Effect of Nasal Surgery in Patients with Remained Snoring and Sleep Apnea after Obstructive Sleep Apnea Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Obstructive sleep apnea syndrome is one type of sleep disorder breathing. During sleep, in respiration, nasal obstruction causes negative pressure, which in turn causes the pharyngeal airway to collapse during inspiration. We investigated how nasal surgery affects patients who have undergone OSA surgery but still suffer from the remaining symptoms of snoring and sleep disorder breathing. SUBJECTS AND METHOD: We reviewed 24 patients, who had undergone obstructive sleep apnea (OSA) surgery only to show no enhancement in snoring and qualities of sleep; they showed nasal septal deviation or inferior turbinate hypertrophy. Septal surgery or inferior turbinoplasty was performed by the same otolaryngologist. Over the period between preoperation and 1, 3, 6, 12 months after operation, we evaluated Apnea-Hypopnea Index (AHI) and oxygen saturation by polysomnography, degree of snoring by Visual Analogue Sacle (VAS) score, satisfaction for quality of sleep by Epworth Sleepiness Scale (ESS), minimal cross section area and volume of nasal cavity by acoustic rhinometry, respectively. RESULTS: After nasal surgery, the volume of nasal cavity and MCA increased. There were significant improvements of AHI, oxygen saturation, VAS and ESS score. CONCLUSION: As for OSA surgery, the evaluation of nasal cavity is an indispensible factor for improving the quality of sleep and snoring. When treating OSA patients who have nasal obstruction, nasal surgery including septoplasty and inferior turbinoplasty should be considered.

The Diagnosis and Treatment of the Cervical Vertigo / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Vertigo is an illusion of environmental movement due to various causes, thus it is hard for medical doctors to determine the exact kind of dizziness in the final diagnosis. Recently, cervical vertigo was reported from several vertigo cases. Cervical vertigo is defined as sensation of rotation, resulting from an alteration of the neck proprioceptive afferents of the upper cervical spine. The aim of our study is to document the clinical features and the treatment outcomes in vertigo patients with myofascial pain syndrome (MPS). SUBJECTS AND METHOD: A total of 488 patients, excluding 18 patients who received other diagnosis, were examined to investigate the reasons for dizziness. We evaluated 34 patients, who were diagnosed with cervical vertigo by questionnaire after MPS treatments. Clinical evaluations for cervical vertigo were performed on all subjects, and vestibular function tests were also performed in patients with vertigo symptoms. All patients received a total of 4 treatments including trigger point injection, physical therapy or medication, and then followed up, respectively. The symptom changes of dizziness, patient satisfaction and cervical pain were checked before and treatment 1, 2, 4 times by Visual Analogue Scale (VAS) score. RESULTS: There were significant improvement in the VAS score of dizziness, patient satisfaction and cervical pain after treatment for MPS. CONCLUSION: Treatment for MPS could improve dizziness in cervical vertigo with MPS patients, but further study is needed to clearly confirm the cervical vertigo with MPS for improving patient's quality of life.

The Efficacy of Posterior Resection of Inferior Turbinate on Patients Who Have Recurred Nasal Obstruction after Inferior Turbinate Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Various surgical techniques have been tried to relieve nasal obstruction in patients who have hypertrophic inferior turbinate. Recently, coblators and microdebriders are the favored surgical procedure. This study is aimed at evaluating the long term efficacy of posterior resection of inferior turbinate performed on patients for whom the previous inferior turbinate surgery had not relieved the symptoms of nasal obstruction. SUBJECTS AND METHOD: We selected 27 patients who have had previous inferior turbinate surgery, but were not relieved of the symptom for nasal obstruction. Under local or general anesthesia, hypertrophied posterior part of inferior turbinate was removed. The symptom changes of nasal obstruction and patients satisfaction were checked pre and postoperatively at 1, 2, 3, 6, 12 month by Visual Analogue Scale (VAS) score. The minimal cross-sectional area of second notch and volume of nasal cavity were measured at 1, 2, 3, 6, 12 month after operation. RESULTS: There were significant improvement in the VAS score of nasal obstruction and patient satisfaction after the operation. The minimal cross-sectional area of second notch did not change significantly after surgery, but the nasal cavity volume was significantly improved after surgery. CONCLUSION: This study suggests that posterior resection of inferior turbinate is an effective surgical procedure for patients who have hypertrophic inferior turbinate especially on the posterior part.

Comparison of Tonsillectomy by Conventional Dissection, Electrocautery, Laser, and Coblation / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Tonsillectomy remains to be an ordinary operative process in otorhinolaryngology. The aim of this study is to evaluate four current tonsillectomy techniques, conventional dissection, electrocautery tonsillectomy, laser tonsillectomy, coblation tonsillectomy, comparing operation time, postoperative pain, postoperative otalgia and postoperative hemorrhage. SUBJECTS AND METHOD: From March 2012 to December 2012, a total of 61 patients between the ages of 10 years and 58 years scheduled for tonsillectomy were randomly assigned to conventional dissection, electrocautery, laser, coblation groups. All tonsillectomies were performed under general anesthesia. RESULTS: Coblation tonsillectomy technique produced the shortest total surgical time, averaging 19.1 minutes. Electrocautery was the most painful method and postoperative pain was less in laser and coblation, but there was no statistically significant difference between the two. The incidence of primary and secondary hemorrhage was statistically insignificant between the surgical methods. CONCLUSION: This study found that coblation tonsillectomy led to statistically shorter surgical time. However, the four techniques showed no statistically significant difference in the postoperative pain, postoperative otalgia and hemorrhage. Coblation tonsillectomy and laser tonsillectomy are found to be both useful in patients who are sensitive to postoperative pain.

Does Bicycle Riding Impact the Development of Lower Urinary Tract Symptoms and Sexual Dysfunction in Men?

PURPOSE: This study was designed to determine whether men who engaged in recreational bicycle riding are more likely to be affected by lower urinary tract symptoms (LUTS) and sexual dysfunction than are man who exercised by amateur marathon running with less perineal impact. MATERIALS AND METHODS: A total of 22 healthy male amateur bicyclists and 17 healthy male amateur marathoners were enrolled in the study. We evaluated questionnaires including the International Prostate Symptom Score (IPSS) and the International Index of Erectile Function (IIEF), serum prostate-specific antigen (PSA), uroflowmetric values, postvoid residual (PVR) urine volume, and transrectal ultrasound of the prostate in all subjects. We also compared the prevalence of urination disorders (UD) and erectile dysfunction (ED). RESULTS: There were no significant differences between the two groups in age, body mass index, comorbidities, or exercise habits (p>0.05). Mean total and subscale scores of the IPSS and IIEF and the prevalence of UD (8/22 vs. 4/17, p=0.494) and ED (11/22 vs. 10/17, p=0.748) were not significantly different between the two groups. Also, there were no significant differences between the two groups in uroflowmetric parameters such as peak urinary flow rates, voided urine volume, PVR urine volume, prostate volume, or serum PSA level. CONCLUSIONS: Bicycle riding seems to have no measurable hazardous effect on voiding function or sexual function in men who cycled recreationally.

Direct Effect of Carbon Monoxide on Relaxation Induced by Electrical Field Stimulation in Rat Corpus Cavernosum

PURPOSE: Carbon monoxide (CO) may mediate smooth muscle relaxation in the rat corpus cavernosum smooth muscle (CCSM). We hypothesized that CO plays a role in neurally derived, frequency-dependent relaxation of rat CCSM. MATERIALS AND METHODS: To study the effect of CO on CCSM relaxation induced by electrical field stimulation (EFS), a CCSM bundle was mounted on a force transducer and perfused with Hanks' balanced salt solution at 37degrees C with 95% O2 and 5% CO2. After 1 hour equilibration with -500 mg of passive tension, contraction of the CCSM bundle was elicited by 10(-5) M phenylephrine, which was continuously added with different concentrations of CO (1%, 2%, and 5%). Frequency-dependent relaxation was induced by EFS trains (0.2 ms at 0.5-32 Hz, for 10 s) repeated at 2 min intervals over 15 min in the presence of adrenergic and muscarinic receptor blocking agents (guanethidine and atropine, respectively). To study the distribution of heme oxygenase-2 (HO-2) in the rat CCSM, we performed immunohistochemical evaluation. RESULTS: CO produced a dose-dependent enhancement of EFS-induced relaxation. Pretreatment with N(G)-nitro-L-arginine (a nitric oxide synthase blocker) greatly reduced the EFS-induced relaxation in the presence of CO (-45%). Pretreatment with zinc protoporphyrin-IX (ZnPP-9, a heme oxygenase inhibitor) had no significant effect on EFS-induced relaxation in the absence or the presence of CO. We found immunoreactivity for HO-2 in CCSM and immunoreactivity for protein gene product 9.5 (PGP 9.5) in nerve fibers. CONCLUSIONS: We conclude that CO produced a dose-dependent enhancement of EFS-induced relaxation in rat CCSM bundles, but neurally derived, frequency-dependent relaxation in the rat CCSM depended mostly on nitric oxide in response to nonadrenergic noncholinergic neurotransmission. Immunoreactivity for HO-2 was found in rat CCSM but not nerve fibers.

The Changes of Serum Prostate-specific Antigen after Ejaculation / 대한비뇨기과학회지

PURPOSE: Prostatic manipulation and surgery have been shown to increase serum prostate-specific antigen (PSA). We studied the effect of ejaculation on the serum PSA levels. MATERIALS AND METHODS: We evaluated 131 men(16 to 64 years old) who had no history of surgery or inflammatory disease of the urogenital tract. The total serum PSA, free PSA, serum total testosterone, free testosterone, luteinizing hormone(LH), and follicular stimulating hormone(FSH) were evaluated 1 hour after ejaculation. RESULTS: A PSA level was detected in all the men. There were statistically significant changes of the serum PSA level before and after ejaculation. We compared the parameters between increased PSA group and the decreased PSA group. There were significant differences between the two groups on comparison of the total prostate volume(25.4+/-3.6g vs 15.1+/-4.2g, respectively) and the transition zone volume(7.1+/-2.7g vs 5.3+/-1.1g, respectively). CONCLUSIONS: Based on our data, ejaculation affects the serum PSA concentration in young men, and there seems to be a physiological relationship between ejaculation and the PSA level. The larger the prostate volume, the more ejaculation has an effect on the serum PSA level.

Factors Predicting Complications After Multiple Pinning of Femoral Neck Fractures / 대한정형외과학회잡지

PURPOSE: To report upon factors predicting complication after multiple pinning of femoral neck fractures, the authors performed a comparative study upon a success group and a failure group and reviewed the literature. MATERIALS AND METHODS: Among cases of multiple pinning from July 1990 to June 1998, we defined 63 cases as successful that had more than 2 years follow-up and had no complications, and 18 cases as unsuccessful that had complications like avascular necrosis, nonunion and required a secondary operation. We analyzed the two groups from the viewpoints of age, cause of injury, classification of fracture, degree of displacement, degree of osteoporosis, time interval to operation and accuracy of reduction. RESULTS: Statistically significant factors were the degree of displacement by Garden classification (p=0.007), the degree of displacement and anatomical position by AO classification (p=0.005), the time interval to operation after 7 days (p=0.012) and the postoperative accuracy of reduction (p=0.010). However, age, Singh index and the type of internal fixation device did not show statistical significance. CONCLUSION: Displaced subcapital fracture, time interval to operation after 7 days and reduction accuracy may be prediction of complications.

Cervical and Thoracic Intervertebral Disc Calaification in 6 an Year Old Girl: A Case Report / 대한정형외과학회잡지

Intervertebral disc calcification is rare in children, and known as a spine disease of unknown cause. Since the original description by Baron in 1924, about 200 cases have been reported worldwide. This disease is usually self-limited and responds to a conservative management unless there is an evidence of disc herniation into the spinal canal with associated neural symptoms. We experienced a case of intervertebral disc calcification in a 6-year-old girl and report the clinical and radiographic findings in detail.

Anthropological Analysis of the Korean Skulls by Moire Contourography / 체질인류학회지

The patterns of the moir'e fringe were investigated in 178 modern Korean skulls (112 males and 66 females) using moir'e contourography. The analysis of fringe patterns was executed using image analyzer on the photographs taken from anterior, both lateral, posterior and superior aspects. In the anterior aspect, the center of fringe was the glabella. The cotyledon shape of fringe (type I) was the most frequently observed in males (77%), but reverse triangular shape (type II) and rhomboid shape of fringe (type III) were more frequently observed in females. In the lateral aspect, the euryon, the center of fringe, was located at higher (4 mm) and more lateral (3 mm) position in females than in males. The contour patterns were more irregular (type I) in males than in females where the stripes were arranged more concentrically (type II, III). In the posterior and superior aspects, there was no difference between males and females in the shape of fringe patterns. The relative position of the opisthocranion, the center of fringe in the posterior aspect, was high by 35 mm to eye -ear plane on the average in both sexes. The stripes in the superior aspect were arranged concentrically in both sexes, but wider in females than in males. The results of this nonmetrical study suggest that the analysis of the moir'e fringe patterns in the Korean skulls is a new method for sex discrimination in the field of forensic anthopology.

Craniometric Study in Modern Korean Adults / 체질인류학회지

Metric dimensions of skull of Korean adults were measured and the indices of each dimension were calculated to identify the morphological characteristics of neurocrania of Koreans in 97 cases. The results were as follows. The maximal anteroposterior length was 171.6±8.4 (149.0~191.0)mm and the maximal lateral length (maximal breadth) was 142.4±5.4 (128.0~155.0)mm. The horizontal cranial index was 83.3±5.0 and therefore the neurocrania of Koreans were classified to brachycranic type (rounded cranium). The auriculo-bregmatic height was 119.3±5.1mm and basio-bregmatic height was 140.5±4.9mm. The height-breadth index on the basis of the auriculo-bregmatic height was 98.5±3.6, and belong to medium skull. The height-length index was 81.8±3.8, therefore they belonged to high skull. Height-breadth index on the basis of auliculo-bregmatic height was 85.4±5.7, and belonged to medium skull, and the height-length index was 70.5±5.4 and belonged to high skull. In the case of mean height index, the auriculo-bregmatic height was 77.2±5.0 (high skull), basio-bregmatic height was 87.6±2.6 (high skull).