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Background/Aims@#Most guidelines recommend surgical resection of all main duct (MD) and mixed-type (MT) intraductal papillary mucinous neoplasms (IPMNs) in suitable patients. However, there is little evidence regarding the malignancy risk of enhancing mural nodules (EMNs) that are present only in the main pancreatic duct (MPD) in patients with MD- and MT-IPMNs.Therefore, this study aimed to identify the clinical and morphological features associated with malignancy in MD- and MT-IPMNs with EMNs only in the MPD. @*Methods@#We retrospectively enrolled 50 patients with MD- and MT-IPMNs with EMNs only in the MPD on contrast-enhanced magnetic resonance imaging. We evaluated the clinical characteristics and preoperative radiologic imaging results of MPD morphology and EMN size and analyzed the risk factors associated with malignancy. @*Results@#Histological findings of EMNs were low-grade dysplasia (38%), malignant lesions (62%), high-grade dysplasia (34%), and invasive carcinoma (28%). On the receiver operating characteristic curve, the cutoff value of EMN size on magnetic resonance imaging for best predicting malignancy was 5 mm (sensitivity, 93.5%; specificity, 52.6%; area under the curve, 0.753).Multivariate analysis showed that only EMN >5 mm (odds ratio, 27.69; confidence interval, 2.75 to 278.73; p=0.050) was an independent risk factor for malignancy. @*Conclusions@#EMNs of >5 mm are associated with malignancy in patients with MD- and MTIPMNs with EMNs that are present only in the MPD, in accordance with the international consensus guidelines.
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Background and Objectives@#The guidelines for cochlear implantation (CIs) are expanding, and the number of CI procedures performed on the elderly is increasing. The purpose of this study was to analyze the results and safety of cochlear implantation in the elderly, as well as to evaluate the predictive factors on CI outcomes. @*Subjects and Methods@#The study included 56 patients aged ≥40 years, who received CIs between 2009 and 2020. They were divided into two groups: 27 younger adults (40-64 years) and 29 elderly (>64 years). The study compared their pre- and postoperative speech perception and category of auditory performance (CAP) scores, surgical complications, and hospitalization periods. It also evaluated associated factors in the elderly group by examining categorical and continuous variables and postoperative CAP score. @*Results@#There was a significant improvement in speech recognition tests (both word and sentence) and CAP scores in both groups compared to the pre-implantation scores (p<0.001). Postoperative results were slightly lower in the elderly group than in younger adults for sentence recognition and CAP scores, except for word recognition. No significant associated factors were found on postoperative CAP scores, except for etiology. Postoperative CAP significantly improved in the sudden hearing loss group compared to the groups with other etiologies (p=0.045). The elderly group had more comorbidities than that in the younger adult group (p=0.026), but there were no significant differences in postoperative complications and hospitalization periods. @*Conclusions@#While speech recognition and CAP scores were relatively lower in the elderly group compared to the younger adults, the elderly group showed significant improvements in audiological results after CI. Moreover, CI was safe and well tolerated in elderly patients.
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The entanglement of multiple central venous catheters is a rare and seriouscomplication. The Swan-Ganz catheter is a responsible for various cases.Case: A 66-year-old male patient was under general anesthesia for a coronary artery bypassgraft surgery. As he had a pre-existing Perm catheter in the right subclavian vein, a SwanGanz catheter was inserted into the left internal jugular vein. Chest radiograph after catheterplacement revealed that the Perm catheter had migrated to the left brachiocephalic vein.The surgeon attempted to reposition it manually, but postoperative radiograph showed thatit had rolled into a loop. On postoperative day 1, radiological intervention was performed tountangle the loop, which was successful.Conclusions: After placing a Swan-Ganz catheter in patients with a pre-existing central venous catheter, the presence of entanglement should be assessed. In such cases, radiology-guided correction is recommended, as a blind attempt to disentangle can aggravate thecondition.
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Cerebrospinal fluid (CSF) leakage may cause intracranial hypotension and postural headache. Secondary intracranial hypotension may result from an iatrogenic dural puncture or traumatic injury associated with pain procedures. Case: A 45-year-old male developed a headache 26 days after spinal pain procedure. Headache was characterized as postural, worsening with standing or sitting and improving while lying down. The pain did not resolve despite the administration of oral and intravenous analgesics. A spinal magnetic resonance imaging revealed epidural venous congestion and a suspicious CSF leak around the left L4/5 level. The patient received an epidural blood patch (EBP), the headache improved dramatically, and the patient was discharged. Conclusions: Delayed postural headaches may not be directly related to pain management. Nevertheless, intracranial hypotension related to pain management should be suspected even in this case. If confirmed, quickly applying an EBP is an effective treatment option.
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Background and Objectives@#The relationship between hearing aid (HA) use and improvement in cognitive function is not fully known. This study aimed to determine whether HAs could recover temporal resolution or hearing in noise functions. @*Materials and Methods@#We designed a prospective study with two groups: HA users and controls. Patients older than 45 years, with a pure tone average threshold of worse than 40 dB and a speech discrimination score better than 60% in both ears were eligible. Central auditory processing tests and hearing in noise tests (HINTs) were evaluated at the beginning of the study and 1, 3, 6, and 12 months after the use of a monaural HA in the HA group compared to the control group. The changes in the evaluation parameters were statistically analyzed using the linear mixed model. @*Results@#A total of 26 participants (13 in the HA and 13 in the control group) were included in this study. The frequency (p<0.01) and duration test (p=0.02) scores showed significant improvements in the HA group after 1 year, while the HINT scores showed no significant change. @*Conclusions@#After using an HA for one year, patients performed better on temporal resolution tests. No improvement was documented with regard to hearing in noise.
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Background and Objectives@#In this study, we introduce our method of hearing aid (HA) verification using real ear measurement (REM). We verified HAs that have gone through the fitting program using speech mapping REM; we then compared the outcome with word recognition scores (WRS) to evaluate functional gain. Subjects and Method Fifty-six patients of sensorineural hearing loss (81 ears) were enrolled in the study. In REM, if the gap between the target gain of HA and real ear aided response (REAR) was less than 10 dB SPL, fitting was considered successful. In speech audiometry, unaided maximum discrimination score (PB max), unaided WRS at 65 dB HL and aided WRS at 65 dB HL were measured. By comparing PB max and aided WRS at 65 dB HL, patients were sorted into best (n=15), good (n=57), and poorly (n=9) aided groups and analyzed for the successes of fitting. Fitting was deemed unsuccessful if REAR was ≥10 dB SPL lower than the target value of HA. @*Results@#The mean aided WRS at 65 dB HL of best, good and poorly aided groups were 85.6%, 77.3%, and 54.2%, respectively. There were statistically significant differences between all groups (p=0.019, 0.001, 0.002). The success rates of HA fitting showed significant differences at 0.5, 0.75, 1, 4 kHz of 55 dB SPL (p=0.023, 0.005, 0.003, 0.014), and at 4 kHz of 65 and 75 dB SPL (p=0.004, 0.001). The high WRS group showed sufficient gain at many frequencies. @*Conclusion@#Well fitted HAs can provide sufficient increase in speech intelligibility. Using the speech mapping REM is a great method to verify fitting of HA.
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The physicochemical properties of crystalline titanium dioxide nanoparticles (TiO2 NPs) were investigated by comparing amorphous (amTiO2 ), anatase (aTiO2 ), metaphase of anatase-rutile (arTiO2 ), and rutile (rTiO2 ) NPs, which were prepared at various calcination temperatures (100℃, 400℃, 600℃, and 900℃). X-ray diffraction (XRD) and scanning electron microscopy (SEM) analyses confirmed that the phase-transformed TiO2 had the characteristic features of crystallinity and average size. The surface chemical properties of the crystalline phases were different in the spectral analysis. As anatase transformed to the rutile phase, the band of the hydroxyl group at 3,600–3,100 cm –1decreased gradually, as assessed using Fourier transform infrared spectroscopy (FT-IR). For ultraviolet-visible (UVVis) spectra, the maximum absorbance of anatase TiO2 NPs at 309 nm was blue-shifted to 290 nm at the rutile phase with reduced absorbance. Under the electric field of capillary electrophoresis (CE), TiO2 NPs in anatase migrated and detected as a broaden peak, whereas the rutile NPs did not. In addition, anatase showed the highest photocatalytic activity in an UV-irradiated dye degradation assay in the following order: aTiO2 > arTiO2 > rTiO2 . Overall, the phases of TiO2 NPs showed characteristic physicochemical properties regarding size, surface chemical properties, UV absorbance, CE migration, and photocatalytic activity.
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The rupture of a pyogenic liver abscess (PLA) with peritonitis is a rare occurrence but a surgical emergency with a high mortality rate in the case of gas-forming PLA. Rare cases of ruptured PLA that recovered completely with only medical treatment have been reported.This paper reports a case of a large PLA rupture with peritonitis. In this case, surgical intervention was too risky because of the patient’s age and poor general condition. The patient recovered fully with appropriate antibiotic therapy and sufficient percutaneous drainage. Therefore, medical treatment may be considered an alternative option in cases of a ruptured large PLA with peritonitis if surgical intervention is too risky.
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The physicochemical properties of crystalline titanium dioxide nanoparticles (TiO2 NPs) were investigated by comparing amorphous (amTiO2 ), anatase (aTiO2 ), metaphase of anatase-rutile (arTiO2 ), and rutile (rTiO2 ) NPs, which were prepared at various calcination temperatures (100℃, 400℃, 600℃, and 900℃). X-ray diffraction (XRD) and scanning electron microscopy (SEM) analyses confirmed that the phase-transformed TiO2 had the characteristic features of crystallinity and average size. The surface chemical properties of the crystalline phases were different in the spectral analysis. As anatase transformed to the rutile phase, the band of the hydroxyl group at 3,600–3,100 cm –1decreased gradually, as assessed using Fourier transform infrared spectroscopy (FT-IR). For ultraviolet-visible (UVVis) spectra, the maximum absorbance of anatase TiO2 NPs at 309 nm was blue-shifted to 290 nm at the rutile phase with reduced absorbance. Under the electric field of capillary electrophoresis (CE), TiO2 NPs in anatase migrated and detected as a broaden peak, whereas the rutile NPs did not. In addition, anatase showed the highest photocatalytic activity in an UV-irradiated dye degradation assay in the following order: aTiO2 > arTiO2 > rTiO2 . Overall, the phases of TiO2 NPs showed characteristic physicochemical properties regarding size, surface chemical properties, UV absorbance, CE migration, and photocatalytic activity.
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The rupture of a pyogenic liver abscess (PLA) with peritonitis is a rare occurrence but a surgical emergency with a high mortality rate in the case of gas-forming PLA. Rare cases of ruptured PLA that recovered completely with only medical treatment have been reported.This paper reports a case of a large PLA rupture with peritonitis. In this case, surgical intervention was too risky because of the patient’s age and poor general condition. The patient recovered fully with appropriate antibiotic therapy and sufficient percutaneous drainage. Therefore, medical treatment may be considered an alternative option in cases of a ruptured large PLA with peritonitis if surgical intervention is too risky.
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Acute unilateral vestibulopathy (AUV) is the recommended term [rather than the more widely used ‘vestibular neuritis (VN)’] for all pathologies involving sudden impairment of the unilateral peripheral vestibular function regardless of the exact location of the lesion. Acute vestibular syndrome (AVS) is an upper-level entity of AUV, which is the most common cause of AVS, and includes acute central vertigo. AVS typically presents with the symptoms of new onset continuous vertigo, gait instability, and nausea/vomiting lasting several days to weeks. The video head impulse test (vHIT) was recently developed and has been widely adopted at clinics and emergency centers. In this study, we will review the differential diagnosis of AVS using vHIT. In addition, we will describe the subtypes of VN and the use of vHIT for follow-up testing in AVS.
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Cholesterol granulomas of the temporal bone can occur in the petrous apex, middle ear, and mastoid cavity. Although cholesterol granulomas in the petrous apex often extend to the middle cranial fossa, cholesterol granulomas in the middle ear and mastoids rarely invade the cranial cavity with bony erosion. We report a case of a large cholesterol granuloma involving the posterior cranial fossa with pneumatic mastoid and not affecting the middle ear. The patient had no otologic or neurologic symptoms, and the mass was found incidentally on a brain MRI included in a regular medical checkup. The mass was removed via a combined transmastoid and suboccipital approach without complications, and characteristic pathology findings demonstrated a cholesterol granuloma.
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Background and Objectives@#The optimal dose or type of systemic steroid for treating idiopathic sudden sensorineural hearing loss (ISSNHL) is unclear. Herein, we compare the efficacy of three steroid treatment protocols.Subjects and Method We reviewed the medical records of 140 adult ISSNHL patients from a tertiary medical center. The patients were divided into three groups based on their treatment regimen: Group 1 received intravenous 10 mg/day dexamethasone combined with intratympanic (IT) steroid injection, followed by prednisolone for 5 days after discharge; Group 2 received 10 mg/day dexamethasone for 5 days, followed by 5 mg/day for 5 days over a 10-day hospitalization period; and Group 3 received 10 mg/day dexamethasone combined with IT steroid injection during a 5-day hospital stay, followed by 5 mg/day dexamethasone for 5 days after discharge. The hearing thresholds were measured using an automatic audiometer at 0.5, 1, 2, 3, 4, and 8 kHz. Hearing recovery on Day 90 was categorized according to Siegel’s criteria. @*Results@#Univariate and multivariate analyses showed that patients in Group 3 had the lowest hearing thresholds, and the best results for speech reception threshold and speech discrimination scores. The impact of favorable thresholds in Group 3 was better among patients with a baseline average hearing threshold of ＜70 dB. Complete recovery was more likely in Group 3 than in the other groups, based on the odds ratios. @*Conclusion@#Administration of dexamethasone-based systemic steroid combined with IT steroid injection and a relatively long hospitalization period produced the most favorable result.
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Idiopathic intracranial hypertension (IIH) is a disorder that commonly occurs in obese young women of childbearing age and is characterized by symptoms such as pulsatile tinnitus, dizziness, headache, nausea, vomiting, and visual loss without any structural or vascular abnormalities in the intracranial cavity. We recently experienced a case of a 33-year-old obese woman who presented with right-sided pulsatile tinnitus, which is an early symptom for IIH. The patient was successfully treated with weight reduction and carbonic anhydrase inhibitor (acetazolamide). Pulsatile tinnitus requires thorough diagnosis and examination because it can be cured if the anatomical or functional cause is identified and treated. When obese women of childbearing age present with pulsatile tinnitus at the otorhinolaryngology outpatient department, treatment for IIH should be initiated after appropriate examination and diagnosis as pulsatile tinnitus may be the only symptom for IIH.
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The antitumor effects of octyl gallate (OG) were investigated on FaDu human hypopharyngeal squamous carcinoma cells. At various concentrations, OG inhibited the proliferation of FaDu cells by suppressing cell cycle regulators and induced apoptosis by activating caspase 3 and its downstream poly (ADP-ribose) polymerase, thereby damaging DNA. Immunoblotting demonstrated that OG significantly suppressed the expression of integrin family proteins (integrin α4, αv, β3, β4), hindering cell adhesion. The reduced expression of integrins subsequently mediated the mitogen- activated protein kinase signaling pathway to stimulate the activation of extracellular signal-regulated kinases and c-jun N-terminal kinases, leading to apoptosis. Thus, OG demonstrated antitumor activity on hypopharyngeal squamous carcinoma cells by suppressing cell proliferation and inducing apoptosis.
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The antitumor effects of octyl gallate (OG) were investigated on FaDu human hypopharyngeal squamous carcinoma cells. At various concentrations, OG inhibited the proliferation of FaDu cells by suppressing cell cycle regulators and induced apoptosis by activating caspase 3 and its downstream poly (ADP-ribose) polymerase, thereby damaging DNA. Immunoblotting demonstrated that OG significantly suppressed the expression of integrin family proteins (integrin α4, αv, β3, β4), hindering cell adhesion. The reduced expression of integrins subsequently mediated the mitogen- activated protein kinase signaling pathway to stimulate the activation of extracellular signal-regulated kinases and c-jun N-terminal kinases, leading to apoptosis. Thus, OG demonstrated antitumor activity on hypopharyngeal squamous carcinoma cells by suppressing cell proliferation and inducing apoptosis.
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Background@#Submental intubation is commonly used during general anesthesia for maxillofacial surgeries as it provides a safe unrestricted surgical access compared to tracheostomy. During submental intubation, soft tissues and blood clots can become lodged in the endotracheal tube. To overcome this problem, we used a laparoscopic trocar.Case: A 52-year-old man with maxillofacial injury was scheduled to undergo an open reduction and internal fixation. We performed submental intubation using laparoscopic trocar, which created sufficient space for the insertion of the endotracheal tube. Unlike conventional methods, our method did not require any blunt dissection and caused significantly less soft tissue damage and required significantly less time. @*Conclusions@#Submental intubation with laparoscopic trocar is a one-step method and is quick and easy-to-perform technique with less complications.
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OBJECTIVE@#The ipsilateral nipple has been used as a directional guide for the insertion of a conventional central venous catheter via the internal jugular vein (IJV). However, the nipple is not an ideal marker since the position of the nipple varies among the characteristics of patients. The utility of the clavicle was investigated for IJV catheterization instead of the ipsilateral nipple through cadaver dissection.@*METHODS@#A total of 14 cadavers were dissected (six fresh cadavers, eight fixed cadavers). Each cadaver was kept in its supine position, and its head was rotated 30° to the left. Length A was the distance between the jugular notch and the point that the line from the nipple to sternocleidomastoid muscle apex meets the clavicle. Length B was the distance between the jugular notch and the clavicle point that passed the IJV. IJV was cut and its circumference measured at regular intervals.@*RESULTS@#Lengths A and B were 3.79±0.35 cm (mean±standard deviation) and 3.71±0.32 cm, respectively, and were significantly correlated (r=0.865, P<0.001). The mean circumference of the vessels were measured to be 3.56±1.29 cm in the right IJV and 3.00±1.32 cm in the left IJV with a significant difference (P=0.013).@*CONCLUSION@#IJV catheterization via the right one, larger than the left one, is appropriate for the first attempt, and we recommend that the needle should be pointed at the clavicle located at a width of two fingers (2nd, 3rd finger average width 1.9 cm) away from the jugular notch.
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Sarcomatoid mesothelioma is not very common, mesothelioma is directly attributable to occupational asbestos exposure, with 90% of cases showing a history of exposure. A 66-year-old male was admitted with an abdominal pain that persisted for 3 weeks. He had no abdominal mass. Computed tomography showed soft tissue thickening in perihepatic space and nodularities in omentum and peritoneum with ascites. There was no absolute diagnosis evidence in ascites analysis. Although the pathology of ascites was free for malignancy, the patient underwent omentum biopsy for definitive diagnosis. In laproscopic exploration, there was omental cake, peritoneal nodular seeding. It was suspected cancer carcinomatosis. Immunohistochemical findings suggested that it was sarcomatoid masothelioma. This is the rare case of a peritoneal sarcomatoid mesothelioma, without any exposure to asbestos.
Subject(s)
Aged , Humans , Male , Abdominal Pain , Asbestos , Ascites , Biopsy , Carcinoma , Diagnosis , Mesothelioma , Omentum , Pathology , Peritoneum , SarcomaABSTRACT
BACKGROUND: Recently, endovascular aortic repair (EVAR) and thoracic endovascular aortic repair (TEVAR), have been used for treatment of thoracic and abdominal aortic aneurysms. The purpose of this study was to analyze the outcome and predictors for 30-day mortality and complications, in patients that underwent EVAR and/or TEVAR under general anesthesia. METHODS: In this study, 151 cases of EVAR and/or TEVAR under general anesthesia in 140 patients during 2009–2017 were studied. The primary outcome was 30-day mortality after surgery. Multivariate logistic regression analysis was used, to clarify risk for postoperative 30-day mortality. RESULTS: Postoperative 30-day mortality rate was 9.9% in the study population (10.3% in EVAR, and 9.3% in TEVAR, respectively). Seventy-two cases (47.7%) experienced postoperative complications within 30 days. Elderly older than age 76.5 (odds ratio [ORs] = 48.89, 95% confidential interval [95% CI] 1.40–1,710.25, P = 0.032), technically expertness (OR = 0.01, 95% CI 0.00–0.40, P = 0.013), severity of systemic complications (OR = 23.24, 95% CI, 2.27–238.24, P = 0.008), and severity of local-vascular complications (OR = 31.87, 95% CI, 1.29–784.66, P = 0.034) were significantly associated with 30-day mortality. CONCLUSIONS: This study revealed that elderly, technically expertness, and severity of systemic and local-vascular complications were associated with 30-day mortality of EVAR and TEVAR in aortic aneurysm.