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.

Rectal perforation caused by a sharp pig backbone in a middle-aged patient with mild depression / 영남의대학술지

In Korea, cases of direct insertion of foreign bodies into the rectum are rare in the literature. Most cases of rectal insertion of foreign bodies are associated with sexual acts and psychiatric disorder such as schizophrenia. Objects inserted into the anus are usually blunt and shaped like the male genitalia. The removal method can be varied depending on the size and shape of the foreign object, its anatomical location, and the accompanying complications. In cases wherein attempts to remove the object fail or there are rectal perforation and peritonitis complications, immediate laparotomy may be required in order to prevent serious complications such as sepsis. Here, we report on a case of rectal perforation and peritonitis due to insertion of a foreign body in a middle-aged patient, with a literature review. He inserted a sharp pig backbone in his rectum and he only had depression. The patient underwent a Hartmann's operation as well as psychiatric counseling and treatment. Thus, after removal of foreign bodies, psychiatric counseling and treatment should be carried out in order to prevent similar accidents and to minimize the need for trauma medicine.

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.

Antimicrobial Prophylaxis Using a 2nd Generation Cephalosporin after Laparoscopic Colorectal Resection: A Randomized Trial of 1-day vs. 3-day

PURPOSE: We performed this study to compare 1-day group using a 2nd generation cephalsporin with 3-day group for evaluating hospital acquired infection. METHODS: The patients underwent laparoscopic colorectal surgery at Korea University Medical Center Anam Hospital, from August, 2007 to June, 2008. They were randomly allocated to 2 groups: 1-day or 3-day group. A 2nd generation cephalosporin was administered within 1 hour before surgery with 12-hour intervals. In cases of suspected infection, further studies were done to identify infection. RESULTS: The study included 154 patients (1-day group - 78, vs. 3-day group - 76). No differences were noted between the 2 groups in age, body mass index, smoking, diabetes mellitus, corticosteroid-use were noted. Gender (P=0.011) and mean operative time (P=0.047) between the 2 groups were different. The preventive rates of infection were 87.18% in the 1-day group compared with 82.89% in the 3-day group (P=0.456). CONCLUSION: Our prospective randomized control study concluded that there were no differences between the 1-day and 3-day group in hospital acquired infection. We could come to the conclusion that 1-day antimicrobial agent in laparoscopic colorectal surgery would be adequate in preventing infection.

A Case of Bradycardia due to Vagal Reflex during Laryngeal Microsurgery / 대한이비인후과학회지

Laryngeal microsurgery has been used popularly for phonosurgery. Sometimes, this procedure is complicated by cardiovascular changes due to insertion of laryngosope. Tachycardia and elevation of blood pressure are common but bradycardia induced by vagal reflex is very rare. The authors report the case of severe bradycardia induced by vagal reflex experienced during laryngeal microsurgery with a review of the literature.

A Case of Chondroid Syringoma of the External Auditory Canal / 대한이비인후과학회지

Chondroid syringoma is a benign sweat gland tumor composed of a mixture of epithelial cells and mesenchymal tissue. It is most frequently located on the head and neck. Chondroid syringoma is usually present as a firm intradermal or subcutaneous nodule. Histologically, the epithelial component consists of tubulocystic structures and aggregates of epithelial cells as well as single scattered epithelial cells throughout the stroma. The treatment of choice is complete local excision. We report a case of chondroid syringoma presenting as a external auditory canal mass in 54 year old man with a brief review of literature.

Safety of Early Chemotherapy after a Laparoscopic Colorectal Cancer Resection: A Case-Control Study

PURPOSE: Since micrometastasis is generally inhibited by primary cancer, surgical ablation of the tumor may stimulate the growth of residual cancer cells, if they exist. This supports the importance of early administration of postoperative chemotherapy. METHODS: We reviewed the cases of patients who underwent a laparoscopic resection and then received chemotherapy (5 fluorouracil+leucovorin or FOLFOX4) between September 2006 and May 2008. The chemotherapy was scheduled on the 7th or the 8th postoperative day, but was postponed when a final pathologic report was delayed or patients were discharged early. The safety of chemotherapy was evaluated in two ways. Early safety, such as the presence of surgical complications and medical toxicity, was prospectively assessed just before the beginning of the second cycle of chemotherapy. Late safety, such as medical toxicity, was retrospectively estimated from the 2nd to the last cycle. These safeties were compared between the two groups: the early chemotherapy group (n=50) for which chemotherapy started on the 7th or 8th postoperative day as scheduled and the delayed chemotherapy group (n=31) for which chemotherapy started after the 14th postoperative day. RESULTS: Patient demographics were not different between the two groups. With regards to early safety, no differences in surgical complications existed between the two groups. In medical toxicities, there were no differences, except for a higher rate of nausea in the early chemotherapy group (20 percent vs. 10 percent, P=0.01). With regards to late safety, the two groups were not different in the development of medical toxicities. CONCLUSION: Because nausea is an easily controllable toxicity, we conclude that chemotherapy is safely started on the 7th or the 8th day after a laparoscopic colorectal cancer resection.

The Impact of Bowel Preparation on Anastomotic Complications after Laparoscopic Colorectal Resection: A Prospective Comparative Study between Oral Polyethylene Glycol and Phosphate Enema

PURPOSE: Although most randomized trials demonstrated no advantage of mechanical bowel preparation for colorectal resection, an oral solution is still widely used. The aims of this study were to evaluate whether a single phosphate enema is as effective as oral polyethylene glycol (PEG) solution in preventing anastomotic complications after laparoscopic colorectal surgery and to examine the clinical courses of anastomotic complications. METHODS: Between September 2006 and December 2007, 309 patients underwent laparoscopic colorectal resection with primary anastomosis. The bowel preparation used was PEG solution during initial period (PEG group), but since February 2007, a single phosphate enema (enema group) was utilized. Postoperative data were prospectively recorded. In patients with anastomotic complications, the clinical course was compared between the two groups. RESULTS: There were 150 patients in the PEG group and 159 patients in the enema group. Demographics did not differ between the two groups. Anastomotic leakage occurred in 3.3 percent of the patients in the PEG group and 5.7 percent of the patients in the enema group (P=0.326). The rates of anastomotic bleeding were 2.0 and 2.5 percent, respectively (P=0.761). The hospital stays for patients with anastomotic complication were not different between the two groups (P=0.137), but patients in the PEG group (80%) needed reoperation more frequently than those in the enema group (11.1%) (P=0.023). CONCLUSION: These results suggest that laparoscopic colorectal surgery may be safely performed with a single phosphate enema instead of oral polyethylene glycol.

A Case of Bilateral Vocal Cord Paralysis from Progressive Supranuclear Palsy / 대한이비인후과학회지

Bilateral vocal cord paralysis generally arises from trauma, tumor compression of the recurrent laryngeal nerves, surgery on neck and neurological diseases. Progressive supranuclear palsy is a rare degenerative disease showing supranuclear ophthalnoplegia, rigidity, bradykinesia, dysarthria and dementia. Bilateral vocal cord paralysis in patients with progressive supranuclear palsy can be found only in a few cases reported in literature. The finding of bilateral vocal cord paralysis is important because it can be life threatening. We managed a patient with the laterofixation of vocal cord for preventing respiratory failure due to glottic airway compromise. We report this case with a review of literature.

Laparoscopic Appendectomy: A Safe Procedure that can be Performed by Surgical Residents

PURPOSE: Although laparoscopic surgery has many advantages and has become popular in various disease settings, surgical residents do not yet have sufficient opportunity to perform laparoscopic surgery. Appendectomies are the most common procedures performed by surgical residents, and they may be suitable for gaining them laparoscopic experience. We had our residents perform laparoscopic appendectomies and analyzed clinical outcomes to verify the utility of this procedure in providing laparoscopy education. METHODS: Between September 2006 and December 2007, 384 patients with a preoperative diagnosis of acute appendicitis underwent laparoscopic appendectomy (n=191, LA) or open appendectomy (n=193, OA). Patient demographic data and outcomes for the two groups were compared. In the LA group, cases performed by surgical residents were compared against those performed by surgical specialists. RESULTS: Both groups of patients were comparable demographically. The incidence of complicated appendicitis in the LA group was 19.4% and that in the OA group was 25.9% (P=0.126). Operative time was similar between the two groups. Postoperatively, recovery time was shorter in the LA group than in the OA group, especially for patients with non-complicated appendicitis. LA performed by surgical residents showed similar outcomes, including operative time and postoperative recovery parameters. CONCLUSION: Laparoscopic appendectomy appears to have many advantages, such as less pain, rapid postoperative recovery, and more economic differential diagnosis. This procedure can be performed safely by surgical residents. Thus, laparoscopic appendectomy is a suitable procedure for laparoscopic surgery education for surgical residents.

A Case of Pleomorphic Adenoma in Cheek / 대한이비인후과학회지

Pleomorphic adenoma are benign neoplasms that typically occur in the major salivary glands. Uncommonly, they arise in minor salivary glands, which account for only 10% of all reported salivary gland pleomorphic adenomas. Minor salivary gland tumors are clinico-histopathological curiosities and arise from glands scattered throughout the oral and pharyngeal mucosa. The cheeks, lips and gingiva are rare sites of occurrence. We experienced a case of a 68-year-old woman who presented a 45-years history of a left cheek mass. The pathologic diagnosis was pleomorphic adenoma. We removed the mass intraorally and obtained good postoperative results. We report this case with a review of literature.

Gastric Adenocarcinoma after Renal Transplantation

PURPOSE: The incidence of malignancy in renal transplant recipients has been reported higher than in the general population. Despite gastric cancer being the most common malignancy in Korea, little is known about the incidence of gastric cancer after renal transplantation. This study was performed to find out the incidence and clinicopathological features of gastric cancer after renal transplantation in an endemic area for gastric adenocarcinoma. METHODS: Between April 1979 and March 2001, 11 gastric adenocarcinoma patients out of 2000 renal transplants at a single institute were reviewed retrospectively. RESULTS: In 5 male and 6 female patients with a mean age of 46.1 years (0.55% of kidney transplanted patients), stomach cancer occurred about 59 months after renal transplantation. Nine patients underwent a gastric resection with a curative intent while 2 with distant metastasis were treated symptomatically. None of the patients received any type of adjuvant therapy. There was no postoperative mortality although there were two postoperative complications, which were treated conservatively. Five patients survived without any evidence of recurrence, whereas 6 died due to recurrences or progression of gastric cancer. Three patients with early gastric cancers remain alive while all 4 stage IV patients died within 4 months of diagnosis. CONCLUSION: Renal transplant recipients are at an increased risk of a gastric adenocarcinoma, the most common malig nancy in Korea. With curative surgery, a favorable prognosis can be anticipated in patients with early gastric cancer after renal transplantation unless there is their diagnosis. Every effort for the early diagnosis should not be overlooked during the follow-up period. However, considering the worse prognoses and the more aggressive behaviors of advanced gastric cancer in renal transplant recipients, the value of adjuvant chemotherapy should be evaluated in the near future.

A case report of malignant paraganglioma with hepatic metastases / 대한내과학회지

We report a case of malignant paraganglioma with hepatic metastases. A 70-year old woman developed huge hepatic tumor 2years after complete resection of the retroperitoneal paraganglioma. CT imaging of abdomen revealed huge hepatic masses, which had not been found previously. A needle biopsy on the liver was performed, resulting in a diagnosis of malignant paraganglioma. These tumors are usually benign but can occasionally produce local and distant metastases. Development of metastatic localizations is the only formal proof of malignancy as histology cannot distinguish between benign and malignant paragangliomas. Surgery is the basis of treament and should be performed early in the operable course. Both chemotherapy and radiotherapy could be given, but satisfactory outcomes were not obtained. We suggest that close investigations for metastasis in patient with paraganglioma, seemed benign initially, as well as periodic follow up examinations should be emphasized.

Two Case Reports of Bone-invading Basal Cell Carcinoma

Basal cell carcinoma is the most common skin cancer, especially on the eyelid and nose. As it rarely invades to a underlying bone or metastasizes an distant site, and is usually found at an early stage, it is regarded as a curative disease. However, basal cell carcinoma on the eyelid and nose may be resected incompletely due to efforts to preserve important structures or as a result of esthetic considerations. We experienced two cases of basal cell carcinoma with local invasion to underlying bone. One was a recurred case on the nasal area extending to the nasal bone arts medial wall of the ethmoid sinus. The lesion was widely resected and covered with a radial forearm free flap. The other was on the eyelid extending to the orbit. It was treated with orbital exenteration and resection of the involved eyelid. The defect was reconstructed with the temporalis muscle flap with split-thickness skin graft. These patients were followed up for 7 months with no evidence of recurrence. Since basal cell carcinoma can invade to the bone and metastasize to a distance site, it should be resected radically in the regions of the eyelid and nose.

Clinical Review of Positive Antinuclear Antibody(ANA) Test in Pediatric Patients

The antinuclear antbody (ANA) test have been used to screen the patients with systemic lupus erythematosus (SLE) and other autoimmune diseases. We had retrospectively reviewed the 263 records of pediatric patients with doing ANA tests who admitted at Department of Pediatrics, Kyung Hee University Hospital, from January 1988 to May 1993. The following results were obtained. 1) The positive rate of ANA test in patients with connective tissue diseases is 16 out of 40(40%).In patients with SLE, the positive rate of ANA test is 9 out of 11 (82%). 2) The positive predictivity for SLE is 9 out 36 (25%). 3) The positive predictivity for connective tissue disease and possible immune disease is 28 out of 36 (78%). 4) The false positive rate is 8 0ut of 36 (22%), Thus, the pediatric patients with positive ANA test should be applicable for diagnosis with prudence. 5) The positive anti-dsDNA in patients with the positive ANA is shown in 4 cases and these patients are all SLE. In conclusion, the patients who had repeated positive ANA should be tested Anti-dsDNA antibody, and further clinical and diagnostic evaluation of other ANA associated diseases.

Renal scarring in relation to visicoureternal reflux in urinary tract infection

The vesicoureteral reflux (VUR) is frequently found among the patients with urinary tract infection (UIT) and some patients with VUR progress to reflux nephropathy. The presence of scarring at UIT is an important determinant in the selection of those at risk of progressive damage. 99m Technetium dimercaptosuccinic acid (99m Tc-DMSA) is a renal scanning agent provides a good quality of renal image as a result of preferential cortical accumulation. 99m Tc-DMSA scan and VCUG were performed in 133 patients diagnosed UTI at pediatric department of Kyung Hee University, College of Medicine from May, 1990 to May, 1992 The results were as follows: 1) VUR was seen in 27 children among 133 patients with UTI. The incidence was 20.3%. Under 1 year of age, male to female ratio was higher incidence of VUR. 2) Incidence of renal scarring was higher in patients with VUR than those of without VUR. 3) Grading of VUR in relation to age, the older the age, the lower the grade. 4) There is no correlation between renal scarring and grades of VUR. 5) In distribution of renal scarring, it was found to have tendency to develop at upper polar area, there was diffuse and multiple in patients with VUR. In conclusion the incidence of renal scarring was related to the age of onset, duration of UTI and the severity of the VUR and 99mTc-DMSA scan is mandatory in patient with UTI even without VUR in order to detect early phase of renal scarring.

Two cases of ectopic kidney / 대한신장학회잡지

No abstract available.