Invasive Aspergillosis Associated Bacterial Infection in the Nasal Septum After Sphenoid Sinus Surgery / 대한이비인후과학회지

Nasal septal infection can result from progression of a fungal infection from the adjacent sinuses. Nasal septal fungal abscesses complicating nasal trauma, surgical procedures, sinus, and dental infections have previously been reported in a small number of cases. Adequate management involves early diagnosis, prompt empiric antifungal therapy, and surgical debridement in order to prevent the development of life-threatening complications. We report a rare case of nasal septum necrosis from Aspergillus infection in a 79-year-old man with diabetes mellitus and chronic renal failure following endoscopic sphenoid sinus surgery due to an isolated sphenoid fungal ball.

A Case of Epithelioid Hemangioendothelioma of the Nasal Cavity / 대한이비인후과학회지

Epithelioid hemangioendothelioma (EHE), a rare vascular tumor that is both clinically and histologically an intermediate between angiosarcoma and hemangioma, was first described by Sharon Weiss and Franz Enzinger. It is characterized by proliferation of a distinct type of endothelial cells, which exhibit epithelioid morphology. It typically occurs in the 20-40 age range with no sex predilection, although the overall age range involved is much broader. This indolent tumor is potentially recurrent, but it rarely metastasizes. There are very few cases of EHE of nasal cavity described in the English literature. We describe here a case of EHE on the left middle turbinate of a 17-year-old male who presented with history of intermittent epistaxis.

Isolation, Identification and Characterization of a Antidementia Acetylcholinesterase Inhibitor-Producing Yarrowia lipolytica S-3

This report describes the isolation and identification of a potent acetylcholinesterase (AChE) inhibitor-producing yeasts. Of 731 species of yeast strain, the S-3 strain was selected as a potent producer of AChE inhibitor. The selected S-3 strain was investigated for its microbiological characteristics. The S-3 strain was found to be short-oval yeast that did not form an ascospore. The strain formed a pseudomycelium and grew in yeast malt medium containing 50% glucose and 10% ethanol. Finally, the S-3 strain was identified by its physiological characteristics and 26S ribosomal DNA sequences as Yarrowia lipolytica S-3.

A Combined Therapy of Steroid Injection, Silicone Gel Sheeting, and Laser for Hypertrophic Scar and Keloid

PURPOSE: For hypertrophic scars and keloids no universally effective treatment modality exists. Surgical revision, intralesional steroid injection, silicone gel sheeting, pressure, laser, and others have been used with variable success, but many treatments are associated with high recurrence rates. Although optimal treatment remains undefined, successful treatment can be obtained through a combined therapeutic approach. METHODS: We used three therapeutic modalities in combination, which are intralesional injection of triamcinolone acetonide, silicone gel sheeting, and 585 nm flashlamp-pumped pulsed dye laser. Fifty-eight cases of hypertrophic or keloid scar were treated by combined therapeutic regimen for mean period of 18 months. The changes of thickness, color, and pliability of scars were evaluated with clinical photographs by grading scale. RESULTS: As summing the grades and categorizing the result into three group, we obtained 28% good, 67% fair, and 5% poor results. There was a desirable improvement of scars with insignificant adverse effects. CONCLUSION: Combination of intralesional steroid injection, silicone gel sheeting, and pulsed dye laser can lead to successful treatment of hypertrophic scar and keloid.

A Combined Therapy of Steroid Injection, Silicone Gel Sheeting, and Laser for Hypertrophic Scar and Keloid

PURPOSE: For hypertrophic scars and keloids no universally effective treatment modality exists. Surgical revision, intralesional steroid injection, silicone gel sheeting, pressure, laser, and others have been used with variable success, but many treatments are associated with high recurrence rates. Although optimal treatment remains undefined, successful treatment can be obtained through a combined therapeutic approach. METHODS: We used three therapeutic modalities in combination, which are intralesional injection of triamcinolone acetonide, silicone gel sheeting, and 585 nm flashlamp-pumped pulsed dye laser. Fifty-eight cases of hypertrophic or keloid scar were treated by combined therapeutic regimen for mean period of 18 months. The changes of thickness, color, and pliability of scars were evaluated with clinical photographs by grading scale. RESULTS: As summing the grades and categorizing the result into three group, we obtained 28% good, 67% fair, and 5% poor results. There was a desirable improvement of scars with insignificant adverse effects. CONCLUSION: Combination of intralesional steroid injection, silicone gel sheeting, and pulsed dye laser can lead to successful treatment of hypertrophic scar and keloid.

The Repair of Critical-Size Defect with Fibrin Sealant in Rat Calvaria

This study was designed to evaluate the capacity of fibrin sealant to mediate the repair of critical size defects of rat calvaria. Twenty-four rats were randomized into four groups(n=6) and an 8-mm circular calvarial defect was made in each rat. In Group I and II, as control groups, defects were left untreated and evaluated at postoperative 6th and 12th week, respectively. In Group III and IV, defects were treated with fibrin sealant implantation and evaluated at the same point of time as in Group I and II, respectively. Results were examined by gross and histologic findings, simple radiographic study, and radiodensitometric analysis for bony density quantitatively. By gross and simple radiographic findings, animals with fibrin sealant implantation generally showed thick coverage of defects and focal radioopacity within defect area, but non-treated animals showed only fibrous healing. Histologically, small amount of new appositional bone growth was only seen at the edge of the defect at 6th week in Group III, but in Group IV, there are substantial amounts of new immature bone with well-organized patterns within the defect at 12th week postoperatively. In the radiodensitometric analysis, there was no statistically significant difference between Group I and Group III at 6th week. Compared with Group II, however, Group IV showed significant bony healing (p=0.0225) at 12th week. In conclusion, the fibrin sealant appeared to be an effective mediator in bone regeneration of this critical-sized calvarial defect model, but long-term implantation period should be needed for optimal results.

Orbital Reconstruction via Extended Transconjuctival and Transpalpebral Approach

In case of blow-out fracture involving floor or inferomedial wall, the fracture site can be accessed by methods such as subcilliary incision, mid-lower eyelid incision, infra-orbital incision and transconjunctival incision. Meanwhile, in case of orbital fracture involving supero-medial wall or roof, above-mentioned methods have the limitation of fracture site exposure, and bicoronal incision is required to overcome the difficult approach. The authors exposed fracture site widely and executed accurate reduction through extended transconjunctival approach and transpalpebral approach, instead of the approach by bicoronal incision. We executed 118 cases of orbital reconstruction by above method among 96 patients who consulted doctors to reconstruct blow-out fracture and enophthalmos from September 1997 to May 2001. Among the 118 cases were 50 cases of orbital floor fracture, 4 cases of orbital roof fracture, 48 cases of orbital medial wall fracture, 13 cases of complex type and 3 cases of enophthalmos. The authors made wide dissection of antero-superial medial wall of orbit and roof fracture of orbit enabled by above methods, which allowed enough exposure and approach to orbital fracture site and prevented side effects such as post operative lower eyelid scar or ectropion and scleral show.

Comparison of an Antiperistaltic Ileostomy with the Conventional Ileostomy

Permanant ileostomy is necessary in the case of a total proctocolectomy for a cancerous change in the distal rectum due to ulcerative colitis or familial adenomatous polyposis coli, but the fecal content after a conventional ileostomy is usually liquid or semiliquid. Sometimes, this resultes in dehydration and some nutrient loss. Nahm-gun Oh has designed an antiperistaltic ileostomy for formed stool evacuation. About a 25 cm length of the most distal ileum is cut, this segment is reversed, and then the antiperistaltic ileostomy is performed. The authors have performed antiperistaltic ileostomies in 6 cases of familial adenomatous polyposis or ulcerative colitis with a cancerous change in the low rectum. During the past 5 years and 7 months at the Department of Surgery, Pusan National University Hospital, we found that the profuse ileostomy discharge of the conventional ileostomy was decreased in the antiperistaltic ileostomy group, and that the antiperistaltic ileostomy discharge had a liquid component which was markedly decreased compared to that of the conventional ileostomy discharge. In addition, the antiperistaltic ileostomy discharge appeared to be much more solid and less voluminous. In conclusion, the antiperistaltic ileostomy should be considered for creating the effect of a reservoir by producing intestinal stasis proximal to the segment. The antiperistaltic ileostomy is effective in reducing the daily amount of ileostomy discharge and is convenient for stoma care due to the diminished water content in the discharge.