PURPOSE: Primary sphenoid carcinoma is rare. It accounts for 0.3% of all primary paranasal sinus malignancies. Because of the rarity of sphenoid carcinoma, large series of patients with outcome and survival statistics are currently unavailable. So we followed up the 1 case of sphenoid sinus carcinoma treated in our hospital and reported the course of the disease. METHODS AND MATERIALS : In a review of case reports and small series of patients, 2-year survival was 7%. Our case is alive at 29 months after diagnosis of sphenoid sinus carcinoma. Intramedullary spinal cord metastasis (ISCM) is an unusual complication of cancer. In our case rapidly progressive paraparesis and urinary retention developed at 25 months after diagnosis of sphenoid sinus carcinoma. MRI of the thoracic spines showed the intramedullary spinal cord tumor mass at T3 and T4 level with accompanying syringomyelia.Here we report a case of ISCM associated with syringomyelia which has developed after primary sphenoid sinus carcinoma with a review of literature about the clinical behavior and treatment of this lesion.
Diagnosis ; Humans ; Magnetic Resonance Imaging ; Neoplasm Metastasis* ; Paraparesis ; Sphenoid Sinus* ; Spinal Cord Neoplasms ; Spinal Cord* ; Spine ; Syringomyelia* ; Urinary Retention

Acetylcholine provocation test was performed in 54 patients who were admitted to Seoul National University Hospital between August, 1989 and October, 1990 with chest painn and normal or near normal(narrowin of less than 30%) coronary arteries on baseline coronary angiogram. 1) After provocation with intracoronary acetylcholine, 19 patients showed coronary artery constriction of less than 50%, 5 patients showed constriction of 50 to 74%, 21 patients showed constriction of 75 to 99% and 5 patients showed total occlusion. patients with typical symptoms of variant angina showed coronary artery constriction of more than 50% in 81% of cases while those without such symptoms showed constriction of more than 50% in only 28%. 2) We classified the coronary artery constriction over 50% after acetylcholine provocation into focal, diffuse, combined type and total occlusion. 3) Branches of coronary artery on which constriction was provoked by acetylcholine were right coronary, left anterior descending and left circumflex in the decreasing order of frequency. 4) In patients with focal constriction less than 50%, there was neither ECG change nor development of chest pain, and out of 13 patients with focal constriction of more than 75%, 11 patients showed both chest pain and ST segment change and 2 of them showed either chest pain or ST sement change. 5) In 4 patients with diffuse constriction of less than 75%, we could not observe ECG change and chest pain and in 11 patients with diffuse constriction of more than 75%, six showed chest pain and ST segment change, four showed chest pain without ECG change and one showed neither chest pain nor ECG change. 6) In 5 patients with total occlusion, 3 of them showed both chest pain and ST segment change and 2 of them showed only chest pain. 7) Patients with coronary artery constriction of more than 75% showed significant difference in occurrence of chest pain and ST segment change in comparison with patients with coronary artery constriction of less than 75%(p<0.01). It is suggested that dynamic coronary artery constriction of more than 75% after acetylcholine provocation can be considered as positive test regardless of the morphologic feature of the lesion, whether it is diffuse or focal.
Acetylcholine* ; Chest Pain ; Constriction ; Coronary Vessels* ; Electrocardiography ; Humans ; Seoul ; Spasm* ; Thorax

Acetylcholine provocation test was performed in 54 patients who were admitted to Seoul National University Hospital between August, 1989 and October, 1990 with chest painn and normal or near normal(narrowin of less than 30%) coronary arteries on baseline coronary angiogram. 1) After provocation with intracoronary acetylcholine, 19 patients showed coronary artery constriction of less than 50%, 5 patients showed constriction of 50 to 74%, 21 patients showed constriction of 75 to 99% and 5 patients showed total occlusion. patients with typical symptoms of variant angina showed coronary artery constriction of more than 50% in 81% of cases while those without such symptoms showed constriction of more than 50% in only 28%. 2) We classified the coronary artery constriction over 50% after acetylcholine provocation into focal, diffuse, combined type and total occlusion. 3) Branches of coronary artery on which constriction was provoked by acetylcholine were right coronary, left anterior descending and left circumflex in the decreasing order of frequency. 4) In patients with focal constriction less than 50%, there was neither ECG change nor development of chest pain, and out of 13 patients with focal constriction of more than 75%, 11 patients showed both chest pain and ST segment change and 2 of them showed either chest pain or ST sement change. 5) In 4 patients with diffuse constriction of less than 75%, we could not observe ECG change and chest pain and in 11 patients with diffuse constriction of more than 75%, six showed chest pain and ST segment change, four showed chest pain without ECG change and one showed neither chest pain nor ECG change. 6) In 5 patients with total occlusion, 3 of them showed both chest pain and ST segment change and 2 of them showed only chest pain. 7) Patients with coronary artery constriction of more than 75% showed significant difference in occurrence of chest pain and ST segment change in comparison with patients with coronary artery constriction of less than 75%(p<0.01). It is suggested that dynamic coronary artery constriction of more than 75% after acetylcholine provocation can be considered as positive test regardless of the morphologic feature of the lesion, whether it is diffuse or focal.
Acetylcholine* ; Chest Pain ; Constriction ; Coronary Vessels* ; Electrocardiography ; Humans ; Seoul ; Spasm* ; Thorax

Background/Aims: Frailty increases the risks of in-hospital adverse events such as delirium, falls, and functional decline in older adults. We assessed the feasibility and clinical relevance of frailty status in Korean older inpatients using the Clinical Frailty Scale (CFS) and Korean version of the Fatigue, Resistance, Ambulation, Illnesses, & Loss of Weight scale (K-FRAIL) questionnaires. Methods: Frailty status was measured using the Korean-translated version of the CFS and K-FRAIL questionnaire within 3 days from admission in 144 consecutive patients aged 60 years or older. The correlation between CFS and K-FRAIL score was assessed. The criterion validity of CFS was assessed using receiver operating characteristic analysis. As outcomes, delirium, bedsore, length of stay (LOS), in-hospital mortality, and unplanned 30-day readmission were measured by reviewing medical records. Results: The mean age of the study population was 70.1 years (range, 60 to 91), and 75 (52.1%) were men. By linear regression analysis, CFS and K-FRAIL were positively correlated (B = 0.72, p < 0.001). A CFS cutoff of ≥ 5 maximized sensitivity + specificity to classify frailty using K-FRAIL as a reference (C-index = 0.893). Higher frailty burden by both CFS and K-FRAIL was associated with higher LOS and bedsores. Unplanned readmission and in-hospital mortality were associated with higher CFS score but not with K-FRAIL score, after adjusting for age, gender, polypharmacy, and multimorbidity. Conclusions Frailty status by CFS was associated with LOS, bedsores, unplanned readmission, and in-hospital mortality. CFS can be used to screen high-risk patients who may benefit from geriatric interventions and discharge planning in acutely hospitalized older adults.

Background/Aims: Frailty increases the risks of in-hospital adverse events such as delirium, falls, and functional decline in older adults. We assessed the feasibility and clinical relevance of frailty status in Korean older inpatients using the Clinical Frailty Scale (CFS) and Korean version of the Fatigue, Resistance, Ambulation, Illnesses, & Loss of Weight scale (K-FRAIL) questionnaires. Methods: Frailty status was measured using the Korean-translated version of the CFS and K-FRAIL questionnaire within 3 days from admission in 144 consecutive patients aged 60 years or older. The correlation between CFS and K-FRAIL score was assessed. The criterion validity of CFS was assessed using receiver operating characteristic analysis. As outcomes, delirium, bedsore, length of stay (LOS), in-hospital mortality, and unplanned 30-day readmission were measured by reviewing medical records. Results: The mean age of the study population was 70.1 years (range, 60 to 91), and 75 (52.1%) were men. By linear regression analysis, CFS and K-FRAIL were positively correlated (B = 0.72, p < 0.001). A CFS cutoff of ≥ 5 maximized sensitivity + specificity to classify frailty using K-FRAIL as a reference (C-index = 0.893). Higher frailty burden by both CFS and K-FRAIL was associated with higher LOS and bedsores. Unplanned readmission and in-hospital mortality were associated with higher CFS score but not with K-FRAIL score, after adjusting for age, gender, polypharmacy, and multimorbidity. Conclusions Frailty status by CFS was associated with LOS, bedsores, unplanned readmission, and in-hospital mortality. CFS can be used to screen high-risk patients who may benefit from geriatric interventions and discharge planning in acutely hospitalized older adults.

Complete urethral loss with vesicovaginal fistula is very infrequently encountered by the urologist. Urethral reconstruction may be accomplished with either bladder or vaginal wall flap. Moreover, it usually is necessary to reinforce the continence of reconstructed urethra with a well-vascularized pedicle flap from either the Martius labial flap, gracilis, perineum, or rectus. We report a case of the complete urethral loss with vesicovaginal fistula treated successfully with bilateral Martius labial fat graft.
Female* ; Humans ; Perineum ; Transplants ; Urethra ; Urinary Bladder ; Vesicovaginal Fistula*