Nutritional Status of Patients with Brain Disorder during the First Six Months

OBJECTIVE: Patients with brain disorder manifest hypermetabolism, increased energy expenditure, and increased protein loss. Nutritional support can prevent loss of immunocompetence, and can decrease morbidity and mortality associated with brain disorder. Thus, we aimed to determine the nutritional status by measuring body mass index (BMI) in patients with brain disorder during the first 6 months and identify factors related to malnutrition in this study. METHOD: We enrolled 244 patients from January 2008 to December 2009. The patients were classified into two groups: BMI under 18.5 were categorized as malnourished, while BMI over 18.5 as not malnourished. Extracted data includes demographic characteristics, type of brain disorder, functional independence measure (FIM) and Korea mini-mental status exam (K-MMSE) scores, history of diabetes mellitus (DM), and laboratory data. Feeding method was classified into oral and enteral tube feeding. RESULTS: The prevalence of malnourished patients was 13.1% (32 out of 244 patients). There was significant difference of total lymphocyte count (TLC) between the two groups. And there was no significant difference of correlation in other parameters. Analysis of feeding method showed that 11.4% of oral feeding patients were malnourished, compared to 17.4% of tube feeding patients who were categorized as malnourished. The tube feeding group tends to be more malnourished. CONCLUSION: The results of this study can be a guide for active rehabilitation of patients with brain disorder, and further studies regarding functional outcome and complications related to early nutritional status is needed.

A Case of Drooling during Sleep Treated with Wharton's Duct Relocation / 대한이비인후과학회지

Sialorrhea, or drooling, is defined as excessive salivary spillage from the mouth. The exact pathophysiology of drooling is unknown but appears to be a defect in the oral phase of swallowing. The most common cause of drooling is cerebral palsy in children and Parkinson disease in adults. Drooling can cause various medical and psychosocial problems. Various treatment modalities include physical therapy, anticholinergic medications, botulinum toxin injection into salivary glands, and surgical procedures. We report a case of 22-year-old woman with excessive drooling during sleep, which was treated with Wharton's duct relocation.

The Assessment of Reliability of Cognitive Evoked Potential in Normal Person

OBJECTIVE: To evaluate intra-tester reliability of P300 more precisely, this study was designed. Event-related potential (ERP) is the result of endogenous brain response following cognitive stimulus. The P300 component of the human ERP is a positive wave with a latency of 300 ms or greater. Our purpose of this study was to estimate reliability of P300 latency and amplitude with 30 normal persons without head injury, as well as to set up them as the reference values in the event that they would be found to be highly reliable. METHODS: ERP was performed at three separate times on 30 normal adults in their 20s and 30s. We measured P300 latency and amplitude among ERP. RESULTS: P300 latency show excellent reliability with intraclass correlation coefficient (ICC) of 0.81. As to P300 amplitude, reliability was good to fair with ICC of 0.53. Average value of P300 latency was 311.3+/-37.0 ms, shorter than reference value of previous study in Korea. CONCLUSION: P300 latency revealed higher reliability than P300 amplitude, although reliability of P300 was confirmed in both component. After further study including precise mechanism, influence factor on measurement and method standardization, it is expected to be an objective indicator to assess the cognitive state and predict prognosis.

A Case of Bilateral Inverted Papilloma with Malignant Transformation on One Side: Analysis of the Expression of Tumor Related Genes on Each Side Tumors / 대한이비인후과학회지

Inverted papillomas are relatively rare, benign tumors of the sinonasal cavity that generate interest to many clinicians because of their high rate of recurrences, locally invasive character and malignant transformation. The incidence of bilateral occurrence, ranging from 2 to 7%, is extremely rare, and the incidence of synchronous malignancy is also rare too. Here, we report an unusual case of bilateral inverted papilloma with a malignant transformation on one side. We compared the expression of molecules that suggested a relation with malignant transformation in inverted papilloma between each side of the tumors.

Complete Laryngotracheal Separation Following Attempted Hanging

Laryngotracheal separation (LTS) is the most immediately life-threatening airway injury. LTS is so rare that very few otolaryngologists have experience with it. LTS is one of the diagnostic and therapeutic challenges in airway diseases and its management remains to be established. We experienced a patient with complete LTS after attempted hanging. A high index of suspicion, adequate imaging, prompt airway establishment and early surgical repair are the most vital factors in managing a patient with LTS.

Reconstruction of the Head and Neck Region Using Lower Trapezius Musculocutaneous Flaps

BACKGROUND: Recent literature has indicated that free flaps are currently considered the preferred choice for head and neck reconstruction. However, head and neck cancer patients are frequently treated with chemoradiotherapy, which is often associated with a poor general and local condition, and thus, such patients are ineligible for free flap reconstruction. Therefore, other reconstruction modalities should be considered. METHODS: We used lower trapezius musculocutaneous (LTMC) flap based on the dorsal scapular artery to reconstruct head and neck defects that arose from head and neck cancer in 8 patients. All of the patients had undergone preoperative chemoradiotherapy. RESULTS: There were no complications except one case of partial flap necrosis; it was treated with secondary intention. Healing in the remaining patients was uneventful without hematoma, seroma, or infection. The donor sites were closed primarily. CONCLUSIONS: The LTMC flap is the preferred flap for a simple, reliable, large flap with a wide arc of rotation and minor donor-site morbidity. The authors recommend this versatile island flap as an alternative to microvascular free tissue transfer for the reconstruction of defects in the head and neck region, for patients that have undergone preoperative chemoradiotherapy.

A Case of Branchio-Oto-Renal Syndrome / 대한이비인후과학회지

The branchio-oto-renal (BOR) syndrome is a clinically and genetically heterogeneous disease entity which is characterized by the association of preauricular pits, branchial cleft anomaly, hearing loss and various renal anomalies. The incidence of BOR syndrome is approximately 1 : 40,000 and its genetic pattern of transmission is autosomal dominant. Hearing loss is the most common feature of BOR syndrome and is reported in almost 90% of affected individuals. EYA1, the human homologue of the Drosophila eyes absent gene, has been shown to cause BOR syndrome. We report, with a review of literatures, a female patient with BOR syndrome.

Neurodevelopmental Disorders of Children Screened by The Infantile Health Promotion System

OBJECTIVE: To perform an in depth evaluation of children, and thus provide a systematic method of managing children, who after infantile health screening, were categorized as suspected developmental delay. METHOD: 78 children referred to the Developmental Delay Clinic of Ilsan Hospital after suspected development delay on infantile health examinations were enrolled. A team comprised of a physiatrist, pediatrician and pediatric psychiatrist examined the patients. Neurological examination, speech and cognitive evaluation were done. Hearing tests and chromosome studies were performed when needed clinically. All referred children completed K-ASQ questionnaires. Final diagnoses were categorized into specific language impairment (SLI), global developmental delay (GDD), intellectual disability (ID), cerebral palsy (CP), motor developmental delay (MD) or autism spectrum disorder (ASD). RESULTS: 72 of the 78 patients were abnormal in the final diagnosis, with a positive predictive value of 92.3%. Thirty (38.4%) of the 78 subjects were diagnosed as GDD, 28 (35.8%) as SLI, 5 (6.4%) as ASD, 9 (12.5%) as MD, and 6 (7.6%) as normal. Forty five of the 78 patients had risk factors related to development, and 18 had a positive family history for developmental delay and/or autistic disorders. The mean number of abnormal domains on the K-ASQ questionnaires were 3.6 for ASD, 2.7 for GDD, 1.8 for SLI and 0.6 for MD. Differences between these numbers were statistically significant (p<0.05). CONCLUSION: Because of the high predictive value of the K-ASQ, a detailed evaluation is necessary for children suspected of developmental delay in an infantile health promotion system.

Effects of Music Therapy on Mood in Stroke Patients

PURPOSE: To investigate the effects of music therapy on depressive mood and anxiety in post-stroke patients and evaluate satisfaction levels of patients and caregivers. MATERIALS AND METHODS: Eighteen post-stroke patients, within six months of onset and mini mental status examination score of over 20, participated in this study. Patients were divided into music and control groups. The experimental group participated in the music therapy program for four weeks. Psychological status was evaluated with the Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) before and after music therapy. Satisfaction with music therapy was evaluated by a questionnaire. RESULTS: BAI and BDI scores showed a greater decrease in the music group than the control group after music therapy, but only the decrease of BDI scores were statistically significant (p=0.048). Music therapy satisfaction in patients and caregivers was affirmative. CONCLUSION: Music therapy has a positive effect on mood in post-stroke patients and may be beneficial for mood improvement with stroke. These results are encouraging, but further studies are needed in this field.

Extracranial Trigeminal Schwannoma Involving the Inferior Alveolar Canal / 대한이비인후과학회지

Although trigeminal schwannomas (TS) are rare tumors that may involve any parts of the trigeminal nerve, most of these tumors are located in the intracranium. Extracranial TS are extremely rare. Management of extracranial TS is challenging because of the anatomic complexity around the tumor. Therefore, thorough surgical planning should be required preoperatively for complete tumor removal with the least morbidities. We presented a 64-year-old man with a trigeminal mandibular schwannoma in the left infratemporal, parapharyngeal, pterygomandibular space and inferior alveolar canal of mandible.

Effects of Nasal Instillation of Staphylococcal Enterotoxin B on Allergic Inflammation in Mice / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The role of Staphylococcus aureus enterotoxin B (SEB) in allergic rhinitis remains controversial. We used a mouse model of airway allergy to determine the effects of nasal instillation of SEB on allergic inflammation. MATERIALS AND METHOD: BALB/c mice were intranasally sensitized with compound of Aspergillus melleus proteinase (AMp) and ovalbumin (ova) in the presence (group 3) or absence of SEB (group 2). Control mice were intranasally sensitized with either phosphate buffered saline (PBS)(group 1) or SEB (group 4) alone. The production of serum antigen-specific antibodies and total IgE, and concentrations of cytokines including interleukin-4 (IL-4), IL-5, interferon-gamma (IFN-gamma) in nasal lavage fluid (NLF) and broncoalveolar lavage fluid (BALF) were compared among the groups. Pathologic studies for eosinophilic infiltrations in the nasal mucosa and peribronchial area were also conducted. RESULTS: Serum ova-specific immunoglobulin E (IgE) & immunoglobulin G1 (IgG1) were significantly increased in group 2 and 3 compared to group 1. The concentrations of IL-4 in BALF were significantly increased in group 2, 3, and 4 compared to group 1. The concentrations of IL-5 in BALF and NLF were significantly increased in Group 2, 3, and 4 compared to group 1. The concentrations of IFN-gamma were significantly increased in group 3 and 4 compared to group 2 although there was no significant difference among the groups in NLF. Group 2 demonstrates increased infiltration of eosinophils in the nasal mucosa and peribronchial area compared to group 3 and 4. CONCLUSION: These results suggest that the nasal exposure to SEB did not aggravate inflammation in allergic mice.

A Case of Synchronous Triple Primary Cancer Undetected by the PET-CT / 대한이비인후과학회지

As diagnosis and treatment methods of malignant tumors have improved, the average length of a patient's life and the opportunity of detecting multiple primary malignant tumors have also increased. Patients with squamous cell carcinoma of the head and neck often have multiple cancers, esophageal cancer being the most common associated cancer. FDG PET-CT has become an accepted and widely used imaging modality for detecting the metastasis or multiple primary cancers and for the follow-up in the head and neck cancer. We report an unusual case of synchronous triple primary cancer undetected by the PET-CT with a review of literature.

A Case of Huge Supraglottic Schwannoma Leading to Exertional Dyspnea / 대한이비인후과학회지

Schwannoma of the larynx is rare. Although it is a benign, slow-growing tumor, it can cause life-threatening laryngeal airway obstruction. Therefore, complete excision is the treatment of choice. Recently, we experienced an unusual case of huge supraglottic schwannoma leading to exertional dyspnea. Therefore, we report this case with a literature review.

A Case of Fibromatosis Occurring in the Levator Scapulae / 대한이비인후과학회지

Fibromatosis is a benign tumor arising from the musculoaponeurotic tissues of the body. The natural history of fibromatosis is slow, progressive growth with invasion of adjacent tissues but this tumor has no malignant or metastatic potential. Complete surgical excision is the mainstay of treatment. However, it is often difficult due to the complex anatomy, close proximity of vital structures in the head and neck region. Preoperative core needle biopsy and MR images can make it possible to diagnose preoperatively and outline the tumor extent, which are very important to treat patients with fibromatosis. In this report, a rare case of fibromatosis occurring in the levator scapulae muscle is presented with a review of literatures.

CSF Leak and Pneumocephalus Caused by Neck Stab Wound / 대한이비인후과학회지

Pneumocephalus is defined as the presence of air within the cranial cavity. Trauma such as automobile accidents, motorcycle accidents, and missile injuries is the most common cause of pneumocephalus. There have previously been four reported cases of pneumocephalus following stab wounds to the neck in the English literature. We present an unusual case of pneumocephalus following a neck stab wound with a review of the literatures.

A Case of Angiolipoma in the Floor of the Mouth / 대한이비인후과학회지

Angiolipoma is a rare vascular variant of the benign lipomatous tumors. Especially, angiolipoma of the head and neck is extremely rare. To our knowledge, there are about 19 previously reported cases of angiolipoma of the head and neck in the world literature review. We experienced a case of angiolipoma that developed in the floor of mouth, and the tumor was successfully removed using the transcervical approach without any complications. We report a case of angiolipoma in the floor of mouth with a review of the related literature.

A Case of Mucoepidermoid Carcinoma Occurring in External Auditory Canal / 대한이비인후과학회지

Malignant tumors of the external auditory canal (EAC) are very rare. Squamous cell carcinoma, adenoid cystic carcinoma and basal cell carcinoma on the decreasing frequency are the most common pathologic forms of EAC malignancy. Mucoepidermoid carcinoma (MEC) of the EAC is extremely rare. Only three cases of MEC occurring in EAC were reported to date in the English literature. We present a case of MEC occurring in the EAC with the review of related literatures.

An Unusual Case of Extramedullary Plasmacytoma Occurring in Arytenoid Apex / 대한이비인후과학회지

Extramedullary plasmacytoma (EMP) is a rare plasma cell neoplasm occurring anywhere in the body. Paranasal sinus is the most commonly involved site of head and neck region, and then nasal cavity, oropharynx on the decreasing frequency. EMP of larynx is quite rare and only two cases of EMP were reported to have occurred in the epiglottis and the false cord of larynx, respectively, in the Korean literature. We report an unusual case of EMP occurring in the arytenoid that was treated by surgical excision.

Effects of Interleukin-18 on Allergic Response of Mouse Model / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The imbalance between a Th1 response and a Th2 response may be one feature of allergic diseases' pathophysiology. IL-18, originally called the IFN-gamma inducing factor, stimulates both Th1 and Th2 responses depending on cytokine milieu. The aim of this study was to investigate and compare the effect of intranasal and intraperitoneal administration of IL-18 in mice with experimentally induced airway allergy. MATERIALS AND METHOD: Female BALB/c mice were systemically sensitized with ovalbumin mixed with aluminum hydroxide and were challenged with the intranasal instillation of ovalbumin. IL-18 was instilled to nasal cavities or injected into peritoneum according to the experimental group. After provocation test, bronchoalveolar lavage fluid (BALF) was collected and IL-4, IL-5, IL-18 and IFN-gamma were measured. The degree of eosinophilic infiltration were evaluated at the peribronchial region of the lung specimen. RESULTS: The concentration of IL-4 and IL-5 within BALF and peribronchial infiltration of eosinophils were significantly suppressed in the groups treated with IL-18 than in the control group. The intranasal instillation of IL-18 suppressed Th2 cytokines more effectively than the intraperitoneal injection. CONCLUSION: It is suggested that allergic inflammation can be suppressed with the intranasal instillation of IL-18.

Effective Management of Head and Neck Cancer Patients with an Improved Registration Program / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Registration programs of head and neck cancer (HNC) have been developed for better patient care and data acquisition. However, there is a lack of unified registration programs of HNC in Korea. We evaluated our new HNC registration program to help effective and systemic management of HNC patients in Chungnam National University Hospital. METHOD: A HNC registration program was developed by using a computer program of 'Delphi', based on patient's demographics, diagnosis, treatment, and follow-up status. This partly cited prior HNC or other cancer registration programs and focused on the specification of the HNC. RESULTS: The program composed of registration, search, and printing forms. The registration form consists of basic epidemiologic data, previous treatment history, cancer status including primary sites, clinical and pathologic stages, treatment modality and follow-up results. The search form used a multiple selection format to enable the data interchangeable to the Excel program for effective use. The program helped to update patient's current status, promptly select data for clinical studies of clinical cancers and better patient care. This program was simple, easy, convenient, time-saving for users and it included important HNC items. CONCLUSION: Although this program is still in its primitive stage, this will be an useful tool for the registration and management of HNC patients. We suggest this program to be used nationwide to unify the registration of HNC patients and annual HNC reports, and increase cooperation among different centers.