A Case of White-Eyed Blowout Fracture / 대한이비인후과학회지

The ‘white-eyed’ blowout fracture is an orbital injury in children that is often initially misdiagnosed as a head injury because of predominant autonomic features and lack of soft tissue signs. Delays in treatment can lead to morbidity. It has been recommended that children who present with a ‘white-eyed’ blowout fracture should have surgery performed within 48 hours of diagnosis, otherwise prognosis is poor. We present a 12-year-old boy who was initially misdiagnosed with a head injury due to the minor appearance of his orbital injury and his presenting complaints of nausea and vomiting.

A Case of White-Eyed Blowout Fracture / 대한이비인후과학회지

The ‘white-eyed’ blowout fracture is an orbital injury in children that is often initially misdiagnosed as a head injury because of predominant autonomic features and lack of soft tissue signs. Delays in treatment can lead to morbidity. It has been recommended that children who present with a ‘white-eyed’ blowout fracture should have surgery performed within 48 hours of diagnosis, otherwise prognosis is poor. We present a 12-year-old boy who was initially misdiagnosed with a head injury due to the minor appearance of his orbital injury and his presenting complaints of nausea and vomiting.

The efficacy of combination treatment of gabapentin and electro-acupuncture on paclitaxel-induced neuropathic pain

Paclitaxel, a chemotherapeutic drug, induces severe peripheral neuropathy. Gabapentin (GBT) is a first line agent used to treat neuropathic pain, and its effect is mediated by spinal noradrenergic and muscarinic cholinergic receptors. Electro-acupuncture (EA) is used for treating various types of pain via its action through spinal opioidergic and noradrenergic receptors. Here, we investigated whether combined treatment of these two agents could exert a synergistic effect on paclitaxel-induced cold and mechanical allodynia, which were assessed by the acetone drop test and von Frey filament assay, respectively. Significant signs of allodynia were observed after four paclitaxel injections (a cumulative dose of 8 mg/kg, i.p.). GBT (3, 30, and 100 mg/kg, i.p.) or EA (ST36, Zusanli) alone produced dose-dependent anti-allodynic effects. The medium and highest doses of GBT (30 and 100 mg/kg) provided a strong analgesic effect, but they induced motor dysfunction in Rota-rod tests. On the contrary, the lowest dose of GBT (3 mg/kg) did not induce motor weakness, but it provided a brief analgesic effect. The combination of the lowest dose of GBT and EA resulted in a greater and longer effect, without inducing motor dysfunction. This effect on mechanical allodynia was blocked by spinal opioidergic (naloxone, 20 μg), or noradrenergic (idazoxan, 10 μg) receptor antagonist, whereas on cold allodynia, only opioidergic receptor antagonist blocked the effect. In conclusion, the combination of the lowest dose of GBT and EA has a robust and enduring analgesic action against paclitaxel-induced neuropathic pain, and it should be considered as an alternative treatment method.

Usefulness of Fibrin Glue in Transantral Orbital Floor Fracture Repair Using Bioresorbable Panel / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The purpose of this study was to evaluate the advantages and limitations of using fibrin glue for securing bioresorbable panels to reconstruct the fractured orbital floor by transantral approach. SUBJECTS AND METHOD: A retrospective study was conducted from July 2009 to July 2015 in 35 patients with pure orbital floor fractures. Nineteen patients underwent reduction surgery for inserting the bioresorbable panel and 16 patients underwent reduction surgery using fibrin glue for securing the bioresorbable panel via a transantral approach. In both groups, a chart review of preoperative and postoperative ocular symptoms, operation records, and complications was conducted. RESULTS: There was no significant difference between two groups in the demographic data of patients. Comparing the surgical outcomes between two groups, diplopia and mean discrepancy between fractured bone chip and intact orbital floor based on computed tomography scans showed much better results in the group that used bioresorbable panel secured by fibrin glue than in the bioresorbable only group. Furthermore, we carried out revision operations in six cases in the bioresorbable panel only group, where we found that the main cause of fracture to be the dislocation of bioresorbable panel. On the other hand, in the bioresorbable panel secured by the fibrin glue group, there were no reoperation and postsurgical complications. CONCLUSION: During the course of the study, we sensed orbital floor fracture repair using bioresorbable panel secured by fibrin glue via a transantral approach as an easy and effective technique with good postoperative results, and minimal implant related complications. This novel procedure is recommended as a surgical option for the reduction of orbital floor fractures, especially in large and posterior fractures.

Significance of the Decreased Expressions of Claudin-1 and ZO-1 Protein as Prognostic Factors in Breast Cancer

PURPOSE: Tight junction proteins are either over-expressed or suppressed in some cancers. These suppressions of claudin-1 and ZO-1 protein are known to have a significant relationship with the progression of breast cancer. The authors reviewed 42 cases of breast cancer and the staining status of claudin-1 and ZO-1 in order to evaluate Claudin-1 and ZO-1 as clinicopathologic risk factors. METHODS: Immunohistological staining for Claudin-1 and ZO-1 was performed in 42 post-operative pathologically diagnosed infiltrating duct carcinoma specimens. The rate of expression was compared with the clinical record, the pathological diagnosis, the estrogen receptor and progesteron receptor status and the c-erbB2 gene to evaluate the protein expression-breast cancer progression relationship and to investigate the expressions of Claudin-1 and ZO-1 as a prognostic factors in breast cancer. RESULTS: The claudin-1 and ZO-1 expressions were both decreased in all the post-operative specimens. The claudin-1 expressions were significantly decreased 100%, 82.4% and 66.7% as the histologic grade increased. The ZO-1 expressions were shown in 44.8% of the lymph node metastasis negative group and in 7.7% of the lymph node positive group. The expression of ZO-1 decreased by 53.3%, 28.6% and 0%, with statistical significance, as the stage increased. CONCLUSION: The claudin-1 expressions were decreased in the poorly differentiated group, i.e., a high histologic grade, and the ZO-1 expressions were decreased in the lymph node positive group and in the high stage cancer. This shows the possibility of Claudin-1 and ZO-1 as factors for tumorigenesis and progression and as prognostic factors in breast cancer.