Response to neuromuscular blockade with rocuronium during general anesthesia in a patient with dermatomyositis: A case report

Dermatomyositis is an idiopathic inflammatory myopathy characterized by skin changes and muscle weakness. Depending on the involvement of various muscles, dermatomyositis can cause aspiration pneumonia, ventilatory impairment, and heart failure. Several reports have documented normal or prolonged neuromuscular blockade following administration of different non-depolarizing neuromuscular blockers in patients with dermatomyositis. We observed delayed onset of blockade and prolonged recovery following administration of 0.6 mg/kg rocuronium in a patient with dermatomyositis. However, when the train-of-four ratio reached 0.3, the patient was administered pyridostigmine and glycopyrrolate, which led to normal response to reversal of rocuronium. The patient was extubated without respiratory complications. The outcomes of this case indicate that response to the usual dosage of muscle relaxants in patients with dermatomyositis might be different from that in patients without this condition. Anesthesiologists should pay attention to preoperative cardiorespiratory evaluation and intraoperative neuromuscular monitoring.

The Usefulness of Cone Beam Computed Tomography in Endoscopic Sinus Surgery

BACKGROUND AND OBJECTIVES: Cone beam CT is a relatively new radiologic technique for head and neck imaging, and is widely used in dentistry to plan implant procedures. Compared to conventional CT, it has greater spatial resolution, a lower radiation dose (about 10% that of conventional CT), and lower cost. The objective of this study was to evaluate the utility of cone beam CT for endoscopic sinus surgery. SUBJECTS AND METHODS: A total of 50 patients were involved. Endoscopic sinus surgery was performed unilaterally under local anesthesia, so we used the half Lund-Mackay score to quantify preoperative CT findings. The intraoperative severity score was also determined, and the relationship between the preoperative Lund-Mackay score and intraoperative severity was assessed. The subjective level of operator satisfaction was scored on a ten-point visual analogue scale in terms of four items: overall satisfaction, disease extent of each sinus, identification of anatomic landmarks, and distinction of soft tissue characteristics. RESULTS: The preoperative half Lund-Mackay score was 5.26 and the intraoperative severity score was 5.02; these two scores were significantly correlated (p < 0.01). The level of overall operator satisfaction was relatively high (9.04/10). CONCLUSION: Cone beam CT is a useful imaging method for preoperative evaluation of endoscopic sinus surgery.

Study on the Biological Characteristics of Cultured Osteoblasts Derived from Alveolar Bone / 대한치주과학회지

Osteoblasts from alveolar bone may have an important role in the bone regeneration for periodontium, but their culture and characterization are not determined yet. The purpose of this study was to investigate the biological characteristics of primary explant cultured osteoblasts(PECO) from alveolar bone. Osteoblasts were isolated and cultured from alveolar socket of extracted tooth in children. To compare the characteristics, osteoblasts and gingival fibroblasts were cultured with DMEM at 37degrees C, 5% CO2, 100% humidity incubator, and human fetal osteoblasts cell line(hFOB1) were cultured with DMEM at 34degrees C, 5%, CO2, 100% humidity incubator. To characterize the isolated bone cells, morphologic change, cell proliferation and differentiation were measured. Morphology of PECO was small round body or cuboidal shape on inverted microscope and was similar with hFOB1. PECO became polygonal shape with stellate and had an amorphous shape at 9th passage in culture. PECO had significantly higher activity than that of gingival fibroblasts and hFOB1 in alkaline phosphatase activity. The expression of osteocalcin and bone sialoprotein in PECO was notably increased when compared with hFOB1 and gingival fibroblasts. These result indicated that PECO from alveolar bone in children has an obvious characteristics of osteoblast, may be applied for the regeneration of bone.

Effects of Ginseng Radix on the Cell Cycle Regulation in Human Fetal Osteoblast / 대한치주과학회지

Ginseng Radix(GR) had been used widely from oriental medicine and the effects of it have been investigated by many researchers. The purpose of present study was to investigate the effects of GR on the cell cycle progression and its molecular mechanism in human fetal osteoblast. The results were as follows. Increased cell proliferation was observed in cells exposed to 100 ng/ml, 10 ng/ml of GR-1 at 12 hours and 24 hours, 1 microgram/ml of GR-1 at 48 hours, and 100 microgram/ml, 10 microgram/ml of GR-2 at 12 hours, all treatment groups of GR-2 at 24 hours(p<0.05). S phase and G1 phase was increased in the group of treated with 100 ng/ml of GR-1, with 10 microgram/ml and 1 microgram/ml of GR-2, with 100 microgram/ml and 10 microgram/ml of GR-3 in the cell cycle analysis. The cell cycle regulation protein levels of Cyclin D1, Cyclin E, CDK 2, CDK 4 and CDK 6 were increased in the group of treated with 1 microgram/ml and 100 ng/ml of GR-1, with 10 microgram/ml and 1 microgram/ml of GR-2, with 100 microgram/ml and 10 microgram/ml of GR-3. On the other hand, p21 was decreased in the treatment group with 1 microgram/ml and 100 ng/ml of GR-1, with 10 microgram/ml and 1 microgram/ml of GR-2, 10 microgram/ml of GR-3, and p53 and p16 was decreased in the treatment group with 100 ng/ml of GR-1, 100 microgram/ml GR-3 and pRb was decreased in the all treatment groups except 1 microgram/ml of GR-1. These results suggested that GR increases the cell proliferation and the cell cycle progression in human fetal osteoblast, which is linked to increased cell cycle regulation protein levels of Cyclin D1, Cyclin E, CDK 2, CDK 4, CDK 6 and decreased cell cycle regulation protein levels of p21, pRb.

Incidence and Clinical Significance of Thyroid Lesions in Patients with Globus Pharyngeus / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Globus pharyngeus represents 3-4% of new otolaryngology outpatient referrals. The globus symptom in the throat may be an indication of thyroid abnormalities. The purpose of this study is to estimate the incidence of impalpable thyroid lesions in patients with globus pharyngeus and investigate possible association between globus pharyngeus and thyroid lesion. MATERIALS AND MEHTODS: The thyroid glands of 128 patients with globus pharyngeus and 50 controls were examined by ultrasound by a consultant radiologist using a 7 MHz probe. RESULTS: Thyroid abnormalities were present in 69/128 (54%) patients with globus and in 11/50 (22%) controls (p<0.05). Of the thyroid lesions in globus pharyngeus, 42/69 (61%) had nodules. The diameter of the echoic nodules varied from 2 to 23 mm. Thyroid lesions were common (78%) in female patients with globus, between the ages of 30 and 40. CONCLUSION: Impalpable thyroid abnormalities are significantly more common in patients with globus pharyngeus than in controls. Abnormalities of the thyroid gland may be the cause of globus symptoms in some patients, and it is necessary to evaluate the thyroid gland for investigation of the cause of globus pharyngeus.

Two Cases of Bilateral Antrochoanal Polyps in Children / 대한이비인후과학회지

Antrochoanal polyp (ACP) is usually unilateral and occurs most commonly in children. However, bilateral ACP in children is extremely rare. In this paper, we report two such cases of bilateral antrochoanal polyps removed by functional endoscopic sinus surgery and discuss the etiology, diagnosis and management of nasal polyps in children.

Psychological Charateristics of Patients with Vocal Nodules: An Investigation Using the Symptom Checklist-90-Revision / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Nodules of vocal cords are considered to be tissue reactions to chronic mechanical irritation such as vocal misuse or abuse. Psychological factors related to the development of the vocal nodules have been documented in the literatures. The purpose of this study is to analyze the psychological characteristics of the patients with vocal nodules and find the relationship between the characteristics and the development of the vocal nodules. MATERIALS AND METHODS: The patient group consisted of 41 house-wives with vocal nodules (mean age 35.7+/-10.4 years) who visited the department of otolaryngology at Kangbuk Samsung Hospital from July 1997 to May 1998. The control group consisted of 35 house-wives who didn't have any vocal pathology (mean age 34.6+/-9.1 years). All the subjects completed the questionnaires related to the voice disorder and SCL-90-R, a widely used psychopathology test. The scores of SCL-90-R of the patient group were compared with those of the control group. The scores of the patient group with less than 1 year duration (acute) and more than 1 year duration (chronic) were also compared with those of the controls. RESULTS: The total patient group differed statistically from the control group on 7 neurotic scales (p<0.001) and 1 psychotic scales (p<0.05). The acute patient group differed on 2 neurotic scales (p<0.05). CONCLUSION: We suggest that the neurotic traits found in the acute patients group may have a role in the development of vocal nodules. The scales found in the total patients group may indicate changes in the psychological characteristics that follow voice change. Thus, psychological characteristics play an important role in the pathogenesis of vocal nodules and warrant more attention to the psychological, emotional aspect of patients in order to treat and prevent these vocal nodules.

Effects of Glycosaminoglycan on the Growth of Human Gingival Fibroblast / 대한치주과학회지

Gingival fibroblasts are embedded in an extracellular matrix. The matrixs have influence on the development, polarity, and behavior of nearby cells. The major component of periodontal extracellular matrix is a glycosaminoglycan. The glycosaminoglycan are large carbohydrates that are composed of repeating disaccharide units and exist in three main form: dermatan sulfate, chondrotitin sulfate, heparan sulfate. The purpose of present study is to examine the biologic effects of glycosaminoglycan on human gingival fibroblast. Human gingival fibroblasts were supplemented with each glycosaminoglycan, and cellular attachment and proliferation was determined by MTT assay. Dermatan sulfate and chondroitin sulfate did not stimulate the attachment and proliferation of human gingival fibroblasts, but heparan sulfate increased the proliferation and attachment in a time- and dose- dependent manner. These results indicated that heparan sulfate seems to have a high potential for gingival regeneration and root surface attachment.

Effects of Histamine 2 Antagonist in the Treatment of Perennial Allergic Rhinitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Clinically, H1 antagonists are beneficial in relieving nasal itching, sneezing, and rhinorrhea in patients with allergic rhinitis. But they have a lesser effect on nasal blockade. Concomitant administration of an H1 antagonist with an H2 antagonist have been reported to improve the symptoms of allergic rhinitis and enhance the wheal suppression in the skin test. The aim of this study was to assess the effect of H2 antagonist in the management of perennial allergic rhinitis. MATERIALS AND METHODS: 60 allergic rhinitis patients with positive skin test was randomly divided by 3 different groups. The groups were H1 antagonist (cetirizine), H2 antagonist (ranitidine), and combination of H1 and H2 antagonist (cetirizine and ranitidine) group. The clinical response, wheal suppression in the skin test, total serum IgE levels, and serum eosinophil count were measured during the clinical trial. RESULTS: There was a significant relief of nasal symptoms, especially nasal obstruction in the combination of H1 and H2 antagonist administered group (p<0.05). And combined therapy with H1 and H2 antagonist reduced the total serum IgE level and increased wheal suppression in skin test (p<0.05). The change in serum eosinophil count was not observed. CONCLUSIONS: In this study, concomitant administration of H1 antagonist with H2 antagonist will be helpful in the treatment of perennial allergic rhinitis.

Outcomes of Transnasal Endoscopic Sinus Surgery in 62 Cases of Antrochoanal Polyp

This study was conducted to review the clinical features of antrochoanal polyp and to evaluate the effectiveness of transnasal endoscopic sinus surgery as a primary surgical method in treating antrochoanal polyp. We reviewed the profiles, which included clinical symptoms, past surgical history, surgical techniques and operative findings, of 57 patients (62 cases) treated for antrochoanal polyp with transnasal endoscopic sinus surgery during the past four years. Out of this subject pool, 45 patients (50 cases) underwent follow-up examinations and were analyzed. The follow-up periods ranged from 18 to 63 months and averaged 33 months. About half of the cases involved pediatric-to-young-adult patients (under 20 years) and five cases were bilateral. The most frequent site of origin was the natural ostium of the maxillary sinus, followed by the posteromedial wall and the posterolateral wall. Recurrences after endoscopic sinus surgery were observed in five cases, which were subsequently treated with revision endoscopic sinus surgery. In these cases of recurrence, there was no evidence of recurrence during a mean follow-up period of 30 months. These results suggest that transnasal endoscopic sinus surgery may be appropriate for the primary treatment of antrochoanal polyp and useful in the treatment of recurrent cases, especially those involving children.

A Case of a Sphenoid Sinus Mucocele Protruding into Both Nasal Cavities: Transnasal Endoscopic Marsupialization

A sphenoid sinus mucocele is a rare condition that causes a variety of symptoms by creating pressure on important contiguous neurological and vascular structures. The lesion is difficult to diagnose due to the subtlety of its symptoms, but careful radiological evaluation, with CT and MRI, for example, can help to provide a correct assessment. Transnasal endoscopic surgery can potentially deliver dramatic reduction in the operative morbidity of surgery for paranasal sinus mucoceles by offering an approach that is minimally invasive under local anesthesia. We experienced a 37-year-old male patient with a large sphenoid sinus mucocele protruding into both nasal cavities. The patient was treated with transnasal endoscopic marsupialization.

Prevalence and Clinical Significance of Incidental Sinus Abnormalities on Brain Magnetic Resonance Imaging in a Non-ENT Population / 대한이비인후과학회지

OBJECTIVES: The purpose of this study is to investigate the prevalence and the types of sinus abnormalities in a non-ENT population and draw any clinical correlation between the two phenomena. MATERIALS AND METHODS: We prospectively evaluated a total 120 patients who underwent brain magnetic resonance imaging (MRI) for suspected intracranial diseases from March to July 1997, in another department at Kang-buk Samsung Hospital. Patients who had been treated for nasal or sinus diseases and who had previous history of nasal or sinus operations were excluded. The sinus abnormalities found on MRI were classified into 6 types as follows; normal, mucosal thickening less than 3 mm and more than 3 mm, fluid collection, polyp or cyst, and others. RESULTS: Among 96 patients studied, 42 (43.7%) patients showed abnormality in one or more sinus group; 12 (20.7%) of the 58 asymptomatic patients and 30 (78.9%) of the 38 symptomatic patients. Sinus abnormalities were most commonly observed in the maxillary sinus. Most common abnormality was the mucosal thickening less than 3 mm. CONCLUSION: Incidental sinus abnormalities detected in a non-ENT population were relatively common. However, pathologic condition which demanded treatment among these abnormalities were rare. Therefore, it would be important to be careful not to overestimate these signs, and one should evaluate their clinical correlations through complete physical examinations before applying any treatment for these lesions.

Histopathologic Changes of Cochlea and Hearing Threshold Changes according to Duration of Noise-Exposure in the Rat / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The degree of noise induced hearing loss was determined principally according to the level and duration of noise and patient's state. The purpose of this study was to investigate the cochlear histopathology and hearing threshold immediately after noise exposure according to duration of noise exposure, and finally to draw relationship between the cochlear pathology and hearing threshold. MATERIALS AND METHOD: Each group of animals (6 ears) has been exposed for 10 minutes, 1 hour, 2 hours, 3 hours, 4 hours, 24 hours and 48 hours to an octave band of noise with a center frequency of 4000 Hz and a sound pressure level of 110 dB. After noise exposure, the hearing thresholds of the subjects were determined with auditory brainstem response (ABR) and immediately their inner ear were fixed and observed with transmission electron microscopy (TEM). RESULTS: ABR thresholds were increased according to lengthening of duration of noise exposure. TEM findings of outer hair cells, Deiters' cells and ganglion cells showed more severe degeneration according to lengthening of duration of noise exposure. Damages of all kinds of cells appeared almost at the same time. CONCLUSION: Through the foregone study, cochlear pathology was proportioned to increased hearing threshold, and the damages of outer hair cells and ganglion cells appeared almost at the same time. It seems that not only damages of outer hair cells, but also damages of ganglion cells contribute to early hearing threshold shift during continuous intense noise exposure.

Effects of Helium Gas on the Phonatory Function / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The development of saturation diving has enabled men to work underseas at great depths and for long periods of time. However, the utilization of HeO2 gas mixture has been a aubject of much study. This paper present a discussion effect of the helium gas on speech by usling gas machine which have been developed. MATERIALS AND METHODS: Twenty male volunteers without voice problems produced /a/ vowel sound before and after helium gas inhalation. The results were analyzed by using an aerophone, an acoustic analyzer, videostroboscopy, and a nasometer. RESULTS: The first formant, the second formant and the bandwidths of the second formant were significantly increased after helium gas inhalation. A meaningful change was noted in asalance. CONCLUSION: The helium gas has an effect on the resonant structure of oral and nasal cavity due to its physical characteristics.

Congenital Duodenal Obstruction

In the neonatal diseases of pediatric surgery, a congenital duodenal obstruction is an important part of congenital disease. Between March 1994 and December 1996, 15 cases of congenital duodenal obstruction were experienced and treated at St. Francisco's General Hospital. The following results were obstained: 1) The types of congenital duodenal obstruction were 5 malrotations, 4 atresia, 3 webs, 2 annular pancreases, and 1 obstruction due to an ectopic pancreas. 2) There were 8 males and 7 females; the male to female ratio was 1.14 : 1. 3) The age on admission was 1 to 7 days in 13 cases (87%), and all cases were admitted within 1 month after birth. 4) The birth weight below 2500 gm in only 2 cases (13%). 5) The main clinical symtom was vomiting (93%). 6) Associated anomalies were found in 11 cases (73.3%): 4 cases of congenital heart disease, 3 of Down's syndrom, 2 of malrotations, 2 of urogenital anmalies, and 1 each of jejunal atresia, midgut volvulus, and polydactyly. 7) Postoperative complications occurred in 4 cases (27%), but there was no deaths.

Outcomes of Endoscopic Surgical Treatment in 41 Cases Nasal and Sinus Inverted Papilloma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Many investigators had argued that aggressive surgical treatments such as medial maxillectomy with external or transantral ethmoidectomy are proper for inverted papilloma. However, lately, many investigators reported that more extended endoscopic surgery could be applied to the field of nasal disease. We evaluated the usefulness of endoscopic endonasal surgery for treatment and follow up of inverted papilloma. MATERIALS AND METHODS: Forty-one patients diagnosed with inverted papilloma in our clinic have undertaken endoscopic sinus surgery from 1992 through 1996. All the patients who were treated endoscopically have had their disease followed for a minimum of 1 year, with an average of 3 years. RESULTS: Six cases (14.6%) showed recurrence. Among them, 2 cases showed recurrence six times during the follow-up period, and endoscopic surgery was done each time until finally cured. There is no case related with malignant change in pathology. CONCLUSION: We conclude that endoscopic procedure is useful for preoperative examination, postoperative recurrence follow-up and treatment of both limited and recurrent inverted papilloma.

A Neurofibroma Arising from the Nasal Septum / 대한이비인후과학회지

Neurofibroma rarely occurs as a solitary lesion but mostly occurs as part of neurofibromatosis and reports of neurofibromas developed in the nasal cavity or paranasal sinus are very rare. We present here a case of neurofibroma in a 57 year-old female who complained of purulent rhinorrhea, nasal obstruction and epiphora, all of which persisted for a year. Anterior rhinoscopic examination showed huge polypoid mass in the right nasal cavity, and CT/MRI revealed an expansive, highly enhancing mass in the right nasal cavity remodeling the right lateral nasal wall, the middle turbinate and the inferior turbinate. The radiologic examinations also showed secretions in the right maxillary and ethmoid sinuses. We removed this tumor completely by transnasal endoscopic surgery. No evidence of recurrence was found by the twelfth month following the operation.

Endoscopic Sinus Surgery in Paranasal Sinus Mucoceles / 대한이비인후과학회지

BACKGROUND: The term mucocele was introduced by Rollet in 1896 and Onodi gave the first histological description in 1901. A variety of conservative and radical surgical procedures have been introduced and each approach has its proponents and opponents. OBJECTIVES: The purpose of this report is to share the experiences of functional endoscopic sinus surgery for paranasal sinuse mucoceles. MATERIALS AND METHODS: Ten patients diagnosed as having paranasal sinus mucocele underwent endoscopic marsupialization from July 1989 to December 1996. The follow-up period was between 2 months and 69 months with a mean of 37.9 months. RESULTS: Endoscopic surgery was attempted in 4 ethmoid, 4 maxillary, 1 frontoethmoid and 1 frontal sinus mucocele. Five cases had preoperative proptosis, four had nasal stuffiness and three had ophthalmoplegia and visual disturbance, and two had frontal headache. Computed tomography scan revealed that 7 cases had erosion of sinus wall. No disease recurrence has been noted to date with endoscopic follow-up of up to 69 months. CONCLUSION: Functional endoscopic sinus surgery provides good surgical results in the treatment of frontal, ethmoid, and maxillary sinus mucoceles with the advantage of restoration of functional drainage system.

Management of Congenital Choanal Atresia with the KTP/532 Laser / 대한이비인후과학회지

Congenital choanal atresia is an uncommon anomaly. In most reported series it has an incidence of 1 in 7,000 or 80,000 births with female preponderance. Approximately 90% of cases are reported as having unilateral bony type congenital atresia. Bilateral congenital choanal atresia cause acute life-threatening respiratory obstruction in newborns, whereas unilateral atresia alone does not cause significant airway obstruction. Rarely an infant may compensate by rapidly learning mouth breathing and the diagnosis may escape detection for months or even years. A variety of techniques are available to correct this problem, but none is entirely satisfactory. The authors recently experienced a case of unilateral membranous type congenital choanal atresia which was treated by KTP/532 laser and report the case with review of literatures.

A Case of Monostotic Fibrous Dysplasia of the Frontal Sinus / 대한이비인후과학회지

Fibrous dysplasia is a benign bone lesion characterized by the replacement of the normal substance of the interior of the bone by the fibro-osseous connective tissue exhibiting varying degree of osseous metaplasia histologically. In the head and neck, the most frequently involved area is the maxilla. We present 29 year-old male with diffuse swelling in the right frontal area, headache and nasal obstruction persisting for 2 years. Computed tomography scan of the paranasal sinus revealed irregular hyperdense mass arising from the right frontal sinus. The interfrontal septum was deviated to the left side by the mass. There was no evidence of invasion through and into the orbit and the cranial vault. Bilateral osteoplastic surgery of the frontal sinus was done. The mass was originated from the posterior wall of the right frontal sinus and expanded to the anterior wall. It's margin was poorly defined with adjacent normal osseous tissues, and it was removed by drilling and curettage. Left nasofrontal duct was well preserved, whereas right nasofrontal duct was obstructed by the mass. The pathologic finding consisted of an abundance of fibroblasts in interlacing bundles or whorls, connective tissue stroma of high vascularity, and islets of irregular trabeculae of new bone.