A Case of Synovial Sarcoma Arising in the Supraglottis / 대한이비인후과학회지

Synovial sarcoma is a rare tumor that usually occur in the extremities of young adults. The head and neck is relatively a rare location as fewer than 100 cases of synovial sarcoma have been reported in the head and neck area. In the head and neck region, however, the most common site is the hypopharynx. There are 12 cases with laryngeal localization in the literature. We experienced a 30-year-old female patient with an endolaryngeal mass. Initial suspension laryngoscopic biopsy specimen of the primary lesion was consistent with laryngeal synovial sarcoma. The tumor arose from the right false vocal cord. It was treated by extended vertical hemilaryngectomy and postoperative radiotherapy. Microscopically, the tumor was characterized by a monophasic fibrous appearance. We report this rare case with a literature review.

Clinical Analysis of Cervical Neurilemmoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Neurilemmoma is a benign tumor originating from the spinal nerve root, peripheral nerve and all kinds of cranial nerves except the optic nerve and olfactory nerve. Approximately 25% to 40% of all neurilemmomas are found in the neural structures of the head and neck. We performed this study to analyze the clinical features, diagnosis, treatment and prognosis of neurilemmomas. SUBJECTS AND METHOD: Twenty-one patients who were diagnosed with cervical neurilemmoma and had received treatment at the Department of Otolaryngology-Head and Neck Surgeries from 1994 to 2004 were analyzed retrospectively. RESULTS: The mean age of 21 patients was 41.0 years, with 10 being male and 11 female. The most common symptom was palpable neck mass and the mean duration of symptoms was 28.2 months. The most common location of tumor was level II and the most common nerve of origin was the vagus nerve (23.8%). Preoperative diagnostic tools were FNA, CT and MRI. Operation was most commonly performed via transcervical approach. In 10 cases, nerves of origin were preserved, whereas, in 5 cases, nerves of origin were sacrificed and in 6 cases, nerves of origin were not found. The postoperative complications were vocal cord palsy (14.3%), arm weakness (14.3%), facial weakness (9.5%), Horner's syndrome (9.5%), sensory (4.8%) and motor (4.8%) impairment of tongue. The mean follow-up period was 5.3 years and recurrence was not found during this period. CONCLUSION: CT or MRI is more helpful than FNA in the diagnosis of neurilemmoma. In excising neurilemmoma, the nerve must be preserved as much as possible.

The Effect of the Topical Injection of Steroid into the Pillar and Tonsillar Bed on Posttonsillectomy Morbidity / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Many studies report using various agents to reduce morbidity of post-tonsillectomy. Steroid, for example, is often given to decrease postoperative morbidity. This study was designed to determine the efficacy of the intraoperative topical injection of steroid into the pillar and tonsillar bed. SUBJECTS AND METHOD: Eighty patients aged between 15 to 30 years were randomly divided into two groups: 40 patients (Group I) received a single intraoperative dose of topical dexametha-sone sodium phosphate, whereas the control group was given normal saline. After the operation, each patient was evaluated for pain, oral intake, use of analgesics. RESULTS: There were no statistically significant differences noted in pain score, oral intake, use of analgesics among the two groups of patients. CONCLUSION: From the post operative day 1 to post operative day 7, dexamethasone sodium phosphate may play a limited role in the patient recovery from tonsillectomy. The results showed that a single dose of the topical dexamethasone sodium phosphate did not affect the postoperative morbidity.

Expression and Distribution of the Na+ : HCO3- Cotransporter(NBC) and K+ : Cl- Cotransporter(KCC) mRNA in Human Nasal Mucosa and Nasal Polyp / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Electrolyte transport by nasal epithelia has been suggested to be important for controlling the quantity and composition of the nasal fluid and may play an important role in the development of nasal polyps. Transepithelial transport of ion and water in various fluid-transporting epithelia is strictly dependent on the localization of specific membrane proteins in the polarized epithelial cells. Na+ : HCO3-cotransporter (NBC) transports Na+ and HCO3- into the intracellular from extracellular space and induces the evacuation of H+, regulating pH. K+ : Cl- cotransporter (KCC) controls the cell volume and resorption of NaCl which is associated with the extracellular transport of K+ and Cl-. The present study evaluated the presense of mRNA for NBC and KCC in human inferior turbinate and nasal polyp. MATERIALS AND METHOD: The expression of NBC and KCC mRNA isoforms in inferior turbinate mucosa and nasal polyp was evaluated, using RT-PCR and in situ hybridization. RESULTS: RT-PCR revealed that the inferior turbinate and nasal polyp mucosa expressed kNBC, KCC1 and 4 mRNA. In in situ hybridization, their distribution was noted in the epithelial layer and submucosal glands of both mucosa. CONCLUSION: These results indicate that these types of ion transporters are expressed in human nasal mucosa and nasal polyp, controlling the fluid and ion transport in nasal epithelium and submucosal glands.

Multiple Metastatic Chordoma only to Muscle & Subcutaneum / 대한정형외과학회잡지

Chordoma is relatively rare and slowly growing tumor arising from notochordal remnant. The tumor is locally infiltrative rather than metastatic. Distant metastasis occured in 5% of Gentil & Coley's cases and 43% of Higinbotham et als cases. Usual sites of metastasis sites were lung, liver adrenal gland and lymph nodes. In 1922, Stewart reported first case of extrapulmonary metastatic chordoma in muscle & subcutaneous layer, which was extremely rare. We have experienced a case of wide spread multiple metastasis to muscle & subcutaneous tissue from primary sacrococcygeal chordoma. The case was 26 years old man, who have had multiple metastatic lesions in trunk, upper & lower extremities. They located in muscle and subcutaneous fat layer. In some lesions neurovascular structure was involved. We have treated the metastatic lesions by complete surgical excision, and they were confirmed as soft tissue chordoma by histologic examination.

The Treatment of Tibial Shaft Fractures By Use of Ender's nailing / 대한정형외과학회잡지

Fracture of the tibial shaft is the most common fracture of the long bones, and due to its frequency, mode of injury and sometimes type of treatment, has become a major source of permanent and temporary disability. The treatment of fractures of the tinial shaft has become one of the most controversial subjects in orthopedic surgery. Recently flexible intramedullary nails have been used successfully in treatment of fractures of the tibial shaft. In this paper we are reporting our experience with the method in 29 selected fractures of the tibia in 28 patients. The results were as follows. l. Of 29 cases, 19 cases were male and 10 cases were female. The average age was 33.4 years and the most common cause of injury was traffic accident. 2. Seventeen cases were closed fractures and twelve cases were open fractures. Nineteen cases were comminuted fracture. The most common level of the fracture was middle third of the tinial shaft. 3. Average interval from injury to Ender nailing was 10.3 days and the mean duration of permmit to full weight bearing was 9.8 weeks. 4. The mean duration of clinical bone union was 10.2 weeks and that of roentgenological bone union was 17.8 weeks. 5. 9 cases of complication were noted among the 29 cases of tibial shaft fracture which was treated by Ender nsiling such as angulation, ankle joint stiffness, and one case of delayed union. 6. Ender nailing are relative ease of nailing, allow early weight bearing and decrease complication. So Ender nailing is considered to be a good methods in treating tibial shaft fracture.