Suicide Attempt by Inhalation of Argon Gas / 계명의대학술지

Suicide attempts using asphyxiants have been increasing compared to the past. Argon is an inert gases which is harmless to the human body, but when inhaled, can causes suffocation due to lack of oxygen. A 24-year-old man was admitted to the emergency department after an attempted suicide using argon gas. At the time of arrival, his mental status was drowsy and hematologic data indicated lactic acidosis. Consciousness was recovered after 3 hours and he was discharged without complications. He stated that he had discovered about argon gas through a suicide website and proceeded to make his purchase online. Nowadays, such websites with information on suicides are exposed to the general public without discretion and has become a major social issue. Therefore, although current suicide rates using argon gas are low in Korea, it is a suicide method to take note of in the future.

Suicide Attempt by Inhalation of Argon Gas / 계명의대학술지

Suicide attempts using asphyxiants have been increasing compared to the past. Argon is an inert gases which is harmless to the human body, but when inhaled, can causes suffocation due to lack of oxygen. A 24-year-old man was admitted to the emergency department after an attempted suicide using argon gas. At the time of arrival, his mental status was drowsy and hematologic data indicated lactic acidosis. Consciousness was recovered after 3 hours and he was discharged without complications. He stated that he had discovered about argon gas through a suicide website and proceeded to make his purchase online. Nowadays, such websites with information on suicides are exposed to the general public without discretion and has become a major social issue. Therefore, although current suicide rates using argon gas are low in Korea, it is a suicide method to take note of in the future.

A case of metoclopramide induced ventricular tachycardia

Metoclopramide is prokinetic drug that inhibits dopamine receptors, and it is commonly used in emergency rooms because of its anti-emetic effect. A 71-year-old man visited the hospital with upper abdominal pain and nausea, but agitation and cold sweating were observed after 5 minutes of metoclopramide injection. The vital signs were blood pressure: 120/70 mmHg, heart rate: 170/minute, respiration: 23 breaths/minute, and temperature: 37.5。C, and the electrocardiogram (ECG) showed ventricular tachycardia. One hour after the injection of amiodarone, normal sinus rhythm was shown on the ECG and the vital signs were stable. Metoclopramide is known to be relatively safe, but rarely causes serious cardiovascular side effects. Therefore, emergency physicians should be aware that metoclopramide can cause serious side effects.

Cardiac Tamponade Associated with Acupuncture / 계명의대학술지

Acupuncture is regarded as a relatively safe procedure, but it may have various complications. Cardiac tamponade after acupuncture is an extremely rare complication but can have fatal outcomes. We present a 73-year-old female patient with decreased consciousness and dyspnea after acupuncture at an oriental medical clinic. Initial vital signs were a blood pressure of 60/40 mmHg and a heart rate of 110 beats/min. Echocardiography and chest computed tomography were performed in the emergency department to determine the cause of the shock, and the result came out as hemopericardium. The patient underwent through an emergency cardiac surgery under the diagnosis of cardiac tamponade following acupuncture and was fully recovered after surgery.

Respiratory Failure following Tetramine poisoning after Ingestion of Sea Snail: A Case Report

Tetramine toxicity due to sea snail ingestion is generally mild and has a good prognosis. Tetramine toxicity acts on the acetylcholine receptor, affecting the neuromuscular junction and autonomic nervous system. A 78-year-old female patient visited the emergency room with vomiting and dyspnea after eating sea snails. At the time of admission, the vital signs recorded were 140/80 mmHg-105/min-24/min-36.5。C, and 90% oxygen saturation. Arterial blood test revealed hypercapnia (pCO2 58.2 mmHg) and respiratory acidosis (pH 7.213, HCO3 - 22.5 mmol/L), whereas other blood tests showed no specific findings. Due to decreased consciousness and hypoxia, endotracheal intubation and mechanical ventilation were administered to the patient. Successful weaning was accomplished after 12 hrs, and the patient was discharged without any further complications. Although tetramine toxicity rarely results in acute respiratory failure due to paralysis of the respiratory muscle, caution is required whilst treating the patient.

A Comparative Study on the Clinical Features and Complications of Snake Bite Patients in Urban and Rural Areas / 農村醫學 地域保健

Purpose@#The purpose of this study is to compare the clinical features and complications of snake bite patients in urban and rural areas. @*Methods@#A retrospective study was conducted on patients over 18 years of age who were hospitalized for snake bites from January 2013 to December 2019. Patients were categorized into urban and rural groups according to their respective locations at the time of the snake bite and the clinical characteristics and complications of the two patient groups were researched and compared. @*Results@#Of the 77 snake bite patients, 44 patients were categorized into the rural group (57.1%). The rura1 group showed significant differences in old age (p=0.011), delayed hospital visits (p=0.010), far hospital distance (p<0.001), high local effect score (p<0.001), high traditional snake-bite severity grading scale (p=0.008) and use of large amounts of antivenins (p=0.026). There was a significantly higher incidence of acute kidney injury (p=0.030), rhabdomyolysis (p=0.026), and coagulopathy (p=0.033) in the rural group as well as a longer hospitalization period (p<0.011). @*Conclusion@#Snake bites that occurred in rural areas resulted in patients with more complications compared to urban areas due to farther distances from hospitals, causing a delay in antivenom treatment.

A Case of Treatment with QRS Widening in Electrocardiogram after Glyphosate Herbicide Poisoning

Glyphosate herbicides, which are widely used worldwide, are known to have low toxicity. However, excessive intake may cause serious life-threatening complications; therefore, caution is needed when using them. A 51-year-old man visited the hospital after ingesting glyphosate herbicide. At the time of admission, his vital signs were 80/60 mmHg-115/min-20/min-37.3℃. Electrocardiogram (ECG) showed QRS widening and corrected QT (QTc) prolongation, and blood tests showed metabolic acidosis. Treatment with gastric lavage, activated charcoal, sodium bicarbonate and intravenous lipid emulsion therapy was performed. After 2 hours, his blood pressure increased to 130/90 mg, and no QRS widening was observed on ECG.

Retrospective analysis of intensity-modulated radiotherapy and three-dimensional conformal radiotherapy of postoperative treatment for biliary tract cancer

PURPOSE: This study was conducted to compare the outcome of three-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) for the postoperative treatment of biliary tract cancer.MATERIALS AND METHODS: From February 2008 to June 2016, 57 patients of biliary tract cancer treated with curative surgery followed by postoperative 3D-CRT (n = 27) or IMRT (n = 30) were retrospectively enrolled.RESULTS: Median follow-up time was 23.6 months (range, 5.2 to 97.6 months) for all patients and 38.4 months (range, 27.0 to 89.2 months) for survivors. Two-year recurrence-free survival is higher in IMRT arm than 3D-CRT arm with a marginal significance (25.9% vs. 47.4%; p = 0.088). Locoregional recurrence-free survival (64.3% vs. 81.7%; p = 0.122) and distant metastasis-free survival (40.3% vs. 55.8%; p = 0.234) at two years did not show any statistical difference between two radiation modalities. In the multivariate analysis, extrahepatic cholangiocarcinoma, poorly-differentiated histologic grade, and higher stage were significant poor prognostic factors for survival. Severe treatment-related toxicity was not significantly different between two arms.CONCLUSIONS: IMRT showed comparable results with 3D-CRT in terms of recurrence, and survival, and radiotherapy toxicity for the postoperative treatment of biliary tract cancer.

Limitation of Psychiatric Intervention for Suicidal Drug Intoxication Patients in Emergency Room

PURPOSE: This study was designed to determine the factors hindering psychiatric intervention for suicide attempters in the emergency room (ER). METHODS: Participants were 299 patients aged 18 years or older admitted to the ER for suicidal drug overdose between July 2012 and June 2014. Patients were divided into two groups according to whether they had received psychiatric treatment in the ER. Medical histories and follow-up treatments were determined by examining patients' medical records and through phone surveys, and were then compared using χ2-test and Fisher's exact test. In addition, the rate of satisfaction of the treatment group and the reasons for their dissatisfaction were also determined. RESULTS: The treatment and non-treatment groups comprised 135 (45%) and 164 patients (55%), respectively. Factors influencing participation in psychiatric intervention were previous history of suicide attempts (p=0.004), history of psychiatric disorder (p<0.001), time of day (p=0.039), and day of the week (p=0.040) of arrival in the ER. Whether or not the patient received follow-up psychiatric treatment was not significantly relevant (p=0.300). Of the 82 patients who participated in the treatment satisfaction survey, 50.2% reported being unsatisfied, mainly because of unfriendly medical personnel (36.6%), discomfort regarding other people's perceptions (24.4%), and cursory care (14.6%). CONCLUSION: To raise the participation rate of psychiatric consult, cooperation with psychiatry at night and on weekends is required, and incorporation of patients without previous history of suicidal attempt or other psychiatric disorder is important. Resolution of complaints toward psychiatric consult in suicide attempt survivors is also required.

Limitation of Psychiatric Intervention for Suicidal Drug Intoxication Patients in Emergency Room

PURPOSE: This study was designed to determine the factors hindering psychiatric intervention for suicide attempters in the emergency room (ER). METHODS: Participants were 299 patients aged 18 years or older admitted to the ER for suicidal drug overdose between July 2012 and June 2014. Patients were divided into two groups according to whether they had received psychiatric treatment in the ER. Medical histories and follow-up treatments were determined by examining patients' medical records and through phone surveys, and were then compared using χ2-test and Fisher's exact test. In addition, the rate of satisfaction of the treatment group and the reasons for their dissatisfaction were also determined. RESULTS: The treatment and non-treatment groups comprised 135 (45%) and 164 patients (55%), respectively. Factors influencing participation in psychiatric intervention were previous history of suicide attempts (p=0.004), history of psychiatric disorder (p<0.001), time of day (p=0.039), and day of the week (p=0.040) of arrival in the ER. Whether or not the patient received follow-up psychiatric treatment was not significantly relevant (p=0.300). Of the 82 patients who participated in the treatment satisfaction survey, 50.2% reported being unsatisfied, mainly because of unfriendly medical personnel (36.6%), discomfort regarding other people's perceptions (24.4%), and cursory care (14.6%). CONCLUSION: To raise the participation rate of psychiatric consult, cooperation with psychiatry at night and on weekends is required, and incorporation of patients without previous history of suicidal attempt or other psychiatric disorder is important. Resolution of complaints toward psychiatric consult in suicide attempt survivors is also required.

Displacement of Surgical Clips during Postoperative Radiotherapy in Breast Cancer Patients Who Received Breast-Conserving Surgery / 한국유방암학회지

PURPOSE: Surgical clips are used as a target for postoperative breast radiotherapy, and displacement of surgical clips would result in inaccurate delivery of radiation. We investigated the displacement range of surgical clips in the breast during postoperative radiotherapy following breast-conserving surgery. METHODS: A total of 178 patients who received breast-conserving surgery and postoperative radiation of 59.4 Gy in 33 fractions to the involved breast for 6.5 weeks were included. Surgical clips were used to mark the lumpectomy cavity during breast-conserving surgery. Patients undertook planning computed tomography (CT) scan for whole breast irradiation. Five weeks after beginning radiation, when the irradiation dose was 45 Gy, planning CT scan was performed again for a boost radiotherapy plan in all patients. The surgical clips were defined in both CT images and compared in lateromedial (X), anteroposterior (Y), superoinferior (Z), and three-dimensional directions. RESULTS: The 90th percentile of displacement of surgical clips was 5.31 mm (range, 0.0–22.2 mm) in the lateromedial direction, 7.1 mm (range, 0.0–14.2 mm) in the anteroposterior direction, and 6.0 mm (range, 0.0–10.0 mm) in the superoinferior direction. The 90th percentile of three-dimensional displacement distance was 9.8 mm (range, 0.0–28.2 mm). On the multivariate analysis, seroma ≥15 mL was the only independent factor associated with the displacement of surgical clips. In patients with seroma ≥15 mL, the 90th percentile of displacement of surgical clips was 15.1 mm in the lateromedial direction, 12.7 mm in the anteroposterior direction, 10.0 mm in the superoinferior direction, and 21.8 mm in the three-dimensional distance. CONCLUSION: A target volume expansion of 10 mm from surgical clips may be sufficient to compensate for the displacement of clips during postoperative radiotherapy after breast-conserving surgery. For patients who had a seroma, a replanning CT scan for a boost radiation should be considered to ensure exact postoperative radiotherapy in breast cancer.

Perforation of Surgical Gloves during Lower Extremity Fracture Surgery and Hip Joint Replacement Surgery / 대한고관절학회지

PURPOSE: To assess the frequencies and sites of surgical glove perforations in lower extremity fracture surgery and hip joint replacement (HJR) surgery. Additionally, we also studied the usefulness of an indicator system glove. MATERIALS AND METHODS: We assessed surgical glove perforations in 30 cases of lower extremity fracture surgery and 18 cases of HJR surgery conducted by one right handed 1st operator from April 2013 to July 2013. We assessed frequencies and sites of perforation in 152 gloves; 95 used in lower extremity fracture surgery and 57 used in HJR surgery. We studied the perforation rates and sites according to participants and operation types. Using the Biogel indicator system glove, which is well known as a fast indicator of glove perforation, we were also able to assess the time difference between operative participant detection of perforation and inspector nurse detection while observing in the operative field. RESULTS: There were 18 of 30 cases in lower extremity fracture surgeries and 12 of 18 cases in HJR surgeries which had more than one surgical glove perforation event. Of all 152 gloves used, perforation occurred in 15 of 57 gloves (26.3%) in HJR surgery and 23 of 95 gloves (24.2%) in lower extremity fracture surgery. Perforation occurred more frequently in operators than assistant doctors or scrub nurses. The most frequent perforation site was the second digit of the left hand. On average, the time difference between operative participant notice of perforation and inspector nurse notice of perforation was 20.6 seconds. CONCLUSION: The perforation of surgical gloves happened in approximately one out of every four persons. Importantly, we noted a 37.0% prevalence of glove perforation in 1st operators. Considering that glove perforation is a critical factor responsible for intra-operative infection, surgeons must be conscious of the risk of surgical glove perforation and use double gloving regularly. Furthermore, indicator double gloving is recommended for fast detection of outer glove perforation.

Results of Primary Total Hip Arthroplasty with 36-mm Femoral Heads on Highly Cross-linked Polyethylene-Minimum Seven-years Follow-up / 대한고관절학회지

PURPOSE: We evaluate the clinical and radiographic midterm results of primary total hip arthroplasty (THA) using a 36 mm diameter femoral head on highly cross-linked polyethylene (minimum 7-year follow-up). MATERIALS AND METHODS: We retrospectively reviewed 73 patients (74 hips) that underwent primary THA with a 36 mm diameter femoral head on highly cross-linked polyethylene between July 2004 and February 2007. Clinical follow-ups included specific measurements like modified Harris hip scores (HHS) and Merle d'Aubigne and Postel score. For radiologic evaluations, together with position of acetabular cup at 6 weeks later of post-operation, we separately calculated the penentrations of femoral heads into polyethylene liners during post-operation and one year later check-ups, and during one year later check-ups and final check-ups. RESULTS: There were no complications except for one case of dislocation. Average modified HHS at final follow-up was 88+/-7.5 (range, 81-96), and Merle d'Aubigne and Postel scores were more than 15 (range, 15-18). Mean acetabular cup inclination and anteversion were 50.1degrees(range, 35degrees-58degrees) and 23.6degrees(range, 5degrees-38degrees), respectively. Average femoral head penetration during the first postoperative year was 0.071+/-0.034 mm/year, and steady-state wear rate determined using radiographs taken at one-year postoperatively and at latest follow-up was 0.051+/-0.022 mm/year. Average femoral head penetration during entire follow-ups was 0.058+/-0.013 mm/year. CONCLUSION: Primary THA with a large diameter femoral head on highly cross-linked polyethylene was found to produce the results comparable to previous in vitro laboratory hip simulation studies. And we also find out good scores in terms of patient's functionality.

High-Dose-Rate Brachytherapy for the Treatment of Vaginal Intraepithelial Neoplasia / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Vaginal intraepithelial neoplasia (VAIN), a rare premalignant condition, is difficult to eradicate. We assess the effectiveness of high-dose rate intracavitary brachytherapy (HDR-ICR) in patients with VAIN or carcinoma in situ (CIS) of the vagina after hysterectomy. MATERIALS AND METHODS: We reviewed 34 patients treated for posthysterectomy VAIN or CIS of the vagina by brachytherapy as the sole treatment. All patients underwent a coloposcopic-directed punch biopsy or had abnormal cytology, at least 3 consecutive times. All patients were treated with a vaginal cylinder applicator. The total radiation dose was mainly 40 Gy in 8 fractions during the periods of 4 weeks at a prescription point of the median 0.2 cm (range, 0 to 0.5 cm) depth from the surface of the vaginal mucosa. RESULTS: Acute toxicity was minimal. Seven patients had grade 1/2 acute urinary and rectal complications. There were 15 cases of late toxicity, predominantly vaginal mucosal reaction in 12 patients. Of these patients, two patients suffered from grade 3 vaginal stricture and dyspareunia continuously. After a median follow-up time of 48 months (range, 4 to 122 months), there were 2 recurrences and 2 persistent diseases, in which a second-line therapy was needed. The success rate was 88.2%. The average prescription point in failure patients was 1.1 mm from the surface of the vagina compared to an average of 2.6 mm in non-recurrent patients (p=0.097). CONCLUSION: HDR-ICR is an effective treatment method in VAIN patients. In spite of high cure rates, we should consider issues regarding vaginal toxicity and radiation techniques to reduce the occurrence of failure and toxicity.

High-Dose-Rate Brachytherapy for the Treatment of Vaginal Intraepithelial Neoplasia / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Vaginal intraepithelial neoplasia (VAIN), a rare premalignant condition, is difficult to eradicate. We assess the effectiveness of high-dose rate intracavitary brachytherapy (HDR-ICR) in patients with VAIN or carcinoma in situ (CIS) of the vagina after hysterectomy. MATERIALS AND METHODS: We reviewed 34 patients treated for posthysterectomy VAIN or CIS of the vagina by brachytherapy as the sole treatment. All patients underwent a coloposcopic-directed punch biopsy or had abnormal cytology, at least 3 consecutive times. All patients were treated with a vaginal cylinder applicator. The total radiation dose was mainly 40 Gy in 8 fractions during the periods of 4 weeks at a prescription point of the median 0.2 cm (range, 0 to 0.5 cm) depth from the surface of the vaginal mucosa. RESULTS: Acute toxicity was minimal. Seven patients had grade 1/2 acute urinary and rectal complications. There were 15 cases of late toxicity, predominantly vaginal mucosal reaction in 12 patients. Of these patients, two patients suffered from grade 3 vaginal stricture and dyspareunia continuously. After a median follow-up time of 48 months (range, 4 to 122 months), there were 2 recurrences and 2 persistent diseases, in which a second-line therapy was needed. The success rate was 88.2%. The average prescription point in failure patients was 1.1 mm from the surface of the vagina compared to an average of 2.6 mm in non-recurrent patients (p=0.097). CONCLUSION: HDR-ICR is an effective treatment method in VAIN patients. In spite of high cure rates, we should consider issues regarding vaginal toxicity and radiation techniques to reduce the occurrence of failure and toxicity.

The role of postoperative pelvic radiation in stage IV rectal cancer after resection of primary tumor

PURPOSE: To evaluate the effect of pelvic radiotherapy (RT) in patients with stage IV rectal cancer treated with resection of primary tumor with or without metastasectomy. MATERIALS AND METHODS: Medical records of 112 patients with stage IV rectal cancer treated with resection of primary tumor between 1990 and 2011 were retrospectively reviewed. Fifty-nine patients received synchronous or staged metastasectomy whereas fifty-three patients did not. Twenty-six patients received pelvic radiotherapy. RESULTS: Median overall survival (OS), locoregional recurrence-free survival (LRFS), and progression-free survival (PFS) of all patients was 27, 70, and 11 months, respectively. Pathologic T (pT), N (pN) classification and complete metastasectomy were statistically significant factors in OS (p = 0.040, 0.020, and 0.002, respectively). RT did not improve OS or LRFS. There were no significant factors in LRFS. pT and pN classification were also significant prognostic factors in PFS (p = 0.010 and p = 0.033, respectively). In the subgroup analysis, RT improved LRFS in patients with pT4 disease (p = 0.026). The locoregional failure rate of the RT group and the non-RT group were 23.1% and 33.7%, showing no difference in the failure pattern of both groups (p = 0.260). CONCLUSION: Postoperative pelvic RT did not improve LRFS of all metastatic rectal cancer patients; however, it can be recommended to patients with pT4 disease. A complete resection of metastatic masses should be performed if possible.

Retrospective Analysis of Chemoradiotherapy for Limited-Stage Small-Cell Lung Cancer / 대한방사선종양학회지

PURPOSE: This study was designed to analyze the outcome and toxicity of thoracic radiation therapy (TRT) and chemotherapy for patients who suffer with limited-stage small-cell lung cancer (LS-SCLC). MATERIALS AND METHODS: We retrospectively studied 35 patients with LS-SCLC. TRT was administered once daily (1.8 to 2 Gy per fraction) and it was directed to the primary tumor for a total 50 to 66 Gy in 6 to 7 weeks. The patients received four cycles of etoposide plus cisplatin. TRT was begun on day 1 of the first cycle of chemotherapy in the concurrent arm and after the fourth cycle in the sequential arm. RESULTS: The median progression-free survival time was 16.5 months (95% confidence interval [CI], 9.0 to 24.1 months) for the sequential arm, and 26.3 months (95% CI, 16.6 to 35.9 months) for the concurrent arm. The 2-year progression-free survival rate was 16.0 percent for the sequential arm and 50.0 percent for the concurrent arm (p=0.0950 by log-rank test). Leukopenia was more severe and more frequent in the concurrent arm than in the sequential arm. However, severe esophagitis was infrequent in both arms. The radiotherapy was interrupted more frequently in the concurrent arm than in the sequential arm due to hematologic toxicities (p=0.001). CONCLUSION: This study suggests that concurrent TRT with etoposide plus cisplatin is more effective for the treatment of LS-SCLC than sequential TRT. However, there is a significant increase in the risk of toxicities, and radiotherapy was frequently interrupted in the concurrent arm due to hematologic toxicities.

Scrotal Arteriovenous Malformation / 대한비뇨기과학회지

Arteriovenous malformation (AVM) of the scrotum is a rare vascular lesion, which is distinguished histologically by ambiguous vessels displaying both arterial and venous characteristics and abnormal muscularization of variable sized ectatic vessels. Complete excision is recommended as a definitive treatment. Here, a case of arteriovenous malformation involving the scrotal vessels is reported.

Effect of Ginkgo Biloba Extract(EGb 761) on Apoptosis in Oral Cavity Cancer Cells / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: To examine the chemopreventive effects of Ginkgo biloba extract (EGb 761) on oral cavity cancer, we investigated the apoptosis of oral cavity cancer cells by EGb 761 and the apoptotic pathway involved. MATERIALS AND METHOD: SCC 1483 cancer cell line derived from a human retromolar trigone carcinoma was used. Inhibition of proliferation was examined by proliferation assay. Apoptosis was measured and confirmed by flow cytometry, DNA fragmentation assay and Western blotting with PARP antibodies. The involvement of the caspase cascade was investigated by co-treating with the caspase inhibitor, z-VAD-fmk. RESULTS: The inhibition of SCC 1483 cells was noted from 250 microgram/ml of EGb 761. Apoptosis was observed after 24 hours of incubation with 250 microgram/ml EGb 761 and it occurred in a time-dependent manner. Apoptosis was confirmed by DNA fragmentation and PARP cleavage. Co-treatment with z-VAD-fmk inhibited apoptosis and PARP cleavage by EGb 761. CONCLUSIONS: EGb 761 induces the apoptosis of SCC 1483 cells and the caspase cascade is involved in this apoptosis. Therefore, EGb 761 may be used as a chemopreventive agent in oral cavity cancer. Further studies are required on the clinical use of EGb 761.

Anti-adhesive Effect of GUARDIX-SL(R) after Endoscopic Sinus Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Adhesion after sinus surgery represents a potential source of surgical failure. GUARDIX-SL(R) which is composed of sodium hyaluronate and sodium carboxymethyl cellulose, is an effective agent that can be used as a surgical adjuvant to decrease adhesion in the abdominal surgery. Therefore, we evaluated the clinical efficacy and safety of the GUARDIX-SL(R) for the prevention of adhesion after endoscopic sinus surgery. SUBJECTS AND METHOD: This study was randomized and double-blinded. At the completion of endoscopic sinus surgery, 6 mL GUARDIX-SL(R) was applied on Merocel(R) and repeatedly applied on the middle meatus after removal of Merocel(R) (n=22). As a control group, normal saline was applied instead of GUARDIX-SL(R)(n=22). Endoscopic examination was performed at 3 days, 1 week, 2 weeks, and 4 weeks, postoperatively. Adhesion formation was graded as G0-G4, and CT scoring was also performed. RESULTS: The rate of adhesion formation was the highest at 2 weeks after operation and was significantly lower in the GUARDIX-SL(R) treated group than in the control throughout the period of observation. The cases were divided into 3 groups according to the CT scores at 2 weeks after operation: The groups with the GUARDIX-SL(R) treatment also showed lower adhesion formation than the control. The safety profile of the patients was normal at 4 weeks postoperatively. CONCLUSION: The results suggest that GUARDIX-SL(R) may be an efficacious and safe material in decreasing the incidence of adhesion after sinus surgery.