Primary Small Cell Carcinoma of the Parotid Gland / 대한이비인후과학회지

Small cell neuroendocrine carcinomas mainly occur in the lung. Four percent of small cell carcinomas arise in extrapulmonary sites. In the head and neck region, small cell carcinomas arise most commonly in the larynx and very rarely in the parotid gland. Although the prognosis for patients with small cell carcinoma of the salivary glands is better than for those with small cell carcinoma of the lung or larynx, it is a high grade malignancy that is treated aggressively. We have recently experienced a case of primary small cell neuroendocrine carcinoma of parotid gland with extensive neck metastases. The histopathologic findings showed undifferentiated small cells with hyperchromatic nuclei, numerous mitoses, ductal differentiations and squamous changes. The positive findings for CD56 and neuron specific enolase staining determined this carcinoma to be a neuroendocrine subtype, and the patient received chemoradiation after surgery. We present this case with a review of literatures.

Two Cases of Wooden Foreign Body in Parapharyngeal Space after Penetrating Injury / 대한이비인후과학회지

Foreign bodies of the parapharyngeal space are rarely encountered in the otolaryngological fields, and may cause severe complications such as descending suppurative mediastinitis, jugular thrombophlebitis with septic pulmonary emboli, cavernous sinus thrombosis, and carotid erosion. Therefore, early diagnosis and surgical intervention are needed to reduce morbidity and motality. Recently, we experienced two cases penetrating injury of parapharyngeal foreign bodies (woodstick). The one was penetrated in right parapharyngeal space from left medial canthal area and the other in left parapharyngeal space from left infraorbital area. They were removed by skin incision and transantral approach with Caldwell-Luc operation, and we report these cases with a review of literature.

Real Time RT-PCR Quantification of Mucin Genes Expression in Human Mastoid Mucosa / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Mucin is involved in the pathogenesis of otitis media, but little is known about its expression in the mastoid mucosa with chronic otitis media. The purpose of this study is to identify MUC1, 2, 4, 5AC, 5B, 8 gene expression in the mastoid mucosa with chronic otitis media, and to compare the results with normal mastoid mucosa. MATERIALS AND METHOD: Normal or inflamed mastoid mucosal specimen were taken at the time of surgery, who underwent cochlear implant surgery and middle ear surgery for chronic otitis media. The profiles of mucin gene expression were examined by Real time reverse transcription polymerase chain reaction. RESULTS: This study revealed that RT-PCR of cDNAs from mastoid mucosa specimen of chronic otitis media showed the expression of MUC1, MUC4, MUC5AC, MUC5B, and MUC8 but MUC2 was not detected while normal mastoid mucosa showed the same pattern of mucin gene expression. In mastoid mucosa with chronic otitis media, mucin mRNA expression was upregulated in MUC1 1.2+/-1.1, MUC4 3.2+/-2.5, MUC5AC 2.5+/-1.0, MUC5B 4.1+/-2.2, and MUC8 2.7+/-2.1 times compared with that of normal mucosa and MUC5B is statistically significant (p<0.05). The MUC1, 4, 5AC, 5B, 8 mRNA expressions were correlated to infiltration of inflammatory cells in the submucosa of mastoid mucosa with chronic otitis media. CONCLUSION: These results suggest that MUC1, MUC4, MUC5AC, MUC5B, and MUC8 are expressed in the normal and inflamed mastoid mucosa and up-regulated by chronic inflammation.

A Clinical Study to Evaluate the Efficacy of 10% Topical Lidocaine as Compared with EMLA Cream for Minor Otologic Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Minor otologic surgeries, such as tympanic injection, myringotomy and ventilating tube insertion are a common otologic procedure. Effective, safe and comfortable anesthetic method is very useful alternative to lidocaine infiltration anesthesia. This study was designed to assess the efficacy of topical lidocaine as compared with eutectic mixture of local anesthetics (EMLA) for pain relief during minor otologic surgery. MATERIALS AND METHODS: One hundred eight patients who were between the age of 4 and 71 years were allocated randomly into 4 groups. Group I (n=30) received 1 spary of topical lidocaine: group II (n=34), 2 sprays of topical lidocaine: group III (n=23), 1 cc of EMLA cream: and group IV (n=21), 2 cc of EMLA cream to the ear canal. Groups were randomized to perform one of otologic minor surgery at anesthetic application time of either 10 or 20 minutes respectively. Patients rated pain and satisfaction during surgery on the comfort scale score. RESULTS: All surgeries were successfully without additional anesthesia. At 10 minute application, group I and II showed significantly lower comfort scores of pain compared with group III (p<0.05). Group II showed significantly lower scores than group III at 20 minute application (p<0.05). In lidocaine applied group I and II comfort scores of pain were significantly lower at 20 minute application than 10 minute application (p<0.05). There was one complication of severe vertigo after one hour of procedure in group II. CONCLUSION: This study demonstrates that 10 minute application of topical lidocaine is more effective for relieving pain associated with minor otologic surgery in office than 10 minute application of EMLA cream and 20 minute application of lidocaine is more effective than 10 minute application.

Changes of Upper Airway According to the Sleep Stage in Normal Subjects / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Sleep has five different periods manifested by changes in the EEG activity and certain behavioral correlates. It has been proposed that the upper airway mechanics would be influenced by sleep stage. Although several methods have been used to evaluate the regions over which the upper airway collapses during sleep, there were seldom reports about the changes of upper airway according to the sleep stage. The present study was conducted to determine the effect of sleep stage on the upper airway dynamics. MATERIALS AND METHOD: Using electron beam, we studied ten normal subjects who did not have any sleep-disordered breathing. Each patient being monitored with EEG was scanned while sleeping naturally. The images were acquired during light sleep, deep sleep and REM sleep during at least two full respiratory cycles. RESULTS: Upper airway collapse was increased with the progression of sleep, but the level of stenosis was relatively constant throughout the sleep. Sleep stage had differential effects on the upper airway size depending on the investigated site. CONCLUSION: Our data suggest that upper airway mechanics are influenced by each sleep stage. This would indicate that the study of either point of sleep or either site of airway in isolation may not allow a proper insight on the overall upper airway pathophysiology.

The Relationship between Anatomic Variation of Nasal Cavity and Paranasal Sinusitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although several studies have failed to confirm an increased incidence of sinusitis in association with anatomic factors, the anatomic variations of the nasal cavity and paranasal sinus are considered as important factors in causing paranasal sinusitis. The aim of this study was to evaluate the effects of anatomic abnormality and septal deviations on the development of paranasal sinusitis. MATERIALS AND METHOD: To evaluate the effect of anatomic variations in sinusitis, computed tomography (CT) of 165 patients with chronic sinusitis and 70 patients with orbital pathology were reviewed to analyze the mucosal abnormalities and the bony anatomic variations. RESULTS: There were no significant difference in the prevalence of anatomic variations between two groups. In patients with deviated septum, paranasal sinusitis was more common and severe in the wide side of the nasal cavity. CONCLUSION: There was no clinical significance of anatomic variations in formation of sinusitis. In septal deviation, the change of air current may affect the development of sinusitis. The increased airflow in the widened nasal cavity may impair the mucociliary clearing function of the nasal cavity and sinuses, which eventually induce the stasis of mucus in sinuses and finally results in paranasal sinusitis.

Neonatal Dacryocystitis Associated with Nasolacrimal Duct Cysts / 대한이비인후과학회지

Although congenital nasolacrimal duct obstruction occurs commonly in infants, it rarely results in neonatal dacryocystitis. Recent reports have indicated a frequent association of neonatal dacryocystitis and nasolacrimal duct cysts. We experienced a case of bilateral nasolacrimal duct cysts in a neonate with dacryocystitis. Marsupialization of the cysts was safely accomplished under the direct endoscopic visualization using a microdebrider. The patient had an excellent postoperative course without recurrence. We report it with a review of the literature.

Cognitive Ability in Total Deafness with K-WISC / 대한이비인후과학회지

The criteria of suitability for a cochlear implant has been extended postlingual deaf adult including prelingual deaf children in their difficulty with speech and vocabulary development. The cognitve ability of deaf students has been investigated in a deaf school using Kedi-WISC. The results are as follows; 1) The deaf students were not inferior in intelligence when compared with normal hearers, but the intelligence between deaf students and normal hearers was different in quality. 2) In subtest they made higher scores at object assembly, block design and coding in senior group 3) It is supposed for deaf student that performance under vision and memory is relatively excellent although concrete and abstract tasks is retarded. No emotional disordered cases is found in this study.

Clinical Analysis of PTFE Graft Arteriovenous Fistula: The long-term patency rate and factors affecting the patency rate

Expanded polytetrafluoroethylene(PTFE) graft fistulas are widely used as secondary vascular access for patients receiving long-term hemodialysis. It is well known also that several factors should be considered in order to maintain PTFE graft fistula adequately. To elucidate these factors, we reviewed 71 cases of PTFE graft arteriovenous fistula that performed at Hallym University Hospitals from March 1991 to December 1995 and analysed it for regard to age, serum creatinine level, diabetes mellitus, hypertension, diameter of graft and operation site and method. The resultes were as follows: 1) The mean duration of patency of PTFE graft fistula was 10month and the 6 month, 12 month and 24 month patency rate was 64.9%, 39.4% and 36.1% respectively. 2) The complication rate was 45%. 3) Of these factors, diabetes mellitus was the only factor that decreased the patency rate(P<0.05).

Complications of Colostomy

Although the creation of a colostomy is often regarded as a minor surgical procedure, complications and underlying diseases associated with colostomy creation alter the quality of life and the life-style of the patient significantly. One hundred forty-five patients underwent a colostomy at the Department of Surgery, Kangnam Sacred Heart Hospital, between 1987 and 1996. There were 83 males and 62 females, with a mean age of 52 years (range: 1 year to 89 years). Sigmoid-end colostomies were performed most commonly (60.7%). The colostomies were performed predominantly for colorectal cancer (110 cases). Complications arising from the colostomy formation occurred in 45 patients (31%), with wound infection being the most common problem observed (16 cases). Colostomy revision was required in 4 cases. Patients with cecostomies had a relatively higher incidence of stomal complications (75%) when compared to those with other types of colostomies. Postoperative complications were more common after emergency operations than after elective operations. The complication rate for patients with obstructive colorectal cancer was higher than that of patients with non-obstructive colorectal cancer. Complications occurred in 3 patients of the 29 patients underwent colostomy closure(10.3%). The incidence of surgical complications was not related to the time interval between colostomy formation and closure. The mortality rate for colostomy formation was 2.7%, and the most common cause of death was sepsis. These results suggest that careful attention to technical details and intraoperative care in the case of emergency colostomy formation for obstructive colorectal cancer are necessary to reduce the risk of postoperative complications.