febrile neutrophilic dermatosis), accompanied by erythematous tender subcutaneous nodules resembling erythema nodosum(EN). The EN-like lesions histologically showed a septal panniculitis with predominantly neutrophilic in-filtrates. The association of Sweet's syndrome with EN seems to be uncommon and only a few cases have been reported until the present. We describe a patient with Sweet's syndrome associated with acute EN.
Adult ; Erythema Nodosum* ; Erythema* ; Humans ; Neutrophils ; Panniculitis ; Sweet Syndrome*

Poststernotomy mediastinitis is a rare but potentially life-threatening complication of cardiac surgery. Up to present, poststernotomy wound infection has been treated by closure of wound directly or by use of myocutaneous flaps after irrigation and debridement of wound. We describe a new treatment of poststernotomy wound infection by using the vacuum- assisted closure technique. This technique was successfully applied in 3 patients with poststernotomy wound infection and mediastinitis, and a healed sternotomy wound could be achieved using this new technique.
Debridement ; Humans ; Mediastinitis* ; Myocutaneous Flap ; Negative-Pressure Wound Therapy* ; Sternotomy ; Thoracic Surgery ; Wound Infection* ; Wounds and Injuries*

We present a case of erosive adenomatosis of the nipple in a 22-year-old woman. The clinical features of erosive adenomatosis of the nipple are similar to Paget's disease in that it has erythematous erosions with oozing and fissured crusts on one nipple. However, histologic findings are characteristic, consisting of dilated tubular structures that are lined by a peripheral layer of cuboidal cells and a luminal layer of columnar cells showing secretary properties into the lumen. The clinical course is benign, so simple mastectomy is enough for treatment.
Female ; Humans ; Mastectomy, Simple ; Nipples* ; Phenobarbital ; Young Adult

PURPOSE: To evaluate the short-term effect and safety of intravitreally injected bevacizumab in patients with macular edema (ME) caused by retinal vein occlusion (RVO) and diabetic macular edema (DME). METHODS: We retrospectively evaluated 59 eyes of 51 patients, 29 with ME caused by RVO and 30 with DME, who received intravitreal injection of bevacizumab. Fifty-one consecutive patients (59 eyes) with ME associated with RVO and DME were treated with intravitreal injections of 1.25-2.5 mg (0.05-0.1 ml) of bevacizumab. Ophthalmic evaluation was performed at baseline and at 1, 3, 6 months after each injection. Clinical evidence of toxicity and complications, changes of visual acuity with an ETDRS chart (LogMAR), and central macular thickness (CMT) using optical coherence tomography (OCT), were evaluated. RESULTS: The follow-up period was 7.3 months (7.3+/-0.31) and the mean number of injections was 1.2. The baseline mean LogMAR was 1.06+/-0.53 and mean CMT was 479.6+/-160.4 micrometer. At 1, 3 and 6 months, the mean LogMAR was 0.90+/-0.52, 0.80+/-0.39 and 0.78+/-0.39, respectively, and the mean CMT was 316.9+/-86.7 micrometer, 281.1+/-67.4 micrometer and 278.4+/-64.6 micrometer, respectively. No adverse incidents were observed, including cataract, retinal detachment, vitreous hemorrhage, and endophthalmitis, although transient increased intraocular pressure was observed. CONCLUSIONS: Intravitreal bevacizumab injections are safe and effective in ME caused by RVO and DME.
Antibodies, Monoclonal, Humanized ; Cataract ; Endophthalmitis ; Eye ; Follow-Up Studies ; Humans ; Intraocular Pressure ; Intravitreal Injections ; Macular Edema ; Retinal Detachment ; Retinal Vein ; Retinal Vein Occlusion ; Retinaldehyde ; Retrospective Studies ; Tomography, Optical Coherence ; Visual Acuity ; Vitreous Hemorrhage ; Bevacizumab

In generalized amyloidosis, involvement of heart is not rare, but development fo severe conduction distubance in cardiac amyloidosis is a rare presentation in a clinical situation. We report the first case in Korea of cardiac amyloidosis with complete atrioventricular block, which was confirmed by endomyocardial biopsy. A 59-year-old woman was admitted due to drowsy mentality. We observed a severe atrioventricular conduction disturbance on the electrocardiogram and a marked hypertrophied ventricular wall and a granular sparkling appearance within the wall, a characteristic feature in cardiac infiltration of amyloidosis, on the echocardiography. Endomyocardial biopsy was performed and revealed extensive deposition of amorphous eosinophilic materials within the cardiac muscle cells. Polarizing illumination after Congo-red staining showed typical green birefrigence. We performed a insertion of permanent pacemaker(VVI type) for the treatment of complete atrioventricular block.
Amyloidosis* ; Atrioventricular Block* ; Biopsy ; Echocardiography ; Electrocardiography ; Eosinophils ; Female ; Heart ; Humans ; Korea ; Lighting ; Middle Aged ; Myocytes, Cardiac

BACKGROUND: Although engraftment following murine allogeneic bone marrow transplantation (BMT) is most commonly confirmed by H2 typing using flow cytometry, recipient mice can be seriously injured during peripheral blood (PB) sampling. Therefore, we developed an alternative DNA-based assay that does not require the large volume of PB necessary for flow cytometry. METHODS: A minute volume of PB from the tail vein was used to evaluate the engraftment by PCR amplification of a microsatellite in the class II Eb gene. Dilution experiments were performed to evaluate the sensitivity of this assay for detecting donor cells in mixed cell populations compared with flow cytometry analysis. RESULTS: Early engraftment and mixed chimerism were confirmed, based on the length variation of the microsatellite in the class II Eb gene. The degree of donor chimerism in the donor-recipient cell mixture could be estimated semiquantitatively in a dilution experiment. The sensitivity of this assay by the naked eye approached 10% of the degree of donor chimerism. CONCLUSION: PCR amplification of a microsatellite in the class II Eb gene can be a useful alternative to flow cytometry for evaluating early engraftment and mixed chimerism following murine nonmyeloablative BMT.
Animals ; Bone Marrow Transplantation* ; Bone Marrow* ; Chimerism* ; Flow Cytometry ; Humans ; Mice ; Microsatellite Repeats* ; Polymerase Chain Reaction* ; Tissue Donors ; Veins

An intestinal obstruction is a common cause of acute abdominal diseases which need emergency measures. Sigmoid volvulus is one of rare causes of colonic obstruction and occupies 2~3% of its causes in Korea. Volvulus requires a prompt diagnosis and decompression in order to prevent its progression to strangulation and gangrene. Although 90% of sigmoid volvulus can be diagnosed just by plain abdominal x-ray, computed tomography or barium enema can be done for more accurate diagnoses. For the successful treatment, accurate early examination, endoscopic reduction and surgical colonic resection are required. Endoscopic reduction has low mortality but is liable to recur, whereas emergency colonic resection has little recurrence rate but a high mortality. We experienced a case of a sigmoid volvulus in a 55-year-old male who companied of sudden abdominal pain. After diagnosed as sigmoid volvulus through plain abdominal x-ray and abdominal computed tomography, endoscopic reduction was done in the early period of development, and the sigmoid resection was performed after 7 days. We report our experience with a review of the literature regarding the diagnosis and treatment of sigmoid volvulus.
Abdominal Pain ; Barium ; Colon* ; Colon, Sigmoid* ; Decompression ; Diagnosis ; Emergencies* ; Enema ; Gangrene ; Humans ; Intestinal Obstruction ; Intestinal Volvulus* ; Korea ; Male ; Middle Aged ; Mortality ; Recurrence

BACKGROUND: Measurement of postoperative serum thyroglobulin (Tg) is important for detecting persistent or recurrent differentiated thyroid cancer. We evaluated the analytic performance of the DxI 800 assay (Beckman Coulter, USA) for serum Tg and anti-thyroglobulin antibodies (TgAbs) in comparison with that of the GAMMA-10 assay (Shinjin Medics Inc., Korea) for serum Tg and RIA-MAT 280 assay (Stratec, Germany) for TgAb. METHODS: We prospectively collected blood samples from 99 patients thyroidectomized for thyroid cancer. The functional sensitivity was investigated in standards and human serum. Precision and linearity were evaluated according to the guidelines of the Clinical and Laboratory Standards Institute. The correlation between the two assays was assessed in samples with different Tg ranges. RESULTS: The functional sensitivity of the DxI 800 assay for serum Tg was between 0.0313 and 0.0625 ng/mL. The total CV was 3.9-5.6% for serum Tg and 5.3-6.9% for serum TgAb. The coefficient of determination (R2) was 1.0 and 0.99 for serum Tg and TgAb, respectively. The cut-offs for serum TgAb were 4.0 IU/mL (DxI 800) and 60.0 IU/mL (RIA-MAT 280), and the overall agreement was 68.7%. The correlation between the two assays was excellent; the correlation coefficient was 0.99 and 0.88 for serum Tg and TgAb, respectively. CONCLUSIONS: The DxI 800 is a sensitive assay for serum Tg and TgAb, and the results correlated well with those from the immunoradiometric assays (IRMA). This assay has several advantages over the IRMA and could be considered an alternative test for Tg measurement.
Autoantibodies/*blood ; Humans ; Immunoradiometric Assay ; Luminescent Measurements ; Prospective Studies ; Reagent Kits, Diagnostic ; Reproducibility of Results ; Thyroglobulin/*blood ; Thyroid Neoplasms/*diagnosis/surgery

PURPOSE: Ischemic brain injury following cardiac arrest presents as cerebral edema. Cerebral edema can be diagnosed using computed tomography (CT) by evidence of difference in the ratio between gray and white matter density. The prognostic value of CT scan use in determining neurologic outcomes remains unclear for cardiac arrest survivors treated with therapeutic hypothermia. We investigated the density of gray and white matter and found that their ratio was associated with neurologic outcome. METHODS: Our study data included 93 cardiac arrest survivors treated with therapeutic hypothermia from January 2008 to June 2011. Cranial CT was performed after the return of spontaneous circulation. Circular regions of CT measurement (9.4 mm2) evaluated locations of interest including the caudate nucleus, putamen, posterior limb of the internal capsule, and the corpus callosum. The average attenuation in Hounsfield Units (HU) for each region was recorded. Neurological outcome was ranked as good or poor at discharge with neurological outcome assessed according to the Cerebral Performance Category scale (CPC) with a poor outcome defined as a CPC of 3-5. RESULTS: Gray matter attenuation was found to be significantly different between the good and poor outcome cases while white matter attenuation was insignificant. All types of gray/white matter ratio were significantly different between two groups. Receiver operating characteristics analysis determined a cut-off value of gray/white matter ratio at less than 1.11 (sensitivity 29.8%) which results in a poor outcome with a specificity of 100%. CONCLUSION: A low gray/white matter ratio (<1.11), as evaluated by CT scan, is associated with poor outcome after cardiac arrest and therapeutic hypothermia. However, the results of a CT scan should be interpreted with caution as the gray/white matter ratio is a low sensitivity marker.
Brain Edema ; Brain Injuries ; Caudate Nucleus ; Corpus Callosum ; Dinucleoside Phosphates ; Extremities ; Heart Arrest ; Humans ; Hypothermia ; Hypothermia, Induced ; Internal Capsule ; Prognosis ; Putamen ; ROC Curve ; Sensitivity and Specificity ; Survivors