The Feasibility of Using Automated Distortion Product Otoacoustic Emission (DPOAE) as a Screening Auditory Function Test of Workers in a Noisy Environment / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Automated DPOAE (Distortion product otoacoustic emission) was tested on workers exposed to a noisy environmnent to determine its feasibility as a screening test for noise-induced hearing loss. SUBJECTS AND METHOD: Sensitivity and specificity were analyzed for in both automated DPOAE and Pure tone audiometry conducted on 300 subjects working in a noisy environment. Of these subjects, a subgroup of 40 workers who were available for a follow-up study underwent the same experiment again a year later, and the results were compared with the first one. RESULTS: In terms of the frequency of automated DPOAE, it was noted that it showed 91% sensitivity with a 9% false negative rate. The pass rate according to the period of service indicated statistical significance, although the results of a 1 year follow-up experiment did not indicate statistical significance. CONCLUSION: The automated DPOAE seems feasible to use as a screening test when frequency and adjusted reference criteria are considered.

Hepatocellular Carcinoma after Radiofrequency Ablation: Recurrent Pattern and Influenting Factor

PURPOSE: To evaluate patterns of recurrence and factors which influence them in radiofreqency (RF) ablation for the treatment of hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Between May 1999 and March 2000, 69 patients with 82 HCCs underwent RF ablation for complete necrosis. They were diagnosed by tissue biopsy or tumor marker, and the results of triphasic spiral CT. The indications were that nodular lesions were clearly visualized at sonography, less than 5 cm in size and less than four in number, and that patients had no history of previous treatment. Local therapeutic efficacy such as complete necrosis and marginal recurrence, and new lesions were evaluated by means of triphasic spiral CT performed at least six months after the completion of ablation. We then analyzed the correlation between local therapeutic efficacy and various influential factors such as tumor size, whether the tumor was attached to the portal vein, gross morphology, Child-Pugh classification, and alpha- fetoprotein level before the procedure, as well as the correlation between new lesions and influential factors which included the alpha-fetoprotein level before the procedure, Child-Pugh classification, and multiplicity per person. RESULTS: During a mean follow-up period of 8.95 (range, 6-14) months after RF ablation, the rate of complete necrosis and of marginal recurrence was 91% and 12%, respectively. When a tumor was larger and was attached to a large branch of the portal vien, the incidence of incomplete necrosis and marginal recurrence was greater. The occurrence rate of new lesion was 19.4%. When the alpha-fetoprotien level before the procedure was higher and a tumor was multiple in number, new lesions occurred more frequently. CONCLUSION: Sufficient knowledge of patterns of recurrence and the factors which influence them might improve the therapeutic effects of RF ablation in patients with HCC.

The Role of Nitric Oxide in Neuropathic Changes Induced by the Autograft of Nucleus Pulposus to the Sciatic Nerve in Rats

OBJECTIVE: To investigate the neuropathic changes induced by nucleus pulposus and possible role of nitric oxide (NO) in the pathogenesis of painful radiculopathy. METHOD: Autologous nucleus pulposus was harvested from the rat coccygeal intervertebral disc and grafted to the sciatic nerve. Pain behavior, neurophysiologic and pathologic changes were compared between autografted and sham operated group during 14-day-period. Western immunoblotting and immunohistochemistry with anti-nitrotyrosine mouse monoclonal antibody were used to compare the NO production and nerve damage in autografted and sham operated nerve tissues. RESULTS: Mechanical allodynia and thermal hyperalgesia were observed 2 days after autograft of nucleus pulposus and persisted during 14-day-period (p<0.05). Motor nerve conduction latency was delayed and compound muscle action potential amplitude was decreased 5 days after autograft (p<0.05). Histologically, nucleus pulposus induced severe inflammatory reaction with fibroblast proliferation and foamy macrophage infiltration, which were persisted during 14-day- period. More nitrated proteins were detected consistently in nerve tissues with autograft of nucleus pulposus and immunohistochemical staining of nitrotyrosine was prominent around foamy macrophages. CONCLUSION: These data suggest that nucleus pulposus induce mechanical allodynia, thermal hyperalgesia and nerve dysfunction through inflammatory reaction with macrophage infiltration. NO and NO related tissue injury may play an important role in the pathogenesis of painful radiculopathy.

Experimental Study on Carpal Tunnel Syndrome as a Cumulative Trauma Disorder

OBJECTIVE: To study the reaction of tissues in the carpal tunnel after repeated flexion of wrist in order to verify the pathophysiology and pathomechanism of the carpal tunnel syndrome as a cumulative trauma disorder. METHOD: Six groups of adult rabbits (5 rabbits were allocated to each groups) were exposed to repeated contractions of the wrist flexors by the median nerve stimulation at the elbow level for different durations; 2 days, 1 week, 2 weeks, 3 weeks, 4 weeks, and 5 weeks. Histological evaluation, morphometric analysis, and electrophysiological studies were carried out after the stimulation. RESULTS: There were no typical nor consistent findings in the tissues in the carpal tunnel except the median nerve. Inflammatory cell infiltration and edematous changes were noted in the epineurial tissue of median nerve. Decrease of large myelinated fibers and changes of fiber shape were observed in the median nerve. On the morphometric analysis, fiber diameter was smaller in groups of longer exposure duration. Changes were most prominent in 5 weeks group and in the periphery of the nerve fascicle in all the groups. Significant reduction of amplitude and increase of duration of compound muscle action potential were noted on electrophysiological study of the median nerve. CONCLUSION: The authors concluded that repeated experimental wrist flexion could give rise to an injury of the median nerve in the carpal tunnel. Accumulation of microtrauma of median nerve by epineurial edema and direct mechanical compression seems to be the pathomechanism of the carpal tunnel syndrome as a cumulative trauma disorder.

Prevalence of and Risk Factors for Carpal Tunnel Syndrome in a Rural Population

OBJECTIVE: The purpose of this study was to investigate the prevalence of and risk factors for carpal tunnel syndrome in a rural population in Korea. METHOD: Among the 1004 residents in a rural district who participated in the health examination, 450 (165 male, 285 female) adults aged between 30 and 79 years were randomly selected. Hand symptom questionnaire and electrodiagnostic studies were used to diagnose and classify carpal tunnel syndrome. General characteristics, female-related factors, work-related factors and anthropometric measurements were compared between normal and carpal tunnel syndrome group to identify the risk factors for carpal tunnel syndrome. RESULTS: Subjects with carpal tunnel syndrome were 76 (16.9%), symptom only subjects were 168 (37.3%), asymptomatic slowing 27 (6.0%) and peripheral polyneuropathy were 16 (3.6%). Age, farming, body mass index and wrist depth width ratio were associated with risk of carpal tunnel syndrome and odds ratio were 1.03 (95% confidence interval 1.01~1.07), 2.62 (95% confidence interval 1.17~5.86), 2.24 (95% confidence interval 1.14~4.40) and 3.13 (95% confidence interval 1.64~5.96), each. CONCLUSION: These data suggest that the prevalence of carpal tunnel syndrome is high in a rural population and physical factors like wrist shape and body mass index, occupation and aging are associated with risk of carpal tunnel syndrome.

Influence of Transcutaneous Electrical Nerve Stimulation on Cutaneous Silent Period

OBJECTIVE: To investigate the influence of high frequency transcutaneous electrical nerve stimulation (TENS) on cutaneous silent period. METHOD: Cutaenous silent period was recorded before and after high frequency TENS application in sixteen healthy adults (11 males, 5 females). Onset latency, duration, and minimum stimulation intensity to evoke cutaneous silent period were compared. In 7 male subjects, temporal changes of cutaneous silent period were observed after TENS application. RESULTS: Minimum stimulation intensity to evoke cutaneous silent period was significantly increased after high frequency TENS application (p<0.05) and yet, onset latency and duration showed no significant change. The increase in minimum stimulation intensity to evoke cutaneous silent period was maintained for 30 minutes after TENS and returned to the baseline level thereafter. CONCLUSIONS: These results suggest that high frequency TENS increase the depolarization threshold of A-delta fiber and this peripheral effect may be one of the pain control mechanisms of TENS.

Detection of Specific lgE Antibody from Nasal Secretion in Allergic Rhinitis with Negative Results of Skin Test and RAST on D.P / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The diagnosis of allergic rhinitis due to specific antibody is essentially dependent upon the patients' clinical histories, physical examinations, skin test results, and especially on the immunological technique in vitro used for the detection for specific IgE antibody in serum. However, some patients with positive results from nasal provocation tests with allergen can have the negative results from skin tests and the immunological technique in vitro. Therefore, systemic allergic reactions are not completely correlative to those of the localized allergy. MATERIALS AND METHODS: This study was therefore designed to explore the relationship between RAST (radioallergosorbent test) results in nasal secretion of 6 localized allergic patients and 10 controls (5 systemic allergic and 5 non-allergic patients). The nasal secretion was collected by nasal suction method each in three groups before and 20 minutes after antigen (Dermatophagoides pteronyssinus) nasal spray, respectively. RESULTS: There were negative RAST results in nasal secretion of localized allergic patients and controls (5 non- allergy patients) before the antigen nasal spray but, positive RAST results in those of localized allergic patients and controls (5 systemic allergic patients) after the antigen nasal spray. This means that there was statistically a significant difference between localized allergic patients and controls of non-allergy patients after the antigen nasal spray (p<0.01). CONCLUSION: We suggest that localized al1ergic reaction is a specific antigen-antibody allergic immunologic reaction and RAST in nasal secretion is good assistant diagnostic technique in localized allergy.

Helical CT Findings of Gastric Wall Thickening by Peptic Ulcer: Compared with Gastric Adenocarcinoma with Ulcer

PURPOSE: To compare on the basis of helical CT findings gastric wall thickening of peptic gastric ulcer with that of gastric adenocarcinoma with ulcer. MATERIALS AND METHODS: Thirty-eight patients with athologically proven gastric lesion [17 cases of peptic ulcer and 21 cases of ulcerative or ulceroinfiltrative gastric cancer (Borrman type II, III)] underwent helical CT, and the findings were retrospectively reviewed in terms of maximum abnormal wall thickness, preservation of the inner enhancing layer, the presence of three discriminate layers of gastric wall, and enhancment pattern. The enhancment pattern of abnormally thick wall was compared with that of the portal phase of back muscle, and was defined as low, iso, or high. The Chi-square test and Student t test were used for statistical analysis. RESULTS: In cases of peptic ulcer and gastric cancer with ulceration, maximum abnormal wall thickness was 7-30 (mean, 16.1)mm, and 11-33 (mean, 21.8)mm, respectively. The inner enhancing layer was preserved in 15 of 17 patients (88.2%) and one of 21 (4.8%); three discriminate layers of gastric wall were observed in 8 of 17 patients (47.0%), and one of 21 (4.8%). The enhancement pattern was low in 12 of 17 patients (70.5%), and 3 of 21 (14.3%); iso in 4 of 17 (23.5%), and 4 of 21 (19.0%), and high in one of 17 (5.9%), and 14 of 21 (66.7 % ). All figures refer, respectively, to the two distinct onditioins. In terms of preservation of the inner enhancing layer, three discriminate layers of gastric wall, and a low enhancement pattern, there were statistically significant differences between peptic ulcer and gastric adenocarcinoma with ulcer. Where the enhancement was high, however, the statistically significant difference between the two conditions was even greater. There was no statistically significant difference in terms of gastric wall thickness or iso-attenuation of thickened gastric. CONCLUSION: Helical CT findings of gastric wall thickening, preservation of the inner enhancing layer, and three discriminate layers of gastric wall, as well as the nature of the observed enhancement pattern, may help differentiate between peptic ulcer and gastric adenocarcinoma with ulcer.

Lengthening of Short Noses

BACKGROUND AND OBJECTIVES: Lengthening of short noses is one of the therapeutic dilemmas in facial plastic surgery. Aesthetically, short noses are characterized by a decreased distance from the root of the nose to the tip-defining point, and this extends less than one third the vertical height of the face. Also, concavity of the dorsum, a low and deep nasion, an overprojected tip, and an obtuse nasolabial angle of the nose will give a shortened appearance. Considering aesthetical and facial analytic factors, we discuss three techniques for the correction of this problem and propose useful procedure for the desired effect of lengthening in this study. MATERIALS AND METHODS: We have experienced eleven cases of lengthening of the short nose during the last 2 years. We categorized these patients into three groups according to nasolabial angle and tip projection which make a distribution in selecting procedure. On-lay graft on the caudal margin of the lower lateral cartilage is used to the patients with mild overrotated tip and proper nasal projection. Cartilage graft between the caudal septum and the lower lateral cartilge combined with on-lay graft on the caudal margin of the lower lateral cartilage is used to the patients with moderately overrotated tip. Full-length dorsal augmentation is applied to the patients with severely overroatated tip and problematic tip projection. RESULTS: We used three techniques aimed at the correction of the short nose. These techniques treated short nose patients and we obtained effective substantial lengthening results in this study. CONCLUSION: Aesthetical and facial analytic factors must be considered in properly selecting a procedure to lengthen the short nose.

Musculoskeletal Problems in Pregnancy

OBJECTIVE: To investigate the frequency, nature and risk factors of musculoskeletal problems in pregnancy. METHOD: We obtained the information through a questionnaire and physical examination of full-term (gestational age over 38 weeks) pregnant women. Prevalence, onset time, severity and risk factors of musculoskeletal problems were analyzed. RESULTS: Among the 70 pregnant women, 37 women (53%) complained of low back pain which was the most common musculoskeletal problem in pregnancy. Other problems were hand symptoms (31%), lower extremity joint pain (31%), leg cramp (29%), chest pain, shoulder pain and neck pain. Previous history of low back pain was significantly correlated with the occurrence of low back pain in pregnancy. Weight gain during pregnancy and amount of time of housework during pregnancy were significantly correlated with carpal tunnel syndrome. Pregnant women suffering from leg cramp were significantly old in age. CONCLUSION: Prevalence of musculoskeletal problems during pregnancy was relatively high and several risk factors were related with occurrence of those problems. So, prophylactic risk factor control would be necessary to reduce musculoskeletal problems during pregnancy.

Distal Motor Nerve Conduction Studies of Medial Plantar Nerve, Lateral Plantar Nerve and Inferior Calcaneal Nerve

OBJECTIVE: To determine the reference values for the diagnosis of isolated entrapment neuropathies of medial and lateral plantar nerve and inferior calcaneal nerve distal to the tarsal tunnel. METHOD: The subjects were neurologically healthy 30 adults (15 males, 15 females). Distal motor nerve conduction study of medial and lateral plantar nerves and inferior calcaneal nerve was performed. The recording muscles for medial and lateral plantar nerves and inferior calcaneal nerve were flexor hallucis brevis, flexor digiti minimi brevis, and abductor digiti minimi pedis, respectively. The stimulation was done at distal and proximal to the tarsal tunnel to differentiate the tarsal tunnel syndrome and the entrapment neuropathy of distal to the tarsal tunnel. The distance of recording and distal stimulation site was fixed to 10 cm for medial and lateral plantar nerves. The skin temperature was maintained 33degrees C or above. The proximal latency, distal latency, peak to peak amplitude, conduction velocity and residual latency were measured. The reference values were obtained by 95 percentile values. RESULTS: The reference values for the diagnosis of isolated entrapment neuropathies of medial plantar nerve, lateral plantar nerve and inferior calcaneal nerve distal to tarsal tunnel are as follows. 1) Medial plantar nerve: distal latency, > 4.3 msec; side to side difference, > 0.7 msec 2) Lateral plantar nerve: distal latency, > 4.1 msec; side to side difference, > 0.6 msec 3) Latency difference of medial and lateral plantar nerve: > 0.7 msec 4) Inferior calcaneal nerve: distal latency, > 4.3 msec; distal peak latency, > 7.2 msec; side to side difference of distal onset latency, > 1.5 msec; side to side difference of distal peak latency, > 0.8 msec; residual latency, > 3.0 msec CONCLUSION: The distal motor nerve conduction method used in this study and the reference values could be used to differentiate entrapment neuropathies of medial and lateral plantar nerve and inferior calcaneal nerve distal to the tarsal tunnel from tarsal tunnel syndrome.

External Nasal Appearance Preferred by Koreans: Photo Analysis

A sound understanding of the preferred appearance of the external nose is central to successful rhinoplasty. A survey using photographs was conducted among college students and employees aged 20 to 39 years in Inchon, Korea. Three hundred and twenty-one subjects filled out a questionnaire about their preferences regarding external nasal appearance. The most commonly preferred height of the nasion, measured from the corneal plane, was 6 mm among both sexes, and the most commonly preferred depth of the nasion, measured from the glabella plane, was 3 mm among both sexes. Regarding the nasofrontal angle, men preferred an angle of 135 degrees and women preferred an angle of 140 degrees. Men preferred a nasofacial angle of 33 degrees while women preferred an angle of 30 degrees. A straight nasal dorsum was most commonly preferred among both sexes and the most commonly preferred dorsal width was 13 mm among men and 10 mm among women. The most commonly preferred tip projection was 30 mm among men and 27 mm among women and the preferred tip angle was 105 degrees among both sexes. The angle of the apex in the most commonly preferred nasal base configuration was 85 degrees among men and 70 degrees among women. The angle of the apex in the most commonly preferred lobular configuration was 65 degrees among both sexes. The most commonly preferred ratio between nostril length and the distance from the subnasale to the tip was 45 percent among both sexes. The most commonly preferred angle between both nostril axes was 60 degrees among both sexes. The most commonly preferred nasolabial angle was 90 degrees among men and 95 degrees among women. The main difference in preference between Koreans and Caucasians seemed to center on the radix area rather than the tip. These results can be useful as basic guidelines for rhinoplasty.

Standards of Photography in Rhinoplasty / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: In rhinoplasty, it is essential to take photographs in order to make preoperative plans and postoperative evaluations. However, for Asians, standardized rules or important photographic points in taking pictures in rhinoplasty have not yet been established. The purpose of this study was to standardize photography in rhinoplasty. MATERIALS AND METHODS: Using a 35 mm single lens reflex camera with 105 mm macro lens, the authors took pitures of various postures, such as close-up frontals, close-up profiles, chin on chest views, as well as conventional postures such as frontal, profile, oblique, and basal. The Frankfort plane was utilized for all frontal and lateral views. The plane was kept horizontal and centered for all photographs. The vertical axis may be checked by aligning it with the midsaggital plane on the frontal view. The oblique photograph is standardized by ligning the tip of the nose with the outline of the cheek. A close up of the nose from frontal and profile views should include the eyebrow and the lips. RESULTS: A close-up frontal and chin on chest views gave more detailed information about the nasal dorsum and the width of alar flare. A close-up profile views were found to be the most suitable for evaluating the nasal tip. It was possible to evaluate preoperative and postoperative results objectively by using the standardized photographs described here. CONCLUSION: Preoperative and postoperative photographs are important in providing good results in rhinoplasty. The use of photographs can also provide grounds for objective comparisons between the works of different plastic surgeons. More studies are needed to complete photographic standardization and the present study contributes to this cause.

Three Cases of Reconstructive Rhinoplasty Using a Local Flap or a Split Calvarial Bone Graft / 대한이비인후과학회지

The nose is located centrally in the face and occupy an important place in the harmonic architecture of the face. Also, it plays important functions such as respiraton, olfaction and phonation. Therefore, reconstructive rhinoplasty is dealt with both cosmetic and functional aspect in mind. We have recently experienced three cases of reconstructive rhinoplasty for seborrheic keratosis of the nose, traumatic nasal defect, and basal cell carcinoma of the nose. Local flap and split calvarial bone graft were used for the reconstruction of the nose.

Expression of Transforming Growth Factor-beta(TGF-beta) Family in Nasal Polyps and Postoperative Polypoid Mucosa after Functional Endoscopic Sinus Surgery

Transforming growth factor (TGF)-beta1, beta2, and beta3 are multifunctional proteins which play an important role in chronic inflammatory process, angiogenesis, and epithelial differentiation. In nasal polyps and postoperative polypoid mucosa after functional endoscopic sinus surgery (FESS), changes of expression of TGF-beta family were assessed to identify its role in formation of nasal polyps and mucosal healing after FESS. Nasal polyps and polypoid mucosa were obtained during FESS and in outpatient clinic after the surgery, respectively. Immunohistochemical staining was performed. TGF-beta family was highly expressed in the epithelium, subepithelial glands, neutrophils and eosinophils of nasal polyps. On the other hand, expression of TGF-beta family decreased in the epithelium and subepithelial gland of polypoid mucosa according to a postoperative period after FESS. These results suggest that TGF-beta family may play an important role in formation of nasal polyps and it decreases in process of mucosal healing after FESS.

Embryonal Rhabdomyosarcoma of the Biliary Tree: A Case Report

Rhabdomyosarcoma are reportedly the most common soft tissue sarcoma occuring in childhood, but the biliary tree is a rare site of origin for this tumor. Recently we experienced a case of embryonal rhabdomyosarcoma of the biliary tree in a 30-month-old child. UItrasonography showed hypoechoic mass filling the dilated left. intrahepatic & extrahepatic bile ducts, and CT showed hypodense mass with heterogeneous enhancement after contrast infusion. Intraoperative cholangiography showed filling defects within the dilated left. intrahepatic & extrahepatic bile ducts. Postoperative MRI showed residual mass within the left. intrahepatic duct which was hypointense on T1WI and hyperintense on T2WI.

Embryonal Rhabdomyosarcoma of the Biliary Tree: A Case Report

Rhabdomyosarcoma are reportedly the most common soft tissue sarcoma occuring in childhood, but the biliary tree is a rare site of origin for this tumor. Recently we experienced a case of embryonal rhabdomyosarcoma of the biliary tree in a 30-month-old child. UItrasonography showed hypoechoic mass filling the dilated left. intrahepatic & extrahepatic bile ducts, and CT showed hypodense mass with heterogeneous enhancement after contrast infusion. Intraoperative cholangiography showed filling defects within the dilated left. intrahepatic & extrahepatic bile ducts. Postoperative MRI showed residual mass within the left. intrahepatic duct which was hypointense on T1WI and hyperintense on T2WI.

Soft tissue masses of extremities:MR findings

To evaluate MR findings of soft tissue masses in extremities and to find the helpful findings of distinguish benignity from malignancy, 28 soft tissue masses (22 benign and 6 malignant) in extremities were reviewed. T1-weighted, proton density, T2-weighted and Gd-DTPA enhanced images were obtained. MR images allowed a specific diagnosis in a large number of benign masses, such as hemangioma(8/9), lipoma(2/2), angiolipoma(1/1), epidermoid cyst(2/2), myositis ossificans(1/1), synovial chondromatosis(1/1) and pigmented villonodular synovitis (1/2). Specific diagnosis was difficult in the rest of the masses including malignancy. However, inhomogenous signal intensities with necrosis and inhomogenous enhancement may suggest malignant masses.