Concordant Surgical Treatment: Non-melanocytic Skin Cancer of the Head and Neck

BACKGROUND: Skin cancer is the most common type of cancer. Of the 4 million skin lesions excised annually worldwide, approximately 2 million are considered cancerous. In this study, we aimed to describe a regional experience with skin cancers treated by a single senior surgeon and to provide a treatment algorithm. METHODS: The medical records of 176 patients with head and neck non-melanocytic skin cancer (NMSC) who were treated by a single surgeon at our institution between January 2010 and May 2016 were retrospectively reviewed, and their data (age, sex, pathological type, tumor location/size, treatment modality) were analyzed. Patients with cutaneous squamous cell carcinoma (cSCC) who were classified as a high-risk group for nodal metastasis underwent sentinel node mapping according to the National Comprehensive Cancer Network guidelines. RESULTS: Among the patients with NMSC who were treated during this period, basal cell carcinoma (BCC; n=102, 57.9%) was the most common pathological type, followed by cSCC (n=66, 37.5%). Most lesions were treated by complete excision, with tumor-free surgical margins determined via frozen section pathology. Thirty-one patients with high-metastasis-risk cSCC underwent sentinel node mapping, and 17 (54.8%) exhibited radiologically positive sentinel nodes. Although these nodes were pathologically negative for metastasis, 2 patients (6.5%) later developed lymph node metastases. CONCLUSION: In our experience, BCC treatment should comprise wide excision with tumor-free surgical margins and proper reconstruction. In contrast, patients with cSCC should undergo lymphoscintigraphy, as nodal metastases are a possibility. Proper diagnosis and treatment could reduce the undesirably high morbidity and mortality rates.

Correlation between the 2-Dimensional Extent of Orbital Defects and the 3-Dimensional Volume of Herniated Orbital Content in Patients with Isolated Orbital Wall Fractures

BACKGROUND: The purpose of this study was to assess the correlation between the 2-dimensional (2D) extent of orbital defects and the 3-dimensional (3D) volume of herniated orbital content in patients with an orbital wall fracture. METHODS: This retrospective study was based on the medical records and radiologic data of 60 patients from January 2014 to June 2016 for a unilateral isolated orbital wall fracture. They were classified into 2 groups depending on whether the fracture involved the inferior wall (group I, n=30) or the medial wall (group M, n=30). The 2D area of the orbital defect was calculated using the conventional formula. The 2D extent of the orbital defect and the 3D volume of herniated orbital content were measured with 3D image processing software. Statistical analysis was performed to evaluate the correlations between the 2D and 3D parameters. RESULTS: Varying degrees of positive correlation were found between the 2D extent of the orbital defects and the 3D herniated orbital volume in both groups (Pearson correlation coefficient, 0.568−0.788; R²=32.2%−62.1%). CONCLUSIONS: Both the calculated and measured 2D extent of the orbital defects showed a positive correlation with the 3D herniated orbital volume in orbital wall fractures. However, a relatively large volume of herniation (>0.9 cm³) occurred not infrequently despite the presence of a small orbital defect (<1.9 cm²). Therefore, estimating the 3D volume of the herniated content in addition to the 2D orbital defect would be helpful for determining whether surgery is indicated and ensuring adequate surgical outcomes.

Analysis of the utilization of existing test data for phase-in substance registration under the Act on the Registration and Evaluation, etc. of Chemical Substances

OBJECTIVES: Approximately 2000 phase-in substances are subject to registration according to the Act on the Registration and Evaluation, etc. of Chemical Substances (KREACH), and the expected testing cost is 2.06 trillion Korean won assuming all the test data required for registration are acquired. The extent to which these enormous test costs can be reduced depends on the availability of existing data that can be used to meet the requirements of the K-REACH we examined the current availability of test data that can be used for chemical substance registration. METHODS: We analyzed the possibility of utilizing the existing test data obtained from 16 reference databases for 369 of 518 kinds of phase-in substances subject to registration that were reported in last October 2014. RESULTS: The physical and chemical properties were available for 57.1% of substances, whereas data regarding human hazards and environmental hazards were available at considerably lower rates, 8.5% and 11.8%, respectively. CONCLUSIONS: Physical and chemical properties were available for a fairly high proportion, whereas human hazards and environmental hazards were reported for considerably fewer substances.

Experience of Total Laparoscopic Hepatectomy

PURPOSE: The aim of this study is to assess the feasibility and clinical outcomes of laparoscopic liver resection by reviewing our experience of laparoscopic liver resection performed in a single institution. METHODS: We retrospectively analyzed the clinical outcome of 64 patients that had undergone laparoscopic liver resection for various liver diseases between May 2003 and June 2006. RESULTS: The patients were composed of 36 men and 28 women, with a mean age of 56.9 years. Indications for laparoscopic liver resection included 37 cases of a tumor (20 hepatocellular carcinomas, 8 metastatic cancers and 9 benign tumors) and 25 cases of IHD stones. The surgical procedures were 19 tumorectomy cases, 24 left lateral sectionectomy cases, 15 left hepatectomy cases, 4 right posterior sectionectomy cases and 2 right hepatectomy cases. The mean surgical time was 280.3 minutes. Intraoperative transfusion was required for 18 patients (28.1%). There was one postoperative death (1.6%) due to biliary sepsis after a left lateral sectionectomy for an IHD stone. Postoperative complications developed in 9 cases (14.0%) (2 intraabdominal abscesses, 1 hematoma, 1 bile leakage, 1 ascites, 1 gastric variceal bleeding, 1 ulcer bleeding and 1 anastomosis leakage), all of which were improved by conservative management. The mean postoperative hospital stay was 11.0 days. CONCLUSION: Our experience shows that laparoscopic liver resection is a feasible operation and is comparable to surgery with the open method. However, a prospective comparative study with long term follow-up is needed to confirm the equivalence of the procedures.

Plasmodium falciparum Cultivation Using the Petri Dish: Revisiting the Effect of the 'Age' of Erythrocytes and the Interval of Medium Change

Differences in the characteristics of the culture conditions can influence the multiplication rate of Plasmodium falciparum. The Petri dish method is one of the most popular methods of cultivating this parasite. In many previous studies, ideal culture conditions of the Petri dish method were achieved by using erythrocytes collected from blood that had been stored for at least 2 weeks, with daily changes of the medium. In the present study, we studied the multiplication rate of P. falciparum in cultures containing erythrocytes of various ages together with changing the medium at various intervals of time. Our results strongly suggest that the rate of in vitro multiplication of P. falciparum was higher in freshly collected erythrocytes than in aged erythrocytes regardless of the anticoagulant and that when the parasitemia is lower than 8% with a hematocrit of 5%, the medium change interval can be as long as 48 hr without a great reduction in the rate of multiplication.

Effect of Pediatric Endoscopic Sinus Surgery with Antrochoanal Polyps on Sinus Growth / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Pediatric endoscopic sinus surgery (ESS) has become widely used for the treatment of chronic or recurrent rhinosinusitis that is unresponsive to medical management. But the effect of pediatric ESS on facial growth or sinus growth are controversial and not well understood. The object of the present study was to determine whether pediatric ESS causes the volumetric restriction of the sinuses. SUBJECTS AND METHOD: Fifteen cases of patients who underwent unilateral endoscopic sinus surgery for antrochoanal polyp were reviewed retrospectively. Postoperative maxillary and ethmoid sinus volumes were measured by computed tomography at 73.5 (51-101) months after surgery, and these were compared with non-operated sinus volumes. RESULTS: The mean volume of the operated and non-operated maxillary sinuses were 18.9+/-6.4 ml and 21.7+/-5.3 ml. and the mean volume of the operated and non-operated ethmoid sinuses were 4.1+/-1.2 ml and 3.7+/-1.2 ml. There was no significant difference in sinus growth between operated and non-operated sinuses. CONCLUSION: There was no evidence that pediatric ESS affected maxillary and ethmoid sinus growth.

Two Cases of Wooden Foreign Body in Parapharyngeal Space after Penetrating Injury / 대한이비인후과학회지

Foreign bodies of the parapharyngeal space are rarely encountered in the otolaryngological fields, and may cause severe complications such as descending suppurative mediastinitis, jugular thrombophlebitis with septic pulmonary emboli, cavernous sinus thrombosis, and carotid erosion. Therefore, early diagnosis and surgical intervention are needed to reduce morbidity and motality. Recently, we experienced two cases penetrating injury of parapharyngeal foreign bodies (woodstick). The one was penetrated in right parapharyngeal space from left medial canthal area and the other in left parapharyngeal space from left infraorbital area. They were removed by skin incision and transantral approach with Caldwell-Luc operation, and we report these cases with a review of literature.

Dynamic Upper Airway Study in Snoring Subjects Using Electron Beam Tomography / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The upper airway caliber shows rhythmic changes according to the respiratory cycle. The dynamic imaging technique is needed to demonstrate nonfixed oropharyngeal obstruction in patients with snoring and/or obstructive sleep apnea. This study was designed with the purpose to determine the level, extent, and dynamics of the oropharyngeal closure from the dynamic view of the oropharynx and to estimate the usefulness of electron beam tomography (EBT) in the snoring and/or obstructive sleep apnea patients. MATERIALS AND METHOD: The upper airway was scanned in 18 patients with snoring by using EBT while awake, asleep, pre and post UPPP (six patients), and pre and post oral appliance (seven patients) during at least two full respiratory cycles. RESULTS: The oropharyngeal stenosis and collapsibility were increased during sleep, especially in the minimum cross sectional area level. In most cases, the sites of stenosis of wakefulness and sleep did not coincide. The degree of stenosis as well as collapsibility of the oropharynx were reduced after UPPP and oral appliance. CONCLUSION: The dynamic study during sleep is needed to evaluate sleep induced airway disease. EBT has the potential to provide information quickly and non-invasively on upper airway dynamics and has certain definite advantages over conventional studies.

The Relationship between Anatomic Variation of Nasal Cavity and Paranasal Sinusitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although several studies have failed to confirm an increased incidence of sinusitis in association with anatomic factors, the anatomic variations of the nasal cavity and paranasal sinus are considered as important factors in causing paranasal sinusitis. The aim of this study was to evaluate the effects of anatomic abnormality and septal deviations on the development of paranasal sinusitis. MATERIALS AND METHOD: To evaluate the effect of anatomic variations in sinusitis, computed tomography (CT) of 165 patients with chronic sinusitis and 70 patients with orbital pathology were reviewed to analyze the mucosal abnormalities and the bony anatomic variations. RESULTS: There were no significant difference in the prevalence of anatomic variations between two groups. In patients with deviated septum, paranasal sinusitis was more common and severe in the wide side of the nasal cavity. CONCLUSION: There was no clinical significance of anatomic variations in formation of sinusitis. In septal deviation, the change of air current may affect the development of sinusitis. The increased airflow in the widened nasal cavity may impair the mucociliary clearing function of the nasal cavity and sinuses, which eventually induce the stasis of mucus in sinuses and finally results in paranasal sinusitis.

Analysis of Fungi in the Nasal Secretion of Chronic Rhinosinusitis Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Fungi have been increasingly recognized as important pathogens in sinusitis. Different types of fungi colonize in the nasal secretion of different individuals and the geographic distribution of fungi is different all across the United States. The aim of this study was to determine the incidence of positive fungal culture in nasal secretions and the spectrum of fungal elements in the Korea population, and to clarify the association between fungal sinusitis with type I hypersensitivity. Materials and Methods: This prospective study evaluated 40 patients with chronic rhinosinusitis (CRS), 20 allergic rhinitis (AR), and 20 normal volunteers. Fungi were cultured with nasal irrigation and swab method, and skin prick test was done to determine the specific IgE against fungi. RESULTS: Fungal cultures of nasal secretions were positive in 92.5% of CRS, 95.0% of AR, and 100% of healthy volunteers by nasal irrigation method. Cladosporium, Alternaria, Fusarium, Penicillium, Aspergillus were commonly cultured, but the fungal culture results were not so significantly different among three groups. Type I hypersensitivity to fungal allergens was not important in the majority of CRS patients. CONCLUSION: Fungi was present in every nasal secretion, and type I hypersensitivity seemed not important in the pathogenesis of CRS.