Reduction of Isolated Zygomatic Arch Fractures with Gillies Approach / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The incidence of facial bone fracture is increasing. The zygomatic bone, due to its anatomical prominence, is the second most common site of all facial bone fractures. In this study, we present the clinical experiences of zygomatic arch fracture in a tertiary hospital and introduce the Gillies approach for reduction and its outcome results. SUBJECTS AND METHOD: We collected data from retrospective chart reviews of patients who underwent surgeries from 2010 to 2017 for zygomatic arch fractures at Chungbuk National University Hospital. Data were analyzed according to age, gender, cause of trauma, location of trauma, and clinical symptoms including trismus. All surgery was performed under general anesthesia and via the use of Gillies approach. The result of surgery was evaluated by postoperative facial computed tomography. RESULTS: Sixteen patients underwent surgery for zygomatic arch fracture. The patients had the average age of 41.3 years, a male predominance of 15:1 and physical assault as the most common cause of trauma. The time lag between injury and surgical reduction was 5.5 days. The surgical outcomes were assessed “good” in 14 cases and “moderate” in one case. Patients who had trismus preoperatively were resolved of it in all cases after operation. Postoperative complications were absent. CONCLUSION: The Gillies approach proved to be a relatively easy, safe, and reliable method, and its surgical outcomes was satisfactory in our experiences.

A Systematic Review of Benefit of Silicone Intubation in Endoscopic Dacryocystorhinostomy

OBJECTIVES: Insertion of a silicone stent during endoscopic dacryocystorhinostomy (DCR) is the most common procedure to prevent rhinostomy closure. It has been claimed that silicone intubation improves the surgical outcomes of endoscopic DCR. However, many reports have documented an equally high success rate for surgery without silicone intubation. Accordingly, we conducted a systematic review and meta-analysis to clarify the outcomes of endoscopic DCR with and without silicone intubation and determine whether silicone intubation is actually beneficial for patients. METHODS: PubMed, Embase, and Cochrane Library databases were searched to identify relevant controlled trials evaluating endoscopic DCR with and without silicone intubation. The search was restricted to English articles published between January 2007 and December 2016. Relevant articles were reviewed to obtain information pertaining to interventions and outcomes. We also performed a meta-analysis of the relevant literature. RESULTS: In total, 1,216 patients included in 12 randomized controlled trials were pooled. A total of 1,239 endoscopic DCR procedures were performed, and silicone stents were used in 533 procedures. The overall success rate for endoscopic DCR was 91.9% (1,139/1,239), while the success rates with and without silicone intubation were 92.9% (495/533) and 91.2% (644/706), respectively. There was no statistically significant heterogeneity among the included studies. A meta-analysis using a fixed-effects models showed no significant difference in the success rate between endoscopic DCR with silicone intubation and that without silicone intubation (OR, 1.38; 95% CI, 0.89 to 2.12; P=0.148; z=1.45). Furthermore, there were no significant differences with regard to surgical complications such as synechia, granulation, and postoperative bleeding. CONCLUSION: The findings of our meta-analysis suggest that the success rate and postoperative complication rate for endoscopic DCR is not influenced by the use of silicone intubation during the procedure.

Selective Musculocutaneous Neurotomy for Spastic Elbow

OBJECTIVE: The purpose of this study was to investigate the effectiveness and outcome of selective musculocutaneous neurotomy (SMcN) for spastic elbow. METHODS: We retrospectively reviewed the medical records of 14 patients with spasticity of their elbows. The patients were selected using clinical and analytical scales, as well as nerve block tests, for assessment. Their mean age was 37.29 years (range, 19-63 years). SMcN was performed for these patients, and the mean follow-up period was 30.71 months (range, 19-54 months). RESULTS: The modified Ashworth scale (MAS) scores recorded before and after the SMcN showed that the patients' mean preoperative MAS score of 3.28 +/- 0.12 was improved to 1.71 +/- 0.12, 1.78 +/- 0.18, 1.92 +/- 0.16 and 1.78 +/- 0.18 at postoperative 3, 6, 12 months and last follow-up, respectively. On the basis of a visual analogue score ranging from 0-100, the patients' mean degree of satisfaction score was 65.00 +/- 16.52 (range, 30-90). CONCLUSION: We believe that SMcN can be a good and effective treatment modality with low morbidity in appropriately selected patients who have localized spastic elbow with good antagonist muscles and without joint contracture.

A Painful Glomus Tumor on the Pulp of the Distal Phalanx

A 52-year-old female patient presented with an 8-year history of progressively intense pain, cold sensitivity, and severe tenderness to palpation of the ulnar side of the tip of her right little finger. Subsequent diagnostic evaluation with ultrasonographic imaging revealed the presence of a glomus tumor in the tender area. Glomus tumors are benign, occurring in the vascular hamartomatous tubercles of the glomus body, which is a myoarterial apparatus typically found in the reticular dermis of the skin. Distal glomus tumors are relatively uncommon, and account for approximately 1% of all hand tumors. Most of them are located in the subungual area because of its high concentration of glomus bodies. We report a case of a glomus tumor with a typical triad of symptoms, yet with a rare location : on the pulp of the ulnar aspect of the distal phalanx of the right little finger.

Sigmoid Colon Perforation by a Distal Ventriculoperitoneal Shunt Catheter / 영남의대학술지

We report an unusual case of a sigmoid colon perforation after ventriculoperitoneal shunt surgery. Distal catheters are known to cause perforation in the setting of colonoscopy. The exact pathogenesis of this complication is not clear, but it can cause serious complications. Hence, patients require prompt and aggressive management, including laparotomy with bowel wall repair, catheter removal, and antibiotic therapy.

Executive Function in Psychiatric Patient Groups through Wisconsin Card Sorting Test Computer Version (WCST) / 신경정신의학

OBJECTIVE: This study was aimed to compare executive functions in patients with Organic Brain Syndrome(OBS), Schizophrenia, Depression and normal control group with Wisconsin Card Sorting Test Computer Version (WCST). METHODS: WCST was administered to 82 normal adults, 32 OBS patients, 29 schizophrenic patients, and 22 depressive patients. WCST 16 indices in four groups were compared, using ANOVA and posthoc comparison. WCST performance was examined by factor analysis on the 15 indices of WCST on total subjects and the factor scores were compared. RESULT: WCST 16 indices in mental disorders (OBS, Schizophrenia, Depression) were lower than those of control groups. Three factors were derived from the analysis. These consisted of 'perseveration', 'nonperseverative error' and 'inefficient sorting'. Comparing factor scores, differences in 'perseverative error' factor and 'inefficient sorting' factor were found. CONCLUSION: The impairment of higher cognitive functions, especially executive function impairment in OBS and schizophrenia, was qualitatively different from those of depression and normal control groups. WCST can differentiate specific pattern of executive function impairment in mental disorders.

Mitral Valve Reconstruction in Mitral Insufficiency: Intermediate-Term Results / 대한흉부외과학회지

BACKGROUND: The advantages of mitral valve reconstruction have been well established and so mitral valve reconstruction is now considered as the procedure of choice to correct mitral vlave disease. This is the report of intermediate-term results of 38 cases that performed mitral valve reconstruction for valve insufficiency(the total number of mitral valve reconstruction were 49 cases, but 11 cases that performed mitral valve replacement due to incomplete reconstruction were excluded). MATERIAL AND METHOD: From March 1991 to March 2001, 38 patients underwent mitral vlave repair due to mitral valve regurgitation with or without stenosis. Mean age was 47.6+/-14.7 years(range 15 to 70 years) : 11 were men and 27 were women. The causes of mitral valve regurgitation were degenerative in 14, rheumatic in 21, infective in 2 and the other was congenital. RESULT: According to the Carpentier's pathologic classification of mitral valve regurgitation, 3 were type I, 16 were type II and 19 were type III. Surgical procedures were annuloplasty 15, commissurotomy 19, leaflet resection and annular plication 9, chordae shortening 11, chordae transfer 5, new chordae formation 2, papillary muscle splitting 2 and vegetectomy 2. These procedures were combined in most patients. There were 2 early death and the causes of death were respiratory failure, renal failure and sepsis. There was no late death. Valve replacement was done in 6 patients after repair due to valve insufficiency or stenosis 3 weeks, 1,3,51,69,84months later respectively. These patients have been followed up from 1 to 116 months(mean 43.0 months). The mean functional class(NYHA) was 2.36 pre-operatively and improved to 1.70. CONCLUSION: In most cases of mitral valve regurgitation, mitral valve reconstruction when technically feasible is effective operation that can achieve stable functional results and low surgical and late mortality.

Coronary Artery Fistula Associated with Atrial Septal Defect: Report of one case / 대한흉부외과학회지

We present a case of coronary artery fistula originating from the proximal left anterior descending artery draining into the main pulmonary artery,which was associated with atrial septal defect.The patient was a 56 year old male who was admitted for exertional dyspnea and abdominal distension.Echocardiogram and selective coronary arteriogram revealed a atrial septal defect and fistulous connection.The patient underwent surgery under the cardiopulmonary bypass with fibrillating heart.The pericardial patch closure of atrial septal defect and internal obliteration of the fistula termination site in the main pulmonary artery were performed.Postoperative hospital courses were uneventful without any specific complication and the patient was discharged without problem.

Protective effect of euonymus alatus extract on experimental liver injury in mice

No abstract available.

Comparison of Abstract Reasoning in Korean Patients with Mental Disorders through Standard Progressive Matrices(SPM) / 신경정신의학

OBJECTIVES: This study was aimed to compare abstract reasoning in patients with mental disorders;Depression, Schizophrenia, Organic Brain Syndrome(OBS), and normal control group using Standard Progressive Matrices(SPM), known as a test measuring visual pattern matching ability and reasoning ability by analogy. METHODS: SPM test in Vienna Test System was administered to 82 normal adults, 29 schizophrenic patients, 22 depression patients, and 32 OBS patients. SPM total score and 5 subtest scores in four groups were compared, using ANOVA and post-hoc comparison. SPM subtest scores in OBS and normal group were compared, using discriminant function analysis. RESULTS: SPM total score and all subtest scores in mental disorders group(schizophrenia, depression, OBS) were lower than in normal control group. SPM total score and all subtest scores in OBS group were lower than in schizophrenia and depression group. No difference between SPM total score in Schizophrenia and depression group was found. Discriminant function of B, E subtest was the hightest. CONCLUSION: The impairment of higher cognitive function, especially abstract reasoning impairment in OBS, was qualitatively different from that of schizophrenia and depression. SPM can differentiate specific pattern of abstract reasoning impairment in mental disorders, so SPM can be used not only as a substitute for intelligence test but also as a neuropsychological test.

Right Pulmonary Artery Agenesis: A Case Report / 대한흉부외과학회지

Congenital unilateral agenesis of pulmonary artery is a rare anomaly and it usually occurs in association with other cardiac anomaly such as tetralogy of Fallot. Since most patients affected by this defect without associated congenital cardiac anomaly or pulmonary infection are asymptomatic, the clinical diagnosis of this anomaly is first recognized by a characteristic pattern in chest roentgenogram taken as a routine checking; the findings on chest film sonsists of cardiac and mediastinal displacement, absence of the pulmonary arterial shadow, smaller hemithorax, and elevationof the hemidiaphragm, all on the affected side. We experienced right pulmonary artery agenesis in a 48 year-old male, who complained of massive hemoptysis, and it was diagnosed by digital subtraction pulmonary arteriogram and perfusin scan, and treated by right middle and lower lobe bi-lobectomy, and we report this case with the review of relevant literatures.

Mitral Valve Replacement / 대한흉부외과학회지

From July 1983 to December 1993, total 112 consecutive mitral valve replacement in 107 patients were performed in patient with mitral valvular abnormalites. To estimate the risk factor related to operative death, all patient's perioperative data were reviewed retrospectively. Except 20 patients received concomitant aortic valve replacement and 2 patients had incomplete data, 85 patients were included in this study. Mean age was 37.3+/-13.1 years ranging from 13 to 72 years. Thirty-seven patients were male and fourty-eight patients were female. Mean follow-up durations were 51.1+/-33.8 months ranging from 6 months to 11 years. Patients in this study showed improvement in mean NYHA functional clssification, from 3.02+/-0.73 to 1.78+/-0.55, and also in cardiothoracic ratio, from 0.61+/-0.09 to 0.58+/-0.08 at 6 months follow-up after operation. Operative complications were detected in 23 patients(27.1%) and common postoperative complications were rhythm disturbance in 7 cases, pulmonary complications in 6 cases and low cardiac output syndrome in 6 cases. Early mortality was 10.6% ( n=9 ) and most common cause of death was congestive heart failure due to low cardiac output syndrome. Main cause of our higher operative mortality than other study was that operative mortality in the initial period of our mitral surgery was high (5 operative deaths among 19 mitral valve replacement from July 1983 to December 1985 ). Actuarial survival was 80.8% at 5 years, 71.8% at 11 years including operative deaths. Actuarial freedom from anticoagulant-related bleeding was 85.3% at 5 years, 78.3% at 11 years. 95.1% at 5 years and 88.8% at 11 years among the patient in this study were free from thromboembolism, and 97.5% at 5 years and 75.1% at 11 years were free from reoperation. Preoperative cardiothoracic ratio and patient's age were statistically significant operative risk factors.