Injury to the Anterior Tibial Artery during Bicortical Tibial Drilling in Anterior Cruciate Ligament Reconstruction

Many complications have been reported during or after anterior cruciate ligament (ACL) reconstruction, including infection, bleeding, tibial tunnel widening, arthrofibrosis, and graft failure. However, arterial injury has been rarely reported. This paper reports a case of an anterior tibial arterial injury during bicortical tibial drilling in arthroscopic ACL reconstruction, associated with an asymptomatic occlusion of the popliteal artery. The patient had a vague pain which led to delayed diagnosis of compartment syndrome and delayed treatment with fasciotomy. All surgeons should be aware of these rare but critical complications because the results may be disastrous like muscle necrosis as in this case.

The Morphological Changes by the Time of Administration of Zanamivir in Rabbit Nasal Mucosa Infected with Influenza A Virus / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study aimed to investigate the differences in the morphologic changes of the nasal mucosa with influenza virus infection between zanamivir treated groups and non-treated group. MATERIALS AND METHOD: Zanamivir was administrated to the 15 rabbits before or after inoculation of the influenza viruses with time difference and 5 rabbits were inoculated the influenza viruses but not treated with zanamivir. The nasoturbinal mucosa was harvested and examined with the light microscope and electron microscope at 7th day after virus inoculation. RESULTS: The light microscopy results revealed that the total inflammatory scores were decreased in the zanamivir treated group. The electron microscopy results showed that the degree of ciliary loss, vacuolar degeneration of mitochondria and endoplasmic reticulum and rupture of cell membrane in the zanamivir treated group was less than those in the untreated group. The effects of inoculated zanamivir was related to the time of administration and best timing was immediate after inoculation of the influenza A virus. CONCLUSION: The use of zanamivir in the treatment of influenza A virus infection during the epidemic period is effective in controlling the inflammatory change.

Transoral Adenoidectomy with the Microdebrider under Transnasal Endoscopy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although there have been various methods to remove adenoid, it is still difficult to achieve complete adenoidectomy due to its unfavorable anatomic structure. The aim of this study was to introduce transoral adenoidectomy using a microdebrider under transnasal endoscopy and to evaluate its efficacy. MATERIALS AND METHOD: The subjects consisted of 80 patients with adenoid vegetation. Among them, 40 patients underwent adenoidectomy using the microdebrider and other 40 cases were performed using the adenoid curette via transoral approach. Preoperative and postoperative lateral skull radiographs were obtained and compared. Also, the amount of intraoperative bleeding, complications, postoperative symptom score, and the duration of operation were compared. RESULTS: There were no statistical differences in the intraoperative bleeding, subjective symptoms after surgery and postoperative complications. But, patients, who had been performed adenoidectomy using the transoral debrider under transnasal endoscopy, had better outcomes in the nasopharyngeal ratio and the shortest nasopharyngeal diameter in lateral skull radiographs. CONCLUSION: Transoral adenoidectomy using the microdebrider under transnasal endoscopy is an effective method for more complete adenoidectomy.

A Case of Blindness after Transsphenoid Approach for Pituitary Adenoma Removal: Revision Treatment Experience under Local Anesthesia

Pituitary adenoma accounts for 10% to 20% of intracranial tumors. Surgical approach to pituitary adenoma had been performed via craniotomy until the early 20th century, but transsphenoidal approach has been accepted as a primary procedure since 1910. However, there are frequent complications in the nose including nasal mucosal laceration, nasal septal perforation, and external nose deformities. Furthermore, cerebrospinal fluid leakage, visual field loss or blindness rarely occur. When blindness occurs by postoperative hematoma compression, revision operation is usually required for bleeding control and hematoma removal under general anesthesia. However, optic nerve decompression with postoperative hematoma removal via transsphenoidal approach can be adequately performed by endoscopic technique under local anesthesia, because there is no sensory nerve innervation in the pia mater and arachnoid membrane. We report a case of successful hematoma removal with bleeding control by endoscopic technique under local anesthesia in a patient who became blind due to postoperative hematoma after transphenoid approach for pituitary adenoma removal.

Pectoralis Major Musculocutaneous Flap for Reconstruction of Permanent Tracheostoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Pectoralis major myocutaneous flap has been considered as a "workhorse" of the pedicled flaps for head and neck reconstruction. We introduce several types of PMMC flap for the reconstruction of tracheostoma with surrounding soft tissue defects and evaluate the usefulness of PMMC flap. MATERIALS AND METHOD: We reviewed retrospectively our experience of using 12 PMMC flaps for the reconstruction of tracheostoma between 1997 to 2002. RESULTS: Five patients received semi-lunar type of PMMC flap, 3 patient received doughnut type, 3 received skin graft type and 1 received mixed type of PMMC flap for the reconstruction of tracheostoma. There was no total necrosis of flap but, 1 case have had marginal necrosis. No other complications were noted. CONCLUSION: The PMMC flap is a safe and convenient method for reconstruction of the permanent tracheostoma with surrounding soft tissue defect after tracheal resection, superior mediastinal dissection. And several types of PMMC flap design can be used according to the types of stoma and the condition of the defect.

Clinical Consideration of Benign Nasal Neoplasm

There are many different kinds of histological types of nasal masses. But there were few studies based on the clinical consideration of benign nasal neoplasms in comparison with its histologic types. In this study we compare and analyze the benign nasal neoplasm in wish to guide for a diagnosis and management. Twenty-seven patients with benign nasal neoplasms excluding inverted papilloma, antrochoanal polyp and dentigenous cyst from March 1996 and June 2003 were selected for this study. Their clinicopathologic records were reviewed retrospectively. The male-female ratio was 1 : 1.25 and the right to left ratio was 1 : 1.7. Bening nasal neoplasms were frequently found in the fifth decade. Hemangioma was the most common benign nasal neoplasm. Nasal obstruction was the most common symptom. Benign nasal masses were frequently found at the inferior turbinate and vestibule. When the masses were found, they were smaller than 1 cm in most cases. An endoscopic and transnasal approach was the most commonly utilized approach method during surgery. There were no recurrent cases during the average 41 months follow up. In conclusion, there is no statistical significance between benign nasal neoplasm and the patient's sex and age. But, they were frequently found in left side rather than the right side. Surgical treatment seemed to be extremely useful in the case of benign nasal neoplasms.

The Analysis of Methylenetetrahydrofolate Reductase Mutation in Recurrent Spontaneous Abortion / 대한불임학회지

OBJECTIVE: To analyze the methylenetetrahydrofolate reductase (MTHFR) mutation in patients with recurrent spontaneous abortion. MATERIAL AND METHOD: The blood samples of patients with recurrent spontaneous abortion were tested by PCR-RFLP method. RESULTS: Of 51 cases of study group, 14 (27.5%) were normal, 25 (49.0%) were heterozygosity, and 12 (23.5%) were homozygosity. Of 58 cases of control group, 20 (34.5%) were normal, 30 (51.7%) were heterozygosity, and 8 (13.8%) were homozygosity. But the difference between two groups was not significant (p=0.190). CONCLUSION: Hyperhomocysteinemia due to MTHFR mutation is a cause of recurrent spontaneous abortion. Therefore, the study for MTHFR mutation should be included in the workup of recurrent spontaneous abortion.

A Case of Coronary Artery Aneurysm

A coronary artery aneurysm was first reported by Bougon in 1812, and was able to be diagnosed during life with advance of selective coronary arteriography. We have recently seen a 62-year-old woman who had intermittent anterior chest pain and dyspnea on exertion(NYHA functional class II) and diagnosed a coronary artery aneurysm by coronary arteriography. A saccular formed coronary artery aneurysm was located at left main coronary artery at the juction of the bifurcation of LAD and left circumflex artery and it's was 2cmx2cm and it's thickness of wall was 0.5cm. After the patency and consistency of coronary arteries were confirmed,resection of aneurysm with aneurysmorrhaphy was performed.

Multiple coronary artery aneurysms in Kawasaki disease

Mucocuaneous Lymph Node Syndrome(Kawasaki disease) is a new diseae entity that was first described by Kawasakiin 1967. It occures predominantly in children less than 5yrs old and acute febrile illness, which is mucocutaneousinvolvment associated with swelling of cervical lymph nodes. The coronary artery aneurysms have been revealed 20–30% of patients with Kawsaki disease. The authors report a case of multiple coronary artery aneurysms inKawasaki disease which was diagnosed by a coronary arteriography.