A Case of Trichilemmal Cyst Invading Submandibular Gland / 대한이비인후과학회지

A trichilemmal cyst is a skin adnexal tumor that usually occurs on the scalps of elderly women. We report a trichilemmal cyst in the submandibular area of a 16-year-old male, masquerading as a second branchial cleft cyst. During surgery, the mass was found to have invaded the submandibular gland and needed to be excised totally in continuity with the submandibular gland. To our knowledge, this is the first reported case of a trichilemmal cyst involving the submandibular gland. Although rare, a trichilemmal cyst may be considered in the differential diagnosis of cystic lesions in the submandibular area. It should also be differentiated from other cystic malignant tumors for its tendency to invade the surrounding structure.

Coblation Tonsillectomy versus Conventional Dissection Tonsillectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: A variety of tonsillectomy has been performed to treat chronic tonsillitis or tonsillar enlargement. Coblation, one of the radiofrequency electrosurgeries, has been introduced as another modality of tonsillectomy to minimizing the heat-induced tissue damage accompanied by electrocautery. The aim of this study is to find the advantages and disadvantages of coblation tonsillectomy compared with conventional tonsillectomy using cold dissection. SUBJECTS AND METHOD: Eighteen patients who underwent tonsillectomy in St. Paul's hospital between January and June in 2006 were included in this study. Conventional tonsillectomy was performed on one side, and coblation tonsillectomy on the other side in one subject. The operation time, postoperative pain, otalgia, bleeding rate and mucosal healing of the tonsillar fossa were evaluated on both sides in every patient. RESULTS: The operation time, postoperative otalgia, and bleeding rate were not significantly different for either sides. The postoperative pain was less severe on the coblation side only on the third day. But the mucosal healing of the tonsillar fossa was more rapid on the coblation side than cold dissection side. CONCLUSION: Coblation tonsillectomy can be a new method that will ensure rapid tissue healing but gives almost the same postoperative outcome in pain and hemorrhage as the conventional dissection tonsillectomy.

Implementation of a Critical Pathway to the Dizzy Patients in the Emergency Center

BACKGROUND AND OBJECTIVES: Dizziness and vertigo are frequent causes of presentation in the emergency center. Nevertheless, the practice guideline for the primary care doctor in the emergency center has not been reported yet. Considering its complex approach for diagnosis, we developed critical pathway for dizzy patients who visited emergency center. We performed this study to show the process of development and the result of implementation of critical pathway. MATERIALS AND METHOD: A critical pathway was developed following the analysis of dizzy patients visiting emergency center by retrospective chart review and in the basis of questionnaire for knowing the needs for critical pathway to the primary care doctor in emergency center. Specialists for caring dizzy patients joined to make the flow sheet and practice guideline for dizzy patients and also made educational materials for doctors in emergency center. The critical pathway was then implemented and its results were analyzed by estimating the practice time and the degree of satisfaction of the patients and doctors. RESULTS: Most of the primary care doctors in emergency center reported the difficulty in diagnostic approach for dizzy patients and the need for critical pathway. More than half of the dizzy patients were diagnosed as peripheral vertigo and the commonest disease was benign paroxysmal positional vertigo. All of the patients with vertigo diagnosed as central origin showed the neurologic deficit. After the implementation of critical pathway, practice time was significantly decreased and many of the dizzy patients and doctors were satisfied. CONCLUSION: Development and implementation of a critical pathway for dizzy patient in emergency center was possible, valuable and effective for the patients and doctors, though the process was not easy and needed interdisciplinary cooperation of involving departments.

Acoustic Rhinnometric Accessment of Nasal Cavity in Normal Neonates / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Acoustic rhinometry, introduced by Hilberg in 1989, is an important investigative tool in rhinology. It should be well suited for studies of the nasal cavities of infants and children in whom nasal airway is more important than in adults. The main objective of this study was to find normal data of nasal cavity dimension in Korean full-term normal neonates. SUBJECTS AND METHOD: Between March 2003 and November 2003, the nasal airways of 100 normal full-term neonates (56 males; 44 females) were examined by acoustic rhinometry (Rhinometrics) and miniprobe. MCA (minimal cross-sectional area), TMCA (total MCA), DMCA (distance from the nostril to the position of MCA) and TVOL40 (sum of volume of the anterior 40 mm of the nasal airway) were calculated. RESULTS: The mean values of TMCA, DMCA and TVOL40 were 0.220 cm2 0.944 cm, 1.716 cm3 respectively. CONCLUSION: Acoustic rhinometry is quick to perform, non-invasive, and it requires minimal co-operation and has no adverse effects. Nasal airway evaluation in neonates is significant in this age group, but limitations in equipment make this difficult. Further studies are required for more accurate evaluation of the nasal airway of neonates and infants.

Functional Results of Voice and Swallowing in Patients Treated with Surgery or Radiation Therapy for Early Glottic Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Laryngeal neoplasms such as early glottic cancer can be effectively treated with several methods, namely laser surgery, conservation laryngeal surgery and radiotherapy. Therefore, the preservation of the ability to speak and swallow normally is another important consideration in the selection of therapy for early glottic cancer. The purpose of this study is to compare the functional results of voice and deglutition for early glottic cancer patients treated with surgery or radiation. SUBJECTS AND METHOD: Between January 2002 and September 2004, 17 patients with the early glottic cancer who had undergone radiotherapy (n=6) or surgery (n=11) were retrospectively investigated. All the patients were phonetically analysed using CSL and Fo, Jitter, Shimmer and NHR were evaluated. For aerodynamic test, maximum phonation time (MPT) and mean air flow rate (MFR) were also evaluated. Modified barium swallow (MBS) was performed to evaluate swallowing function. RESULTS: There were no significant difference in all the vocal parameters between radiotherapy group and surgery group. But Shimmer differed significantly between radiotherapy group and laser cordectomy group. In aerodynamic study, MPT was significantly longer in the radiotherapy group than in the surgery group, but no significant difference was observed between the radiotherapy group and laser cordectomy group. MBS showed better results in the surgery group than in the radiotherapy group. CONCLUSION: Therapeutic modality for patients with early glottic cancer should be chosen in consideration of voice quality and swallowing, and according to multiple parameters of the patients' conditions.

A Case of Pemphigus Vulgaris Localized to the Oral Mucosa and Esophagus / 대한피부과학회지

We recently encountered a case of pemphigus vulgaris, which was localized within the oral mucosa and esophagus. The patient was a 62-year-old women, who had had a few recurrent erosions on the oral mucosa for 1 year. Newly developed erythematous erosions on the esophagus appeared 7 days pre previously. Histopathological findings showed suprabasal blisters in the epithelium of the buccal and esophageal mucosa. On direct immunofluorescence, intercellular IgG and C3 bindings were found in the epithelium of the buccal mucosa. Treatment with oral steroids resulted in a remission of the lesions and the other skin lesions were not found for a period of 6 months.

The Study on the Hospital - Based Relative Frequency , and Clinical and Laboratory Findings of Atopic Dermatitis / 대한피부과학회지

Background : Atopic dermatitis(AD) is a common disease, and population-based studies indicate that the frequency of AD has increased substantially during recent decades. However, there have been few studies on the hospital based relative frequency, and clinical and laborat,ory findings of AD in Korea. OBJECTIVE: The presenl study was aimed to elucidate the relative frequency of AD on the outpatient base, and to investigate the clinical manifestations and immunological laboratory findings. METHODS: Our study was designed by analysing outpatients with AD via physical examination, questionnaires and immunological investigations such as skin prick tests, Multi test CMI, and measurernent of eosinophil counts, total IgE, Derrnatophagoides pteronyssinus-specific IgE and eosinophil cationic protein(ECP). RESULTS: The results were as follows : 1. The relat,ive frequen:y of AD on the hospital base in 1995-1996 was 8.6%. 2. The mean age of onset was 3.36 years. 57.3% of the patients had their onset of eczema by the age of 1 year, 65.5% by 2 years and 83% by 5 years. The most common site at the onset was the face followed by antecubital area, popliteal area, neck, and trunk. 3. The predilection site on physical examination were the face, neck, antecubit,al area, popliteal area and trunk in decreesing order. 4. Concomitant allergic rhinitis, keratoconjunctivitis and asthma were present in 2~3.4%, 14.1%, and 9.5% of patients with AD, respect.ively, whereas pure AD was present in 34.1%. 5. Family history of atopy was observed in 60.5% of AD patient.s. 6. The most frequent ninor fea~ture of AD was xerosis followed by perifollicular accentuation, allergic shiner, cheilitis, imitation allergy, palrnar hyperlinearity and molluscum cantagiosum. 7. Seasonal aggravation was found in 86.8% of patients with AD, especially in summer and winter, The rnost significant aggravating factors were wools followed by sweating, heating, dryness, excessive bat.hing and emotional stress. 8. Abnormal levels of .osinophils, total IgE and ECP were seen in 44.8%, 78.9% and 31.7% Of patients with AD, respec.ively. 9. Cell mediated immunty was decreased in 68.2% of patients with AD. 10. Positive reactivity( at least rnore than one allergen) in the skin prick t,est was noted in 76% of pat,ients with AD and the most popular 8 allergens were D. pteronyssinus, D. farinae, cat fur, M4 mixed threshing dust., dog hair, mugwort pollen, H3 tree pollen and birch pollen. 11. The specific IgE aritibodies to D. pteronyssinus(>+1) were found in 72.3% of AD patients and correlated with the r esults of the skin prick test in 76%. CONCLUSION: The hospi al-based relative frequency of AD investigated in our study tends to be increased. As the clinica features and laboratory findings of AD might be influenced by genetic, environrnental and psychological factors, the systernic evaluation of patients with AD will be needed.

A Case of Trichilemmal Carcinoma

We report a case of trichilemmal catcinoma in a 79-year-old woman presentde an atrophic scar remaining after excision of a recurrent nodule on the right mandibular area, Her past history revealed that there had been a painful pea-sized brownish nofule on the same site for two years. Eleven months before presentation, it had been excised but recurred 9 months later. Histopathologic findings showed a clear cell neoplasm with trichilemmal keratinization. The tumor cells showed PAS-positive cytoplasm and cytologic atypia with a few mitoitic figures. Immunohistochemical staining for high molecular weight cytokeratin was positive but carcinoembryonic antigens and epithelial membrane antigens were all negative. To our knowledge this is the first report of trichilemmal carcinoma in Korea.

Two Cases of Soft Fibroma Developing Subepidermal Blister / 대한피부과학회지

We report a 34-year-old woman and a 16-year-old girl who had a soft fibroma with blister on the thigh and on the back, respectively. Histopathologically, in the biopsy of both tumors, a subepidermal blister overlying the tumor and the degeneration of the epidermis were observed without any evidence of dermal degeneration. The major cause of the blister formation seems to be ischemia due to twisting or compression of the neck of the soft fibroma.

Four Cases of Clear Cell Hidradenoma / 대한피부과학회지

Clear cell hidradenoma is a relatively infrequent benign tumor that shows differentiation from or toward the structure of the eccrine sweat gland. We report four cases of clear cell hidradenoma which consists mainly of typical clear cells with small numbers of polyhedral cells. Clinically these tumors represented solitary erythematous firm nodular or cystic mass. In immunohistochemical study of one case, polyhedral cells rather than clear cells reacted positively for carcinoembryonic antigen and cytokeratin. We also review the previous reports of clear cell hidradenoma in Korean dermatologic literature.

A Case of Giant Cell Tumor of the Tendon Sheath Developing on the Dorsum of the Foot / 대한피부과학회지

We report a case of giant cell tumor of the tendon sheath involving the foot, in a 21-year-old female patient, who presented with an asymptomatic tumor on the dorsum of her right foot. Histopathologically the tumor is surrounded by thin fibrous connective tissue. The characteristic findings of the excised specimen revealed a typical mixture of abundunt round or polygonal histocyte-like cells with varying portions of spindle-shaped fibroblast-like cells and multinucleated giant cells. Variable amounts of hyalinized fibrous stromal tissue were also present. After excision, local recurrence has not been observed for 3 months.

A Case of Amelanotic Melanoma Developing in a Burn Scar / 대한피부과학회지

Carcinomatous degeneration of chronic scars, known as Marjcinulcer, are relatively rare. The majority of them are quamous cell carcinoma or other skin cancers including basal cell carcinoma. But malignant melanone, especially amelanotic melanoma oveloping from a chronic burn scar is extremely rare. We have experiencedl a case of amelanotic melanoma arising ron a chronic burn scar in a patient, 53 year-old female, who had a painful erythematous ulcra edonodule on the left heel for about 20 years since she had sustained a burn there at the age of 1 year. Although there are no melanin pigments in hematoxylinsin(H & E) stain as well a Fontana Masson stain, a biopsy specimen from the skin lesion revealed cytologic atypia and junctional activity in the dermoepidermal junction arcl positive immunohistochemical staier, for S-100 protein, which is consistent with amelanotic melanoma. lesion was widely excised and a skin graft was dure She was also treated with intralesional BCG injection and recurrence or metastasis was ot detected during the follow up period of 6 months.