The observation on the clinical effect of CSEA by using orbital needle external needle in PCEA post cesarean delivery / 中国医学装备

Objective: To observe the clinical effect of combined spinal epidural anesthesia(CSEA)by using orbital needle in patient-controlled epidural analgesia(PCEA)post cesarean delivery.Methods: 94 puerperas who received cesarean were divided into observation group(47 cases)and control group(47 cases).The patients of two groups were narcotized by using CSEA combined with PCEA.And the observation group adopted a new type of lumbar vertebral combined puncture needle and the control group adopted the traditionally typical lumbar vertebral combined puncture needle.The score of visual analogue scale(VAS)and sedation score of Ramesay of two groups of postoperative 1h,4h,12h,24h and 48h were compared.And the number of times in 48h,the drug dosage and adverse reaction of using analgesia pump also were compared.Results: In postoperative 12 h,the VAS scores of the two groups showed an increasing trend.And the VAS scores of pain of two groups within postoperative 12-48 h decreased gradually.The differences of VAS scores of pain of two groups within postoperative 1-12h and 12-48h between observation group and control group were statistically significant(F=29.596,F=156.366,P＜0.05),respectively.And the VAS scores of pain post operative 4h and 12h of observation group [(2.01±0.51)and(3.49±0.74)]were significantly lower than that of control group [(2.32±0.47)and(3.85±0.69)](t=3.064,t=2.439,P＜0.05),respectively.Within postoperative 1-48h,there were no significant fluctuation in sedation score of Ramesay and the difference of sedation score between the two groups were no significant.And the number of times(11.35±3.04)and drug dosage(65.67± 7.98)mL of using analgesic pump of observation group were significantly lower than that of control group [(20.08±5.32)and(82.07 ± 9.05)mL],(t=9.768,t=9.318,P＜0.05),respectively.Besides,the incidences of postoperative nausea and skin pruritus of observation group(4.26％and 14.89％)were significantly lower than that of control group(17.02％and 34.04％)(x2=4.029,x2=4.663,P＜0.05),respectively.Conclusion: The analgesia effect of orbital needle external needle in implementing CSEA for cesarean delivery is better than that of traditional needle inner needle,and its adverse reactions are less and it is safety.

The Significance of Orbital Preservation in Surgery of the Sinonasal Malignancies / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Preservation of orbital contents during surgery of paranasal sinus malignant tumors encroaching on the orbit remains a controversial issue. The purpose of this study is to investigate significance of orbital preservation in the surgery of sinonasal malignancies abutted orbit in view of oncological safety and functional outcome. SUBJECTS AND METHOD: A retrospective review was conducted using medical records of 41 patients who underwent surgery between Mar 1991 and Feb 2006 for sinonasal malignancies abutting or eroding orbit. RESULTS: Among 41 cases of sinonasal tract malignancies abutting or invading into the orbit, thirty-four of 41 tumors were amenable for surgical treatment with orbital preservation and the remaining 7 underwent orbital exenteration. 71.4% (5/7) of the patients whose orbit was exenterated had local recurrence, compared with 20.5% (7/34) of the patients whose orbit was preserved. The 5-year survival rate was 50.0% in the orbit exenterated group and 59.9% in the orbit preserved group. This difference was not statistically significant (p> 0.05). In the preservation group, local recurrence rate was 27.1% (2/9) in the periorbita involvement group, 22.2% (2/9) in the bony destruction group and 14.3% (2/14) in the abutting orbit group. There is no statistically significant difference among three groups. Although some patients had problems, the fact that all patients retained their orbit demonstrates adequate visual acuity. CONCLUSION: Local recurrence and survival rate were not significantly different between the orbital preservation and exenteration group and also between the bony destruction and periorbita involvement group. So, in the selected case of periorbita invasion, orbital preservation could be considered.

A Case of Thymic Squamous Cell Carcinoma Misdiagnosed as a Thyroid Cancer / 대한이비인후과학회지

Thymic carcinoma is a rare tumor that develops in the anterosuperior mediastinum. The prognosis of thymic carcinoma is poor. It is often misdiagnosed as a thyroid tumor in the fine needle aspiration cytology because of its rarity and non-organotypic cytoarchitectural structure. We have experienced a case of thymic carcinoma that was misdiagnosed as a thyroid carcinoma in the clinical, radiologic and cytologic evaluation. The patient visited our department due to hoarseness. Neck and chest CT scan showed a huge mass, and we supposed a malignant thyroid tumor from lower pole of the thyroid, which extended toward the superior mediastinum. The fine needle aspiration cytologic diagnosis of the mass showed that it was anaplastic carcinoma of the thyroid. Total thyroidectomy including mass and selective neck dissection was performed. Postoperative pathologic diagnosis was squamous cell carcinoma of the thymus. So we report this case with a review of literature.

Treatment of Radicular Cyst in Maxilla / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Radicular cysts, the most frequent cyst of the teeth bearing areas, occur commonly in the premaxillary region of young and middle aged persons. The lesion is usually silent, but large radicular cyst, especially in the maxilla, can make various symptoms and signs. The purpose of this study was to investigate the clinical characteristics and proper treatment of the radicular cyst in the maxilla. SUBJECTS AND METHOD: Ten radicular cysts in the maxilla, which were diagnosed and surgically treated between January, 2004 and June, 2006 at the Department of Otolaryngology, were included for this retrospective study. Clinical variables such as sex, age, frequency, symptoms, site of occurrence, histopathology, treatment and results of surgery were analyzed. RESULTS: From incisor to canaine, about 62.1% of the radicular cyst occurred around pre-maxillary region. The average age was 34.1 years and the most commonly occurring age fell between 20 and 30 years old. The most common symptoms were facial swelling or mass. All patients had preoperative dental check-up, and underwent root canal therapies in seven cases and dental extraction in one case. Complete enucleation was performed in all patients by Caldwell-Luc approach, sublabial approach and trans-palatal approach. CONCLUSION: Root canal therapy and complete surgical enucleation were both effective treatment methods for radicular cyst.

A Case of Meningioma Presenting as a Nasal Polyp: Endoscopic Reconstruction of Skull Base Defect after Removing the Tumor / 대한이비인후과학회지

Olfactory groove meningioma extending into the paranasal sinuses and nasal cavities is unusual. On rare occasions, it presents in the nasal cavity as a polypoid mass with ENT symptoms. We have experienced a case of meningioma presenting as a nasal polyp, in which the only clinical symptom was the sensation of having a foreign body in the left nasal cavity. The patient underwent polypectomy at a local clinic without radiologic evaluation, but because the polyp seemed to have originated from the nasal roof the patient was referred to our hospital. Magnetic resonance imaging (MRI) revealed an extensive intracranial tumor with extracranial extensions into the ethmoid sinuses and nasal cavities, and the tumor was confirmed as meningioma by histological and immunohistochemical examination. The tumor was removed by a transcranial route, and the cranial base defect was repaired with various nasal mucosal flaps and with abdominal fat via an intranasal endoscopic approach. After 8 months of treatment, no evidence of recurrence or of mucosal defect was noted.