Palatal Implants for Persistent Snoring and Mild Obstructive Sleep Apnea After Laser-Assisted Uvulopalatoplasty

Laser-assisted uvulopalatoplasty (LAUP) was widely performed in 1990s as a surgical therapeutic procedure to improve snoring or mild obstructive sleep apnea (OSA). However, LAUP is not currently recommended as a treatment for OSA because the evidence for its efficacy is insufficient. Little is known about alternative minimally invasive surgery in patients who refuse continuous positive airway pressure or oral appliance after failed LAUP. We present a case of successful surgical treatment of persistent snoring and mild OSA with palatal implants after LAUP. This case suggests that palatal implants may be offered as an alternative surgical procedure for selective patients with persistent or recurrent snoring or mild OSA after LAUP.

Tumor bed volumetric changes during breast irradiation for the patients with breast cancer

PURPOSE: The aim of this study was to evaluate changes in breast tumor bed volume during whole breast irradiation (WBI). MATERIALS AND METHODS: From September 2011 to November 2012, thirty patients who underwent breast-conserving surgery (BCS) followed by WBI using computed tomography (CT) simulation were enrolled. Simulation CT scans were performed before WBI (CT1) and five weeks after the breast irradiation (CT2). The tumor bed was contoured based on surgical clips, seroma, and postoperative change. We retrospectively analyzed the factors associated with tumor bed volumetric change. RESULTS: The median tumor bed volume on CT1 and CT2 was 29.72 and 28.6 mL, respectively. The tumor bed volume increased in 9 of 30 patients (30%) and decreased in 21 of 30 patients (70%). The median percent change in tumor bed volume between initial and boost CT was -5%. Seroma status (p = 0.010) was a significant factor in tumor bed volume reduction of 5% or greater. However, patient age, body mass index, palpability, T stage, axillary lymph node dissection, and tumor location were not significant factors for tumor bed volumetric change. CONCLUSION: In this study, volumetric change of tumor bed cavity was frequent. Patients with seroma after BCS had a significant volume reduction of 5% or greater in tumor bed during breast irradiation. Thus, resimulation using CT is indicated for exquisite boost treatment in breast cancer patients with seroma after surgery.

A Prospective Population-based Study of Total Nasal Resistance in Korean Subjects

OBJECTIVES: Rhinomanometry is a widely accepted method for objective assessment of nasal patency. However, few studies have reported the values of otherwise healthy population for nasal resistance in East Asians. The purpose of this study was to measure normal total nasal resistance (TNR) values in a large sample of Korean adults and to reveal parameters contributing to TNR values. METHODS: Subjects were enrolled from a cohort of the Korean Genome and Epidemiology Study. They were evaluated by anthropometry, questionnaire, and active anterior rhinomanometry at transnasal pressures of 100 and 150 Pascal (Pa). RESULTS: The study sample consisted of 2,538 healthy subjects (1,298 women and 1,240 men) aged 20 to 80 years. Normal reference TNR values were 0.19+/-0.08 Pa/cm3/second at 100 Pa and 0.22+/-0.09 Pa/cm3/second at 150 Pa. The TNR of women was significantly higher than that of men (P<0.0001). TNR decreased with increasing age in both genders (P<0.05). In women, lower body weight was related to increasing TNR. In men, current smokers had higher TNR than ex-smokers and never smokers. CONCLUSION: The results of the present study provide information regarding the values of otherwise healthy population of TNR and parameters associated with TNR in Korean adults.

Evaluation of Urine Cytology in Urothelial Carcinoma Patients: A Comparison of CellprepPlus(R) Liquid-Based Cytology and Conventional Smear

BACKGROUND: Urine cytology is an important test in the screening of urothlelial neoplasms. The conventional smear (CS) method of testing urine samples has a low sensitivity, approximately 50% result accuracy for detecting urothelial carcinomas, while liquid-based cytology (LBC) has much improved diagnostic accuracy, sensitivity, and specificity. The aim of this study was to compare the morphologic features and diagnostic efficacy of CellprepPlus(R) LBC with those of CS for urine cytology. METHODS: A total of 713 cases of urine specimens collected from November 2009 to September 2010 were included. All specimens were divided equally for the preparation of CellprepPlus(R) LBC and CS for each case. RESULTS: CellprepPlus(R) revealed more cellularity, a cleaner background and better cytomorphologic features, but it showed a less intact architectural pattern compared to that of CS. Of the 88 histologically confirmed cases, the diagnostic sensitivity for CellprepPlus(R) was 50% and higher than the 37.5% for CS. The specificity of both preparations was 100%. CONCLUSIONS: The CellprepPlus(R) showed an improved quality of slides and provided better diagnostic accuracy, thus CellprepPlus(R) could be a first-line screening tool in urinary tract cytology.

CellprepPlus(R) Liquid-based Smear in Sono-guided Thyroid Fine Needle Aspiration: A Comparison of Conventional Method and CellprepPlus(R) Liquid-based Cytology

BACKGROUND: Fine needle aspiration (FNA) of the thyroid is a useful tool for the evaluation of benign or malignant thyroid nodules. The improvements in the quality of cytological preparations using the liquid-based cytology (LBC) method have been well-documented. The principal objective of this study was designed to evaluate the diagnostic adequacy, sensitivity, and specificity of the thyroid FNA comparing a conventional smear with the LBC adapted with the filtration method described herein. METHODS: One hundred ninety eight cases of FNA samples obtained from May 2009 to September 2009 were included in this study. All patients were subjected to ultrasound-guided aspiration twice at a target lesion by a radiologist and two types of slides were prepared using conventional smear and LBC. RESULTS: When compared with conventional method, the cellularity was reduced in LBC. However, the malignant tumor cells evidenced the larger and more vesicular nuclei, prominent nucleoli, and distinct nuclear membranes in LBC. Thirty two cases (16.16%) of conventional smear were inadequate, but 96 cases (48.49%) of LBC were inadequate. CONCLUSIONS: Most of the slides using CellprepPlus(R) LBC evidenced lower cellularity and clearer background. However, the conventional smears were found to generate much more applicable samples than CellprepPlus(R) LBC.

Clinical Implications of Mandible and Neck Measurements in Non-Obese Asian Snorers: Ansan City General Population-Based Study

OBJECTIVES: Anthropometric abnormalities of the mandible and neck may contribute to snoring in non-obese Asians. The study evaluated the clinical implications of mandible and neck measurements in non-obese Asian snorers. METHODS: The external mandible and neck measurements (neck circumference, two lengths of neck, mandibular body angle, and lengths of mandibular ramus and body) were compared between snorers and non-snorers in a sample of 2,778 non-obese Koreans (1,389 males, 1,389 females) aged 40 to 69 years (mean, 48.47+/-7.72 years). RESULTS: The overall prevalence of snoring was 64.7% (899/1,389) and 48.3% (671/1,389) in non-obese male and female subjects, respectively. In non-obese males, snorers had significantly a greater neck circumference (P<0.0001) and shorter mandibular body length (P=0.0126) than non-snorers. In non-obese females, snorers had significantly greater neck circumferences (P=0.0165), compared with non-snorers. However, there were no statistically significant differences in other variables between non-snorers and snorers. CONCLUSION: Anthropometric abnormalities of the mandible and neck, including thick neck circumference in both genders and small mandible size in males, may be relevant contributing factors to snoring in non-obese Asian snorers.

Clinical Implications of Mandible and Neck Measurements in Non-Obese Asian Snorers: Ansan City General Population-Based Study

OBJECTIVES: Anthropometric abnormalities of the mandible and neck may contribute to snoring in non-obese Asians. The study evaluated the clinical implications of mandible and neck measurements in non-obese Asian snorers. METHODS: The external mandible and neck measurements (neck circumference, two lengths of neck, mandibular body angle, and lengths of mandibular ramus and body) were compared between snorers and non-snorers in a sample of 2,778 non-obese Koreans (1,389 males, 1,389 females) aged 40 to 69 years (mean, 48.47+/-7.72 years). RESULTS: The overall prevalence of snoring was 64.7% (899/1,389) and 48.3% (671/1,389) in non-obese male and female subjects, respectively. In non-obese males, snorers had significantly a greater neck circumference (P<0.0001) and shorter mandibular body length (P=0.0126) than non-snorers. In non-obese females, snorers had significantly greater neck circumferences (P=0.0165), compared with non-snorers. However, there were no statistically significant differences in other variables between non-snorers and snorers. CONCLUSION: Anthropometric abnormalities of the mandible and neck, including thick neck circumference in both genders and small mandible size in males, may be relevant contributing factors to snoring in non-obese Asian snorers.

Optimal Continuous Positive Airway Pressure Level in Korean Patients with Obstructive Sleep Apnea Syndrome

OBJECTIVES: The aim of this study was to investigate optimal continuous positive airway pressure (CPAP) level, to examine the factors affecting optimal CPAP level, and to develop a predictive equation for optimal CPAP level in Korean patients with obstructive sleep apnea syndrome (OSAS). METHODS: A total of 202 patients with OSAS who underwent successful manual titration for CPAP treatment were included in this study. Correlations between the optimal CPAP level and baseline data including anthropometric and polysomnographic variables were analyzed. A predictive equation for optimal CPAP level was developed based on anthropometric and polysomonographic data. RESULTS: The mean optimal CPAP level in 202 patients with OSAS was 7.8+/-2.3 cm H2O. The mean optimal CPAP level in the mild, moderate, and severe OSAS groups was 6.0+/-1.3, 7.4+/-1.9, and 9.1+/-2.1 cm H2O, respectively. The apneahypopnea index (AHI) (r=0.595, P<0.001), arousal index (r=0.542, P<0.001), minimal SaO2 (r=-0.502, P<0.001), body mass index (BMI) (r=0.494, P<0.001), neck circumference (r=0.265, P<0.001), and age (r=-0.164, P=0.019) were significantly correlated with optimal CPAP level. The best predictive equation according to stepwise multiple linear regression analysis was: Optimal CPAP level (cm H2O)=0.681+(0.205xBMI)+(0.040xAHI). Forty-two percent of the variance in the optimal CPAP level was explained by this equation (R2=0.42, P<0.001). CONCLUSION: A predictive equation for optimal CPAP level in Korean patients with OSAS was developed using AHI and BMI, which can be easily measured during the diagnostic process.

The Prevalence and Characteristics of Positional Sleep Apnea in Korea / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Obstructive sleep apnea (OSA) patients are classified into positional patients with supine apneahypopnea index (AHI) that is at least twice as high as the non-supine AHI, and non-positional patients with a supine AHI that does not reach double values of the non-supine AHI. We determined the prevalence of positional sleep apnea and compared clinical characteristics between positional and non-positional OSA patients. SUBJECTS AND METHOD: This was a cross-sectional study at a tertiary rhinologic referral center. We evaluated 113 patients whose AHI were over 5 and whose sleep time of supine, nonsupine position were over 15 minutes as a result of overnight polysomnography taken from January 2007 to July 2008. The body position of patients was confirmed with sleep position sensor and direct observation. RESULTS: Positional sleep apnea was seen in 14/22 (63.64%) with mild sleep apnea (AHI, 5 to 15/h), 16/36 (44.44%) with moderate sleep apnea (AHI, 15 to 30/h), 14/55 (25.45%) with severe sleep apnea (AHI, > or =30/h) and over all prevalence of positional sleep apnea in this study is 38.9%. The severity of OSA, weight, waist and waist to hip ratio (WHR) is related to the positional tendency. CONCLUSION: The result of this study revealed that positional sleep apnea was more common in patients with mild OSA and the positional tendency of OSA patients was affected by central obesity

Misplaced IUD / 대한산부인과학회잡지

Intrauterine device is one of the most used contraception in the world. One of the major complications of intrauterine contraception is perforation through the uterine wall into the pelvic or abdominal cavity. The currently accepted treatment of choice for displaced IUD is its removal of surgical laparoscopy or laparotomy. We report on three cases with misplaced IUD in pelvic or abdominal cavity, followed by a review of the literature.

Clinical Analysis of The Thyroid Papillary Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Papillary carcinoma of the thyroid is the most common malignant neoplasm in the thyroid gland. We performed this study for the purpose of getting further understanding and more supporting ideas for the diagnosis and treatment of thyroid papillary cancer. SUBJECTS AND METHOD: One hundred seventy eight cases of papillary carcinoma of thyroid gland who had been diagnosed and had received treatment at the department of otolaryngology-Head and neck surgery at the Korea university hospital from 1992 to 2001 were analyzed retrospectively. RESULTS: The mean age of cases was 43.6 years in females and 47.9 years in males. The most common symptom was anterior neck mass. Symptoms were usually presented within three months. The size of thyroid mass was not related to the duration of illness. The most frequently performed operative procedure was total thyroidectomy (76.4%). The post operative complications were temporary vocal cord palsy (4.5%), iatrogenic vocal cord palsy (1.7%), temporary hypocalcemia (16.9%) and permanent hypocalcemia (3.9%). Of all patients, 43 (24.1%) had preoperatively metastatic cervical nodes. Of the 175 patients, 52 (29.2%) had postoperative nodal metastasis. Local recurrences had occurred in 17 patients (9.6%). According to the AMES classification, 114 cases (64.1%) fell into the low risk group and 64 cases (35.9%) to the high risk group. The 10-year survival rate was 100% for the low risk group but 91.2% for the high risk group. The 10-year disease free survival rate was 92% for the low risk and 81.2% for the high risk group. CONCLUSION: We reaffirmed that the clinical characteristics of thyroid papillary cancer corresponded with the reports of other foreign studies. We suggest that this study needs to be followed up by a larger, long-term research.

Three Cases of Papillary Carcinoma from the Thyroglossal Duct Cyst / 대한이비인후과학회지

Carcinoma from the thyroglossal duct cyst (TGDC) is a rare disease. Clinically, it may be confused with a benign tumor and diagnosed during operation or postoperatively. The recommended treatment is the Sistrunk procedure but no clear consensus exists regarding further management after an adequate excision of the cyst, especially with the role of total thyroidectomy and the postoperative radioactive iodine therapy. We have recently experienced three cases of papillary carcinoma in the TGDC. Two of the cases actually had the unsuspected thyroid carcinoma, and thus total thyroidectomies were performed consequent to the diagnosis. We describe three cases of papillary carcinoma from the TGDC. They underwent Sistrunk operations and total or nearly total thyroidectomies, and then radioactive iodine therapies were performed. The patients were satisfied and there was no evidence of recurrence.

Efficacy and Predictors of Success of Methotrexate Treatment in Women with Unruptured Tubal Ectopic Pregnancies / 대한산부인과학회잡지

OBJECTIVE: To evaluate the efficacy and predictors of success of methotrexate (MTX) treatment in selected cases of unruptured tubal pregnancies. METHODS: This study was retrospectively performed in 36 women who had diagnosed unruptured tubal pregnancies. Patients received intramuscular MTX. Serial beta-hCG measurement was performed weekly, and success was defined as the achievement to beta-hCG concentration of 10 mIU/mL without surgical intervention. Surgical intervention was performed for presumed tubal rupture. Pretreatment serum concentration of beta-hCG, the size of tubal mass and gestational sac by transvaginal ultrasonography were measured to evaluate the predictors of MTX therapy. RESULTS: 29 patients (81%) were successfully treated by MTX systematic treatment. There were not significant differences in the patient's age, parity, gestational age and the size of tubal ectopic mass, but significant differences in the gestational sac size and serum beta-hCG concentration between success group and failure group of MTX treatment. The mean time for achieving successful treatment was 33.8 days. The success rate of systemic MTX was significantly decreased and resolution time was prolonged if the initial pretreatment serum beta-hCG was 10,000 mIU/mL or gestational sac size was >or=1 cm. CONCLUSION: Pretreatment serum beta-hCG concentration and gestational sac size are important predictors of success of MTX treatment in women with unruptured tubal pregnancy.

Expression of Midkine mRNA in Human Nasal Mucosa / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: A heparin-binding polypeptide called midkine is a family of secreted growth/differentiation cytokines and has a role in tumor growth by enhancing endothelial proliferation, vascular density and angiogenesis. In this respect, midkine may be involved in the pathogenesis of nasal polyposis. The aim of the present study is to evaluate the expression of midkine mRNA in the human nasal mucosa and polyps. MATERIALS AND METHOD: The total RNA was isolated from freshly disected inferior turbinate of patients who underwent rhinoplasty and from nasal polyps of chronic rhinosinusitis patients. The expression and distribution of midkine mRNA was investigated by reverse transcriptse- polymerase chain reaction (RT-PCR) and in situ hybridization. The midkine mRNA expression in nasal mucosa and polyps were semi-quantitatively evaluated by Southern blot hybridization. RESULTS: The expression of midkine mRNA was identified in both normal inferior turbinate and nasal polyp. Histochemistry of in situ hybridization revealed that midkine mRNA in normal inferior turbinate was intensely expressed in the surface epithelium, submucosal glands, vascular endothelium, and inflammatory cells scattered in submucosal tissues. Midkine mRNA was expressed in the nasal polyps, many inflammatory cells and newly formed vascular endothelium, but not in the newly formed glandular epithelium. In semi-quantitative southern blot hybridization, midkine mRNAs did not have different expression levels between inferior turbinate and nasal polyps. CONCLUSION: These results indicate that midkine mRNA is innately expressed in human nasal mucosa, playing a role in nasal physiology. Also, the results show that midkine may be involved in the pathogenesis of nasal polyps via angiogenesis, tissue growth, and inflammatory process.

A Case of Primary Tuberculous Peritonitis in Pregnancy / 대한주산의학회잡지

Although the diagnosis of primary tuberculous peritonitis in pregnancy is seems challenging because of protean manifestations and difficult surgical intervention, prompt diagnosis and treatment can minimize both maternal and fetal/neonatal mortality. We have experienced one case of this disease in 23-year-old primigravida in 24 weeks of gestation.

Tumor necrosis factor - a ( TNF - a ) , Vascular cell adhesion molecule - 1 ( VCAM - 1 ) and Lipid peroxide in Maternal plasma of Uncomplicated Pregnancy / 대한산부인과학회잡지

OBJECTIVE: The purpose of study was to assess in a longitudinal study of maternal plasma concentrations of Tumor necrosis factor-alpha(TNF-alpha), Vascular cell adhesion molecule-1(VCAM-1), Lipid peroxide (malonaldehyde, MDA) in uncomplicated pregnancy. METHODS: Blood was collected from healthy women at 4 to 41 weeks' gestation and non-pregnant women. Plasma samples were measured by immunoassay for TNF-alpha, VACM-1 and by colorimetric assay for lipid peroxide, and data were statistically analyzed. RESULTS: Plasma concentration of TNF-alpha was not significantly elevated during first trimester compared with non-pregnant women, but significantly elevated during second and third trimester compared with non-pregnant women. Plasma concentration of VCAM-1 was significantly elevated during first trimester compared with non-pregnant women. Plasma concentration of lipid peroxide was not significantly elevated during pregnancy compared with non-pregnant women. CONCLUSION: The plasma concentration of TNF-alpha and VCAM-1 were significantly higher than that of non-pregnant state during second and third trimester in case of TNF-alpha, and during first trimester in case of VCAM-1. But the plasma concentration of lipid peroxide during pregnancy was not significantly different from that of non-pregnant, and the plasma concentration was kept up constant levels during gestation. These were seems to be meant that abnormal pregnancy would be happened if the level is above or below the measured level.