A Case of Peritoneal Sarcomatoid Mesothelioma with Absence of Occupationl Exposure to Asbestos / 고신대학교의과대학학술지

Sarcomatoid mesothelioma is not very common, mesothelioma is directly attributable to occupational asbestos exposure, with 90% of cases showing a history of exposure. A 66-year-old male was admitted with an abdominal pain that persisted for 3 weeks. He had no abdominal mass. Computed tomography showed soft tissue thickening in perihepatic space and nodularities in omentum and peritoneum with ascites. There was no absolute diagnosis evidence in ascites analysis. Although the pathology of ascites was free for malignancy, the patient underwent omentum biopsy for definitive diagnosis. In laproscopic exploration, there was omental cake, peritoneal nodular seeding. It was suspected cancer carcinomatosis. Immunohistochemical findings suggested that it was sarcomatoid masothelioma. This is the rare case of a peritoneal sarcomatoid mesothelioma, without any exposure to asbestos.

Unilateral Retinitis Pigmentosa: A Case Series and Literature Review

PURPOSE: We report 4 cases of unilateral retinitis pigmentosa (URP) with a literature review. METHODS: A retrospective, observational case series of 4 URP patients with no signs of bilateral involvement during the follow-up period of up to 5 years. RESULTS: The subjects were 4 female patients with an average age of 37 years. The mean follow-up period was 7 years. The subjects' blood analysis excluded any infective diseases. History of trauma or any family history of ocular diseases including retinitis pigmentosa was absent. The full-field electroretinograms (ERGs) were normal in the unaffected eyes and the affected eyes showed markedly low or undetectable responses. Computerized visual field examinations were normal in the unaffected eyes, while 3 of the affected eyes had total visual field loss and 1 had concentric narrowing within 20 degrees. CONCLUSIONS: A long term follow-up of at least 5 years is required for diagnosis of URP to exclude a delayed onset in the unaffected eye. ERG is a reliable test to monitor the course of the disease and to confirm the diagnosis when uncertain. The etiology of URP is unknown although several studies regarding genetic causes that resulted in URP have been reported in recent years.

Comparison of Eye Protection Methods of Ointment Instillation under General Anesthesia

PURPOSE: To compare the efficacy of 3 different eye ointment instillations with eyelid taping and eyelid taping alone to prevent eye complications during surgery under general anesthesia. METHODS: A total of 296 eyes of 148 patients who underwent general anesthesia for at least 60 minutes were randomly assigned to 1 of the following 4 groups: group A, eyelid taping alone; group B, eyelid taping with solcoseryl ointment; group C, eyelid taping with carbomer ointment; group D, eyelid taping with lanolin ointment. Schirmer test, tear film break-up time (TF-BUT), conjunctival hyperemia scale (CHS), National Eye Institute corneal staining scale (NSS), and ocular surface disease index (OSDI) were prospectively evaluated before and after general anesthesia. RESULTS: TF-BUT was significantly increased in the group B compared with the preoperative value (p = 0.035). CHS was significantly decreased in all 3 ointment groups (p < 0.05) after general anesthesia and the degree was significantly higher in groups B and C (p < 0.001). No corneal abrasion developed after general anesthesia. However, corneal erosion developed in 20 eyes of previously healthy subjects; 8 eyes (12.5%) in group A, 0 eye (0%) in group B, 2 eyes (2.5%) in group C, and 10 eyes (13.9%) in group D. The occurrence rates of new lesions were significantly lower in groups B and C (p = 0.035). CONCLUSIONS: Both eyelid taping alone and eyelid taping with eye ointment are effective protection methods against corneal abrasion during operation under general anesthesia. Eye ointment instillation together with eyelid taping shows not only improvement of subjective symptoms but also improvement of objective ocular surface parameters proving to be an effective ocular protection during general anesthesia.

Comparison of Eye Protection Methods of Ointment Instillation under General Anesthesia

PURPOSE: To compare the efficacy of 3 different eye ointment instillations with eyelid taping and eyelid taping alone to prevent eye complications during surgery under general anesthesia. METHODS: A total of 296 eyes of 148 patients who underwent general anesthesia for at least 60 minutes were randomly assigned to 1 of the following 4 groups: group A, eyelid taping alone; group B, eyelid taping with solcoseryl ointment; group C, eyelid taping with carbomer ointment; group D, eyelid taping with lanolin ointment. Schirmer test, tear film break-up time (TF-BUT), conjunctival hyperemia scale (CHS), National Eye Institute corneal staining scale (NSS), and ocular surface disease index (OSDI) were prospectively evaluated before and after general anesthesia. RESULTS: TF-BUT was significantly increased in the group B compared with the preoperative value (p = 0.035). CHS was significantly decreased in all 3 ointment groups (p < 0.05) after general anesthesia and the degree was significantly higher in groups B and C (p < 0.001). No corneal abrasion developed after general anesthesia. However, corneal erosion developed in 20 eyes of previously healthy subjects; 8 eyes (12.5%) in group A, 0 eye (0%) in group B, 2 eyes (2.5%) in group C, and 10 eyes (13.9%) in group D. The occurrence rates of new lesions were significantly lower in groups B and C (p = 0.035). CONCLUSIONS: Both eyelid taping alone and eyelid taping with eye ointment are effective protection methods against corneal abrasion during operation under general anesthesia. Eye ointment instillation together with eyelid taping shows not only improvement of subjective symptoms but also improvement of objective ocular surface parameters proving to be an effective ocular protection during general anesthesia.

Esophageal tolerance to high-dose stereotactic radiosurgery

PURPOSE: Esophageal tolerance is needed to guide the safe administration of stereotactic radiosurgery (SRS). We evaluated comprehensive dose-volume parameters of acute esophageal toxicity in patients with spinal metastasis treated with SRS. MATERIALS AND METHODS: From May 2008 to May 2011, 30 cases in 27 patients with spinal metastasis received single fraction SRS to targets neighboring esophagus. Endpoints evaluated include length (mm), volume (mL), maximal dose (Gy), and series of dose-volume thresholds from the dose-volume histogram (volume of the organ treated beyond a threshold dose). RESULTS: The median time from the start of irradiation to development of esophageal toxicity was 2 weeks (range, 1 to 12 weeks). Six events of grade 1 esophageal toxicity occurred. No grade 2 or higher events were observed. V15 of external surface of esophagus was found to predict acute esophageal toxicity revealed by multivariate analysis (odds radio = 1.272, p = 0.047). CONCLUSION: In patients with spinal metastasis who received SRS for palliation of symptoms, the threshold dose-volume parameter associated with acute esophageal toxicity was found to be V15 of external surface of esophagus. Restrict V15 to external surface of esophagus as low as possible might be safe and feasible in radiosurgery.

Osteochondroma of the Rib Mimicking a Mediastinal Mass: Unexpected Menifestation in Hereditary Multiple Exostoses / 영남의대학술지

Osteochondroma is a common bone tumor but a rare tumor in the rib. It is often asymptomatic and observed incidentally. This is a case report of a 49-year-old woman with an osteochondroma mimicking a mediastinal mass in hereditary multiple exostoses. The chest X-ray and computed tomography (CT) scans revealed the bony density feature of the mass. Surgical excision confirmed that the lesion was an osteochondroma.

Association of Coronary Artery Disease and Osteoporotic Vertebral Fracture in Korean Men and Women

BACKGROUND: The association of osteoporotic vertebral fracture or osteoporosis with coronary artery disease (CAD) was investigated in Korean men and women. METHODS: Four hundred consecutive postmenopausal women and men aged 50 years and older, undergoing coronary angiography, were enrolled for the evaluation of established or suspected coronary artery disease. CAD was diagnosed if there was narrowing of > 50% diameter in one or more major coronary artery. Morphometric vertebral fracture was assessed using lateral thoracic and lumbar spine radiographs. Bone mineral density was performed using dual-energy x-ray absorptiometry. RESULTS: Of the 400 subjects in the study (mean age of 61.9 +/- 11.6 years), 256 patients had CAD. Vertebral fracture was observed in 94 (23.5%) patients. There was no difference in vertebral fracture according to the presence or absence of CAD. In logistic regression analysis, vertebral fracture was not significantly associated with CAD after adjustment for multiple risk factors. Although women had lower BMD at any given site than men, BMD was not associated with the presence or absence of CAD among 191 patients. CONCLUSION: Our study demonstrated that osteoporotic vertebral fracture or osteoporosis was not associated with coronary artery disease in Korean men and women.

Index of Microcirculatory Resistance as Predictor for Microvascular Functional Recovery in Patients with Anterior Myocardial Infarction

IMR is useful for assessing the microvascular dysfunction after primary percutaneous coronary intervention (PCI). It remains unknown whether index of microcirculatory resistance (IMR) reflects the functional outcome in patients with anterior myocardial infarction (AMI) with or without microvascular obstruction (MO).This study was performed to evaluate the clinical value of the IMR for assessing myocardial injury and predicting microvascular functional recovery in patients with AMI undergoing primary PCI. We enrolled 34 patients with first anterior AMI. After successful primary PCI, the mean distal coronary artery pressure (Pa), coronary wedge pressure (Pcw), mean aortic pressure (Pa), mean transit time (Tmn), and IMR (Pd * hyperemic Tmn) were measured. The presence and extent of MO were measured using cardiac magnetic resonance image (MRI). All patients underwent follow-up echocardiography after 6 months. We divided the patients into two groups according to the existence of MO (present; n = 16, absent; n = 18) on MRI. The extent of MO correlated with IMR (r = 0.754; P < 0.001), Pcw (r = 0.404; P = 0.031), and Pcw/Pd of infarct-related arteries (r = 0.502; P = 0.016). The IMR was significantly correlated with the DeltaRegional wall motion score index (r = -0.61, P < 0.01) and DeltaLeft ventricular ejection fraction (r = -0.52, P < 0.01), implying a higher IMR is associated with worse functional improvement. Therefore, Intracoronary wedge pressures and IMR, as parameters for specific and quantitative assessment of coronary microvascular dysfunction, are reliable on-site predictors of short-term myocardial viability and Left ventricle functional recovery in patients undergoing primary PCI for AMI.

A Case of Severe Pulmonary Thromboembolism in a Young Male With Klinefelter Syndrome

A young male patient diagnosed with Klinefelter syndrome was admitted to our hospital via the emergency room with chief complaints of acute chest pain and dyspnea. Pulmonary thromboembolism was diagnosed from his chest CT images. His symptoms improved after he underwent thrombolysis and anticoagulation treatment. Klinefelter syndrome has a tendency towards hypercoagulability due to hormonal imbalance and one or more inherited thromophilic factors. Thus, Klinefelter syndrome patients with a past medical history of venous thromboembolism require continuous oral anticoagulation therapy for a period of at least six months.

Parameters Measuring Beta-Cell Function Are Only Valuable in Diabetic Subjects with Low Body Mass Index, High Blood Glucose Level, or Long-Standing Diabetes

PURPOSE: The aim of this study was to identify the most precise and clinically practicable parameters that predict future oral hypoglycemic agent (OHA) failure in patients with type 2 diabetes, and to determine whether these parameters are valuable in various subgroups. MATERIALS AND METHODS: We took fasting blood samples from 231 patients for laboratory data and standard breakfast tests for evaluation of pancreatic beta-cell function. Hemoglobin A1c (HbA1c) levels were tested, and we collected data related to hypoglycemic medications one year from the start date of the study. RESULTS: Fasting C-peptide, postprandial insulin and C-peptide, the difference between fasting and postprandial insulin, fasting beta-cell responsiveness (M0), postprandial beta-cell responsiveness (M1), and homeostasis model assessment-beta (HOMA-B) levels were significantly higher in those with OHA response than in those with OHA failure. The area under the curve (AUC) of the receiver operating characteristic (ROC) measured with postprandial C-peptide to predict future OHA failure was 0.720, and the predictive power for future OHA failure was the highest of the variable parameters. Fasting and postprandial C-peptide, M0, and M1 levels were the only differences between those with OHA response and those with OHA failure among diabetic subjects with low body mass index, high blood glucose level, or long-standing diabetes. CONCLUSION: In conclusion, postprandial C-peptide was most useful in predicting future OHA failure in type 2 diabetic subjects. However, these parameters measuring beta-cell function are only valuable in diabetic subjects with low body mass index, high blood glucose level, or long-standing diabetes.

A Case of Eosinophilic Bronchitis Associated with Tracheal Diverticulum / 영남의대학술지

Tracheal diverticulum is relatively rare. It results from congenital or acquired weakness of the tracheal wall. Most cases are asymptomatic, but when symptoms are present, they are usually nonspecific. A 54-year-old man complained of sputum lasting for several months. Chest computed tomography showed an air-containing cystic structure in the trachea. Fiberoptic bronchoscopy demonstrated ostium arising from the right posterolateral wall at the trachea. Reported herein is a case of eosinophilic bronchitis associated with tracheal diverticulum.

Comparative Study of Cerebral Vasospasm between Endovascular Treatment and Conventional Surgery of Acutely Ruptured Aneurysms: Clinical Study / 대한뇌혈관외과학회지

OBJECT: Generally, it seems like that the incidence of vasospasm of vasospasm in endovascular coil embolization is higher than clipping in aneurysmal subarachnoid hemorrhage. But endovascular coil embolization in our study group was not associated with higher incidence of symptomatic vasospasm than direct clipping and we made an analysis of that cause. METHODS: The authors reviewed 220 patients with aneurysmal subarachnoid hemorrhage who had been treated with either neck clipping or coil embolization by a single surgeon between January 1997 and December 2002. Poor initial grade (Hunt & Hess grade IV & V) patients were excluded. Finally 171 patients were enrolled in this study. 126 patients(74%) underwent direct surgical clipping and 45 patients (26%) underwent endovascular treatments of their aneurysms. RESULTS: Overall symptomatic vasospasm occurred in 32 (19%) patients, 4 of 45 patients (9%) were coiling group and 28 of 126 (22%) were surgically treated group. There was no difference between two groups in age, initial Hunt & Hess grade, Glasgow coma scale, operation time, treatment initiation time, patient's medical status. CONCLUSIONS: Patients who underwent coil embolization were not more likely to suffer from symptomatic vasospasm than aneurysm neck clipping in better clinical grades (Hunt & Hess grade of I to III) patients in our institute.

Comparative Study of Cerebral Vasospasm between Endovascular Treatment and Conventional Surgery of Acutely Ruptured Aneurysms: Clinical Study / 대한뇌혈관외과학회지

OBJECT: Generally, it seems like that the incidence of vasospasm of vasospasm in endovascular coil embolization is higher than clipping in aneurysmal subarachnoid hemorrhage. But endovascular coil embolization in our study group was not associated with higher incidence of symptomatic vasospasm than direct clipping and we made an analysis of that cause. METHODS: The authors reviewed 220 patients with aneurysmal subarachnoid hemorrhage who had been treated with either neck clipping or coil embolization by a single surgeon between January 1997 and December 2002. Poor initial grade (Hunt & Hess grade IV & V) patients were excluded. Finally 171 patients were enrolled in this study. 126 patients(74%) underwent direct surgical clipping and 45 patients (26%) underwent endovascular treatments of their aneurysms. RESULTS: Overall symptomatic vasospasm occurred in 32 (19%) patients, 4 of 45 patients (9%) were coiling group and 28 of 126 (22%) were surgically treated group. There was no difference between two groups in age, initial Hunt & Hess grade, Glasgow coma scale, operation time, treatment initiation time, patient's medical status. CONCLUSIONS: Patients who underwent coil embolization were not more likely to suffer from symptomatic vasospasm than aneurysm neck clipping in better clinical grades (Hunt & Hess grade of I to III) patients in our institute.

Dissecting Aneurysm at the A1 Segment of the Anterior Cerebral Artery Manifesting as Subarachnoid Hemorrhage: Two Case Reports / 대한뇌혈관외과학회지

Two cases of intracranial dissecting aneurysms of the A1 segment of the anterior cerebral artery(ACA) associated with subarachnoid hemorrhage(SAH) are described. Two patients presented with a ruptured dissecting aneurysm manifesting as sudden bursting headache. Computerized tomography(CT) revealed subarachnoid hemorrhage. In the first case, cerebral angiography revealed a diffuse dilatation of left A1 segment with pooling of contrast medium and poor collateral flow through the anterior communicating artery(AcomA). The dissecting aneurysm was wrapped with a trousers shaped artificial dura, fixed with an aneurysmal clip and coated with fibrin glue. He was discharged without neurological deficit. In the second case, 3 dimensional computerized tomography(3D CT) was checked because the diagnostic angiography was not available due to poor patient's condition. 3D CT showed fusiform dilatation of right A1 segment, focal severe stenosis of proximal A1 segment of ACA, AcomA within normal shape and no laterality of A1 dominance. Trapping surgery was done successfully and she had no neurological deficit at discharge. In the case of SAH of unknown origin, dissecting aneurysm should be kept in mind and surgical treatment might be beneficial.

A Case of Adenomatoid Odontogenic Tumor / 대한이비인후과학회지

Adenomatoid odontogenic tumor (AOT) which accounts for only about 3% of all odontogenic tumors is characterized by the duct-like structures of epithelial components at the lesion. There are three variants of AOT; 1) follicular, a central lesion associated with an embedded tooth; 2) extrafollicular, a central lesion without connection to a tooth; and 3) peripheral. AOT slowly grows with few or no symptom. The central variants account for 97.2%, 73.0% of which are follicular variants. AOTs occur most commonly in the second and third of life and have a distinct predilection for the anterior maxilla of young female. The pathogenesis of this odontogenic tumor appears to involve persistent remnants of the dental lamina, especially after odontogenesis of the successional and accessional laminae. Conservative surgical excision is the treatment of choice.

Change of the DPOAE on Contralateral Ear after Exposure of the Drilling Noise / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Drill-generated noise during chronic ear surgery, as well as surgical trauma, has been incriminated as a cause of sensorineural hearing loss in the operated ear. The contralateral ear, on the other hand, is subject to drill noise but is spared the surgical trauma. Using the distortion product otoacoustic emission recording, this study is aimed to evaluate changes in micromechanical cochlear properties which could occur in the contralateral ear following an ear surgery. MATERIALS AND METHODS: Twenty-seven patients undergoing mastoidectomy procedures were tested both preoperatively and postoperatively using pure tone audiometry, distorsion product otoacoustic emission. Surgical drilling duration was recorded. These patients had no otological history and showed no abnormalities on the physical examination of the contralateral ear. For all frequencies (1-6 kHz), amplitude were measured and analyzed. RESULTS: 1) Pure tone audiometry average was not significantly changed on the preoperative and postoperative day. 2) Average amplitude of DPOAE was significantly lower on the first postoperative day than on the preoperative day. 3) Average amplitude of' DPOAE was recovered on the seventh postoperative day. 4) Duration of drilling affected DPOAE results. CONCLUSION: The drill noise conducted to the nonoperated ear by vibrations of the intact skull exposure results in dysfunction of the outer hair cells, which produce a temporary hearing loss.

Clinical Study of Chondritis in the Burned Ear / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The chondritis of the auricle is a relatively common and severe complication of ear burns and frequently leads to the destruction of unburned cartilage, thus destroying the shape of the ear. The purpose of this study is to document the clinical nature of the injury, the results of various methods of treatment and to recommend the management protocol for chondritis of the burned ear. MATERIALS AND METHODS: A retrospective study of 69 patients who suffered the chondritis of the burned ear were carried out. These patients had been admitted to the Burn center at the Hangang Sacred Heart Hospital, Hallym University from January, 1993 through December, 1998. RESULTS: 1) The most common causative agent was flame burns (91.3%). 2) A mean interval of onset was 29.36 days. 3) Pseudomonas aeruginosa was noted on 68.5% of the cultures taken. 4) The sensitivity studics showed that Cefoperazone is the most sensitive antibiotics to P. aeruginosa. 5) The methods of treatment were dressing with cerettage (36%), incision and drainage with antibiotics soaking (22%), chondrectomy (35%), and chondrectomy with through and through drain (7%). 6) The final results of treatment were affected by the initial degree of burn. CONCLUSION: The most important preventive measures were strict avoidance of pressure on the injured ear and effective topical chemotherapy to control microbial proliferation. Early detection and early surgical intervention of chondritis were essential to limit progression of infection and necrosis, and to minimize the deformity of the auricle.

A Case of Relapsing Polychondritis / 대한이비인후과학회지

Relapsing polychondritis is a rare disorder that involves a multisystem characterized by recurrent inflammation, degeneration of cartilage and connective tissue. The following tissues, in the order of decreasing frequency, may be involved: auricules, joint, nose, eyes, respiratory tract, heart valve and skin. The cause is unknown but an autoimmune mechanism has been thought to be the causative factor. Authors have recently experienced a case of relapsing polychondritis in a 71 year old man diagnosed by direct immunofluoroscene and auricular chondritis.

The Reaction of Unerodable Porous Polymer Treated with CO2 Laser in Rat Middle Ear / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Long term success of the implant depends on the biocompatibility and biofunctionality. Biomaterial engineering and tissue engineering have provided important clue for choosing adequate biomaterials. Recently, laser application in reconstructive surgery has been developed in the fields of vascular, intestinal and nerve anastomosis. In the otologic field ear drum or polymer prostheses was treated with laser for reconstructive use. However, there was only a few attempts to find the morphological change and tissue reaction of laser treated material or tissue in otologic field. The aim of this study is to evaluate the biocompatibility and biofunctionality of laser treated polymer in the middle ear. MATERIALS AND METHODS: Ultra high molecular weight polyethylene (UMWP) was chosen. UMWP was inserted into middle ear of Sprague-Dawley rats. After 1, 2, 4 weeks, the bullae were removed and tissue reactions were observed with Hematoxilin-Eosin stain. RESULTS: In the animal study, more inflammatory cells were infiltrated on surface of laser treated UMWP compared with non-treated UMWP after 1 week. After 2 weeks, more macrophages and fibroblasts were found in the laser treated UMWP than in the nontreated UMWP. After 4 weeks, thin fibrous encapsulations were formed around the UMWP in both groups. In the laser treated UMWP, more pronounced destruction was found. CONCLUSION: These results indicated decrease of biofunctionality and acceptable biocompatibility of UMWP.