Compound Nerve Action Potential of Common Peroneal Nerve and Sural Nerve Action Potential in Common Peroneal Neuropathy

To enhance the accuracy for determining the precise localization, the findings of the compound nerve action potentials (CNAPs) of the common peroneal nerve (CPN) were investigated in patients with common peroneal mononeuropathy (CPM) in the knee, and the sural sensory nerve action potentials (SNAPs) were also analyzed. Twenty-five patients with CPM in the knee were retrospectively reviewed. The findings of the CNAPs of the CPN recorded at the fibular neck and the sural SNAPs were analyzed. The lesion was localized at the fibular head (abnormal CNAPs) and at or distal to the fibular head (normal CNAPs). Seven patients were diagnosed as having a lesion at or distal to the fibular neck, and 18 cases were diagnosed as having a fibular head lesion. The sural SNAPs were normal in all the cases of lesion at or distal to the fibular neck. Among 18 cases of fibular head lesion, the sural SNAPs were normal in 7 patients: two cases of conduction block and 5 cases of mild axon loss. Eleven patients showed abnormal sural SNAPs. Of those, 9 cases were severe axon loss lesions and 2 patients were diagnosed as having severe axon loss with conduction block. The recording of the CNAPs may enhance precise localization of CPM in the knee. Moreover, the sural SNAPs could be affected by severe axonal lesion at the fibular head.

The Effect of Genotype of NAT2, TNF-alpha and TGF-beta Genes on Allergic Rhinitis in Korea / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The inflammatory reaction is affected by the genotype or phenotype of genes related with inflammation modulating cytokines and allergen metabolizing enzyme. This study was performed to investigate the relationship between N-acetyl transferase 2 (NAT2), tumor necrosis factor-alpha(TNF-alpha), transforming growth factor-beta(TGF-beta) and the allergic rhinitis in Korea. SUBJECTS AND METHOD: One hundred forty five allergic rhinitis patients and 167 controls were included. Venous blood samples were collected and the genotypes were analyzed by PCR technique. NAT2 phenotypes were designated as 'high', 'medium' and 'low' by known genotype-phenotype relationship. TNF-alpha genotypes were classified as 'A/A', 'A/G' and 'G/G'. TGF-beta genotype was classified as 'Arg/Arg', 'Arg/Pro' and 'Pro/Pro'. These data were analyzed by SAS for windows ver 8.02. RESULTS: The phenotype of NAT2 and genotype of TGF-beta showed no significant effect on allergic rhinitis. G/G or G/A genotype of TNF-alpha significantly increases the risk of allergic rhinitis. High activity phenotype of NAT2 showed higher level of total serum IgE. CONCLUSION: Genetic factors including TGF-beta are important in the development of allergic rhinitis in Korea. NAT2 phenotype affect allergic reaction.

Glial Choristoma in the Middle Ear and Mastoid Bone: A Case Report

Heterotopic brain tissue usually involves extracranial midline structures of the head and neck such as nose, nasopharynx, and oral cavity. Its occurrence in the non-midline structures, including middle ear, is rare. We described a 50-yr-old-man with heterotopic glial tissue in the middle ear and mastoid bone. The patient presented with progressive hearing loss for 8 yr. There was no history of congenital anomalies, trauma, or ear surgery. Computed tomography revealed a mass-like lesion with soft tissue density occupying the middle ear cavity and mastoid antrum. At the operation, a graywhite fibrotic mass was detected in the epitympanic area. Mesotympanum and ossicles were intact. The patient underwent left simple mastoidectomy with type I tympanoplasty. During operation, definite cranial bone defect or cerebrospinal fluid leakage was not found. Histologically, the lesion was composed of exclusively mature, disorganized glial tissue with fibrovascular elements in a rather loose fibrillary background. Glial tissue showed diffuse positive reaction for glial fibrillar acidic protein and S100 protein on immunohistochemical study.

A Case of Conductive Hearing Loss by Heterotopic Neuroglial Tissue in the Middle Ear / 대한이비인후과학회지

Heterotopic brain tissue is defined as displaced neuroglial tissue that has no connection with the central nervous system. Mostly it involves the midline structures including nose, nasopharynx, oropharynx, palate, lips tongue, and tonsil. Rarely it involves non-midline structures such as middle ear, mastoid, and orbit. Commonly accepted theory is that heterotopic neural tissue is a variant of encephalocele in which the central nervous system connection has been lost or became vestigial. We experienced a case of heterotopic neuroglial tissue found in a patient who had conductive hearing loss in unilateral ear, and report it with a review of the related literature.

A Case of Spindle Cell Carcinoma Accompanied by Inverted Papilloma / 대한이비인후과학회지

Spindle cell carcinoma (sarcomatoid carcinoma) of the upper aerodigestive tract is a rare malignant neoplasm and can be misdiagnosed as reactive lesion or mesenchymal lesion. Spindle cell carcinoma is found predominantly in the larynx and pharynx, but they also occur in the sinonasal tract, oral cavity, and esophagus. The best diagnostic tool of spindle cell carcinoma is immunohistologic staining. Spindle cell reacts positively with cytokeratin and vimentin, but reacts negatively with desmin, smooth muscle actin, collagenIV and s-100 protein. Squamous cell carcinoma is the major malignancy that is associated with inverted carcinoma. To our knowledge, this is the first case report of spindle cell carcinoma accompanied by inverted papilloma, and we represent the case with a review of the related literatures.

Long Term Follow-up Results of Total Knee Arthroplasty

PURPOSE: We purpose to analyse the clinical and radiologic results of total knee arthroplasty and long term survival rate and to assess the cause of failure. MATERIALS AND METHODS: We retrospectively investigated 156 TKAs(110 patients) from January 1985 to March 1992 followed up for more than 10 year. These series of 110 patients included 20 men and 90 women, the mean follow-up period was 12 years 3 months(range 10~18 years). In primary diagnosis, there were Degenerative Arthritis (DA) 105 knees, Rheumatoid Arthritis(RA) 45 knees, others 6 knees. Of 156 knees, there were 139 Cruciate-Retaining type(CR), and 17 Posterior-Stabilized type(PS). Both femoral and tibial component were fixed with cement in 71 knees, 15 knees were fixed without cement, and only one component was fixed with cement in 70 knees(Hybrid). Press Fit Condylar(PFC) prosthesis were 133, Miller Galante(MG) were 16, and others 7. 16 cases of patella were preserved and 140 knees were resurfaced. The clinical outcome was evaluated according to the HSS and American Knee Society scoring system and radiologic analysis was made by tibiofemoral angle and radiolucent line by American Knee Sociey system. Results: The HSS score was improved from 51.7 to 86.4 and ROM was improved from 101.3 degrees to 111.7 degrees. The last ROM was improved in DA group than RA, and HSS score of PFC prosthesis was higher than Miller-Galante. The failure were seven(5.3%) in PFC, but seven(43.8%) in MG. The survival rate was 93.0% after 10 years, and 88.8% after 14 years when the endpoint was defined as revision arthroplasty. The arthroplasty fails due to wear, aseptic loosening and deep infection and patellofemoral complication. CONCLUSION: The total knee arthroplasty is a safe, durable, and predictable procedure and has a long survivorship if we select the proper prosthesis.

A Case of Submental Lymphadenitis by Toxoplasmosis / 대한이비인후과학회지

Toxoplasma gondii, an intracellular coccidian protozoan and a widespread parasite affecting various animals and humans, is one of the common causes of cervical lymphadenitis in human. Cervical lymphadenitis is the most common clinical manifestation of toxoplasmosis in an immunocompetent host, but still more rare in Korea than in other countries, including United States and Europe. In Korea, number of travelers to and from other countries and inclusion of meat as a part of daily diet are increasing, possibly increasing the incidence of toxoplasma lymphadenitis, which should be considered by differential diagnosis of lymphadenitis. We present a case of toxoplasma lymphadenitis in submental lymph nodes in an immunocompetent host.

A Study of the Natural Course and Radiologic Findings in the Bilateral Vocal Cord Palsy Originating from Acute Cerebral Lesions / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Bilateral vocal cord paralysis is a potentially life-threating problem, but it accompanies a relatively rare complication of acute cerebral lesions. We attempted to estimate the usefulness of radiologic studies as predictive factors of recovery from this condition. MATERIALS AND METHOD: Five patients who developed acute respiratory failure after acute ischemic stroke were included in the study and followed up. Radiologic studies (CT or MRI) were performed to localize the brain lesions. Bilateral vocal cord paralyses were confirmed by rigid or fiberoptic laryngoscopy. RESULTS: Recovery of vocal cord mobility was observed in three patients. Vocal cord paralysis was not resolved in two patients with lateral medullary infarction and large subcortical infarction. CONCLUSION: Bilateral vocal cord paralyses resulting from acute cerebral lesions have different prognoses according to their location and extent. Therefore, radiological studies may be useful for predicting the recovery of centrally originated bilateral vocal cord paralysis.

A Case of Chondrodysplasia Punctata Combined with Unilateral Choanal Atresia / 대한이비인후과학회지

Chondrodysplasia punctata is a rare congenital disease. It is classified into four main types according to the clinical features and heredity: autosomal dominant (Conradi-Hunermann's) type, autosomal recessive (rhizomelic) type, X-linked dominant type and X-linked recessive type. Among the four, rhizomelic chondrodysplasia punctata (RCDP) is the most lethal form of the disease, and most patients die in the neonatal period. Diagnosis of the RCDP relies on its characteristic features and radiological finding. The characteristic features are craniofacial dysmorphism (flat face, flat nasal bridge, anteverted nostril, telecanthus), cataracts, rhizomelic limb shortening, ichthyosis, and mental retardation. Radiologic findings include rhizomelic symmetrical shortening of upper or lower extremity, coronal cleft of vertebral body, metaphysical spraying and stippled calcification. This case shows typical abnormality in the face and extremity and also radiologic abnormality, uniquely combined with unilateral choanal atresia.

A Case of Acquired Transient Laryngomalacia Associated with Diabetic Ketoacidosis / 대한이비인후과학회지

Collapse of epiglottis during inspiration is an unusual cause of upper airway obstruction. It is usually classified as a congenital anomaly but several acquired cases have been reported to occur in patients who have lost pharyngeal airway support by head injury and coma. Recently, we experienced a case of laryngomalacia that was associated with diabetic ketoacidosis and compromised the airway. A tracheotomy was first needed to maintain the respiration, then conservative management including diabetes control was enough to restore the patient's condition. This case supports the neuromuscular dysfunction theory which purports laryngomalacia as its cause.

A Case of Kartagener's syndrome combined with congenital nystagmus / 대한이비인후과학회지

Primary ciliary dyskinesia results in characteristic clinical symptoms, including chronic pansinusitis, recurrent infections of the respiratory tract, and infertility. Kartagener's syndrome is clinically distinguishable by the presence of situs inversus from this group of diseases. Other otolaryngological manifestations of primary ciliary dyskinesia which have been reported include otitis media with effusion, tympanosclerosis, keratosis obturans, and chronic cholesteatoma. Congenital nystagmus is another otological symptom characterized by ocular oscillation, which usually appears in the early infancy, and is often associated with visuosensory abnormalities. Recently, we experienced a 13 year-old boy with congenital nystagmus in addition to all other manifestations of Kartagener's syndrome. Although the clinical implication is not clear, it is possible that two diseases share the same developmental abnormality.

Three Cases of Ossifying Fibroma of the Facial Bones / 대한이비인후과학회지

Ossifying fibroma is a diagnostic designation for fibro-osseous lesion characterized by osteoid rims and osteoblasts lying in irregularly shaped bony trabeculae. We experienced 3 cases of pathologically proven ossifying fibroma. One occured in the gingivobuccal area of an 10-year-old male; another involving the maxillary sinus and alveolus of 22-year-old female and the last one in the ethmoid sinus of 31-year-old female which is unique in its presentation as a cystic mass. Total or near total excision resulted in a disease-free follow-up period of 11 to 26 months. It appeared that ossifying fibroma is demarcated from adjacent cancellous bone and when growing beyond the confines of the involved bone, is separated from the adjacent soft tissue by an expanded and attenuated layer of cortical bone.

Treatment Results of Osteoplastic Frontal Sinus Operation / 대한이비인후과학회지

Objectives: We aimed to look for indications and find out treatment outcomes of osteoplastic frontal sinus operation (OFSO) for frontal sinus diseases. MATERIALS AND METHODS: We retrospectively evaluated nine patients undergoing OFSO between 1993 and 1997 and examined indications for surgery, complications, and outcomes. All patients were male and their ages ranged from 27 to 63 years with a mean age of 42 years. RESULTS: Indications for surgery were found in 3 cases of fracture involving frontal sinus, mucopyocele (3 cases), osteoma (2 cases), and inverted papilloma (1 case). In five patients, bilateral frontal sinuses were opened through bone flaps and in four patients unilateral frontal sinus was opened. Follow up information was available on 8 patients all of whom were cured without evidence of recurrence to date. No serious complications, either intracranial or orbital, occurred, however, all 8 followed up patients have persistent abnormal forehead sensation and abnormal bony contour of forehead, either depression or bossing, developed in 4 patients. CONCLUSION: Osteoplastic frontal sinus operation seems to be a rational approach to eradicate frontal sinus diseases such as tumors, fractures, and mucopyoceles, which cannot be treated by endoscopic sinus surgery. Minor sequelae such as supraorbital hypesthesia and forehead deformity may develop postopera-tively and the patients should be informed of them preoperatively.

A Modified Colonna Capsular Arthroplasty For Old Unreduced DDH in Late Childhood and Adolescence: A Mid-term follow-up study / 대한정형외과학회잡지

Sixteen patients who underwent 18 modified Colonna capsular arthroplasty for old unreduced DDH1 between 1984 and 1992 were recalled and critically reviewed. The average age at operation was 11.5 years (range, 8.1 to 14.5 years). The average follow-up period was 7 years and 1 month (range, 5 to 13 years). All of the patients had pain or discomfort of the hip and limp. Femoral shortening was combined in all patients, and 13 hips required concurrent pelvic osteotomy (Chiari osteotomy in 5 hips Salter innominate osteotomy in 1 hips and Steel s osteotomy in 2 hips) or slotted shelf augmentation (5 hips) due to small and shallow acetabulum relative to the femoral head. In the remaining 5 hips which had thick medial acetabular wall acetabular reaming alone was performed. At the latest followup, 9 hips showed excellent 5, good; and 4, fair results according to the modified Harris hip score and IOWA hip score. In addition, all patients except one were satisfied with the outcome in terms of regaining hip stability and decrease in pain or discomfort and limp. Radiological evaluation revealed progressive, significant increase in size of the femoral head and sphericity improvement in 12 hips. The sphericity of the femoral head did not improve in other 2 hips. In the remaining 4 hips, in which preoperative femoral head shape was relatively aspherical, the sphericity worsened after affection of ischemic necrosis or osteoarthrosis. Complications included undisplaced femoral neck fracture during physiotherapy in 2, ischemic necrosis in 2, heterotropic ossification in 2, acetabular protrusio due to too much reaming in 3 hips, and residual subluxation requiring additional pelvic surgery in 2 hips, In conclusion, we believe that modified Colonna capsular arthroplasty with femoral shortening is valid, if properly done, in the reconsruction of painful hip with old unreduced DDH in late childhood and adolesence.