A Case of Large Cell Neuroendocrine Carcinoma of the Maxillary Sinus / 대한두경부종양학회지

Large cell neuroendocrine carcinoma is a rare epithelial neuroendocrine malignancy and is preferentially located in gastrointestinal tract and pancreas. Cases of large cell neuroendocrine carcinoma have been reported in many other locations, including the thymus, gallbladder, prostate, larynx, salivary glands, nasopharynx, tonsil and mastoid. However, primary sinonasal large cell neuroendocrine carcinoma never have been reported in Korea. We experienced a case of primary large cell neuroendocrine carcinoma arising from left maxillary sinus recently. A 82-year-old male patient presented with nasal obstruction and epistaxis. The biopsy revealed large cell neuroendocrine carcinoma with poor differentiation. After a general evaluation, the patient was staged as cT3N0M0. The patient was treated by combined radiotherapy and chemotherapy. We report this rare case with literature review.

Extramedullary Tibial Bone Cutting Using Medial Cortical Line in Total Knee Arthroplasty

PURPOSE: This study aims to identify the effectiveness of the medial cortical line for attaining a more accurate tibial component alignment in proximal tibial resection using an extramedullary alignment rod. MATERIALS AND METHODS: The study examined 100 cases of total knee arthroplasty performed from December 2013 to February 2014 in a retrospective manner. On a preoperative anteroposterior (AP) radiograph of the entire tibia, we identified the medial cortical line that runs parallel to the tibial anatomical axis and passes the medial tibial spine, and measured the point where the medial cortical line crosses between the medial malleolus and the lateral malleolus in the ankle joint. RESULTS: The preoperative AP radiograph of the tibia showed the medial cortical line passing the point 40.4%±0.8% medial to the distance from the medial malleolus to the lateral malleolus including the skin thickness in the ankle joint. When the proximal tibial resection was performed with the extramedullary tibial cutting guide aligned with the medial cortical line, the tibial component angle averaged 0.7°±0.3° varus and the alignment accuracy of the tibial component within 0°±3° varus amounted to 97.0%. CONCLUSIONS: The use of the medial cortical line in proximal tibial resection with an extramedullary tibial cutting guide allowed for relatively accurate alignment of the tibial component.

Optimal Regimen and Period for the Treatment of Patients with Laryngopharyngeal Reflux Disease / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Various drugs can be used for treatment of laryngopharyngeal reflux disease (LPRD). However, the optimal medical treatment regimen is still controversial. This study was performed to determine the optimal medical treatment regimen and duration for LPRD. SUBJECTS AND METHOD: We studied 172 patients who were diagnosed as LPRD by reflux symptom index (RSI) or reflux finding scores (RFS). The study group was divided into 4 groups according to the medication regimen: proton pump inhibitor (PPI), PPI and prokinetics, PPI and H2 blocker, and double dose PPI groups. All patients took medicines for 3 months or more. Clinical remission was defined as 70% improvement of initial RSI scores. RESULTS: 36 (20.9%) patients were prescribed PPI only, 65 (37.8%) patients PPI with prokinetics, 51 (29.6%) patients PPI with H2 blocker, 20 (11.6%) patients double dose PPI. Pretreatment with RSI and RFS did not differ among the four groups. RSI was improved after one month of medication in all of the groups. RSI and RFS tended to decrease during the treatment in all groups (p for trend <0.001). The mean clinical remission time was 2.3 months in patients receiving PPI alone, 2.6 months in PPI and prokinetics group, 2.5 months in the PPI and H2 blocker group and 1.8 months in the double dose PPI group. About 70% of patients reached clinical remission within 3 months. CONCLUSION: PPI with or without prokinetics or H2 blocker is effective treatment for LPRD, and the appropriate duration of medication seems to be about 3 months. Double dose PPI can be used for those whom normal dose PPI is ineffective.

A Case of Metastatic Auricle Cancer from Gastric Adenocarcinoma / 대한이비인후과학회지

Auricle cancers are relatively uncommon head and neck neoplasm and most of them are squamous cell carcinoma. Metastatic auricle cancer is extremely rare; metastases from internal organ have not been reported so far. We recently experienced a case of metastatic auricle cancer from adenocarcinoma of stomach. Seventy years old man who had undergone gastrectomy for stomach cancer 10 years ago visited our hospital complaining painless auricle mass. Biopsy of the auricle mass revealed a metastatic adenocarcinoma that is same as that of the stomach cancer. Patient underwent excision of auricle mass and adjuvant chemotherapy. Here we report this case with the review of related literatures.

Clinical Characteristics and Prognosis of Idiopathic Sudden Sensorineural Hearing Loss in Old Age / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: In aging society, interest in idiopathic sudden sensorineural hearing loss (ISSNHL) in elderly have been increased. However, as there has been little discussion about prognostic factors of ISSNHL in old age, this study aims to investigate clinical factors related with prognosis of ISSNHL in elderly and compare with that in adults. SUBJECTS AND METHOD: A retrospective medical chart review was performed in patients over 19 years old who diagnosed with ISSNHL from Jan. 2010 to Dec. 2012. Patients were categorized into the old age group (over 65 years old, n=62) and the control group (aged 19 to 64 years old, n=218). Clinical findings, audiological result and treatment outcomes were compared between two groups. And possible prognostic factors of SSNHL in elderly were also investigated. RESULTS: Significant difference of hearing recovery was identified between the old age group (33.9%, 21/62) and control group (50.9%, 111/218) according to Siegel's criteria (p=0.021). Multivariate analysis concluded that delayed treatment and low speech discrimination score (SDS) might lead to poor prognosis in elderly. The presence of tinnitus or dizziness, audiometric configurations, hypertension and diabetes mellitus did not affect the treatment results of ISSNHL in the old age group. CONCLUSION: Onset of treatment and initial SDS could be possible prognostic factors of ISSNHL in elderly. Early diagnosis and urgent treatment are more important in old age.

The Changes in Esophageal Acidity during Percutaneous Endoscopic Gastrostomy Feeding / 대한소화관운동학회지

BACKGROUND/AIMS: Generally, we try on nasogastric tube (NGT) feeding in brain-injury patients with impaired swallowing. It has been known that percutaneous endoscopic gastrostomy (PEG) tube feeding is less complicated than NGT feeding. However, there is no accurate report for gastroesophageal reflux as complication following PEG and NGT. Therefore, we measured esophageal acidity before and after changing NGT feeding into PEG feeding in management of brain-injury patients, and then evaluated the degree of gastroesophageal reflux. METHODS: Thirteen patients with impaired swallowing in brain-injury were included in this study. They all underwent NGT followed by PEG. Before and after PEG placement, 4 variables of acid exposure were evaluated with 24 hour ambulatory pH monitoring. RESULTS: Number of acid reflux episodes decreased in 5 cases. Number of long acid reflux episodes decreased in 3 cases. Total and fraction time pH below 4.0 decreased in 6 cases. There was no significant difference in improvement of acid reflux between before and after PEG feeding (p>0.05). CONCLUSIONS: Our data showed that acid reflux had a tendency to decrease in patients undergoing percutaneous endoscopic gastrostomy feeding, but it was increased in some of them.

The Effect of the Cryptorchidism on the Testicular Volume and Gender Identity after Adolescence / 대한비뇨기과학회지

PURPOSE: To investigate the influence of cryptorchidism on the testicular volume and gender identity of young men within a community. MATERIALS AND METHODS: Of 27,202 men, aged 20 years, within the community, a 10% sampling fraction was randomly selected, of which 2,080 (a response rate 77.0%) agreed to participate in the study. All volunteers underwent a standard evaluation, including a detailed medical history and physical examination. To evaluate the influence of cryptorchidism on gender identity, we used the Bem Sex Role Inventory (BSRI) in the men without testicular disease, but who were observed to have cryptorchidism on physical examination, or had a history of operation for cryptorchidism. RESULTS: Of the participants, 38 (1.8%) were observed to have cryptorchidism, or had a history of operation for cryptorchidism (right; 15, left; 21, bilateral; 2). Of these patients, 29 had a history of operation, with a mean age at the time of operation of 8.9+/-3.9 years, ranging from 2 to 19 years. Of the 36 patients with unilateral cryptorchidism, the contralateral testicular volume of the men that underwent an orchiopexy was no different to that of those that underwent an orchiectomy or that had no operation at all. Comparing the masculinity and femininity scores, using the BSRI between the orchiopexy and normal groups, the masculinity score of the orchiopexy group was lower than that of the normal group. CONCLUSIONS: Our results demonstrate that a delayed orchiopexy does not improve the growth of the testicular volume on the affected side, or the masculine identity, in men with unilateral cryptorchidism. In addition, these findings suggest that there is a need to increase the awareness related to cryptorchidism amongst all parties involved in the health care of children.

Purple Urine Bag Syndrome / 대한비뇨기과학회지

Purple urine bag syndrome (PUBS) is a rare phenomenon where the urinary catheter and bag turns purple following catheterization. The colors are formed from the substrate indoxyl sulfate (indican). PUBS is associated with urinary tract infections induced by the reaction of some species of bacteria with indoxyl sulfatase. We report here in a case of purple urine bag syndrome.

A Mixed Liposarcoma of the Paratesticular Tissue / 대한비뇨기과학회지

A liposarcoma of paratesticular origin is extremely rare, and preoperative diagnosis is difficult. Most are a low-grade malignancy. We report a case of a mixed liposarcoma of the paratesticular tissues in a 74-year-old man. Treatment consisted of a radical orchiectomy without retroperitoneal lymph node dissection. The patient has survived 18 months with no evidence of a recurrence.

Experimental Studies on Tissue Mast Cell Changes in Relation to Effects of Various Neurotic Agents / 대한피부과학회지

With the artificially applied local inflammatory stimulus by ultraviolet irradiation to the inner aspect of the left albino rat thigh skin, the tissue mast cell changes were observed for the nerve effectiveness on the irradiated thigh (Lt.) and non-irradiated opposite thigh (Rt.) and tongue. Using the distilled water (for control group), Bistrium Bromide blocking agent), Yhenobarbital Sodium (sedative and hypnotic) and (autonomic ganglion Reserpine (tranquillizer) were regularly subcutaneously injected every 8 hours, and the following results of most cell changes were observed. 1) Without ultraviolet ray irradiation, the rats of first group were received distilled water and average number of mast cells at the Rt. and Lt. inner aspects of thigh and tongue were gradually decreased and 24 hours after injection, the number of each part showed lowed curve, that was 85. 1%, 84. 8% and 91. 8% of normal average number. On the second and 4th day of the injection, increasing number of each part reached to the normal average number. The 7th day of injection maximum number of above average was l02.1%, 110.8% and 110.7% 2) With the ultraviolet ray irradiation the rats of second group received distilled water. At the Rt, and Lt. inner aspects of the thigh and tongue, the average number of mast cells gradually decreased and on the 4th day of the injection, the lowest number was 59.3,"o, 78.7% and 86. 2% of each average number. However on the 7th day the increasing number showed 75.0%, 84.6% and 89.6% of average number. 3) Group 3; Received Bistrium Bromide injection respectively, 24 hours after injection at the Rt. and Lt. inner aspects of the thigh the gradually decreasing number of mast cells showed the lowest curve, it accounted 70.6% and 74.0% of normal value. However at the tongue it was 77.2% on the second day of injection. Their highest number was seen on the 7th day, it was 95.7%, 100.5% and 107. 8% respectively 4) Group 4; Received Bistrium Bromide and ultraviolet ray irradiation, the average number of mast cells at the Rt. and Lt. inner aspects of the thigh and tongue showed decreasing curve. On the second day of injection the lowest number was 43.3%, 65.4% and 74.9/o of normal value respectively. On the 4th day of injection and irradiation the average number was increased, then after 7th day of injection maximum value was 93. 7%, 92.1% and 115.1% of normal number. 5) Group 5; Received Phenobarbital Sodium, the average number of mast cells at the Rt. and Lt. inner aspects of the thigh and tongue was gradually decreased, the lowest number was seen on the 24 hours after injection, it was 76.7%, 8.7% and 90. 9% of normal value. On the second and 4th day of injection, the curve was increased and on the 7tIi day, the highest value was 106.5%, 104.8% and 104. 6% of normal average value. 6) Group 7; Received Phenobarbital Sodium with ultraviolet rayirradiation at the Rt. and Lt. inner aspects of the thigh and tongue, the average number of must cells were gradually decreased. On the 4th day of injection and irradiation, they reached to the lowest number, and it was 43.3%, 80.6% and 74.0% of normal number. On the 7th day it showed the highest value of 74.9%, 97.2% and 95.8% respectively. 7) Group 7; Received Reserpine at the Rt. and Lt. inner aspect; of the thigh and tongue, the number of mast cells gradually decreased. On the 4 hours after injection 85.4%, 84.0% and 87.9% of average normal number was seen. On the second day, respectively number was increased. On the 7th day maximum increasing number was 103.1%, 115.2% and 95.0% of normal average number 8) Group 8; Received Reserpine and ultraviolet ray irradiation, the decreasing number of mast cells reached to the lowest value on the 4th day after injection, it was 53.5%, 80.3% and 84. 4% of normal value. On the 7th day of procedure, increased number showed 94.8%, 110.3% and 92.9 % of normal value. From the above experimental study, Ristrium Bromide, Phenobarhital Scdium and Reserpibne gave some effect to the change of mast cell at the irracliaticn area by ultraviolet ray and non-irradiated distant part.

Experimental Study on Sporotrichum by Inoculation in Rats / 대한피부과학회지

Sporotrichsis is a chronic granulomatous mycosis caused by Sporotrichum species. In Korea, Kim et al. had reported two cases of cutaneous sporotrichosis involving upper extremities for the first time in 1960. They had determined their strain to be similar to a variant of S.beuermanni by culture. These Kim's strain has inoculated into the peritoneum of rats pathogenicity, virulence and course by examining the macroscopic The conclusion were as follows: 1. Rats were inoculated intraperitoneally and killed at intervals of 12, 20, 30, 40 and 50 days and followed by postmortem examination. Macroscopic findings: At twelve day and lesions were observed. At 20 to 50 days all showed grayish brown lymphnodules varying in size, which were disseminated on the mesentery, omentum, peritoneum and inguinal region. On lung, liver, spleen and kidney, various changes i. e.; congestion, necrosis and degenerative changes were noted at 30 to 40 days after inoculation. 3. Microscopic findings: a. Most nodules were characterized by three distinct zones, i. e.; central suppurative, mirldle tuberculoid, and peripheral syphiloid zones. b. Visceral organs showed the following pathological changes varying with the duration of infection; diffuse hepatic necrosis, bronchitis and pneumonitis, splenitis and degene- rative changes in the kidney. c. Microorganisms could found in tissue by PAS stain, Its frequency rate shows 52% in lymphnodules and 16% in visceral organs. 4. For some unknown reasons isolation of the organisms by culture was successful only from 3 rats.