A Case of Carcinoma with Sebaceous Differentiation arising in the Patient who was Treated with Parotid Gland Adenocarcinoma / 대한두경부종양학회지

Sebaceous carcinoma is extremely rare in the parotid gland. Recently, we experienced a case of carcinoma with sebaceous differentiation arising from the parotid gland in patient who was diagnosed as parotid adenoma carcinoma and underwent total parotidectomy.A 73-year-old male visited our department for the evaluation of 3-month history of infra-auricular mass combined with pain. Radiologic finding showed lobulated enhancing and solid mass with calcification in the right parotid gland. Initially, total parotidectomy with supraomohyoid neck dissection was performed. Pathological findings showed capsulated whitish mass with hemorrhage and cystic degeneration. Immunohistochemically, CK7, CK5/6, p63 were positive and CEA was negative. The intra-operative frozen section diagnosis was mucoepidermoid carcinoma. The permanent diagnosis was changed to adenocarcinoma, NOS(not otherwise specified). Fourteen months later, the newly developed mass was noticed on the operation bed. The mass was clinically diagnosed as recurred adenocarcinoma. Revision parotidectomy was performed and pathological findings revealed that the tumor was newly developed sebaceous carcinoma. We report a case of carcinoma with sebaceous differentiation in parotid gland with a review of literature.

Assessment of Change in Microbiology and Antibiotic Sensitivity of Deep Neck Infection Over 10 Years / 대한이비인후과학회지

Background and Objectives@#Treatment using systemic antibiotic administration and surgical drainage has been the common treatment modality for deep neck infection. This study compared the changing pattern of isolated pathogens to recommend the best empirical antibiotics for deep neck infection.Subjects and Method Reviewed retrospectively were medical charts of 131 patients who, confirmed with deep neck infection, underwent surgical drainage for pus cultures at Ewha Womans University Medical Center between January, 2009 and July, 2019. We analyzed the changing pattern of isolated pathogens and antibiotic susceptibility tests using their pus cultures. @*Results@#Streptococcus viridans was the most commonly isolated organism (35.1%), followed by Klebsiella pneumonia (13.7%) and Staphylococcus aureus (4.6%). The isolation rate of Streptococcus viridans increased in the recent 10 years [p=0.016, odds ratio (OR)=3.417]. Antibiotic susceptibility tests showed that all pathogens were resistant to ampicillin, but susceptible to ampicillin/sulbactam and cephalosporin. The isolation rate of clindamycin resistant pathogens was increased with statistical significance (p=0.020, OR=8.076). @*Conclusion@#Antibiotics effective against both Streptococcus viridans and Klebsiella pneumonia should be used as the first-line of treatment for deep neck infection. Ampicillin/sulbactam or amoxicillin/clavulanic acid were sufficient to treat deep neck infection empirically regardless of age or underlying diseases.

Feasibility of Intraoperative Parathyroid Hormone Monitoring in Minimally Invasive Surgery / 대한이비인후과학회지

Background and Objectives@#There has been a long debate on whether intraoperative parathyroid hormone (IOPTH) monitoring is mandatory or not in the excision of a single abnormal parathyroid gland. The aim of this study is to suggest a new criteron of IOPTH monitoring. Subjects and Method We retrospectively analyzed 31 patients who underwent parathyroidectomy from 2005 to 2019. Patients had IOPTH not measured and those with secondary hyperparathyroidism were excluded. IOPTH was measured preoperatively (EX00), at 10 minutes (EX10) and 20 minutes (EX20) after the excision and analyzed. We determined the surgery as a ‘successful excision of lesion (SEOUL)’ when it met the following criteria: criterion 1) the level of EX10 or EX20 decreased under the upper normal or under upper limit of parathyroid hormone (65 pg/mL); criterion 2) EX20 decreased below 50% of EX00 and less than 195 pg/ mL (3 times the upper normal limit); criterion 3) multiglandular disease. @*Results@#Twenty-five patients among 31 patients were included this study (M:F=8:17). Twenty- two patients were suspected of single lesion and three patients of multiple lesions on preoperative images (99mTc-sestamibi scan, neck CT, and PET-CT). IOPTH of EX00, EX10, and EX20 were 488.92±658.74, 121.36±134.73, and 92.44±111.55 pg/mL, respectively. Sixty-four percent patients (16/25) met the criterion 1. Six patients (24%) successfully excised a lesion meeting the criterion 2. Three patients had multiglandular disease, meeting the criterion 3. @*Conclusion@#Our new criteria suggest when we could stop the procedure. If the level of IOPTH does not meet the SEOUL criteria, it means that there might be more lesions.

A Case of Nontuberculous Mycobacterial Infection on Branchial Cleft Cyst / 대한이비인후과학회지

Nontuberculous mycobacteria (NTM) is commonly found in the surrounding environment and can cause opportunistic infection. Mainly, it causes lymph node infection in the cervical area, which is often known to occur in children. Recently, we have experienced a case of NTM infection on a branchial cleft cyst in a 36-year old male. NTM was diagnosed by fine needle aspiration and branchial cleft cyst was confirmed by postoperative pathologic findings. We report this case with a review of literature.

Development of Acellular Respiratory Mucosal Matrix Using Porcine Tracheal Mucosa

BACKGROUND@#Respiratory mucosa defects result in airway obstruction and infection, requiring subsequent functionalrecovery of the respiratory epithelium. Because site-specific extracellular matrix (ECM) facilitates restoration of organfunction by promoting cellular migration and engraftment, previous studies considered decellularized trachea an idealECM; however, incomplete cell removal from cartilage and mucosal-architecture destruction are frequently reported. Here,we developed a decellularization protocol and applied it to the respiratory mucosa of separated porcine tracheas. @*METHODS@#The trachea was divided into groups according to decellularization protocol: native mucosa, freezing–thawing (FT), FT followed by the use of Perasafe-based chemical agents before mucosal separation (wFTP), after mucosalseparation (mFTP), and followed by DNase decellularization (mFTD). Decellularization efficacy was evaluated by DNAquantification and hematoxylin and eosin staining, and ECM content of the scaffold was evaluated by histologic analysisand glycosaminoglycan and collagen assays. Biocompatibility was assessed by cell-viability assay and in vivotransplantation. @*RESULTS@#The mFTP mucosa showed low antigenicity and maintained the ECM to form a proper microstructure.Additionally, tonsil-derived stem cells remained viable when cultured with or seeded onto mFTP mucosa, and the in vivohost response showed a constructive pattern following implantation of the mFTP scaffolds. @*CONCLUSION@#These results demonstrated that xenogenic acellular respiratory mucosa matrix displayed suitable biocompatibilityas a scaffold material for respiratory mucosa engineering.

Development of Acellular Respiratory Mucosal Matrix Using Porcine Tracheal Mucosa

BACKGROUND@#Respiratory mucosa defects result in airway obstruction and infection, requiring subsequent functionalrecovery of the respiratory epithelium. Because site-specific extracellular matrix (ECM) facilitates restoration of organfunction by promoting cellular migration and engraftment, previous studies considered decellularized trachea an idealECM; however, incomplete cell removal from cartilage and mucosal-architecture destruction are frequently reported. Here,we developed a decellularization protocol and applied it to the respiratory mucosa of separated porcine tracheas. @*METHODS@#The trachea was divided into groups according to decellularization protocol: native mucosa, freezing–thawing (FT), FT followed by the use of Perasafe-based chemical agents before mucosal separation (wFTP), after mucosalseparation (mFTP), and followed by DNase decellularization (mFTD). Decellularization efficacy was evaluated by DNAquantification and hematoxylin and eosin staining, and ECM content of the scaffold was evaluated by histologic analysisand glycosaminoglycan and collagen assays. Biocompatibility was assessed by cell-viability assay and in vivotransplantation. @*RESULTS@#The mFTP mucosa showed low antigenicity and maintained the ECM to form a proper microstructure.Additionally, tonsil-derived stem cells remained viable when cultured with or seeded onto mFTP mucosa, and the in vivohost response showed a constructive pattern following implantation of the mFTP scaffolds. @*CONCLUSION@#These results demonstrated that xenogenic acellular respiratory mucosa matrix displayed suitable biocompatibilityas a scaffold material for respiratory mucosa engineering.

A Case of Intraductal Papilloma arising in the Parotid Gland / 대한두경부종양학회지

Intraductal papilloma is an extremely rare benign tumor especially when it arises from major salivary gland. Recently, we experienced a case of an intraductal papilloma arising from the parotid gland in a 51-year-old woman. The radiologic finding showed lobulated enhancing and cystic solid mass in the left parotid superficial lobe. Superficial parotidectomy was performed. Pathological findings showed papillary proliferations with fibrovascular cores lined with bland cuboidal or columnar epithelial cells, and immunohistochemical stain results were consistent with intraductal papilloma. We report a case of intraductal papilloma in parotid gland with a review of literature.

A Case of Thyroarytenoid Myoneurectomy Using LASER and Monopolar Electrical Device in Spasmodic Dysphonia

Spasmodic dysphonia is a focal laryngeal dystonia that results in involuntary spasms during speech. The etiology of spasmodic dysphonia is not yet defined, but it is presumed to be a neurological abnormality of central nervous system motor function. The treatment of choice for spasmodic dysphonia is botulinum toxin injection directly at the laryngeal muscles. However botulinum toxin injection requires repeated procedures. Many different kinds of surgical treatments have been introduced but the recurrence rate is still high. So we performed myomectomy with LASER and neurectomy with specially designed electrical surgical knife which can cut recurrent laryngeal nerve branch selectively with its noble curved section. We report a case of a 43-year-old male patient with spasmodic dysphonia treated by thyroarytenoid myoneurectomy.

A Case of Pseudoaneurysm of the Superior Thyroid Artery after Core Needle Biopsy

A pseudoaneurysm is a collection of blood that locates between the two outer layers of an artery, the muscularis propria and the adventitia. It is resulted from disruption of a portion of the arterial wall. A pseudoaneurysm can be caused by trauma, blood vessel intervention, intravenous drug use, vasculitis, infectious aneurysm, and postoperative anastomotic leakage. The pseudoaneurysm of superior thyroid artery after core needle biopsy is rare. We report a case of pseudoaneurysm caused by thyroid core needle biopsy and treated by surgical treatment.

An analysis of consultations requested to a pain clinic

BACKGROUND: The study investigated in detail the current status of the consultations requested in a pain clinic. We evaluated the characteristics of the consultations to determine the kind of contents requested, referring departments and factors including demographics, co-morbidities, previous medical problems, and the descriptions of the reasons for the consultation to the pain clinic. METHODS: Clinical data were collected in the authors' institution between 1 January 2009 and 31 December 2013. The medical records were reviewed and compared. Characteristics of both outpatients and inpatients were analysed. RESULTS: Data from 1,140 patients was available for this study. Seven hundred thirteen individuals belonged to the outpatient group and 427 individuals belonged to the inpatient group. Orthopedic surgery, neurosurgery, and otolaryngology were the main departments that requested consultations to the pain clinic. The most frequent requested lesion and diagnostic term were low back and lumbar spinal stenosis, respectively, and the most common reason for consulting was for "control of pain not controlled by medications." Factors that were significantly different between the two groups were gender, questions about other illnesses apart from the main diagnoses, history of specific diseases, acute onset, cancer, operation within 3 months, and physical system abnormalities. CONCLUSIONS: The medical problems addressed by a pain clinic consultation service were diverse. It is rational to develop standardized guidelines for pain consultations, and treatment strategies aimed at alleviating pain per se as well as caring for comorbid conditions.

A Case of Bilateral Vocal Fold Paralysis Induced by Concurrent Rheumatoid Arthritis Involvement of Laryngeal Nerve and Cricoarytenoid Joint

Rheumatoid arthritis (RA) is a connective tissue disease involving the larynx in 30% of the patients. Foreign body sensation, hoarseness, and cough are common symptoms in laryngeal involvement. An urgent tracheostomy is required when acute airway obstruction occurs in case of bilateral vocal fold paralysis. The most common cause of bilateral vocal fold paralysis in RA patients is a cricoarytenoid joint arthritis. Laryngeal nerve degeneration is rare cause of bilateral vocal fold paralysis in RA patients. In this case report, an emergent tracheostomy was performed on a 64-years-old male patient with acute dyspnea, and concurrent involvement of RA on laryngeal nerve and cricoarytenoid joint was revealed by laryngeal electromyography and histopathology. The vocal fold mobility was restored after 3-months medical treatment.

The Development of an Automatic Chronic Otitis Media Operation Recording System with Concurrent Data Input Process / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It takes considerable time and effort to make an operation record for the chronic otitis media. Also there are risks of incorrectness or omission of data. We developed an automatic operation recording system in order to reduce the burden of the resident keeping the record and to give completeness to the operation data. SUBJECTS AND METHOD: The model-view-controller (MVC) pattern isolates the domain logic (controller) from the user interface (data model-view), permitting independent development. We used the MVC pattern to design the program it since it matched with the feature of the operation recording system. RESULTS: We implemented this system using the Python programming language, which is composed of 98 fields and 4 different types of widgets linked to those fields. The outputs of the 4 views can be easily copied and pasted to the word processor and the electronic medical recorder. In the pilot test, this system reduced significant amount of time and effort needed for operation recording. CONCLUSION: The automatic operation recording system reduces the resident's works and the operation data loss. Furthermore, it could be applied to other types of operation records.

Porous Polyurethane Scaffold as a Tracheal Prosthesis Material / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The purpose of this study was to confirm the usefulness of the porous polyurethane scaffold as a tracheal prosthesis for repair of partial tracheal defect. SUBJECTS AND METHOD: A porous polyurethane (PU) scaffold was manufactured by salt-leaching method. Polyethylene glycol (PEG) was grafted onto the surface of the PU scaffold following surface ozonation treatment. Scanning electro-microscopy (SEM) was then performed to evaluate the morphklogy. For the biocompatibility evaluation, a 5x5 mm sized PU scaffold was implanted into the rabbit's ear. A histological examination was performed with the tissue one month later. Polymerase chain reaction for tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, procollagen, fibromodulin, fibronectin, and actin was also performed. The tensile strength was measured and compared with beagle's trachea to evaluate the mechanical property of the prosthesis. RESULTS: The effect of ozonation and surface grafting with PEG was on the porous scaffold was confirmed by SEM and X-ray photoelectron spectroscopy. The histological examination showed a large amount of fibrous tissue and capillary had grown through the pores of the porous scaffold. The inflammatory reaction was not so severe. TNF-alpha and IL-6 were slightly elevated in the PU scaffold transplanted tissue. However, the concentration levels of the other cytokines were similar between transplanted tissue and normal tissue. The tensile strength was very similar with the beagle's normal trachea. CONCLUSION: The polyethylene grafted polyurethane scaffold is a good candidate prosthesis for tracheal reconstruction.

Blood Cyst of Subvalvular Apparatus of the Mitral Valve in an Adult

Blood cysts of the heart are rare benign tumors, usually involving the cardiac valves. They are found mainly in the first month of life and in children; and are rarely seen in adults. Here, we report a case of a blood cyst on the subvalvular apparatus of the mitral valve, which was incidentally discovered during chest computed tomography in a 47-year-old man. To the best of our knowledge, this is the first reported case of blood cyst of the heart in an adult in Korea.

Incidentally Detected Situs Ambiguous in Adults

Situs ambiguous is rare congenital anomaly in adults. In 2 adult patients who admitted for different cardiac problems, situs ambiguous with polysplenia was detected. A 42-year-old male admitted for radio frequent catheter ablation of atrial fibrillation, and he had left-sided inferior vena cava (IVC), hepatic segment of IVC interruption with hemiazygos continuation, multiple spleens and intestinal malrotation. And in a 52-year-old female case who was hospitalized due to infective endocarditis after implanting pacemaker for sick sinus syndrome, multiple spleens, left-sided stomach, bilateral liver with midline gallbladder, and left-sided IVC were found. Those findings were consistent with situs ambiguous with polysplenia, but their features were distinctive.

Two Cases of Percutaneous Intervention for Coronary Artery Bypass Graft Anastomoses With Paclitaxel-Eluting Balloon Catheters

Coronary artery bypass graft (CABG) intervention, particularly anastomosis site intervention, is challenging for interventional cardiologists. A paclitaxel-eluting balloon catheter (SeQuent Please) is a recently-introduced device capable of delivering paclitaxel homogeneously into the targeted vessel wall. We herein report our experience with two cases. In the first case, coronary angiography showed significant stenosis at the site of anastomosis between the saphenous vein graft and the left anterior descending artery (LAD). In the second case, coronary angiography showed significant stenosis at the site of anastomosis between the left internal mammary artery and the LAD. We performed percutaneous intervention of these CABG anastomoses using paclitaxel-eluting balloon catheters, and obtained favorable angiographic and clinical outcomes.

A Case of Supernumerary Tooth within Fungus Ball in the Maxillary Sinus / 대한이비인후과학회지

The ectopic eruption of a supernumerary tooth can occur in the sinonasal area, but due to its rarity, few cases of ectopic tooth eruption in the maxillary sinus have been reported. A fungus ball in the paranasal sinuses usually involves just one sinus, most frequently the maxillary sinus. Here, the authors present a case of an ectopic supernumerary tooth embedded in a fungus ball of the maxillary sinus.

Spontaneous Visceral Artery Hemorrhage in a Patient with Systemic Lupus Erythematosus Combined with Antiphospholipid Syndrome: A Case Report / 대한류마티스학회지

Spontaneous visceral hemorrhage is a rare complication of systemic lupus erythematosus (SLE). We report here on a 55-year old male with SLE and who presented with acute abdominal pain due to bleeding of the hepatic artery and the splenic artery. Angiography revealed a spontaneous hemorrhage from branches of the hepatic artery and the splenic artery. We report here on a case of spontaneous recurrent non-traumatic hemorrhage of a visceral artery in a patient with secondary antiphospholipid syndrome (APS), and such a condition has not been previously described in a Korean patient with SLE.

A case of HELLP syndrome accompanied by retinal detachment / 대한내과학회지

Weinstein et al. first described the HELLP (hemolytic anemia, elevated liver enzymes, and low platelets) syndrome in 1982. The incidence of HELLP syndrome is 0.2~0.6% in normal pregnant women and 4~12% in women with preeclampsia. This syndrome is accompanied by serious medical complications, including hepatic and renal failure, coagulopathy, hypertension, and pulmonary edema. Retinal detachment is an unusual, but well documented, complication of hypertensive disorder in pregnancy affecting 0.2~2% of patients with severe preeclampsia and 0.9% of patients with HELLP syndrome. This paper reports on a patient with HELLP syndrome accompanied by retinal detachment who recovered after controlling the blood pressure and receiving systemic steroids.

A Case of Esophageal Gastrointestinal Stromal Tumor Treated by Endoscopic Submucosal Dissection following an Initial Mucosectomy Using a Transparent Cap / 대한소화기내시경학회지

Gastrointestinal stromal tumor (GIST) is the most common mesenchymal neoplasm of the gastrointestinal (GI) tract, but the lesion occurs rarely in the esophagus. Although only 10~30% of GISTs are malignant at the time of diagnosis, many reports show that it is difficult to predict the prognosis and underlying potential of non-malignant ones. Thus, the surgical removal of GISTs is even being proposed as a standard treatment. Recently the endoscopic removal of submucosal tumors of the GI tract is being done in popular, but it has been still considered as both difficult and risky to resect a tumor originating from the muscularis propria layer using the endoscopic methods. Herein, we report a case of an incidentally found submucosal tumor originating from the muscularis propria treated with an endoscopic submucosal dissection method which was performed after a preceding mucosectomy using a transparent cap. The mass turned out to be an esophageal GIST.