Type II postobstructive pulmonary edema developes after the relief of chronic airway obstruction. We describe one case of type II postobstructive pulmonary edema during adenotonsillectomy. Awareness of this rare complication is crucial for the anesthesiologist to make early diagnosis and treatment.
Airway Obstruction ; Early Diagnosis ; Pulmonary Edema

BACKGROUND: Anesthetics have been suspected of impairing various aspects of the immune function either directly by affecting the function of immunocompetent cells or indirectly by modulating the stress response. Splenocytes play important roles in the cellular host defense against infection. In order to assess the immune modulatory effects of propofol, this study examined the cytotoxic and proliferative effects of propofol on splenocytes. METHODS: Splenocytes, as responders, were isolated from BALB/c mice (n = 10). The cells were pretreated with different propofol concentrations (0micrometer, 30micrometer, 100micrometer, 300micrometer) for 24 hours. The cytotoxic effect was assayed by the NADH dehydrogenase activity and the proliferation was evaluated by the level of 5-bromo-2'-deoxyunridine (BrdU) incorporation during DNA synthesis in the presence or absence of propofol, in addition to lipopolysaccharide (LPS, 1 microgram/ml) for mitogenic stimulation. A cell proliferation enzyme-linked immuno-sorbent assay (ELISA) system was used, and the stimulation index was calculated in the presence or absence of propofol. RESULTS: The percentage of the NADH dehydrogenase activity was changed by the propofol pretreatment (P < 0.001). LPS stimulation significantly decreased the NADH dehydrogenase activity at 100micrometer and 300micrometer compared with the propofol-added or pretreated cells (P < 0.05). The stimulation index to LPS was lower at concentrations of 100micrometer and 300micrometer than at 30micrometer, and proliferative response of splenocytes were completely abrogated by adding toxic concentrations (100micrometer) of propofol (P < 0.05). CONCLUSIONS: Neither cytotoxicity, as defined by the NADH dehydrogenase activity, nor a proliferative effect, as measured by the level of (BrdU) incorporation in the splenocytes, were affected by the clinical concentration of propofol.
Anesthetics ; Animals ; Bromodeoxyuridine ; Cell Proliferation ; DNA ; Mice ; NADH Dehydrogenase ; Propofol

We managed a case in which an inferior vena cava filter was inserted for a pulmonary thromboembolism that occurred during general anesthesia. A 71-year-old woman was prepped for reduction of a distal femur fracture and arthroplastic surgery. Her initial vital signs were stable, but the end-tidal CO2 and SaO2 were decreased gradually after application of the tourniquet for surgery. Because of impaired ventricular wall motion and a dilated inferior vena cava on echocardiogram, we suspected a pulmonary thromboembolism. Thus, we inserted an inferior vena cava filter percutaneously under propofol sedation in the Radiology Department. In addition to ventilatory support and hemodynamic management, heparin was administered as anticoagulant therapy postoperatively in the intensive care unit. Multiple thrombi in the pulmonary artery were confirmed on chest CT. On the 4th postoperative day, she was transferred to the general ward without any complications.
Aged ; Anesthesia, General ; Female ; Femur ; Hemodynamics ; Heparin ; Humans ; Intensive Care Units ; Patients' Rooms ; Propofol ; Pulmonary Artery ; Pulmonary Embolism ; Thorax ; Tourniquets ; Vena Cava Filters ; Vena Cava, Inferior ; Vital Signs

Background: Only a few studies have established the epidemiology of prolactinoma and Cushing’s disease in Korea. Furthermore, the incidence of these disease are increasing than before associated with the development of technologies. This study was designed to evaluate the epidemiology of prolactinoma and Cushing’s disease and their survival analysis according to treatment. Methods: The nationwide, population-based study evaluated incidence and prevalence of prolactinoma and Cushing’s disease using de-identified claims data in The Korean Health Insurance Review and Assessment Service database between 2013 and 2017. The survival analysis investigated regarding treatment over a period of 6 years. A log-rank test and Cox proportional hazard regression analysis were used. Results: The 6,056 patients with newly diagnosed prolactinoma and 584 patients with Cushing’s disease were recorded between 2013 and 2017. The annual incidence of prolactinoma was 23.5 cases per million, and its prevalence was 82.5 cases per million, and 2.3 cases per million/year and 9.8 cases per million for Cushing’s disease. The survival benefit was insignificant in prolactinoma according to treatment, but treatment of Cushing’s disease ameliorated the survival rate significantly. Conclusion Overall, the incidence of prolactinoma and Cushing’s disease was similar with those found previously, but the prevalence of two diseases were inconsistent when compared with the early studies. The present study also proposed necessity of treatment in Cushing’s disease for improving the survival rate.

Background: Only a few studies have established the epidemiology of prolactinoma and Cushing’s disease in Korea. Furthermore, the incidence of these disease are increasing than before associated with the development of technologies. This study was designed to evaluate the epidemiology of prolactinoma and Cushing’s disease and their survival analysis according to treatment. Methods: The nationwide, population-based study evaluated incidence and prevalence of prolactinoma and Cushing’s disease using de-identified claims data in The Korean Health Insurance Review and Assessment Service database between 2013 and 2017. The survival analysis investigated regarding treatment over a period of 6 years. A log-rank test and Cox proportional hazard regression analysis were used. Results: The 6,056 patients with newly diagnosed prolactinoma and 584 patients with Cushing’s disease were recorded between 2013 and 2017. The annual incidence of prolactinoma was 23.5 cases per million, and its prevalence was 82.5 cases per million, and 2.3 cases per million/year and 9.8 cases per million for Cushing’s disease. The survival benefit was insignificant in prolactinoma according to treatment, but treatment of Cushing’s disease ameliorated the survival rate significantly. Conclusion Overall, the incidence of prolactinoma and Cushing’s disease was similar with those found previously, but the prevalence of two diseases were inconsistent when compared with the early studies. The present study also proposed necessity of treatment in Cushing’s disease for improving the survival rate.

Sebaceous trichofolliculoma is a rare benign tumor and represents a variant of trichofolliculoma. It presents as a centrally depressed solitary tumor and occurs in areas rich in sebaceous lobules. Microscopically, it shows keratin-filled cystic cavities and sebaceous lobules. The lobules are connected to the cystic wall. Herein we report a case of sebaceous trichofolliculoma on the right cheek in a 64-year-old man.
Cheek ; Follicular Cyst ; Humans ; Middle Aged ; Neoplasms, Basal Cell ; Skin Neoplasms

Sebaceous trichofolliculoma is a rare benign tumor and represents a variant of trichofolliculoma. It presents as a centrally depressed solitary tumor and occurs in areas rich in sebaceous lobules. Microscopically, it shows keratin-filled cystic cavities and sebaceous lobules. The lobules are connected to the cystic wall. Herein we report a case of sebaceous trichofolliculoma on the right cheek in a 64-year-old man.
Cheek ; Follicular Cyst ; Humans ; Middle Aged ; Neoplasms, Basal Cell ; Skin Neoplasms

Carcinosarcoma is a biphasic tumor that has both epithelial as well as mesenchymal components. It most commonly occurs at the esophagus, lung, upper respiratory tract and urinary bladder, however it rarely occurs on the skin. A 62-year-old men presented with a bean sized crusted ulcer on his right cheek. A biopsy specimen revealed atypical sqamous cells mixed with spindle-shaped cells with hyperchromatic nuclei. Furthermore, immunohistochemical study showed positive reactions for AE1/AE3, cytokeratin7, epithelial membrane antigen and vimentin, but negative reactions for S100 protein, CD34 and smooth muscle actin. Based on these histopathological and immunohistochemical findings, we diagnosed this case as cutaneous carcinosarcoma. The patient was treated with complete excision and a local flap.
Actins ; Biopsy ; Carcinosarcoma ; Cheek ; Esophagus ; Humans ; Lung ; Male ; Middle Aged ; Mucin-1 ; Muscle, Smooth ; Respiratory System ; Skin ; Ulcer ; Urinary Bladder ; Vimentin

Tinea incognito is a dermatophytosis modified by previous treatments such as prolonged use of corticosteroids. Because the lesions often atypical appearing without classic features of ringworm, the diagnosis can be delayed or missed especially when tinea incognito is on the face and neck. A 75-year-old male patient who had been treated with topical steroids at the local dermatologic clinic for 10 years for the eczematous lesion on the scalp and face and recently the lesions spread throughout his neck and back. Physical examination showed ill-defined erythematous scaly patches on the face, neck and back and reddish crusted papules on the scalp. Potassium hydroxide (KOH) preparation on the left face and right neck showed hyphae and fungus cultures were positive for colonies of Trichophyton rubrum (T. ruburum). The result of DNA sequencing from the colony was identical to that of T. rubrum. The lesions were treated by oral terbinafine and topical isoconazole.
Adrenal Cortex Hormones ; Aged ; Diagnosis ; Fungi ; Humans ; Hyphae ; Male ; Neck* ; Physical Examination ; Potassium ; Scalp ; Sequence Analysis, DNA ; Steroids ; Tinea* ; Trichophyton

Alternaria is a common saprophytic fungus found in the environment such as soil, air, and a variety of objects. The cutaneous infection caused by this fungus occurs more frequent in patients with immunocompromission than in immunocompetent people. We report a case of cutaneous alternariosis in a 63-year-old woman presented with a tender erythematous patch on the right forearm. She was on medication only for hypertension. Histopathologic examination showed a dermal mixed-cell infiltrate including multinucleated giant cells. PAS staining revealed fungal elements in the dermis. Microscopic examination of the colonies showed muriform conidia. A diagnosis of cutaneous infection due to Alternaria species was made on the basis of the above mentioned findings. Oral administration of fluconazole revealed resolution of her cutaneous lesion.
Administration, Oral ; Alternaria ; Alternariosis ; Dermis ; Female ; Fluconazole ; Forearm ; Fungi ; Giant Cells ; Humans ; Hypertension ; Middle Aged ; Soil ; Spores, Fungal