Utilization and Application of Modified Action Camera in Otorhinolaryngoloic Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: In recent years, surgical imaging has become important for legal and educational purposes. Significant improvements can be made from the surgeon's point of view in recording surgical procedures, particularly with respect to the action camera with high-definition video recordings. For otolaryngologic surgery, the surgical view is narrow, and there is a limit to proper imaging using the existing lens of the action camera. Therefore, we aimed to find out if we could obtain surgical images through simple modification of action camera. MATERIALS AND METHOD: The action camera was modified to match the surgical field. We selected a suitable lens for otolaryngology surgery using a calculation formula. The action camera was simply modified according to the design. The modified action camera can be mounted on the surgeon's head or the surgical light. We compared the images taken with the modified action camera and the images taken with the existing camcorder. The modified action camera was able to capture a narrow surgical field for otolaryngologic surgery. RESULTS: Unlike the existing method, we were able to obtain high-quality images using a modified action camera at the first person's viewpoint without auxiliary manpower. The action camera was considerably cost effective compared to other methods of recording surgery. CONCLUSION: The modified action camera allows for high-definition, cost-effective, and firstperson viewpoint for otolaryngologic surgery. The modified action camera allows for detailed videography that can enhance surgical teaching, presentation and patient education materials.

A Case of Acute Supraglottitis Following Anti-Thyroid Drug-Induced Agranulocytosis

Acute supraglottitis is characterized by an inflammation and edema of the supraglottic region and a potential life-threatening condition because of its risk for sudden upper airway compromise. Prompt diagnosis, administration of broad spectrum antibiotics, and airway management is pivotal for reducing serious complications. In the immunocompromised host, microorganisms are more likely to elicit mucosal inflammations, thus clinicians should pay attention to those patients for prompt removal of the causes of immune disruption. Here we report a case of acute adult supraglottitis with neutropenia caused by anti-thyroid drug with a review of the related literatures.

The effectiveness of an enhanced recovery after surgery protocol in head and neck cancer surgery with free-flap reconstruction

PURPOSE: An enhanced recovery after surgery (ERAS) protocol incorporates up-to-date perioperative care principles; the primary aim in using an ERAS protocol is to reduce issues that delay the recovery and cause the complications. The aim of this study was to compare outcomes associated with head and neck cancer surgery with free-flap reconstruction before and after implementation of an ERAS protocol. METHODS: Outcomes were analyzed by dividing patients into 2 groups: 29 patients in the non-ERAS group and 60 patients in the ERAS group. The ERAS group performed a prospective observational cohort study of patients who underwent a head and neck cancer surgery with free-flap reconstruction in Ajou University Hospital from August 2015 to December 2017. The non-ERAS group retrospectively reviewed the medical records of patients who had undergone the same surgery from August 2012 to July 2015. RESULTS: Demographics, comorbidities, hospital length of stay (LOS), postoperative complications, starting time of rehabilitation, and postoperative periods before radiotherapy for the non-ERAS and ERAS groups were compared. Hospital LOS was significantly lower for patients whose care followed the ERAS protocol than for patients in the non-ERAS group (30.87 ± 20.72 days vs. 59.66 ± 40.43 days, P < 0.0001). CONCLUSION: In this study, hospital LOS was reduced through fast recovery after the implementation of the ERAS protocol. Therefore, the ERAS protocol appeared feasible and safe in head and neck cancer surgery with free-flap reconstruction.

A 12-Month Single Arm Pilot Study to Evaluate the Efficacy and Safety of Sirolimus in Combination with Tacrolimus in Kidney Transplant Recipients at High Immunologic Risk

The optimal immunosuppressive strategy for renal transplant recipients at high immunologic risk remains a topic of investigation. This prospective single arm pilot study was undertaken to evaluate the safety and efficacy of a combined tacrolimus and sirolimus regimen in recipients at immunological high risk and to compare outcomes with a contemporaneous control group received tacrolimus and mycophenolate mofetil. Patients that received a renal allograft between 2010 and 2011 at high risk (defined as panel reactive antibodies > 50%, 4 or more human leukocyte antigen mismatches, or retransplantation) were enrolled. All patients received basiliximab induction and corticosteroids. A total of 28 recipients treated with tacrolimus and sirolimus were enrolled in this study and 69 recipients were retrospectively reviewed as a control group. The sirolimus group showed a higher, but not statistically significant, incidence of biopsy proven acute rejection and a lower glomerular filtration rate than the control group. Furthermore, sirolimus group was associated with significant increases in BKV infection (P = 0.031), dyslipidemia (P = 0.004), and lymphocele (P = 0.020). The study was terminated prematurely due to a high incidence of adverse events. A de novo tacrolimus/sirolimus combination regimen may not be an ideal choice for recipients at high immunological risk.

Effect of donor-specific antibodies and panel reactive antibodies in living donor liver transplant recipients

PURPOSE: Preformed circulating donor-specific antibodies (DSAs) immunologically challenge vascular endothelium and the bile duct. However, the liver is an immune-tolerant organ and can avoid immunological challenges. This study was undertaken to analyze the effects of DSAs after adult living donor liver transplantation (LDLT). METHODS: We retrospectively reviewed 219 LDLT patients' records treated at our center. RESULTS: Of the 219 patients, 32 (14.6%) were DSA (+) and 187 (85.4%) were DSA (-). Class I DSAs were present in 18 patients, class II in seven patients, and both in seven patients. Seven patients (3.2%) showed DSA to HLA-A, four (1.8%) to HLA-B, seven (3.2%) to HLA-DR, and 14 (6.4%) to two or more HLAs. More DSAs were observed in female recipients than male recipients in the DSA (+) group. The DSA (+) group showed significantly higher levels of class I and II panel reactive antibody (PRA) than did the DSA (-) group. No significant intergroup differences were found between incidences of primary nonfunction, acute rejection, vascular complication, or biliary complication. There were no significant differences in graft survival rates between the two groups. However, the recipients with multiple DSAs tended to have more acute rejection episodes and events of biliary stricture and lower graft survival rates than did patients in the DSA (-) group. CONCLUSION: In LDLT, the presence of multiple DSAs and high PRA seemed to be associated with poor graft outcomes, although our results did not reach statistical significance. Large cohort studies are necessary to clarify the impact of DSA and PRA in LDLT.

Clinical Characteristics and Risk Factors for Renal Cell Carcinoma after Kidney Transplantation / 대한이식학회지

BACKGROUND: The occurrence of malignancy following kidney transplantation has been estimated three to five times the incidence compared to that of the general population. It is estimated that particularly in renal cell carcinoma (RCC), the relative risk increases. The aim of this study was to analyze the characteristics, risk factors, and prognosis of RCC following kidney transplantation. METHODS: Total number of 3,272 kidney recipients who underwent transplantation from April 1979 to December 2012 and patients who had RCC following kidney transplantation were retrospectively reviewed and analyzed. RESULTS: We found that among 232 cases of posttransplant malignancies, 25 recipients were diagnosed with RCC. We have observed in our study that it took an average of 175.2+/-71.0 months to develop RCC after their first kidney transplantation. However, with longer follow up period, interval incidence of RCC increased. Fourteen patients (56%) were diagnosed with RCC 15 years after transplantation. We also found that with reference to the risk factor analysis for posttransplant RCC, the long-term follow-up period was the only independent risk factor. In our study, 21 patients with RCC were treated with radical nephrectomy. Of them, 16 patients survived, and four RCC-related deaths occurred. Furthermore, the patient survival rate of RCC recipients was lower than that of the nonmalignancy group despite the graft survival rate were not different. CONCLUSIONS: We conclude that the incidence of RCC increased in a time-dependent manner following kidney transplantation. Therefore, we strongly recommend the procedure of regular-interval screening for the patients who are on compulsive long-term immunosuppression.

Clinical Characteristics of Focal Segmental Glomerulosclerosis Recurrence after Adult Renal Transplantation / 대한이식학회지

BACKGROUND: Recurrence of focal segmental glomerulosclerosis (FSGS) after kidney transplantation is a frequent and still unpredictable complication. Moreover, risk factors for recurrence have not yet been clearly identified. METHODS: We enrolled into our study 2,882 adult kidney recipients who underwent transplantation between April 1979 and April 2009. We retrospectively reviewed clinical manifestations of recurrence of FSGS. RESULTS: Among the 2,784 adult renal recipients, forty four had undergone renal transplantation for primary FSGS. Of the 44, 12 (27.3%) showed recurrent FSGS. Mean duration between transplantation and FSGS recurrence was 22.8+/-37.4 months. There were no significant differences in patient characteristics in the recurrence and non-recurrence groups. The cumulative incidence of FSGS recurrence was 13.8% within 1 year after kidney transplantation and 23.2% within 3 years. The overall graft survival rate in the recurrence group was significantly lower than that of the non-recurrence group (P=0.0018) and non-FSGS group (P=0.0001). Graft failure happened more in the recurrence group (75%) than in the non-recurrence group (37.5%, P=0.042). CONCLUSIONS: We failed to find any significant risk factors for FSGS recurrence after renal transplantation.

Clinical Characteristics of Acute Appendicitis in Kidney Transplant Recipients / 대한이식학회지

BACKGROUND: Appendicitis is a common surgical disease. There are many problems for the early diagnosis of acute appendicitis in kidney transplant patients; differential diagnosis for acute rejection, limitation in imaging study, problems of immunosuppressant and non-characteristic symptoms. METHODS: We reviewed medical records and transplant database of 2,947 renal transplant patients between April, 1979 and September, 2009 retrospectively. Patient's characteristics, diagnostic methods for appendicitis and operative/postoperative progresses were analyzed. RESULTS: Of the 2,947 renal transplant patients, there were 15 (0.51%, 13 males and 2 females) acute appendicitis patients. Mean age at the diagnosis of appendicitis was 37.2+/-10.1 years. Fourteen (93.3%) patients suffered from prodromal symptom, such as abdominal pain, direct or rebound tenderness, nausea and vomiting. There were 12 (80%) patients with leukocytosis (WBC count >10,000/microliter). Computed tomography scans were performed in 5 (33.4%) patients for diagnosis. Laparoscopic appendectomies were applied for 8 (53.4%) patients. In pathologic diagnosis, 2 cases were reported as 'non pathologic diagnosis' complications occurred in 2 patients as remnant appendicitis and pancreatitis. However, there was no patient with mortality and renal failure during the hospitalization. CONCLUSIONS: There were no significant differences between the transplant patients and the general population in the incidence, clinical features, diagnosis and postoperative progresses of acute appendicitis.

Posttransplant Lymphoproliferative Disorders in Kidney Transplant Patients: Report from a Single-center over 25 Years / 대한이식학회지

BACKGROUND: Posttranplant lymphoproliferative disorder (PTLD) is a fatal complication of organ transplantation and standard treatment is either ineffective or too toxic to tolerate. This study aims to evaluate the characteristics of PTLD patients retrospectively. METHODS: We enrolled 2,630 kidney recipients who underwent transplantation from April 1979 to June 2007. And we retrospectively reviewed clinical manifestations of PTLD. RESULTS: Among one hundred ninety post-transplant malignancies from 2,630 renal recipients, 11 PTLD were diagnosed during 195.3+/-11.5 months (0~388 months) of mean follow up duration. PTLD predominantly occurred in male (Male : Female=10 : 1) and mean age of PTLD patients at the time of PTLD diagnosis was 51+/-15 year (18~71 year). Mean time interval to PTLD diagnosis were 126.6+/-74.8 months (6~240 months). In aspect of WHO classification, there were no early lesion, 1 polymorphic PTLD (9.1%), 10 monomorphic PTLD (90.9%) and no other types. In aspect of involved organ, GI tract was involved in 1 case, lung in 2 cases, bone in 2 cases, spleen in 2 cases, neck node in 2 cases, liver in 1 case, and multiple organs in 1 case. CONCLUSIONS: Our findings showed that the prevalence of PTLD was 0.46%, which was less than reports from Western countries. We also found that the late onset PTLD was more than early onset one, which was another difference from previous reports.

Vestibulo-Ocular Reflex according to the Change of Angular Acceleration in Sinusoidal Harmonic Acceleration Test / 대한이비인후과학회지

We investigated the vestibulo-ocular reflex which is followed by the change of angular acceleration in sinusoidal harmonic acceleration test. 20 normal volunteers with no evidence of previous otoneurologic disease were tested. The maximal slow phase eye velocity, gain and asymmetry were obtained in five different amplitudes of rotation, 30degrees, 60degrees, 90degrees, 120degrees and 150degrees with properly fixed conditions such as darkness and the frequency of rotation fixed at 0.05Hz. During each test, we asked the examinees to be alert and keep the eyes open. At least 5 minute interval was given between the tests and recalibrations were done before each test. The results of this test were as follows. 1) The maximal slow phase eye velocities were gradually increased according to the increment of the amplitudes of rotation with the statistical significances(p0.05). Therefore, from the above results, sinusoidal harmonic acceleration test with the frequency fixed at 0.05Hz, gain is higher when the amplitude of rotation is smaller and the pattern of the nystagmus is more evident when the amplitude of rotation is bigger. But The authors conclude that in order to get the results which are statistically significant, the amplitude of rotation should be lower than 90degrees.