A Case of Septal Perforation Repair with Middle Turbinate Flap

The nasal septal perforation is an inadvertent complication of septal surgery which is caused by traumatic, iatrogenic, caustic or inflammatory reasons. Repair of the perforation is indicated when complications such as whistling sound, marginal crusting, frequent nasal bleeding and low-grade perichondritis develop. There is no standard surgical method for repair of a septal perforation. The size, site and the causing factor of perforation determine closure methods. A septal perforation using the concha bullosa flap of middle turbinate was successfully repaired.

Histological Evaluation of Gore-Tex(R) used in Nasal Augmentation of Human / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although Gore-Tex is popularly used in nasal augmentation in human, studies about the histological changes have been carried out only in animal models. The purpose of this study is to investigate histological changes of Gore-Tex used in nasal augmentation in human. SUBJECTS AND METHODS: Gore-Tex of 24 patients who underwent nasal augmentation using Gore-Tex (non-reinforced sheets) 2-36 months ago and had re-operated for the sole cosmetic problems was obtained. Histologic examination was performed from specimens including Gore-Tex and the surrounding soft tissue with light microscope and electromicroscope. RESULTS: Histologically, connective tissue ingrowth was observed in all specimen. But the degree of foreign body reaction and collagen deposit varied from specimen to specimen and had no relationship with the duration. Neovascularization was observed from specimen whose duration was longer than 12 months and degenerative calcification was observed from 36 month old specimen. CONCLUSION: Unlike the findings of previous reports, individual differences and partial degenerative lesions in Gore-Tex were observed. Additional studies are required to confirm the stability of Gore-Tex as an implant to be used in human.

The Clinical and Radiological Evaluation of Results about Closed Reduction for Children with Nasal Bone Fractures / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It has generally been accepted that closed reduction is the management of nasal fracture in children. But proper management is still confusing and clinical and radiological evaluation about long term results have yet to be determined. The purpose of this study is to determine which closed reduction method for nasal bone fractures in children is effective when considering clinical and radiological aspects. MATERIALS AND METHOD: We analysed the medical records of 35 children with nasal bone fractures up to the age of 15, who were operated by closed reduction between 2000 and 2002. We evaluated postoperative satisfaction of doctors and patients and postoperative CT scan score (Motomura et al 2001) of 14 children over more than at least 2 postoperative years. RESULTS: A peak incidence ages ranged from 13 to 15 years. The most frequent cause was sports injuries. The degree of postoperative satisfaction and postoperative CT scan score was favorable. CONCLUSION: In management of nasal fracture in children, closed reduction is effective and satisfactory when clinical and radiological aspects are considered.

Clinical Study of Open Nasal Bone Fracture

BACKGROUND AND OBJECTIVES: Little is known about the treatment of open nasal bone fracture (ONF). The operative technique, timing, and management of ONF is still confusing. This study presents our treatment policy of ONF to help otolaryngologists decide proper management plan. MATERIALS AND METHODS: Of 380 consecutive patients who required surgical intervention, 57 patients underwent open nasal reduction. Of 57 patients, 15 had one-stage operation, and 42 had two- stage operation. Postoperative patients' satisfaction was evaluated using a visual analogue scale and the reasons of dissatisfaction were analyzed. RESULTS: ONF had poorer outcome than closed nasal bone fracture. Unsatisfactory cosmetic results such as scan of the external nose and change of the skin color were the most common problems associated with open nasal reduction. CONCLUSION: Operation timing and technique should be selectively applied to different types of nasal bone fracture and wound state. Meticulous wound care as well as accurate nasal bone reduction is mandatory for ONF.

Anaphylactoid reaction to ofloxacin with cross-reactivity to other fluoroquinolones / 천식및알레르기

Fluoroquinolones are antimicrobial agents that have a broad range of activity against both gram-negative and gram-positive organisms. Anaphylactoid reactions have been sporadically reported with fluoroquinolones. There have been a few reports that describes cross-reactivity between fluoroquinolones. We experienced a case of ofloxacin-induced anaphylactoid reaction, and confirmed cross-reactivity between ofloxacin and ciprofloxacin with the oral challenge test. Cross-reactivity between fluoroquinolones may be important, and avoidance of any fluoroquinolones should be mandatory for patients with hypersensitivity reaction to one of these drugs.

Clinical Analysis of Traumatized Auricular Laceration / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Contusions and lacerations of the auricle are common, but reconstructive procedures are difficult because the auricle has an intricate cartilage framework covered with delicate skin. The purpose of this study was to present therapeutic principles of traumatized auricular laceration. SUBJECTS AND METHOD: The study was performed retrospectively and included 35 traumatized auricular laceration patients. Their wound state, degree of laceration, whether or not had exposure of cartilage, methods of reconstruction used and postoperative complications were analyzed. RESULTS: Multiple laceration was found in 11 patients. Eight of 19 patients who had cartilage exposed had been performed cartilage suture method for alignment. Primary reconstruction was performed for two avulsed subtotal injury patients. Pocket principle technique was used for one patient whose auricle was contaminated and amputated. Postoperative complications were noted as paresthesia, color change, delayed healing, deformity and partial loss of auricle. CONCLUSION: Rapid and active management of traumatized auricular lacerations is important to prevent infection and postoperative complications.

Delivery of Dialysis Dose of Intermittent Hemodialysis in the Patients with Acute Renal Failure and its Contributing Factors / 대한신장학회잡지

BACKGROUND: Recent studies have suggested that the outcomes of the patients with acute renal failure (ARF) may related to delivered dose of dialysis. In such context, a number of investigators have reported about delivered dose of dialysis and its contribution to outcomes of ARF, using Kt/V. The purpose of the study was to evaluate actual delivered dose of dialysis in intermittent hemodialysis (HD) in critically ill ARF patients, clinical factors contributing delivery of dialysis dose, and relationship of delivered dialysis dose and survival. METHODS: Delivered and prescribed dose of dialysis, presented as Kt/V, were measured in ARF patients intermittent HD in intensive care unit of Inha University Hospital from January 1999, until December 1999, using single pool urea kinetic model. RESULTS: All subjects received intermittent HD of 6.4+/-4.8 times with mean of 225.6+/-40.4 min per session. Overall survival was 55.5%. Prescribed Kt/V in all subjects was 1.24+/-0.39, but actual delivered Kt/ V was 1.08+/-0.17. A mean delivered/prescribed Kt/V ratio was 87.1+/-43%. Duration of HD session (R= -0.547, p=0.019), Cleveland Clinic Foundation Severity Score (R=-0.486, p=0.041), and frequency of hypotensive episodes (R=-0.419, p=0.043) were significantly correlated with delivered/prescribed Kt/V ratio. Delivered dose was under 1.2 in 66.7% of the subjects. Survival rate of these patients was 50.0%, which was lower as compared to 66.6% of the patients with delivered dose over 1.2. Patients with low delivered dose (Kt/V<1.2) showed significantly low prescribed dose and short HD time (p<0.05). Delivered Kt/V was correlated with BUN at initiation of dialysis, HD duration, and prescribed Kt/V (p<0.05). Non-survivors showed significantly low initial serum creatinine, low CCF severity score, high frequency of hypotensive episodes, and less use of heparin (p< 0.05). Prescribed Kt/V was not different between survivors and non-survivor (1.22+/-0.30 vs 1.31+/-0.45), but delivered Kt/V (1.17+/-0.17 vs. 1.04+/-0.17; p<0.05) and delivered/prscribed Kt/V (95.9+/-22.6% vs. 73.9+/-15.6%; p<0.05) were significantly higher in survivors than in non-survivors. CONCLUSION: In ARF patients, the delivery of dialysis was significantly lower than as was expected. Delivered/prescribed Kt/V was about 87% and more than half of the patients received intermittent HD of Kt/V less than 1.2. Better survival was associated with higher delivered dose of dialysis. We need further prospective studies about the causal relationship between delivered dose of dialysis and outcomes in ARF patients.

A Case of Left Atrial Myxoma Presenting with Myocardial Infarction

Coronary artery embolization is an extremely rare and potentially lethal complication of atrial myxomas. We observed of a case of left atrial myxoma associated with acute anteroseptal and inferior myocardial infarction. A transthoracic echocardiographic study revealed the presence of an echogenic, mobile mass, compatible with myxoma in the left atrium. Coronary angiography disclosed abrupt occlusions of the distal left anterior descending artery and the right coronary artery. The tumor was successfully removed surgically after medical treatment and the patient was doing well post operatively at 6-month follow-up.

A case of systemic amyloidosis involving liver, kidney and peritoneum after cholecystectomy / 대한내과학회지

Amyloidosis is a heterogenous group of often fatal disorders characterized by extracellular deposition of a proteinaceous material with a unique fibrillar form in various tissues and organs. Deposition of amyloid may cause widespread dysfunction of the involved organs. Recently, we experienced a case of 40-year-old male patient with nephrotic syndrome, uncontrolled ascites and jaundice, which developed after cholecystectomy. We confirmed systemic amyloidosis involving kidney, liver and peritoneum by kidney and liver and peritoneum biopsy. The case that, having about a month of incubation period after cholecystectomy, amyloidosis occurred in a healthy man before the operation, and that amyloid was deposited in the peritoneum site incised during the operation provides grounds that amyloidosis may be triggered by cholecystectomy. Given the rarity of this case, the following is a report of this case and a review of the relevant literatures.