• Archives of Plastic Surgery
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• 제38권5호
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• pp.691-694
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• 2011

Purpose: With an increase in the population of immunocompromised patients, the incidence of maxillary sinus aspergillus infection has also escalated. Maxillary sinus aspergillosis is generally extended to the sinus antrum, base or thin orbital wall and ethmoid air cell region. We experienced a case of maxillary sinus aspergillosis which was extended directly to the soft tissue of the cheek. Methods: A 46-year-old man with acute myelogenous leukemia was consulted for the defect of the anterior wall of the maxillary sinus, and cheek. Radiologic and histologic findings were consistent with invasive maxillary sinus aspergillosis. The otolaryngology department performed debridement via endoscopic sinus surgery first. Coverage of the resulting defect in the anterior wall of the maxillary sinus and its inner layer was undergone by the plastic and reconstructive surgery department, using a pedicled superficial temporal fascia flap and a split thickness skin graft. The remaining skin defect of the cheek was covered with a local skin flap. Results: The patient went through an uneventful recovery. There was no recurrence during 6 months of follow-up. Conclusion: Maxillary sinus aspergillosis usually involves the orbit or the gingiva but in some cases it may directly invade soft tissues of the cheek. Such an atypical infection extending into the cheek may lead to a large soft tissue defect requiring coverage. Thus, any undiagnosed soft tissue defect involving the cheek or maxillofacial area, especially in immunocompromised patients, should be evaluated for aspergillosis. We present this rare case, with a review of the related literature.

• Journal of Chest Surgery
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• 제38권2호
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• pp.168-171
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• 2005

고립성 섬유성 종양은 주로 흉막에서 발생하는 드문 종양으로 중피하 중간엽에서 기원하며 드물게 흉막 외에서 발생하기도 한다. 많은 경우에서 증상이 없이 우연히 발견되나 다른 중요 장기를 침범하거나 종양의 크기가 커질 경우 증상이 나타나기도 한다. 일반적으로 진단은 영상의학적 검사와 세침흡인을 통한 생검으로 하며 면역조직화학검사를 시행하여 더 정확히 판별할 수 있다 대부분의 경우 양성의 경과를 보이며 병변의 완전한 제거 여부가 가장 중요한 예후 인자가 된다고 알려져 있다. 저자들은 우하엽에 발생한 폐실질 내에 생긴 고립성 섬유성 종양을 채기 절제술로 치험하여 이에 보고하는 바이다

• Journal of Chest Surgery
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• 제45권5호
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• pp.287-294
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• 2012

Background: Biologic valved grafts are important in cardiac surgery, and although several types of graft are currently available, most commercial xenografts tend to cause early disfiguration due to intimal proliferation and calcification. We studied the graft failure patterns on non-fixed and glutaraldehyde-fixed pulmonary xenograft in vivo animal experiment. Materials and Methods: Pulmonary valved conduits were obtained from the right ventricular outflow tract of eleven miniature pigs. The grafts were subjected to 2 different preservation methods; with or without glutaraldehyde fixation: glutaraldehyde fixation (n=7) and non-glutaraldehyde fixation (n=4). The processed explanted pulmonary valved grafts of miniature pig were then transplanted into eleven goats. Calcium quantization was achieved in all of the explanted xenograft, hemodynamic, histopathologic and radiologic evaluations were performed in the graft which the transplantation period was over 300 days (n=7). Results: Grafts treated with glutaraldehyde fixation had more calcification and conduit obstruction in mid-term period. Calcium deposition also appeared much higher in the glutaraldehyde treated graft compared to the non-glutaraldehyde treated graft (p<0.05). Conclusion: The present study suggests that xenografts prepared using glutaraldehyde fixation alone appeared to have severe calcification compared to the findings of non-glutaraldehyde treated xenografts and to be managed with proper anticalcification treatment and novel preservation methods. This experiment gives the useful basic chemical, histologic data of xenograft failure model with calcification for further animal study.

• 한국임상수의학회지
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• 제32권4호
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• pp.313-318
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• 2015

The lung opacity on radiography is influenced by various factors. The physical density of the lung and the attenuation ensured on computed tomography (CT) scans is determined by three components : lung tissue, blood, and air. Temporary right lateral recumbency may responsible for the increase of opacity on ventrodorsal projection view. Thus, our aim is to demonstrate that the effect of right lateral recumbency posture on right lung opacity using radiograph and CT scan. In this study, 62 dogs without clinical or radiologic signs of cardiopulmonary disease are selected. Thorax radiographs per 30 seconds for 2 minutes (30s, 60s, 90s, 120s) were performed for 62 dogs. After discussion of the radiographic findings of lung field by two radiologists and a student at Chungbuk national university veterinary medical center a consensus opinion was recorded. Computed tomography per a minute (1 min, 2 min) for 2 minutes were performed for 2 dogs. Mean x-ray attenuation of lung was measured quantitatively using software at two levels (aortic arch and basal level). Among 62 dogs with radiograph comparison, 9.3% of dogs showed influence by postural effect. However, all 2 dogs with computed tomography comparison, showed influence by postural effect. In conclusion, position dependent changes of lung density in CT exam are not consistent with thoracic radiograph.

• Journal of Korean Neurosurgical Society
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• 제55권4호
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• pp.226-229
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• 2014

We describe a rare case of intradural-extramedullary primary spinal cysticercosis. A 42-year-old man visited our institute for lower back pain. He denied having consumed raw meet. Magnetic resonance (MR) images revealed an intradural pure cystic mass at the L3-L4 level. A radiologic diagnosis of spinal arachnoid cyst was established. Three years later, he complained of aggravated back pain, and follow-up MR examination showed a markedly expanded cyst, occupying the subarachnoid space from the T11 to the S1 level. L2 hemilaminectomy was performed, and a yellowish infected cyst bulged out through the dural opening. The cyst was removed en bloc. The histopathological findings of the cyst were consistent with parasitic infection. Serum enzyme-linked immunosorbent assay (ELISA) confirmed the presence of spinal cysticercosis. As there was no intracranial lesion, the final diagnosis was primary spinal cysticercosis, which is very rare. MR imaging is a sensitive diagnostic tool for detecting cystic lesions in the spine; however, it is difficult to distinguish cysticercosis from non-infectious cysts such as an arachnoid cyst without using gadolinium enhancement. Clinicians treating spinal cysts with an unusual clinical course should include cysticercosis as a differential diagnosis. We recommend contrast-enhanced MR imaging and serum ELISA in the diagnostic work-up of such cases.

• 대한두개안면성형외과학회지
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• 제12권1호
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• pp.71-74
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• 2011

Purpose: Sarcoidosis is a systemic noncaseating granulomatous disease of an unknown origin, and can involve any organ including the skin. The infiltration of sarcoid granuloma in an old cutaneous scar is an uncommon cutaneous manifestation of sarcoidosis. This paper reports a 35-year old female who presented with cutanesous nodules in previous facial scars. Methods: A 35-year-old female presented with cutaneous nodules for 2 months in previous scars of the forehead and lower lip that she had acquired in the childhood. An excisional biopsy of the lower lip mass, serologic examinations and radiologic studies were performed. Results: The excisional biopsy revealed noncaseating granulomas consistent with sarcoidosis. Chest CT revealed both hilar and paratracheal lymphadenopathy with nodular densities in both lung fields. Routine laboratory tests, serologic tests, serum angiotensin converting enzyme level, sputum for acid-fast bacilli, ophthalmoscopic examination, TB-PCR and NTM-PCR showed normal findings. Therefore, the patient was diagnosed with sarcoidosis. The patient refused fiberoptic bronchoscopy and medication with oral steroid. Currently, the clinical manifestation and progress are being monitored closely, and treatment is expected to start with oral steroid according to the progress. Conclusion: For the proper management of cutaneous sarcoidosis, particularly scar sarcoidosis, plastic surgeons should be aware of the many clinical and histopathological features of sarcoidosis and recommend a systemic evaluation for early diagnosis and proper treatment.

• Allergy, Asthma & Respiratory Disease
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• 제6권6호
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• pp.303-309
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• 2018

Purpose: Foreign body aspiration in children is emergent and can cause serious complications. This study aims to show the clinical characteristics of foreign body aspiration and to analyze the clinical cases of delayed diagnosis to predict and prevent complications. Methods: We retrospectively reviewed the medical records of 63 children (48 in Inha University Hospital and 15 in Gachon University Gil Medical Center) who were diagnosed with foreign body aspiration through bronchoscopy from 1996 to 2017 in Incheon City, and analyzed clinical characteristics. Patients were divided into 3 groups: those were diagnosed within 24 hours, delayed after 24 hours, or delayed more than 7 days according to time elapse from the time of foreign body aspiration, and clinical characteristics of each group were compared. Results: Aspiration occurred in 58.7% at 1 year and 15.9% at 2 years. Cough (65.1%) and coarse breathing sound (41.3%) were most common, and radiologic findings were commonly presented as emphysema on the affected side (41.3%). Nuts were most common (42.9%), and there was no difference in the frequency between the right and left main bronchi. The documented history of foreign body aspiration was more frequently found in the early diagnosed group; however, sputum, fever, and complications were more frequent in the delayed diagnosed group. Conclusion: If a patient with respiratory disease has persistent fever or sputum, foreign body aspiration should be suspected.

• Journal of Yeungnam Medical Science
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• 제38권4호
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• pp.289-307
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• 2021

Avulsion injuries result from the application of a tensile force to a musculoskeletal unit or ligament. Although injuries tend to occur more commonly in skeletally immature populations due to the weakness of their apophysis, adults may also be subject to avulsion fractures, particularly those with osteoporotic bones. The most common sites of avulsion injuries in adolescents and children are apophyses of the pelvis and knee. In adults, avulsion injuries commonly occur within the tendon due to underlying degeneration or tendinosis. However, any location can be involved in avulsion injuries. Radiography is the first imaging modality to diagnose avulsion injury, although advanced imaging modalities are occasionally required to identify subtle lesions or to fully delineate the extent of the injury. Ultrasonography has a high spatial resolution with a dynamic assessment potential and allows the comparison of a bone avulsion with the opposite side. Computed tomography is more sensitive for depicting a tiny osseous fragment located adjacent to the expected attachment site of a ligament, tendon, or capsule. Moreover, magnetic resonance imaging is the best imaging modality for the evaluation of soft tissue abnormalities, especially the affected muscles, tendons, and ligaments. Acute avulsion injuries usually manifest as avulsed bone fragments. In contrast, chronic injuries can easily mimic other disease processes, such as infections or neoplasms. Therefore, recognizing the vulnerable sites and characteristic imaging features of avulsion fractures would be helpful in ensuring accurate diagnosis and appropriate patient management. To this end, familiarity with musculoskeletal anatomy and mechanism of injury is necessary.

• Journal of Korean Neurosurgical Society
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• 제65권2호
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• pp.245-254
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• 2022

Objective : The etiology of angiographically occult spontaneous subarachnoid hemorrhage (AOsSAH) is unclear. Three-dimensional (3D) high-resolution vessel wall magnetic resonance imaging (HVM) might be useful in detecting the hidden arterial wall angiopathy in patients with AOsSAH. We aimed to demonstrate the feasibility of HVM for detecting the arterial cause of AOsSAH. Methods : Patients, who were diagnosed with AOsSAH in the first evaluations and underwent HVM, were enrolled. Their clinical and radiologic data were retrospectively reviewed. Especially, focal enhancement of arterial wall on HVM and repetitive catheterized angiograms were precisely compared. Results : Among 251 patients with spontaneous SAH, 22 patients were diagnosed with AOsSAH in the first evaluations (8.76%). After excluding three patients who did not undergo 3D-HVM, 19 patients were enrolled and classified as convexal (n=2) or perimesencephalic (n=4), and diffuse (n=13) groups. In convexal and perimesencephalic groups, no focal enhancement on HVM and no positive findings on repetitive angiography were noted. In diffuse group, 10 patients showed focal enhancement of arterial wall on HVM (10/13, 76.9%). Repeated angiography with 3D reconstruction revealed four patients of angiographically positive causative arteriopathy and possible lesion in one case in the concordant location of intramural enhancement on 3D-HVM (5/10, 50%). Three of them were treated with endovascular stent insertion. All patients, except one, recovered with good clinical outcome (3-month modified Rankin score, 0 and 1). Conclusion : 3D-HVM was useful in detecting hidden true arteriopathy in AOsSAH. It may provide new insights into the etiologic investigation of AOsSAH by proving information about the arterial wall status.

• Journal of Trauma and Injury
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• 제35권1호
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• pp.56-60
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• 2022

The most common cause of foot drop is lumbar degenerative disc herniation, particularly at L4/5. We present a rare case of spinal cord injury accompanied by a thoracolumbar lesion that presented with bilateral foot drop. A 69-year-old male patient presented with sudden-onset severe bilateral leg pain and bilateral foot drop. Radiologic findings revealed T12 spondylitis compressing the conus medullaris. He had undergone vertebroplasty for a T12 compression fracture after a fall 6 months before. A physical examination showed bilateral foot drop, paresthesia of both L5 dermatomes, increased deep tendon reflex, and a positive Babinski sign. An acute bilateral L5 root lesion and a conus medullaris lesion were suspected based on electromyography. A surgical procedure was done for decompression and reconstruction. After the operation, bilateral lower extremity muscle strength recovered to a good grade from the trace grade, and the patient could walk without a cane. The current case is a very rare report of bilateral foot drop associated with T12 infectious spondylitis after vertebroplasty. It is essential to keep in mind that lesions of the thoracolumbar junction can cause atypical neurological symptoms. Furthermore, understanding the conus medullaris and nerve root anatomy at the T12-L1 level will be helpful for treating patients with atypical neurological symptoms.