BACKGROUND AND OBJECTIVES: The epidermoid cyst is a common benign disease of the skin caused by inflammation of hair cortex follicles and proliferation of epidermal cells within the dermis or superficial subcutaneous tissue. The purpose of this study was to investigate the characteristics of epidermoid cysts of the external auditory canal (EAC) by analyzing the clinical and radiologic features. SUBJECTS AND METHODS: The clinical records were retrospectively reviewed for patients diagnosed with epidermoid cyst of the EAC from March 2004 to December 2013. The epidermoid cysts were diagnosed clinically by endoscopy and microscopy examinations and by temporal bone CT images, and were confirmed by histopathologic examination. Characteristics of epidermoid cysts in bony EAC and cartilaginous EAC were compared. RESULTS: Eight patients had an epidermoid cyst in the bony EAC and nine patients had one in the cartilaginous EAC. Swelling and otalgia were common symptoms, but 47% of cysts were found incidentally. The mean age of patients was 49.6 years (age range, 26-67 years) in the bony EAC cases and 26.1 years (age range, 6-57 years) in the cartilaginous EAC cases. The mean size of the epidermoid cyst was 3.50 mm (size range, 2-7 mm) in the bony EAC cases and 9.55 mm (size range, 2-20 mm) in the cartilaginous EAC cases. CONCLUSIONS: Comparison of epidermoid cysts of the bony EAC and the cartilaginous EAC revealed that epidermoid cysts of the bony EAC is usually found incidentally, arose in older patients and had smaller size.
Dermis ; Ear Canal* ; Earache ; Endoscopy ; Epidermal Cyst* ; Hair ; Humans ; Incidental Findings ; Inflammation ; Microscopy ; Retrospective Studies ; Skin ; Subcutaneous Tissue ; Temporal Bone

PURPOSE: Prealbumin is known as a biochemical marker for assessing nutritional status, and it is influenced by a systemic inflammatory condition. This study aims to find any correlation between patients' low serum prealbumin in electrical burn and unhealed burn surface area and insufficient nutritional support. METHODS: Data were collected by a review of the medical charts of patients admitted to Hanil General Hospital for electrical burn. Laboratory results such as prealbumin, albumin, total lymphocyte count (TLC), and C-reactive protein (CRP) were collected and tested every week. Residual burn surface area (residual BSA) during a specific period was calculated from the surgery record. Statistical analysis was conducted using Pearson's correlation and multiple regression analysis. RESULTS: A total of 30 subjects were selected, all male. Average total burn surface area was 20.9±14.9%, and patients were operated on about three times after admission. There was statistical significance among all variables in Pearson's correlation test, but in multiple regression analysis, albumin and CRP were significant compared with prealbumin. CONCLUSION: The results could indicate that burn causes a systemic inflammatory reaction, which could affect the serum prealbumin level. Further study concerning the biological plausibility of each variable is needed.
Biomarkers ; Burns* ; Burns, Electric ; C-Reactive Protein ; Hospitals, General ; Humans ; Lymphocyte Count ; Male ; Nutritional Status ; Nutritional Support ; Prealbumin*

A sudden hearing loss with vertigo may originate from vascular insufficiency and sometimes presents as an initial manifestation of posterior brain circulation infarction. However, it is unusual that sudden hearing loss and vertigo present as a prodrome of transient ischemic attack. Here we describe the case of a 54-year-old male patient with hypertension who presented with a sudden onset of hearing loss in his right ear and recurrent severe, whirling type dizziness without associated neurological signs or symptoms. The diffusion-weighted magnetic resonance imaging (MRI) was normal on initial presentation. Ten days later, however, the patient developed dysarthria. A follow-up MRI including the diffusion-weighted images was normal but cerebral angiography showed severe narrowing of right vertebral artery. Transient ischemic attack caused by vertebrobasilar artery stenosis should be considered in sudden hearing loss and vertigo, especially patients with vascular risk factors, even though images of brain MRI are normal.
Arteries ; Brain ; Cerebral Angiography ; Constriction, Pathologic ; Dizziness ; Dysarthria ; Ear ; Ear, Inner* ; Follow-Up Studies ; Hearing Loss ; Hearing Loss, Sudden ; Humans ; Hypertension ; Infarction ; Ischemic Attack, Transient* ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Risk Factors ; Vertebral Artery* ; Vertebrobasilar Insufficiency* ; Vertigo

Epithelioid hemangioendothelioma is a vascular tumor of endothelial origin that commonly occurs in the deep soft tissue, bone, lung and liver. This vascular tumor rarely occurs within the external auditory canal (EAC). Epithelioid hemangioendothelioma has a biologic behavior that is an intermediate between a hemangioma and an angiosarcoma. Here, we present a case of 57-year-old female patient with an epithelioid hemangioendothelioma in her EAC. She underwent tympanomastoidectomy and histopathological examination revealed an epithelioid hemangioendothelioma.
Bone and Bones ; Ear Canal* ; Female ; Hearing Loss, Conductive ; Hemangioendothelioma, Epithelioid* ; Hemangioma ; Hemangiosarcoma ; Humans ; Liver ; Lung ; Middle Aged

Sudden hearing loss and vertigo are the typical presentation of anterior inferior cerebellar artery infarction, but may rarely occur in posterior inferior cerebellar artery (PICA) infarction. Here we describe a 65-year-old man who presented with sudden hearing loss in his left ear and severe vertigo. The diffusion-weighted magnetic resonance imaging revealed acute infarction in the territory of PICA and cerebral angiography showed non-visualization of left vertebral artery. Sudden hearing loss and vertigo may be a presentation of PICA infarction.
Aged ; Arteries ; Cerebral Angiography ; Ear ; Hearing Loss, Sudden ; Humans ; Infarction ; Lateral Medullary Syndrome ; Magnetic Resonance Imaging ; Pica ; Vertebral Artery ; Vertigo

It is essential during extracorporeal membrane oxygenation (ECMO) to extend the activated clotting time (ACT) using anticoagulants to prevent blood clot formation. Traditionally, heparin has been used as an anticoagulant during ECMO. Hemorrhaging due to systemic heparinization is considered a major complication of ECMO. A 48-year-old man was admitted due to cardiogenic shock with acute myocardial infarction. ECMO was instituted because of recurrent ventricular tachycardia and refractory shock. We used nafamostat mesilate (Futhan) as an anticoagulant to reduce hemorrhagic complications. The total bypass time was 153 h. The average dose of nafamostat mesilate was 2.64+/-1.11 mg/kg/h; the average ACT was 128.68+/-21.24 seconds. Only a few units were transfused, and there was no oxygenator failure or hemorrhagic complications. Thus, nafamostat mesilate may reduce the need for transfusions and hemorrhagic complications during ECMO.
Anticoagulants ; Extracorporeal Membrane Oxygenation ; Guanidines ; Hemorrhage ; Heparin ; Humans ; Mesylates ; Middle Aged ; Myocardial Infarction ; Oxygen ; Oxygenators ; Shock ; Shock, Cardiogenic ; Tachycardia, Ventricular

PURPOSE: This study aims to analyse the difference in bacteriology and antibiotics resistance on colonization of burn wound by the change of burn wound dressing. METHODS: A retrospective review of all medical records of patients admitted with burns to the burn center of the Hanil General Hospital in 2002 when the conservative wound dressing was managed and in 2009 when the advanced wound dressing was carried out. Patient demographics, extent and type of burn, mortality rates were reviewed. Isolation and identification of microorganisms was done using the standard procedure. Disc diffusion tests were performed for all the isolates for antimicrobial susceptibility. RESULTS: A total of 456 patients in 2002 and a total of 208 patients in 2009 were admitted. Of them, 27 patients in 2002 (Group A) and 35 patients in 2009 (Group B) have the result of colonization on burn wound by surface swab culture after post admission day 7. Mean age was 43.59+/-3.64 (Group A), 49.46+/-2.79 (Group B). The sex ratio of the patients was 1:0.4 with 20 men and 7 women (Group A), 1:0.5 with 24 men and 11 women (Group B). The mean admission day was 61.46+/-12.02 (Group A), 61.62+/-7.55 (Group B). The average value of total body area burned was 32.30+/-4.43 (Group A), 10.40+/-1.73 (Group B). A total of 3 patients (Group A) has inhalation burn. Three patients (Group A) and one patient (Group B) died. The most common cause of burn was flame burn (59.3%) (Group A), scald burn (48.6%) (Group B). The frequency of resistant microorganisms causing colonization on burn wound was 44.44% (Group A), 22.86% (Group B). CONCLUSION: In group managed with the conservative burn dressing, the resistant microorganisms and pathogens are more frequent than in the advanced burn dressing group. However there was no statistically significant. Ongoing data collection and reanalysis is required.
Anti-Bacterial Agents ; Bacteriology ; Bandages ; Burn Units ; Burns ; Burns, Inhalation ; Colon ; Data Collection ; Demography ; Diffusion ; Female ; Hospitals, General ; Humans ; Male ; Medical Records ; Retrospective Studies ; Sex Ratio

PURPOSE: Burn injuries still produce a significant morbidity and mortality. The collection and analysis of burn epidemiology data would provide insights into new prevention management strategies in terms of nationwide profile. We reviewed and compared the data from other countries. METHODS: This study was carried out to analyze the epidemiology, current etiological factors (circumstances), treatment methods and mortality of 4,321 acute burn patients, excluding electrical burn, who were admitted to Hanil Hospital Burn Center during 12 years (1996~2007). RESULTS: 1) The male to female ratio was 1.3:1. The mean age of admission was 30.0 years. The children below 18 years made up 38.9%, and adult over 60 years 10.2%. 2) The scald was the most common cause making up 53.8% followed by flame (30.8%), contact (9.3%), steam (3.6%) and chemical (2.1%) burn. The mean extent was 9.8%, 19.1%, 3.8%, 7.2%, 8.7% respectively. 3) The etiologies of scald burn were boiled water (32.9%), hot food soup (28.1%), boiling water (13.8%), instant food (10.3%) at home (87.4%). The 13.7% of victims underwent surgery of STSG (12.9%), FTSG (0.6%), local flap (1.2%) and advanced flap (0.1%). 4) The majority of flame burn occurred at home (43.7%) and work place factory (23.5%). Leading causes were inflammables (29.3%), fire (14.0%), explosion of butane can (12.8%), gas range (10.1%) and LPG (8.7%). The 31.4% of victims underwent STSG (26.2%), FTSG (0.8%), local flap (0.2%) and major amputation (0.1%). 5) The major victims (50.6%) of steam were children below 2years by exposing to steam of rice cooker (70.0%) at home. The 28.9% of victims underwent STSG (14.7%), FTSG (16.0%) and local flap (5.1%). 6) The contact burns occurred at various places (home; 56.5%, work place; 16.9%, vehicles; 9.0%, sauna; 4.5%) by various causes (Ondol; 11.9%, hot pack; 11.2%, oriental herb medicine; 6.7%). The 45.8% of victims underwent STSG (36.3%), FTSG (6.7%), local flap (5.2%), advanced flap (2.0%) and minor amputation (1.2%). 7) The chemical burn occurred at various place (home; 39.3%, work place; 49.4%) by acids (43.8%), alkalies (11.2%), vinegar (15.7%) and herb moxa (16.9%). The 28.1% of victims underwent STSG (22.5%), FTSG (9.0%), local flap (7.9%) and minor amputation (6.7%). 8) Children<18 years old were burnt mainly by scald (79.0%) while for adults below 50 years old was flame, over 50 years was scald. Children below 2 years old had higher frequency of steam (9.2%) and contact (7.9%) burn. The contact burn had relatively higher frequency among 7th (17.6%) and over 8th (20.4%), while chemical among 6th (3.9%) decade. 9) Inhalation injury was accompanied in 13.8% of flame burn (4.3% of total). The inhalation injury only was 4.9% of flame (1.5% of total). 10) The overall mortality rate was 1.8%. The mean age of death was 47.3 years old and burn extent was 74.5%TBSA. There was a strong correlation between flame burn (96.2% of total death), TBSA (50~60%; 9.3% vs 70~80%; 65.2%, 80~90%; 71.4%, over 90%; 87.9%) and mortality. The prognosis was poor for those over 70 year old (7.7% vs 30~50 yo; 2.8%, 7 th decade; 3.7%), flame burn (5.6% vs scald; 0.04%) and combined inhalation injury (22.3%). The patients died at mean 17.3 PBD by ARDS (51.3%), sepsis (44.9%), burn shock (20.5%) and ARF (5.1%) 11) The severity and sequelae of scald by prepackaged instant food, steams of rice cooker, flame by used butane can, contact by Ondol, sauna and chemical by vinegar should be added to preventive programs. CONCLUSION: Further study for implications of changes in management protocols and policies on treatment outcomes would improve the provision of appropriate care for the patients.
Acetic Acid ; Adult ; Alkalies ; Amputation ; Burn Units ; Burns ; Burns, Chemical ; Butanes ; Child ; Explosions ; Female ; Fires ; Humans ; Hypogonadism ; Inhalation ; Male ; Mitochondrial Diseases ; Ophthalmoplegia ; Penicillin G Benzathine ; Prognosis ; Retrospective Studies ; Sepsis ; Shock ; Steam ; Steam Bath ; Water ; Workplace

BACKGROUND: Tsutsugamushi, leptospirosis and hemorrhagic fever with renal syndrome (HFRS) are the prevalent diseases among the acute febrile illnesses in Korea. Pulmonary involvement in the patients with these diseases remains poorly recognized in endemic regions, and this is despite reports of recent outbreaks and epidemic episodes. Pulmonary involvement and a higher CRP level as clinical manifestations show a more severe form of infection. The aim of this study is to analyze the correlation of pulmonary involvement and the CRP level in patients with acute febrile illnesses. METHODS: We retrospectively reviewed the clinical records of 105 patients who were diagnosed with tsutsugamushi, HFRS and leptospirosis from January 2002 to May 2008 in Chuncheon Sacred Heart Hospital. The radiographic images were retrospectively analyzed by two radiologists. We analyzed the pulmonary complications of the patients with these febrile diseases and we checked the CRP level at admission. RESULTS: The study included 105 patients who were diagnosed with febrile diseases. Of these patients, 32 patients had hantaan, 10 patients had leptospirosis and 63 patients had tsutsugamushi disease. 42 (40%) patients had pulmonary complications, 20 patients had pulmonary edema, 20 patients had pleural effusion and 2 patients had interstitial pneumonitis. The patients with pulmonary involvement showed a more severe form of infection and a higher CRP level than that of those patients without pulmonary involvement (p=0.0073). CONCLUSION: Pulmonary involvement in patients with acute febrile diseases might be correlated with a higher CRP level. Identification of this factor on admission might provide useful selection criteria for the patients who need early intensive care.
C-Reactive Protein ; Disease Outbreaks ; Heart ; Hemorrhagic Fever with Renal Syndrome ; Humans ; Incidence ; Critical Care ; Korea ; Leptospirosis ; Lung Diseases, Interstitial ; Patient Selection ; Pleural Effusion ; Pulmonary Edema ; Retrospective Studies ; Scrub Typhus

BACKGROUND/AIMS: This study compared the prognostic values of the Model for End-stage Liver Disease (MELD) and the hepatic venous pressure gradient (HVPG) in the prediction of death within 3 and 12 months in patients with decompensated liver cirrhosis. METHODS: We used data from 136 consecutive patients with decompensated cirrhosis who underwent HVPG between January 2006 and June 2008. Cox regression analysis was used to investigate the independent relationships with death of MELD and HVPG. The prognostic accuracies of MELD and HVPG were analyzed by calculating the area under the receiver operating characteristic curve (AUROC) for the occurrence of death within 3 and 12 months. RESULTS: Both MELD and HVPG were independent predictors of death [hazard ratio (HR)=1.11 and 1.12, respectively; 95% confidence interval (CI)=1.04~1.20 and 1.08-1.16]. Analysis of the AUROC demonstrated that the prognostic power did not differ between MELD and HVPG for predicting the 3-month survival (HR=0.76 and 0.68, respectively; 95% CI=0.62~0.89 and 0.52~0.84; P=0.22) or the 12-month survival (HR=0.72 and 0.73, 95% CI=0.61~0.83 and CI=0.61~0.84). CONCLUSIONS: Both MELD and HVPG are independent prognostic factors of death within 3 and 12 months in patients with decompensated liver cirrhosis, and their accuracies are similar. However, HVPG has a limited role in the prediction of death in decompensated cirrhosis due to its invasiveness and limited use.
Adult ; Aged ; Area Under Curve ; Cohort Studies ; Female ; Hepatic Veins/*physiopathology ; Humans ; Liver Cirrhosis/diagnosis/*mortality/physiopathology ; Liver Failure/diagnosis/*mortality/physiopathology ; Male ; Middle Aged ; Models, Biological ; Predictive Value of Tests ; Prognosis ; Proportional Hazards Models ; Regression Analysis ; Retrospective Studies ; Severity of Illness Index ; Survival Analysis ; Venous Pressure