Predictability of Acoustic Pharyngometry for the Obstructive Sleep Apnea / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Acoustic pharyngometry is a relatively new noninvasive method that quantifies the geometrically complex oropharyngeal dimensions. We aimed this study to investigate the predictability and usefulness of acoustic pharyngometry in the diagnosis of obstructive sleep apnea (OSA). SUBJECTS AND METHOD: We conducted a prospective clinical trial in consecutive 49 patients with snoring or sleep apnea. Polysomnography was used to determine whether the patient had OSA. All subjects were examined by acoustic pharyngometry in sitting, supine, and both lateral recumbent positions while awake with tidal breathing. Morphometric oral cavity measurements were obtained and the Kushida index was calculated for each patient. RESULTS: Upper-airway cross-sectional areas measured by acoustic pharyngometry were significantly smaller in patients with OSA than in subjects without OSA. Especially, the oropharyngeal junction area (OPJ) in supine position was the most prominent parameter to discriminate between them. CONCLUSION: Acoustic pharyngometry can be a clinically useful tool for localizing the upper-airway obstruction and for predicting obstructive sleep apnea.

Effects of Preincisional Infiltration with Bupivacaine and Oral Dextromethorphan on Postoperative Pain in Uvulopalatopharyngoplasty / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Uvulopalatopharyngoplasty is one of the most painful surgical procedures in otolaryngology. Repetitive nociceptive impulses from injured peripheral tissues and activation of N-methyl-D-aspartic acid (NMDA) receptors induce central sensitization and post-injury pain hypersensitivity states. We aimed this study to evaluate whether bupivacaine for preincisional block of nociceptive afferent inputs and dextromethorphan, a clinically available NMDA receptor antagonist could reduce postoperative pain after uvulopalatopharyngoplasty. MATERIALS AND METHOD: Thirty patients scheduled for uvulopalatopharyngoplasty were randomly assigned to one of the three groups : control, bupivacaine, and bupivacaine- dextromethorphan groups. The second and third group had 10 ml of 0.25% bupivacaine hydrochloride infiltrated around tonsils and soft palate before incision. The third group was given oral doses of dextromethorphan before and after surgery. Pain was assessed using numeric rating scale at rest and on swallowing on postoperative day 0, 1, 2, 3, and 5. Daily consumption of supplementary diclofenac sodium was also recorded. RESULTS: Resting pain scores were significantly lower in the groups treated with bupivacaine infiltration with or without dextromethorphan on postoperative days 0, 1, 2, 3, and 5. Swallowing pain scores were significantly lower in the bupivacaine-dextromethorphan group on days 0, 1, and 2. CONCLUSION: Preincisional infiltration with bupivacaine and oral dextromethorphan could decrease the intensity of postoperative pain following uvulupalatopharyngoplasty.

The Evaluation and Treatment of the Obstructive Biliary Disease through the Percutaneous Transhepatic Choledocoscopy (PTCS ) / 대한소화기내시경학회지

BACKGROUND/AIMS: Obstructive jaundice is developed from the cholangiocarcinoma, biiliary tract stone, biliary benign stricture and pancreatic head cancer and is rapidly progress to cholangitis or sepsis. So early decompression, accurate diagnosis and treatment are very important. Percutaneous transhepatic choledocoscopy (PTCS) and endoscopic retrograde choledocoscopy (ERCS) have been used for evaluation of the obstructive jaundice. We performed, through the PTCS, electrohydraulic lithotripsy (EHL) for biliary tract stone rernoval, biopsy for diagnosis of biliary stric and self expandible metalic coil stent (EndocoilTM stent, Instent Co.) insertion on biliary stricture to evaluate the usefullness of PTCS in patients with obstructive jaundice. METHODS: Between Auguest 1994 and September 1995, PTCS was performed in 37 patients with obstructive jaundice. First, percutaneous transhepatic biliary drainage (PTBD) with 7Fr. drainage tube was done. Three days later, we exchainged the 7Fr. drainage tube with 16Fr.. Seven days later, through the PTCS, we performed EHL, biopsy and EndocoilTM stent insertion.