Analysis of Clinical Feature and Management of Fish Bone Ingestion of Upper Gastrointestinal Tract

OBJECTIVES: Fish bone impaction in the upper gastrointestinal tract is a common reason for patients to seek emergent care. The aim of this study was to find a clinical characteristics of patients with fish bone impaction in the upper gastrointestinal tract. METHODS: The study was conducted on 286 fish bone ingestion patients who complained of dysphagia and irritation after eating fish. The patients were treated according to the hospital protocol regarding the removal of fish bone. The parameters for the analysis included the age and sex of the patients, location and characteristics of the foreign body, method of removal, and type of fish. RESULTS: The fish bone could be observed by the physical examination in the oral cavity and laryngopharynx in 198 patients (69.23%). For those patients in whom the foreign body could not be observed in oral cavity and laryngopharynx, noncontrast computed tomography (CT) (from nasopharynx to diaphragm) was performed. The fish bone was discovered in the esophagus of 66 patients (23.08%). The esophageal fish bone was successfully removed by transnasal flexible esophagoscopy (TNE) in 55 patients, the fish bone moved to the stomach in 10 patients and one fish bone was removed by rigid esophagoscopy due to esophageal abscess. The esophageal fish bone was mostly found in patients aged 50 years and older. CONCLUSION: Fish bone foreign body ingestion in the esophagus appeared to be more common in older patients. Incorporating noncontrast CT and TNE can facilitate decision-making and adequate treatment for patients with fish bone impactions.

Osteoclast-Like Giant Cell Tumors with a Carcinomatous Component of Parotid Gland / 대한이비인후과학회지

The giant cell tumor of the salivary gland is very rare. A 57-year-old man had noticed a mass in the right parotid area for several weeks. The diagnosis using aspiration cytology was a giant cell tumor possibly with a carcinomatous component. Parotidectomy was carried out. Histologically, the tumor consisted of evenly distributed osteoclast-like giant cells, mononuclear cells and two small foci of a carcinomatous component. Because so little is known about giant cell tumor of the salivary gland, we used the occasion of this case report to describe the cytologic, histologic and immunohistochemical characteristics that we observed.

Meta-Analysis of Squamous Cell Carcinoma of Thyroid / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Primary squamous cell carcinoma (SCC) of thyroid is an unusual tumor, accounted for approximately 1.1% of all neoplasms of the thyroid gland. It is highly lethal, like anaplastic thyroid carcinoma, in terms of aggressive clinical behavior. In the literature, the best treatment of this tumor is by surgery and the use of combination therapy that includes postoperative radiation, chemotherapy and radioiodine therapy; however, the effect of treatment is very poor. This study aims to identify the clinical features of SCC of thyroid, and to devise a better treatment method. SUBJECTS AND METHOD: Journals citing SCC of thyroid were identified from Pubmed, Korea Med, and Google and the clinical records reported therewithin from 1990 to 2013 were reviewed. A total of 40 patients were analyzed from 21 well-organized papers by searching the following keywords: squamous cell carcinoma, primary, thyroid, excerpt of the patient's age, sex, clinical features, pathologic findings, therapy, course and prognosis. RESULTS: We analyzed the treatment results of 40 patients from a total of 21 papers. Patients, consisting of 17 men and 23 women, were found in the age range of 24-88, with the mean age of 63.2. The follow-up period ranged from one to 96 months, with the mean being 15 months, and the size of the mass varied from 1 cm to 15 cm. Histopathologically, we found 13 patients with only SCC mixture of SCC and 22 patients with papillary thyroid carcinoma (PTC). Each of the following diseases were identified with one patient: a mixture of SCC and Hashimoto thyroiditis, a mixture of follicular thyroid carcinoma (FTC), SCC and FTC and mixed Hurtle cell cancer, SCC and PTC and mixed Hashimoto thyroiditis, and SCC, PTC with mixed insula cancer. Thirty-two patients underwent total thyroidectomy, and 30 patients underwent total thyroidectomy accompanied by neck dissection. Twelve patients received postoperative radiation therapy, and five patients received postoperative chemotherapy. Nineteen patients were observed without recurrence of the disease, and ten patients were found to be in stage III or less. CONCLUSION: SCC of the thyroid showed aggressive clinical characteristics, however, good results can be expected with early diagnosis and treatment. If tumor is found only within the thyroid, we expect good therapeutic results after the same treatment as PTC.

A Case of Primary Thyroid Lymphoma Originated from Thyroid Gland / 대한이비인후과학회지

We present a case of a 53-year-old woman with a rapidly growing neck mass. She had one-year history of hypothyroidism associatied with Hashimoto thyroiditis. She had noticed progressive dyspnea with rapid enlargement of the thyroid gland over a month. An incisional biopsy of the thyroid gland for combined pathology and immunohistochemistry revealed diffuse large B cell non-Hodgkin's lymphoma. A combined chemotherapy including cyclophosphamide, doxorubicin, vincristine, prednisone plus rituximab (R-CHOP) was initiated, which dramatically shrunk the tumor and completely resolved the compression symptoms within a few days. Here we report on a case of thyroid lymphoma with a review of the relevant literature.

Comparison of Natural Drainage Group and Negative Drainage Groups after Total Thyroidectomy: Prospective Randomized Controlled Study

PURPOSE: The aim of this study was to compare a negative pressure drain with a natural drain in order to determine whether a negative pressure drainage tube causes an increase in the drainage volume. MATERIALS AND METHODS: Sixty-two patients who underwent total thyroidectomy for papillary thyroid carcinoma (PTC) were enrolled in the study between March 2010 and August 2010 at Gyeongsang National University Hospital. The patients were prospectively and randomly assigned to two groups, a negative pressure drainage group (n=32) and natural drainage group (n=30). Every 3 hours, the volume of drainage was checked in the two groups until the tube was removed. RESULTS: The amount of drainage during the first 24 hours postoperatively was 41.68+/-3.93 mL in the negative drain group and 25.3+/-2.68 mL in the natural drain group (p<0.001). After 24 additional hours, the negative drain group was 35.19+/-4.26 mL and natural drain groups 21.53+/-2.90 mL (p<0.001). However, the drainage at postoperative day 3 was not statistically different between the two groups. In addition, the vocal cord palsy and temporary and permanent hypocalcemia were not different between the two groups. CONCLUSION: These results indicate that a negative pressure drain may increase the amount of drainage during the first 24-48 hours postoperatively. Therefore, it is not necessary to place a closed suction drain when only a total thyroidectomy is done.

A Case of Acute Suppurative Labyrinthitis Complicated by Chronic Otitis Media / 대한이비인후과학회지

With the development of antibiotics, tympanogenic labyrinthitis complicated by otitis media rarely occurs nowadays. Only few cases of acute serous or suppurative labyrinthitis in otitis media patients have been reported previously in the literature. Acute suppurative labyrinthitis caused by direct bacterial invasion into the inner ear leads to potentially severe, irreversible hearing loss, vertigo and spontaneous nystagmus toward the healthy side. Magnetic resonance image might be helpful to recognize the inflammatory lesions of the labyrinth. Treatment for tympanogenic labyrinthitis includes an appropriate use of antibiotics and establishment a draining route. Recently, we experienced an unusual case of acute suppurative labyrinthitis complicated by chronic otitis media without cholesteatoma. We also review and discuss the clinical manifestations, radiologic findings and treatment strategy of this disease.

A Case of Cerebellar Infarction Caused by Vertebral Artery Injury / 대한이비인후과학회지

Injury to vertebral vessel is not usually associated with neurologic deficit and a lot of such injuries have not been recognized. Also, vertebral artery injuries are the least common arterial injuries because of their deep location in a bony canal. The incidence of vertebral artery injury occurring in penetration wound of the neck varies from 1.0% in gunshot wounds to 7.4% in stab wounds. But even vertebral artery injuries in penetration wound of the neck rarely results in cerebellar infarction. Authors experienced a case of cerebellar infarction induced by post-vertebral artery injury in penetration wound of the neck with hypoplastic contralateral verterbral artery. We thus report with a review of the related literature.