Surgical Treatment of Contact Point Headache

OBJECTIVES: Contact point headache is caused by contact between the nasal septum and the lateral nasal wall, resulting in referred pain involving the trigeminal nerve. We aimed to assess the benefits of surgical correction in patients with endoscopic and radiographic evidence of a contact point in the nasal cavity. MATERIALS AND METHODS: A prospective study was performed on patients who met the following criteria:) history of chronic headache, 2) lack of acute or chronic inflammatory findings, 3) presence of a contact point upon nasal endoscopy and CT scan, 4) relief of headache within five minutes after applying topical anesthesia to the contact point. The severity of pain was assessed preoperatively and postoperatively using a visual analogue scale (VAS). The duration and frequency of headaches were also assessed using a questionnaire. RESULT: The patients whose headaches were believed to result from an intranasal contact point underwent surgical management. According to the same pain questionnaire given preoperatively and postoperatively, severity, duration, and frequency of headache were significantly reduced. CONCLUSION: A contact point headache must be considered in patients who have no other obvious causes of headache. Significant relief can be obtained by surgery in patients with endoscopic and radiographic evidence of a contact point in the nasal cavity.

Blunted erythropoietin response: the common findings in various anemic patients / 대한내과학회지

BACKGROUND/AIMS: The characteristics of erythropoietin response in patients suffering with anemia of chronic disease and in the patients with various other anemias are poorly defined. Thus, we evaluated the clinical factors that influence the erythropoietin response. METHODS: We enrolled the anemic patients (hemoglobin <13 g/dL for males and <12 g/dL for females) who visited the Hematology-Oncology department of Konkuk University Hospital from Mar 2006 to April 2007. The laboratory tests, including the complete blood count, serum ferritin, serum vitamin B12/folate, the peripheral blood morphology and serum erythropoietin, were done. The erythropoietin response to anemia was assessed by the ratio of the log of the measured erythropoietin to the log of the expected erythropoietin. RESULTS: A total of 161 patients, including 42 iron-deficiency anemia (IDA) patients, were analyzed. 119 non-IDA patients were diagnosed with infection (n=46), chronic renal failure (n=27), cancer (n=20), heart failure (n=12), or with other diseases (n=14). Except for the cancer patients, all the patients with other diseases showed a blunted erythropoietin response in comparison with the IDA patients (p=0.000). Among the non-IDA patients, those patients older than 65 years showed more blunted erythropoietin response than did the younger patients (p=0.01), and the diabetics without renal dysfunction also tended to respond better to erythropoietin than did the non-diabetics (p=0.055). CONCLUSION: A blunted erythropoietin response was observed in most of the anemic patients in our study. Old age and diabetes may further blunt the erythropoietin response. The feasibility of erythropoietin testing and supplementation treatment in these patients merits further evaluation.

Symptomatic Rathke's Cleft Cyst in the Interpeduncular Cistern: Case Report

The Rathke's cleft cyst is generally thought to be derived from Rathke's pouch remanants. Symptomatic Rathke's cleft cyst was first described by Goldzieher in 1913. Recently, several cases have been reported by the gradual development of diagnostic methods. We present our experience of a rare case of ectopic suprasellar Ratheke's cleft cysts. The cysts were located in the interpeduncular cistern. We performed a successful operation and made immunohistochemical examinations.

Surgical Management of Patients with Isthmic Spondylolisthesis with Transpedicular Screw Fixation and Posterior Lumbar Interbody Fusion using Posterior Movable Segment

Twenty three patients with isthmic spondylolisthesis were operated on from December 1993 to June 1995. There were 14 female and 9 male patients and the average age of the patients was 50(ranging 20-67) years old. Symptoms in the lower extremities had been present for 3 months to 10 years, although varying degrees of back pain had existed for longer periods. Disability was caused mainly by claudication in 20 patients. Diagnostic studies included plain films, tomography, CT scaning, and MRI. Single interspace was involved in 18 patients, and in five patients, two interspaces were involved. After wide decompression and discectomy, stabilization was reestablished by segmental pedicular screw fixation device(Diapason(R) pedicular system) and interbody fusion using posterior movable segment as graft material. Between 6 to 24 months postoperatively, all patients exhibited radiographic fusion. The results were excellent in 12 cases, good in 8 cases and fair in 3 cases. The authors believe that full four nerve roots decompression, pedicular screw fixation. Posterior lumbar interbody fusion using movable segment as graft material, and prevention of nerve root traction injury during insertion of graft bone are important points to get good post-operative results.

Observation on the Findings of Excretory Urogram During Acute Pyelonephritis / 대한비뇨기과학회지

16 patients with acute pyelonephritis took excretory urogram during their sick period, from March 1975 until February 1978. The following results were obtained after analysis of the findings. 1) Abnormal findings were observed in 6 cases (37%) out of the 16 cases and other 10 cases ( 63%) had the findings within normal limit. 2) In abnormal 6 cases, there were 1 male and 5 female and their age is ranging from 27 to 72, right side was involved in 4 and left in 2 cases. 3) Among abnormal 6 cases, one case had 3 abnormal findings, each of another 2 cases had 2 and the other 3 cases had only 1. 4) Abnormal findings consist of delayed caliceal appearance time in 3 cases, decreased density in 2, renal enlargement in 2, dilatation of collecting system in 2 and caliceal distortion in 1.

Observation on the Effect of Triamcinolone Local Injection in Urethral Syndrome / 대한비뇨기과학회지

The term "urethral syndrome" is used to describe, in the female, a syndrome of recurrent episodes of frequency of voiding and dysuria, without evidence of infection in the urine. The treatment for this syndrome is usually not easy in office practice. The submucosal injection of triamcinolone acetonide around Skene's gland to decrease inflammation and scarring was done for 20 patients with urethral syndrome and the following results were observed. 1) Of a total of 20 cases, 7 cases had excellent effect( 35%), 8 cases were improved (40%) , and other 5 cases got no effect ( 25%). So overall effect rate was 75%. 2) No side effect was noted in all patients. 3) Triamcinolone periurethral injection is a simple, effective office procedure for urethral syndrome, but it is desirable to have further evaluation for more patients and longer period.

A Case of Widespreaded Primary Macular Atrophy / 대한피부과학회지

Macular atrophy is relatively rare skin disease and is characterized histologically by deficiency of elastic fibers and clinically by circumscribed area of thin, wrinkled bulging out skin. Whether the association with identificable specific dermatosis or not divides the macular atrophy into primary & secondary type. I present a case of widespreaded primary macular atrophy. A 28 year old male has been suffered from symptomless, slowly progressive, numerous, well demarcated, neither coalesced nor grouped, rice sized, round to oval shaped, hypopigmented, protruded, wrinkled surfaced eruptions which began from both flank at first about 3 years ago and then spreaded to abdomen, chest, back and all extremities except hands & feet. General physical & laboratory examinaions did not show distinct abnormality except skin tindings. Histopatholgical study revealed fragmentation, scantiness or disappearance of elastic fibers by means of Verhoeff-VanGieson stain and no increase of Periodic acid-Schiff stain positive material ruled out the possibility of amyloidosis. Diagnosis was confirmed by clinical & histochemical findings. Literature was briefly reviwed for the discussion.