Availability of Ultrasongraphic Study in Larynx / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The observation about the movements of laryngopharyngeal or surrounding structures is very important to understand the physiology of phonation or swallowing and to diagnose the disease. Many investigating methods were used but most of them were ineffective because those were invasive or indirect methods. Ultrasonographical examination of larynx can be applied, but the shortcomings of mechanics limits the usage of ultrasonographical study of larynx. Recently, the revolution of computer and videosystem made ultrasonographical study to be applied to the larynx. In this study, authors wanted to find out the availability of the ultrasonographical study of larynx. MATERIALS AND METHODS: 3.5 and 7.5 MHz probes were applied to anterior neck and the ultrasonographical findings were observed according to the various phonation types. RESULTS: In the axial plane, the movements of bilateral vocal folds were observed. Unilateral movement of vocal cord alone was seen in the case of unilateral vocal cord paralysis. In the parasagittal plane, the movements of whole laryngopharyngeal structures were observed simultaneously. A specific tongue shape was seen on each vowel phonation. On phonation with high pitch, hyoid bone and thyroid cartilage were elevated. And thyroid cartilage was elevated and laid upon the hyoid bone moving medially. On phonation with high pitch extremely, the hyoid bone went down. On phonation loudly, echogenicity of surrounding muscles was increased. CONCLUSION: Authors think that the ultrasonographical study can be applied to the physiologic study of phonation as well as diagnostic tools or therapeutic tools.

The Significance of Recording Electrode Placement in ENoG Measurement / 대한이비인후과학회지

ENoG is the objective electrophysiologic measurement of the muscle compound action potential(CAP) to assess the rate of degenerated nerve fibers. However, occasional discorrelation with clinical findings may diminish the utility of the ENoG. So, we studied the significance of recording electrode placement, which is considered to affect the result of the ENoG. We performed the interside variance in 20 healthy adults(20 males) volunteers and retest was performed in 6 adults of 20 volunteers. The recording electrode was placed at 3 positions.(whole nasolabial fold(A), 2 / 3 of the nasolabial fold(B), 1 / 2 of the nasolabial fold(C)) And then we compared the results: 1) In the first measurement, the mean CAP was 3.02+/-0.98mV(A), 2.80+/-0.75mV(B), 2.56+/-0.57mV(C) on the right side, 2.70+/-1.02mV(A), 2.50+/-0.90mV(B), 2.33+/-0.86mV(C) on the left side, and there was no significant difference between right and left inter-side amplitude(p>or=0.05). 2) In the first measurement, the mean interside variance(ISV) was 32.7%(37.55+/-16.32%(A), 29.88+/-17.15%(B), and 30.67+/-18.56(C)) and there was no significant difference among them(A, B, C)(p>or=0.05). The minimal individual ISV was 20.35+/-12.44%. There was significant difference between it and the other individual 3 positions(por=0.05). The minimal individual ISV was varied in each testing at 3 positions. And the value was 14.32+/-2.69%. There was no significant difference between it and other 3 postions(p>or=0.05). So we recommand that the recording electrode may be fixed at the bilateral same position of the nasolabial fold. But if there is any indication of facial nerve decompression, you must find the best recording electrode position to get the minimal ISV before operation.

A Case of Spontaneous Intracerebral Hemorrhage during Ear Surgery under General Anesthesia

There are many complications after the ear surgery to correct chronic otitis media(COM). They include facial nerve paralysis, perichondritis, injury of the dura or the sigmoid sinus, chocolate cyst or mucocele in the healed mastoid cavity, recurrence of cholesteatoma, granulation tissue and otorrhea. However, there has been no report of spontaneous intracerebral hemorrhage during ear surgery to correct COM under general anesthesia. We had encountered one case of spontaneous intracerebral hemorrhage after COM ear surgery under general anesthesia. There was no problem during the operation. We suspected that certain cerebral vascular anomaly triggered the intracerebral hemorrhage while under the general aesthsia. However, the speculation remains verified.

Clinical Study of Posterior Comminution of the Femoral Neck Fractures / 대한정형외과학회잡지

The management of the femoral neck fractures remains a major challenge to the orthopaedic surgeons because there are many critical complications such as non-union and avasular necrosis in spite of the advanced technics of treatment. The posterior comminution of this fracture is known to be an important comtributing factor of these complications as the most important cause of the instalility of reduction after internal fixation as well as difficulty of stable reduction, Authors reviewed 61 cases of the femoral neck fractures which were able to identify the presence or absence of posterior comminution on x-ray or operative findings and were managed at Daegu Fatima Hospital during the 10 years from 1975 to 1984 and the following results were obtained. 1. The incidence of posterior comminution in 61 femoral neck fractures was 56% in x-rays of lateral view and operative findings. 2. Open reductions were performed in 31% of 39 cases in which reductions were necessary for internal fixation and 43% of the fractures with posterior comminution were unstable to reduce by closed method while 88% of the fractures without postrior comminution were reduced by closed method. 3. The positions of reductio were in valgus in 46% and anatomic in the rest of cases and valgus reductions were more common in the cases of posterior comminution. 4. Loss of the reduction after internal fixation noted in 48% of the fractures with posterior comminution and 9% without posterior comminution. 5. 77% of the fractures united including 14% of mal-union and the late complication of non-union noted in 14% and avascular necroris in 9% in 35 cases which were followed for over 1 year. 6. The normal unions were more common in the fractures without posterior comminution, the cases of open reduction and the reduction in valgus position. 7. Most of the mal-unions and non-unions noted in the fractures with posterior comminution, the cases of closed reduction and the reduction in anatomic position. 8. These results suggest that the posterior comminution of the femoral neck fracture causes considerable instability and the better results could be expected in the femoral neck fractures with posterior comminution by the reduction in valgus and by the open reduction if necessary.