Photodynamic Therapy for Recurrent Head and Neck Malignancy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: As a preliminary study, authors tried to verify clinical and side effects of Radachlorin in a photodynamic therapy for recurrent head and neck malignancy. Radachlorin shows an absorption peak at 662 nm, which indicates that it penetrates up to 10 mm. SUBJECTS AND METHOD: We treated 12 sites for 9 treatments in 6 recurrent head and neck malignacies, 4 cases of squamous cell cancers and each of adenoid cystic cancer, and undifferentiated nasopharyngeal cancer. A dose of 1 mg/kg or 2-5 mL of Radachlorin was i.v. injected into the mass according to the mass size. We used a diode laser, MILON-662 (Milon Laser Company, Russia) and Medlight cylindrical 10/20 radial diffuser and frontal diffuser as light delivery devices. About 3 hrs after intravenous injection, or 30 min after intralesional injection, a light dose of 200-300 J/cm2 or cm of laser was irradiated onto the tumor or intralesionally with the light dose of 200-300 J/cm2, or cm. RESULTS: There was partial tumor regression in three of the five primary tumors. In one case of metastatic node treated by intralesional injection and irradiation, tumor showed complete necrosis. But there was no effect in 2 cases of subcutaneous metastases. There were no side effects such as fever, chill and photosensitivity in any of the cases. CONCLUSION: The clinical effect of photodynamic therapy (PDT) using Radachlorin with 662 nm of laser light is not clear yet, but it seems to be a safe treatment for head and neck malignancy. We need to investigate the effect of this PDT system in untreated head and neck malignancies.

Hearing Results of Tympanoplasties in 175 Patients with Chronic Otitis Media / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: To report the hearing results of tympanoplasty for chronic otitis media with or without cholesteatoma. SUBJECTS AND METHOD: One hundred and seventy-five patients presenting chronic otitis media with or without cholesteatoma were involved in a retrospective study. Tympanoplasties were performed by the same surgeon over a 30-month period. Audiometric results were reviewed. Audiometric results according to the following techniques were measured: tympanoplasty type 1 (T1), interposition (Si) and/or columella (Sc) over stapedial head, and interposition or columella (Fic) over footplate. The follow-up period ranged from 6 to 32 months. Audiological parameters using the average of four frequencies were assessed pre- and post-operatively. RESULTS: Overall hearing results showed postoperative air-bone gaps (ABG) < or =20 dB in 69% of cases. ABG was closed to within 20 dB in 89% for T1, 67% for Sc, 58% for Si, and 30% for Fic. ABG was closed to within 30 dB in 95% for T1, 67% for Sc, 83% for Si, and 70% for Fic. There was a significant improvement between preoperative and postoperative ABGs. The overall improvement of the air-bone gap was 8+/-13 dB. There was no significant functional difference between different surgical techniques. CONCLUSION: Our hearing results after tympanoplasties were similar to those from other studies. The hearing results observed in this study confirmed that successful results can be obtained by applying the current principles and approach to ossicular reconstruction.

A Case of Deep Neck Infection by Tuberculosis Destroying the Cervical Vertebrae / 대한이비인후과학회지

Deep neck infections affect fascial compartment of the head and neck, and their contents. Fever, pain, and swelling are the most common presenting symptoms. Also, the development of septic shock or mediastinitis depends on the degree of progression of the disease. The advent of antibiotics decreases the incidence and mortality of the deep neck infection. Antibiotics also alters the causation and management of this disease. In a recent report, mixed species with anaerobe were found in 50% of patients, whereas Staphylococci and Hemolytic streptococci were the leading causes of deep nect infections in the past. Also, in the case of immunocompromised host, deep neck infections caused by tuberculosis or fungus are not excluded. We experienced a 23 year old man with deep neck infection caused by tuberculosis presenting bone destruction of cervical spine. In this article, we reviewed the etiology, diagnosis, and treatment of this case, with a review of literatures.

Analysis of Mortality Cases of Transcranial Aneurysm Surgery / 대한뇌혈관외과학회지

OBJECTIVES: The authors analyze the causes of mortality cases after transcranial aneurysm surgery for comparing the safety of the treating methods and for the improvement of treatment outcomes of transcranial surgery. METHODS: Patients recordings and radiological studies were retrospectively reviewed. Causes of postoperative mortality were divided into death related to vasospasm, procedure-related, medical complications and preoperative poor neurological conditions. RESULTS: Postoperative mortality cases were 61 (5.78%) of 1054 transcranial aneurysm surgery during a period of from Jul. 1996 to Nov. 2001. Delayed ischemia related to cerebral vasospasm was a leading cause of death following transcranial aneurysm surgery and accounts for 2% (n=21) of all transcranial surgery and 34.4% of all mortality cases. Procedure-related death were 1.23% (n=13) and were related to inadvertent major artery occlusion, vital perforator injury or intraoperative aneurysm rupture. Death related to medical complications (n=8, 0.75%) were mainly from pneumonia (n=6) in the old age (>65) patients. Patients of initial poor neurological grade (Hunt-Hess grade IV-V, n=19) were mainly from large intracranial hematoma (>30 cc) in temporal lobe or sylvian fissure or multiple aneurysmal bleeding before admission. CONCLUSION: The procedure-related mortality of the transcranial aneurysm surgery is about 1% in this large transcranial aneurysm surgery series and transcranial surgery can be a safe mean of treating intracranial aneurysms compared with other tratment modalities.

Clinical and Histologic Features of Antrochoanal Polyps

Antrochoanal polyp (ACP) usually appears as a large, soft, gelatinous mass in the nasopharynx. Recently, ACP is considered as a separate entity among sinonasal polyps. Histologically, the antral part of the polyp can be cystic or polypoid with a fibrous and solid choanal part. However, the extent of inflammation of the paranasal sinuses has not well been demonstrated. In addition, pathologic patterns of ACP have not been well revealed. The aim of our study is to evaluate the disease patterns of ACPs by clinical and pathologic analysis. Thirty two patients with ACPs were evaluated by a retrospective study. We evaluated sinus involvement by operative findings and pathologic patterns were investigated in 28 cases by predominant infiltrating cells and types of polyp. In order to evaluate the histologic differences between the antral and choanal portion, each A CP was divided into proximal and distal portion. The involved sinuses were multiple and diverse and the most of them had a polyp. The most common pathologic type was chronic inflammatory polyp. Lymphocyte and neutrophil were visualized in many ACPs predominantly. The histologic differences between the proximal and distal portion was not observed significantly. Clinical analysis suggest that ACPs are not sole polyp but mixed disease with inflammation of the nose and sinuses in most cases. Histologic analysis suggest that ACPs are caused by chronic inflammation in many cases and each portion of ACPs is composed of the same histologic type.

Effects of Low-Dose Long-Term Macrolide Therapy on the Postoperative Symptom Change, Mucociliary Clearance and Polyp Regrowth

Low-dose long-term macrolide therapy (LDLMT) has been reported as an effective treatment in chronic respiratory tract diseases such as diffuse panbronchiolitis and chronic paranasal sinusitis. The mechanism of action of LDLMT is not fully revealed. The aim of this study was to evaluate the clinical effect of LDLMT on the postoperative patients of chronic sinusitis with polyp. Thirty eight control groups were defined empirically treated with antibiotics after endoscopic sinus surgery (ESS) and 62 experimental group were defined 8 weeks LDLMT (Clarithromycin 250 mg ) after postoperative 2 weeks in ESS patients. Preoperatively, we checked mucociliary clearance with saccharine test (MCT), symptom scores and sinus CT scan and total IgE, and allerg ic skin test were evaluated for allergy. After ESS, MCT and symptom scores were checked on postoperative patients at 2, 6 and 10 weeks, respectively. Recurrence of polyp was also evaluated with endoscopic examination. The improvement rate (IR) of MCT was s ignificantly higher in the experimental group than in the control group, but the IR of symptom scores was not significant statistically. High total IgE affected the IR of MCT and symptom scores in the experimental group. Allergy proven by allergic skin test also affected the IR of MCT, but the IR of symptom scores was not affected in the experimental group. The polyp recurrence rate was significantly higher in the control group compared to the experimental group. We can conclude that LDLMT has a beneficial affect on the postoperative treatment of sinusitis patients and high total IgE and allergy may affect the effect of LDLMT in postoperative patients who have undergone ESS.

The effects of exponential rise rate of serum estradiol concentration on the follicular development and the outcome of in vitro fertilization and embryo transfer / 대한산부인과학회잡지

No abstract available.