Aggravation of Relapsing Polychondritis due to the Infection and Its Manifestation on a Nasal Tip Graft.

Relapsing polychondritis (RP) is an uncommon systemic disease that is characterized by episodic and progressive inflammation of the cartilaginous structures, which can be very debilitating and in some instances life-threatening. The pathogenic pathways of RP are largely unknown. However, several hypothesis have been suggested. We had an interesting case of aggravation of RP due to the infection. Graft cartilage on the nasal tip was affected by RP also. This case can give a clue of revealing the pathogenesis of RP. We introduce a case with a review of the literature.

Sleep quality and effects of position on sleep apnea in East Asian children.

OBJECTIVES: To assess whether obstructive sleep apnea syndrome (OSAS) affects sleep architecture and quality in East Asian children, and also to assess the effects of body position during sleep on respiratory disturbance during sleep. MATERIALS AND METHODS: We enrolled 50 consecutive East Asian children with habitual snoring between 2007 and 2009. Nineteen children had OSAS (apnea-hypopnea index, AHI≥5; OSAS group) and 31 children were simple snorers (control group). They underwent polysomnography and physical examination of their nasal and oral cavities with a roentgenogram of the nasopharynx. Sleep architecture and other polysomnographic variables were compared between the OSAS and control groups. The effect of body position during sleep on respiratory disturbance was examined, and also in relation to obesity and adeno-tonsillar size. RESULTS: There was a decrease in total sleep time and in sleep efficiency, as well as increased arousal and heart rate (P<0.05) in the OSAS group. Sub-analysis of AHI according to sleep posture showed that AHI is higher when the patient is in the supine position than in the non-supine position (P=0.032). The presence of OSAS and kissing tonsils were contributing factors to the positional difference in AHI (P<0.05). Obesity and adenoid hypertrophy did not affect the positional difference of AHI. CONCLUSIONS: OSAS may have a greater influence on the sleep architecture of East Asian children, and East Asian children may have a higher AHI when sleeping in the supine position. Tonsillar hypertrophy and the presence of OSAS are possible contributing factors for positional difference of AHI in East Asian children.

Questionnaire evaluation of sequelae over 5 years after parotidectomy for benign diseases.

The aim of this study was to evaluate long-term (more than 5 years) quality of life issues after parotidectomy for the treatment of benign disease. A questionnaire survey was performed after institutional review board approval, on patients who had undergone any type of parotidectomy for benign salivary diseases. Fifty-three patients were surveyed at more than 5 years (the long term group) and 39 patients at 1-2 years after surgery (the control group). The questionnaire included the items on self perception of known sequelae. Descriptive and comparative analyses were performed to determine major sources of discomfort and changes in sequelae over time. Possible factors that contribute to sequelae were also analysed for significance. Frey's syndrome was identified as the most serious self-perceived sequela, and resulting discomfort worsened with time (P=0.01). Scores for other sequelae were similar in the two study groups. Subjective perception of Frey's syndrome was significantly different (P<0.001) according to the extent of surgery, and it was most serious in total parotidectomy cases, even from 1 year postoperatively. Of the sequelae of parotidectomy for benign diseases, Frey's syndrome was of greatest concern to patients, even at more than 5 years postoperatively. Therefore, additional measures which prevent or ameliorate Frey's syndrome are likely to improve long-term quality of life after parotidectomy.

A prospective, randomized comparison of the effects of inhaled sevoflurane anesthesia and propofol/remifentanil intravenous anesthesia on salivary excretion during laryngeal microsurgery.

BACKGROUND: One of the goals of anesthesia for laryngeal microsurgery is to provide a clear surgical view, and therefore anesthetics that produce less saliva are desirable. Sevoflurane inhalation anesthesia and total IV anesthesia with propofol/remifentanil are widely used for anesthesia during laryngeal microsurgery; however, few rigorous comparisons of the effects of sevoflurane and propofol/remifentanil on salivation have been performed. METHODS: Forty subjects undergoing laryngeal microsurgery were randomly assigned for sevoflurane or propofol/remifentanil anesthesia. We prospectively compared the salivary flow rates, compositions, the number of suction episodes required to clearly view the laryngeal lesions before the main procedures, and residual secretion volume after the procedure in both groups. RESULTS: The mean salivary excretion rate was significantly higher in the propofol/remifentanil group than in the sevoflurane group (0.53 +/- 0.39 vs 0.28 +/- 0.15 mL/min, P < 0.001). Before starting the main procedure, the number of suction episodes required to clearly view the laryngeal lesions was also higher in the propofol/remifentanil group (5.0 +/- 2.3 vs 2.1 +/- 1.5, P < 0.001). Mean residual secretion in the oral cavity and oropharynx after the procedure was greater in the propofol/remifentanil group (2.13 +/- 0.59 vs 0.45 +/- 0.32 mL, P < 0.001). In addition, a significant difference in chloride levels in collected secretion was noted (sevoflurane; 93 +/- 19 vs propofol/remifentanil; 135 +/- 58 U/L, P = 0.004). CONCLUSIONS: Salivary excretion under propofol/remifentanil anesthesia is greater than under sevoflurane anesthesia during laryngeal surgery.