A Nasal Myoepithelioma Removed through Preoperative Embolization and Endoscopic Surgery: A Case Report and Literature Review / 대한이비인후과학회지

Myoepithelioma is a rare benign tumor, most frequently located in the salivary gland. However, involvement of an extra-salivary gland is even rarer and very few cases involving the nasal cavity have been reported in the literature. A 51-year-old female patient presented with a complaint of progressive nasal obstruction and occurrence of recurrent epistaxis in the left nasal cavity over several months. A hemorrhagic and erythematous mass occupying the left nasal cavity was observed on physical examination using a nasal endoscope. A preoperative angiogram confirmed that he tumor was receiving blood supply from the sphenopalatine artery. We performed embolization to prevent hemorrhage during surgery; one day later, the lesion was successfully removed through endoscopic excision. Histopathological examination revealed that the tumor contained myoepithelial cells and myxoid stroma. Immunohistochemical studies showed that the tumor was positive for cytokeratin marker and S-100 protein, confirming the diagnosis of myoepithelioma. The patient recovered without any nasal symptoms or postoperative deficits.

A Case of Middle Ear Implantation Using the Vibrant Soundbridge in a Patient with Bilateral Mixed Hearing Loss / 대한이비인후과학회지

It is challenging to achieve sufficient hearing gain in patients with mixed hearing loss. In chronic middle ear diseases, conventional passive reconstructive surgeries often result in suboptimal hearing gain and additional hearing aids may have limitations due to insufficient sound amplification, occlusion effect, acoustic feedback, and skin irritation. Middle ear implantation (MEI) using Vibrant Soundbridge (VSB) is another option for auditory rehabilitation in mixed hearing loss as well as sensorineural hearing loss. The floating mass transducer of VSB can be placed on various middle ear structures either directly or using different types of couplers in order to deliver vibratory mechanical energy to the cochlea. We report a patient who presented with bilateral mixed hearing loss due to chronic otitis media and had limitations using conventional hearing aids in the worse hearing ear. The patient was successfully treated with MEI using the Bell coupler together with middle ear surgery in a single step.

Pseudo-Spontaneous Nystagmus and Head-Shaking Nystagmus in Horizontal Canal Benign Paroxysmal Positional Vertigo / 대한평형의학회지

OBJECTIVES: The purpose of this study was to examine the clinical manifestations and significance of pseudo-spontaneous nystagmus (PSN) and head-shaking nystagmus (HSN) in horizontal canal benign paroxysmal positional vertigo (HC-BPPV). METHODS: Two hundred fifty-two patients diagnosed as HC-BPPV were reviewed retrospectively. After excluding 55 patients with ipsilateral vestibular diseases, multiple canal BPPV, or those who were lost to follow-up, we analyzed the direction of PSN and HSN in patients with HC-BPPV. We also compared the clinical characteristics and treatment outcome between PSN-positive and PSN-negative groups. RESULTS: Our study included 197 patients composed of 80 patients with geotropic HC-BPPV and 117 patients with apogeotropic HC-BPPV. PSN was observed in 13.7% patients and HSN was observed in 45.2%. The incidence of HSN was higher in apogeotropic HC-BPPV, while the proportion of PSN was not statistically significant between the two subtypes. There was no directional preponderance in geotropic HC-BPPV, while ipsilesional PSN and contralesional HSN showed higher incidence in apogeotropic HC-BPPV. The dizziness handicap inventory score in the PSN-positive group was higher than that in the PSN-negative group (p<0.001), and the duration of symptom onset in the PSN-positive group was shorter than that in the PSN-negative group (p=0.047). However, there was no significant difference in the treatment outcome between the two groups. CONCLUSIONS: The incidence of HSN was higher than that of PSN in patients with apogeotropic HC-BPPV. Patients with HC-BPPV showing PSN demonstrated more severe initial symptoms and visited the hospital in a shorter period of time after the onset of symptoms.

The Effect of Application of Injury Area to Overcrowding Indices in Local Emergency Department

PURPOSES: There have been many efforts to improve the service of emergency centers. In spite of these, no evidence is showing any landmark advancement of emergency services, especially in the hospital stage, exists. We need some efficient standard criteria to evaluate emergency service in the hospital stage, and a useful method might utilize the overcrowding index. We want to know the change in the overcrowding index at a regional emergency center after injury area administration. Injury area means an area in which only an assigned duty physician manages patients with injuries such as those from traffic accidents, falls, assualts, collisions, lacerations, amputations, burns, intoxication, asphyxia, drowning, animal bites, sexual assualts, etc. METHODS: We started to operate an injury area in our emergency department from late 2004, and from January to June in 2004 and in 2005, we collected patients' data, age, sex, assigned department, and result from hospital order communication system to figure out overcrowding indices and result indices. We found the daily number of patients, the turnover rate, the admission rate, the ICU admission rate, the emergency operation rate, the ED stay duration, and the ED patient volume to be overcrowding indices. Also we found the withdrawal rate, the transfer rate, and mortality to be result indices. We compared these indices between 2004 to 2005 by using a t-test. RESULTS: There was a significant increase in the daily number of visiting patients in 2005, overcrowding indices, such as the turnover rate, the admission rate, the ICU admission rate, and the emergency operation rate, also showed statistically significant increases in 2005 (P<0.001). As for the result indices, there was a noticeable decrease in the number of withdrawals (11.77/day in 2004 to 4.53/day in 2005). CONCLUSION: Operating an injury area in a mildly overcrowded local emergency center is beneficial. Evaluating the effect of operating an injury area and it's impact on hospital finances by conducting a similar study analyziing patients for a longer duration would be valuable.

Usefulness of Clinical Treatment Protocol on the Acute Pyelonephritis for Diabetic and Elderly Female Patients

PURPOSE: To know the feasibility of ED observation unit treatment for acute pyelonephritis (APN) in women with diabetes or older age. METHODS: From January 2006 to February 2007, we enrolled adult women APN patients with diabetes or older age (65 years old or more) prospectively, and managed them with predetermined written protocol including intravenous ciprofloxacin, anti-pyretics, anti-emetics, and hydration. After 6 hour observation, we evaluated the patients to be admitted or not according to the protocol (the after group). From May 2003 to December 2005, data of ED visited APN patients were collected retrospectively for comparison (the before group). We compared the admission rates, re-visits to ED, and ultimate admission rates in older or diabetic patients in the before- and after-protocol group. RESULTS: 55 and 39 diabetic cases were enrolled respectively in the before- and after group respectively. The initial admission rate in diabetic patients was significantly lower in the after group (31.6% vs 76.4% p<0.001) and the revisit rate was not significantly different (p=0.586). In older patients, 95 and 57 cases were enrolled respectively. The initial admission rate was significantly lower in after group (69.5% vs 42.1%) and the revisit rate was not statistically different (p=0.452). CONCLUSION: For diabetic and older women patients with APN, ED observation unit treatment protocol can be applied safely and shows significant decrease in admission rate.

Factors Affecting Fatigue and Stress in Male Manufacturing Workers / 대한산업의학회지

OBJECTIVES: The aims of this study were to investigate the factors affecting the fatigue and stress in male manufacturing workers. METHODS: A questionnaire investigating general characteristics, lifestyle factors, job characteristics, fatigue and stress was distributed to 896 subjects. From 851 respondents, 11 responses with insufficient data were excluded. The data were analyzed to investigate the factors affecting personal fatigue and stress. RESULTS: Among the general characteristics, both fatigue and stress in the older group were significantly lower than in the younger group (p<0.05). Fatigue in the group with higher education was significantly higher than in the group with only high school education (p<0.05). The group who lived alone had significantly more stress (p<0.05). Among lifestyle factors, people who exercised regularly had significantly lower fatigue and stress than those who did not (p<0.05). Fatigue was negatively correlated with decision latitude, supervisor support, and coworker support. Stress was positively correlated with job demand and negatively correlated with decision latitude, supervisor support, and coworker support. Fatigue and stress were positively correlated with each other. Multiple linear regression analysis showed that among job characteristic factors, coworker support affected fatigue while job demand and supervisor support affected stress. CONCLUSIONS: Fatigue and stress were positively correlated, but the job characteristics that affected each were different. This suggests that for effective management of fatigue and stress, the details of job characteristics need to be considered individually for the intervention and prevention of fatigue and stress.

Expression of Galectin-3 and Its Diagnostic Utility as Preoperative Diagnostic Marker for Thyroid Nodule / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Thyroid cancer is the most common endocrine malignant disease, but making a preoperative diagnosis of this disease remains a challenge. Fine-needle aspiration biopsy (FNAB) is the most accurate and cost-effective method for the preoperative diagnostic method of thyroid nodules, but not for differential diagnosis between thyroid follicular adenoma and follicular carcinoma. In this study, we assessed the usefulness of immunohistocytochemical staining for the potential marker of malignant thyrocytes, galectin-3. SUBJECTS AND METHOD: From October 2001 to January 2003, the preoperative expression of galectin-3 was examined immunohistochemically in 178 cases of fine needle apsiration biopsy (FNAB). All patients had then undergone therapeutic thyroid surgery and a permanent biopsy was obtained from each of them. The biopsy showed 30 adenomatous goitor, 105 papillary carcinoma, 30 follicular adenoma, 11 follicaulr carcinoma, 1 anaplastic carcinoma and 1 papillary carcinoma combined with follicular carcinoma. We compared the preoperative galectin-3 expressions in FNAB with the results of postoperative permanent pathology. RESULTS: The immunoghistochemical staining results showed galectin-3 expression in the preoperative FNAB in 14 cases of 30 adenomatous goitors, 76 cases out of 105 papillary carcinomas, 11 cases out of 26 follicular adenoma, 8 cases out of 11 follicular carcinoma, no case out of anaplstic carcinomas and 1 case out of papillary combined follicular carcinoma. The preoperative galectin-3 staining for differential diagnosis of follicular cell carcinoma from benign follicular lesions showed that sensitivity was 73%, specificity 43%, positive predictive value 28%, and negative predictive value 88%. CONCLUSION: This study found that the integration of galectin-3 immunostaining with conventional cytomorphological and clinical diagnostic procedures did not serve well in properly identifying preoperative thyroid carcinomas and thyroid follicular carcinoma. Galectin-3 has some limitation in differentiating benign from malignant thyroid follicular lesions. Specific immunostaining features of galectin-3 or follicular cell carcinoma specific molecules have to be investigated more in the future.

A Case of Lung Cancer Caused by Long-Term Asbestos Exposure / 대한산업의학회지

OBJECTIVES: To report a case of lung cancer caused by long-term asbestos exposure in a shipyard. METHODS: We evaluated chest X-ray, pulmonary function test, and chest CT and analyzed asbestos concentration in the lung tissue and bulk sample from the workplace. We also performed a workplace survey. RESULTS: The patient had worked at the shipyard for 31 years. The biopsy samples were processed to determine the asbestos content in the lung tissue and bulk sample using a transmission electron microscope (TEM) equipped with an energy dispersive X-ray analyzer (EDX). The TEM-EDX analysis revealed many asbestos fibers, the majority of which were amosite. In addition, the concentration asbestos fibers in the workplace exceeded the occupational exposure limits of asbestos. CONCLUSIONS: Our findings strongly suggest that this patient's lung cancer was related to the long-term asbestos exposure.

Clinical Significance of the Detection of Human Papillomavirus using DNA Chip Microarray Method In Respiratory Papilloma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Human Papillomavirus (HPV) is detected in the great majority of respiratory papillomas (RP). The current study was designed to investigate the significance of the presence and the type of HPV DNA and their relationship with the clinical course in RP. SUBJECTS AND METHOD: A total of 65 patients diagnosed with RP by pathologic examinations at the Asan medical center between July, 1990 and April, 2003 were included. There were 43 males and 22 females, with the mean age of 39.8+/-8.7 years (range: 1 to 64 yrs). Of these, 33 patients were treated for the recurrent RPs: the mean follow up period was 22.5 months. HPV DNA and the type were examined using paraffin embedded tissue by the DNA chip method. RESULTS: HPV DNA was detected in the tissue samples in 52 cases (80%); HPV types 16, 6, and type 11, in the order of frequency. Of the 33 recurrent RPs, HPV was detected in 31 cases (93.9%). Multiple infections observed in 23 patients, was more frequent in patients with 4 or more operations (54%) than in those with 3 or less operations (41%) (p value=0.193). While viral types remained the same in most cases of RPs with single HPV type infections, the HPV types changed in the majority of the cases of RPs with multiple HPV infections. The type of HPV was not correlated with the recurrence rate. CONCLUSION: This study confirms the presence of HPV in the great majority of RP in accordance with the literature, and demonstrates the utility of the DNA chip method. The most frequent HPV type was 16, in contrast to the types 6 and 11 of the previous studies. There was a trend for higher rates of multiple infections among recurred cases (p=0.193). During recurrences, HPV viral types changed in the majority of RPs with multiple HPV infections. HPV type did not show any correlation with recurrences.

A Case of Stapedectomy with Total Ossicular Replacement Prosthesis in Stapes Fixation without Malleus and Incus / 대한이비인후과학회지

This study was done on a case of chronic otitis media in both ears of a 47-year-old woman who received tympanization in the left middle ear in a local hospital three years ago. Ossiculoplasty was not tried in this case due to fixation of the stapes. However, conductive hearing loss of the left ear continued after tympanization, necessitating middle ear exploration. After the exposure of middle ear cavity, we found the absence of malleus and incus, and the fixation of stapes. Stapedectomy was carried out and total ossicular replacement prosthesis was also performed for the protection of the oval window by using perichondrium, cartilage and fascia. Postoperative bone conduction showed improvement of 15 dB, and air conduction showed improvement of 22 dB. After the operation, an average air-bone gap was improved within 10 dB. We experienced good hearing improvement without significant complications during the follow up period.