Is the Patient-Controlled Analgesia(PCA) Helpful for the Recovery from the Tonsillectomy? / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study investigates the effect of patient controlled analgesia (PCA) on post-tonsillectomy pain for the first two weeks of operation, and its effects on the postoperative bleeding and the pain duration. SUBJECTS AND METHOD: In a prospective group study, 43 patients with tonsillectomy were studied. PCA was applied for 48 hours after surgery. Pain scores, postoperative bleeding, and pain duration were compared. RESULTS: PCA reduced postoperative pain during the time it was appled but pain was worse after disconnection. There were no differences between the groups regarding postoperative bleeding and recovery time. CONCLUSION: PCA could effectively control the post-tonsillectomy pain only during its application period. It was not helpful for long term pain control, pain duration, or post-tonsillectomy bleeding. Other long lasting and effective pain control method should be administered to reduce post-tonsillectomy pain during the recovery period.

A Case of Stapedectomy with Total Ossicular Replacement Prosthesis in Stapes Fixation without Malleus and Incus / 대한이비인후과학회지

This study was done on a case of chronic otitis media in both ears of a 47-year-old woman who received tympanization in the left middle ear in a local hospital three years ago. Ossiculoplasty was not tried in this case due to fixation of the stapes. However, conductive hearing loss of the left ear continued after tympanization, necessitating middle ear exploration. After the exposure of middle ear cavity, we found the absence of malleus and incus, and the fixation of stapes. Stapedectomy was carried out and total ossicular replacement prosthesis was also performed for the protection of the oval window by using perichondrium, cartilage and fascia. Postoperative bone conduction showed improvement of 15 dB, and air conduction showed improvement of 22 dB. After the operation, an average air-bone gap was improved within 10 dB. We experienced good hearing improvement without significant complications during the follow up period.

Analysis on the Treatment Outcome of Early Glottic Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The choice of the treatment in early glottic cancer depends on various factors. To evaluate the differences between the radiotherapy and conservation, laryngeal surgery including laser cordectomy, vertical hemilaryngectomy and supracricoid partial laryngectomy in early glottic cancer is thought to be valuable in defining the exact indication and recommending treatment modality on the early glottic cancer patients. MATERIALS AND METHOD: The medical records of 136 patients with glottic TisN0, T1N0 or T2N0 cancer diagnosed at Asan medical center, University of Ulsan college of medicine from May, 1989 to July, 2001 were retrospectively reviewed. The five-year survival rate, local control rate, and expenses were compared among the radiation therapy group, the laser cordectomy group and the partial laryngectomy group. RESULTS: Surgical management and radiotherapy showed 97.2% and 96.0% 5-year survival rate, respectively. And laser cordectomy and partial laryngectomy had 95.0% and 92.9% local control rate, respectively while radiotherapy got 87.6% local control rate. Laser cordectomy costs lower than any other treatment. CONCLUSION: On the basis of the oncologic result, both the surgery and radiotherapy had the similar results, but surgical management seemed to show more organ preservation rate. Besides, in anterior commissure invasion, there was no significant difference between the survival and local control rate between surgery and radiotherapy.

A Case of Acute Generalized Exanthematous Pustulosis with Erythema Multiforme-like lesions / 대한피부과학회지

Acute generalized exanthematous pustulosis(AGEP) is a disease entity caused mostly by drugs or viral infections. Clinically, it manifests as generalized erythema and tiny pustules with fever, but may manifest targetoid lesions, purpura, edema, blisters and mucosal erosions in addition to pustules. We describe a case of AGEP with erythema multiforme-like features in a 46 year old woman who presented with acute onset of high fever and a noticeably polymorphic eruption consisting of numerous tiny pustules on erythematous bases, edematous targetoid lesions and purpuric lesions. The histology revealed subcorneal neutrophilic pustules on the tiny pustular lesions and markedly papillary dermal edema on the erythema multiforme-like lesions. Systemic corticosteroid and antihistamines were initiated, resulting in rapid resolution without recurrence.

A Case of Verrucous Hemangioma in Flank, an Unusual Location / 대한피부과학회지

Verrucous hemangioma is an infrequent variant of deep-seated capillary or cavernous hemangioma with reactive epidermal hyperplasia. The lesion generally appears at birth or in early childhood, mostly on the lower limbs and typically present as warty, bluish, vascular papule, plaque or nodule. A 6-year old girl presented with well-circumscribed, hyperkeratotic, red-black, vascular nodule on her right flank. Histopathologic examination showed characteristic features of verrucous hemangioma. We report a case of verrucous hemangioma developed on an unusual site.

Chronic Cutaneous Graft versus Host Disease: Clinicopathologic study / 대한피부과학회지

BACKGROUND: Chronic graft-versus-host disease(GVHD) is a major cause of morbidity and mortality in long-term survivors of bone marrow transplantation, an increasingly used therapeutic option for hematological disorders. Cutaneous manifestations are frequently the presenting feature; therefore, the dermatologist needs to be aware of the wide spectrum of chronic cutaneous GVHD, enabling early diagnosis and management. OBJECTIVE: We investigated the clinical and histological features of chronic cutaneous GVHD in recipients receiving allogenic BMT. METHODS: On the basis of the patients' charts, photographs and biopsy specimens, we investigated the occurring interval, clinical manifestations and histological characteristics of chronic cutaneous GVHD in 37 patients from January 1, 1996 through December 31, 2000. RESULTS AND CONCLUSION: 1. The chronic cutaneous GVHD was preceded by the acute form of GVHD in 56.7% of patients, and occurred as an extension(18.9%) of acute GVHD, after a disease-free interval(37.8%), or with no precedent(43.2%). The disease usually developed at a mean 251days after transplant. 2. The chronic cutaneous GVHD mainly presented as maculopapular(37.8%), lichenoid(37.8%), or sclerodermoid(13.5%) patterns. 3. Histologically, 35.1% of biopsy specimens showed characteristic acute GVHR-like change, 40.5% showed lichen planus-like, and 13.5% was scleroderma-like histology. Lichen planus-like feature mixed with scleroderma-like was 2.7%, and 8.1 % was non-specific. 4. Appearing after day 100, the acute GVHD other than chronic GVHD was detected in some cases, and the lichenoid rash of chronic GVHD in one case was observed as early as day 60. 6. Our opinions are that the time of occurrence is not a reliable parameter for the clinical picture of GVHD and histologic parameters do not absolutely separate between acute and chronic GVHD as defined by days after BMT. 7. Mortality rate was 21 % in our cases.

A Case of Annular Pustular Psoriasis / 대한피부과학회지

Pustular psoriasis refers to a group of disorder characterized by recalcitrant, sterile pustular eruption. It classified into four clinical patterns: Zumbusch, annular, exanthematous, and localized. Annular pustular psoriasis consists of gyrate, annular lesions with an erythematous, scaly, pustular margin. In contrast to the Zumbusch variety, the annular type is benign and less severe. We herein report a case of annular pustular psoriasis of a 9-year-old girl with review of the literature.

The Effect of Radiation Therapy on Paranasal Sinus Opacification in Nasopharyngeal Cancer Patients

BACKGROUND AND OBJECTIVES: Previous studies have reported that irradiation influences mucociliary clearance by damaging ciliary motility in respiratory mucosa. The purpose of this study is to investigate the effect of radiotherapy (RT) on opacification of paranasal sinuses in patients with nasopharyngeal carcinoma, and to find out what kind of influence anatomic variations such as nasal septal deviation or concha bullosa may have on the pathogenesis of sinus opacification. MATERIALS AND METHODS: Subjects were 26 patients (19 males and 7 females, aged 23 to 69) of early nasopharyngeal carcinoma (T1, T2) who were treated with RT between 1989 and 1999. Pre-RT and post-RT Computerized Tomography (CT) and medical records were reviewed retrospectively. The mean radiation dosage was 6965 cGy and mean follow-up period was 30 months (6 months to 7 yeas 1 month). Eighteen patients had nasal septal deviation and 9 patients had nasal septal deviation with concha bullosa. A total of 52 maxillary sinuses and 52 ethmoid sinus sides were analyzed. RESULTS: In 15 (57.7%) of 26 patients, opacifications of sinuses were newly developed or were aggravated after RT. The prevalence of aggravated sinus opacification according to anatomic variations was as follows : 30.8% in no anatomic variations, 32.1% in the concave side of nasal septal deviation, 36.8% in the convex side of nasal septal deviation, 42.9% in the concave side of nasal septal deviation with concha bullosa, and 68.8% in the convex side of septal deviation with concha bullosa. There was a significant difference in sinus opacification between sinuses without variations and sinuses with septal deviations combined with concha bullosa (p<0.05). CONCLUSION: These data suggest that irradiation of the nasopharynx may induce or aggravate paranasal sinusitis, and anatomic variations such as nasal septal deviation or concha bullosa may contribute to the pathogenesis of sinusitis.

A Case of Cold Urticaria and Cholinergic Urticaria in the Same Patient / 대한피부과학회지

Cold urticaria and cholinergic urticaria are considered to be distinct disorders in which mediator release and hives can be induced by different stimuli. Cold urticaria can be induced by cold stimuli, and cholinergic urticaria, characterized by micropapular wheals, by exercise, emotional stimuli, or other stresses that increase the body temperature. While neither cold urticaria nor cholinergic urticaira is rare, it is unusual to see both disorders occurring in the same patient. Also, our case presents atypical urtication to cold exposure, similar to classic cholinergic urticarial lesions, called "cold-induced cholinergic urticaria". We present a 20-year-old man with 4-year history who experienced generalized micropapular wheals induced by cold exposure as well as exercise and hot environment.

A Case of Primary Cutaneous CD30 Negative Large T cell Lymphoma / 대한피부과학회지

Primary CD30 negative large T cell lymphomas consist of CD30 negative large tumor cells without prior or concurrent mycosis fungoides. Clinically, it presents with solitary, localized or generalized plaques, nodules, or tumors and most cases show an aggressive clinical course. The histologic appearance may be identical to that of classic mycosis fungoides undergoing transformation into large cell lymphoma and large tumor cells represent at least 30 percent of the total tumor cell population. We experienced a case of CD30 negative large T cell lymphoma and report it with a review of literatures.

A Case of Linear and Whorled Nevoid Hypermelanosis Associated with Congenital Hemihypertrophy / 대한피부과학회지

Linear and whorled nevoid hypermelanosis(LWNH) is a congenital disorder characterized by hyperpigmented macules in a linear and whorled pattern along Blaschko's lines, and develops a few weeks after birth. Skin manifestations closely resemble hypomelanosis of Ito with inverse pigmentation. There is no preceding inflammatory event and no pigmentary incontinence histologically. It may be associated with various congenital abnormalities. We report a case of linear and whorled nevoid hypermelanosis associated with congenital hemihypertrophy of left extremities in a 10-year old boy.

Comparative Analysis of Diagnostic Tools for Parapharyngeal Tumors / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The parapharyngeal tumors are rare and treated mostly by surgical removal. The preoperative diagnosis of parapharyngeal tumors is very important because the surgical removal of neurogenic tumor, which is the main mass in the parapharyngeal space, can induce severe complications. There are many diagnostic tools for parapharyngeal tumors and their effectiveness are variable. In this study, we focused on the diagnostic accuracy of each diagnostic tool. SUBJECTS AND METHOD: We compared the preoperative diagnostic results with the final pathologic reports of 56 parapharyngeal tumors. Diagnostic tools used were computed tomography (CT), magnetic resonance imaging (MRI), ultrasonography (US), and fine needle aspiration biopsy (FNAB). RESULTS: The diagnostic accuracy of MRI, CT and US was 68.2%, 51.6% and 42.8%, respectively. The sensitivity (83%) and specificity (87.5%) of FNAB for neurogenic tumor are higher than those of MRI (75%, 50%). CONCLUSION: These results suggest that FNAB is the most precise and reliable diagnostic tool and MRI is the most reasonable and effective imaging study.

Treatment of Wart by Formic acid / 대한피부과학회지

BACKGROUND: Various modalities are available to treat warts, but surgical or destructive treatments are problematic in children and intolerable patients because these modalities are painful and frightening. For these reasons, some treatment strategies, such as keratolytic, caustic, and immunomodulatory agents, to reduce pain and discomfort are under investigation. OBJECTIVE: This study is to evaluate the efficacy and safety of 85% formic acid for the treatment of warts. METHODS: Twenty patients with 52 lesions of warts were included. Formic acid was applied to the warts using stick 1 to 5 times according to the degree of response. This procedure was repeated at 2-6 day-intervals until the lesions disappeared. Assessment for response and the occurrence of side-effects was performed every visit until clinical cure or up to a maximum of 10 weeks RESULTS: Twenty-six of 52 (50%) lesions showed complete clearance. Fifteen (29%) showed partial clearance-good, which is a >50% reduction in wart size, and 10 (19%) showed partial clearance-poor, which is a <50% reduction. Only one(2%) showed no response. The number of treatments required for the warts to disappear was 1-9 (mean 5). Seven patients reported adverse effects, such as pain, stinging, nail discoloration, and erythema, but were generally mild and transient. CONCLUSION: 85% formic acid is a relatively safe and effective alternative in the treatment of warts with few side-effects and good compliance.

A Case of Dermal Duct Tumor / 대한피부과학회지

Dermal duct tumor arising from the intradermal portion of the eccrine duct is a variant of benign eccrine sweat duct tumor. The tumor is a rare, usually occurs on the head and neck or limbs and presents as a non-characteristic, usually asymptomatic, flesh-colored or erythematous, firm nodule or papule. Histologically, the tumor lobules are located principally in the dermis with or without connection to the epidermis, showed similar architectural features and identical cytologic features of eccrine poroma. We report a case of dermal duct tumor which developed on the left calf area in a 57-year-old male patient

A Case of Pigmented Bowen's Disease in Perianal Area / 대한피부과학회지

Pigmented Bowen's disease is an unusual form of squamous cell carcinoma in situ characterized by a hyperpigmented appearance, which is exceedingly uncommon and represents less than 2% of Bowen's disease. An 80-year'old woman developed a sharply demarcated, irregularly marginated, hyperpigmented plaque with a velvety surface on her perianal area. Microscopically, the cells of the stratum malphighii lay in a disordered pattern, and many cells were atypical. Increased melanin pigment was noted throughout the epidermis and in the upper dermis. We report a case of pigmented Bowen's disease developed on perianal area in an 80-year-old female patient

A Case of Actinomycosis of the Zygomatic Region / 대한의진균학회지

Actinomycosis is a chronic suppurative and granulomatous bacterial infection most commonly involving the cervicofacial region, thorax and the abdomen. Cervicofacial infection is the most frequent presentation and this results when microorganism invading damaged oral mucosa following dental extraction or other mouth trauma, causing a painful, indurated cutaneous and soft tissue swelling. Actinomycosis on the face can mimic various infectious or inflammatory skin diseases and a high degree of clinical suspicion should be entertained. We report a rare case of cutaneous actinomycosis in a 63-year-old male who presented solitary firm nodule with purulent discharge and fistula on the right cheek. He denied any recent dental procedure or trauma to the area. Histopathologic findings showed acute and chronic inflammation with characteristic sulfur granules consisting of a granular basophilic center surrounded by a radiating zone of eosinophilic, hyaline, club-shaped projection.

A Case of Papuloerythroderma of Ofuji / 대한피부과학회지

Papuloerythroderma of Ofuji is a rare, distinctive clinical entity characterized by a widespread pruritic eruption of coalescence of flat-topped erythematous papules producing an erythroderma with sparing of the skin folds (the 'deck-chair' sign). Other common features of papuloerythroderma are blood eosinophilia, lymphopenia, a raised serum IgE and a nonspecific or eczematous-like histopathologic feature. Its etiology has been reported as variable, and the condition is thus considered as a pattern of cutaneous expression induced by a range of pathological process for systemic disease. We experienced a 71-year-old male patient with a 4-month history of a generalized pruritic eruption which clinical features were compatible with papuloerythroderma of Ofuji. Treatment with systemic steroid resulted in marked improvement.

A Case of Nodular Melanoma Mimicking Seborrheic Keratosis / 대한피부과학회지

The diagnosis of nodular melanomas can be sometimes difficult, in case they lack the conventional clinical features of melanoma. Herein, we report a case of malignant melanoma mimicking seborrheic keratosis. The clinical diagnosis was seborrheic keratosis. The histopathologic examination revealed nodular melanoma with features of reticulated form of epidermal hyperplasia, pseudohorn cysts, and irregular hyperkeratosis and acanthosis. The tumor was excised with 2.5 cm margins and no remnant of tumor cells was found in the microscopic examination.

A Case of Trichotillomania Associated with Diffuse Neurofibroma / 대한피부과학회지

A 13-year-old girl presented in our unit with progressive alopecia and a long history of edematous scalp in the occiput. Biopsy specimen of a lesion showed two-type pathologic abnormality consisting of diffuse neurofibroma in the lower portion and trichotillomania in the upper portion. Since the tumor spread diffusely through the lower dermis and subcutaneous fat tissue without destroying surrounding structures, we concluded that the trichotillomania might result from repetitive scratching or other traumatic behavior at the same site of underlying diffuse nerurofibroma. We reported a case of the concomitant occurrence of trichotillomania associated with diffuse neurofibroma.

Clinical Analysis on the Cystic Lesions in the Maxilla

BACKGROUND AND OBJECTIVES: Jaw cysts are frequently diagnosed by dentists, however they are also presented with symptoms specific to otolaryngology which are different from common symptoms found in dentistry. Thus, those diagnosed by otolaryngologists are likely to show different clinical manifestations. The purpose of this study was to investigate the clinical characteristics of jaw cysts found in otolaryngology. MATERIALS AND METHODS: A retrospective study was carried out. Frequency, sex, age, symptoms, site of occurrence, histopathology, treatment and results of 30 jaw cysts, were analyzed. These were diagnosed and surgically treated between May, 1990 and August, 1998 at our otolaryngology department. RESULTS: Among 30 jaw cysts, there were 15 cases (50%) of nasolabial cysts, 8 cases (27%) of dentigerous cysts, 5 cases (17%) of nasopalatine cysts and 2 cases (6%) of radicular cysts. Nasolabial cysts (NLC) were the most common among middle-aged females, and they showed a common complaint of cheek swelling. They were all removed surgically by gingivobuccal incision. One case of cellulitis was reported postoperatively and it was treated with antibiotics. Dentigerous cysts (DC) were mostly found among young males. The most common chief complaint was cheek swelling. 4 cases (50%) of DC were associated with chronic paranasal sinusitis. In 5 cases (63%) the cysts were surgically removed after opening the maxillary sinus by gingivobuccal incision. 3 cases (37%) were removed by the Caldwell-Luc approach. Nasopalatine cysts (NPC) were prevalent during the third and fourth decade. Common symptoms were palatal swelling, pain and tenderness. All were treated with surgery by the transpalatal approach. One case of postoperative palatal fistula was reported and was successfully repaired. There were 2 cases of radicular cyst (RC). 1 case was removed by sublabial incision, and the other case was removed by the Caldwell-Luc approach. CONCLUSION: The most common jaw cysts in the maxilla were nasolabial cyst. Most jaw cysts were treated by surgery without recurrence.