A Case of Multiple Schwannoma That Originated in the Nasal Septum / 대한이비인후과학회지

Schwannomas are benign peripheral nerve sheath tumors that occur throughout the body. They may appear as either a solitary mass or multiple masses. A 76-year-old woman visited our clinic with swelling of her nasal tip. Initially, based on her medical history, physical examination and CT scan, we diagnosed the disease as a neurogenic tumor or metastatic carcinoma; however, the incisional biopsy result revealed schwannomas that had originated from the nasal septum. The two masses were completely resected using the external rhinoplasty approach. Multiple schwannomas that originate in the nasal septum are extremely rare, and we report herein with a review of literature.

A Case of Angioleiomyoma Arising from the Right Inferior Turbinate / 대한이비인후과학회지

Leiomyoma is a benign smooth muscle neoplasm that rarely becomes malignant. It can occur in any organ of the human body that contains smooth muscles, but the most common forms occur in female genitourinary organs, including the uterus, gastrointestinal organs, including the small bowel and the esophagus and the skin. It rarely occurs in the head and neck area, including the sinonasal cavity. When it occurs in the nasal cavity, its clinical symptoms include nasal obstruction, nasal discharge, nasal bleeding, and pain. We describe herein a case of a 55-year-old man with a leiomyoma in his right inferior nasal turbinate. Transnasal endoscopic excision and paranasal sinus CT were performed. A soft tissue mass on the right inferior turbinate was confirmed from the paranasal sinus CT, and the pathological results revealed a vascular leiomyoma.

Colon Interposition via the Retrosternal Approach without Enlargement of the Thoracic Inlet for the Management of Esophageal Stricture / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: To report our experience of colon interposition without thoracic inlet widening for the management of esophageal stricture. SUBJECTS AND METHOD: Between 2005 and 2012, five patients underwent esophageal replacement using colon graft. Clinical data, such as surgical techniques including thoracic inlet widening, surgical outcomes, and patient's age and gender were retrospectively analyzed. The follow-up period ranged from 10 months to 5 years. RESULTS: All five patients had corrosive esophageal stricture and underwent colon interposition without thoracic inlet widening; four underwent pharyngocologastrostomy and one total laryngopharyngectomy and pharyngocologastrostomy. No major complications, such as aspiration, dysphagia, reflux, or swallowing disorder developed during the postoperative long term follow-up. CONCLUSION: A colon graft without enlargement of the thoracic inlet is an excellent esophageal substitute for patients with an esophageal corrosive stricture. Further surgical experience and more long-term follow-up data are required to produce more precise and statistically meaningful results.

Thrombotic Thrombocytopenic Purpura after Percutaneous Coronary Intervention

Thrombotic thrombocytopenic purpura (TTP) is a rapidly progressive hematological syndrome defined by the pentad of thrombocytopenia, microangiopathic hemolytic anemia, neurologic abnormalities, fever and renal dysfunction. TTP has been associated with major surgical procedures and specific medications. However, there is no known previously reported case in which acute TTP occurred after a percutaneous coronary intervention (PCI). We report a case of TTP after a PCI, that presented with the pentad of symptoms, as well as hepatitis and pancreatitis.

Changes of Echocardiographic Findings after Surgical Correction of Atrial Septal Defect in Adult

BACKGROUND: The aim of surgical treatment for atrial septal defect is correction of anatomical and physiologic anomaly. Incidence of heart failure, cerebrovascular accident, atrial fibrillation and late mortality depend on the timing of surgery. Echocardiographic cardiac functional alteration after surgery is not surveyed sufficiently. So we intended to observe the alteration and function of cardiac anatomy after surgery. METHODS: We studied 22 patients who were undergone correction surgery of atrial septal defect at Keimyung university medical center. We devided patients into two groups according to age. Group I consists of patients who undergone surgery before 41 year old(mean age 32.25 year old, male 3, total 12). Group II comprises patients who undergone surgery after 41 year old(mean age 53.4 year old, male 1, total 10). We compared chief complaint, preoperative cardiac catheterization finding, pre- and post-operative echocardiographic finding(ejection fraction, end diastolic right and left ventricular dimension, grade of tricuspid regurgitation, paradoxical septal motion) between 2 groups. RESULTS: Preoperatively 6 patients(50%) of group I patients were diagnosed as mild congestive heart failure(according to NYHA functional class) and 2 patients(20%) of group II patients were in mild congestive heart failure. The Qp/Qs of both group were 3.5+/-1.7, 2.9+/-1.3, systolic right ventricular pressure were 42.1+/-10.5, 44.5+/-9.5mmHg, systolic pulmonary arterial pressure were 31.3+/-4.3, 36.6+/-7.3mmHg. 1 of group I patients and 2 of group II patients showed ejection fraction below 55% on postoperative echocardiography. The others showed normal ejection on echocardiography. Mean end diastolic right ventricular dimension was 3.84cm preopratively and 2.53cm postoperatively on group II patients. Mean end diastolic right ventricular dimension of group I patients was 3.94cm preoperatively and 2.81cm postoperatively. 3 of group I patients showed mild TR(tricuspid regurgitation), 5 showed moderate TR, and 4 showed severe TR preoperatively. 3 of group I patients showed loss of TR, 1 showed moderate TR, 8 showed mild TR. 3 of group II patients showed mild TR, 2 showed moderate TR, 5 showed severe TR preoperatively. 6 of group II patients showed mild TR, 3 showed moderate TR, 1 showed severe TR postoperatively. Paradoxical septal motion reflects right ventricular pressure overloading and was observed on both groups preoperatively. But after correction surgery, paradoxical septal motion persists at 6(50%) of group I patients, 6(60%) of group II patients. CONCLUSION: Conclusively, surgical correction for atrial septal defect before age of 41 is effective to prevent or slow down the manifestation of congestive heart failure, persistence of TR. Ejection fraction was improved significantly on echocardiography on both groups. But paradoxical septal motion persist after surgery, so more survey is needed.

Clinical Status in Patients Who Restrictive Pattern on Doppler Transmitral Flow Pattern

BACKGROUND: Restrictive pattern on Doppler transmitral flow pattern represent reduced left ventricular compliance and associated with poor prognosis in patients with systolic dysfunction due to congestive heart failure or myocaridal infarction. Although there are many clinical evaluation about clinical significance of restrictive transmitral flow pattern, investigation about what kinds of disease reveal the characteristic restrictive transmitral flow pattern and significance according to criteria of restrictive transmitral flow pattern is few. Therefore, we have analyzed patients with restrictive transmitral flow pattern in order to evaluate clinical diagnosis and clinical significance according to criteria of restrictive transmitral flow pattern. METHODS: The study population consisted of 229 patients(male 129 patients, female 102 patients, mean age 40.6 years old) who show E/A ratio p 2 on Doppler echocardiography from september 1994 to aprial 1996. We have reviewed the medical records of that patients. RESULTS: 1) In case of patients more than 2 at E/A ratio, we found that subjects not related with cardiovascular diseases were 76 persons(33.2%), valvular heart disease 75 patients(32.3%), ischemic heart disease 25 patients(10.9%), cardiomyopathy 16 patients(6.9%). Among valvular heart disease, mitral regurgitation was most frequently observed(44.5%). In these patients, patients with left ventricular systolic dysfunction were 60 patients(26.2%). 2) Patients more than 2 at E/A ratio and less than 150msec at deceleration time of E wave were 126 patients(55.0%). In these patients, we found that valvular heart disease was also most frequently observed(49 patients, 38.8%), subjects not related with cardiovascular diseases 30 persons(23.8%), cardiomyopathy 15 patients(11.9%),pericarditis 7 patients(5.6%), hypertension 3 patients(2-3%). Patients with left ventricular systolic dysfunction in this group were 39 patients(31.0%). CONCLUSION: Although restrictive transmitral flow pattern on Doppler echocardiography represents reduced compliance of left ventricle or severe heart failure in patients with symptoms of congestive heart failure, this pattern also may be seen in persons not related with cardiovascular disease. Therefore, when making dicision about clinical significance of restrictive pattern, one should consider about any factors can influece the transmitral flow pattern and correlate the clinical diagnosis with mitral flow velocity.

The Effect of Lens Extraction on Hyaluronic Acid Concentration in Rabbit Vitreous

The cataract extraction is sometimes followed by postoperative complications related to changes in the vitreous. The lack of stability of vitreous in the aphakic eyes may be due not only to loss of the mechanical support of the lens but also to changes in the vitreous molecular composition. To define the effect of lens extraction on hyaluronic acid concentration in rabbit vitreous, six cases of rabbit eye were operated with ECCE and posterior capsulotomy equivalent to ICCE. In control rabbit group, hyaluronic acid concentration in vitreous was 202.3 +/- 77.8 ug/ml and the seventy days after surgical intervention, hyaluronic acid concentration in vitreous was 79.0 +/- 55.7 ug/ml. These result indicated that ECCE and posteror capsulotomy induced marked decrease of hyaluronic acid concentration in rabbit vitreous, which is statistically significant(p<0.05).

A Case of Acute Posterior Multlfocal Placoid Pigment Epithellopathy

Acute posterior multifocal placoid pigment epitheliopathy(APMPPE), first described in 1968 by Gass, is chracterized by rapid loss of central vision secondary to multifocal, yellow-white placoid lesions at the level of the pigment epithelium and choroid and significant visual improvement after spontaneous resolution of the active lesions within several weeks or months. Fluorescein angiography shows chracteristically that the chtoidal fluorescence is not visible at the site of acute lesion in the early arterial and arteriovenous phases and become hyperfluorescent due to staining of the lesions in the late venous phases. We experienced a case of acute multifocal placoid pigment epitheliopathy in 26 years old female patient occurring in both eyes.