Compensatory Technique Using Therapeutic Band for Dysphagia / 대한연하장애학회지

A 63-year-old man visited outpatient clinic complaining of dysphagia due to left jugular foramen meningioma. The patient underwent conventional dysphagia rehabilitation programs but functional improvement was not enough. A videofluoroscopic swallowing study (VFSS) revealed decreased laryngeal elevation and a lot of residue in pyriform sinus and vallecula. We noticed that enhancing laryngeal elevation like mendelshon maneuver promotes functional compensation, so we developed a therapeutic band for promoting laryngeal elevation. In follow-up VFSS, swallowing function was improved on the band. Persistent dysphagia due to decreased laryngeal elevation is very common and this case showed the possibility of improvement of symptom using therapeutic band we devleoped with conventional dysphagia rehabilitation programs.

Intramuscular Hematoma Following Radial Extracorporeal Shockwave Therapy for Chronic Neurogenic Heterotopic Ossification: A Case Report

Extracorporeal shockwave therapy (ESWT) has been reported to be a safe and effective method for decreasing pain and relieving range of motion (ROM) limitations caused by neurogenic heterotopic ossification (NHO), though there has been no report that it might cause hematoma if applied to NHO. We hereby report a case of massive hematoma after ESWT, specifically the radial shockwave therapy (RSWT) device at both hips in a 49-year-old female patient with NHO. She had developed NHO after extensive subarachnoid hemorrhage. We had applied RSWT according to the previous report. The pain and the ROM limitations were gradually improved. Six weeks later, she reported pain and ROM limitations on the right hip. From a medial aspect, swelling and bruising of the right thigh could be seen. Magnetic resonance imaging and ultrasonography suggested a large hematoma between right hip adductor muscles. The symptoms disappeared after conservative treatment for one month, and subsequent follow-up imaging studies demonstrated resolution of the hematoma.

An Analysis between Pre- and Post-exercise of the Respiratory and Metabolic State for the Acute and Subacute Stroke Patients

To evaluate oxygenation and metabolic state of the non-brainstem stroke patients after the moderate intensity exercise using arterial blood gas analysis (ABGA). Fifty-two stroke patients were recruited. All the subjects were to follow the instructions for the exercise, not suffered cardiopulmonary diseases before, and not diagnosed with brainstem disorders. They were ordered to maintain 70% heart rate of maximal heart rate during exercise and checked blood pressure, pulse rate, respiratory rate (RR), and ABGA before and after the exercise, respectively. O² saturation, PaO², PaCO², O² content, HCO³⁻, pH, and anion gap were compared between the exercise, and those data changes were performed correlation analysis into age and the time after stroke onset. The data comparison was also done into the subgroup of the severity of stroke using National Institutes of Health Stroke Scale (NIHSS). The statistically significant results were observed in the change of O² saturation, PaO², PaCO², O² content, HCO3⁻, pH, and anion gap after the exercise. The decrease of HCO³⁻ and increase of RR were proportional to age, however the data showed no correlation with the NIHSS. These results suggest relatively preserved respiratory compensation mechanism and homeostatic effect to maintain metabolic balance among the non-brainstem stroke patients.

Ultrasonographic Measurement of Thickness of the Thyrohyoid Muscle: A Pilot Study

OBJECTIVE: To evaluate the normal thickness of the thyrohyoid muscle, which is one of the key muscles related to swallowing, by ultrasonography. METHODS: The thickness of the left and right thyrohyoid muscles was measured in normal male and female adults ranging in age from 20 to 79 years by ultrasonography. The groups were classified according to age as follows: subjects ranging in age from 20 to 39 years were classified into group A, subjects ranging in age from 40 to 59 years were classified into group B, and subjects ranging in age from 60 to 79 years were classified into group C. The measurement level was the line that joins the upper tip of the superior thyroid notch and the oblique line of the thyroid cartilage. Also, a correlation with the thyrohyoid muscle was investigated by collecting information regarding height, weight, body mass index (BMI), age, and gender of subjects in the healthy group. RESULTS: The number of subjects in each group was as follows: group A (n=82), group B (n=62), and group C (n=60). Also, the thicknesses of the left and right muscles were 2.72±0.65 mm and 2.87±0.76 mm in group A, 2.83±0.61 mm and 2.93±0.67 mm in group B, and 2.59±054 mm and 2.73±0.55 mm in group C, respectively. Thyrohyoid muscle had a correlation with height, weight, and BMI. The thickness of the left and right thyrohyoid muscles was greater in male subjects than in female subjects and the right side muscle was thicker than the left side muscle. CONCLUSION: The average thickness of the left and right thyrohyoid muscles was 3.20±0.54 mm in male subjects and 2.34±0.37 mm in female subjects. The thickness of the thyrohyoid muscle was positively correlated with height, weight, and BMI, and the thyrohyoid muscle was thicker in male subjects than in female subjects and the right side muscle was thicker than the left side muscle.

Urgent Recanalization with Stenting for Severe Intracranial Atherosclerosis after Transient Ischemic Attack or Minor Stroke

OBJECTIVE: Stenting of symptomatic intracranial stenosis has recently become an alternative treatment modality. However, urgent intracranial stenting in patients with intracranial stenosis following a transient ischemic attack (TIA) or minor stroke is open to dispute. We sought to assess the feasibility, safety, and effectiveness of urgent intracranial stenting for severe stenosis (>70%) in TIA or minor stroke patients. METHODS: Between June 2009 and October 2010, stent-assisted angioplasty by using a balloon-expandable coronary stent for intracranial severe stenosis (>70%) was performed in 7 patients after TIA and 5 patients after minor stroke (14 stenotic lesions). Technical success rates, complications, angiographic findings, and clinical outcomes were retrospectively analyzed. RESULTS: Stenting was successful in all 12 patients. The mean time from symptom onset to stenting was 2.1 days (1-8 days). Post-procedural angiography showed restoration to a normal luminal diameter in all patients. In-stent thrombosis occurred in one patient (n=1, 8.3%), and was lysed with abciximab. No device-related complications, such as perforations or dissections at the target arteries or intracranial hemorrhaging, occurred in any patient. The mortality rate was 0%. No patient had an ischemic event over the mean follow-up period of 12.5 months (range, 7-21 months), and follow-up angiography (n=7) revealed no significant in-stent restenosis (>50%). CONCLUSION: Urgent recanalization with stenting is feasible, safe, and effective in patients with TIA or acute minor stroke with intracranial stenosis of > or =70%.

Clinical Characteristics of Papillary Thyroid Microcarcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Most papillary thyroid microcarcinoma (PTMC) carry a favorable prognosis, but a few patients present with aggressiveness. We classified PTMC according to the tumor size, and investigated the treatment, pathological finding and clinical behavior. SUBJECTS AND METHOD: Out of 714 patients submitted to surgical treatment for well differentiated thyroid cancer between 1996 and 2006, 179 (25%) patients had been identified as PTMC. These records were reviewed retrospectively, and followed up for 4 to 114 months (mean 43.3 months). RESULTS: The incidentaloma was 53 from 179 PTMC. The surgical procedures were hemithyroidectomy (n=79) or total thyroidectomy (n=100) including completion thyroidectomy. In the pathologic finding, 46 cases (25%) had extrathyroidal extensions and 37 cases (20%) had lymph node metastasis. In the total thyroidectomy cases, 35 cases had multiplicity, including 18 bilateral cases. When mass sizes were divided into those either bigger or smaller than 5 mm, statistical significance was found only in the extrathyroidal extensions (p=0.023). There were 2 recurrences in the total thyroidectomy cases and 4 in hemithyroidectomy, but without any statistical difference. With respect to size, there was only 1 recurrence in patients whose mass size was smaller than 5 mm and 5 in patients whose mass size was bigger than 5 mm; there was no statistical difference, however. CONCLUSION: Pathologically, extrathyroidal extension was more common in cases with tumor size more than 5 mm. This finding could be the evidence of poorer prognosis in these cases. However, there was no difference in the recurrence rate between the groups of different sizes and thyroidectomy methods. Therefore, surgical options should be carefully decided in the treatment of PTMC.

A Comparison of Histopathologic Findings in the Nasal Polyp, Maxillary Sinus Mucosa, and Inferior Turbinate Mucosa

BACKGROUND AND OBJECTIVES: The nasal polyp is the most common form of mass lesion in the nose with an unclear etiology and pathogenesis among patients in Asia. Also, the pathological characteristic of nasal polyps in these patients is eosinophil infiltration. These findings, as reported in Asia, are distinct from those of the West. Moreover, the role of eosinophil is recently found to be on the increase even in Asia. So, we investigated the proportion of eosinophil infiltration in the nasal polyp among patients in Korea. MATERIALS AND METHODS: The study group consisted of 35 patients with a mean age of 43 years (ranging from 6 to 72 years). Tissue samples were taken via endoscopic sinus surgeries from the nasal polyp, inflammatory sinus mucosa, and the inferior turbinate. We compared 5 parameters of mucosal histopathology. RESULT: The incidence of a severe eosinophilic infiltration in the nasal polyp was 70%. Nasal polyp and inflammatory sinus mucosa had a larger eosinophil, lymphocyte and polymorphonuclear leukocyte infiltration than a normal nasal mucosa. Also, the nasal polyp and sinus mucosa had a more severe basement membrane thickening and goblet cell hyperplasia. Distinctively, the nasal polyp had a severe eosinophilic infiltration and a more thickened basement membrane. CONCLUSION: The present histopathologic feature of the nasal polyp among Koreans indicates that cases of eosinophilic nasal polyp seems to be on the increase.

Usefulness of Sialendoscopy in Unusual Obstructive Salivary Ductal Diseases / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Ductal calculi and stenosis are well known causes of salivary ductal obstructive lesions. As a direct view of the ductal systems was not possible for the surgeons, sialendoscopy has been a convenient tool for finding out these obstructive lesions. This study contains some unusual endoscopic findings that we have found during diagnostic and interventional sialendoscopy. SUBJECTS AND METHOD: Retrospective chart reviews were done, and endoscopic findings were reviewed for patients who received sialendoscopy from September 2003 to January 2007. Sixtyfour patients received sialendoscopy for either diagnostic or interventional method. RESULTS: We found unusual findings in 7 cases (10.9%). Three cases of basin malformation were observed. Two cases had spontaneous ductal perforation, and we also observed 2 cases of occult stone. CONCLUSION: The sialendoscopy is an excellent method in evaluating and treating salivary ductal diseases. We found out that the sialendoscopy made it possible to explore ductal systems completely, as well as to detect unusual findings, and to help in the management of some salivary ductal diseases.

The Clinical Significance of Atypia in Thyroid Fine-Needle Aspiration / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Fine-needle aspiration cytology (FNAC) of thyroid nodules has become the primary diagnostic tool in the evaluation of thyroid nodules. However, the diagnostic utility of thyroid cytology may be limited by the presence of atypical cytologic patterns. In patients with atypical cytology in FNAC, the treatment concept is not established. The purpose of this study is to correlate subcategories of atypical cytology with final histologic diagnosis and help determining treatment concept of thyroid nodule. SUBJECTS AND METHOD: Retrospectively, we analysed 143 specimens of patients with atypical cytology in preoperative FNAC, who underwent thyroidectomy from May 1996 to July 2005 at the Department of Otolaryngology and Surgery, Inha University Hospital. We divided atypical cytology into six groups by its cytologic characteristics and correlated those with final histologic diagnosis. RESULTS: Among 143 specimens with atypical cytology, there were 97 cases (67.8%) in follicular neoplasm with nuclear atypia (FNA) group, 2 cases (1.4%) in follicular neoplasm without nuclear atypia (FNS) group, 13 cases (9.1%) in nodular hyperplasia with nuclear atypia (NHA) group, 23 cases (16.1%) in possibility of papillary carcinoma (PP) group and 5 cases (3.5%) in thyroiditis with nuclear atypia (TA) group and 3 cases (2.1%) in atypical cells (AC) group. Of 97 cases in FNA group, 29 cases (29.9%) were malignant. Malignant cases in NHA and PP groups were 11 cases (47.8%) and 3 cases (23.1%), respectively. But, not all groups have a statistically significant high incidences of malignant pathologic result. Of 29 cases diagnosed as malignant in the FNA group, only 1 case (3.4%) had lymph node metastasis in final pathologic result. Also in NHA and PP groups, only 1 case (NHA : 33.3%, PP : 9.1%) had metastatic lymph nodes. Three cases (10.3%) showed recurrence postoperatively of the 29 cases diagnosed malignant in the FNA group. In PP group, one case (9.1%) revealed recurrence postoperatively. No statistical differences existed between all groups for lymph node metastasis and recurrence. CONCLUSION: Surgery should be considered in FNA, NHA and PP groups. The extent of resection should be determined by frozen section intraoperatively.

Isolated Heterotopic Gastric Mucosa of the Upper Esophagus / 대한소화기내시경학회지

BACKGROUND: Isolated heterotopic gastric mucosa of the upper esophagus(HGME), often referred to as inlet patch, is an asyptomatic benign lesion. It may, however, cause retrosternal chest pain and dysphagea, and rarely produce complications such as ulceration and stricture. It may be suspected on characteristic finding of endoscopy, and the diagnosis is usually proved by biposy. We studied several characteristics of HGME. METHOD: From January 1996 to May 1997, endoscopy was performed on 2000 consecutive patients (1068 male, 932 female). HGME was seen 25 patients(12 male, 13 female) among 2000 patients. RESULT: Prevalence of HGME is 1.25%. There was no significant difference of the prevalence of HGME between male and female. HGME was presented as a velvety and salmon-pink patch with a distict border from the normally pale squamous cell mucosa of the esophagus, and was seen as multiple lesions in 8 patients among 25 patients. Thirty three locailzed gastric mucosal patches, varying in size 3 mm to 30 mm in the longest diameter, were detected within or just below of upper esophageal spincter in all the twenty five patients. Biopsy specimens taken from the miucosal patches demonstrated gastric mucosa. Among 25 patients with HGME, four patients complained foreign body sensation on throat or heartburn, without other diseases such as GERD, gastritis or peptic ulcer. CONCLUSION: Further studies of a large scale about pathogenesis, prevalence, and complication of HGME will be required.

A Case of Unilateral Lung Agenesis (Right) Associated with Skeletal Anomalies

No abstract available.

A Clinical Study of Intussusception in Infants And Children

No abstract available.