Hamartomas are non-neoplastic malformations or congenital errors of tissue development. Hamartoma is composed by an excessive growth of mature tissue present in wrong proportions and abnormal arrangements. The lesion usually presents as a submucosal mass with ill-defined margins. Hamartoma occurs in all areas of the body, especially in the liver, spleen, kidney and lung. However, hamartoma is very rare in the head and neck. Presenting symptoms of hamartoma are typically vague and nonspecific. Treatment of hamartomas consists of adequate surgical excision. We present a 59 year-old male patient who presented with submental swelling. Malignancy could not be ruled out with preoperative radiologic examination, so surgical excision was planned. The mass was excised with transcervical approach. Histopathologic examination has confirmed the mass as a mucinous gland adenomatoid hamartoma.
Hamartoma ; Head ; Humans ; Kidney ; Liver ; Lung ; Male ; Mucins ; Neck ; Spleen

Lemierre syndrome is characterized by anaerobic bacterial infection in the head and neck and clinical or radiological evidence of internal jugular vein thrombophlebitis. The most common pathogens are Fusobacterium species, particularly Fusobacterium necrophorum. Septic emboli resulting from infected thrombophlebitis of the internal jugular vein leads to metastatic infections involving lung, liver, kidney, bone and central nervous system. The accurate diagnosis and treatment is important because it may be associated with a high mortality rate if untreated. We present a case of 28-year-old man with an atypical history for the diagnosis of Lemierre syndrome, which showed no definite evidence of internal jugular thrombophlebitis.
Adult ; Bacterial Infections ; Central Nervous System ; Diagnosis ; Empyema ; Fusobacterium ; Fusobacterium necrophorum ; Head ; Humans ; Jugular Veins ; Kidney ; Lemierre Syndrome* ; Liver ; Lung ; Mortality ; Neck ; Thrombophlebitis

PURPOSE: To evaluate the efficacy and safety of robotic procedures performed using the da Vinci Robotic Surgical System at a single institute. MATERIALS AND METHODS: We analyzed all robotic procedures performed at Severance Hospital, Yonsei University Health System (Seoul, Korea). Reliability and mortality rates of the robotic surgeries were also investigated. RESULTS: From July 2005 to December 2013, 10267 da Vinci robotic procedures were performed in seven different departments by 47 surgeons at our institute. There were 5641 cases (54.9%) of general surgery, including endocrine (38.0%), upper (7.7%) and lower gastrointestinal tract (7.5%), hepato-biliary and pancreatic (1.2%), and pediatric (0.6%) surgeries. Urologic surgery (33.0%) was the second most common, followed by otorhinolaryngologic (7.0%), obstetric and gynecologic (3.2%), thoracic (1.5%), cardiac (0.3%), and neurosurgery (0.1%). Thyroid (40.8%) and prostate (27.4%) procedures accounted for more than half of all surgeries, followed by stomach (7.6%), colorectal (7.5%), kidney and ureter (5.1%), head and neck (4.0%), uterus (3.2%), thoracic (1.5%), and other (2.9%) surgeries. Most surgeries (94.5%) were performed for malignancies. General and urologic surgeries rapidly increased after 2005, whereas others increased slowly. Thyroid and prostate surgeries increased rapidly after 2007. Surgeries for benign conditions accounted for a small portion of all procedures, although the numbers thereof have been steadily increasing. System malfunctions and failures were reported in 185 (1.8%) cases. Mortality related to robotic surgery was observed for 12 (0.12%) cases. CONCLUSION: Robotic surgeries have increased steadily at our institution. The da Vinci Robotic Surgical System is effective and safe for use during surgery.
Head ; Kidney ; Korea* ; Lower Gastrointestinal Tract ; Mortality ; Neck ; Neurosurgery ; Prostate ; Robotic Surgical Procedures ; Stomach ; Surgeons ; Thyroid Gland ; Ureter ; Uterus

PURPOSE: Oxidized low-density lipoprotein (oxLDL) plays a key role in endothelial dysfunction, vascular inflammation, and atherogenesis. The aim of this study was to assess blood clearance and in vivo kinetics of radiolabeled oxLDL in mice.METHODS: We synthesized ¹²³I-oxLDL by the iodine monochloride method, and performed an uptake study in CHO cells transfected with lectin-like oxLDL receptor-1 (LOX-1). In addition, we evaluated the consistency between the ¹²³I-oxLDL autoradiogram and the fluorescence image of DiI-oxLDL after intravenous injection for both spleen and liver. Whole-body dynamic planar images were acquired 10 min post injection of ¹²³I-oxLDL to generate regional time-activity curves (TACs) of the liver, heart, lungs, kidney, head, and abdomen. Regional radioactivity for those excised tissues as well as the bladder, stomach, gut, and thyroid were assessed using a gamma counter, yielding percent injected dose (%ID) and dose uptake ratio (DUR). The presence of ¹²³I-oxLDL in serum was assessed by radio-HPLC.RESULTS: The cellular uptakes of ¹²³I-oxLDL were identical to those of DiI-oxLDL, and autoradiograms and fluorescence images also exhibited consistent distributions. TACs after injection of ¹²³I-oxLDL demonstrated extremely fast kinetics. The radioactivity uptake at 10 min postinjection was highest in the liver (40.8 ± 2.4% ID). Notably, radioactivity uptake was equivalent throughout the rest of the body (39.4 ± 2.7% ID). HPLC analysis revealed no remaining ¹²³I-oxLDL or its metabolites in the blood.CONCLUSION: ¹²³I-OxLDL was widely distributed not only in the liver, but also throughout the whole body, providing insight into the pathophysiological effects of oxLDL.
Abdomen ; Animals ; Atherosclerosis ; CHO Cells ; Chromatography, High Pressure Liquid ; Cricetinae ; Fluorescence ; Head Kidney ; Heart ; Inflammation ; Injections, Intravenous ; Iodine ; Kinetics ; Lipoproteins ; Liver ; Lung ; Methods ; Mice ; Radioactivity ; Spleen ; Stomach ; Thyroid Gland ; Urinary Bladder

Osteonecrosis (ON) is a common comorbidity in gout; however, avascular ON of multiple sites is unusual. Multifocal ON is defined as osteonecrotic lesions affecting three or more separate anatomic sites. We report a case of a 31-year-old woman diagnosed with gout, who had multifocal ON. Initially, she was treated with benzbromarone, colchicine, and meloxicam. Two years later, she developed severe tophi and was diagnosed with chronic renal failure. Magnetic resonance imaging (MRI) of both legs revealed bilateral ON of the femoral head. She underwent bilateral hip replacement surgeries. After two years, she had pain and limited movements in the left shoulder, with tophi identified via dual-energy computed tomography. Despite management with non-steroidal anti-inflammatory drugs, colchicine, and prednisolone, she had persistent shoulder pain. MRI of the left shoulder revealed ON. She therefore underwent left shoulder replacement surgery. Following the case report, we review the literature on multifocal ON with gout.
Adult ; Benzbromarone ; Colchicine ; Comorbidity ; Female ; Gout* ; Head ; Hip ; Humans ; Kidney Failure, Chronic ; Leg ; Magnetic Resonance Imaging ; Osteonecrosis* ; Prednisolone ; Shoulder ; Shoulder Pain

PURPOSE: There are many types of intraoperative consultations by vascular surgeons during non-vascular surgery. Therefore, we examined the current state of intraoperative consultations during non-vascular surgery in a single center. MATERIALS AND METHODS: From January 2014 to December 2015, we reviewed records of 40 patients (0.3%) who received an intraoperative consultation from a vascular surgeon for 10,734 non-vascular surgeries in Inha University Hospital. We examined patient characteristics, operative details, and clinical results. RESULTS: There were 40 intraoperative vascular surgical consultations relating to bleeding (n=14, 35.0%), dissection from the vessel (n=13, 32.5%), arterial occlusion (n=10, 25.0%), and retroperitoneal approach (n=3, 7.5%). The locations of surgery were lower extremity (n=10, 25.0%), kidney (n=8, 20.0%), spine (n=6, 15.0%), pelvis (n=6, 15.0%), head and neck (n=4, 10.0%), abdomen (n=4, 10.0%), and upper extremity (n=2, 5.0%). The methods of surgery included primary closure or ligation (n=17, 42.5%), end-to-end anastomosis (n=12, 30.0%), bypass (n=10, 25.0%), thrombectomy (n=4, 10.0%), retroperitoneal approach (n=3, 7.5%), and embolization (n=2, 5.0%). Postoperative treatment was performed in the intensive care unit for 13 patients (32.5%), while 3 patients (7.5%) died following surgery. CONCLUSION: Intraoperative consultation by vascular surgeons during non-vascular surgery occurred in approximately 0.3% of non-vascular surgeries. The region undergoing operation and type of surgery were variable. Therefore, it is necessary for vascular surgeons to have a comprehensive knowledge of vascular anatomy and to make rapid surgical decisions.
Abdomen ; Head ; Hemorrhage ; Humans ; Intensive Care Units ; Kidney ; Ligation ; Lower Extremity ; Neck ; Pelvis ; Referral and Consultation ; Spine ; Surgeons ; Thrombectomy ; Upper Extremity ; Vascular Surgical Procedures

Lung cancer survivors need to undergo continuous care by primary care physicians after acute treatment. The health problems of lung cancer survivors are associated with their treatment: for example, severe pain, respiratory difficulty, poor quality of life, or pneumonitis. They also have various comorbidities, such as stroke, myocardial infarction, arrhythmia, chronic obstructive pulmonary disease, or psychological problems. Surveillance of lung cancer survivors is based on an annual chest CT with routine physical examination. Incidence of second primary cancer in lung cancer survivors is reported to increase in the remnant lung, head and neck, kidney, bladder, thyroid, stomach, and breast. Therefore, lung cancer survivors need to undergo regular health examination for early detection of cancer. Smoking status, weight change, drinking behavior, and vaccination, especially influenza and pneumococcal vaccination, should be assessed whenever the patient meets a clinician. The primary care physician would be expected to take on the role of managing the health problems of Korean lung cancer survivors comprehensively, including physical and psychosocial problems, from screening to survivorship care.
Arrhythmias, Cardiac ; Breast ; Comorbidity ; Drinking Behavior ; Early Detection of Cancer ; Head ; Humans ; Incidence ; Influenza, Human ; Kidney ; Korea* ; Long-Term Care ; Lung Neoplasms* ; Lung* ; Mass Screening ; Myocardial Infarction ; Neck ; Neoplasms, Second Primary ; Physical Examination ; Physicians, Primary Care ; Pneumonia ; Primary Health Care ; Pulmonary Disease, Chronic Obstructive ; Quality of Life ; Smoke ; Smoking ; Stomach ; Stroke ; Survival Rate ; Survivors* ; Thyroid Gland ; Tomography, X-Ray Computed ; Urinary Bladder ; Vaccination

Xanthogranulomatous inflammation (XGI) is characterized histologically by the deposition of foamy macrophages and infiltration of inflammatory cells. While XGI is extremely rare, it has been reported in the gallbladder, kidney, stomach, and lymph nodes. A 61-year-old woman presented with epigastric pain for 2 weeks. Abdominal computed tomography and magnetic resonance imaging showed a pancreatic head mass with distal common bile duct wall thickening. Endoscopic ultrasonography followed by fine needle aspiration was performed, and subsequent pathology report revealed a benign disease. Because uncontrolled abdominal pain persisted and possibility of malignancy could not be excluded, Whipple's operation was eventually performed, and pathology report showed xanthogranulomatous pancreatitis (XGP). Herein, we report a case of symptomatic XGP mimicking of pancreas cancer. Although XGP is extremely rare, it should be considered as a differential diagnosis of neoplastic lesions of the pancreas.
Abdominal Pain ; Biopsy, Fine-Needle ; Common Bile Duct ; Diagnosis, Differential ; Endosonography ; Female ; Gallbladder ; Head ; Humans ; Inflammation ; Kidney ; Lymph Nodes ; Macrophages ; Magnetic Resonance Imaging ; Middle Aged ; Pancreas ; Pancreatic Neoplasms* ; Pancreatitis* ; Pathology ; Stomach

Immunoglobulin G4-related sclerosing disease (IgG4-RD) is histologically a chronic inflammatory disorder characterized by infiltration of lymphoplasmacytes, sclerosis, and an elevated serum level of IgG4 and IgG4 positive plasmocytes. IgG4-RD is associated with autoimmune pancreatitis, sclerosing cholangitis, sialalithiasis, retroperitoneal diseases, inflammatory arotitis and Mikulicz's disease, typically including the lacrimal glands, salivary glands, pancreas, thyroid gland, lungs and kidneys. It is important to distinguish IgG4-RD from neoplastic disease as it responses well to steroid. Because consensus for nomenclature of IgG4-RD is recently made, reports of IgG4-RD in the Head and Neck area are still rare. In the first case, a 68-year-old man presented with a recurring submandibular gland mass from 7 years ago; he underwent submandibular gland resection and was diagnosed as IgG4-RD. In the second case, a 69-year-old mass presented with a relapsing right neck mass on level Ib. He underwent an exsional biopsy and was diagnosed with the same disease entity. We experienced two cases of IgG4-RD, and so report them with a brief literature review.
Aged ; Biopsy ; Cholangitis, Sclerosing ; Consensus ; Head ; Humans ; Immunoglobulin G ; Immunoglobulins* ; Kidney ; Lacrimal Apparatus ; Lung ; Neck ; Pancreas ; Pancreatitis ; Salivary Glands ; Sclerosis ; Submandibular Gland ; Thyroid Gland

A renal cell carcinoma (RCC) is known for its high propensity for early metastasis. Among the metastatic cancers of the head and neck, RCC is the third most common disease after breast cancer and lung cancer. Head and neck metastasis of RCC occurs mainly in the thyroid gland (36.6%), nose and sinus (9.1%), and lesions in the ear canal and temporal bone are very rare. Although extremely rare, metastatic malignancy in the breast, lung, prostate, kidney to the external auditory canal have been reported in the literature. We report a case of metastatic RCC of the left external auditory canal in a 78-year-old male patient who had experienced multiple organ metastasis after nephrectomy due to renal cell carcinoma.
Aged ; Breast ; Breast Neoplasms ; Carcinoma, Renal Cell* ; Ear Canal* ; Head ; Humans ; Kidney ; Lung ; Lung Neoplasms ; Male ; Neck ; Neoplasm Metastasis ; Nephrectomy ; Nose ; Prostate ; Temporal Bone ; Thyroid Gland