Risk Factors of Saddle Nose Deformity after Septoplasty / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Surgeons operate carefully to prevent nasal deformity during septoplasty, however, rarely unfavorable esthetic outcomes such as saddle nose deformity may occur. This study was designed to investigate patient factors associated with post-septoplasty saddle deformity. SUBJECTS AND METHOD: Of 588 patients who underwent endonasal conservative septoplasty from Jan. 2011 to Dec. 2014, a total of 183 patients were enrolled in this study group after exclusion. Patients were divided into two groups: 12 patients who developed saddle deformity of nasal dorsum after septoplasty belonged to the 'deformity group', and the remaining 171 patients were enrolled in the 'non-deformity group'. We investigated preoperative external nose status, patterns of septal deformity, dorsal septal thickness, the angle of axial and coronal deviation of caudal sepum on CT scan. RESULTS: The postoperative saddle deformity was not found to correlate with the location of the most deviated septum and the thickness of dorsal septum (p>0.05). 50% of patients in the deformity group had saddle nose preoperatively, showing statistical differences between the two groups (p=0.000). 75% of patients in the deformity group had severe deviation at the most deviated site, also showing a significant difference compared with the non-deformity group (p=0.011). The axial and coronal deviation angle of caudal septum in the deformity group were significantly increased compared with the non-deformity group (p<0.01). CONCLUSION: The preoperative saddle nose, severity of deviation, and angle of axial and coronal deviation of caudal septum are all possible risk factors of postoperative saddle deformity. We recommend that the surgeon should check these factors before septoplasty to prevent postoperative saddle nose deformity.

Transantral Orbital Floor Fracture Repair Using a Folded Silastic Tube

OBJECTIVES: The purpose of this study was to evaluate the advantages and limitations of using a silicon tube to support the fractured orbital floor by a transantral approach. METHODS: A retrospective study was conducted from January 2000 to December. 2011 in 51 patients with pure orbital floor fractures. The patients underwent reduction surgery via a transantral approach for inserting a folded silastic tube to support the fractured orbital floor in the maxillary sinus. A chart review of preoperative and postoperative ocular symptoms, operation records, and complications was maintained. RESULTS: In 18 out of 25 patients with diplopia, postoperative improvement was seen. In 13 out of 15 patients with extraocular muscle limitation, postoperative improvement was seen. Enophthalmos resolved postoperatively in four of five patients. Postsurgical complications occurred in three patients: an overcorrection, an infection in the maxillary sinus, and an implant extrusion, all of which were resolved by revision surgeries. CONCLUSION: During the course of the study, we sensed reduction using a folded silastic tube via a transantral approach as an easy and effective technique with good postoperative results, and minimal implant related complications. This novel procedure is recommended as a surgical option for the reduction of orbital floor fractures.

A Case of Endoscopic Removal of Clival Chordoma through Extended Transclival Approach / 대한이비인후과학회지

Clival chordoma is a rare malignant tumor which arises from the remnants of notochord. Although it is a slow-growing tumor that rarely metastasize to other organs, it is regarded as clinically malignant because of local invasiveness and high recurrence rate. Furthermore, because its location is critical and surgical resection is difficult, it has poor prognosis. Neurosurgeons have traditionally taken the lead in managing tumor, however, with the development of endoscopic techniques and wide spread of usage in skull base surgery, the role of ENT surgeon has become bigger recently. We report a recent case of recurrent clival chordoma successfully removed by endoscopic extended transclival approach.

A Case of Middle Turbinate Headache Syndrome Caused by Middle Turbinate Concha Bullosa Included Fungal Ball / 대한이비인후과학회지

Middle turbinate headache syndrome was the first reported by Wolff and the incidence is rare. It is caused by pneumatization or hypertrophy of the middle turbinate contacts between the nasal septum and the lateral nasal wall, resulting in headache in the periorbital region. The diagnosis is made by anterior rhinoscopy, computerized tomography, and confirmation by the lidocaine test. Treatment is achieved by relieving the contact point by medical or surgical means. We report a 51-year-old female patient who suffered from left periorbital pain, and left posterior nasal drip for 30 years. The patient had middle concha bullosa which contained a fungal ball that caused periorbital headache. Anterior ethmoidectomy, middle meatalantrostomy, and middle concha bullosectomy were performed using nasal endoscopy, and subsequently the symptoms disappeared. We report on this case of middle turbinate headache syndrome and the successful results of endoscopic surgical treatment.

Collision tumor of the ampulla of Vater - Coexistence of neuroendocrine carcinoma and adenocarcinoma: report of a case

Herein, we present a case of coexisting neuroendocrine carcinoma and conventional adenocarcinoma (collision tumor) in the ampulla of Vater, which has seldom been reported in the literature. A 51-year-old man presented with a month history of jaundice. MRCP disclosed about 1.9x1.8 cm sized heterogeneously enhancing mass in ampulla of Vater, causing obstructions of distal common bile duct. He underwent pylorus-preserving pancreaticoduodenectomy under the diagnosis on ampulla of Vater cancer. Pathologically, sections on the ampulla of Vater showed conventional ductal adenocarcinoma extended and collided with poorly differentiated neuroendocrine carcinoma. In conclusion, we hereby presented a case of coexisting neuroendocrine carcinoma and conventional adenocarcinoma in the ampulla of Vater.

Clinical Usefulness of Otoacoustic Emission Sum in Sudden Sensorineural Hearing Loss Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Sudden hearing loss remain a controversial issue with respect to its prognostic indicators. In a recent study, the change in distortion product otoacoustic emission (DPOAE) has been shown to provide useful information about its prognosis. The purpose of this study is to evaluate the relationship between the changes of DPOAE and hearing improvement in sudden deafness patients. SUBJECTS AND METHOD: Sixty-one patients underwent pure tone audiometry (PTA) and DPOAE on their first hospital day; among them 35 patients underwent DPOAE after 2 weeks. These patients were divided into mild ( or =71 dB) group according to their initial hearing thresholds. RESULTS: Of the 22 patients in the moderate to severe group, 11 patients showed a DPOAE response and 5 patients (45%) showed hearing improved. In 11 non-DPOAE response patients, 4 patients (36.4%) had improved. We compared PTA and OAE sum gap results by analyzing 35 patient's initial thresholds with those measured 2 weeks after the therapy. The correlation coefficient between the two group was 0.547 (p<0.05). CONCLUSION: The results show that OAE sum is an efficient and non-invasive objective method and that it can be used to monitor the effects of treatment in sudden hearing loss patients.

Impact of lymph node ratio as a valuable prognostic factor in gallbladder carcinoma, focusing on stage IIIB gallbladder carcinoma / 대한외과학회지

PURPOSE: It is increasingly being recognized that the lymph node ratio (LNR) is an important prognostic factor for gallbladder carcinoma patients. The present study evaluated predictors of tumor recurrence and survival in a large, mono-institutional cohort of patients who underwent surgical resection for gallbladder carcinoma, focusing specifically on the prognostic value of lymph node (LN) status and of LNR in stage IIIB patients. METHODS: Between 2004 and 2011, 123 patients who underwent R0 radical resection for gallbladder carcinoma at the Chonnam National University Hwasun Hospital were reviewed retrospectively. Patients were staged according to the American Joint Committee on Cancer 7th edition, and prognostic factors affecting disease free survival, such as age, sex, comorbidity, body mass index, presence of preoperative symptoms, perioperative blood transfusion, postoperative complications, LN dissection, tumor size, differentiation, lymph-vascular invasion, perineural invasion, T stage, presence of LN involvement, N stage, numbers of positive LNs, LNR and implementation of adjuvant chemotherapy, were statistically analyzed. RESULTS: LN status was an important prognostic factor in patients undergoing curative resection for gallbladder carcinoma. The total number of LNs examined was implicated with prognosis, especially in N0 patients. LNR was a powerful predictor of disease free survival even after controlling for competing risk factors, in curative resected gallbladder cancer patients, and especially in stage IIIB patients. CONCLUSION: LNR is confirmed as an independent prognostic factor in curative resected gallbladder cancer patients, especially in stage IIIB gallbladder carcinoma.

Effect on the Local Recurrence and the Survival of Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection in Rectal Cancer

PURPOSE: One of the most common sites of recurrence after a curative resection of rectal cancer is the pelvis, and local control is a major goal of surgical treatment. The advantages of lateral pelvic lymph node dissection are regarded as questionable because lateral pelvic lymph node metastasis does not occur so frequently and because a lateral lymphadenectomy has a negative influence on the postoperative quality of life. The aim of this study was to clarify if lateral pelvic lymph node dissection (LPLD) conferred any benefit. METHODS: A total of 769 patients who underwent curative surgery for rectal cancer between 1981 and 2005 at the Department of Surgery, OOO Hospital, were reviewed retrospectively. One hundred ninety-three of these patients underwent a lateral pelvic lymph node dissection, and 576 patients had a total mesorectal excision with high ligation of the IMA. RESULTS: There was no difference in pathological characteristics between the two groups. Patients who underwent a lateral pelvic lymph node dissection had no statistically significant difference in terms of the 5-year survival rate at stage II and III (64% vs 65% at stage II, P=0.391; 49% vs 47% at stage III, P=0.815). CONCLUSIONS: A lateral pelvic lymph node dissection has no advantage as part of a standard operation for rectal cancer. A total mesorectal excision alone has good local control and survival compared with a lateral pelvic lymph node dissection.

Neuroendoscopic Removal of Large Choroid Plexus Cyst: A Case Report

Choroid plexus cysts (CPCs) are the most commom neuroepithelial cysts, occuring in more than 50% of some autopsy series. They are typically small and asymptomatic and are discovered incidentally in older patients, usually in the trigone of the lateral ventricle. Symptomatic CPCs (usually exceptionally large, 2-8 cm) are rare. The authors report a case of large symptomatic choroid plexus cyst, located in the trigone of the right lateral ventricle in a 26-yr-old man who presented with headache and vomiting. The patient underwent endoscopic removal through a burr hole placed 3 cm from the midline and just behind the hair line. The histological examination of the cyst wall was consistent with choroid epithelium. Despite of postoperative intraventricular hemorrhage and catheter infection, he discharged home without neurologic deficits. The endoscopic fenestration rather than excision should be considered as the first surgical procedure because the goal of treatment is shrinkage of the cyst until normal cerebrospinal fluid flow is restored.

Prognosis and Clinical Significance of Traumatic Subarachnoid Hemorrhage

No abstract available.

Study on the blood estradiol level and follicle development in induced superovulation of insufficient menstrual cycles / 대한산부인과학회잡지

No abstract available.

Creatine Phosphokinase Isoenzymes in Head Injury

We performed a electrophoresis to determine the serum level of isoenzyme of creatine phosphokinase in 30 patients with head injuries. The present study was undertaken to examine whether the measurement of serum level of brain type isoenzyme(CPK-BB) and heart type isoenzyme(CPKMB) were valuable in evaluating the clinical status of head injuries. All patients were diagnosed by Glasgow coma scale score, CT scan and then we performed a serial blood sampling during the first 7days. Brain type creatine phosphokinase(CPK-BB) was detected in the serum in 4 of 30 patientts(13.3%) and heart type creatine phosphokinase(CPK-MB) was detected in the serum in 8 of 30 patients(26.7%). These findings were seen within 48 hours after head injuries. The higher level were associated with severe brain damage; hemorrhagic contusion, subdural hemorrhage, subarachnoid hemorrhage and pneumocephalus.

Vasospasm in Intracranial Aneurysm

The literature concerning cerebral vasospasm associated with subarachnoid hemorrhage(SAH) due to ruptured intracranial aneurysm contains no definitive study of patients to determine whether there is (1) any clinical picture consistently present coincident with known cerebral vasospoasm, (2) any relationship between mortality and known vasospasm, and (3) any relationship between serious brain damage(morbidity) and known vasospasm. To answer these important questions, experience with 138 consecutive acute SAH patients due to ruptured intracranial aneurysm was studied. The results were (1) The vasospasm was seen in 61 patients(44.2%) and the clinical vasospasm was seen in 41 patients(29.8%);(2) The average interval between last SAH and vasospasm was 8.3 days;(3) The most common neurological deficit was a hemiparesis or a hemiplegia;(4) There is no relationship between mortality and vasospasm.

Vasospasm in Intracranial Aneurysm

The literature concerning cerebral vasospasm associated with subarachnoid hemorrhage(SAH) due to ruptured intracranial aneurysm contains no definitive study of patients to determine whether there is (1) any clinical picture consistently present coincident with known cerebral vasospoasm, (2) any relationship between mortality and known vasospasm, and (3) any relationship between serious brain damage(morbidity) and known vasospasm. To answer these important questions, experience with 138 consecutive acute SAH patients due to ruptured intracranial aneurysm was studied. The results were (1) The vasospasm was seen in 61 patients(44.2%) and the clinical vasospasm was seen in 41 patients(29.8%);(2) The average interval between last SAH and vasospasm was 8.3 days;(3) The most common neurological deficit was a hemiparesis or a hemiplegia;(4) There is no relationship between mortality and vasospasm.

A Case of Huge Calcified Chronic Subdural Hematoma in the Elderly

After von Rokitansky's description in 1984 of a calcified chronic subdural hematoma, the number of such lesions has reached so far a total of 108. The majority of patients reported have been children and young adults. On review of the literature, elderly patients reported over the age of sixty five years are only 5, so far as we know. A 68-year-old Korean male with a calcified chronic subdural hematoma is reported. He was admitted to our department because of a status epilepticus. During Korean war (1950), abut 37 years before admission, he had been suffered from a blunt head injury, but mistreated then, and afterwards th had several episodes of convulsion. Neurological examination on admission revealed only a drowsy consciousness and mild papilledema on the left. Plain skull X-ray films and brain CT scan demonstrated a left sided biconvex type of intracranial calcification. A left frentoparietal craniotomy was performed. After opening the dura mater, the thickened outer membrane, the subdural hematoma and the thin bone like plate were removed thoroughly. Content of the subdural hematoma was brown muddy substance. In the eight months following the operation, the generalized seizure did not appear. Postoperative CT scan demonstrated complete re-expansion of the brain parenchyme.

Clinical Applications of Digital Subtraction Angiography(DSA) in Neurosurgical Field

Methods for the identification and amplification of signals from quantities of intravascularly administered iodinated contrast agent and their combination with image subtraction have evolved into a clinically useful technique called digital subtraction angiography (DAS). The initial motivation for the development of DSA was the desire to replace standard conventional angiographic procedures with simpler, less invasive techniques. We have evaluated IV-DSA and IA-DSA which are made in 150 patients with clinically suspected intracranial diseases from Dec. 1983 to Mar. 1985. Comparison with IA-DSA and conventional angiography indicated that the quality and information of content of the film were equivalent. IV-DSA image quality was inferior to that of conventional angiography. But IV-DSA can be used for intracranial studies to evaluate results of surgery of aneurysm, AVM or tumor and to revaluate vasospasm after subarachnoid hemorrhage before surgery. Also, IV-DSA can be used for neck vessel appearance due to reveal adequate information.

A Case of Intradural Spinal Ossifying Schwannoma

The spinal schwannomas are the most common spinal cord tumors and they make some regressive changes such as necrosis, mucous or cystic degeneration, caseation or calcification occasionally. We experienced a case of intradural ossifying schwannoma in 17 years old male, which occurred in the 2nd 3rd thoracic region. On operative finding, it was a very hard, pinkish gray and bean sized mass, and it firmly adhered to the spinal cord. We found dark bluish necrotic changes at the adhered sites of the spinal cord. On microscopical finding it revealed multiple foci of myxoid degeneration and osseous metaplasia with fibromatosis structure in schwannoma.