A Case of Biphenotypic Sinonasal Sarcoma Found in a Young Woman’s Nasal Cavity / 대한이비인후과학회지

Biphenotypic sinonasal sarcoma (BSNS) is a newly recognized, very rare malignant tumor of nose and paranasal sinuses, which usually occurs in women. This tumor contains both neural and muscle tissue in the tumor tissue. It is an invasive disease occuring locally in the nasal cavity. However, if not found early, it can spread along the facial structure, for instance, the orbit, skull base, intracranium, and the oropharynx. This tumor is an uncommon disease that has not been reported in Korea to date. We report a case of a 35-year-old female recently diagnosed with BSNS with a review of the literature.

Prevention of Septal Perforation Using a Combination of Crushed Cartilage and Thin Silastic Sheet During Septoplasty

Background and Objectives@#The aim of the present study was to investigate the effects of a combination of crushed cartilage and thin silastic sheet for patients with a risk of septal perforation during septoplasty. @*Materials and Methods@#A total of 195 people who underwent septoplasty surgery at Dong-A University Hospital from January 2019 to December 2020 were enrolled retrospectively. Among 195 people, our surgical method was provided for those with damage to both septal mucosa. The cartilage was collected, crushed with the cartilage crusher, and inserted between perforated mucosa. After the cartilage insertion, a 0.254-mm-thin silastic sheet was designed to cover both sides of the perforated septal mucosa. Next, a penetrating suture was placed. After thin silastic was applied on both mucosa, a 1-mm-thick silastic sheet was inserted on both sides of the nasal cavity and penetrating sutures were placed on the anterior and inferior septum. The operation concluded after packing both sides of the nasal cavity using non-absorbable packing material. The packing was removed on the second day after the operation, and the nasal cavity condition was checked every week. Thick silastic sheets were removed 5 days after surgery, and thin silastic sheets were maintained until both septal mucosa healed. @*Results@#Of nine total cases, only one 78-year-old male experienced septal perforation at the cartilage portion two months after surgery. In this case, no other action was taken to cover the perforation site because he reported no symptoms or discomfort during the 9 months after surgery. In the other eight cases, both septal mucosa healed completely, and there were no complications. @*Conclusion@#This method with crushed cartilage and silastic sheets to fill the defect after septal surgery is thought to help prevent postoperative perforation at no additional cost, and further research is needed.

Clinical characteristics of sleep bruxism patients with idiopathic facial pain

Purpose@#To profile various clinical characteristics of sleep bruxism (SB) patients with idiopathic facial pain (IFP) in the orofacial region. @*Materials and Methods@#We analyzed 28 SB patients among 210 patients with IFP complaints. The profiles were evaluated using patient charts including gender, age, pain duration, pain location, pain intensity and affected areas by pain. @*Results@#SB with IFP occurred more often in females (85.7%) than males (14.3%). The mean age at presentation was 48.9 years. The most common IFP sites of SB patients were the right maxilla (28.6%) and the right mandible (25.0%). The pain complaints occurred mostly in 2 teeth or areas (50.0%), followed by 1 area (28.6%) and then in ≥ 3 teeth or areas (21.4%). The mean pain intensity was 5.9 on a visual analogue scale from 0 to 10. The pain was spontaneous in 20 patients (71.4%), and the mean pain duration was 24.4 months. @*Conclusion@#Identification of clinical characteristics of SB patients with IFP could be useful in the diagnosis of various IFP patients and beneficial in decreasing unnecessary care to reduce IFP. Further studies with larger number of subjects and extended duration are required for more systemized diagnostic methods and development of future treatment guidelines.

The Usefulness of Esophageal Baseline Impedance Levels for the Diagnosis of Nonerosive Reflux Disease and the Proper Time for Measurement in Endoscopy-negative Korean Patients With Esophageal or Supraesophageal Symptoms

Background/Aims@#Low baseline impedance levels (BILs) have been suggested to be evidence of GERD. The aim of this study is to investigate the usefulness of esophageal BILs for the diagnosis of nonerosive reflux disease (NERD) and the proper time for measurement in endoscopy-negative Korean patients with esophageal or supraesophageal symptoms. @*Methods@#Endoscopy-negative patients with esophageal or supraesophageal symptoms who underwent esophageal multichannel intraluminal impedance-pH monitoring were included. BILs were measured in the proximal and distal esophagus around 10 minutes before meals, 10 minutes and 30 minutes after meals, 30 minutes before the start of nighttime sleep, and 30 minutes and 60 minutes after the start of nighttime sleep. @*Results@#A total of 104 patients were included in the study. Distal and proximal esophageal BILs were decreased after meal ingestion. The BILs of the distal esophagus were significantly lower at all time points in the NERD group, but not in the reflux hypersensitivity (RH) group, compared with the functional group. The area under the receiver operating characteristic curve for the diagnosis of NERD was significant at all time points, but that for the diagnosis of RH was not. The cut-off value of 2375 Ω or 2125 Ω measured around 30 minutes before or 60 minutes after the start of nighttime sleep, respectively, were appropriate for the diagnosis of NERD. @*Conclusion@#The BILs of the distal esophagus measured at time points before or after the start of nighttime sleep appear to be useful for the diagnosis of NERD, but not for the diagnosis of RH, in endoscopy-negative Korean patients with esophageal or supraesophageal symptoms.

Hypoglycemia and Dementia Risk in Older Patients with Type 2 Diabetes Mellitus: A Propensity-Score Matched Analysis of a Population-Based Cohort Study

BACKGROUND: Type 2 diabetes mellitus (T2DM) is associated with an increased risk for dementia. The effects of hypoglycemia on dementia are controversial. Thus, we evaluated whether hypoglycemia increases the risk for dementia in senior patients with T2DM.METHODS: We used the Korean National Health Insurance Service Senior cohort, which includes >10% of the entire senior population of South Korea. In total, 5,966 patients who had ever experienced at least one episode of hypoglycemia were matched with those who had not, using propensity score matching. The risk of dementia was assessed through a survival analysis of matched pairs.RESULTS: Patients with underlying hypoglycemic events had an increased risk for all-cause dementia, Alzheimer's dementia (AD), and vascular dementia (VaD) compared with those who had not experienced a hypoglycemic event (hazard ratio [HR], 1.254; 95% confidence interval [CI], 1.166 to 1.349; P<0.001 for all-cause dementia; HR, 1.264; 95% CI, 1.162 to 1.375; P<0.001 for AD; HR, 1.286; 95% CI, 1.110 to 1.490; P<0.001 for VaD). According to number of hypoglycemic episodes, the HRs of dementia were 1.170, 1.201, and 1.358 in patients with one hypoglycemic episode, two or three episodes, and more than three episodes, respectively. In the subgroup analysis, hypoglycemia was associated with an increased risk for dementia in both sexes with or without T2DM microvascular or macrovascular complications.CONCLUSION: Our findings suggest that patients with a history of hypoglycemia have a higher risk for dementia. This trend was similar for AD and VaD, the two most important subtypes of dementia.

Supplementary Technique for Unstable Clavicle Shaft Fractures: Interfragmentary Wiring and Temporary Axial K-Wire Pinning

BACKGROUND: Treatment of unstable clavicle fractures remains a challenge for orthopedic surgeons, but the evolution of treatment strategies has allowed for reliable results with minimal complications. Although several surgical options exist, open reduction with plating remains the treatment of choice for clavicle fractures. The purpose of this study is to determine an easy way to achieve successful preplating reduction while minimizing surrounding soft tissue damage during treatment of midshaft fractures of the clavicle. METHODS: A retrospective study included all consecutive adult patients operated on by a single surgeon for acute displaced clavicular midshaft fracture between January 2010 and October 2014. Hybrid technique with interfragmentary cerclage wiring, temporary axial K-wire pinning, or their combination was used in all patients. The demographic data and clinical outcomes, including operation time, union time, restoration of anatomy, shoulder functional score, and complications were evaluated. RESULTS: There were 54 male and 19 female patients, with an average age of 39.3 years (range, 18 to 77 years) for males and 58.3 years (range, 39 to 77 years) for females. They were followed up for 24 months (range, 12 to 44 months). All patients had reliable bone union after surgery using interfragmentary cerclage wiring and temporary axial K-wire fixation; fracture union was obtained at an average of 11.7 weeks (range, 8 to 21 weeks) postoperatively. Additionally, there was no postoperative loss of fracture reduction or plate loosening. At the final follow-up, all patients had regained excellent functional outcomes. CONCLUSIONS: The cognizant effort to achieve anatomic reduction without surrounding soft tissue insult before definitive plating allows excellent radiologic and functional outcomes. Interfragmentary cerclage wiring and temporary axial K-wire pinning can overcome difficulties associated with unstable clavicle fractures to allow proper fracture reduction. In this article, we introduce a concise technique for achieving the desired outcomes reliably and efficiently when treating unstable clavicle midshaft fractures.

A proposal of injection points of botulinum toxin into temporal region for chronic migraine

Botulinum toxin (BoNT) injections have been used not only in the field of cosmetic surgery such as forehead and eye wrinkle treatment but also in the treatment of chronic migraine, dystonia, spasticity, temporomandibular disorders (TMD). BoNT injections are the only approved therapies to date for prophylactic treatment of chronic migraine patients. Unlike the previously known paralysis of motor neurons, the mechanism of action for migraine is to block the release of non-cholinergic neurotransmitters such as substance P, CGRP, and glutamate, which are associated with peripheral sensitization and neurogenic inflammation in the sensory nerve, it is hypothesized that the signal is blocked. This review focuses on the analgesic effects of BoNT and suggests the direction for the development of injection methods for chronic migraine patients.

Is Anterior Bridge Plating for Mid-Shaft Humeral Fractures a Suitable Option for Patients Predominantly Involved in Overhead Activities? A Functional Outcome Study in Athletes and Manual Laborers

BACKGROUND: To assess the functional and radiological outcomes of minimally invasive anterior bridge plating (ABP) for mid-shaft humerus fractures in patients predominantly involved in overhead activities (athletes and manual laborers). METHODS: Forty-eight patients fulfilling inclusion criteria were treated with ABP at a level-I trauma center using a 4.5-mm dynamic/locking compression plate and followed for a period of 1 year. Functional outcome was assessed using the Constant, Mayo elbow, and Disabilities of the Arm, Shoulder and Hand (DASH) scores. Range of motion (ROM), subjective strength, and radiographic union were assessed. A general satisfaction questionnaire was also administered. RESULTS: Most patients achieved excellent functional and radiological outcomes. ROM and strength of the shoulder girdle exhibited clinically nonsignificant loss as compared to the opposite side. The mean time for return to the original activities was 64 days (range, 36 to 182 days) and the mean time for confirmed radiographic union was 45 days (range, 34 to 180 days). The mean Constant, Mayo elbow, DASH scores were 95.73 ± 5.76 (range, 79 to 100), 95.94 ± 6.74 (range, 85 to 100), and 1.56 ± 3.15 (range, 0.0 to 14.0), respectively. The majority of patients (43 patients, 89.6%) who fell in the excellent or very good category according to our questionnaire were extremely satisfied. There were 2 cases (4.17%) of nonunion and 3 patients (6.25%) had to change/modify their original occupation. CONCLUSIONS: ABP is fundamentally different from traditional open posterior plating or conventional intramedullary nailing. It gives relative stability with union taking place by callus formation, and a longer plate on the tensile surface ensures that the humerus can withstand greater amount of rotational and bending stresses. The minimally invasive nature causes minimal soft tissue damage and, if done correctly, causes no damage to the vital structures in proximity. ABP for mid-shaft humerus fractures in patients predominantly engaged in overhead activities is a safe and effective treatment modality yielding high rates of union, excellent functional recovery, minimal biological disruption, better cosmesis, and superior satisfaction rates.

Diagnosis of headaches in dental clinic

Headache disorders, one of most common disease in general population, have been developed according to many versions of international classifications. The primary headaches are those in which no consistently identified organic cause can be determined. It is divided into the following categories: (1) migraine, (2) tension-type headache, (3) cluster headache and other trigeminal autonomic cephalalgias, (4) other primary headaches. This review described a diagnosis of primary headache disorders based on International Classification of Headache Disorders (ICHD)-3 beta criteria.

Treatment of Periprosthetic Femoral Fractures in Hip Arthroplasty

BACKGROUND: We analyzed the radiological and clinical results of our study subjects according to the management algorithm of the Vancouver classification system for the treatment of periprosthetic femoral fractures in hip arthroplasty. METHODS: We retrospectively reviewed 18 hips with postoperative periprosthetic femoral fractures. The average follow-up was 49 months. The fracture type was determined based on the Vancouver classification system. The management algorithm of the Vancouver classification system was generally applied, but it was modified in some cases according to the surgeon's decision. At the final follow-up, we assessed the radiological results using Beals and Tower's criteria. The functional results were also evaluated by calculating the Harris hip scores. RESULTS: Seventeen of 18 cases (94.4%) achieved primary union at an average of 25.5 weeks. The mean Harris hip score was 92. There was 1 case of nonunion, which was a type C fracture after cemented total hip arthroplasty, and this required a strut allograft. Subsidence was noted in 1 case, but the fracture was united despite the subsidence. There was no other complication. CONCLUSIONS: Although we somewhat veered out of the management algorithm of the Vancouver classification system, the customized treatment, with considering the stability of the femoral stem and the configuration of the fracture, showed favorable overall results.

Comparison of IOLMaster(R) and A-Scan Ultrasound: Change in Axial Length After Vitrectomy in Macular Disease

PURPOSE: To evaluate the differences between IOLMaster(R) and A-scans in changes in axial length after vitrectomy in patients with macular disease. METHODS: Using IOLMaster(R) and A-scans, we measured preoperative and postoperative axial length in 12 eyes with epiretinal membranes (ERM) and in 8 eyes with macular holes (MH). The relationship between the absolute error in axial length after vitrectomy and both methods was assessed using Mann-Whitney U test. The correlation to central macular thickness was evaluated by Spearman's correlation coefficient. RESULTS: In eyes with ERM and MH, preoperative and postoperative axial lengths obtained with both methods had no significant difference (p>0.05). The absolute error in axial length after vitrectomy was not significant using IOLMaster(R) (ERM: 0.07+/-0.05 mm, MH: 0.04+/-0.02 mm, p>0.05) but was significant using A-scan (ERM: 0.20+/-0.11 mm, MH: 0.30+/-0.07 mm, p0.05, MH; correlation coefficient = -0.054, p>0.05, A-scan: ERM; correlation coefficient = -0.210, p>0.05, MH; correlation coefficient = -0.156, p>0.05). CONCLUSIONS: The IOLMaster(R) is more useful than the A-scan when measuring axial length without refractive errors after vitrectomy in eyes with macular disease.

Comparison of IOLMaster(R) and A-Scan Ultrasound: Change in Axial Length After Vitrectomy in Macular Disease

PURPOSE: To evaluate the differences between IOLMaster(R) and A-scans in changes in axial length after vitrectomy in patients with macular disease. METHODS: Using IOLMaster(R) and A-scans, we measured preoperative and postoperative axial length in 12 eyes with epiretinal membranes (ERM) and in 8 eyes with macular holes (MH). The relationship between the absolute error in axial length after vitrectomy and both methods was assessed using Mann-Whitney U test. The correlation to central macular thickness was evaluated by Spearman's correlation coefficient. RESULTS: In eyes with ERM and MH, preoperative and postoperative axial lengths obtained with both methods had no significant difference (p>0.05). The absolute error in axial length after vitrectomy was not significant using IOLMaster(R) (ERM: 0.07+/-0.05 mm, MH: 0.04+/-0.02 mm, p>0.05) but was significant using A-scan (ERM: 0.20+/-0.11 mm, MH: 0.30+/-0.07 mm, p0.05, MH; correlation coefficient = -0.054, p>0.05, A-scan: ERM; correlation coefficient = -0.210, p>0.05, MH; correlation coefficient = -0.156, p>0.05). CONCLUSIONS: The IOLMaster(R) is more useful than the A-scan when measuring axial length without refractive errors after vitrectomy in eyes with macular disease.

The Effect of Intravitreal Triamcinolone Acetonide Injection according to the Diabetic Macular Edema Type

PURPOSE: To determine if intravitreal injection of triamcinolone acetonide (IVTA) is effective for diabetic macular edema according to the type of macular edema. METHODS: This prospective, clinical series study was carried out on 31 eyes with diabetic macular edema, which had received an intravitreal injection of 4 mg of triamcinolone acetonide. We analyzed the visual acuity and foveal thickness at post-treatment 1 week, 1, 3, and 6 months according to the type of diabetic macular edema by optical coherence tomography (OCT). RESULTS: OCT showed 3 patterns of macular edema: cystoid type (18 eyes), sponge type (7 eyes), and serous detachment type (6 eyes). Visual acuity and foveal thickness improved in all patients. The cystoid types of macular edema show better response than the other types in visual acuity and foveal thickness. CONCLUSIONS: IVTA is a good therapeutic options for diabetic macular edema. IVTA is more effective in cystoid macular edema. Furthermore, study with more patients and focal laser treatment according to the type of macular edema may be necessary for further evaluation.

A case of Infantile Polycystic kidney

No abstract available.

Two Case of Aplastic Anemia Following Hepatitis

No abstract available.

A Case of Human Fascioliasis

No abstract available.

Clinical Studies of Purulent Meningitis in Infant and Children

No abstract available.

A Case of Holoprosencephaly

No abstract available.

Clinical study of low birth weight infants

No abstract available.

Clinical Study of Shigellosis

Clinical and Bacteriological studies were carried out on 57 cases of infants and children with shigellosis who were cared from January, 1976 to December, 1980 in our hospital. The results were as follows: 1. The age distribution revealed the range between 6 months and 5 years(85% of all) with sex ratio of 30(53%) of male and 27(47%) of female, 1.1:1. 2. The peak incidence was noted in summer, althought there were occurrence throughout the year, even in winter. 3. On bacteriological studies, Shigellan flexneri was isolated most frequenty(90%) and Shigella sonnei was the next(8.8%). 4. Only 8.3% of Shigella strains were resistant to ampicillin between 1976 and 1977 but resistance increased to 76.7% in 1980. Gentamicin and Kanamycin which are aminoglycosiides were quite effectived but their use was limited becauseof their nephrotoxicity. 5. The average duration from the onset to the clinical improvement including stool character in the 32 ampicillin treated patients was 3.6 days and in the 25 rifampin treated patients was 2.2 days. Rifampin was effective in eradicating the shigella stralins and stool cultures taken at 7th therapeutic day remained negative in all 25 rifampin treated patients but yielded growth of shigella strains in 13 ampicillin treated patients. There was no doubt that rfaimpin was superior to ampicillin for bacillary dysentry. 6. One of these 57 cases was expired and motality rate was 1.8%.