Effectiveness of applying continuous positive airway pressure in a patient with paradoxical vocal fold movement after endotracheal extubation: a case report / 대한마취과학회지

Paradoxical vocal fold movement (PVFM) is an uncommon upper airway disorder defined as paradoxical adduction of the vocal folds during inspiration. The etiology and treatment of PVFM are unclear. The physician should manage this condition because of the possibility of near complete airway obstruction in severe case of PVFM. We report a case of successful airway management in a patient with PVFM by applying continuous positive airway pressure (CPAP). In this case, PVFM was detected after removing an endotracheal tube from a 67-year-old male who underwent excision of a laryngeal mass. The patient recovered without complications in 1 day with support by CPAP.

Lethal coronary air embolism caused by the removal of a double-lumen hemodialysis catheter: a case report / 대한마취과학회지

Coronary air embolism is a rare event. We report a case in which an acute myocardial infarction occurred in the region supplied by the right coronary artery after the removal of a double-lumen hemodialysis catheter. Emergent coronary angiography revealed air bubbles obstructing the mid-segment of the right coronary artery with slow flow phenomenon distally. The patient expired due to myocardial infarction.

An unusual abscess formation in the masticator space after acupressure massage: a case report

Clinical features of masticator-space abscess (MSA) are very similar to those of parotitis or temporomandibular disorder (TMD), making early differential diagnosis difficult. Local causes of MSA include nerve block anesthesia, infection after tooth extraction, and trauma to the temporomandibular joint (TMJ); the systemic cause is immunodeficiency. Odontogenic causes account for most etiologies, but there are also unusual causes of MSA. A 66-year-old male patient visited the emergency room (ER) presenting with left-side TMJ pain three days after receiving an acupressure massage. He was tentatively diagnosed with conventional post-trauma TMD and discharged with medication. However, the patient returned to the ER with increased pain. At this time, his TMD diagnosis was confirmed. He made a third visit to the ER during which facial computed tomographic (CT) images were taken. CT readings identified an abscess or hematoma in the left masticator space. After hospitalizing the patient, needle aspiration confirmed pus in the infratemporal and temporal fossa. Antibiotics were administered, and the abscess was drained through an incision made by the attending physician. The patient's symptoms decreased, and he was discharged.

A Case of Laryngeal Web Injury during Intubation in Pediatric Patient / 계명의대학술지

Laryngeal web is a rare congenital disease, and its incidence has been estimated to be 1 in 10,000 live births. A 4-year-old female child with laryngeal web was scheduled for laryngeal web removal. Smooth intubation without causing damages to the laryngeal web is important during induction. Also, it is very important to select the appropriate tube size during pediatric anesthesia. There is lack of a registered cuffed micro-laryngeal surgery (MLS) tube 3.5 mm inner diameter (ID) in Korea, and also our hospital did not have an uncuffed MLS tube 4.0 mm ID. Therefore we could not select the appropriate size of the laser tube. The patient's laryngeal web was slightly injured during intubation. We report a case of laryngeal web injury caused by intubation for laryngeal web removal and wish to state that there is lack of a registered laser tube in the size, such as a cuffed MLS tube 3.5 mm ID.

The simultaneous application of positive-end expiratory pressure with the Trendelenburg position minimizes respiratory fluctuations in internal jugular vein size / 대한마취과학회지

BACKGROUND: The respiratory cycle alters the size of the right internal jugular vein (RIJV). We assessed the changes in RIJV size during the respiratory cycle in patients under positive pressure ventilation. Moreover, we examined the effects of positive-end expiratory pressure (PEEP) and the Trendelenburg position on respiratory fluctuations. METHODS: A prospective study of 24 patients undergoing general endotracheal anesthesia was performed. Images of the RIJV were obtained in the supine position with no PEEP (baseline, S0) and after applying three different maneuvers in random order: (1) a PEEP of 10 cmH2O (S10), (2) a 10degrees Trendelenburg tilt position (T0), and (3) a 10degrees Trendelenburg tilt position combined with a PEEP of 10 cmH2O (T10). Using the images when the area was smallest and largest, cross-sectional area (CSA), anteroposterior diameter, and transverse diameter were measured. RESULTS: All maneuvers minimized the fluctuation in RIJV size (all P = 0.0004). During the respiratory cycle, the smallest CSA compared to the largest CSA at S0, S10, T0, and T10 decreased by 28.3 8.5, 8.0, and 4.4%, respectively. Furthermore, compared to S0, a 10degrees Trendelenburg tilt position with a PEEP of 10 cmH2O significantly increased the CSA in the largest areas by 83.8% and in the smallest areas by 169.4%. CONCLUSIONS: A 10degrees Trendelenburg tilt position combined with a PEEP of 10 cmH2O not only increases the size of the RIJV but also reduces fluctuation by the respiratory cycle.

A Case of Interstitial Pneumonitis Induced by Acitretin / 대한내과학회지

Retinoids are effective systemic agents in the treatment of psoriasis. Acitretin, a synthetic aromatic derivative of retinoic acid, has replaced etretinate in retinoid therapy of psoriasis because of its more favorable pharmacokinetic profile, including a significantly shorter half-life. Most of the adverse effects associated with acitretin are teratogenicity, hepatotoxicity, pseudotumor cerebri, pancreatitis, hyperlipidemia, hyperostosis, and mucocutaneous side effects. There are two reports worldwide describing patients who developed acute respiratory distress syndrome associated with acitretin. This suggests the possibility of serious lung complications associated with acitretin. We report a case of a 61-year-old man who developed interstitial pneumonitis that might have been induced by acitretin during the treatment of pustular psoriasis. In these cases, immediate withdrawal of retinoic acid is necessary, and corticosteroid therapy should be considered.

Catastrophic Antiphospholipid Syndrome Improved by Anticoagulation Alone / 대한내과학회지

Catastrophic antiphospholipid syndrome (APS) is an accelerated subtype of APS that results in multiorgan failure. Although catastrophic APS represents about 0.8% of all APS cases, it is usually a life-threatening medical condition that requires high clinical awareness. Catastrophic APS has been managed by various therapies, including anticoagulation, corticosteroids, plasma exchange and IV immunoglobulin, but it still has a high mortality rate. A few cases treated by anticoagulation and steroids have been reported in Korea. In this paper, we report a case of catastrophic APS that improved after anticoagulation therapy alone. Thus, we consider hat our case shows another clinical aspect of catastrophic APS.

A Case of Fournier's Gangrene Caused by Streptococcus anginosus / 감염과화학요법

Fournier's gangrene is a rare, rapidly progressive, necrotizing fasciitis of the genital, perianal and perineal regions. It is usually caused by a synergistic infection of aerobic and anaerobic organisms. A 51-year-old male patient with diabetes mellitus and chronic renal insufficiency on peritoneal dialysis was admitted with severe scrotal pain and swelling that lasted 4 days. An emergent non-contrast-enhanced computed tomography revealed extensive gas formation, fatty haziness and edema in the left scrotal and inguinal area. The patient was successfully treated with immediate surgical debridements and antibiotics. Streptococcus anginosus group Streptococcus anginosus was isolated from surgical wound cultures and identified with biochemical identification methods and direct sequencing of DNA. Herein, we report a rare case of Fournier's gangrene caused by S. anginosus. We also review the relevant literature

Submandibular mass excision in an Asian population: a 10-year review

<p><b>OBJECTIVES</b>The objectives of this study were to compare the prevalence of submandibular gland neoplasia in an Asian population with a Western population and to evaluate the accuracy of fi ne needle aspiration cytology (FNAC) and computed tomography (CT) scan in the study of submandibular gland pathologies.</p><p><b>MATERIALS AND METHODS</b>We conducted a 10-year retrospective review of 101 submandibular mass excisions. Data on the demographic profi le of patients, clinical features, correlation of fi ne needle aspiration cytology, CT scans and histology and morbidities related to surgery were collected.</p><p><b>RESULTS</b>The prevalence of submandibular gland neoplasia was 27.1%. Most (78.9%) of these were benign. FNAC and CT scans were accurate for benign neoplasia. However, the accuracy of FNAC and CT scans for sialadenitis without sialolithiasis was low.</p><p><b>CONCLUSION</b>The prevalence of submandibular gland malignancy was lower in the Asian population. FNAC and CT scans were accurate for benign neoplasia of the submandibular gland.</p>

Portal and Mesenteric Venous Thrombosis Complicating Endoscopic Injection Sclerotherapy / 대한소화기내시경학회지

Endoscopic injection sclerotherapy is an effective and relatively safe modality for controlling bleeding esophageal varices. Injection of sclerosant causes acute mural thrombosis with a necroinflammatory response and subsequent sclerosis in the venous system of the distal esophagus. A few cases of mesenteric venous thrombosis with small bowel infarction after sclerotherapy have been reported, and most of which were fatal. The association between mesenteric venous thrombosis and sclerotherapy has been strongly suggested, but this still remains unproved. We report here on a case of mesenteric venous thrombosis with small bowel infarction that developed after endoscopic injection sclerotherapy.