Severe hypoxemia and hypotension during general anesthesia of a patient with an anterior mediastinal mass: A case report / 대한마취과학회지

Mediastinal masses may cause compression of vital structures such as major airways, the superior vena cava and, rarely, the pulmonary artery. The latter could cause cardiorespiratory compromise during or after induction of general anesthesia. We observed a case of a 45-year-old woman with an anterior mediastinal mass that caused severe hypoxemia and hypotension during sternotomy for mass resection, probably by pulmonary artery compression. Immediately upon opening the chest to relieve pulmonary artery compression, oxygen saturation and blood pressure returned to normal. Therefore, we suggest that unexpected hypoxemia and hypotension in a patient with a mediastinal mass can be due to pulmonary artery compression.

Anesthetic Experience for Trans-Sphenoidal Surgery of Pituitary Adenoma on a Patient with Brugada Syndrome: A Case Report / 영남의대학술지

Brugada syndrome is characterized by an ECG pattern of right bundle branch block and ST segment elevation in the right precordial leads (V(1)-V(3)) without structural heart disease. It is also characterized by sudden cardiac death that's caused by ventricular fibrillation. This is a familial syndrome with an autosomal dominant inheritance pattern and it may be considerably more common in Southeast Asia. Many factors during anesthesia can precipitate malignant dysrrhythmia in these patients, so careful choice of anesthetics is required. We experienced a case of Brugada syndrome in a 59-year-old male patient who was under general anesthesia for trans-sphenoidal surgery to treat a pituitary adenoma, and the patient was diagnosed as having Brugada syndrome without any untoward cardiovascular events.

Open-Set Speech Perception Performance and Its Contributing Factors for Children Received Cochlear Implantation at Older Age / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study aims to investigate the development of open-set speech perception abilities in children who received cochlear implantation at older age and to examine the preoperative variables contributing to the postoperative speech perception outcomes. SUBJECTS AND METHOD: Open-set speech perception abilities were assessed with the Monosyllabic Word and Common Phrases Tests for 37 prelingually deafened children who received implantation between the ages of 7 and 17 years. Their performance was compared to that of 60 children who received implantation before 7 years of age. To identify the factors contributing to the postoperative open-set speech perception abilities, we analyzed age at hearing aid fitting, age at implantation, duration of implant use, preoperative language and speech perception abilities, and pure tone thresholds in the better ear. RESULTS: The children who received implantation after 7 years of age significantly improved during the first year of implant use, but reached a plateau by 1.5 to 2 years after implantation, reaching scores between 60% and 70%. Children who received implantation after age 7 showed higher speech perception scores than the younger children over the first year of implant use, but showed lower scores than the younger children after 2-3 years of implant use. The variables associated with the postoperative open-set speech perception abilities were speech perception ability, language ability, and hearing levels before implantation. CONCLUSION: Prelingually deafened children who received implantation at older age can obtain substantial open-set speech perception understanding, but tended to reach a plateau between 1.5-2 years after implantation. Speech perception, language abilities, and hearing level before implantation contribute to the outcome.

Closed Reduction of Nasal Bone Fracture Under the Mask Ventilation Anesthesia Using Oral Airway

PURPOSE: The majority of nasal fractures have been treated by closed reduction. And they were manipulated under local anesthesia or general anesthesia. Under the local anesthesia, patients can feel the pain and fear, so general anesthesia through the endotracheal intubation became popularized recently to treat the nasal fracture. But it has still the drawbacks of postanesthetic complication. Therefore, under the mask ventilation anesthesia using oral airway, we tried to manipulate the nasal fracture. METHODS: From July 2007 to November 2007, we worked with fifty patients that were manipulated the nasal fracture. Fifty patients were divided into two groups, general anesthesia with the endotracheal intubation group(n=25) and the mask ventilation using oral airway group(n=25). We checked up the anesthesia time, postanesthetic complication, postoperative aesthetic & functional problem of nose in two groups. RESULTS: In total operation time and sore throat frequency among the postoperative anesthetic complications, there was statistically significant difference between the mask ventilation group and the endotracheal intubation group(p0.05). And no patients complained of postoperative nasal complication such as septal deviation, septal perforation, nasal obstruction and hump nose in two groups. CONCLUSION: Through the mask ventilation using oral airway, we could reach satisfactory results in the anesthetic time and postanesthetic complication.

A Case of Neurilemmoma in the Nasal Vestibule

A schwannoma, also known as neurilemmoma, is a relatively rare benign tumor originating from the schwann cells of the nerve sheath. It occurs along any somatic, sympathetic and cranial nerves except the olfactory and optic nerves. It occurred most frequently in the head and neck but rarely in the nasal cavity and paranasal sinuses. Occurrence was especially rare in the nasal vestibule. Recently we experienced an unusual case of the schwannoma involving the left nasal vestibule. The mass was completely removed via a sublabial approach and histopathological examination and immunohistochemical staining study confirmed the schwannoma. We report this case with review of literatures.

Long-Term Development of Auditory Performance in Children with Cochlear Implants / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study focused on the long-term development of auditory performance evaluated by CAP for children with cochlear implants. MATERIALS AND METHOD: The subjects for this study were 39 children who received the Nucleus multichannel cochlear implants. All children were prelingually deaf and the mean age for these children at the time of implantation was 4 years 5 months (range from 23 months to 10 years 9 months). All children were categorized by means of CAP prior to implantation, and at 6 and 12 months following implantation, and annually thereafter. Thirty children had reached the 1-year stage whereas 24, 21, 14 children, and 8 were in the 2, 3, 4, and 5-year stages, respectively. RESULTS: Eighty-three percent could discriminate speech sounds at 12 months. Their auditory performances gradually developed over 5-year period. Sixty-seven percent of the children who reached the 3-year stage could understand common phrases without lip-reading. Fifty-seven percent of the children who reached the 5-year stage could understand conversation without lip-reading. It is important to consider that the respective percentages at the 3-year stage and the 5-year stage are much higher (93% and 80%), when the eleven children with additional disabilities and/or children who received implants after the age of 7 are excluded. CONCLUSION: The long-term results of this study indicate that the majority of prelingually deaf children, who their cochlear implants before the age of 7 and/or without additional problems, can develop significant auditory performance.

A Case of Cochlear Implantation in a Child with Common Cavity Inner Ear Malformation / 대한이비인후과학회지

Encouraging results have been reported in implanted patients with cochlear malformations, but relevant information about results in the common cavity is not enough. This case study is to report postimplantation performance in a boy with common cavity inner ear malformation. The subject received a Nucleus 22-channel cochlear implant at the age of 34 months. Radiological assessments using CT and MRI revealed bilateral common cavity deformities. Twelve electrodes were inserted premeditatedly, and eleven electrodes were active in his pseudomonopolar mode map. A wide pulse width needed to be used because the T level was high, and facial twitching was present at the higher C level. Speech perception and speech-language evaluations were conducted at pre and postoperative 6-month intervals for up to 4 years. He showed limited sound response and could not perform the formal speech perception tests for initial several months. However, he was able to complete the Body-Parts and ESP tests (low version) at 1 postoperative year and achieved the score of 80% for NU-CHIPS at 2 years after implantation. His open-set word recognition ability has shown continuous improvement over time. PBK score was 80% on phonemes and 50% on words at 2 years, Common Phrases score was 90% at 3 years following implantation. He also developed age appropriate language skills after 3 years of implantation. This report demonstrates that this child could remarkably benefit from cochlear implant even with severe cochlear malformation.