Clinical Practice Guideline for Stroke Rehabilitation in Korea

The clinical practice guideline for the stroke rehabilitation was formulated through both extensive review of published literature and consensus meeting of the specialists. The purposes of this study were to provide optimum practical guideline for acute and subacute stroke rehabilitation and to enhance the quality of stroke rehabilitation team in Korea. This guideline contains evidences and recommendations on the organization of post-stroke rehabilitation team, timing, evaluation, and intensity of rehabilitation, detailed management of dysphagia, neurogenic bladder and bowel, movement, shoulder problem, cognition, neglect, language, mood and complications commonly encountered in the acute and subacute period of stroke rehabilitation. Clinicians who are working in the field of stroke rehabilitation can adopt this guideline for their practice and give the feedback for further revision.

Effect of Adenotonsillectomy on Inattention and Hyperactivity in Children with Sleep Disordered Breathing / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Sleep disordered breathing (SDB) is a common problem in the otolaryngology clinic and adenotonsillar hypertrophy is thought to be one of the most common etiologic factors. SDB possibly exhibits problems of behavioral regulation, such as inattention, hyperactivity and impulsive behavior. The goal of this study was to assess the effect of adenotonsillectomy on inattention and hyperactivity in children. SUBJECTS AND METHOD: We selected 54 pediatric patients with sleep disordered breathing. Adenotonsillectomy was performed for all patients. Adenotonsillar hypertrophy and the degree of SDB were evaluated preoperatively. The degree of inattention and hyperactivity was evaluated by attention deficit hyperactivity disorder rating scale-IV (ADHD RS-IV) before and after surgery. RESULTS: ADHD RS-IV score showed significant improvement after the operation in most children with SDB. But the improvement of ADHD RS-IV was not associated with the degree of adenotonsillar hypertrophy. However, much improvement in postoperative ADHD RS-IV was observed with children having higher preoperative ADHD RS-IV and/or SDB scale. CONCLUSION: Adenotonsillectomy seems to improve inattention and hyperactivity in most children with SDB. Improvement is more apparent in children with severe sleep disturbance and severe attention deficit and hyperactivity.

A Case of Congenital Sensorineural Hearing Loss with Multinodular Goiter / 대한이비인후과학회지

Pendred syndrome is an autosomal recessive condition classically characterized by congenital deafness and goiter, and is the most common cause of hereditary deafness in Korea. It is caused by mutations in the PDS gene (SLC26A4) located in 7q31. The PDS gene encodes a chloride-iodide transport protein called pendrin, which plays a role in the reabsorption of endolymph and the maintenance of the endolymph homeostasis in the inner ear and in the uptake and organification of iodide in the thyroid gland. A mutation in PDS also causes non-syndromic recessive deafness (DFNB4) and therefore securing the diagnosis is important for genetic counseling purposes. The perchlorate discharge test and radiological conformation of the inner ear anomaly are useful diagnostic aids but have limited diagnostic value. However, because PDS mutations are widely distributed along the gene, it consumes too much time and money to perform molecular studies in clinics. We present a case of congenital sensorineural hearing loss with multinodular goiter, which shows definite findings of Pendred syndrome.

Efficacy of Benzodiazepines to Laryngopharyngeal Reflux: A Double-Blind, Randomized Controlled Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Anti-anxiety drugs such as benzodiazepines are often given to globus patients in practice, based on the notion that globus is a kind of somatization disorder. However, many of globus are caused by laryngopharyngeal reflux (LPR) and the effects of anti-anxiety drugs to LPR are unknown. The study goal was to assess the efficacy of benzodiazepines to LPR. SUBJECTS AND METHOD: We selected 51 LPR patients, who were confirmed by 24-hour double-probe ambulatory pH monitoring. Patients were allocated into case and control groups at random and entered into a double-blind trial. Patients in the control group received proton pump inhibitors and prokinetics. Diazepam was added to patients in the case group. Assessments were made after 4 weeks of treatment using reflux symptom index (RSI) and reflux finding score (RFS). RESULTS: In both groups, RSI and RFS were improved significantly at the end of the study. However, there was no significant difference between the two groups. CONCLUSION: Diazepam seems to have little efficacy in the treatment of LPR.

Study on Correlations among Polysomnogram Indices for Obstructive Sleep Apnea-Hypopnea Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The polysomnography is essential for diagnosis of obstructive sleep apnea-hypopnea (OSAH) and provides important objective information. But, in fact, there are some difficulties for comprehensive interpretation of multiple indices from the polysomnogram. This study was designed to find out which polysomnogram indices were significant to respiratory distress indices (RDI) and apnea index (AI) on statistical correlation and which other indices should be considered together for proper management plan apart from RDI and AI (respiratory index). SUBJECTS AND METHOD: We evaluated 40 patients whose RDI were over 5 as the result of overnight polysomnography before any management from February 2003 to September 2003 at Eulji medical center. By multiple linear regression analysis, we studied the relationship of RDI and AI as dependent variables to ST, O2 desaturation events (O2DE), lowest O2 saturation (LoO2), slow wave sleep portion (S3&S4), arousal index (ArI), body-mass index (BMI) and age. We also studied the relationship of ST as an dependent variable to O2DE, LoO2, S3&S4, ArI, BMI, and age. RESULTS: 1) There were significant correlations between RDI and O2DE, ArI as was true between AI and O2DE, ArI (p<0.05). And there was no significant difference in the degree of the correlation between RDI and AI. 2) Other variables such as ST, LoO2, S3&S4, BMI and age were not significant. 3) ST had no significant correlation with respiratory index and any other variables (p<0.05). CONCLUSION: Because the respiratory index may not the entire physical status during sleep for OSAH patients, multiple indices (such as LoO2, BMI, ST, S3&S4, age) should be considered together apart from the respiratory index for proper management plan.

A Case of Adenomatoid Hamartoma Originated from Nasal Cavity / 대한이비인후과학회지

Hamartomas are non-neoplastic malformations or congenital errors of tissue development. They are characterized by an abnormal mixture of tissues indigenous to that area of the body, but with an excess of one or more of the tissue types. Adenomatoid hamartomas are pathologically unique-appearing sinonasal tract and nasopharyngeal lesions and defined as follows ; the glandular component of the hamartoma consisted of respiratory epithelium originating from the surface epithelium, and polypoid growth resulted from respiratory epithelial-lined adenomatoid proliferation. Hamartomas occur in all areas of the body, especially in the liver, spleen, kidney and lung, but very rarely in the nasal cavity, paranasal sinuses, or nasopharynx. The histopathological differential diagnosis of adenomatoid hamartoma of the sinonasal tract includes inverted papilloma and adenocarcinoma. Misinterpretation as a true neoplasm may result in unnecessary radical surgery. We present a case of adenomatoid hamartoma in the nasal cavity, which was treated with complete resection by endonasal endoscopic approach.

Age-related Changes of Doublecortin Positive Cells in the Olfactory Bulb of the Rat / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It is well-established that neurogenesis continues to occur during life in the restricted brain areas, such as the glomerular and granule cell layers of the olfactory bulb. Doublecortin is a protein required for neuronal migration in the developing brian and olfactrory bulb, and is expressed in postmitotic migrating and differentiating neurons during embryonic and postnatal development periods. We investigated age-related changes of doublecortin positive cells in the olfactory bulb of aged rat compared with new born rat. MATERIALS AND METHOD: Four months old (control group, n=7) and 24 months old (aged group, n=7) male Fischer 344 rats were used in this study. Olfactory bulbs of the rats were cut into 40 micro m-thick coronal sections and immunostained. We counted the doublecortin positive cells and neurofibrils, and measured the optical density of doublecortin by layer. We compared the results between the aged group and the control group. RESULTS: In the olfactory bulbs of aged group, we observed less doublecortin positive cells, neurofibrils and lower optical density than the control group. Doublecortin is expressed during life in migratory neuroblasts of the olfactory bulb of the rats. This expression is reduced in the aged group and the reduced degree is variable according to the layer. CONCLUSION: Age-related changes of the olfactory bulb are associated with the reduction of postnatal neurogenesis, especially during the migration and differentiaion stages. This changes result in reduction of interneurons of the olfactory bulb, and may be responsible for the decreased olfactory function.

Ranula in an infant

A Case of the Treatment of a Cystic Hygroma with the Use of Picibanil / 대한이비인후과학회지

Cystic hygroma is an uncommon lymphatic tumor seen rarely in adults. The majority of cystic hygromas occur in the head and neck, particularly in the posterior triangle. We present an unique case of a postpartum woman who experienced sudden onset of a large cystic hygroma in the neck without history of antecedent swelling, infection, or trauma. And we show the safety of the sclerotherapy by picibanil, a lyophilised incubation mixture of group A Streptococcus pyogenes of human origin, in the cystic hygroma.

A case of pimary malignant melanoma originated from esophageal melanosis / 대한내과학회지

Primary malignant melanoma of the esophagus(PMME) is an extremely rare but aggressive disease that composes less than 0.1% of all primary malignant neoplasm of the esophagus. PMME was first reported in 1906 and nearly 180 cases of primary esophageal malignant melanoma have been published in the medical literature. Symptoms of the primary malignant melanoma of the esophagus mimic that of any malignant obstructing lesion of the esophagus and the metastatic spread by lymphatics and vascular routes are common. Resection of the tumor with an anastomotic procedure seems to be the treatment of choice, however prognosis is poor. At present, chemotherapy and immunotherapy have no major role in treatment. We report a case of 67-year-old man with primary malignant melanoma of the esophagus originated from esophageal melanosis with a review of the literature.

A Case of Nonrecurrent Inferior Laryngeal Nerve / 대한이비인후과학회지

Damages on the recurrent laryngeal nerve (RLN) during thyroid surgery is the most common iatrogenic cause of vocal cord paralysis. Identification of the recurrent laryngeal nerve and meticulous surgical techniques can significantly decrease the incidence of this complication. The nonrecurrent inferior laryngeal nerve is an exceedingly rare anomaly of the recurrent laryngeal nerve. The nonrecurrent inferior laryngeal nerve is associated with abnormal development of the aortic arch, where the innominate (brachiorephalic) artery is not found and the right common carotid artery rises directly from the aortic arch. The aberrant right subclavian artery can always be felt against the vertebral column behind the esophagus. Surgeons need to be aware of the positions of these arteries to avoid damaging them. We experienced a case of nonrecurrent inferior laryngeal nerve in the right side with the aberrant right subclavian artery. The patient received a total thyroidectomy with neck dissection for thyroid carcinoma with nodal metastasis. Incidentally, we also found nonrecurrent inferior laryngeal nerve, and also found an aberrant right subclavian artery by the computed tomography scan. The patient presented transient vocal cord paralysis but gained complete recovery of vocal cord mobility after one and a half month later.

The Significance of Small Polyp of colon in Koreans / 영남의대학술지

BACKGROUND: There are two theories in the development of colon cancer. One is the adenoma-carcinoma sequence theory and the other is the de novo cancer theory. Western countries believe in the adenoma-carcinoma sequence theory, however there are many recent reports from Japan about cancers developing from small adenomas. METHODS: The present study analyzed 408 polyps from 508 cases that were taken by colonoscopic polypectomy at the Departmant of Internal Medicine, Yeung-Nam University Hospital. RESULTS: The percentage of patients who have polyp was 41.3%(210cases out of 526cases) and the peak incidence was noted in patients in their 50's and 60's. There was no difference between the sexes, but we noted significant increase in the incidence of polyps in patients over age of thirty. We found 395 polyps below 1cm and 13 polyps above 1cm. Among 408 polyps, 5 cases cancerous polyps and 3 cases showed polyp size of less than 1cm each. The first case was a polyp of 0.4cm in size with elevated mucosa at the ascending colon. The second was 0.5cm in size with round elevation and hyperemic mucosa in the rectum. The third polyp was 0.6cm in size with tubular elevation at the hepatic flexure. CONCLUSIONS: colon polyp is common disease in Koreans. even small polyps can have cancer tissue, which should be removed if discovered during colonoscopy. We believe that not all colon cancer originates in the manner described by the adenoma-carcinoma sequence theory. However further studies with a larger sample population are needed to determine the exact role colon polyps plays in the development of colon cancer.

Endoscopic Diagnosis of Right-Sided Colonic Diverticulitis / 대한소화기내시경학회지

BACKGROUND/AIMS: Recently, it has been well known that the incidence of colonic diverticulosis is increasing in Korea. However, cases of right-sided colonic diverticulitis are rare although diverticula are located in right-sided colon more than left-side. The major clinical symptom of right-sided colonic diverticulitis is acute right lower quadrant pain which may mimic acute appendicitis. Therefore, we evaluated the clinical characteristics of the patients with right-sided colonic diverticulitis and safety of the colonoscopic examinations in these patients. METHODS: The evidence of diverticulitis was confirmed by the presence of pus at the diverticular lesions on colonoscopy. We retrospectively analyzed clinical menifestations, laboratory findings, colonoscopic findings and the presence of complications after colonoscopy, and radiologic findings of the patients with right-sided colonic diverticulitis. RESULTS: All the patients with right-sided colonic diverticulitis had abdominal pain. Physical examinations showed abdominal tenderness in all patients and leukocytosis was noticed in 8 out of 12 patients (66%). There was no complication during and after colonoscopy. All the patients were managed with conservative treatment including broad-spectrum antibiotics and improved without clinical aggravation. CONCLUSIONS: The colonoscopic examination may be helpful to diagnose right-sided colonic diverticulitis.

A Clinical Study of Parathyroid Gland Tumors / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Parathyroid gland tumor is a relatively rare disease in Korea. The purpose of our study is to assess the clinical features, diagnostic tools and therapeutic results. MATERIALS AND METHOD: Seven patients with parathyroid gland tumor were analyzed retrospectively. They were diagnosed and received surgical therapy in our hospital from 1995 to 1999. The patients were all female with mean age of 45.3 years (in the range of 21-64 years old). We used ultrasonography, computed tomography, magnetic resonance imaging, parathyroid scan and 18F-FDG positron emission tomograph (PET) to identify the location of parathyroid gland neoplasm. RESULTS: All patients received proper surgical management. Three patients were diagnosed as parathyroid carcinoma, three as parathyroid adenoma and one patient as cavernous hemangioma. Two patients were found as recurrent tumor, Parathyroid carcinoma recurred in one patient, and parathyroid hyperplasia occurred in patient who was previously diagnosed as parathyroid adenoma. CONCLUSION: The results would he a useful guideline for better diagnostic strategies, proper surgical management and follow-up study for recurrence in the parathyroid gland tumor.

A Case of Right Atrial Mass Associated With Hepatocellular Carcinoma / 영남의대학술지

Right atrial metastasis occurs in 1 to 4% of patients with hepatoma. and the extention to intracavitary or metastasis of tumor as a large mass rare. However, the high risk of progressive heart failure and sudden death from the tricuspid valve obstruction necessitates prompt diagnosis of intracavitary extension, and adequate intervention is needed to prolong a patient's life. A 49 year-old female was referred to our hospital for further evaluation of a liver mass, which was identified at a local clinic. The liver mass was confirmed as hepatocellular carcinoma with CT and celiac angiographic finding. She was treated with transarterial chemoembolization. Thirty-four months after discharge, a low density right atrial mass was noted incidentally with chest computed tomography while investigating massive right pleural effusion for possible pulmonary metastasis. Echocardiography showed a huge inhomogenous echogenic mass at the right atrium. The present report describes a case of primary hepatocellular carcinoma with a intracavitary cardiac mass detected with two dimensional echocardiography.

A Case of the Rhabdomyosarcoma Involving Maxillary Sinus and Orbit / 대한이비인후과학회지

Recently, the 5-year survival rate of rhabdomyosarcoma has been greatly increased by combining therapy with radical surgery, radiation and chemotherapy. But it still has poor prognosis and there are few case reports of rhabdomyosarcoma of head and neck with long term survival rate. Here, we treated a rhabdomyosarcoma patient with radical surgery, radiation and chemotherpy. The patient visited our hospital in 1990 with a complaint of left facial protruding mass, diplopia and exopthalmos. She was diagnosed as rhabdomyosarcoma involving maxillary sinus and orbit. In september 1990, she received left total maxillectomy and eyeball exentration. After the surgery, we applied a 5000 cGy neutron therapy, 2000 cGy external radiation and 9 cycle pulse, along with VAC chemotherapy. She remains free of disease as of her last follow-up in February 1998.

A Clinical Analysis in Minor Salivary Gland Tumor / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Minor salivary gland tumors vary in their primary sites, histopathology and biological behavior. Therefore, various factors are considered in selecting the treatment modality and predicting the prognosis. Generally, it is reported that the prognosis of malignant tumors of minor salivary glands are worse than that of such lesions of major salivary glands. We performed this study to find out the clinical features and determine the prognostic factors of minor salivary gland tumors. MATERIALS AND METHODS: We analyzed retrospectively, 83 cases of minor salivary gland tumor and the 10 year survival rates using the Kaplan-Meier method. RESULTS: We found 16 benign tumors and 67 malignant tumors. Among the patients, 43 were males and 40 were females. The most common age group was the sixties, with the mean age of 50. The most common site of benign tumor was the palate, whereas malignant tumors were most commonly found in the maxillary sinus, palate, and floor of mouth, etc. Histopathologically, 14 patients with benign tumor had pleomorphic adenoma, and 39 patients with malignant tumor had adenoid cystic carcinoma. According to the criteria set by the AJCC on staging, the most common stage found for the subjects were the stage IV. Overall, the 5 year and 10 year survival rates were 56.1% and 46.9%, respectively. Histopathologic type had no effect on 10 year survival rates. The clinical stage had a significant impact on survival. CONCLUSION: In minor salivary gland tumor, the most significant prognostic factor was its clinical stage. Considering the frequent local recurrence and distant metastasis, long term follow ups will be needed.

Antenatal ultrasonographic diagnosis of congenital cystic adenomatoid malformation of lung: report of a case / 대한산부인과학회잡지

No abstract available.

Two cases of theca cell tumor of the ovary / 대한산부인과학회잡지

No abstract available.