Cisplatin nephropathy in patients with lung cancer / 대한내과학회지

BACKGROUND/AIMS: This study characterized the cisplatin nephrotoxicity occurring in patients treated with chemotherapy for lung cancer. METHODS: In all, 124 patients with lung cancer received cisplatin 70 mg/m2 on day 1 every three weeks for up to six cycles with preventive hydration using 3 L of 0.45% saline. Acute and chronic cisplatin nephropathy were defined as an increase in serum creatinine > or =30% at 3 weeks after each cisplatin administration and an increase in serum creatinine > or = 50% after the six cycles of chemotherapy, respectively. RESULTS: Acute cisplatin nephropathy occurred in 23 of 124, 8 of 110, 6 of 92, 10 of 68, 7 of 59, and 7 of 45 patients after the 1st to 6th cycle of chemotherapy, respectively. In all, 51 patients (51.5%) experienced acute cisplatin nephropathy. Chronic cisplatin nephropathy occurred in 25 out of 45 patients (55.5%). The occurrence of chronic cisplatin nephropathy was significantly associated with that of acute cisplatin nephropathy (p<0.01). In chronic cisplatin nephropathy, the serum creatinine increased to 1.82+/-1.18 mg/dL from the basal 0.82+/-0.11 mg/dL (p<0.01). It was 1.60+/-1.05 mg/dL at the end of the follow-up period (112+/-90 days). CONCLUSIONS: Despite prophylactic hydration, the incidence of cisplatin nephropathy in patients with lung cancer is still high. Acute cisplatin nephropathy may predispose patients to chronic cisplatin nephropathy, but the latter does not seem to be progressive.

A Study for the Assessment of Disability and Compensation in Patients with Hearing Impairment / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Disability in hearing impairment represents not only an increase in hearing threshold level, but also unmeasurable subjective discomfort to patients. Until now, several guidelines for quantitative assessment of disability of hearing impairment have been offered. In Korea, laws for industrial accident compensation insurance (IACI) and disabled persons welfare (DPW), and guidelines proposed by American Medical Association (AMA) were frequently used to assess the degree of disability in hearing impaired patients, but there were some discrepancies in the methods and criterions of assessment among the different guidelines and laws. The purposes of this study were to compare these guidelines and look for the problems and to suggest a plan for the improvement in the objective assessment of disability in hearing impaired patients. MATERIALS AND METHOD: The grades of Korean laws for IACI and DPW were converted into the impairment percentage rates used in the AMA guideline. We compared inter-guideline and inter-grade differences in impairment percentage rates. RESULTS: We found several problematic areas in the grades of IACI and there were some differences in the understanding of the degree of disability in hearing impairment between guideline of the Korean laws and foreign guidelines. CONCLUSION: Some changes are needed to be made in the guidelines for disability assessment in the Korean laws for IACI and DPW. Modification of the current grading system into the percentage rating system that is suited to the Korean sociocultural situation would be beneficial in the objective and balanced assessment of the disability of hearing impaired patients.

Endoscopic Thyroidectomy via Axillary Approach / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: A hypertrophic scar of the anterior neck is the leading complaint of patients who underwent conventional thyroid surgery. In order to minimize the postoperative scars, endoscopic thyroidectomy via axillary approach was tried. SUBJECTS AND METHOD: Thirty-nine cases (female 37, male two, average age 36.3 yrs) with either benign unilateral thyroid nodule or cyst underwent endoscopic thyroidectomy. Under general anesthesia, less than 7 cm of skin incision was made in the axilla of the same side and subcutaneous tunnel was made over the clavicle. Specially created retractor was placed within the tunnel between platysma and sternocleodomastoid muscle, and under rigid endoscope (4 mm, 5 mm ; 0degrees, 30degrees) thyroidectomy was performed. RESULTS: There were 35 cases of thyroid nodulectomy, one case of isthmusectomy, and three cases of subtotal lobectomy. Complete enucleations with the intact capsule were 13 cases, 24 cases with partial rupture of the capsule, and two cases with incomplete removal of the capsule. The mean operative time was 112.5 minutes. Postoperative complications included one case of postoperative bleeding, two cases of delayed wound healing, three cases of paresthesia of shoulder and arm, and five cases of hypertrophic scar of the axilla. For all cases, hospitalization period was two days. CONCLUSION: Endoscopic thyroidectomy via axillary approach has an excellent cosmetic advantage; however, the procedure requires longer operation time of about three times the conventional method. Operation time can be reduced with the development of more versatile surgical tools. However, limited thyroidectomy surgery can not be avoided.

Total Arterial Revascularization Using Y-composite Graft for Isolated Left Main Coronary Artery Disease / 대한흉부외과학회지

BACKGROUND: For the treatment of isolated left main coronary artery disease, twelve arterial revascularizations with Y-composite grafts using left internal thoracic artery and radial artery or right gastroepiploic artery were performed. This study was performed to investigate whether Y-composite graft can satisfy the blood flow required to make myocardium act properly or not. Borderline stenotic lesions on the left main coronary artery, which are very prone to remodel the bypassed vessels due to competitive flows, were also considered. MATERIAL AND METHOD: Among 247 patients who underwent coronary artery bypass grafting from March 2000 to April 2003, 12 patients (4.7%) who had received total arterial revascularizations for the isolated left main coronary artery disease were studied retrospectively. RESULT: Left anterior descending arteries were bypassed with left internal thoracic artery by off-pump technique in all patients, however, 2 cases of left obtuse marginal branches were bypassed under on-pump beating heart. Except for one patient, who did not have an obtuse marginal branch more than 1 mm in diameter, 11 patients had gone through complete arterial revascularizaions by use of the Y shape arterial graft. Among five patients who had less than 75% stenosis, one patient showed string sign on left internal thoracic artery grafted to left anterior descending artery. However, two grafts to obtuse marginal branches were completely obstructed and one showed slender sign. There were no graft-dominant flow in patients with stenotic lesion less than 75%. On the contrary to the result of patients with stenotic lesions less than 75%, all the patients with stenotic lesions more than 90% showed graft-dominant blood flow. CONCLUSION: In conclusion, it is assumed that, when stenotic lesions are over 90%, coronary artery bypass grafting with an Y shape arterial graft could possibly give enough help to the obstructed coronary arteries in blood supplying to myocardium, which needs massive quantity of blood to act well. However, when patients have borderline stenoses, through scrupulous examinations, more prudent and flexible decisions are required in choosing the treatment methods, such as, direct anastomosis of vein or artery to aorta, or adding supplementary treatment methods like percutaneous coronary intervention, rather than choosing a fixed treatment methods.

Treatment of Intra-Oral Ranula with Picibanil(R) in Children / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although surgical excision has been considered to be the treatment of choice by most of the surgeons, sclerotherapy of ranula has gained popularity during recent years. A prospective clinical trial was conducted to evaluate the efficacy of Picibanil(R) sclerotherapies for treating ranula children. SUBJECTS AND METHOD: Three patients were enrolled in the study conducted during 2002. All patients were not hospitalized. Picibanil(R) was injected into the lesion. One girl and two boys with ages ranging from 8 to 12 years were treated. RESULTS: Disappearance or marked reduction of the lesion and no recurrence of the ranula were observed in all children. Following each injection, local pain at the injection site was observed in 2 children and transient fever was observed in one child, but such problems resolved within a few days and no serious complication was developed. CONCLUSION: Our experience gives a suggestion that intralesional injection therapy using Picibanil(R) for intraoral ranula is relatively safe and can be used as a substitute for surgery in the treatment of ranula.

A Case of Inflammatory Fibrosarcoma in the Maxillary Sinus / 대한이비인후과학회지

Inflammatory fibrosarcoma is an uncommon disease that results from accumulation of inflammatory cells and relatively high recurrences rate in childhood. It has been reported that it most often occurs in lungs and sometimes in gastrointestinal tract, and head and neck. Head and neck lesion is from nasal cavity and paranasal sinus. Early symptoms are nonspecific and early diagnosis is difficult. Most cases are therefore diagnosed at the late stage. Invasion of inflammatory fibrosarcoma to orbital wall, cribriform plate and skull base is also common. We present a 75-year-old woman with inflammatory fibrosarcoma, which occurred in the right maxillary sinus and nasal cavity.

Anthropometric Growth Study of the Auricle in Korean / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Knowledge of the postnatal growth of ear is decisive in determining the optimal time for ear reconstruction and planning the morphology of an artificial ear. However, basic population studies have not been carried out in Korea and the dynamics of ear growth and the age of maturation have not been clearly determined and established. The aim of this study was to establish the age of ear maturation and to help determine the optimal time of ear reconstruction for Koreans. SUBJECTS AND METHOD: From June 2000 through February 2001, we measured facial length and the 3 lengths of the auricle, i.e., length, width, the distance between the two insertion points of the auricle and facial length in 950 Korean subjects between the ages of 0 to 18. RESULTS: The auricle length reached 90% of its mature size at 14 years and width at 15 years. The distance between the two insertion points of the auricle was not significantly different in this study. CONCLUSION: The length and width of auricle reached 90% of the adult size at the age of 14 and 15, respectively. Therefore, when performing auriculoplasty, consideration should be given for auricle growth up to the age of 15 years.