Laparoscopic Repair for Enterocutaneous Fistula Caused by Laparoscopic Right Hemicolectomy for Pan-Peritonitis due to Cecal Cancer Perforation

Enterocutaneous fistula (ECF) can occur after any intra-abdominal procedure and is a concern for most surgeons. We report a case of laparoscopic treatment of an ECF in a 65-year-old male patient who had undergone a laparoscopic right hemicolectomy for peritonitis due to perforated colon cancer four months previously. Two weeks after discharge from the hospital, he visited the outpatient clinic complaining of a malodorous abscess draining from the right trocar site. Although we allowed two months for the fistula to close naturally, it did not close and formed an abscess. The patient subsequently underwent a laparoscopic colectomy of the fistula between the colonic stump and the skin. The operation time was 110 minutes, and he was discharged 10 days after surgery without any postoperative complication.

Phantom Study of a New Laser-Etched Needle for Improving Visibility During Ultrasonography-Guided Lumbar Medial Branch Access With Novices

OBJECTIVE: To compare the visibility and procedural parameters between a standard spinal needle and a new laser-etched needle (LEN) in real-time ultrasonography guided lumbar medial branch access in a phantom of the lumbosacral spine. METHODS: We conducted a prospective single-blinded observational study at a rehabilitation medicine center. A new model of LEN was manufactured with a standard 22-gauge spinal needle and a laser etching machine. Thirty-two inexperienced polyclinic medical students performed ultrasonography-guided lumbar medial branch access using both a standard spinal needle and a LEN with scanning protocol. The outcomes included needle visibility score, needle elapsed time, first-pass success rate, and number of needle sticks. RESULTS: The LEN received significantly better visibility scores and shorter needle elapsed time compared to the standard spinal needle. First-pass success rate and the number of needle sticks were not significantly different between needles. CONCLUSION: A new LEN is expected to offer better visibility and enable inexperienced users to perform an ultrasonography-guided lumbar medial branch block more quickly. However, further study of variables may be necessary for clinical application.

The Ratio-Based N Staging System Can More Accurately Reflect the Prognosis of T4 Gastric Cancer Patients with D2 Lymphadenectomy Compared with the 7th American Joint Committee on Cancer/Union for International Cancer Control Staging System

PURPOSE: The utility of N classification has been questioned after the 7th edition of the American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) was published. We evaluated the correlation between ratio-based N (rN) classification with the overall survival of pathological T4 gastric cancer patients who underwent D2 lymphadenectomy. MATERIALS AND METHODS: We reviewed 222 cases of advanced gastric cancer patients who underwent curative gastrectomy between January 2006 and December 2015. The T4 gastric cancer patents were classified into four groups according to the lymph node ratio (the number of metastatic lymph nodes divided by the retrieved lymph nodes): rN0, 0%; rN1, ≤13.3%; rN2, ≤40.0%; and rN3, >40.0%. RESULTS: The rN stage showed a large down stage migration compared with pathological T4N3 (AJCC/UICC). There was a significant difference in overall survival between rN2 and rN3 groups in patients with pT4N3 (P=0.013). In contrast, the difference in metastatic lymph nodes was not significant in these patients (≥16 vs. <15; P=0.177). In addition, the rN staging system showed a more distinct difference in overall survival than the pN staging system for pathological T4 gastric cancer patients. CONCLUSIONS: Our results confirm that rN staging could be a good alternative for pathological T4 gastric cancer patients who undergo D2 lymphadenectomy. However, before applying this system to gastric cancer patients who undergo D2 lymphadenectomy, a larger sample size is required to further evaluate the usefulness of the rN staging system for all stages, including less advanced stages.

Atypical Traumatic Pneumorrhachis Accompanied by Paraparesis

Pneumorrhachis, caused by intraspinal air, is an exceptional but important radiographic finding that is accompanied by different etiologies. Pneumorrhachis, by itself, is usually asymptomatic and gets reabsorbed spontaneously. Therefore, the patients with pneumorrhachis are mostly managed conservatively. We encountered a unique case of atypical traumatic pneumorrhachis accompanied by paraparesis.

Paraplegia due to Spinal Epidermoid Cyst Rupture at Asthma Attack

Spinal epidermoid cyst is less than 1% of the entire spinal cord tumor and a rare tumor. It is a slowly proliferating benign tumor and can be a result of either congenital or acquired factors. In particular, reports of acute paraplegia due to spinal epidermoid cyst rupture are very rare. Since authors experienced paraplegia resulting from congenital spinal epidermoid cyst rupture during an asthma attack, it is reported with a review of literature.

The Complicated Changes of External Nose after Corrective Rhinoplasty / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Rhinoplasty is not a simple technique but a series of interrelated, interdependent surgical maneuvers performed consequently. Each maneuver should be calculated to correct the total nasal deformity by creating a series of small defects or repositioning various anatomic components that must ultimately fit together. The purpose of this study is to review undesirable complicated changes that occur in the external nose following corrective rhinoplasty and to provide useful reference for better practice in rhinoplasty. MATERIALS AND METHODS: We have carried out 42 cases of corrective rhinoplasty from January, 1994 to December, 1998. We have observed complicated changes of the external nose after corrective rhinoplasty by conducting serial photogaphic documentation and analyses, questionnaires which were answered by the patients and the surgeons. RESULTS: We analyzed the various undesirable complicated changes and found out that the most common changes were widening of the nasal dorsum. The major causes of this nasal widening were the failure of perfect osteotomy, inadequate postoperative contouring, aging process of patients' nose, and the lack of ability of surgeon to predict the healing dynamics. CONCLUSION: To prevent and to minimize such undesirable changes following corrective rhinoplasty, surgeons need to gain skillful surgical techniques and adequate postoperative contouring skills. Most importantly, a thorough appreciation and understanding of the healing dynamics of rhinoplasty should be recognized.

Clinical Analysis of Epistaxis : Result of the Recent 10 Years / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Epistaxis is a common occurrence and most of us have at least one episode in a life time. These episodes are usually minor events and resolved spontaneously, although those who need help can be admitted. It is important to know about etiologic factors of each case of epistaxis, sex and age distribution of patients, bleeding site, seasonal incidence and methods of management. MATERIAL AND METHOD: We performed a retrospective study of epidemiology, etiology and control methods and their effectiveness in patients of epistaxis who visited Korea Veterans Hospital out-patient department in otolaryngology and emergency room from January, 1990 to December, 1999. RESULTS: It was more prevalent in male and commonly occured in the left nasal cavity. Incidence of epistaxis was the greatest in the month of May and the least in August. Among the age groups of patients, it was most prevalent among the fifties followed by the twenties. The most common cause was idiopathic, with the local causes being more attributable. It was found to easily occurr in the convex side with septal deformity. Kiesselbach's area was the most common bleeding site, although when compared with previous reports, the incidence rate has been decreasing. Recurrent bleeding was more common in posterior epistaxis. Most cases were adequately managed with anterior nasal packing (65.4%), but in the minority, posterior nasal packing and blood transfusion were needed. CONCLUSION: Incidence of bleeding have increased and the most frequent bleeding sites have become more variable, because of the increasing rate of air pollution, cerebrovascular accidents and heart diseases. Epistaxis easily occurred when the atmospheric changes were severe. Further prospective studies are mandatory to clarify the correlation between epistaxis and multifactorial causes.

Evaluation of Augmentation Rhinoplasty and Tip Surgery Using Cartilage Autograft by Standardized Lateral View of Photodocumentation / 대한이비인후과학회지

BACKGROUND AND OBJECTIVE: Nasal tip projection and dorsal realignement are important defining features of nasal profile. Recently, the use of rhinoplasty has increased by rhinologic surgeons and good cosmetic results have been reported. But, sufficient analysis of postoperative results is not presented in augmentation rhinoplasty. We aimed to evaluate the augmentation rhinoplasty using pre- and postoperative lateral view under similar conditions. MATERIALS AND METHODS: We performed 22 cases of augmentation rhinoplasty with cartilage auteograft (8 males and 14 females, aged 21 to 53 years) between September 1997 and August 1998. Using lateral view, pre- and postoperative nasofrontal, nasofacial, nasolabial, nasal tip rotational angle, and height of nasion, depth of the nasion, tip projection, tip angle were analysed. RESULTS: The increment of nasofrontal angle was 3.3degreesin males and 3.8degrees in females. The increment of height of the nasion was 1.4 mm in males and 2.1 mm in females, and the increment of tip projection was 1.3 mm in males and 1.7 mm in females, and the increment of tip angle was 1.6degreesin males and 2.1degreesin females. The increment of nasofacial angle was 2.9degrees in males and 3.9degrees in females, and the increment of nasolabial angle was 0degrees in males and 1.6degreesin females. The increment of nasal tip rotational angle was 0.2degrees in males and 0.7degreesin females, respectively. CONCLUSION: We achieved good cosmetic results by cartilage autograft and hoped to increase the efficacy of augmentation rhinoplasty in future, based on this study.