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Background and Objectives@#Interposition using acellular allograft between perforated septal flaps is a popular procedure among surgeons because of its usefulness. However, allograft dermal matrix itself tends to become infected sometimes, and can easily undergo necrosis or be displaced from the implanted site. Here, the authors would like to introduce a newly devised interposition graft made up of allograft and cartilage, which is easy to manipulate and can be fixed in the desired position.Subjects and Method We performed a retrospective chart review from January 2018 to August 2020. A total of 12 patients with septal perforation who received surgical treatment were included in this study. Acellular human dermal allograft (MegaDerm® ; L&C Bio) was used as an interposition allograft piled up by autologous cartilage, and it was positioned between the mucoperichondrial flaps via the endonasal approach. @*Results@#The most common etiology was previous septal surgery (n=8); in one case, the etiology was repeated electrocauterization due to frequent epistaxis; the etiology was not verified for three cases. All 12 cases achieved the result of complete septal perforation closure. All patients on follow-up inquiry reported marked improvements in the visual analogue scale score (mean value, 4.1 to 1) and Nasal Obstruction Symptom Evaluation scale (mean value, 7.3 to 1.8). @*Conclusion@#Composite graft made up of cartilage and allograft dermal matrix achieved successful results without having to fix the graft. It can be an alternative technique to treat septal perforation for inexperienced surgeons and with a limited operation field.
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Various treatment modalities for obstructive sleep apnea (OSA) patients were introduced including continuous positive airway pressure (CPAP), lifestyle modification, and surgery. Numerous factors such as compliance, treatment failure, and preference should be considered when deciding the treatment. In general, patients for whom CPAP or other conservative treatment modalities failed become candidates for surgical treatments. Uvulopalatopharyngoplasty is one of the most generally performed surgeries, of which success rate is relatively low. Recently, numerous techniques that can correct lateral pharyngeal obstruction for OSA patients were introduced. However, some of them are technically difficult and aggressive. In this article, we introduce a novel surgical method for OSA called palatopharyngeal muscle suspension suture technique.
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Perioperative stroke is one of the most fatal complications for patients as well as for doctors. It is defined as a brain infarction or hemorrhage, occurring during or within 30 days after a surgical procedure. Most of the perioperative strokes have ischemic etiology while only 1% has hemorrhagic etiology, according to one study. The incidence of perioperative stroke is influenced by the complexity and type of the surgery. Generally, its incidence is very low, being about to 0.1-1.9%, with majority of the cases pertaining to cardiac, vascular, neurological surgeries. Based on our research, most cases are perioperative strokes that occur after cardiac and vascular surgeries. Here we report two cases of cerebral infarction after endoscopic sinus surgery, which are very rare.
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The infratemporal fossa consists of critical structures affecting patient quality of life. Though abscess formation in the infratemporal fossa is very rare, drainage is highly recommended to avoid severe complications. We recently experienced a rare case of infratemporal fossa abscess. Such an abscess is easy to misdiagnose due to its rarity. Endoscopic drainage of the infratemporal fossa was conducted in this case, and its limited invasiveness was an advantage for a conservative approach. We present this case with a brief review of the approach to abscess of the infratemporal fossa area.
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Background@#We investigated the impact of previous catheter ablation (CA) on the midterm outcomes of totally thoracoscopic ablation in patients with lone atrial fibrillation (AF). @*Methods@#Between February 2012 and July 2018, 332 patients underwent totally thoracoscopic ablation for the treatment of AF (persistent AF; n=264, 80%). The patients were stratified into CA (n=47, 14%) and non-CA (nCA; n=285, 86%) groups according to their CA history. @*Results@#All the baseline clinical characteristics and risk factors were similar between the groups except for age, percentage of male patients, prevalence of paroxysmal AF, prior percutaneous coronary intervention, and left atrial volume index (LAVI). No significant intergroup differences were observed in the incidence of early and late complications. At late follow-up, normal sinus rhythm was observed in 92% (43 of 47) of the patients in the CA group and 85% (242 of 285) of the patients in the nCA group (p=0.268). The rate of freedom from AF recurrence at 5 years was 55.3%±11.0% in the CA group, which was similar to that in the nCA group (55.7%±5.1%, p=0.690). In Cox regression analysis, preoperative brain natriuretic peptide levels and LAVI were associated with AF recurrence, but CA history was not significant. @*Conclusion@#Totally thoracoscopic ablation was safe and effective in treating AF irrespective of CA history. A history of CA did not appear to affect the procedural complexity.
ABSTRACT
Hand-foot-and-mouth disease, a highly contagious viral infection, occurs more common in children than in adults. However, there was a recent outbreak of Coxsackievirus A6-induced infection with an atypical presentation among the adult population. Stevens– Johnson syndrome is a severe mucocutaneous disease characterized by extensive necrosis and detachment of the epidermis, and this condition is commonly caused by medications.Herein, we describe a 30-year-old male patient taking allopurinol for the management of gout. The patient presented with numerous erythematous papules, vesicles, and patches with mucosal eruptions on the whole body, oral mucositis, and fever, and he was finally diagnosed with hand-foot-and-mouth disease.
ABSTRACT
Hand-foot-and-mouth disease, a highly contagious viral infection, occurs more common in children than in adults. However, there was a recent outbreak of Coxsackievirus A6-induced infection with an atypical presentation among the adult population. Stevens– Johnson syndrome is a severe mucocutaneous disease characterized by extensive necrosis and detachment of the epidermis, and this condition is commonly caused by medications.Herein, we describe a 30-year-old male patient taking allopurinol for the management of gout. The patient presented with numerous erythematous papules, vesicles, and patches with mucosal eruptions on the whole body, oral mucositis, and fever, and he was finally diagnosed with hand-foot-and-mouth disease.
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Lipoma is the most common benign neoplasm in adults. While it is commonly found in the neck, trunk, and extremities, it is extremely rare in the nasal cavity, paranasal sinus, or nasal septum. To our knowledge, there have been only a few cases of septal lipomas reported in the English literature. A 32-year-old woman visited Kosin University Hospital complaining of left nasal congestion and throat discomfort. Upon nasal endoscopy examination and CT, we found a polypoid mass of 2.7×1.5 cm with an elongated neck occupying a region left of the nasopharyngeal to the oropharyngeal cavity. The mass was completely removed via endoscopic endonasal surgery under general anesthesia and was identified as a fibrolipoma in the histopathological examination. We report a case of a successfully treated fibrolipoma originating from the posterior margin of the nasal septum.
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Thyroid ophthalmopathy is an autoimmune disease that affect the orbital and periorbital soft tissue, characterized by bulging eye (exophthalmos) and compressed orbital structures, such as the optic nerves. The indications for surgical treatment for thyroid ophthalmopathy include decreased visual acuity caused by optic neuropathy, conjunctivitis and progressive facial deformity caused by exophthalmos. Orbital wall decompression by nasal endoscopy resulte in good cosmetic effects and visual recovery. Balanced orbital decompression is considered to be a safe and effective surgery that can help avoid postoperative diplopia. We introduce three successful cases of orbital wall decompression for the treatment of thyroid ophthalmopathy.
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PURPOSE: To evaluate the clinical presentations of focal choroidal excavation and to report long-term outcomes of cases without retinal disorders at the initial presentation. METHODS: A retrospective review of medical records was performed for patients diagnosed with focal choroidal excavation. Concomitant retinal disorders at the initial presentation were identified. In cases without retinal disorders, the development of retinal disorders during follow-up was also evaluated. RESULTS: Forty-five eyes in 45 patients were examined in this study. Focal choroidal excavation was accompanied with retinal disorders in 16 eyes (35.6%). In the remaining 29 eyes, only focal choroidal excavation was noted without any accompanying retinal disorders. The accompanying retinal disorders included choroidal neovascularization (n = 8), central serous chorioretinopathy (n = 4), epiretinal membrane (n = 1), macular hole (n = 1), branch retinal vein occlusion (n = 1), and uveitis (n = 1). Of the 29 eyes without retinal disorders, 22 were followed up for a mean period of 33.5 ± 18.2 months. Consequently, choroidal neovascularization was found to have developed in one eye at 59 months, and subretinal fluid had developed in two eyes at 17 and 28 months, respectively. CONCLUSIONS: Focal choroidal excavation was accompanied by retinal disorders in 35.6% of the included patients. In patients without retinal disorders, the development of a retinal disorder was noted in some eyes, suggesting the need for long-term regular follow-up in patients diagnosed with focal choroidal excavation.
Subject(s)
Humans , Central Serous Chorioretinopathy , Choroid , Choroidal Neovascularization , Epiretinal Membrane , Follow-Up Studies , Medical Records , Retinal Perforations , Retinal Vein Occlusion , Retinaldehyde , Retrospective Studies , Subretinal Fluid , UveitisABSTRACT
Thyroid ophthalmopathy is an autoimmune disease that affect the orbital and periorbital soft tissue, characterized by bulging eye (exophthalmos) and compressed orbital structures, such as the optic nerves. The indications for surgical treatment for thyroid ophthalmopathy include decreased visual acuity caused by optic neuropathy, conjunctivitis and progressive facial deformity caused by exophthalmos. Orbital wall decompression by nasal endoscopy resulte in good cosmetic effects and visual recovery. Balanced orbital decompression is considered to be a safe and effective surgery that can help avoid postoperative diplopia. We introduce three successful cases of orbital wall decompression for the treatment of thyroid ophthalmopathy.
Subject(s)
Autoimmune Diseases , Congenital Abnormalities , Conjunctivitis , Decompression , Diplopia , Endoscopy , Exophthalmos , Optic Nerve , Optic Nerve Diseases , Orbit , Thyroid Gland , Visual AcuityABSTRACT
Hamartoma is a developmental anomaly or non-neoplastic malformations composed by an excessive growth of indigenous mature tissue present in wrong proportions and abnormal arrangements. Hamartomas may develop in all areas of the body but it is extremely rare in the larynx. The treatment of hamartomas consists of adequate surgical excision leading to an excellent prognosis. We present an incidentally detected subglottic mass during intubation in a 70-year-old male patient. The mass was excised by transoral laser surgery. Histopathologic examination of the lesion revealed that it consisted of hamartoma.
Subject(s)
Aged , Humans , Male , Hamartoma , Intubation , Larynx , Laser Therapy , PrognosisABSTRACT
OBJECTIVES: Insertion of a silicone stent during endoscopic dacryocystorhinostomy (DCR) is the most common procedure to prevent rhinostomy closure. It has been claimed that silicone intubation improves the surgical outcomes of endoscopic DCR. However, many reports have documented an equally high success rate for surgery without silicone intubation. Accordingly, we conducted a systematic review and meta-analysis to clarify the outcomes of endoscopic DCR with and without silicone intubation and determine whether silicone intubation is actually beneficial for patients. METHODS: PubMed, Embase, and Cochrane Library databases were searched to identify relevant controlled trials evaluating endoscopic DCR with and without silicone intubation. The search was restricted to English articles published between January 2007 and December 2016. Relevant articles were reviewed to obtain information pertaining to interventions and outcomes. We also performed a meta-analysis of the relevant literature. RESULTS: In total, 1,216 patients included in 12 randomized controlled trials were pooled. A total of 1,239 endoscopic DCR procedures were performed, and silicone stents were used in 533 procedures. The overall success rate for endoscopic DCR was 91.9% (1,139/1,239), while the success rates with and without silicone intubation were 92.9% (495/533) and 91.2% (644/706), respectively. There was no statistically significant heterogeneity among the included studies. A meta-analysis using a fixed-effects models showed no significant difference in the success rate between endoscopic DCR with silicone intubation and that without silicone intubation (OR, 1.38; 95% CI, 0.89 to 2.12; P=0.148; z=1.45). Furthermore, there were no significant differences with regard to surgical complications such as synechia, granulation, and postoperative bleeding. CONCLUSION: The findings of our meta-analysis suggest that the success rate and postoperative complication rate for endoscopic DCR is not influenced by the use of silicone intubation during the procedure.
Subject(s)
Humans , Dacryocystorhinostomy , Endoscopy , Hemorrhage , Intubation , Population Characteristics , Postoperative Complications , Silicon , Silicones , StentsABSTRACT
Catheter and surgical ablation of atrial fibrillation (AF) have evolved from investigational procedures to their current role as effective treatment options for patients with AF. Surgical ablation of AF is available in most major hospitals throughout the world. Catheter ablation of AF is even more widely available, and is now the most commonly performed catheter ablation procedure. Management of patients with AF has traditionally consisted of three main components: (1) anticoagulation for stroke prevention; (2) rate control; and (3) rhythm control. With the emergence of large amounts of data, which have both defined and called attention to the interaction between modifiable risk factors and the development of AF and outcomes of AF management, we believe it is time to include risk factor modification as the fourth pillar of AF management. Catheter and surgical ablation of AF are highly complex procedures, therefore a decision to perform catheter or surgical AF ablation should only be made after a patient carefully considers the risks, benefits, and alternatives to the procedure.
Subject(s)
Humans , Atrial Fibrillation , Catheter Ablation , Catheters , Risk Factors , StrokeABSTRACT
In this part the writing group will cover strategies, techniques, and endpoints of atrial fibrillation (AF) ablation. Prior to all, electrical isolation of the pulmonary veins is recommended during all AF ablation procedures. In addition, techniques to be used for ablation of persistent and long-standing persistent AF, adjunctive ablation strategies, nonablative strategies to improve outcomes of AF ablation, and endpoints for ablation of paroxysmal, persistent, and long-standing persistent AF will be reviewed. Currently many technologies and tools are employed for AF ablation procedures. Radiofrequency energy, cryoablation, and other energy sources and tools are in various stages of development and/or clinical investigation. Finally, anticoagulation strategies pre-, during, and postcatheter ablation of AF and technical aspects of ablation to maximize safety are discussed in this section.
Subject(s)
Atrial Fibrillation , Catheter Ablation , Catheters , Cryosurgery , Pulmonary Veins , WritingABSTRACT
Catheter ablation of atrial fibrillation (AF) is one of the most complex interventional electrophysiological procedures. The success of AF ablation is based in large part on freedom from AF recurrence based on electrocardiography (ECG) monitoring. Arrhythmia monitoring can be performed with the use of noncontinuous or continuous ECG monitoring tools. AF ablation is an invasive procedure that entails risks, most of which are present during the acute procedural period. However, complications can also occur in the weeks or months following ablation. Recognizing common symptoms after AF ablation and distinguishing those that require urgent evaluation and referral to an electrophysiologist is an important part of follow-up after AF ablation. This section reviews the complications associated with catheter ablation procedures performed to treat AF. The types and incidence of complications are presented, their mechanisms are explored, and the optimal approach to prevention and treatment is discussed. Finally, surgical and hybrid AF ablation technology and the indications for concomitant open or closed surgical ablation of AF, stand-alone and hybrid surgical ablation of AF are covered in this section.
Subject(s)
Arrhythmias, Cardiac , Atrial Fibrillation , Catheter Ablation , Catheters , Electrocardiography , Follow-Up Studies , Freedom , Incidence , Recurrence , Referral and ConsultationABSTRACT
A 54-year-old man, suffering from severe headache and ophthalmoplegia after undergoing endoscopic sinus surgery was referred to a tertiary hospital. Computed tomography (CT) revealed soft tissue density lesions in the left sphenoid sinus. The internal carotid artery was shown to be occluded in brain magnetic resonance imaging (MRI) scans without any other cerebral lesion. Endoscopic view of left nasal cavity shows whitish hyphae in the ethmoid and the sphenoid sinuses. We diagnosed him with cavernous sinus syndrome caused by mucormycosis and conducted endoscopic sinus surgery to remove remaining lesions and decompress orbit and optic nerves. After the revision surgery the patient's headache and ophthalmoplegia were improved. However, multifocal cerebral infarctions were newly discovered in a postoperative CT scan. We experienced a case of mucormycosis of sphenoid sinus resulting in occlusion of internal carotid artery and multifocal cerebral infarction, and report it with a brief review of these disease entities.
Subject(s)
Humans , Middle Aged , Brain , Carotid Artery, Internal , Cavernous Sinus , Cerebral Infarction , Headache , Hyphae , Magnetic Resonance Imaging , Mucormycosis , Nasal Cavity , Ophthalmoplegia , Optic Nerve , Orbit , Sphenoid Sinus , Tertiary Care Centers , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: The purpose of this study was to investigate the differences in health behaviors and dietary habits between the metabolically healthy group and the metabolically abnormal group in overweight and obese subjects based on the data of National Health and Nutrition Survey (NHANES). METHODS: Using the NHANES data (2007–2010), a total of 18,188 subjects were grouped into the metabolically healthy group and the abnormal group using the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) definition. Then we compared their health behaviors, dietary behaviors and nutrient intakes after adjustment for variables in overweight and obese groups. RESULTS: The proportion of metabolic abnormalities tended to increase with increasing age in both overweight and obesity groups.(P for trend <0.001) After adjusting various confounding variables, the odds ratio (95% confidence interval) of skipping any meal and breakfast for metabolically abnormality were 1.318 (1.066–1.631) and 1.354 (1.076–1.705) in male obese group and those of skipping breakfast and carbonated drink intake were 1.578 (1.168–2.133) and 1.540 (1.188–2.492) in female obese group. Daily potassium intake (P=0.032) and daily vitamin C intake (P=0.048) in the male overweight group and daily water intake (P=0.046) and daily carbohydrate intake (P=0.038) in the female overweight group were associated with metabolically abnormality. CONCLUSIONS: There were differences in health behaviors and nutrient intake according to metabolically abnormality in overweight and obese groups.
Subject(s)
Adult , Female , Humans , Male , Adenosine Triphosphate , Ascorbic Acid , Breakfast , Carbonated Beverages , Cholesterol , Drinking , Education , Feeding Behavior , Health Behavior , Meals , Nutrition Surveys , Obesity , Odds Ratio , Overweight , PotassiumABSTRACT
PURPOSE: To assess the trends in pars plana vitrectomy surgery rates and factors affecting rate change between 2002 and 2013 in South Korea. METHODS: Data from National Health Insurance Service-National Sample Cohort 2002–2013, which represents 1,025,340 samples with a sampling rate of 2.2% from the total eligible Korean population, was analyzed. RESULTS: A total of 3,816 vitrectomy procedures were performed (male, 2,010; female, 1,806) from 2002 to 2013. Annual rates of vitrectomy increased from 15.1 (in 2002) to 49.4 (in 2013) per 100,000 individuals, and this trend was prominent in those aged 60 years or older. As for the anesthetic method, vitrectomy under local anesthesia increased more prominently than vitrectomy under general anesthesia. The most common diagnoses associated with vitrectomy were diabetic retinopathy, retinal detachment, epiretinal membrane, and macular hole. CONCLUSIONS: The average annual rate of vitrectomy surgery was 31.5 per 100,000 between 2002 and 2013, and the rate has steadily increased.
Subject(s)
Female , Humans , Anesthesia, General , Anesthesia, Local , Cohort Studies , Diabetic Retinopathy , Diagnosis , Epiretinal Membrane , Incidence , Korea , Methods , National Health Programs , Republic of Korea , Retinal Detachment , Retinal Perforations , VitrectomyABSTRACT
BACKGROUND: The aim of this study was to investigate the relationship between serum ferritin and diabetes mellitus (DM) in the Korean population. METHODS: This cross-sectional study included 9,576 subjects (4,264 men, 2,394 pre-menopausal women, and 2,918 post-menopausal women) older than 19 years using data from the 2010-2012 Korean National Health and Nutrition Examination Survey. DM was defined as fasting plasma glucose ≥126 mg/dL, glycosylated hemoglobin ≥6.5%, or use of any glucose-lower medication including insulin therapy. RESULTS: The overall prevalence of DM was 12.0, 3.6, and 17.3% in men, pre-menopausal women, and post-menopausal women, respectively. DM prevalence was greater with ferritin levels from Q1 to Q4: 10.3, 10.2, 12.7, and 14.8% in men; 2.0, 2.8, 2.8, and 6.4% in pre-menopausal women; and 13.9, 14.4, 18.1, and 22.9% in post-menopausal women, respectively. Compared with participants in Q1, the odds ratios (95% confidence intervals) for DM among participants in Q4 were 1.67 (1.20-2.32) in men, 2.06 (0.91-4.66) in pre-menopausal women, and 1.60 (1.09-2.35) in post-menopausal women after adjusting for age and other covariates. CONCLUSION: Serum ferritin concentration was positively associated with a higher risk of DM in adult men and post-menopausal women.