Comparison of the incidence of venous thromboembolism between epidural and general anesthesia for total knee arthroplasty: a retrospective study

BACKGROUND: Substantial variation exists in the reported rates of postoperative venous thromboembolism (VTE) following total knee arthroplasty (TKA) in the Asian population. This retrospective study aimed to compare the early postoperative VTE incidence between patients managed with epidural anesthesia and those managed by general anesthesia at the time of TKA. METHODS: We reviewed 589 cases of unilateral primary TKA performed between January 2011 and June 2014. We selected epidural versus general anesthesia groups as the main anesthetic choices, with postoperative patient-controlled analgesia. All the patients underwent deep vein thrombosis (DVT) computed tomography angiography on postoperative day 7. The incidence of DVT and pulmonary thromboembolism (PTE) was evaluated and compared between epidural and general anesthesia. RESULTS: The overall incidence of VTE was 8.0% in the two groups together. The incidence did not differ between the groups. The odds ratio in the generalized estimation equations analysis showed a higher incidence of DVT and PTE in the epidural group; however, this result was not statistically significant. Although, the odds ratio for age showed that the risk of developing DVT and PTE increased 1.12 times per year. CONCLUSIONS: Total VTE incidence was not significantly different between patients who underwent general anesthesia and those who underwent epidural anesthesia for TKA. A prospective multicenter study is required to evaluate the nature of the Korean VTE status in major orthopedic surgeries, and to prepare guidelines and protocols for medical prophylaxis for DVT and PTE in Korea.

Surgical Results of Endoscopic Dacryocystorhinostomy and Lacrimal Trephination in Distal or Common Canalicular Obstruction

OBJECTIVES: To evaluate the surgical outcomes of endoscopic dacryocystorhinostomy followed by canalicular trephination and silicone stenting in patients with distal or common canalicular obstructions. METHODS: The medical records of 29 patients (31 eyes) from January 2001 to December 2009 who underwent endoscopic dacryocystorhinostomy followed by canalicular trephination and silicone tube insertion for the treatment of distal or common canalicular obstructions were retrospectively reviewed. The level of obstruction was confirmed by intraoperative probing. The outcome of the surgery was categorized as a complete success, partial success, or failure according to the functional and anatomic patency. RESULTS: The average age of the patients was 52 years. The duration of silicone intubation ranged from 4 to 11 months with an average of 5.7+/-1.6 months. The follow-up period after stent removal ranged from 4 to 15 months with an average of 8.2+/-3.3 months. Complete success was achieved in 25 out of 31 eyes (80.6%), partial success in 4 out of 31 eyes (12.9%), and failure in 2 out of 31 eyes (6.5%). CONCLUSION: Endoscopic dacryocystorhinostomy followed by canalicular trephination and silicone stent intubation may be safe and considered as an initial treatment of patients with distal or common canalicular obstructions.

A Case of Endoscopic Treatment of a Huge Chondrosarcoma Originating from the Ethmoid Sinus / 대한이비인후과학회지

Chondrosarcoma of the ethmoid sinus is a rare malignant tumor and has a poor prognosis due to the frequent local recurrence and distant metastasis. It has unique and distinctive histologic characteristics, being composed of chondroid tumor cells with spindled cytoplasmic extensions. Wide surgical resection is the treatment of choice and radiation or chemotherapy can be combined with the surgery. The prognosis of chondrosarcoma depends on the anatomical location, resectability, and cytologic differentiation of the tumor. The authors experienced a case of huge chondrosarcoma of the left nasal cavity in a 47-year-old woman, which was resected successfully via endoscopic approach. We present the clinical characteristics, pathology, treatment, and prognosis of the tumor with a review of the literature.

A Case of Sinonasal Undifferentiated Carcinoma Originating from the Ethmoid Sinus / 대한이비인후과학회지

Sinonasal undifferentiated carcinoma (SNUC) is a rare, aggressive malignancy and commonly asymptomatic until the tumor has extensively progressed. Patients with SNUC usually show the involvement of multiple sinuses and the nasal cavity. In addition, the invasion of the orbit or cranial vault is a frequent finding. Most case series of SNUC report very poor prognosis despite aggressive multimodality therapy. We present a case of SNUC in a 19-year old female occurred from the right ethmoid sinus with invasion to the orbital content.

A Case of the Schwanomma Originated in the Middle Ear Cavity / 대한이비인후과학회지

Schwannoma is benign tumor that is originated from the schwann cell. It rarely occurs in the middle ear. Schwannomas of the middle ear may originate from the nerves of the middle ear cavity or by extensions from its neighboring structures. Most schwannomas arising from the middle ear are facial nerve schwannomas. We present a case of a 16-year-old male patient with primary middle ear schwannoma believed to arise from Jacobson's nerves. The tumor was easily dissected from the facial nerve and the chorda tympani nerve. The mass was successfully removed by canal down mastoidectomy, while preserving the hearing and facial nerve functions of the patient.

Microleakage of endodontic temporary restorative materials under dynamic loading / 대한치과보존학회지

The purpose of this study was to compare the sealing abilities of four endodontic temporary restorative materials using a methylene blue dye penetration test under dynamic loading. Standardized access cavities were prepared in forty-four intact human permanent molar teeth, and the cavities were restored with Caviton, MD-Temp, IRM, or ZOE. After thermocycling, an intermittent load of 98 N at 1 Hz was applied for 1,000 cycles to the long axis of the functional cusp of each of the teeth, which were immersed in a 1% methylene blue solution. The teeth were split in half, and the linear depth of dye penetration was evaluated according to the criteria. The results were analyzed using one-way ANOVA (p = 0.05) and Duncan's multiple range test. The results demonstrated that Caviton and MD-Temp showed significantly lower microleakage than IRM and ZOE. It was concluded that Caviton and MD-Temp exhibited better sealing ability than IRM and ZOE under dynamic loading.

Clinical diagnosis of herpes zoster presenting as odontogenic pain / 대한치과보존학회지

Herpes zoster, an acute viral infection produced by the varicella zoster virus, may affect any of the trigeminal branches. This case report presents a patient with symptoms mimicking odontogenic pain. No obvious cause of the symptoms could be found based on clinical and radiographic examinations. After a dermatologist made a diagnosis of herpes zoster involving the third trigeminal branch, the patient was given antiviral therapy. Two months later, the facial lesions and pain had almost disappeared, and residual pigmented scars were present. During the diagnostic process, clinicians should keep in mind the possibility that orofacial pain might be related to herpes zoster.

Vascular Endothelial Growth Factor (VEGF) and Advanced Glycation End Products (AGEs) Overexpression in the Retina and Serum and Lens Opacities of Streptozotocin-induced Diabetic Rats / 당뇨병

BACKGROUND: Vascular Endothelial Growth Factor (VEGF) and Advanced Glycation End products (AGEs) have been implicated in the development of diabetic retinopathy. In this study, we examined the expression of VEGF and AGEs in the retina and serum, apoptosis in the retina, and lens opacities in streptozotocin (STZ)-induced diabetic rats. METHODS: The localization of VEGF and AGEs in the retina of STZ-induced diabetic rats was determined by immunohistochemical analysis, and apoptotic cell death was assessed using the TUNEL assay. In the serum, STZ-induced diabetic rats were assayed for VEGF and AGEs by ELISA. Lenses were also isolated to detect the opacity. RESULTS: Expression of VEGF and accumulation of AGEs were significantly increased in the retinal ganglion cell layers (GCL) and nuclear cell layers (NCL) of STZ-induced diabetic rats compared to normal control rats. In addition to cellular expression, serum VEGF and AGEs levels were also increased significantly in STZ-diabetic rats compared to normal rats (both P < 0.001) and there was a significant correlation between the serum VEGF and AGEs levels (r = 0.504). The lens opaque density of STZ-induced diabetic rats were significantly higher than in normal rats (P < 0.001). CONCLUSIONS: AGEs could be involved in the development of diabetic retinopathy through the induction of VEGF. One could possibly correlate this lens opaque formation with elevation of AGE induced VEGF level. Thus, this study should be considered as a basic research for studying pathology of the retina and lens in diabetic experimental models.