Correlation of Driving-related Cognition and Cognitive Impairment in Drivers over the Age of 60

BACKGROUND: A rate of traffic accidents by elderly drivers increased by 70% between 2011 and 2015 in Korea. Elderly drivers with cognitive impairment are more susceptible to be involved traffic accidents than cognitively normal individuals. This study aimed to evaluate the correlation of driving-related cognition and cognitive impairment in drivers over the age of 60 using the standardized program developed by the Road Traffic Authority (RTA). METHODS: Current drivers older than 60 years were recruited for the study. All participants were tested using the Mini-Mental Status Examination (MMSE), Rey Complex Figure Test (RCFT)-copy, and Digit Symbol Substitution Test (DSST) for cognitive function assessments. The driving aptitude test (DAT) for the elderly developed by RTA consists of 4 different tasks including speed and distance driving tests (SD), visuospatial memory driving tests (VM), sustained attention driving tests (SA), and divided attention driving tests (DA). The participants were divided into two groups by their MMSE score (normal cognition, CN; cognitive impairment, CI). RESULTS: One hundred fourteen participants were enrolled in the study and 57 of them were assigned to the CI group. In comparison, drivers in CI showed worse scores at DSST, SD, VM, and DA than those in CN. DSST and DA were worsened with increasing age. DSST was the best predictive assessment to be the risk or caution grade in DAT. CONCLUSIONS: We could find a correlation between DAT and cognitive function in drivers over the age 60. These results could be used as the basis of investigating optimal tools for decreasing driving risks in the cognitive impaired elderly.

Differences among Ophthalmology Patients Referred to Tertiary Medical Centers according to Referral Hospital

PURPOSE: This study aimed to investigate the diagnosis and severity of patients who were referred to tertiary medical centers according to the type and function of the referral hospitals. METHODS: First-visit patients referred from July 2015 to June 2016 were retrospectively reviewed with regard to referral hospital, final diagnosis, treatment necessity, and medical fees for the six months after their first hospital visit. Based on these data, differences in type and function of medical institution were examined. RESULTS: In a comparison of hospitals according to their number of beds, clinics, hospitals and, tertiary hospitals had no differences in the ratio of patients who needed treatment (p = 0.075) and their medical fees over six months (p = 0.372). When hospitals were classified by functional capability in terms of doctors' medical specialty, increasing ratios of patients requiring medical treatment (p < 0.001) and medical fees for six months (p < 0.001) were found in the order of non-eye specialists, eye specialists, and eye specialists in trainee hospital. CONCLUSIONS: Efficient healthcare delivery systems should classify medical institutions by functionality capability based on medical specialties rather than hospital size according to the number of beds.

Efficacy of Prophylactic Uterine Artery Embolization before Obstetrical Procedures with High Risk for Massive Bleeding

OBJECTIVE: To evaluate the safety and efficacy of prophylactic uterine artery embolization (UAE) before obstetrical procedures with high risk for massive bleeding. MATERIALS AND METHODS: A retrospective review of 29 female patients who underwent prophylactic UAE from June 2009 to February 2014 was performed. Indications for prophylactic UAE were as follows: dilatation and curettage (D&C) associated with ectopic pregnancy (cesarean scar pregnancy, n = 9; cervical pregnancy, n = 6), termination of pregnancy with abnormal placentation (placenta previa, n = 8), D&C for retained placenta with vascularity (n = 5), and D&C for suspected gestational trophoblastic disease (n = 1). Their medical records were reviewed to evaluate the safety and efficacy of UAE. RESULTS: All women received successful bilateral prophylactic UAE followed by D&C with preservation of the uterus. In all patients, UAE followed by obstetrical procedure prevented significant vaginal bleeding on gynecologic examination. There was no major complication related to UAE. Vaginal spotting continued for 3 months in three cases. Although oligomenorrhea continued for six months in one patient, normal menstruation resumed in all patients afterwards. During follow-up, four had subsequent successful natural pregnancies. Spontaneous abortion occurred in one of them during the first trimester. CONCLUSION: Prophylactic UAE before an obstetrical procedure in patients with high risk of bleeding or symptomatic bleeding may be a safe and effective way to manage or prevent serious bleeding, especially for women who wish to preserve their fertility.

Comparison of Pain-relieving Effects of Fentanyl versus Ketorolac after Eye Amputation Surgery

PURPOSE: To investigate the analgesic effect and incidence of postoperative nausea and vomiting (PONV) between the opioid fentanyl and the non-steroidal anti-inflammatory drug ketorolac in patients who underwent eye amputation surgery. METHODS: Retrospective observational case series. Eighty-two patients underwent evisceration or enucleation surgery by one surgeon over a 2-year period. Fentanyl by intravenous patient-controlled analgesia (IV-PCA) at 20 microg/kg with 12 mg/kg ondansetron or intravenous ketorolac at 2 mg/kg/day was administered to patients at postoperative days 0, 1, and 2. The pain score was measured using an 11-point visual analog scale (VAS). The incidence of severe nausea requiring anti-emetics and the incidence of vomiting were reviewed. RESULTS: The mean postoperative VAS in the fentanyl group was significantly lower than that in the ketorolac group on the day of operation for both types of surgery (p = 0.001 and p = 0.004, respectively). At postoperative days 1 and 2, the mean VAS was not different between the two groups for either surgical type (p > 0.05 for both days). The mean VAS was significantly higher in eviscerated patients than in enucleated patients at postoperative days 0 and 1 in the fentanyl group (p = 0.023 and p = 0.016, respectively). However, this was not observed in the ketorolac group. The incidence of PONV was higher in the fentanyl group than in the ketorolac group, although this was not statistically significant for either surgical type (p > 0.05 for both groups). CONCLUSIONS: Fentanyl was more effective as an analgesic than was ketorolac on the day of operation for both surgical types. There was no difference between the two analgesics on postoperative day 1. The analgesic effect of fentanyl in enucleated patients was significantly higher than in eviscerated patients at postoperative days 0 and 1. The use of fentanyl by IV-PCA was associated with greater PONV despite co-administration with anti-emetics, although this finding was not significant.

Reconstruction of the Medial Canthus Using an Ipsilateral Paramedian Forehead Flap

BACKGROUND: The medial canthus is an important area in determining the impression of a person's facial appearance. It is composed of various structures, including canthal tendons, lacrimal canaliculi, conjunctiva, the tarsal plate, and skin tissues. Due to its complexity, medial canthal defect reconstruction has been a challenging procedure to perform. The contralateral paramedian forehead flap is usually used for large defects; however, the bulkiness of the glabella and splitting at the distal end of the flap are factors that can reduce the rate of flap survival. We reconstructed medial canthal defects using ipsilateral paramedian forehead flaps, minimizing glabellar bulkiness. METHODS: This study included 10 patients who underwent medial canthal reconstruction using ipsilateral paramedian forehead flaps between 2010 and 2012. To avoid an acute curve of the pedicle, which can cause venous congestion, we attempted to make the arc of the pedicle rounder. Additionally, the pedicle was skeletonized from the nasal root to the glabella to reduce the bulkiness. RESULTS: All patients had basal cell carcinoma, and 3 of them had recurrent basal cell carcinoma. All of the flaps were successful without total or partial flap loss. Two patients developed venous congestion of the flap, which was healed using medicinal leeches. Four patients developed epiphora, and 2 patients developed telecanthus. CONCLUSIONS: Large defects of the medial canthus can be successfully reconstructed using ipsilateral paramedian forehead flaps. In addition, any accompanying venous congestion can be healed using medicinal leeches.

The Morphological Changes in Main Corneal Incision (2.2 mm vs. 2.8 mm) Evaluated Using Anterior Segment Optical Coherence Tomography

PURPOSE: To investigate wound characteristics and ultrastructural changes in the 2.2-mm and 2.8-mm main corneal incisions. METHODS: Forty-four eyes of 34 patients undergoing cataract surgery were randomized to receive a 2.2-mm or 2.8-mm main corneal incision. All incisions were evaluated 1, 7, and 30 days postoperatively using anterior segment optical coherence tomography. The angle, length, maximal thickness of the incision, and if present, corneal gap length and incision gap area were calculated. The existence of Descemet's membrane detachment was recorded. RESULTS: The mean endothelial gap length and gap area of the 2.2-mm wound were larger than the 2.8-mm, with the only statistically significant difference observed on postoperative day 30 (p = 0.015 and 0.027, respectively). There was no difference in the mean incision angle, length, and corneal thickness between the 2 incision sizes. The ratio of Descemet's membrane detachment increased with older age and low postoperative IOP, but not associated with incision size (p < 0.05). CONCLUSIONS: Both the 2.2-mm and 2.8-mm main corneal incisions showed excellent wound healing outcome without significant postoperative complications. Older patients with low postoperative IOP required a more careful wound care management. The incision parameters in the present study can be used as an indicator of the healing process to reduce wound-related complications.

The Potential Role of the Retinal Acuity Meter For Predicting Visual Outcome after Cataract Surgery

PURPOSE: To investigate the accuracy and usefulness of the retinal acuity meter (RAM) in predicting visual acuity after cataract surgery. METHODS: We randomly selected 47 eyes from 43 patients who underwent cataract surgery in our clinic. Preoperative BCVA and 3 month postoperative BCVA were measured by the Snellen chart, and we recorded the preoperative visual acuity by RAM. We also grouped the patients according to diabetic retinopathy and preoperative BCVA 20/100. By comparing the expected visual acuity by RAM with actual postoperative BCVA values, we analyzed the accuracy of the RAM's predictability after surgery. The cataract types and macular disease were taken under consideration when analyzing our results. RESULTS: Of the 47 eyes in our study, the postoperative Snellen visual acuity was predictable within three lines (90.9%) in 11 eyes with diabetic retinopathy and without macular disease. In the 36 eyes without diabetic retinopathy, the postoperative Snellen visual acuity was predictable within three lines (91.6%) of the cases. In both groups, the preoperative RAM acuity and postoperative BCVA were significantly correlated (R2=0.692, R2=0.812, p<0.05). In 41 eyes with preoperative BCVA 20/100 or more, the postoperative Snellen visual acuity was highly predictable in 95.1% (R2=0.763, p<0.05). However, in 6 eyes with preoperative BCVA levels less than 20/100, the postoperative Snellen visual acuity was not predictable (66.6 %). In the patients with both nucleosclerosis and posterior subcapsular opacity and in the patients with additional cortical opacity, the postoperative BCVA differed from the preoperative RAM acuity by more than three lines on the Snellen chart. CONCLUSIONS: RAM is useful in predicting postoperative visual acuity in cataract patients, but may be unreliable in the patients with combined cataract forms or with preoperative BCVAs less than 20/100.

Minimal Requirement of Limbal Epithelium for Successful Limbal Cell Transplantation in Rabbit Corneas

PURPOSE: To investigate the minimal requirements of the limbal epithelium for successful limbal stem cell transplantation and the healing process. METHODS: Nine rabbits were divided into 4, 6, and 8 clock-hour transplantation groups. Limbal autografts from the healthy fellow eye were transplanted to the iatrogenic damaged eye. The amniotic membrane served as a stem cell niche. Experimental corneas were evaluated by slit lamp examination and immunohistochemistry. RESULTS: In the over 9 hours transplantation group, the healing process of the epithelium from the limbal stem cell was revealed and cornea-specific keratin k3, transcription factor p63, and connexin 43 were detected by immunohistochemistry. The normal corneal epithelium was regenerated after 60 days postoperatively in the fellow donor eye. CONCLUSIONS: Limbal cell transplantation of over 9 hours seems to be a safe and effective method in the treatment of severe ocular surface disorders. In addition, the donation of limbal epithelium for up to 8 hours did not affect the normal corneal regenerating capability.

The Effect of Capsular Tension Ring on Posterior Capsular Opacity in Cataract Surgery

This study was performed to evaluate the efficacy and safety of the capsular tension ring on posterior capsular opacity in comparison with cases undergoing intraocular lens (IOL) implantation alone. We analyzed 127 eyes which had undergone cataract surgery, including capsular tension ring insertion, along with 127 eyes which had undergone IOL implantation alone by the same surgeon from September 1998 to March 2003. In the insertion group, 41 eyes (group A) had been followed up for more than one year after silicone IOL implantation, as had 40 eyes (group B) in the control group. We compared the incidence, type, and degree of capsular opacity between A and B groups and also endothelial cell loss after surgery between the two groups. For insertion group A, the frequency of posterior capsular opacity was lower (7.3%), the duration to development was longer, and the energy required for Nd-Yag capsulotomy of PCO was less than for control group B (25%) (p=0.037). The endothelial cell count loss rate was not significantly different between the two groups (p=0.522). The capsular tension ring is associated with a significantly reduced incidence of posterior capsular opacity and is a safe procedure.

Relationship between Clinical History Method and Orbscan II for Measuring Corneal Power after LASIK

PURPOSE: To evaluate the relation between clinical history method and Orbscan II for corneal power measurement after laser in situ keratomileusis (LASIK). METHODS: A total of 77 consecutive eyes of 43 patients who were treated with LASIK for myopia were followed up for at least 6 months. Corneal power by clinical history methods (CK) was compared with 3.0 mm zones of simulated keratometry (Sim-K), with 0.5, 1.0, 1.5, 2.0 and 3.0 mm zones of axial power maps (AP) and with 2.0, 3.0, 3.5, 4.0 and 5.0 mm zones of total optical power maps (TOP). RESULTS: Sim-K and all AP-map zones using Orbscan II were significantly higher (P<.001) than the CK value, while all TOP-map zones were significantly lower (P<.001) than the CK value. Among them, 3.0 and 4.0 mm TOP-map zones showed the highest correlation with the corneal power by CK (r2=0.889, P<.001; r2=0.889, P<.001). The correlation was higher with 3.0 mm TOP-map zone (r2=0.800, P<.001) than with 4.0 mm TOP-map zone (r2=0.793, P<.001) in high myopia patients. CONCLUSIONS: Although 3.0 and 4.0 mm TOP-map zones of Orbscan II were correlated highly with the CK value, these correlations were relatively low in high myopia patients and 3.0 mm TOP-map zone was better correlated than 4.0 mm TOP-map zone in these patients.

Risk Factors and Clinical Evaluation for Corneal Ectasia after LASIK

PURPOSE: To describe the clinical evaluation of corneal ectasia after laser in situ keratomileusis (LASIK) and evaluate risk factors. METHODS: Sixteen patients (21 eyes) who had undergone LASIK with corneal ectasia from 1997 to 1999 were reviewed retrospectively. The uncorrected visual acuity, best-corrected visual acuity (BCVA), spherical equivalent (SE), pachymetry, keratometry, intraocular pressure (IOP) and corneal topography were measured before and after LASIK. The targeted residual bed thickness (TRBT) and the ablation percentage of the total corneal thickness were checked. To determine risk factors, we reviewed 60 eyes with uneventful LASIK for 4 years after LASIK. The control group was selected with matched preoperative SE and TRBT similar to the ectasia group. RESULTS: Five (31.3%) of 16 patients developed ectasia bilaterally and the rate of preoperative asymmetric bow-tie pattern was 64.7% in corneal topography. At the final post-LASIK follow-up, disagreement of apices location on anterior and posterior was 33.3% in the right eye and 50.0% in the left eye. The mean time to onset of ectasia was 26.9 15.1 months and 28.6% developed ectasia after more than 40 months after LASIK. In the ectasia group, pachymetry before LASIK, TRBT and pachymetry at postoperative 2 months were thinner than the control group (p<0.05). CONCLUSIONS: Asymmetric bow tie pattern showed a high frequency in the corneal topography of the ectasia group before LASIK and about 1/3 of the cases developed ectasia more than 3 years after LASIK. The incidence of pachymetry before and after LASIK and TRBT was related to the development of ectasia.

The Evaluation of Photodynamic Therapy for Idiopathic Subfoveal Choroidal Neovascularization with Imaging Studies

PURPOSE: To evaluate the effect of photodynamic therapy (PDT) for idiopathic subfoveal choroidal neovascularization with various imaging studies. METHODS: We retrospectively reviewed the medical records and imaging studies of 17 patients (17 eyes) who were diagnosed with idiopathic subfoveal choroidal neovascularization and treated with PDT between December 2000 and May 2003. Slit lamp examination, fluorescein angiography (FAG), indocyanine green angiography (ICGA), and optical coherence tomography (OCT) were conducted before and after PDT. RESULTS: After PDT, the mean visual acuity was improved from 0.23 (20/80) to 0.48 (20/40). On FAG, the mean size of neovascular lesion (the longest length of lesion) was slightly decreased from 2038 +/- 592 micrometer to 1872 +/- 622 micrometer after PDT. However, the change was not significant. Fluorescein dye leakage decreased or disappeared, but staining of the lesion was noted. On OCT, the macular edema disappeared, but the hyperreflective area remained after PDT. CONCLUSIONS: PDT was effective in the treatment of idiopathic choroidal neovascularization. The factors representing the therapeutic effect of PDT were visual improvement, decreased leakage on FAG, and decreased macular edema on OCT, and these three factors were significantly related to each other.

Prediction of the Postoperative Changes of the Cranial Base in Unicoronal Craniosynostosis using CT Scan

Three unilateral craniosynostosis (plagiocephaly) patients who had undergone the cranial vault surgery in 4,9,18 months after birth were evaluated. The CT scans were obtained with high resolution. The CT scan data were reconstructed three dimensionally via Analyze AVW software, and visualized as volume rendering mode. The reconstructed volume data was realigned using 4 anatomical landmarks, nasion, basion, left and right external auditory meatus. After all data sets were realigned with same orientation, the target axial slice was obtained. The target slices are determined that is passing the center of the sellar trucica. The anterior, posterior and lateral distances were measured and the midsagittal angles were measured on the selected target slices. The pre- and post-operative data of measurement were compared. As results, the growth of affected side was seemed to be more rapid than that of normal side in patients who had undergone surgery at the time of 4 and 9 months old. Midsagittal angle was also increased up to about 180 degrees. However it was not definite in the 18month old patient. These results can be an evidence of the compensatory growth of the synostotic cranial base of synostosed side as same as other previous reports, however, much more cases should be examined to make the results to be more objective.

Torsion of Ovarian Cyst in the Fetal Period: a Case Report

Ovarian cyst is found in 32% of necropsies in neonates, and can be visualized during gestation by ultrasonography. The clinical evolution of these cysts is variable, but in most cases the prognosis is favorable. Ovarian torsion, bleeding, rupture, and peritonitis have been described as complications. We report a newborn girl with torsion of ovarian cyst. A cystic mass measuring 41.9x31.9 mm on left side of abdomen was identified at 32 weeks of gestation by fetal ultrasonography. Surgery was performed after birth.

A Case of Medullomyoblastoma of Cerebellopontine Angle Mimicking Acoustic Neuroma

Medulloblastoma is a common malignant central nervous system neoplasm found mainly in children. One the contrary, medulloblastoma of the cerebellopontine angle, the location of the tumor is very unusual. This is the the first case of the medullomyoblastoma, a rare form of medulloblastoma, occurring in the cerebellopontine angle. A 15-year-old boy experienced a sudden hearing loss in the left ear. Conservative medical treatment failed, and temporal MR imaging revealed a heterogeneously enhancing mass at the left cerebellopontine angle cistern and in the internal auditory canal; therefore, the lesion was regarded as a typical acoustic neuroma. Few days before surgery, an ipsilateral facial palsy developed, and a follow-up MR imaging showed a rapid growth of the previous lesion. The extended translabyrinthine approach permitted surgical removal. And under pathological diagnosis of malignancy, radiation therapy and series of chemotherapy was performed.

Imaging Findings of Mantle Cell Lymphoma Involving Gastrointestinal Tract

Clinical manifestations and imaging findings of mantle cell lymphoma involving gastrointestinal tract were evaluated. The subjects were 7 cases of mantle cell lymphoma involving the gastrointestinal tract. All cases were pathologically confirmed in our hospital during the period from April 1994 to July 2000. Five patients were male and 2 were female, and their age ranged from 49 to 63 years (average 57.4). The objectives were: 1) characteristics and distribution of multiple polyposis, 2) presence, location and enhancement pattern of bowel wall thickening or mass formation, 3) presence of splenomegaly, 4) presence and location of abdominal lymph node enlargement, 5) involved extra-abdominal organs, 6) combined cancer and location, and 7) other findings. All mantle cell lymphomas occurred in elderly persons, over 40 years, and most showed multiple polyposis (6/7), bowel wall thickening or mass formation (6/7), lymph node enlargements (6/7) and extra- abdominal involvement (5/7). All cases of polyposis involved the small bowel and colon, and the size of the polyps ranged from 0.1-4.0cm. Four of 6 patients showed combined sessile and polypoid polyps, while the other 2 showed only sessile polyps. Most of or some of the polyps in 3 patients showed small central ulcerations. Most of the patients (5/6) showed an uncountable number of polyps. Polyposis was predominant in the rectum, ascending colon, rather than other sections in the colon, and the ileum were almost always involved by polyposis. Bowel wall thickening or mass formation developed exclusively in the ascending colon, rectum or ileum. Extra- abdominal involvement developed either simultaneously or nonconcurrently with gastrointestinal involvement. Some of patients showed splenomegaly (3/7), appendiceal enlargement (2/7), and intussusception (1/7), and some had associated adenocarcinomas (3/7).

Radiologic Findings of Vestibulocochlear Nerve Deficiency: CT and MRI / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Sensorineural hearing loss (SNHL) could be caused by dysfunction of the cochlea, abnormality of vestibulocochlear nerve (VCN), or disorder of central auditory pathway. Among these causes, VCN deficiency is one of the causes of profound sensorineural hearing loss. The aim for this study was to evaluate radiologic characteristics of VCN deficiency by reviewing temporal bone computed tomography (TBCT) and magnetic resonance image (MRI) findings of patients with profound unilateral SNHL, diagnosed as VCN deficiency and also, we compared the width of the bony canal of the cochlear nerve (BCCN) between the normal and affected side on TBCT and tried to clarify the diagnositc value of BCCN. MATERIALS AND METHOD: We reviewed TBCT and temporal submillimetric axial and parasagittal 3D turbo spin echo (3D-TSE) T2-weighted MRI of 9 patients who were diagnosed as unilateral VCN deficiency. We evaluated MRI findings in terms of the presence and comparative size of the component nerves (facial, cochlear, superior vestibular, inferior vestibular nerve) then we classified the type of VCN deficiency, according to the Casselman's proposal. We compared the difference of width of IAC and BCCN between normal and affected side on TBCT. RESULTS: We could find the detail anatomic feature of VCN in IAC by parasagittal MRI and could classify the type of VCN deficiency of patients, based on the Casselman's classification. According to the result of the classification, 8 patients were type 2A and the other one was type 1. In the TBCT study, the size of IAC and BCCN of the affected 8 ears were smaller than that of side and one patient had normal IAC but narrow BCCN of the affected ear. CONCLUSION: In this study, we conclude that TBCT and MRI could be useful methods for diagnosis of VCN deficiency. Also, the hypoplastic bony canal of the cochlear nerve on TBCT is finding to overlook easily and may be another important indicator for evaluating VCN deficiency.

A Case of Malignant Myoepithelioma in Parotid Gland / 대한이비인후과학회지

Myoepithelial cells are a significant component of most types of salivary gland neoplasms, but, pure myoepitheliomas are rare, comprising less than 1% of all salivary gland tumors. Malignant myoepithelioma, or myoepithelial carcinoma, is even more rare. It occurs most frequently in the parotid gland among salivary glands, and is similar to benign myoepitheliomas. The palate is the most common intraoral site of involvement. As far as the treatment of myoepithelial carcinoma is concerned, surgical excision is the mainstay of therapy. The role of radiation therapy and chemotherapy is not yet established. We present a case of malignant myoepithelioma of the left parotid gland in a 67-year-old female patient who was treated with surgical excision followed by adjuvant radiation therapy.

Clinical Analysis of Basal Skull Fracture / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Basal skull fractures are different from cranial vault fractures in several aspects. These fractures are difficult to diagnose by ordinary X-ray, routine head CT and are frequently inferred from clinical signs. It involves more commonly the cranial nerves, makes fistulae of cerebrospinal fluid (CSF) and lead to central nervous system infections. Despite the clinical significance of basal skull fracture in otorhinolaryngology, there have been only a few clinical studies. So we began this research for better treatment of basal skull fracture (BSF). MATERIALS AND METHOD: The authors analyzed 100 cases of basal skull fracture treated in the department of neurosurgery, from January 1998 to December 2000. We reviewed the clinical features, radiologic findings, and rate of delayed diagnosis. RESULTS: The basal skull fractures were more common in men than women. In the decreasing order of cause in basal skull fractures were traffic accidents (64%), fall down and assault. Clinical features were nasal bleeding (42%), ear bleeding (41%) and hearing loss (36%). Most of CSF leakages were noted within 24 hours after injury and had ceased by conservative management. The degree of facial palsy had an influence on the recovery of facial nerve function. The types of hearing loss had a role in the recovery of hearing. Six cases (6%) were delayed in the diagnosis of BSF. CONCLUSION: In the BSF patient's treatment, many parts needed otorhinolaryngological treatment. But in the patient's treatment, otorhinolaryngological problems had been ignored by the neurosurgical concerns. From the otorhinolaryngoloical aspect, BSF patients should be given an active treatment.

A Case of Extramedullary Plasmacytoma of the Larynx / 대한이비인후과학회지

Extramedullary plasmacytoma is a rare soft tissue malignancy composed of plasma cells. This tumor may be primary or secondary to the generalized multiple myeloma. The great majority of extramedullary plasmacytoma occurs in the head and neck region, mainly in the upper respiratory tract and oral cavity. The most frequently involved sites are the nasal cavity, paranasal sinus, and nasopharynx, in the decreasing order. However extramedullary plasmacytoma of the larynx is rare. Laryngeal plasmacytomas accounts for between 6 to 18% of all extramedullary plasmacytomas. We report, with a review of literature, a case of extramedullary plasmacytoma of the larynx in a 41 year-old female patient.