Preservation of the Facial Artery during Submandibular Gland Resection: Preoperative Sonographic Assessment of Facial Artery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The traditional surgical method for submandibular gland resection includes ligation of facial artery. In this study, we used ultrasound preoperatively and tried to preserve the facial artery if facial artery passed on an extra-glandular course with a glandular branch. SUBJECTS AND METHOD: Patients undergoing submandibular gland resection either because of submandibular gland tumor or submandibular gland stone were prospectively included. Preoperative sonographic assessment was done to evaluate the intra-glandular or extra-glandular course of facial artery. For the cases with extra-glandular course with a glandular branch of facial artery, we tried to preserve facial artery by ligation of the glandular branch. RESULTS: A total of 34 cases were included in this study. Among them, 6 cases (17%) hadfacial artery passing on an extraglandular course with glandular branching. For these 6 cases, we easily could find the facial artery and glandular branch in the operative field and were able to preserve the facial artery. For the remaining 28 cases, however, the facial artery penetrated through the submandibular gland, thus we opted for the ligation of facial artery rather than preserving it to minimize bleeding or trauma during the surgery. There were no statistic difference between two groups with respect to clinical and surgical variables. CONCLUSION: Extra-glandular course of facial artery was easily assessed by preoperative ultrasound. In those cases, we could preserve facial artery easily without bleeding or trauma to the submandibular gland by ligation of glandular branch. As facial artery is animportant vessel for reconstruction and facial rejuvenation, it is preferable to preserve this artery if the course of this artery makes it possible to preserve.

Clinical Characteristics and Microbiology of Acute Otitis Media of Children: Multicenter Studies / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Acute otitis media (AOM) is one of the most common forms of bacterial infection in children. The aim of this study was to investigate the clinical characteristics and the common pathogens of AOM children who visited three different centers. SUBJECTS AND METHOD: We have conducted a retrospective study of 133 children under 15 years with the diagnosis of AOM that had been seen between January 2010 and January 2011. We examined of AOM children's symptoms, signs and culture results. RESULTS: The most common symptoms were in the order of crying or irritability, otalgia and fever. Otorrhea was significantly higher under 2 years old and drum injection was over 2 years old. The most common pathogens were Streptococcus pneumoniae (26.6%), followed by Moraxella catarrhalis (19.0%), Haemophilus influenzae (11.4%) and Staphylococcus aureus (11.4%). Among the total pathogens, about 71% of pathogens were resistant to amoxicillin, 78% to macroride, and 55.2% to clindamycin. About 58.3% of H. influenza and M. catarrhalis were positive to beta-lactamase. CONCLUSION: More than half of pathogens were resistant to standard dose amoxicillin. For the appropriate treatment of AOM, decisions were made based on the common symptoms, signs and antibiotic resistances of pathogens.

Quality of Life and Sexual Outcomes: Radical Prostatectomy and External Beam Radiation Therapy for Prostate Cancer / 대한비뇨기과학회지

PURPOSE: We assessed the impact of treatment modalities, such as radical prostatectomy or external beam radiation therapy, for prostate cancer on the health related quality of life (HRQoL) and sexual function of patients. MATERIALS AND METHODS: 137 eligible patients, with localized or locally advanced prostate cancer, were enrolled from two treatment groups: radical prostatectomy (RP) and external beam radiation therapy (EBRT). To compare changes in the HRQoL and sexual function after treatment with these two modalities, an interview or postal survey was performed for the patients that were followed up at least 12 months after treatment. Finally, 57 patients (RP 34 and EBRT 23) were eligible to remain on the study. Standardized questionnaires, including the EORTC QLQ-C30 (version 3.0) and QLQ-PR25, for evaluation of HRQoL, and the International Index of Erectile Function (IIEF), for sexual function, were employed. RESULTS: On global health status and functional scales, the progression in the mean scores between the baseline and treatment were worse in the PR group. The PR group also had worse urinary incontinence, erection and ejaculation problems than the EBRT group. EBRT was associated with adverse bowel function. The IIEF demonstrated significant changes between the baseline and post-treatment scores across all five domains with the two treatment modalities, especially with a RP. CONCLUSIONS: The majority of prostate cancer patients were unable to return to functional sexual activity after both a RP and EBRT. The assignment of patients to the two treatment modalities entails different risks of urinary leakage and bowel dysfunction. These findings will help facilitate counseling, with regard to sexual function and HRQoL expectations, for prostate cancer patients.

Detrusor Overactivity in Patients with Benign Prostatic Obstruction: The Clinical and Urodynamic Characteristic / 대한비뇨기과학회지

Purpose: Benign prostatic obstruction (BPO) and detrusor overactivity (DO) are the major factors that cause lower urinary tract symptoms (LUTS) in men, but they usually coexist. Therefore, the clinical and urodynamic characteristics of BPO with DO were reviewed. Materials and Methods: One hundred nineteen patients, aged over 50 years and diagnosed as the bladder outlet obstruction (BOO) on urodynamic study, were included. Patients with a neurological history that might affect their bladder function were excluded. All patients were systemically examined, with digital rectal examination, transrectal ultrasound, s-PSA and an urodynamic study, and IPS-score and ICS male questionnaires also completed. After a pressure-flow study, BOO was defined based on the Abrams- Griffiths number (>or=20). Patients were divided into the pure BOO and those combined with idiopathic detrusor overactivity (IDO) groups, and their clinical and urodynamic variables compared. Results: Of the 119 BPO men, 57 (48%) were combined with IDO. The patients with combined IDO were older (68+/-9.8 vs. 60+/-8.9 years, por=70 years: 83%, p<0.05). In the comparison of the symptoms questionnaires, the BPO combined with IDO group was found to have higher scores than the pure BPO group for irritative symptoms (IPS-score: 9.09+/-3.83 vs. 11.27+/-3.12, ICS male questionnaires: 17.44+/-3.66 vs. 20.37+/-4.56, p<0.05). Conclusions: These data indicate that BPO with IDO is considered to be a more progressed disease, and a more pronounced obstruction and older age were also noted than with pure BOO. The incidence of BPO with IDO would also increase as irritative symptom score increased.

High Flow Priapism Developed after Treatment of Low Flow Priapism / 대한비뇨기과학회지

Priapism is a pathologic state of persistent penile erection in the absence of sexual stimulation. Low flow priapism is more common, which is caused by a venous outflow obstruction. However, high flow priapism is rare, and is caused by uncontrolled arterial flow into penis following perineal or penile blunt injuries. We report a case of high flow priapism secondary to the treatment of low flow priapism.

Xanthogranulomatous Cystitis / 대한비뇨기과학회지

Xanthogranulomatous cystitis is a rare benign chronic inflammatory disease of unknown etiology. Herein, an extensive case presenting as a mass around the dome of bladder, with infiltration of perivesical fat and a part of omentum, is reported.

Predictive Factor for the Early Progression of Androgen Independent Prostate Cancer in Intermittent Androgen Deprivation Therapy / 대한비뇨기과학회지

PURPOSE: The purpose of this study was to define the predictive factors for the early progression of androgen independent prostate cancer in patients receiving intermittent androgen deprivation (IAD) therapy. MATERIALS AND METHODS: A total of 101 patients (stages A to C in 29 and stage D in 72), who had completed at least 1 cycle of IAD, were included. A variety of possible prognostic factors, such as age, initial prostate-specific antigen (PSA) and testosterone, Gleason score, lymph node or bone metastasis, nadir PSA and testosterone, duration to nadir PSA, duration of off treatment, and ECOG performance index were analyzed using uni- and multivariate tests. RESULTS: Patients had completed at least one, and up to six, treatment cycles with a median follow-up of 43 (13-100) months. The median nadir PSA levels were 0.28, 0.41, 0.71, 0.88, 1.85 and 0.79ng/ml for cycles 1 to 6 (median 4.6 months), respectively. The median one cycle duration (on off treatment) was 14 months, 44% of that time spent off treatment, but the off treatment duration decreased with increasing number of treatment cycles. A total of 42 patients progressed to androgen independent prostate cancer, and the progression free rates at 36 and 60 months were 72 and 52%, respectively, according to the Kaplan-Meier method. Using multivariate analysis, the nadir PSA (p=0.044), ECOG performance index (p= 0.039) and lymph node or bone metastasis (p=0.03) were the strongest predictors for the progression of androgen independent prostate cancer. CONCLUSIONS: On receiving IAD, prostate cancer patients with lymph node or bone metastasis, a poor performance status and comparatively higher serum PSA nadir value after the first treatment phase, there is a high possibility for the early progression of androgen independent prostate cancer.