Primary Adenocarcinoma of Duodenum Located in Third Portion Cured by Wedge Resection

Primary adenocarcinoma of duodenum is an uncommon neoplasm. Besides its rarity, vague symptoms and signs with the lack of physical findings can delay diagnosis and result in poor treatment outcome. Aggressive surgical managements including pancreaticoduodenectomy was generally recommended for localized cancers despite high operational mortality. However, if early stage cancer is detected, wedge resection can be a therapeutic option. The authors encountered a 2.5x1.5 cm sized subepithelial tumor like mass with spontaneous bleeding and central dimpling located in the third portion of duodenum on esophagogastroduodenoscopy. After repeated deep biopsy, the patient underwent wedge resection and regional lymph node dissection of the duodenum. Finally, the mass was proven as adenocarcinoma and the patient remains in good condition without recurrence for over 2 years. Due to it's low incidence and high mortality, meticulous endoscopic examination of duodenum is essential for early diagnosis and limited operational methods may improve survival and quality of life of patients.

Primary Adenocarcinoma of Duodenum Located in Third Portion Cured by Wedge Resection

Primary adenocarcinoma of duodenum is an uncommon neoplasm. Besides its rarity, vague symptoms and signs with the lack of physical findings can delay diagnosis and result in poor treatment outcome. Aggressive surgical managements including pancreaticoduodenectomy was generally recommended for localized cancers despite high operational mortality. However, if early stage cancer is detected, wedge resection can be a therapeutic option. The authors encountered a 2.5x1.5 cm sized subepithelial tumor like mass with spontaneous bleeding and central dimpling located in the third portion of duodenum on esophagogastroduodenoscopy. After repeated deep biopsy, the patient underwent wedge resection and regional lymph node dissection of the duodenum. Finally, the mass was proven as adenocarcinoma and the patient remains in good condition without recurrence for over 2 years. Due to it's low incidence and high mortality, meticulous endoscopic examination of duodenum is essential for early diagnosis and limited operational methods may improve survival and quality of life of patients.

Effectiveness of Suppressive Therapy with Levothyroxine in Benign Thyroid Nodules / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The effectiveness of suppressive therapy with Levothyroxine in benign thyroid nodule is controversial. The favorable response varies between 9-68%. The aim of this study was to evaluate the effect of Levothyroxine suppressive therapy on benign thyroid nodules in comparison with untreated patients. SUBJECTS AND METHOD: A total 98 patients diagnosed with benign thyroid nodules by high resolution ultrasonography and fine needle aspiration cytology from January 2001 to June 2007 was evaluated retrospectively. The case group included 55 patients who received Levothyroxine suppressive therapy for longer than 6 months with documentation of thyroid stimulating hormone (TSH) suppression level. The control group included 43 patients who were followed up without any treatment. We measured TSH, free T4, and thyroid nodule volume by ultrasound every 6 months. RESULTS: In 13 patients (23.6%) of the case group, nodule volume decreased more than 50% after the Levothyroxine suppressive therapy. In 10 (23.2%) of the control group, nodule volume decreased more than 50 % after the follow-up of 6 months. There was no significant difference between the two groups. The change of nodule volume was not related to the TSH suppression level, the number of nodule or the type of nodule. CONCLUSION: We concluded that Levothyroxine suppressive therapy was not effective in volume reduction of benign thyroid nodules.

The Significance of Orbital Preservation in Surgery of the Sinonasal Malignancies / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Preservation of orbital contents during surgery of paranasal sinus malignant tumors encroaching on the orbit remains a controversial issue. The purpose of this study is to investigate significance of orbital preservation in the surgery of sinonasal malignancies abutted orbit in view of oncological safety and functional outcome. SUBJECTS AND METHOD: A retrospective review was conducted using medical records of 41 patients who underwent surgery between Mar 1991 and Feb 2006 for sinonasal malignancies abutting or eroding orbit. RESULTS: Among 41 cases of sinonasal tract malignancies abutting or invading into the orbit, thirty-four of 41 tumors were amenable for surgical treatment with orbital preservation and the remaining 7 underwent orbital exenteration. 71.4% (5/7) of the patients whose orbit was exenterated had local recurrence, compared with 20.5% (7/34) of the patients whose orbit was preserved. The 5-year survival rate was 50.0% in the orbit exenterated group and 59.9% in the orbit preserved group. This difference was not statistically significant (p> 0.05). In the preservation group, local recurrence rate was 27.1% (2/9) in the periorbita involvement group, 22.2% (2/9) in the bony destruction group and 14.3% (2/14) in the abutting orbit group. There is no statistically significant difference among three groups. Although some patients had problems, the fact that all patients retained their orbit demonstrates adequate visual acuity. CONCLUSION: Local recurrence and survival rate were not significantly different between the orbital preservation and exenteration group and also between the bony destruction and periorbita involvement group. So, in the selected case of periorbita invasion, orbital preservation could be considered.

Orbital Apex Syndrome in a Patient with Sphenoid Fungal Balls

Orbital apex syndrome (OAS) is a rare disease that presents with a complex of symptoms, including ophthalmoplegia, ptosis and visual loss. Due to the poor prognosis, making a prompt diagnosis and administering the appropriate treatment must be initiated without delay if OAS is suspected. We report here on a case of a patient with sphenoid fungal balls, and he presented with acute visual loss and ophthalmoplegia.

Diagnostic and Surgical Approaches of the Parapharyngeal Space Tumors / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Tumors originating in the parapharyngeal space are rare, accounting for about 0.5% of all head and neck tumors. The anatomic characteristics of the parapharyngeal space makes clinical examination of this area difficult and unreliable method for assessment of these tumor. This study was performed to evaluate the proper diagnostic and surgical approaches for the parapharyngeal space tumors with our experiences. SUBJECTS AND METHOD: During the period from January 1998 to December 2006, 34 patients underwent surgery for parapharyngeal space tumors. We reviewed medical records and imaging study retrospectively. RESULTS: 82.4% (28/34) of the parapharyngeal space tumors were benign; 17.6% (6/34) were malignant. 41.2% (14/34) were of salivary glandular origin, 35.3% (12/34) were of neurogenic origin, and 23.5% (8/34) were of miscellaneous origin. 76.5% (26/34) of cases had been performed fine needle aspiration cytology (FNAC) before surgery. 14 of 19 patients (73.7%) who had a diagnostic sample had a correct or highly suggestive diagnostic finding. Most of the parapharyngeal space tumors were treated with transcervical (44.1%;15/34) or transparotid (44.1%; 15/34) approach, and transparotidcervical approach was performed in 4 patients (11.8%). All patients with salivary gland tumor were located in the prestyloid space, and most (92.9%) of them were treated with transparotid approach. Most patients (91.7%) with neurogenic tumor were located in the poststyloid space and treated with transcervical approach. CONCLUSION: In our study, the origin and location of the parapharyngeal space tumors were correlated with surgical approaches (p<0.05). Preoperative FNAC showed high accuracy to diagnose the tumor in the parapharyngeal space.

The Obstetrical Study on Pregnancy and Delivery of Unmarried Mother / 대한주산의학회잡지

OBJECTIVE: This study is focused on providing baseline data to help and guide unmarried mothers throughout their pregnancy and delivery. METHODS: We surveyed 165 unmarried mothers who gave birth from January, 2003 to December, 2006 at Seoul Red Cross Hospital. They were divided into three age groups; 10's group, 20's group, and 30's to 40's group, and obstetric and social aspects of each group was analyzed with Chi-square test (x2), ANOVA, using SPSS (Ver. 10.0) verified with 95% of significance level. RESULTS: In this study, 61.1% of all unmarried mothers were in their 20's. Unmarried mothers were examined on the average 3.88 times before giving birth and 53.3% of them recognized their pregnancy before 3 months gestation. Unmarried mothers depend upon, mass communication such as the internet for medical information. Cesarean section rate was 21.8%, and the older the unmarried mothers are, the higher it gets. 22.2% of unmarried mothers have a higher education background; presently college students or above. Their smoking rate was 53.3%, which means more than half of them have smoked. 70.3% of the mothers in the survey wanted their children to be adopted after delivery. CONCLUSION: In this time of lowering birth rates, we should reconsider today's fragmentary welfare policies which only provide financial aid for delivery. It is necessary to provide welfare services which can cover delivery and rearing as well, so unmarried mothers choose to bring up their own children instead of sending the children off for adoption.

Significance of Modified Radical Neck Dissection Type III in Node-Positive Neck in Patients with Head and Neck Squamous Cell Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The most significant prognostic factor in patients with squamous cell carcinoma of the head and neck is the presence of cervical nodal metastases. Until 1960s, radical neck dissection (RND) was the standard surgical treatment of the cervical lymphatic nodes. However, with increasing recognition of the substantial morbidity of radical surgery, more emphasis is being placed on surgical conservatism if it does not negatively impact disease control and if it offers improved postoperative function and cosmesis. We performed this retrospective study to evaluate the oncologic and functional efficacy of a modified radical neck dissection type III (MRND type III) that spares the spinal accessory nerve (SAN), internal jugular vein (IJV) and sternocleidomastoid (SCM) muscle in patients with pathologically node-positive squamous cell carcinoma of the head and neck. SUBJECTS AND METHOD: We studied retrospectively the results of 66 comprehensive neck dissections performed on 61 patients with pathologically positive nodal metastases from squamous cell carcinoma of the head and neck between August, 1995 and January, 2005. We analyzed the regional recurrence rates, the patency of the preserved IJV and the cross sectional area of the SCM muscle in patients who had a MRND type III. RESULTS: Regional recurrence rates [RND or extended RND (ERND) group: 18.2%; MRND type I or II group: 21.4%; MRND type III group: 15.9%] were not statistically different between the MRND type III and other comprehensive neck dissection groups (p=NS). After the MRND type II or III, IJV were significantly narrowed in 5 patients (10.9%), the overall blood flow was still intact. There was no evidence of the intraluminal thrombosis in this study. The cross-sectional area of the preserved SCM muscles (n=44) was reduced by 12.7% (+/-9.6%). But, no patient showed significant morphological change and functional disability of the SCM muscle. CONCLUSION: The MRND type III in the pathologically node-positive neck does not adversely affect neck control. Despite some narrowing of IJVs and atrophic change of SCM muscles after MRND type III, they reported satisfactory functional and cosmetic outcomes.

Gasless Endoscopic Thyroidectomy by an Axillary Approach(Preliminary Report) / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Surgical treatments for thyroid diseases require skin incisions that can result in prominent scars in the anterior neck. For a reduction in scar size or the elimination of scar in the neck, the various kinds of minimally invasive thyroidectomies were reported. In this study, we report our early experience of endoscopic thyroidectomy by the axillary approach. SUBJECTS AND METHOD: Between February 2005 and October 2005, 12 patients underwent endoscopic thyroidectomy by gasless axillary approach. We assessed pathologic diagnosis, duration of operation, size of thyroid tumor and complication of our experiment of endoscopic thyroidectomy. RESULTS: Endoscopic procedures were performed successfully in 11 cases (3 total lobectomy, 5 subtotal lobectomy and 3 lumpectomy). Conversion to conventional thyroidectomy was required in one patient because of recurrent laryngeal nerve injury and tracheal laceration. Final histopathologic diagnoses were 7 cases of adenomatous hyperplasia, 4 follicular adenoma, 1 papillary carcinoma. The mean operating time was 302 minutes and it gradually became shorter. CONCLUSION: Gasless endoscopic thyroidectomy via axillary approach may be a safe and technically feasible procedure that leads to an improved cosmetic result.

The Diagnosis of Laryngopharyngeal Reflux: The Role of Esophageal Mucosal Biopsy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The reflux symptoms, laryngoscopic findings and 24-hour dual-probe pH monitoring are main diagnostic tools for laryngopharyngeal reflux disease. In particular, 24-hour dual-probe pH monitoring is the most specific and sensitive test, but some patients tend to fail the test due to discomfort. Eosinophilia in the esophageal mucosa may be diagnostic of gastroesophageal reflux disease, but esophageal biopsy has rarely been studied in laryngopharyngeal reflux. In this study, to discover another or alternative diagnostic tools that might help in the diagnosis of laryngopharyngeal reflux, we investigated the significance of esophageal mucosal biopsy in patients with laryngopharyngeal reflux symptoms. SUBJECTS AND METHOD: The study group consisted of 110 patients with laryngopharyngeal reflux symptoms and all patients were evaluated by 24 hour dual probe pH monitoring. The results of the 24 hour dual probe pH monitoring was compared with reflux symptom index (RSI), reflux finding score (RFS), gastroesophagoscopic findings, esophagogram and esophageal mucosal biopsy. RESULTS: In 61 of the 110 patients, laryngopharyngeal reflux were confirmed by 24 hour dual probe pH monitoring. The mean RSI and RFS of the laryngopharyngeal reflux group was higher (7.3+/-2.5, 6.0+/-3.9) than those of the group without laryngopharyngeal reflux (6.3+/-3.5, 4.6+/-2.9). Intraepithelial eosinophils in proximal esophageal biopsy was correlated with laryngopharyngeal reflux by 24-hour dual-probe pH monitoring. CONCLUSION: Esophageal mucosal biopsy is a reliable diagnostic test for laryngopharyngeal reflux and it could be used for patients who tend to fail 24-hour dual-probe pH monitoring due to discomfort.

Radiologic Diagnosis and Surgical Treatment of Primary Hyperparathyroidism / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: With the advance in serum chemical analyses, the diagnosis of primary hyperparathyroidism has become more common, and patients without signs or symptoms attributable to the disease have increased. We performed this study to obtain further understanding and more supporting ideas for the diagnosis and treatment of primary hyperparathyroidism. SUBJECTS AND METHOD: A retrospective study of 19 patients with primary hyperparathyroidism who were treated by surgery from march 1999 to June 2005 was performed. RESULTS: Preoperative localization was performed with computerized tomography, ultrasonography and 99m Tc-sestamibi scan. A 99m Tc-sestamibi scan has an accuracy of 84% and ultrasonography has an accuracy of 67% for parathyroid tumors. Combination of ultrasonography and 99m Tc-sestamibi scan had the accuracy of 93%. All patients were treated by surgery. After surgery, serum calcium and intact parathyroid hormone levels returned rapidly to normal. Parathyroid carcinomas were firm in consistency and adhered to the surrounding tissue and thyroid gland. CONCLUSION: Ultrasonogram and 99m Tc-sestamibi scan was effective for preoperative localization of tumor. If parathyroid carcinoma is suspected, the mass with potential local invasion or regional metastasis should be removed with en bloc resection.

Effect of Granisetron Plus Dexamethasone in the Prevention of Delayed Nausea and Vomiting / 대한암학회지

BACKGROUND: Granisetron, a new 5-HT3 receptor antagonist, was reported as a highly effective antiemetics, especially in combination with dexamethasone, in the prevention of acute emesis induced by cisplatin. But there is lack of data about effectiveness in the prevention of delayed emesis. In this study, the efficacy of granisetron plus dexamethasone in the prevention of delayed emesis induced by cisplatin was evaluated. MATERIALS AND METHODS: Sixty-four patients who were to receive high-dose cisplatin containing chemotherapy regimen were enrolled in this study. They were received 20 mg of dexamethasone and 3 mg of granisetron at 30 min and 10 minutes prior to cisplatin infusion, respectively. They were monitored for 5 days, first 24 hours for acute nausea/ vomiting and the subsequent 4 days for delayed nausea/vomiting. Antiemetic effect of granisetron was evaluated according to the criteria of Italian Group of Antiemetic Research. RESULTS: Control of delayed nausea and vomiting was achieved in 58% and 84%, respectively. Eastern Cooperative Oncology Group performance status was a statistically significant prognostic factor for control of acute vomiting and delayed nausea/vomiting. There were no stastically significant differences between control of delayed nausea/ vomiting and other prognostic factors, including sex, age, and prior history of cisplatin therapy. The antiemetic effect was greater in the patients who had controled acute nausea/ vomiting than those who had not. CONCLUSION: Granisetron plus dexamethasone is an excellent regimen in the control of not only acute emesis but also delayed emesis induced by high-dose cisplatin chemotherapy.

A Case of Tongue Tuberculosis with Pulmonary Tuberculosis / 대한내과학회지

Up to 1937, 357 cases of tongue tuberculosis had been reported. However, Since potent antituberculosis drugs had been introduced, the incidence of oral tuberculosis lesions has been dramatically decreased. This might be related to the marked vascularity of the tongue which enables a high concentration of the drug to be reached to the lesion. Both the primary and secondary types of tuberculosis can be revealed in the oral cavity. In the primary type, the causative organisms are directly inoculated in the oral mucosa of a person who has never been tuberculosis earlier and who has not acquired an immunity to the disease, In the secondary type, tuberculosis of the oral cavity is coexistent with pulmonary disease. We report a case of tongue tuberculosis with pulmonary tuberculosis, with a review of literature.