Performance of the combined models of Pediatric Risk of Admission scores I and II, and C-reactive protein for prediction of hospitalization in febrile children who visited the emergency department

PURPOSE: To study the performance of the combined models of Pediatric Risk of Admission (PRISA) scores I and II and Creactive protein (CRP) for prediction of hospitalization in febrile children who visited the emergency department.METHODS: We reviewed febrile children aged 4 months-17 years who visited a tertiary hospital emergency department between January and December 2017. White blood cell count, CRP concentration, the PRISA scores, and systemic inflammatory response syndrome score were calculated. We compared areas under the curves (AUCs) of the admission decision support tools for hospitalization using receiver operating characteristic curve analysis.RESULTS: Of 1,032 enrolled children, 423 (41.0%) were hospitalized. CRP and the PRISA scores were significantly higher in the hospitalization group than in the discharge group (all P < 0.001). Among the individual tools, CRP showed the highest AUC (0.69; 95% confidence interval [CI], 0.66–0.72). AUC was 0.71 (95% CI, 0.69–0.74) for the combined model of the PRISA I score and CRP, and 0.71 (95% CI, 0.68–0.74) for that of the PRISA II score and CRP. The AUC of PRISA score I and CRP combined was significantly higher than that of isolated CRP (P = 0.048).CONCLUSION: The combined model of the PRISA I score and CRP may be useful in predicting hospitalization of febrile children in emergency departments.

Clinical Predictors of Subarachnoid Hemorrhage in Patients with Acute Non-traumatic Headache in Emergency Department

PURPOSE: Missing subarachnoid hemorrhage (SAH) can cause catastrophic results. We aimed to find clinical factors for predicting SAH in neurologically intact patients with acute non-traumatic headache visiting the emergency department (ED). METHODS: This was a retrospective chart review study. Data were collected from September 2006 until October 2011. We included patients aged over 16 with acute non-traumatic headache who had brain imaging work up results during ED visits. Information on candidate clinical predictor variables was obtained from previous reports, and the outcome was confirmed SAH in brain imaging work up or cerebrospinal fluid study. We found the predictors for SAH through multivariable analysis with variables chosen in univariable analysis considering clinical application. Then we simulated possible SAH prediction scoring models using receiver operating characteristic (ROC) analysis and assessed model fit through the Hosmer-Lemeshow test. RESULTS: A total of 3294 patients were enrolled. Seven clinical characteristics were proven for relation of SAH; age, visiting emergency department within six hours from symptom onset time, visiting mode, vomiting, neck pain or neck stiffness, blood pressure, and respiratory rate. We constructed six available SAH prediction scoring models. The area under the ROC curves of each model ranged from 0.810 to 0.834 and all simulated models were good-fit. With these models, we can expect to reduce unnecessary computed tomography use. CONCLUSION: Seven clinical predictors could be helpful in selection of high risk patients of SAH. The proposed SAH prediction models using these characteristics will have to be tested prospectively for external validation.

Usefulness of Blood Cultures in Children Aged Under 3 Years with Fever at the Emergency Department

PURPOSE: Blood cultures are commonly performed in evaluation of febrile children without an obvious source of infection. Pediatric clinicians treat patients with a positive blood culture before final identification of the organism. This study sought to determine the yield and the clinical usefulness of blood cultures in pediatric patients younger than 3 years with fever at the emergency department. METHODS: We conducted a retrospective review of all children between the ages of 1 and 36 months with a body temperature of at least 38.0degrees C who underwent blood culture in the emergency department (ED) from January 2008 to December 2010. RESULTS: Bacteria growth occurred in 126(10.3%) out of 1,219 blood cultures. True positives (TPs), defined as true pathogens, were observed in 2.5% of cultures, representing 23.8% of positives. False positives (FPs), defined as contaminants, were observed in 7.9% of cultures, representing 76.2% of positives. Patients with TP cultures had lower mean pH (7.36+/-0.17 vs 7.41+/-0.08, p=0.031), higher mean base deficit (4.9+/-6.0 mmol/L vs 2.9+/-2.5 mmol/L, p=0.012), and higher mean C-reactive protein (CRP) level (3.3+/-3.7 mg/dL vs 1.8+/-3.2 mg/dL, p=0.034) than those with FP cultures. CONCLUSION: True positive results were observed relatively infrequently in blood cultures of febrile children younger than 3 years in the ED; therefore, changes in treatment of pediatric patients with fever are uncommon. However, bacteria identified by blood cultures are likely to be the true pathogen in a pediatric patient with a large base deficit or a high CRP level.

Endovascular Mechanical Thrombectomy in Basilar Artery Occlusion: Initial Experience

OBJECTIVE: This study was conducted to assess the efficacy and safety of endovascular mechanical thrombectomy (EMT) for patients diagnosed with basilar artery (BA) occlusion. MATERIALS AND METHODS: We retrospectively analyzed clinical and imaging data of 16 patients diagnosed with BA occlusion who were treated with endovascular intervention from July 2012 to February 2013. Direct suction using the Penumbra system and thrombus retrieval by the Solitaire stent were the main endovascular techniques used to restore BA flow. The outcomes were evaluated based on rate of angiographic recanalization, rate of improvement of National Institutes of Health Stroke Scale (NIHSS) score, rate of modified Rankin Scale (mRS) at discharge and after 3 months, and rate of cerebral hemorrhagic complications. Successful recanalization was defined as achieving Thrombolysis In Cerebral Infarction (TICI) of II or III. RESULTS: Sixteen patients received thrombectomy. The mean age was 67.8 +/- 11 years and the mean NIHSS score was 12.3 +/- 8.2. Eight patients treated within 6 hours of symptom onset were grouped as A and the other 8 patients treated beyond 6 hours (range, 6-120) were grouped as B. Successful recanalization was met in six patients (75%) for group A and 7 (87.5%) for group B. Favorable outcome occurred in 4 patients (50%) for group A and 5 (62.5%) for group B. CONCLUSION: Our study supports the effectiveness and safety of endovascular mechanical thrombectomy in treating BA occlusion even 6 hours after symptom onset.

Endovascular Mechanical Thrombectomy in Basilar Artery Occlusion: Initial Experience

OBJECTIVE: This study was conducted to assess the efficacy and safety of endovascular mechanical thrombectomy (EMT) for patients diagnosed with basilar artery (BA) occlusion. MATERIALS AND METHODS: We retrospectively analyzed clinical and imaging data of 16 patients diagnosed with BA occlusion who were treated with endovascular intervention from July 2012 to February 2013. Direct suction using the Penumbra system and thrombus retrieval by the Solitaire stent were the main endovascular techniques used to restore BA flow. The outcomes were evaluated based on rate of angiographic recanalization, rate of improvement of National Institutes of Health Stroke Scale (NIHSS) score, rate of modified Rankin Scale (mRS) at discharge and after 3 months, and rate of cerebral hemorrhagic complications. Successful recanalization was defined as achieving Thrombolysis In Cerebral Infarction (TICI) of II or III. RESULTS: Sixteen patients received thrombectomy. The mean age was 67.8 +/- 11 years and the mean NIHSS score was 12.3 +/- 8.2. Eight patients treated within 6 hours of symptom onset were grouped as A and the other 8 patients treated beyond 6 hours (range, 6-120) were grouped as B. Successful recanalization was met in six patients (75%) for group A and 7 (87.5%) for group B. Favorable outcome occurred in 4 patients (50%) for group A and 5 (62.5%) for group B. CONCLUSION: Our study supports the effectiveness and safety of endovascular mechanical thrombectomy in treating BA occlusion even 6 hours after symptom onset.

A Comparison of Stent-Assisted Mechanical Thrombectomy and Conventional Intra-Arterial Thrombolysis for Acute Cerebral Infarction

BACKGROUND AND PURPOSE: We evaluated whether stent-assisted thrombectomy (SAT) is safer or more clinically beneficial than aggressive mechanical clot disruption (AMCD) for patients with acute intracranial artery occlusion. METHODS: We retrospectively analyzed the clinical data of 72 patients (33 with SAT and 39 with AMCD) who underwent intra-arterial thrombolysis for acute intracranial artery occlusions. Procedure parameters, clinical outcomes, and incidence of complications were compared between the SAT and AMCD groups. RESULTS: The time interval to recanalization was shorter in SAT patients (69.2+/-39.6 minutes, mean+/-standard deviation) than in AMCD patients (94.4+/-48.0 minutes, p<0.05). Recanalization was achieved in more SAT patients (91%) than AMCD patients (80%), but with no statistically significance. Urokinase was used less frequently in SAT patients (21%) than in AMCD patients (92%, p<0.05), and the incidence of symptomatic hemorrhages was lower in SAT patients (3%) than in AMCD patients (18%, p<0.05). Device-related complications in SAT patients comprised two cases of stent fracture and one case of distal migration of a captured thrombus. The proportion of patients with good outcomes, defined as scores from 0 to 3 on the modified Rankin Scale, was similar in the two groups at discharge (SAT, 46%; AMCD, 39%), but significantly higher in the SAT group than in the AMCD group at 3 months (64% vs. 40%, p<0.05) and 6 months (67% vs. 42%, p<0.05) after discharge. CONCLUSIONS: The outcomes and clinical parameters were better for SAT during thrombolytic procedures for acute intracranial artery occlusions than for AMCD for up to 6 months. However, some device-related complications occurred during stent interventions.

Comparison of Clinical Characteristics of Pulmonary Tuberculosis between General and Homeless Patients

PURPOSE: We compared characteristics and outcomes of pulmonary tuberculosis in homeless and non-homeless patients. METHODS: A retrospective, cross-sectional study was conducted in a Seoul municipal medical center between January 2007 and December 2011. All adult patients diagnosed with pulmonary tuberculosis were included. We classified these patients into homeless and non-homeless and compared the disease characteristics, risk factors, mortality, treatment completion rate, and resistance rate. RESULTS: All 157 patients were diagnosed with pulmonary tuberculosis (75 homeless and 82 non-homeless). Most homeless patients were male (97.3%) and had higher emergency medical service (EMS) use (77.3%). Additionally, most homeless patients used alcohol l(76%) and smoked (77.3%). When compared with the non-homeless group, the homeless group had a higher in-hospital mortality rate (14.7%; adjusted odds ratio (OR), 4.69; 95% confident interval (CI), 1.03-21.34), and were more likely to be admitted for (adjusted OR=3.27(1.07-9.97)), but not to complete tuberculosis treatment (adjusted OR=9.10(2.24-36.98)). CONCLUSION: Pulmonary tuberculosis showed higher mortality in homeless than non-homeless patients. Additionally, homeless had a lower treatment completion rate and fewer resistant microorganisms.

Mechanical Thrombectomy Using a Solitaire Stent in Acute Ischemic Stroke; Initial Experience in 40 Patients

OBJECTIVE: This study was conducted in order to demonstrate the initial experience of the Solitaire AB stent in mechanical intracranial thrombectomy. METHODS: We conducted a retrospective review of 40 consecutive patients who underwent intra-arterial Solitaire AB stent thrombectomy for treatment of acute ischemic strokes between October 2010 and November 2011. Demographic, clinical, and radiological presentations and outcomes were studied. RESULTS: Twenty six men and 14 women with a mean initial National Institutes of Health Stroke Scale (NIHSS) score of 14.1 (range, 8-26) and a mean age of 65.4 (range, 32-89) years were included in this study. Occlusion sites were as follows: internal carotid artery (n = 11), middle cerebral artery M1 (n = 22), M2 (n = 5), and basilar artery (n = 2). Successful revascularization was achieved in 36 (90%) patients. The mean NIHSS score was 11.6 (range, 1-23) at 24 hours after the procedure, and 42.5% of patients showed a modified Rankin scale score of < or = 2 at 90 days. New occlusion by migrated emboli was observed in one (2.5%) case. Post-procedural intracerebral hemorrhage occurred in only one case (2.5%), with an all-cause mortality of two (5%). CONCLUSION: The Solitaire AB device is a relatively safe and effective tool for use in performance of mechanical thrombectomy in patients with acute ischemic stroke.

Effect of Emergency Department Video-nystagmography for Patients with Dizziness

PURPOSE: We evaluated the effects of emergency department (ED)-based video-nystagmography (VNG) testing on consultation with other departments and length of ED stay of patients with dizziness. METHODS: A before-and-after study was performed at a tertiary ED from May 13, 2011 to May 12, 2012. Adult patients (age> or =15 years) with dizziness were enrolled, excluding patients with incomplete information. We defined the before- and after-phase according to implanting of the ED-based VNG test. The VNG test was performed by an internship physician supervised by 2nd or 3rd grade emergency medicine residents. Primary outcome was any consultation to other specialty departments and the secondary outcome was the length of stay at the ED. The adjusted odds ratios (ORs) with 95% confidence interval (95% CI) for outcomes by phase were estimated using multivariate logistic regression analysis adjusting for potential co-variates. RESULTS: Of 1,485 eligible patients, 1,449 patients (male: 37.0%, mean age: 59.2+/-15.5 years) were enrolled (415 in the before-phase and 1,034 in the after-phase). The final diagnosis group was stroke (4.8%), peripheral vestibulopathy (44.9%), other specific disease (29.0%), and non-diagnostic symptom (21.4%). The consultation request was more reduced in the after-phase (38.1%) than the before-phase (52.5%). The LOS was not changed between both phases (7.4+/-7.5 hours versus 7.4+/-7.3 hours, p=0.76). The adjusted OR (95% CI) for the consultation of after-phase compared to before-phase was 0.46(0.35, 0.61), while the adjusted OR (95% CI) for LOS was 1.39(0.99, 1.95). CONCLUSION: Implementation of ED-based VNG test significantly reduced the consultation with other specialty departments, while LOS was not affected.

Effect of a SMS (short message service) System on Emergency Department Overcrowding

PURPOSE: Emergency departments (ED) are always overcrowded. Overcrowding is an important problem associated with emergency department treatment and patient satisfaction. Overcrowding can be caused by specific and complex issues and is affected by multiple influences. In an effort to reduce the degree of overcrowding, we evaluated relationships within the SMS (short message service) specialist's notification system. METHODS: This study involved establishment of a SMS specialist's notification system and other activity for resolution of emergency department overcrowding. We conducted a comparative analysis of ED patients from January 2010 to December 2010, before establishment of the system, and from January 2011 to December 2011, after establishment of the system. Data on ED patients were obtained from electronic medical records and the clinical data warehouse. Data were compared for mean length of stay and patient admission number. RESULTS: Results of comparison showed that the mean length of stay for discharge, admission, operation, and transfer had been effectively reduced. Mean residence time for patients in each administration sector was reduced 80.3, 462.3, 127.3, and 89.3 minutes, respectively, after overcrowding had been diminished. Significant differences for mean residence time were observed in each sector (p<0.001). In addition, comparison of before and after adoption of the SMS specialist's notification system for each clinical department showed that mean length of stay of patients admitted to the emergency department was significantly shorter after its adoption. CONCLUSION: By establishing a SMS specialist notification system, overcrowding can be resolved and length of stay can be shortened, which would result in improved satisfaction of both patients and emergency department professionals.

Distal Lenticulostriate Artery Aneurysm Presenting With Spontaneous Intracerebral and Intraventricular Hemorrhage: A Case Report and a Review of the Literature / 대한뇌혈관외과학회지

The authors report here on a rare case of aneurysm involving the distal lenticulostriate artery (LSA) in a 66-year-old man who presented with intracerebral hemorrhage (ICH) in the right basal ganglia and also intraventricular hemorrhage (IVH). Three-dimensional computed tomography angiography (3D-CTA) and conventional cerebral angiography showed a 4 mm, round-shaped aneurysm in the right distal LSA and this was combined with moyamoya-like disease. We performed proximal clipping of the aneurysm using a microsurgical technique and we evacuated the hematoma. After the operation, there was recurrent bleeding around the operation site and hydrocephalus gradually developed, and we implanted a ventriculo-peritoneal (V-P) shunt. The patient did well after the final shunt surgery and rehabilitation. Presently, he has no motor weakness or significant neurologic deficit, but mild cognitive dysfunction remains. When spontaneous ICH occurs in an unusual site, a thorough investigation is important to rule out a structural vascular abnormality.

The Effect of Intra-Arterial Low-Dose Nicardipine for the Treatment of Aneurysmal Subarachnoid Hemorrhage-associated Vasospasm / 대한뇌혈관외과학회지

OBJECTIVE: Delayed cerebral ischemia due to vasospasm after aneurysmal subarachnoid hemorrhage (SAH) is a leading cause of morbidity and mortality. Recent reports have confirmed that intra-arterial infusion of calcium-channel blockers, which are widely used to counteract vasospasm, is effective for treating SAH with a low risk of complications. Here we report on our experience with intra-arterial nicardipine angioplasty in a consecutive series of 32 patients with SAH. METHODS: This retrospective review evaluated a series of 32 consecutive patients with symptomatic vasospasm that was treated with intra-arterial nicardipine. The patients included in the study were diagnosed with aneurysmal SAH between January 2007 and February 2011. All the patients underwent microsurgical clipping or endovascular coiling. Angioplasty using intra-arterial nicardipine was performed in those patients who were refractory to medical therapy such as triple H therapy. RESULTS: The 32 patients underwent a total of 55 procedures. The total amount of nicardipine used in each angioplasty procedure did not exceed 12 mg, with a maximum dose of 3 mg for each vessel. The Glasgow Coma Scale (GCS) score improved in all patients with an average improvement of 2.4 (range : 1~5). During angioplasty, there were no complications such as thromboembolic events and/or acute transitory spasm. The clinical results were evaluated using the modified Rankin Scale (mRS). Good outcomes (mRS 0~2) were determined in 19 (63.3%) of the 30 patients. The 11 patients (36.7%) with poor outcomes initially had a high Hunt and Hess grade (III or IV) or they had intra-operative complications (mRS: 3~6). CONCLUSION: Our study results support the effectiveness and safety of low-dose nicardipine when performing intra-arterial angioplasty for the treatment of vasospasm after aneurysmal SAH.

Early Factors Affecting Prognosis of Patients with Hanging Injury

PURPOSE: Hanging is a common method of suicide around the world. The prognosis after hanging injury is highly variable. Some patients die despite intensive treatment, while other patients recover without neurologic sequelae. The purpose of this study was to identify several prognostic factors affecting the outcome in patients with hanging injury. METHODS: Thirty-five patients presented at Gyeongsang National University Hospital between May 2005 and July 2009 following hanging injury. Patients, of whom 30 were unconscious, were classified as being in the initial mental status. For these patients, we investigated several factors and identified correlations between factors and prognosis. We investigated the type of hanging, mental status, presence of pupillary light reflex, glasgow coma scale (GCS), laboratory findings, presence of cardiopulmonary resuscitation (CPR) and intubation, history of psychiatric disease, alcohol use, hanging duration, brain computed tomography (CT), and injury of the spine and neck soft tissue. RESULTS: Factors suggesting a poor prognosis factors were complete hanging, poor mental status, the absence of pupillary light reflex, initial GCS, pH, bicarbonate and excess level of base, the practice of CPR and intubation. In particular, patients who showed GCS scores lower than 4.5 in the emergency room were highly likely to die. CONCLUSION: Patients after hanging injury can recover without neurologic sequelae despite altered mental status. The prognosis of patients who present with hanging injury can be established by the type of hanging, initial mental status, the presence of pupillary light reflex, initial GCS, arterial blood gas analysis (ABGA), and the practice of CPR and intubation. Therefore patients with hanging injury should be treated aggressively with consideration of prognostic factors.

Intentional Sparing of Daughter Sac from Coil Packing in the Embolization of Aneurysms Causing the Third Cranial Nerve Palsy : Initial Clinical and Radiological Results

OBJECTIVE: Cerebral aneurysms which cause oculomotor nerve [cranial nerve (CN) III] palsy, are frequently found with a daughter sac of the aneurysm dome. We assumed that CN III might be compressed by the daughter sac and it would be more helpful not to fill the daughter sac with coils than vice versa during endosaccular embolization for recovering from CN III palsy, because it may give a greater chance for the daughter sac to shrink by itself later. We reviewed the initial results of our experiences of such cases. METHODS: Among 9 aneurysms accompanied by CN III palsy, 7 (6 unruptured, 1 ruptured) showed a daughter sac. We tried to fill the main dome completely and spare the daughter sac from coil filling to increase the possibility of decompression. We evaluated the short-term effectiveness of this concept using medical records and angiograms. RESULTS: After initial embolization, all of CN III palsy caused by unruptured aneurysms (6/6) resolved completely after various periods (3-90 days) of time. No adverse effects were noted during and after the procedures except for one case of harmless coil stretching during coil filling using double microcatheter. CONCLUSION: During the coil embolization of the cerebral aneurysm causing CN III palsy, sparing the daughter sac from coil packing while tightly packing the main dome, can be helpful in increasing the effectiveness of decompression. However, a long-term follow-up will be required.

Related Factors and their Effects on Acute Renal Failure Resulting from Rhabdomyolysis after Pesticide Intoxication

PURPOSE: Rhabdomyolysis is one of the most important complications of pesticide intoxication. It affects a patient's clinical prognosis and can cause acute renal failure. It is important that patients diagnosed with pesticide intoxication receive an accurate initial diagnosis and proper treatment to prevent significant complications. This study's objective was to investigate and confirm related factors causing acute renal failure by verifying clinical observations and laboratory findings collected following pesticide intoxication. METHODS: A retrospective analysis was made of 734 patients who presenting to our emergency medical center after ingesting pesticides between January 2006 and December 2008. Of these, 513 patients were selected for the study. Two hundred and twenty-one patients were excluded because of paraquat intoxication, age (if under 18), or chronic renal failure. Seventy-four patients were diagnosed with rhabdomyolysis, based on serum creatinine phosphokinase levels were >1,000 U/L. Acute renal failure was diagnosed when creatinine levels were > 2.0 mg/dL. RESULTS: Among the 74 patients diagnosed with rhabdomyolysis, 26 (35.1%) experienced acute renal failure. The most meaningful related factor in the prediction of acute renal failure was initial arterial pH and creatinine level. CONCLUSION: Initial arterial pH and creatinine level are predictors of complications such as acute renal failure in patients with rhabdomyolysis.

A Case of Granulocytic Sarcoma Presenting as a Head and Neck Neoplasm / 대한이비인후과학회지

The granulocytic sarcoma is a rare tumor and occurs primarily in patients with acute myelogenous leukemia (AML). The granulocytic sarcoma can arise before, concurrent with, or following acute myeloid leukemia. This tumor can be rarely represented as the initial presentation of acute myeloid leukemia without any signs or symptoms of leukemia. Granulocytic sarcoma, rarely, can also occur in unexpected regions, including the head and neck. This tumor is very often misdiagnosed as a malignant lymphoma which leads to inappropriate treatment and poor outcome. Therefore, clinical, histopathological and immumohistochemical findings should be evaluated before any diagnosis of malignant lymphoma. We report, with a brief review of literature, a case of granulocytic sarcoma presenting as a head and neck neoplasm.

The Rate of General Anesthesia after Laser Tympanostomy with Ventilation Tube Insertion: A Prospective Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this study is to evaluate if laser tympanostomy (LT) flexibly combined with ventilation tube insertion(VT) would result in the decreased rate of general anesthesia. This approach (LT+VT) would be an initial surgical approach for children with otitis media with effusion (OME). SUBJECTS AND METHOD: We made a prospective study that enrolled all the children with bilateral otitis media with effusion (OME) eligible for surgical intervention from January 2003 to December 2003, and 12 months postoperative follow-up. Laser tympanostomy under topical anesthesia was followed by VT insertion in the cooperative children. The success of treatment was defined as VT insertion under topical anesthesia or management of MEE without general anesthesia for 12 months. RESULTS: 79 children with bilateral OME were included. Overall cooperation to bilateral laser tympanostomy was 87%. Further cooperation to 1st VT was possible in 73% and 2nd VT in 45%. Overall efficacy of LT+VT was 91%. VT insertion on the cooperative children was presumed to increase the efficacy of laser tympanostomy by 24%. LT with VT might eliminate 80% of general anesthesia and the rate of G/A was 20% in our hospital. The rate of general anesthesia decreased to 9% when the child tolerated LT on both ears and to only 3% when the child tolerated at least one VT. CONCLUSION: LT with VT insertion might help to maintain high cooperation rate (87%), improved efficacy (91%), and therefore could reduce the rate of general anesthesia. LT+VT used under topical anesthesia might be an initial surgical approach for all OME children if the surgeon is willing to.

GUARDIX-SL(R) in Sinus Surgery: A Preclinical Animal Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The most frequent complication of FESS (functional endoscopic sinus surgery) is stenosis of the operation site. The complication may influence the postoperative wound healing and the outcome of surgery. There are several measures proposed to prevent the complication. We sought to determine the efficacy of GUARDIX-SL which is made from sodium hyaluronate and sodium carboxymethylcellulose in soluble form. MATERIALS AND METHOD: For 7 rabbits, we made a surgical opening anterior to sinus ostium of the maxillary sinuses on both sides. We put the gelfoams soaked with GUARDIX-SL into the left openings and those soaked with normal saline into the right openings as a control group. We measured the size of the openings after two weeks. RESULTS: There was no synechiae in GUARDIX-SL group whereas we found synechiae developed in two openings in the control group. The mean area of the opening was 9.29 mm2 and 1.61 mm2 in GUARDIX-SL group and the control group (p=0.027), respectively. CONCLUSION: GUARDIX-SL was effective in reducing postoperative stenosis in the animal model.