Surgical Treatment of Two Cases of Benign Symmetrical Lipomatosis Causing Dyspnea / 대한이비인후과학회지

Benign symmetrical lipomatosis, known as Madelung's disease, is a rare disease characterized by non-encapsulated fat tissue accumulation in a symmetrical manner around the neck, shoulders, and upper extremities, rarely involving the lower limbs and the lower body. To date, there have been approximately 200 cases reported. We experienced two cases of Madelung's disease, 57 and 59 year-old man with neck and shoulder swelling and the symptom of dyspnea. Laryngoscopic and CT scan findings showed severe narrowing of supraglottic and paraglottic area, caused by fat tissue accumulation. The fat tissues were surgically excised, one by external approach and the other by laryngomicrosurgery using LASER under direct laryngoscope, with successful result. We report it with a review of the current literatures.

Effect of Ginkgo Biloba Extract(EGb 761) on Apoptosis in Oral Cavity Cancer Cells / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: To examine the chemopreventive effects of Ginkgo biloba extract (EGb 761) on oral cavity cancer, we investigated the apoptosis of oral cavity cancer cells by EGb 761 and the apoptotic pathway involved. MATERIALS AND METHOD: SCC 1483 cancer cell line derived from a human retromolar trigone carcinoma was used. Inhibition of proliferation was examined by proliferation assay. Apoptosis was measured and confirmed by flow cytometry, DNA fragmentation assay and Western blotting with PARP antibodies. The involvement of the caspase cascade was investigated by co-treating with the caspase inhibitor, z-VAD-fmk. RESULTS: The inhibition of SCC 1483 cells was noted from 250 microgram/ml of EGb 761. Apoptosis was observed after 24 hours of incubation with 250 microgram/ml EGb 761 and it occurred in a time-dependent manner. Apoptosis was confirmed by DNA fragmentation and PARP cleavage. Co-treatment with z-VAD-fmk inhibited apoptosis and PARP cleavage by EGb 761. CONCLUSIONS: EGb 761 induces the apoptosis of SCC 1483 cells and the caspase cascade is involved in this apoptosis. Therefore, EGb 761 may be used as a chemopreventive agent in oral cavity cancer. Further studies are required on the clinical use of EGb 761.

Is the Dissection of the Level IV Lymph Node Pads Necessary in the Elective Lateral Neck Dissection of N0 Supraglottic Squamous Cell Carcinoma? / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: To determine whether level IV lymph nodes can be saved in the elective lateral neck dissection (LND) as a treatment for patients with squamous cell carcinoma of the supraglottic larynx. SUBJECTS AND METHODS: From January 1997 to May 2002, 42 patients with supraglottic squamous cell carcinoma and a clinically N0 neck who underwent an elective LND were studied prospectively. The incidence of pathological metastasis to the level IV lymph nodes and a regional recurrence after an elective LND were evaluated. RESULTS: Of the 42 patients, 10 (24%) had lymph nodes positive for microscopic metastatic squamous cell carcinoma. Two (5%) of the 42 patients had involvement of the level IV lymph nodes, whose clinical T-stages were above cT3. None of the clinical T1 or T2 tumors showed level IV nodal metastasis. There were two cases (5%) of the ipsilateral neck recurrence: these patients developed recurrence in the level II and stomal area, respectively. CONCLUSION: The level IV lymph node metastasis was rare in this study, and nodal recurrence after LND in squamous cell carcinoma of the supraglottic larynx was infrequent. Therefore, this region may be preserved in elective LND for patients with early squamous cell carcinoma of the supraglottic larynx.

Histology and Stroboscopic Findings after Injection of Artecoll(R) and Restylane(R) into Paralyzed Canine Vocal Fold: in vivo Canine Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aims of this study are to introduce Artecoll and Restaylane, that have been available for facial augmentation, as new materials for injection laryngoplasty, to investigate the mucosal wave of true vocal folds after the injection of these two materials into the true vocal fold, and to assess its biocompatibility and durability. SUBJECTS AND METHOD: After complete paralysisof the right recurrent laryngeal nerve of 6 Beagle dogs, the dogs were divided into the Artecoll injection group and the Restylane injection group, and Artecoll or Restylane was injected into vocalis muscle and vocal ligament. The recurrent laryngeal nerve of the opposite side was stimulated, the posterior commissure was sutured, and the mucosal wave of true vocal folds was examined by stroboscopy in in vivo canine study 1, 3, and 6 months after the injection. And, histopathological change of the injected materials after total laryngectomy was examined by hematoxylin and eosin (H & E) staining and masson trichrome staining. RESULTS: In both the Artecoll injection and the Restylane injection groups, the mucosal wave of true vocal folds was detected by stroboscopic examination until 6 months after the injection, and the difference of the mucosal wave of true vocal folds between these two groups was difficult to detect. Histological studies revealed that the injected materials remained in the vocal ligament and vocalis muscle and theses two materials were resorbed with time, Artecoll showing less resorption. These two materials were biocompatible and, particularly, Restylane showed less foreign body reaction. CONCLUSION: Since both Artecoll and Restylane are biocompatible and durable, they areconsidered as the suitable material for injection larygoplasty, and additional long-term studies are required.

Outcome and Predictors of Biofeedback Therapy for Patients with Internal Rectal Intussusception

PURPOSE: The aim of this study was to determine the outcome and identify predictors of success of biofeedback therapy for patients with internal rectal intussusception. METHODS: Twenty-one patients (median age. 54 years, 15 female, 6 male) diagnosed with internal rectal intussusception by using cinedefecography were evaluated by standardized questionnaire, before, immediately after treatment, and at follow-up. Clinical bowel symptoms and anorectal physiological studies were also analyzed. RESULTS: Follow up (median: 15, range 2~24 months) results were evaluated by an independent observer in 20 patients. At post-biofeedback, 20 (95%) patients felt improvement in symptoms, including 7 (33%) with complete symptom relief. At follow-up, 17 (85%) patients felt improvement in symptoms, including 7 (35%) with complete symptom relief. There was a significant reduction in difficult defecation (from 90 to 29, 10 percent, from pre-biofeedback to post-biofeedback, and at follow up respectively; P<0.001), sensation of incomplete defecation (from 90 to 24, 35 percent; P<0.001), enema use (from 29 to 0, 0 percent; P<0.01), and anal pain (from 19 to 0, 0 percent; P<0.05). Digitation (from 19 to 0 percent, from pre- biofeedback to at follow up; P<0.05) and laxative use (from 29 to 5 percent; P<0.05) were also decreased. Normal spontaneous bowel movement was increased from 52 percent, at pre-biofeedback to 86 percent, at post- biofeedback (P<0.05), 95 percent at follow up (P<0.005). Low bowel frequency, at pre-biofeedback (P<0.01), and hard stool (P<0.05) predicted poor outcome. Long puborectalis length during push (P<0.05) and dynamic descent (P<0.05) on defecography also predicted poor outcome. Low electrical activities of puborectalis and anal sphincter muscle during rest (P<0.001), squeeze (P<0.01) and push (P<0.005) on pre-biofeedback electromyography were related to poor outcome. No patient developed full rectal prolapse during follow up. CONCLUSIONS: Biofeedback is an effective option and should be considered as the first line therapy especially for patients that don't have low bowel frequency, long puborectalis during push, and dynamic descent before treatment.

A Case of Hyperparathyroidism induced from Cystic Parathyroid Adenoma / 대한내분비학회지

Cystic parathyroid adenoma is one of the rare causes of hyperparathyroidism, and is usually located in neck and mediastinum. This type of adenoma tends to cause increased serum level of parathyroid hormone and alkaline phosphatase, similar serum calcium level when compared to those of solid adenoma. Thanks to current radioimmunoassay and easy accessibility to serum autoanalyzer, serum calcium level and parathyroid hormone level are more easily measured, which in turn lead to more easier diagnosis of hyperparathyroidism. Also improvement in imaging and nuclear diagnostic method of parathyroid lesion are suggested to enable easy diagnosis of cystic parathyroid adenoma. A 35-year-old male presented with easy fatigability for 12 months. The serum calcium, phosphate, alkaline phosphotase were 11.5mg/dL, 1.4mg/dL, 194IU/L respectively and his parathyroid hormone level in serum was 126.42pg/mL. Neck CT showed enlargement of right lobe of thyroid gland with well defined inhomogenously enhanced density inside the right thyroid gland. The patient was diagnosed of hyperparathyroidim due to parathyroid adenoma and was surgically removed. The surgical biopsy showed cystic parathyroid adenoma. After operation his general condition was improved and serum calcium, phosphate, parathyroid hormone level were normalizd. We report a case of hyperparathyroidism caused by cystic parathyroid adenoma with brief review of literature.

A Study on the Regional Self-sufficiency for In-patient Care Services / 예방의학회지

The utilization of medical care services has been partly regionalized with the implementation of referral requirement by the government since July 1, 1989 when the health insurance coverage was extended to all the people. For the purpose of regionalization, the whole country has been primarily divided into tertiary care regions, and each of them again into secondary care regions. This study investigates the self-sufficiency for in-patient care services of secondary care regions focusing on why it varies among the regions. In doing so, analysis is performed to examine a model which embodies three sets of hypotheses as follows: 1) The regional self-sufficiency for medical care services would be subject to direct influences of regional characteristics, amount of available services and structural properties of regional medical care system ; 2) The regional characteristics would have indirect effects on the self-sufficiency which are mediated by medical care services ; and 3) The amount of available services would indirectly affect the self-sufficiency by influencing the structure of regional medical care system. The results of analysis were generally consistent with the model. The findings have some practical implications. The regional self-sufficiency for medical care services partly depends upon basic properties of each region which cannot be changed in a short period of time. Thus the self-sufficiency for medical care services can be improved by health policy measure. In some of the regions the self-sufficiency for in-patient care services was much higher or lower than can be predicted from the bed-population ratio. Indication is that the allocation of health resources should be made considering a variety of factors bearing upon the supply of and demand for health care ; not on the basis of just a single criterion like the availability. The self-sufficiency of a certain region is related to not only its own characteristics but also the characteristics of neighboring regions. Therefore, attention should be also directed to the inter-regional relationships in health care when the needs for investment of health resources in a region are assessed. However, it should be noted that this study used the data collected before the referral requirement was imposed. A replication of this analysis using recent data would provide an evaluation of the impact on the self-sufficiency of the referral requirement as well as a confirmation of the findings of this study.