Navigation-Assisted Balloon Eustachian Tuboplasty for Eustachian Tube Dilatory Dysfunction

Objectives@#. Balloon Eustachian tuboplasty (BET) is a novel treatment method for Eustachian tube dilatory dysfunction (ETD). However, surgeons cannot identify the insertion depth of the catheter during BET, resulting in potential risks such as internal carotid artery (ICA) injury. Therefore, we developed an image-guided navigation balloon catheter to identify the insertion depth of the catheter and to establish awareness of the proximity of the ICA. This study aimed to evaluate the technical feasibility of this image-guided navigation balloon catheter system in patients with ETD. @*Methods@#. Twenty-nine patients (38 ears; nine bilateral; 21 right ears, and 17 left ears) diagnosed with ETD were assessed. All patients who showed no improvement despite medical therapy with topical steroids, anti-reflux medication, and the Valsalva maneuver for a minimum of 6 weeks received image-guided navigation-assisted BET. The 7-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7) score and Valsalva maneuver were used to evaluate patients’ symptoms preoperatively and at the postoperative follow-up. @*Results@#. Image-guided navigation-assisted BET was safely performed in all patients. The mean total ETDQ-7 score was 25.4±7.1 preoperatively, 17.5±6.2 at 1 month, and 15.2±7.0 at 6 months (P<0.001). In total, a Valsalva maneuver was possible for 28 of 38 ears (73.7%) at the time of the patient’s final visit at 6 months post-procedure. @*Conclusion@#. Image-guided navigation balloon catheters are a potentially valuable tool in patients with ETD. Their use is also technically feasible and safe when performing BET to treat ETD.

Management of Acquired Cholesteatoma Associated With Patulous Eustachian Tube and Habitual Sniffing

OBJECTIVES: To investigate the effect of surgical treatment with eustachian tube (ET) catheter insertion in patients with acquired cholesteatoma associated with patulous eustachian tube (PET) and habitual sniffing. METHODS: Nine ears of nine patients (two men and seven women; age, 20 to 65 years; average, 37.9±12.0 years) of acquired cholesteatoma associated with PET and habitual sniffing who underwent cholesteatoma surgery with simultaneous additional ET catheter insertion were examined in this study. Successful treatment was defined as stoppage of sniffing, a relief of a PET handicap inventory-10 (PHI-10), an improvement of autophony grade and no cholesteatoma recurrence. RESULTS: ET catheter insertion was performed in all ears. Follow-up duration ranged from 16 to 37 months (average, 25.4 months). Cases consisted of nine pars flaccida type (100%). All patients obtained relief from aural symptoms and stopped sniffing. Postoperative PHI-10 scores were significantly lower than preoperative scores (P<0.001). During an average follow-up of 25.4 months, no cholesteatoma recurrence has occurred to date. One patient developed otitis media with effusion (OME) post-catheterization; OME resolved spontaneously without treatment. Four patients had a consecutive ET catheter insertion on the other side to resolve PET-related aural symptoms. CONCLUSION: In case of acquired cholesteatoma with PET and habitual sniffing, ET catheter insertion performed simultaneously with cholesteatoma surgery could help reduce aural symptoms and stop sniffing. Moreover, the procedure might help in preventing cholesteatoma recurrence.

Accuracy assessment of a PION TCI pump based on international standards

BACKGROUND: Inaccuracies associated with target-controlled infusion (TCI) delivery systems are attributable to both software and hardware issues, as well as pharmacokinetic variability. However, little is known about the inaccuracy of the syringe pump operating in TCI mode. This study aimed to evaluate the accuracy of the TCI pump based on international standards.METHODS: A test apparatus for accuracy evaluation of a syringe pump (PION TCI®, Bionet Co. Ltd.) was designed to apply the gravimetric method. Pump accuracy was evaluated in terms of deviation defined by the following equation: infusion rate deviation (%) = (Rate(mea) − Rate(est)) / Rate(est) × 100, where Rate(mea) is the infusion rate (ml/h) as measured by the gravimetric system, and Rate(est) is the infusion rate (ml/h) as estimated by the pump. An infusion rate representing TCI mode was determined from previous clinical trial data which evaluated the predictive performance of the pharmacokinetic model. The PION TCI pump used in that clinical trial was used to evaluate accuracy of the syringe pump. The distribution of infusion rates obtained from the clinical trial was calculated, and the median value of the distribution was determined as the representative value.RESULTS: The representative infusion rate representing TCI mode was 31 ml/h, at which the infusion rate deviation was 4.5 ± 1.6%.CONCLUSIONS: The inaccuracy of the syringe pump contributing to TCI system inaccuracy is insignificant.

Surgical Technique for the Functional Preservation of the Inferior Parathyroid Glands

BACKGROUND AND OBJECTIVES: The inferior parathyroid glands receive their blood supply from the inferior thyroid artery. The anatomic relationship of this artery and the recurrent laryngeal nerve can assume three different patterns. To maintain the vascular supply of the inferior parathyroid glands during central neck dissection, we considered the anatomic relationship of these structures in our surgical approach. MATERIALS AND METHODS: Fibrofatty tissue in the central neck compartment was removed by dissection proceeding along the recurrent laryngeal nerve. During the dissection, care was taken not to injure the vascular supply of the inferior parathyroid gland. RESULTS: For an inferior parathyroid gland that receives its blood supply from the posterolateral vascular pedicle, preservation is achieved by performing the dissection along the recurrence laryngeal nerve on the gland's medial side. In patients in whom the inferior thyroid artery travels deep to the right recurrent laryngeal nerve, such that the right parathyroid gland receives its blood supply from the posteromedial vascular pedicle, central neck dissection should be performed carefully along the lateral side of the gland to preserve the pedicle. CONCLUSION: Preservation of inferior parathyroid gland function requires a detailed understanding of the anatomic relationship between the inferior thyroid artery and recurrent laryngeal nerve. The direction of the dissection along the nerve should be adjusted according to its anatomic relationship to the inferior thyroid artery.

Treatment of Meningoencephalocele of Temporal Bone Occurred after Open Cavity Mastoidectomy / 대한이비인후과학회지

Meningoenceophalic herniation into the external auditory canal is a rare and potentially life threatening condition that needs a surgical treatment. It can lead to potential infectious sequelae including meningitis, encephalitis, otologic brain abscess and dysfunctional herniated brain tissue can trigger epilepsy. It is caused by chronic otitis media, cholesteatoma, middle ear surgery, trauma, congenital skull base defect and irradiation. We present a case of meningoencephalic herniation into the external auditory canal that had occurred 8 years after open cavity tympanomastoidectomy, which was treated with subtemporal middle cranial fossa approach.

A Case of Solitary Sarcomatoid Carcinoma of the Neck / 대한이비인후과학회지

Sarcomatoid carcinoma is a rare biphasic tumor characterized by a combination of malignant epithelial and mesenchymal cells. The known characteristics are rapid growth, a high recurrence rate, and an extremely poor prognosis. This type of tumor is also uncommon but has been found in several anantomical sites: female genital tract, skin, gastro-intestinal tract, heptatobiliary system, head, neck, respiratory system, and urinary tract. However, solitary sarcomatoid carcinoma of the neck area is rare. Here, we report a patient who presented an extremely aggressive solitary sarcomatoid carcinoma of the neck.

Comparison of Clinical Outcomes between Pylorus Preserving Pancreaticoduodenectomy and Pancreaticoduodenectomy / 한국간담췌외과학회지

PURPOSE: A pancreaticoduodenectomy (PD) and pylorus-preserving pancreaticoduodenectomy (PPPD) are the two methods commonly used to treat periampullary neoplasms. This study was designed to compare these two methods in terms of the post-operative complications, the recurrence rate, and the post-operative weight change. METHODS: The medical records of 110 patients who underwent PD or PPPD from February 1986 through to June 2002 were retrospectively reviewed. The PD was performed on 54 patients and PPPD was performed on 56 patients, respectively. The mean follow-up periods were 25.33 months in the PD group and 25.39 months in the PPPD group, respectively. RESULTS: Diabetes mellitus occurred in 9 patients (16.7%) in the PD group and 8 patients (14.3%) in the PPPD group, and gastric emptying was delayed in 14 (25.9%) and 15 (26.8%) patients of each group after surgery. Procedure related deaths occurred in 2 (3.7%) and 4 (7.1%) patients from each group. There were no statistically significant differences in the post-operative complications between the two groups. The disease recurrence rate was significantly lower in the PPPD group than in the PD group (60.5% vs. 22.9%, p=0.001). Post-operative weight loss just after surgery at 3 months and 6 months after surgery was 3.56 kg, 3.68 kg, and 3.97 kg in the PD group and 2.78 kg, 1.77 kg, and 1.8 kg in the PPPD group, respectively, without showing a statistically significant difference. CONCLUSION: The clinical outcomes of the PPPD was not different from those of the PD in terms of the post-operative complications and weight loss. The disease recurrence rate was lower in the PPPD group. These results suggest that PPPD could be the treatment choice periampullary neoplasms.

Pedigree of the Specific Family of the FAP in Specific District of Korea and Psychologic Distress

Familial Adenomatous Polyposis (FAP) is a rare and autosomal dominantly inherited disorder characterized by the development of hundreds to thousands of colorectal polyps. Korean Polyposis Registry was established in July, 1990 for early detection and management of the FAP patient. Recently, we have experienced in our institution a case of the FAP family kindred living in Jeju Island of Korea. Their relatives have been managed for the past 20 years and are listed in the Korean polyposis registry. Pathologic diagnosis of our proband was stage III (T3N1M0) rectal cancer with thousands of colonic polyps. Intrafamilial strife and psychologic distress was significant due to the late detection and progression to rectal cancer. Therefore, we reviewed our case of the FAP family with literature regarding the psychologic distress and the role of the regional registry.

Multivariate Analysis of Prognostic Factors in Gastric Cancer

BACKGROUND: Worldwide stomach cancer death rates have been steadily declining in most countries since World War II, but in Korea the incidence of stomach cancer is still high and is a major concern for public health. Surgical resection is the best method of treatment and offers a chance for cure, but the overall results of surgical treatment have been dismal. METHODS: The authors performed a retrospective study of 958 patients treated for adenocarcinomas of the stomach with curative intent over the period from March 1986 through December 1994 at Kyung Hee University Hospital. The study examined the prognostic influence of 2 host factors (age and sex of the patients), 7 tumor factors (location of tumor, number of lesions, size of tumor, depth of invasion, extent of lymph-node involvement, number of metastatic lymph nodes, and TNM stage), and 4 treatment factors (type of gastrectomy, combined resection, extent of lymph-node dissection, and adjuvant chemotherapy) by univariate and multivariate analysis. RESULTS: In univariate analysis, 9 prognostic factors - the age of the patients, the size of lesions, the depth of invasion, the extent of lymph-node involvement, the number of metastatic lymph nodes, the TNM stage, the type of gastrectomy, the extent of lymph-node dissection, and combined resection - were significantly correlated with survival. In multivariate analysis using the Cox proportional hazard model, 5 independent prognostic factors significantly correlated with survival: the age of the patients (RR = 1.480), the depth of invasion (RR = 1.287), the number of metastatic lymph nodes (RR = 2.700), the TNM stage (RR = 1.592), and the extent of lymph-node dissection (RR = 1.390). CONCLUSIONS: The authors can make a prognosis for stomach cancer more precisely on the basis of these independent prognostic factors, and an extended D2 operation (D2 alpha operation) may be a valuable means to treat gastric cancer.

A Survey II for Satisfaction for Stoma on Ostomates

PURPOSE: This survey was designed to acknowledge that it is necessary to rehabilitate ostomates. METHODS: This medical survey attempted to make an analysis of the types and causes of stoma, the problems stemming from the stoma, the degree to which ostomates are satisfied with their life quality, and the extent to which they are affected in doing their jobs, on the basis of the examinations conducted for eighty eight ostomates, who responded to the questionnaire at the 3rd Workshop for Stoma Rehabilitation for Ostomates on August 29, 1998 by the Department of Surgery, Kyung-Hee University Hospital, or who replied back to the questionnaire that was sent by mail. RESULTS: On examination, it was found that the ratio of male to female was nearly 1.5:1 (53:35); by age distribution, the ostomates in their 50 and 60's constituted 65.9%; by stoma pattern, colostomy was made up of 81 cases (92%), ileostomy 4 cases (4.5%), urostomy 2 cases (2.3%); by duration, permanent stoma was 81 cases (92%), temporary stoma 6 cases (6.8%); by the cause of stoma operation, malignancy consisted of 78 cases (88.6%), IBD 4 cases (4.5%), congenital anomaly 1 case, car accident 1 case, benign bladder disease 1 case, intestinal obstruction after radiation therapy 1 case, but 2 cases were not identified. Besides, it was also examined that, regarding the degree of post-operation satisfaction for stoma, dissatisfaction amounted to 58 cases (65.9%); as for the problems stemming from the stoma, skin irritation or injury reached 30 cases (34.1%), discomfort for stoma location 17 cases (19.35%), parastomal hernia 8 cases (9.1%), stoma retraction 4 cases (4.5%) and disease recurrence 3 cases (3.4%); as for the degree of the satisfaction of ostomates for their life quality, dissatisfaction revealed 70 cases (79.5%); regarding the extent to which the ostomates are affected in doing their jobs, fifty four out of eighty eight ostomates (62.0%) had a disturbance. CONCLUSIONS: This medical survey clearly shows that most of ostomates suffered from stoma in their daily lives and doing their occupations, thus they need helps from the experts such as colorectal surgeons and enterostomal therapists, or the ostomy association. In addition, it is also necessary to pay a more deliberate attention to determining the location of stoma.

A Clinical Analysis of 604 Cases of Varicose Veins

PURPOSE: We reviewed 604 cases of varicose veins managed in our hospital and the clinical feature and the results were analyzed between injection sclerotherapy and operative method. METHODS: Retrospective review of clinical records was done from January 1990 to June 1998. All of them were diagnosed as primary varicose veins of lower extremities. Sclerosing agents used were ethanolamine oleate, most commonly, hypertonic saline, sodium tetradecyl sulfate and sclerodex. Injections of the sclerosants were 1 to 5 times as the clinical courses. Then, elastic stocking was applied for 2 weeks. Operations were done under the spinal or general anesthesia and postoperatively remnant varicoses were managed by injection sclerotherapy. Student t-test was used in statistics. RESULTS: The distribution of age were 5th decade (36.8%), 6th decade (24.0%), 4th decade (22.2%) in order of frequency, and the mean age was 44.3 year and the male to female ratio was 1:4.0. The mean duration of illness was 12.6 year, and it was longer in female than male (13.2 vs. 8.7, p=0.02). The most common presumed predisposing factor was longstanding occupation (82% of all) and pregnancy was the 2nd in female (12.0%). Chief complaint was only cosmetic problem in 73% of patients and the others complained varicose induced symptoms and complications. Both lower extremities were involved in 41.9% and right leg was in 26.0%, left leg was in 32.1%. The locations of lesions were calf (41.4%), greater saphenous vein (34.6%), lesser saphenous vein (15.0%). Sclerotherapy was done in 48.0%, operation with sclerotherapy in 23.7%, operation only in 17.2%. The mean duration of illness in sclerotherapy group was significantly shorter than operation group (8.8 vs 14.7 year, p=0.0001). Operation methods were stab avulsion only (48.1%), greater saphenous vein stripping (37.3%) and perforator ligation (11.8%) and others. CONCLUSIONS: Injection sclerotherapy method is very effective and sufficient treatment modality in the management of lower extremity varicose vein with low recurrence and complication rate, especially in the early treated cases.

Change of Hepatic Volume after Selective Bile Duct Ligation: An Experimental Study in the Rabbit

PURPOSE: To evaluate the role of bile duct obstuction in the development of atrophy of the liver, using ananimal model. MATERIALS AND METHODS: Seven rabbits were divided into two groups : group 1(n=5), in which therewas selective bile duct ligation, and group 2(n=2), which underwent a sham operation. Each group was evaluated using CT for changes in hepatic volume after selective bile duct ligation or a sham operation. In group I, the diameter of dilated bile duct was measured 2, 4, 8, 12 and 16 weeks after bile duct ligation, while gross andhistologic change were evaluated in all cases. RESULTS: In group 1, bile duct dilatation was seen on CT two weeks after selective bile duct ligation, and did not change significantly during follow-up. In four of five cases, CT revealed no evidence of significant atrophy of the involved segment. Pathologic specimens, however, revealed dilatation of the bile duct, periductal fibrosis, infiltration of chronic inflammatory cells, and periportalfibrosis. One of five cases showed segmental liver atrophy after selective bile duct ligation. In addion to the above pathologic findings, there was obstruction of the portal vein by foreign body reaction. In group 2, no evidence of dilated bile duct or liver atrophy was revealed by CT or pathologic specimen after a sham operation. CONCLUSION: During long-term follow-up of 16 weeks, obstruction of the bile duct did not play a major role in the development of lobar atrophy in the rabbit.

A Case of Perianal Adenocarcinoma Developing in Chronic Tuberculous Anal Fistula

Mucinous adenocarcinomas of the anal region constitute only 2% of anal cancer and adenocarcinoma developing in a chronic tuberculous anal fistula is extremely rare. In most cases, its origin is difficult to ascertain because the primary sites have already been destroyed before any diagnosis of malignancy is made. We experienced a case of perianal adcnocarcinoma developing in chronic tuberculous anal fistula, which was treated by abdominoperineal resection with preoperative chemo-irradiation. We reported a case and reviewed the related literatures.

Multiple Primary Colorectal Cancer

To assess the clinico-pathological characteristics of patients with multiple primary colorectal cancer, 458 patients who underwent curative surgery and being followed-up at our institution between Jan. 1987 and Dec. 1993 were evaluated in this study. The median follow-up period was 42 months. Synchronous cancer was defined as distinct lesions separated by a distance of greater than 4cm with the invasion of the tumor below the muscularis mucosa at the time of diagnosis or within 6 months after initial treatment, and metachronous cancer was defined as the development of colon cancers more than 6 months after the initial treatment without evidence of the recurrence or metastases from primary tumor. There were 29 cases of multiple primary colorectal cancer(6.3%). Eighteen cases(3.9%) of them were synchronous, 11 cases(2.4%) were metachronous cancers. Seven cases(1.5%) were related to 5 hereditary non-polyposis colorectal cancer(HNPCC) families. During the follow-up period, 11 patients(2.4%) developed cancers in other organs. Adenomatous polyps were identified 14 cases of 29 patients with multiple primary colorectal cancers(48.3%), compared to 43 cases(10%) in 429 patients with solitary colorectal cancer(p0.05). In aspect of family history, there was close-relationship with this regarding in the group of multiple primary colorectal cancers. However, authors were unable to make analysis this regarding in the group of solitary primaries because of lack of the information. Conclusively, authors guess the frequent association of the adenomatous polyps in multiple primary colorectal cancers as the evidence of the adenoma-carcinoma sequence. In addition, authors emphasized the importance of the total colonoscopic examinations in pre-and post-operation in order to make diagnosis of the multiple primary colorectal cancers and paying attention as to the family history of colorectal cancer patients because we have good therapeutic results after operation of early stage in synchronous cancers and co-existent adenomatous polyps.

A Survey on Ostomates With the special reference to physical, psychosocial and sexual problems

The survey was undertaken among the 105 ostomates who attended the 2nd Workshop for Stoma Rehabilitation on Aug. 30th, 1997 by the Department of Surgery, Kyung-Hee University Hospital to assess the physical, psychosocial and sexual problems with a stoma. The 97% of ostomates had permanent colostomies following abdominoperineal resection. The 67% of ostomates had one or more physical problems caused by stoma. Frequent bowel movement (94.3%), impairment of irrigation (64.6%), unpleasant odor (27.3%), and urinary frequency (21.3%) were common problems encountered by ostomates. Concerning the psychosocial problems, 3.8% of them suffered from profound restriction of social activities and 1.9% of them had psychologic problems such as depression. 42 of 58 ostomates (72.4%) who were employed before operation returned to their work. Among 71 men, 44 (62%) were impaired by sexual function. Most ostomates suffered physical, social, psychologic and sexual problems in their daily life and needed helps of experts such colorectal surgeons, enterostomal therapists, and ostomy association. Attention is needed more to improve the quality of life for the ostomates.

Pathologic Review of the Rectal Villous Adenoma

Neoplastic polyps of colon are one of the most risky factors for colorectal cancer. Particularly villous adenomas have more malignant potential than other neoplastic polyps. The preoperative detection of malignant change in villous adenoma is very important to determine treatment modality of patients. We conducted that total twenty-four cases of villous adenoma who were diagnosed and treated at our institution between January 1990 and December 1995 were reviewed retrospectively. The peak incidence of age was 7th decades. And male to female ratio was 2 : 1. Size of the adenoma ranged from 1.2 to 10.7 cm with a mean diameter of 3.9 cm. Five cases(20.8%) were between 1 and 2 cm, 10(41.7%) between 2 and 4 cm, and 9(31.5%) greater than or equal to 4 cm. Location of the adenoma were 10 cases(41.7%) in upper rectum, 8(33.3%) in rectosigmoid, and 6(25.0%) in lower rectum respectively. Pathologic examination of the resected specimen were diagnosed 9(37.5%) as benign villous adenomas, 10(41.7%) as in situ carcinoma, and 5(20.8%) as invasive carcinoma. The diagnostic accuracy to detect in situ carcinoma or invasive carcinoma was endoscopic examination in 66.7 percent and digital examination in 86.7 percent. The grade of in situ carcinoma had not significantly relationship with the size of the adenoma on our study. However, invasive carcinoma was significantly related to adenoma size(P<0.05) as following results zero percent between 1 and 2 cm, 20 percent between 2 and 4 cm, and 33.3 percent greater than or equal to 4 cm. In conclusion, the larger villous adenoma has higher malignant potential, especially greater than or equal to 4 cm in size. Added, the clinical impression of the malignancy on digital examination can be more accurate than preoperative endoscopic examination on our study.

Hereditary Nonpolyposis Colorectal Cancer

Hereditary nonpolyposis colorectal cancer(HNPCC) is an autosomal dominantly inherited disease associated with a marked increase in cancer susceptibility, especially cancer of the colorectum. The frequency of HNPCC in the general population is yet to be determined, but HNPCC may account for as much as 2% to 5% of colorectal cancer, Colorectal cancer in HNPCC differs from sporadic colorectal cancer by an early age of cancer onset, proximal predominance of colorectal cancer, an excess of synchronous and metachronous colorectal cancer, and excess extra-colonic cancers. We have found 5 HNPCC families since 1992 when we reported first HNPCC family (KHU-Hl) In order to register the patients of HNPCC and to review the clinicopathologic feature and appropriate management, we have analysed 5 HNPCC families. Five HNPCC families included 16 colorectal cancer patients(14 males and 2 females). The average age of first diagnosis was 39. Among 16 patients, 8 patient were operated at the KyungHee University hospital and their operative and pathologic records were available. Two synchronous and seven metachronous cancers were founded, so that eight patients had 15 colorectal cancer lesions. Ten cancers were located proximal to splenic flexure and five were distal. Partial resection of colon was performed in seven cases except one when the first diagnosis was made and recurrence was founded in 5 patients. Recurrence was treated by total colectomy in 3 cases and subtotal colectomy in two. In conclusion, we re-confirmed that HNPCC patient should be treated by no less than a subtotal colectomy because of high multiplicity and high recurrence rate of partial resection.

Urodynamic investigation after pelvic autonomic nerve preserving procedure for rectal cancer

No abstract available.

An immunohistochemical study on p53 and PCNA expression in gastric cancer related to survival and prognostic factors

No abstract available.

Prognostic factors of colorectal cancer according to age

No abstract available.