Bilateral Hypertrophic Olivary Degeneration with Oculopalatal Tremor after Brainstem Hemorrhage: A case report

Hypertrophic olivary degeneration is a form of transynaptic degeneration, which is caused by a lesion in the dentate-rubro-olivary pathway. Commonly described lesions were brainstem stroke, neoplasm, demyelination, and trauma. It's clinical presentations are Holmes tremor, and palatal tremor. This case was a 49-year-old man who was diagnosed as bilateral brainstem hemorrhage. About 2 months later, he had developed bilateral Holmes tremor of upper extremities and oculopalatal termor. Brain MRI was performed at 13 months after onset. MRI showed hyperintense and hypertrophied lesion on T2-weighted image in both inferior olivary nuclei.

Feasibility of Ultrasonographic Area Ratio of Median Nerve in the Diagnosis of Carpal Tunnel Syndrome in Korea

OBJECTIVE: To examine the usefulness of ratio of maximal swelling to normal cross sectional area (CSA) of median nerve with ultrasound in patients with carpal tunnel syndrome (CTS) and healthy controls. METHOD: Patients with electrodiagnostically proven CTS underwent ultrasonography of the median nerve. The median nerve area was measured at three points (maximal swelling site, 2 cm proximal to maximal swelling site, 12 cm proximal to maximal swelling site) and compared to values from asymptomatic volunteers. RESULTS: The ratio of maximal swelling site to 12 cm proximal was 1.34+/-0.14 in asymptomatic volunteers and 2.31+/-0.43 in patients presenting with CTS. The ratio of maximal swelling site to 12 cm proximal gave 73.7% sensitivity and 90.0% specificity. While using only median nerve area at the wrist resulted in 81.6% sensitivity and 70.0% specificity, depending on the cutoff value used. CONCLUSION: The ratio of maximal swelling site to proximal in patients with CTS is elevated as compared to asymptomatic controls. The ratio of maximal swelling site to 12 cm proximal has higher specificity to diagnose CTS, and may be superior to measuring median nerve area at the wrist alone.

The Effect of the Amniotic Membrane on Treatment of Tympanic Membrane Perforation / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Tympanic membrane perforations are usually caused by trauma, infection, surgical procedures such as tympanoplasty or myringoplasty. Because perforations interfere with the transmission and perception of sound, whatever the cause of the perforation, repair of the membrane is desirable. The purpose of this study is to investigate the clinical application and usefulness of allograft amniotic membrane, instead of autograft materials, in the management of tympanic membrane perforation. SUBJECTS AND METHOD: A retrospective study was performed on 14 patients who underwent myringoplasty with allograft amniotic membrane for tympanic membrane perforation from October 2006 to September 2007. Information was collected on sex, age, the cause of perforation, the perforation size, postoperative hearing result, the success rate. RESULTS: Of 14 patients, 13 patients were successfully treated by myringoplasty with allograft amniotic membrane and one patient failed due to infection. So the overall success rate was 93%. The mean air-bone gap was improved from 13.3 dB to 7.1 dB. CONCLUSION: The myringoplasty with allograft amniotic membrane is a successful procedure for the healing of tympanic membrane perforations.

Ethmoidal Osteoid Osteoma / 대한이비인후과학회지

Osteoid osteoma is a benign osteoblastic lesion which has been reported in almost every bone of the human body, especially in the shaft of long bones. Most commonly occurring locations are in the femur, tibia and spine, while ethmoidal bone is the rarest sites of involvement. It is usually seen in the second and third decades of age and a male preponderance has been noted. Clinical features of this tumor are an intermittent vague pain, gradually increasing in severity, with nocturnal paroxysm. This pain responds characteristically to aspirin treatment. Histologically, the nidus is sharply delineated from the surrounding, variably thick layers of dense bones and has no reports of malignant transformation. The treatment of choice appears to be en bloc resection. Recently, the authors experienced a case of ethmoidal osteoid osteoma, which was removed with intranasal endoscopic approach. Hence, we report a rare case with a review of literature.

Sudden Hearing Loss Caused by Acute Pontine Infarction: Reports of Two Cases / 대한이비인후과학회지

In most cases, sudden deafness results from viral infection, vascular occlusion or cochlear membrane rupture, but occasionally, its central origin can not be excluded. Although a number of signs are theoretically plausible in patients with pontine infarction such as facial weakness, lateral gaze palsy, Horner syndrome, limb dysmetria, crossed sensory loss or vertigo, isolated sudden deafness is a very rare manifestation. When pontine infarction occurs, it is usually identified on T2-weighted and diffusion-weighted magnetic resonance imaging (MRI). Early treatment with anticoagulant and antiplatelet agents leads to a more rapid resolution of symptoms and preservation of existing brain function. Recently, the authors have experienced two cases of sudden hearing loss caused by acute pontine infarction. Hence, we report two cases with a review of literature.

Combined Expression of COX-2, MMP-9, p53 and VEGF in Squamous Cell Carcinoma of the Head and Neck / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: COX-2, MMP-9, p53 and VEGF play an important role in the invasion and metastasis of tumor, and their roles are known to interact with each other. In this study, we investigated the relationship between gene protein expression and clinical parameters including synchronicity to the progression and metastasis in the head and neck squamous cell carcinoma. SUBJECTS AND METHOD: Tissue samples and clinical data were obtained from 69 head and neck squamous cell carcinoma patients who underwent surgery as initial treatment except nasopharngeal carcinoma from January 1999 to December 2003. Their primary sites were: oral cavity (12), pharynx (18) and larynx (39). Immunohistochemical stain was performed to evaluate the expression rate of COX-2, MMP-9, p53, VEGF and then expression patterns and clinical data were analysed. RESULTS: The expressions of COX-2, MMP-9, p53 and VEGF immunoreactivities were observed as 57.9%, 49.3%. 60.9% and 44.9%, respectively. MMP-9 was significantly correlated with T-stage (p=0.021) and COX-2 and p53 levels were significantly correlated with lymph node metastasis (p=0.019 and p=0.001, respectively). Multiple (2 kinds, 3 kinds, 4 kinds) expressions of gene protein were found in 31.9%, 21.7%, and 10.2%, respectively. There was a significant statistical difference between the multiple expression of gene protein to lymph node metastasis and a single expression of gene protein (p=0.030). CONCLUSION: These data suggested that COX-2, MMP-9 and p53 expression may play a role of tumor progression and metastasis in the head and neck squamous cell carcinoma. We may conclude that the synchronous gene protein expression was superior to the single gene expression in estimating progression and metastasis of the head and neck squamous cell carcinoma.

The Clinical Effectiveness of Open Septorhinoplasty for Primary Treatment of Nasal bone Fracture

BACKGROUND AND OBJECTIVES: Closed reduction has been a primary treatment procedure for nasal bone fracture, but the post-operative results have not always been satisfactory. We compared the satisfaction rate of closed reduction with that of open septorhinoplasty for the treatment of nasal bone fracture and evaluated the effectiveness of open septorhinoplasty for the primary treatment of nasal bone fracture. MATERIALS AND METHOD: We performed a retrospective review of patients who underwent a closed reduction treatment for nasal bone fracture from March 2004 to February 2006 and conducted telephone surveys to monitor their post-operative cosmetic and functional problems. We estimated the factors that were involved in the low satisfaction rate and determined the indications of open septorhinoplasty. Prospectively, the patients who underwent open septorhinoplasty from September 2006 to August 2007 were interviewed for their cosmetic and functional satisfaction rate. RESULTS: Forty percent of the patients who underwent closed reduction had cosmetic concerns and twenty percent had functional concerns. The factors involved in the low satisfaction rate were septal fracture, associated fractures, and multiple fragmentation. Eight percent of the patients who underwent open septorhinoplasty had cosmetic concerns and other eight percent had functional concerns. CONCLUSION: A careful pre-operative evaluation of the type of fracture is important for the treatment of nasal bone fracture. Also, when nasal bone fracture is combined with septal fracture, associated fracture or unilateral fragmentation, open septorhinoplasty has to be considered to reduce secondary deformities and to improve the satisfaction rate of the patients.

A Case of Adenoid Cystic Carcinoma on Subglottis / 대한이비인후과학회지

Adenoid cystic carcinoma (ACC) is a rare malignant tumor. Its incidence is less than 1 percent of all head and neck malignancies and approximately 10 percent of all salivary neoplasms. There are no clear guidelines for the treatment of ACC, but a combination of surgery and postoperative radiotherapy has been usually recommended. Subglottic cancer has a lower incidence than does laryngeal cancer, whose incidence is in the range of 4 to 6 percent of all cancers of the larynx. Because of the rarity of this tumor in the larynx, no series has been large enough to permit statistical evaluation of treatment. We report a case of adenoid cystic carcinoma on subglottis, which was treated with surgical excision and postoperative radiotherapy. The relevant literature is briefly reviewed.

Comparison of Bispectral Index at Each Thiopental Sodium Induction Dose / 대한마취과학회지

BACKGROUND: Thiopental sodium is one of the most commonly used intravenous anesthetics, but there exists no reliable report of BIS that can predict the hypnotic state. Our purpose was to compare BIS values after administering different doses of thiopental sodium. METHODS: With institutional review board approval and informed consent, sixty adult patients scheduled for elective surgery were studied. The patients were divided into three groups according to induction doses as follows: group 1: 3 mg/kg, group 2: 4 mg/kg, group 3: 5 mg/kg. After induction the BIS was monitored at 15 second intervals to 90 seconds. The number of patients with a BIS of less than 55 was recorded. RESULTS: The BIS at baseline and 15 seconds after administration were not statistically different in the three groups. The BIS at 30 seconds in group 1 differed from those of groups 2 and 3, but all of the mean BIS values were more than 55. The BIS values at 45 and 90 seconds were statistically different for three groups, and the mean BIS values of groups 2 and 3 were less than 55. The number of patients with a BIS of less than 55 at any point was eight in group 1, and twenty in groups 2 and 3. CONCLUSIONS: BIS monitoring suggests that a dosage above 4 mg/kg of thiopental sodium is sufficient for the reliable induction of anesthesia.

Anesthetic Management during Aortic Arch Surgery Using Anterograde Selective Cerebral Perfusion / 대한마취과학회지

Cerebral protection during aortic arch surgery is an anesthetic challenge, since the surgical procedures for aortic arch aneurysm involve an interruption of cerebral blood flow. We report a successfully managed case of aortic arch aneurysm repair with antegrade selective cerebral perfusion (SCP) during TCA (total circulatory arrest) using a transcranial oximeter, cerebral oxygenation was monitored during surgery. Although at the beginning of TCA a decrease in the regional cerebral oxygen saturation was observed, this was soon recovered by SCP. Except for the short period of TCA without SCP, regional cerebral oxygen saturation (rSO2) value were well maintained during surgery.

The Differential p53 Expression in Breast Cancer Development and the Correlation to Proliferative Index of Breast Cancer

p53 plays an important function as a negative regulator of cell growth and also inhibits transformation. It has been hypothesized that p53, acting as a control gene at a G1 check point, may detect DNA damage, slow the cell devision, and allow time for DNA repair. If damage is irreparable, the cell may be driven down into the apoptotic pathway, thus preventing replication of defective cells. In this retrospective study, we investigated the correlation between p53 protein expression by IHC staining and benign breast disease with or without atypical ductal hyperplasia, DCIS and invasive breast cancer. Also We analyzed the association between p53 protein expression and the following prognostic parameters in breast cancer patients; age, tumor size, axillary node involvement, stage, histologic grade, estrogen receptor, and progesteron receptor, and DNA ploidy. And, we investigated the correlation between p53 protein expression and the proliferative index of S phase fraction in diploid breast cancer. The results were as follows ; 1) In histopathological classification, none out of ten benign breast diseases, none out of seventeen fibrocystic disease with atypical ductal hyperplasia patients were p53 protein positive, 3 out of fifteen DCIS (20%), 29 out of eighty-six (34%) invasive breast cancer patients were p53 protien positive.2) There were no significant differences between p53 positivity and age, tumor size, axillary node involvement, stage, histologic grade, ER and PGR status, and DNA ploidy by Fisher's exact test with chi-squre test for trend, in invasive breast cancer. (n=86) 3) In diploid tumor (n=35), statistically significant differences were noted such that high S-phase fraction tumor revealed increased p53 positivity. (p<0.05) We have found that immunopositivity for p53 was detected in 20% of in situ carcinoma, suggesting that p53 mutation can be acquired early in malignant progression. We have also found that there is a strong direct correlation between the amount of mutant protein and tumor proliferation rate. These results are consistent with the hypothesis that wild-type p53 is involved in suppression of the cell cycle.