A Survey Study on Rheumatologist Consultation Time in Korean Hospitals

OBJECTIVE: In Korea, short physician consultation time has been a cause of concern as it compromises the care provided. This study was aimed at finding the actual and optimal consultation time per patient for rheumatology outpatient clinic in Korea.METHODS: The surveys were prepared based on a study of the literature and consisted of multiple-choice questions as well as additional open questions. Surveys were conducted from November to February, 2018~2019. Rheumatologist members of the Korean College of Rheumatology were invited to complete the web-based survey as well as paper survey.RESULTS: The mean duration of consultation allocated to a new and an established patient was found to be 12.3 and 4.8 minutes, respectively, which corresponded to only 22%~35.3% of perceived optimal consultation time. On the other hand, the intrusion of physician autonomy for optimal patient care by the hospital executive was manifest such that only 4.7% responded discretion in allocating consultation time for patients and that 61.3% replied that they have been restrained from keeping the adequate outpatient clinic volumes. Sixty six percent of respondents replied that insufficient consultation time affects patient safety including errors in prescription.CONCLUSION: Rheumatology consultation time is very insufficient compared to optimal situation. A drastic change in health care policy promoting good quality of care, such as appropriate compensation which guarantees sufficient consultation time, as well as strong policy to control excessive profit-driven management policy of the hospitals is urgently needed.

Comparison of Wearable Activity Tracker with Actigraphy for Sleep Evaluation and Circadian Rest-Activity Rhythm Measurement in Healthy Young Adults

OBJECTIVE: The purpose of this study was to evaluate the applicability of data obtained from a wearable activity tracker (Fitbit Charge HR) to medical research. This was performed by comparing the wearable activity tracker (Fitbit Charge HR) with actigraphy (Actiwatch 2) for sleep evaluation and circadian rest-activity rhythm measurement. METHODS: Sixteen healthy young adults (female participants, 62.5%; mean age, 22.8 years) wore the Fitbit Charge HR and the Actiwatch 2 on the same wrist; a sleep log was recorded over a 14-day period. We compared the sleep variables and circadian rest-activity rhythm measures with Wilcoxon signed-rank tests and Spearman's correlations. RESULTS: The periods and acrophases of the circadian rest-activity rhythms and the sleep start times did not differ and correlated significantly between the Fitbit Charge HR and the Actiwatch 2. The Fitbit Charge HR tended to overestimate the sleep durations compared with the Actiwatch 2. However, the sleep durations showed high correlation between the two devices for all days. CONCLUSION: We found that the Fitbit Charge HR showed high accuracy in sleep evaluation and circadian rest-activity rhythm measurement when compared with actigraphy for healthy young adults. The results suggest that the Fitbit Charge HR could be applicable on medical research as an alternative tool to actigraphy for sleep evaluation and measurement of the circadian rest-activity rhythm.

A Mixed Hemangioma Originated from the Middle Turbinate / 대한이비인후과학회지

A hemangioma is a kind of benign tumor which occurs mostly on the skin of the head and neck, but it is a relatively rare in the nasal cavity. We report a case of a mixed hemangioma of left nasal cavity. A 41-year-old man was presented with frequent epistaxis and progressive left sided nasal obstruction about for 2 months. A physical examination revealed a large polypoid necrotic mass in the left nasal cavity originated from the middle turbinate and extended inferiorly to the nasal floor. He was required to get immediate punch biopsy and then the lesion is characterized pathogenically to a mixed hemangioma. After preoperative embolization, mass was completely excised through the endoscopic technique. There is no evidence of recurrence after 6 months from the operation.

A T-Cell Lymphoma of Sphenoid Sinus Extended to Suprasellar Area Accompanying with Acute Visual Loss / 대한이비인후과학회지

Sinonasal lymphomas are relatively uncommon and represent less than 1% of all head and neck malignancies. It is absolutely rare in the United States but its incidence has been reported to be higher in Asian and South American. A primary malignant lymphoma in the paranasal sinuses usually occurs in the maxillary or ethmoid sinus, and it is very rare in the sphenoid sinus. We present a case of a 48-year-old male patient, who complained both of reduced visual acuity and diplopia for a week. An opthalmologic examination revealed no light perception of the right eye. A nasal endoscopy revealed yellowish crusts and a mucosal swelling in both nasal cavity, but no definite mass like lesion was found in the nasal cavity. CT scans of sinuses demonstrated mass lesions in the posterior ethmoid and sphenoid sinus and on the suprasellar area. A mass showed up in the T1 and T2 intensified MR image. He was required to get biopsy for definite diagnosis at the operating room by endoscopic technique, which then allowed it to be pathogenically characterized as angiocentric immunoproliferative lesion (AIL). The lesion was finally defined as T-cell lymphoma by immunochemical study, which showed it to be positive to CD45Ro. After the patient underwent mass biopsy, he received steroid therapy for 5 days. And then both visual acuity was improved abruptly. The patient was treated with both chemotherapy (CHOP) and radiation therapy (4400 cGy). He has been in complete remission state for 1 year after a combination therapy.

Expression of MLH1, MSH2 in Malignant Melanoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: MLH1 and MSH2, which are DNA mismatched repair genes, used to be studied in HNPCC (hereditary nonpolyposis colon cancer). Now, the defects in MLH1 and MSH2 are known to be related with malignant transformations of other tumor. Mismatched repair proteins are widely dispersed in the adnexal structures. According to studies, if mismatched repair proteins were stained, as melanocytic nevi progresses into melanocytic dysplastic nevi and cutaneous malignant melanoma, positive immunoreactivity decreases. The purpose of the study is to find out the appearance pattern of DNA mismatched repair proteins, and MLH1 and MSH2 known to be associated with microsatellite instability and carcinogenesis. MATERIALS AND METHODS: Of 19 patients who had been diagnosed with malignant melanoma by pathological study in Asan medical center between June, 1989 and January, 2002, 11 patients had mucosal malignant melanoma while 8 patients had malignant melanoma on the skin. There were 9 males and 10 females, with the average age of 55 (32-77). We investigated the nuclear positivity of MLH1 and MSH2 by immunochemical staining of paraffin tissue method. RESULTS: The nuclear positivity of MLH1 and MSH2 were 27.3% (3/11) and 36.8% (7/11), respectively, indicating that there were no significant differences. Three cases of 4 metastatic mucosal malignant melanoma cases showed negative MLH1 response and MSH2 had 2 positive and 2 negative responses. Biopsy after metastasis represented negative conversion of nuclear activity in MLH1 in only on case, and this indicated a loss of activity as the disease progressed. Four except one of the metastatic cutaneous malignant melanoma cases showed negative staining of MLH1 and MSH2. CONCLUSION: We found decreased nuclear activity in MLH1 and MSH2 in the cutaneous malignant melanoma and mucosal malignant melanoma. This information can be applied for diagnosis or follow-up methods of malignancy in the future.

The Practical Role of Nasal Bone CT in the diagnosis of Nasal Bone Fractures / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The accurate diagnosis of nasal bone fracture by means of simple radiographs and physical examination is difficult in cases of severe soft tissue swelling or minimally displaced fracture. The purpose of this study is to evaluate the practical effectiveness of nasal bone CT for the diagnosis of nasal bone fracture. MATERIALS AND METHODS: The authors reviewed nasal bone CT and simple radiographs of 11 patients with nasal bone injury who were suspected to have nasal bone fracture after history taking and physical examinations. The nasal bone fracture was classified as one of three types on nasal bone CT : type I (simple fracture), type II (simple fracture with displacement) and type III (comminuted fracture). Associated facial bone injuries were also evaluated and simple radiographs of nasal bone were reviewed for comparison. RESULTS: Nine out of eleven patients showed followingfracture lines on nasal bone CT: 3 cases of type I, 4 cases of type II, and 2 cases of type III. Seven out of eleven patients showed fracture lines on simple radiographs, but one patient out of those seven showed no fracture lines on CT. Four patients showed no fracture lines on simple radiographs, but three of them showed fracture lines on CT. Out of three cases of type I fracture, only two cases were detected on plain radiographs. Four patients showed complicated nasal septal fracture on CT, which could not be detected on simple radiographs. One other patient had fracture of the frontal process of maxilla. Conclusion: Nasal bone CT is a useful tool for diagnosis of nasal bone fracture since it provides accurate identification and evaluation of associated injuries such as nasal septal fracture.

The Prognostic Value of DNA Flow Cytometry in Patients with Early Primary Oral Cavity and Oropharyngeal Squamous Cell Carcinoma / 대한이비인후과학회지

BACKGROUNDS AND OBJECTIVE: It has been known that tumor size, regional neck metastasis state and tumor thickness are the prognostic factors of oral cavity or oropharyngeal cancer. Additionally, DNA flow cytometry has also been reported to be one of the pronosic factors. We would like to evaluate the prognostic value of DNA flow cytometry in early oral cavity or oropharyngeal squamous cell carcinoma. MATERIALS AND METHODS: We analyzed the relation between tumor thickness or neck metastasis and survival rate in 59 patients with early oral cavity or oropharyngeal cancer. Among those patients, DNA flow cytometry was performed in 28 cases and the prognostic value of the parameters of DNA flow cytometry was analyzed. RESULTS: Overall, a 2-year survival rate of the patients was 90.1%. Neither tumor thickness nor neck metastasis state was related to the overall survival rate. Tumor thickness was not related to neck metastasis state, either. Of the parameters of the DNA flow cytometry, only the S phase fraction of aneuploidy was related to the overall survival rate (p=0.0288). Also the total proportion of aneuploidy was weakly related to the state of neck metastasis (p=0.0518). CONCLUSION: These results indicate that DNA flow cytometry can be used as a good complementary factor for predicting the overall survival or neck metastasis in patients with early primary oral cavity or oropharyngeal squamous cell carcinoma.

Clinical Characteristics of Chronic Paranasal Sinusitis in the Patients with End Stage Renal Disease

BACKGROUND AND OBJECTIVES: Infections account for much of the morbidity and nearly half of the mortality in renal transplant recipient. Recently there has been a marked increase in the number of renal transplantation and preoperative screening test for chronic paranasal sinusitis. Authors analyzed the clinical manifestations and postoperative courses after the endoscopic sinus surgery in the patients with end stage renal disease. MATERIALS AND METHODS: 1,175 patients had been consulted to the otolaryngology department for routine evaluations about the presence of acute and chronic paranasal sinusitis prior to kidney transplantation between Jun. 1989 to Aug. 1998. Among them, 30 patients were diagnosed as significant chronic paranasal sinusitis and 5 patients were treated with endoscopic sinus surgery. Medical records and radiographs of the 30 patients were reviewed retrospectively. RESULTS: The prevalence of chronic paranasal sinusitis in patients with end stage renal disease was 2.5%. Twelve patients were asymptomatic and chief complaints of symptomatic patients were nasal obstruction (55.6%), rhinorrhea (27.8%), and postnasal drip (16.7%). Eleven patients had nasal polyps and twelve patients showed purulent discharge. All the patients who were surgically treated experienced postopertive bleeding and 2 of them required transfusion. CONCLUSION: The presence of asymptomatic sinusitis among the patients with end stage renal disease necessitates diagnositc screening tests for chronic paranasal sinusitis. The incidence of postoperative bleeding after endoscopic sinus surgery in patients with end stage renal disease is much higher than that of otherwise healthy sinusitis patients.

Clinical Characteristics of Chronic Paranasal Sinusitis in the Patients with End Stage Renal Disease

BACKGROUND AND OBJECTIVES: Infections account for much of the morbidity and nearly half of the mortality in renal transplant recipient. Recently there has been a marked increase in the number of renal transplantation and preoperative screening test for chronic paranasal sinusitis. Authors analyzed the clinical manifestations and postoperative courses after the endoscopic sinus surgery in the patients with end stage renal disease. MATERIALS AND METHODS: 1,175 patients had been consulted to the otolaryngology department for routine evaluations about the presence of acute and chronic paranasal sinusitis prior to kidney transplantation between Jun. 1989 to Aug. 1998. Among them, 30 patients were diagnosed as significant chronic paranasal sinusitis and 5 patients were treated with endoscopic sinus surgery. Medical records and radiographs of the 30 patients were reviewed retrospectively. RESULTS: The prevalence of chronic paranasal sinusitis in patients with end stage renal disease was 2.5%. Twelve patients were asymptomatic and chief complaints of symptomatic patients were nasal obstruction (55.6%), rhinorrhea (27.8%), and postnasal drip (16.7%). Eleven patients had nasal polyps and twelve patients showed purulent discharge. All the patients who were surgically treated experienced postopertive bleeding and 2 of them required transfusion. CONCLUSION: The presence of asymptomatic sinusitis among the patients with end stage renal disease necessitates diagnositc screening tests for chronic paranasal sinusitis. The incidence of postoperative bleeding after endoscopic sinus surgery in patients with end stage renal disease is much higher than that of otherwise healthy sinusitis patients.

Cholesterol granuloma of the paranasal sinuses: Report of five cases / 대한이비인후과학회지

It is common to find cholesterol granuloma in the mastoid antrum and air cells of the temporal bone, but it is very rare in paranasal sinuses, especially in ethmoid sinus. Diagnosis is rarely suspected preoperatively, and depends on the finding of characteristic histological picture. It is currently thought that disturbed ventilation, impaired drainage and hemorrhage play a significant role in the formation of cholesterol granuloma. Five cases with cholesterol granuloma of the paranasal sinus, one that was limited to ethmoid sinus and the others of the maxillary sinuses, are presented and discussed.