Intranasal Helicobacter Pylori Colonization in Chronic Rhinosinusitis Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Helicobacter pylori (HP) has been reported to be detected in lower esophagus, palatine tonsil, and adenoid. The object of this study was to investigate the prevalence of HP in the nasal cavity of chronic rhinosinusitis (CRS) patients and compare the results with those of healthy controls. SUBJECTS AND METHOD: 43 patients aged 18 to 68 years with CRS who underwent endoscopic sinus surgery and 16 healthy controls aged 24 to 72 years without sinus diseases were enrolled in this study. Tissue samples were collected from nasal polyp or the mucosa of sphenoethmoidal recess. HP infection of nasal cavity was investigated using rapid urease (CLO) test and immunohistochemical (IHC) analysis. GER symptoms and esophagogastroscopic findings were gathered by questionnaire or medical records. RESULTS: HP was detected in nasal cavity by CLO test in 17 of 43 patients (40%) with CRS compared with none of 16 healthy controls (0%) (p=0.003), and 19 of 43 patients (44%) by IHC analysis compared with 2 of 16 healthy controls (13%) (p=0.032). Eleven of 43 patients (26%) were positive in both CLO test and IHC analysis but none of controls (0%) was positive in both two tests (p=0.026). Four of 8 patients (50%) who complained GER specific symptoms were HP positive in both two tests (p=0.033). CONCLUSION: HP was detected in nasal cavity and it was more prevalent in patients with CRS than healthy controls without sinus diseases. GER may have a positive correlation with the colonization of HP. However, whether HP is a causative agent for CRS or a result of CRS is not known.

Parathyroid Hormone as an Early Predictor of Post-thyroidectomy Hypocalcemia / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Parathyroid dysfunction following a total or completion thyroidectomy is not uncommon and it may be associated with significant patient morbidity. If there is a simple test with proven high predictability for identifying which patients will develop hypocalcemia, it would be very useful to determine the necessities of careful monitoring and calcium replacement. The purpose of this study is to determine which test would be the most valuable predictor of post-thyroidectomy hypocalcemia. SUBJECTS AND METHOD: Prospective series of 63 consecutive patients undergoing total or completion thyroidectomy were enrolled for this study. Calcium and ionized calcium were measured before and immediately after surgery, and daily during hospitalization. Parathyroid hormone (PTH) was measured immediately after surgery and early in the morning of the next day. Slopes of serum calcium, ionized calcium and PTH level change were calculated. Sensitivity, specificity and predictive values of each test for the symptomatic and biochemical hypocalcemia were compared. RESULTS: With the cut-off value of 10 pg/ml of spot PTH, sensitivity, specificity, positive and negative predictive values of hypocalcemia were 97%, 64%, 77% and 95% respectively. By combining the spot PTH and the slope of ionized calcium change, the above values became 94%, 82%, 87% and 92%. CONCLUSION: Immediate postoperative spot PTH level was the most valuable single test for predicting post-thyroidectomy hypocalcemia. Combination of a spot PTH and the slope of ionized calcium change resulted in improved specificity and positive predictability.

Management of Calculi in the Hilum of Submandibular Gland: Intraoral Removal with Marsupialization of the Duct / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The excision of submandibular gland (SMG) has been commonly used for the treatment of calculi in the hilum of SMG, since intraoral removal of the hilar stone has the potential risk of lingual nerve injury and the poor surgical field. However, it would leave loss of remained gland function and external scars after the excision. Therefore, the authors modified the intraoral retrieval techniques as the marsupialization of the Wharton's duct up to the calculi in the hilum. This study reports our clinical experience with the modified intraoral retrieval technique and the advantages of this modality for calculi in the hilum of SMG. SUBJECTS AND METHOD: SMG excision and intraoral removal with marsupialization (IRM) were used from 1994 through 2003 to treat 9 and 16 cases of calculi in the hilum of SMG, respectively. We analyzed the characteristic findings of calculi, surgical morbidities and complications by comparing two different treatment groups. RESULTS: The mean diameter of the calculi was 6.1 mm in patients with SMG excision and 7.8 mm in patients with IRM. The success rate of extraction by IRM of calculi in the hilum were 86.7%. The surgical complications were similar in both groups. The proportion of palpable calculi were significantly increased in the IRM group (92.9% vs 22.2%). We failed to remove the stone by IRM from patients, and stones were impalpable intraorally preoperatively. CONCLUSION: IRM is an excellent alternative method for the removal of palpable calculi located in the hilum of SMG. Furthermore, it would preserve the salivary gland function without external scars and with acceptable surgical complications and morbidities.