Surgical Strategy for Colonic Intussusception Caused by a Giant Colonic Lipoma: A Report of Two Cases and a Review of the Literature

A colon lipoma is a remarkably rare tumor. In most cases, the tumors are asymptomatic and small in size, need to be differentiated from malignant tumors, and do not need any special treatment. Selection of the right surgical strategy depends on the status of bowel, as well as the size and the location of tumor. We encountered two patients with giant submucosal lipomas that had induced intussusceptions: one with a lipoma in the transverse colon and the other with a lipoma in the ascending colon. The diagnoses were made by using histological examinations. We report the clinical features, diagnoses, and treatments of, as well as our experience with, these two uncommon cases, and we present a review of the literature on this subject.

A Stercoral Perforation of the Rectum

A stercoral perforation of the rectum due to a fecaloma is a rare disease with a high mortality rate. Although multiple case reports of colonic perforations have been published, the data regarding rectal perforations are limited. This case report will highlight one such case of a stercoral rectal perforation that was successfully treated with a laparoscopic operation.

The efficiency of IV PCA with remifentanil and ketorolac after laparoscopic-assisted vaginal hysterectomy / 대한마취과학회지

BACKGROUND: This randomized, double-blinded clinical study was designed to evaluate the efficiency and safety of remifentanil with ketorolac for IV PCA after laparoscopic-assisted vaginal hysterectomy. METHODS: Eighty patients were randomly allocated into four groups. Group R received IV PCA using only remifentanil at a basal rate of 0.025 microg/kg/min and a bolus of 0.375 microg/kg. Group RK1 received IV PCA using remifentanil at a basal rate of 0.015 microg/kg/min and a bolus of 0.225 microg/kg. Group RK2 received IV PCA using remifentanil at a basal rate of 0.0075 microg/kg/min and a bolus of 0.1125 microg/kg. Group F received IV PCA using fentanyl at a basal rate of 0.3 microg/kg/h and a bolus of 0.075 microg/kg. In addition, ketorolac at a basal rate of 0.04 mg/kg/h and a bolus of 0.01 mg/kg was added to Group RK1, RK2, and F. All PCA conditions had a lock out period of 15 minutes. Pulse rate, systolic and diastolic BP, sedation score, visual analogue scale (VAS), and PONV score were recorded at 1, 3, 6, 12, and 24 hours after the operation. Total opioid use and the patients' number for rescue analgesic drug were also collected. RESULTS: The groups did not differ in PONV score and hemodynamic changes. The VAS in Group RK2 was high compared with the other groups. In addition, the sedation score was high in Group R. CONCLUSIONS: The additional ketorolac administration in remifentanil IV PCA had remifentanil sparing effects and reduced sedation among the side effects. Further studies will be needed to evaluate the precise and adequate dosage of ketorolac.

The Risk Factors of Reflux Complication after Gastrectomy for Proximal Gastric Cancer

PURPOSE: The aim of this study was to investigate the risk factors of reflux associated complications (reflux symptoms, reflux esophagitis, and esophageal stricture) after gastrectomy for proximal gastric cancer. METHODS: 150 patients with proximal gastric cancer were included from January 2005 to December 2008. Their medical and surgical records were retrospectively analyzed concerning clinical and pathologic characteristics, operation methods, morbidity, reflux associated complications and nutritional states. RESULTS: Tumor sizes and operation methods were statistically significant in univariate analysis of risk factors for reflux associated complications (P0.05). However, reflux complications were significantly more common in proximal gastrectomy groups (72.4%) than in total gastrectomy groups (29.5%). Severe reflux esophagitis (LA classification C or D) was found in only proximal gastrectomy groups. CONCLUSION: Total gastrectomy is favorable for proximal early gastric cancer in terms of reduced esophageal reflux complications.

Comparison of ramosetron and ondansetron for preventing nausea and vomiting after middle ear surgery under general anesthesia with sevoflurane and remifentanil / 대한마취과학회지

BACKGROUND: In this randomized, double-blinded study, we evaluated the efficacy of ramosetron and ondansetron for preventing postoperative nausea and vomiting (PONV) after middle ear surgery. METHODS: Seventy patients of either sex, ASA 1-2, scheduled middle ear surgery (mastoidectomy and tympanoplasty) under general anesthesia with sevoflurane and remifentanil were included. Patients were randomly divided into two groups and received IV ramosetron 0.3 mg (group R) or ondansetron 4 mg (group O) before the end of operation (n = 35 each). The incidence and severity of PONV, pain score (VAS), rescue antiemetic, rescue analgesic and side effects were assessed following 6 hr, 24 hr and 48 hr after surgery. RESULTS: The incidence of PONV showed no significant difference between groups at each time points after surgery. There were no difference in the severity of nausea, pain score, rescue antiemetic, analgesic drug usage and side effects between groups. CONCLUSIONS: Prophylactic therapy with ramosetron is as effective and safe as conventional prophylactic therapy with ondansetron for preventing PONV in patients undergoing general anesthesia for middle ear surgery.

A Case of Repair of Retroauricular Skin Defect and Mastoid Cavity with Posterior Wall Reconstruction Using Tutoplast(R)(Allograft Cancellous Bone Chip) and Bone Dust after Canal Wall Down Mastoidectomy / 대한이비인후과학회지

Canal wall down mastoidectomy is often selected for the complete eradication of lesion and prevention of recurrence in patients with cholesteatoma. However, potential complications include a chronically draining cavity, retention of debris that requires frequent cleaning, difficulty with fitting a hearing aid. Aimed at solving these problems, surgeons have attempted reconstruction with a variety of techniques and materials: the reconstruction of an anatomically correct canal wall and complete obliteration of the mastoid cavity. We recently experienced a case of a retroauricular skin defect and cavity after canal wall down mastoidectomy of a 58-year-old male patient. The skin defect and cavity were repaired using a local skin flap, mastoid obliteration and posterior wall reconstruction methods using Tutoplast(R)(Allograft cancellous bone chip). We report this along with a review of literature.

Allergic Reaction to a Latex Face Mask for Manual Ventilatory Support : A case report

The number of latex-induced allergic reactions, including anaphylaxis, has been increasing since latex induced contact urticaria was first reported in surgical patients by Nutter in 1979. Latex allergy is frequently seen in the healthcare industry, and is associated with systemic symptoms, hand eczema, and allergic contact dermatitis. Reactions range from contact urticaria, rhinitis and conjunctivitis, angioderma or bronchospasm to the recently recognized severe anaphylactic shock with cardiovascular collapse. We encountered a 55-year-old female patient who developed a severe anaphylactic reaction after manual vetilatory support using a facemask that contained latex. A subsequent allergy workup revealed a delayed-type hypersensitivity to latex. This case highlights the need for anesthesiologists to be able to diagnose the signs and symptoms of allergic reactions in patients during the peri-anesthetic period. Two types of allergic reactions to natural rubber latex (NRL) and rubber products are now known to exist: type I (immediate-type) and type IV (delayed-type hypersensitivity [DTH]). Patients with NRL allergy should be provided with information on non-latex devices and latex avoidance in medical, dental, and occupational settings. In addition, we should pay more attention to the management of allergic reactions to latex in high risk groups.

Effect of Caffeine on UTP-induced Ca2+ Mobilization and Mucin Secretion in Human Middle Ear Epithelial Cells / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Puringeric receptors and their agonists like uridine-5-triphosphate (UTP) and adenosine triphosphate (ATP), regulate mucin secretion in middle ear epithelial cells. In the present study, we examined the effects of purinergic agonists on Ca2+ influx ([Ca2+]i ) in normal human middle ear epithelial (NHMEE) cells. We also examined the effect of caffeine, an inositol 1, 4, 5-triphosphate (IP3) inhibitor, on UTP induced [Ca2+]i and mucin secretion in NHMEE cells. MATERIALS AND METHOD: NHMEE cells were stimulated with various purinergic agonists, such as UTP, and [Ca2+]i was measured using a miniature double perfusion chamber. UTP-induced mucin secretion was quantitated by immunoblotting assay. RESULTS: The determined order of purinergic agonist potency with respect to [Ca2+]i was ATP=UTP>2-MeSATP>ADP>> adenosine. UTP-induced mucin secretion was inhibited when the intracellular Ca2+ was removed with 2-bis (2-aminophenoxy)ethane-N, N, N', N'-tetraacetic acid-acetoxymethyl ester. Caffeine suppressed UTP-induced [Ca2+]i, and but inhibited UTPinduced and constitutional mucin secretion. CONCLUSION: Our results suggest that caffeine may have a therapeutic effect in mucoid otitis media by suppressing mucin secretion.

Morphologic Change of the Vestibular Organ in the Na+-K+-2Cl- Cotransporter Deficiency Mouse

BACKGROUND AND OBJECTIVES: The Na+-K+-2Cl- cotransporter-1 (NKCC1) is a member of the cation-coupled chloride transporter that participates in salt transport and cell volume regulation in diverse tissues. NKCC1 deficient mice exhibit deafness, and have structural alterations in the cochlea. In addition to hearing loss, NKCC1-deficient mice show a shaker-waltzer behavior, which suggests a vestibular system defect. This study investigated the morphology of the vestibular system of NKCC1-deficient mice. In addition, this study evaluated whether NKCC1 mRNA and its protein are expressed in human vestibular end organs. MATERIALS AND METHOD: NKCC1-deficient and wild type mice aged 4~5 weeks were sacrificed. Their heads were cut in the midsagittal plane, fixed and decalcified. For light microscopy, 5 m sections were cut, and stained with hematoxylin and eosin. Human vestibular end organs were harvested during acoustic tumor surgery via translabyrinthine approach. Some of these end organs were used for the total mRNA extraction and the remainder was used for immunostaining. RT-PCR was performed for NKCC1. RESULTS: The scala media of the cochlear of the NKCC1-deficient mice were collapsed but the bony labyrinth of the cochlea appeared unaffected. However, the semicircular canals (SCCs) were much smaller than those in the wild type. Furthermore, the SCCs were completely missing in some NKCC1-deficient mice. NKCC1 mRNA was expressed in both human macula and crista ampullaris and its protein was expressed mainly in the transitional and dark cell area of the human crista ampullaris. CONCLUSION: NKCC1 may be essential for maintaining the vestibular morphology and its function in mice and NKCC1 is well expressed in human vestibular end organs.

Morphologic Change of the Vestibular Organ in the Na+-K+-2Cl- Cotransporter Deficiency Mouse

BACKGROUND AND OBJECTIVES: The Na+-K+-2Cl- cotransporter-1 (NKCC1) is a member of the cation-coupled chloride transporter that participates in salt transport and cell volume regulation in diverse tissues. NKCC1 deficient mice exhibit deafness, and have structural alterations in the cochlea. In addition to hearing loss, NKCC1-deficient mice show a shaker-waltzer behavior, which suggests a vestibular system defect. This study investigated the morphology of the vestibular system of NKCC1-deficient mice. In addition, this study evaluated whether NKCC1 mRNA and its protein are expressed in human vestibular end organs. MATERIALS AND METHOD: NKCC1-deficient and wild type mice aged 4~5 weeks were sacrificed. Their heads were cut in the midsagittal plane, fixed and decalcified. For light microscopy, 5 m sections were cut, and stained with hematoxylin and eosin. Human vestibular end organs were harvested during acoustic tumor surgery via translabyrinthine approach. Some of these end organs were used for the total mRNA extraction and the remainder was used for immunostaining. RT-PCR was performed for NKCC1. RESULTS: The scala media of the cochlear of the NKCC1-deficient mice were collapsed but the bony labyrinth of the cochlea appeared unaffected. However, the semicircular canals (SCCs) were much smaller than those in the wild type. Furthermore, the SCCs were completely missing in some NKCC1-deficient mice. NKCC1 mRNA was expressed in both human macula and crista ampullaris and its protein was expressed mainly in the transitional and dark cell area of the human crista ampullaris. CONCLUSION: NKCC1 may be essential for maintaining the vestibular morphology and its function in mice and NKCC1 is well expressed in human vestibular end organs.

Squamous Cell Carcinoma of the External Auditory Canal: Treatment Results of 15 Cases / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The management of external auditory canal (EAC) squamous cell carcinoma (SCC) is very difficult because the structure of the temporal bone is complicated. We aimed to analyze the surgical results of EAC SCC and propose a treatment protocol. SUBJECTS AND METHOD: Fifteen patients with EAC SCC who underwent operations between July 1984 and June 2001 were analyzed. We divided the patients into five classes according to the extent of tumor progression. In patients classified under Class I, the tumor involved the cartilaginous ear canal. Tumors of patients within Class II involved the bony ear canal or mastoid cortex. Tumors that involved the deep structures of the temporal bone but limited involvement of within the middle ear cavity were classified under Class IIIA. In Class IIIB, tumors involved the facial canal, the base of the skull, or mastoid air cells. In Class IIIC, tumors involved the cochlea, the medial wall of middle ear, dura, sigmoid sinus, or other structures such as the parotid gland, carotid canal, or petrous apex. We analyzed data concerning patients and tumors, surgical methods, and surgical outcomes. RESULTS: The number of patients classified under Class I, Class II, Class IIIA, Class IIIB and Class IIIC were 3, 3, 2, 1, and 6, respectively. Surgical approaches were local canal resection, partial temporal bone resection (TBR), subtotal TBR, and total TBR. Follow up period was 5 to 138 months with a mean (+/-SD) of 40 months (+/-37.5), and the five-year disease free survival rate was 40.6%. CONCLUSION: From this study, we suggest the treatment modality for the EAC SCC. We recommend a partial TBR for surgery of Class I or Class II EAC SCC cancers, a subtotal TBR for Class IIIA, and a total TBR when it is close to Class IIIB or Class IIIC.

Voice Analysis after the Vertical Partial Laryngectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It is generally believed that reconstruction of the glottic region after vertical partial laryngectomy (VPL) can improve glottic and supraglottic function. But reports on secondary healing without glottic reconstruction after VPL are lacking. This study attempts to obtain an objective phonatory data after VPL without glottic reconstruction. MATERIALS AND METHODS: From 1993 to 2001, 13 patients, who had been treated with VPL without glottic reconstruction, and 44 patients who underwent VPL were included in this study. Patients who had been followed up postoperatively less than 12 months were excluded from this study. Seven lesions were classified as T1 glottic cancer and six as T2 glottic cancer ; classic VPL (11 cases) and frontolateral VPL (2 cases). For the evaluation of voice, acoustic (fundamental frequency (Fo), jitter, shimmer, noise to harmonic ratio (NHR)), aerodynamic (maximal phonation time (MPT), mean flow rate (MFR)) analysis and videostroboscopy were done. RESULTS: There were significant differences in Fo, jitter, shimmer, NHR, MPT and MFR between VPL group and the normal control group. In videostroboscopy, the following tendencies were observed in many cases: incopmplete glottic closure, decreased and irregular mucosal wave and amplitude, supraglottic voicing, abnormal arytenoid movement and anterior commissure blunting. CONCLUSION: We had objective phonatory data after VPL without glottic reconstruction, which showed that voice quality after VPL without glottic reconstruction were somewhat unsatisfactory. Further studies on other surgical techniques of VPL would help to elucidate better ways of improving voice quality in these patients.

The Effectiveness of Biofeedback Therapy for Children Patients with Chronic Constipation

PURPOSE: Chronic constipation is not uncommon even in children. Recently biofeedback treatment (BT) is considered as a useful modality in the treatment of various types of constipation. The aim of this study was to evaulate the effectiveness of BT in children with chronic constipation. METHODS: We reviewed 24 cases of childhood constipation (17 boys, 7 girls) who visited the Jinju Hakmoon colorectal surgery clinic and GNUH1 between April, 2001 and September, 2002. Balloon-mediated anorectal manometry system was used for BT. The effects of therapy was assessed by bowel movement, defecation time, fecal soiling and balloon evacuation test in the early course of therapy. The long term follow up survey was done by telephone interview at January 2003 and the effects of therapy was assessed by bowel movement, defecation time, fecal soiling and parents' satisfaction. RESULTS: Patients received the BT for the three times on average, and as the result of the therapy, 20 patients experienced disappearance of symptoms (87%) or at least improvement of symptoms. In terms of manometric values, the mean resting pressure was 113.4 mmHg before the BT, but decreased to 86.3 mmHg after the BT (P=0.0012). Mean pushing pressure dropped to 85.98 mmHg from 130.45 mmHg (P=<0.0001). Mean sensitivity decreased from 55 ml to 35 ml (P=0.0053). Mean compliance decreased from 20.28 H2O/cm to 4.21 H2O/cm (P=0.0015). 13 patients (76%) showed disappearance or improvement of symptoms in the long term follow up. CONCLUSIONS: The Balloon mediated biofeedback therapy is effective in children with chronic constipation. It is safe, easy to administer and also improve symptoms and objective parameters of anorectal function. Balloon mediated biofeedback therapy could be the first-line therapy in child patient with chronic constipation who failed conservative management.