The Long Term Results of Ossicular Chain Reconstruction Using IONOS(R) in Chronic Otitis Media Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The goals in the surgery of chronic otitis media are to gain control of infection, closure of the tympanic membrane defects and hearing rehabilitation via ossicular chain reconstruction. Polymaleinate ionomeric cement, which has been used in dentistry as a filling and lute material for more than 15 years, has recently been used to construct total and partial ossicular prostheses. We intended to evaluate the hearing results of ossicular chain reconstruction using polymaleinate ionomeric prosthesis (IONOS(R)) in patients with chronic otitis media with the minimum 3 years postoperative follow-up periods. MATERIALS AND METHOD: Forty-four cases (30 PORP and 14 TORP), who underwent ossicular chain reconstruction using IONOS(R) in the Chonnam University Hospital from 1993 to 1996, were reviewed retrospectively. A postoperative hearing was accessed by the postoperative air-bone gap (ABG). Postoperative ABG was divided into the following three groups, ABG of or=31 dB. RESULTS: In the 44 total cases, 14 cases (31.8%) had

A Study on the Hearing Recovery Patterns in Sudden Sensorineural Hearing Loss Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Sudden sensorineural hearing loss is a disease that is developed within several hours to several days, but its etiology is not verified yet. Therefore, no specific regimen is available for the treatment of this disease. The purpose of this study is to seek the therapeutic effect of the corticosteroid on the sudden sensorineural hearing loss patients through many variables known as prognostic factors. The author also tried to find a relationship between the hearing recovery patterns and the prognostic factors that were not established yet. MATERIALS AND METHOD: Clinical analysis was performed in 173 patients with sudden hearing loss admitted in Chonnam National University Hospital from January 1996 to July 2001. RESULTS: Recovery was seen in 104 cases out of 173 cases, with the total recovery rate of 60.1%. Patients who had been treated within a week after the symptoms had a better recovery rate than those treated after a week (p< OR =0.05). The recovery rate was better for the moderate-severe, and severe hearing loss (p< OR =0.05). Patients of all audiograms except the profound one had a better recovery rate (p< OR =0.05). Among the patients who had been treated within a week, the dizzy patients had the lower recovery rate than the non-dizzy patients (p< OR =0.05). Other factors such as age and sex, tinnitus and ear fullness as accompanying symptoms, the site of disease, and the presence of underlying disease were not related with prognosis. CONCLUSION: The recovery rate was better in patients who had been treated within a week, and for those whose hearing was moderate-severe and severe, and their audiogram upsloping, V-shape, flat, and downsloping, and who were not dizzy.

A Case of Vancomycin-induced Drug Fever in a Patient with Zygomatic Subperiosteal Abscess / 대한이비인후과학회지

Drug fever is the most common side effect due to antibiotic-mediated hypersensitivity and accounts for 10% to 15% of unexplained fevers in hopitalized patients in the United States. Most drug fevers are caused by antibiotics and are particularly common with diuretics, stool softeners, antiseizure medications, antiarrhythmics, sedatives, antihypertensives, and pain medications. Vancomycin, in particular, has rarely been reported in the literature for inducing drug fever, although it has been widely used. However, we recently experienced a case of vancomycin-induced drug fever in a 15-month-old child with zygomatic subperiosteal abscess and therefore report it with a review of literature.

A case of Langerhans cell histiocytosis of bilateral temporal bone / 대한이비인후과학회지

Langerhans cell histiocytosis refers to a group of disorders of the reticuloendothelial system which is characterized by a proliferation of histiocytes and includes eosinophilic granuloma, Letterer-Siwe diseases, and Hand-Schuller Christian disease. It may involve the femur, pelivis, scapulae, vertebrae, ribs, mandible, maxilla, skull including the temporal bone, and skin, lymph node, viscera. The severity of these diseases and their prognosis and treatments differ greatly. We have experienced a case of Langerhans cell histiocytosis in 2 year old male with bilateral temporal bone involvement. We report it with the review of literature.

The Effect of Mastoid Obliteration Technique Using Superiorly Based Musculoperiosteal Flap and Autologous Conchal Cartilage / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The debate regarding the surgical technique for the management of open mastoid cavity still continues. In this study, we investigated the mastoid obliteration effect of superiorly based musculoperiosteal flap (SBF) with or without the combination of autologous conchal cartilage comparing with the well known Palva flap. MATERIAL AND METHOD: The 51 ears of 51 chronic otitis media or cholesteatoma patients who had been performed open cavity tympanomastoidectomy surgery with mastoid obliteration during the period from 1998 to 1999 were included in this study. Of the 51 ears, mastoid obliteration was performed using SBF and conchal cartilage in 25 ears, using SBF only in 18 ears and using the Palva flap in 8 ears. The duration of cavity epithelization and the increment of ear canal volume were compared among these three groups. The volume of ear canals and postoperative cavities were measured by filling the ear canals with sterile saline solution up to the cartilaginous part of the ear canal, starting at the level of tympanic membrane when the patient was lying on his side with the ear examined facing upward. RESULTS: Analysis of the data showed significant differences among the three groups in either duration of cavity epithelization (SBF & cartilage: 76+/-20 days, SBF only : 85+/-18 days and Palva flap : 106+/-21 days) and increased rate of postoperative ear canal volume (SBF & cartilage : 72%, SBF : 102% and Palva flap : 171%). CONCLUSION: The results of this study shows better outcomes in the groups of SBF & cartilge or SBF only compared with the group of Palva flap in terms of duration of cavity epithelization and increment of ear canal volume. Especially, SBF combined with autologous conchal cartilage achieves more favorable results. Thus, we suggest that the SBF & cartilage mastoid obliteration technique is one of the useful technique for the patients with open cavity tympanomastoidectomy.

Expression of GAP-43 in Rat Facial Motor Neurons According to the Facial Nerve Injury Types / 대한해부학회지

The neuronal phosphoprotein GAP-43 has been implicated in neuritogenesis during developmental stages of the nervous system and in regenerative processes and neuronal plasticity in the adult. It was previously reported that the level of increased GAP-43 expression in facial motor neurons following crush injury or nerve resection was paralleled the process of axonal regeneration. Since the optimal timing of repair after facial nerve transection injury has been debated for several decades, the author designed this study for the evaluation of optimal timing of facial nerve repair after injury by using the level of GAP-43 expression in facial motor neurons as a marker of neural regeneration. The increased expression of GAP-43 in facial motor neurons was returned to undetectable level by 4 weeks following the compression injury and by 8 weeks following the nerve transection and immediate end-to-end anastomosis, while it was maintained for at least 16 weeks after the nerve ligation and 1 week delayed anastomosis. This study suggests that the best functional outcomes could be obtained when the transected facial nerve is repaired as early as possible.

A Case of Acute Myelogenous Leukemia Recurred in Both Temporal Bone after Complete Remission / 대한이비인후과학회지

The clinical manifestations of leukemic patients who have temporal bone infiltration are acute mastoiditis, hearing impairment, tinnitus, dizziness, otorrhea, retro-auricular mass and facial nerve palsy. Otologic manifestations of leukemic patients have also been reported several times. However, reports about temporal bone infiltration by leukemic cells after complete remission have been rare, and there have not yet been any reports about both temporal bone infiltration that has been confirmed by mastoid biopsy after remission. We recently experienced a case of recurring acute myelogenous leukemia in both temporal bones after a complete remission and report it with a review of the literature.

Immunohistochemical Localization of Na/K-APTase Subunit Isoforms in Rat Inner Ear / 대한해부학회지

The endolymph and perilymph of the inner ear have unique ionic composition and electrical potential. It is widely accepted that normal auditory function depends on them and Na/K-ATPase plays a central role in production and maintenance of them. The distribution of five Na/K-ATPase subunit isoform (alpha1, alpha2, alpha3, beta1, and beta2) in rat inner ear was determined by immunohistochemistry after decalcifying the temporal bone with Gooding and Stewart's solution. In the cochlear regions, Na/K-ATPase alpha1beta1 isozyme was abundantly expressed in the infrastrial fibrocytes, suprastrial fibrocytes, spiral prominence, outer sulcus cells and spiral ganglion, and also detected in cochlear nerve and interdental cells. alpha1beta2 isozyme was abundantly expressed in all layers of stria vascularis and alpha3beta1 isozyme was detected in cochlear nerve and spiral ganglion. alpha3beta2 isozyme was expressed in spiral ganglion. In vestibular regions, Na/K-ATPase alpha1b1 isozyme was expressed in macular sacculi hair cell, transitional cells of ampulla, and vestibular ganglion, and alpha1b2 isozyme was abundantly expressed in ampullary dark cells and transitional cells and vestibular ganglion. a3b1 isozyme was abundantly expressed in crista ampularis, macula utriculi, and macula sacculi hair cells, and also moderately detected in ampullary, utricular, and saccular nerves, and vestibular ganglion. alpha3beta2 isozyme also detected in ampullary, utricular, and saccular nerves, and vestibular ganglion. But, alpha2beta1 and alpha2beta2 isozymes were not detected in any regions of inner ear. These findings suggest the possibility of four unique Na/K-ATPase isozymes deferentially expressed among the various cell types of the inner ear. This structural diversity imparts considerable biological versatility to the Na/K-ATPase and would be provided the explanations for the differences in fluid and ion transport and its regulation among the inner ear regions.

A Case of Primary Tuberculous Otitis Media with Lateral SinusThrombosis and Subperiosteal Abscess / 대한이비인후과학회지

Tuberculosis of the middle ear is a disease rarely encountered in recent years. Because what used to be the typical clinical signs of this disease have been changed in recent years and the index of suspicion being low, there is frequently a considerable delay prior to diagnosis. This can lead to irreversible complications. A case of tuberculous otitis media complicated with lateral sinus thrombosis and subperiosteal abscess is reported with review of the literature, emphasizing the fact that this entity must be considered in the differential diagnosis of persistent suppurative otitis media.

Clinical survey of the Ocular Trauma Patients visited Emergency Department

The authors analysed statically 420 Cases of the ocular trauma among 35,460 patients who visited to the emergency department, from Jul. 1995 to Jun. 1996. Ocular trauma is one of the commonest causes of eye diseases and blindness, but its patterns and incidences are variable according to the environment. A large number of patients can be readily treated in the emergency department. Prevention is, of course, the best management, but when an ocular injury occurs, proper emergency treatment can often prevent permanent damage.

Pediatric Poisoning: Clinical Analysis and Severity Grading

BACKGROUND: To find out characteristics and classification of toxic agents by clinical analysis of pediatric poisoning and to determine the clinical availability of grading by using MSPC score. METHOD: Subjects were patients under 15 years exposed to toxic agents, who visited Ajou university hospital emergency center from June, 1994 to October, 1997. The study was performed retrospectively. RESULTS: The subjects were 126 cases and male to female sex ratio was 1.2:1. Mean age was 29+/-30 months old. The most common route of exposure was ingestion, following contact, inhalation and bite. The most common reason was mistake by the patient, following mistake by caregiver, suicide attempt and accident. The MSPC score distribution of symptomatic patient was as follows; 1 point: 26 cases(63.4%), 2 point: 12 cases(29.2%), 3 point: 1 case(2.4%), 4 point: 2 cases(4.8%). The classification of exposed poison was as follows; therapeutic drugs: 29 cases(23.0%), non-therapeutic drugs: 97 cases(73.0%). The most common exposed poison was household products: 23 patients(18.3%) were admitted to hospital. CONCLUSION: There was statistically significant difference in the classification of poison, MSPC score, treatment modality at hospital, first follow up period after discharge between admitted group and non-admitted group. There was statistically significant difference in the reason of exposure, route of exposure, MSPC score, admission period according to patient's age. severity grading according to MSPC score is regarded as an available method to determine the modality of management.

Differential Expression and Cellular Localization of Na+-K+-ATPase Isoforms in Rat Salivary Gland / 대한해부학회지

It is the existence of a polarized distribution of ion transporters and channels which is thought to underlie the vectorial salt movement. The present study was performed to examine the expression and polarized distribution of Na+-K+-ATPase isoforms believed to be essential for salivary secretion in the rat salivary gland using immunohis-tochemistry. Na+-K+-ATPase alpha1 subunit immunoreactivity was prominent in the granular convoluted duct of the submandibular gland, and striated and excretory duct of three major salivary glands. The submandibular ganglion and postganglionic nerve fiber exhibited moderate immunoreactivity, whereas the intercalated duct and acinar cells of major salivary gland were weakly labeled. Na+-K+-ATPase beta1 subunit immunoreactivity was prominent in the granular convoluted duct of the submandibular gland, intercalated duct of the sublingual gland, acinar cells of the parotid gland, and striated and excretory ducts of major salivary gland. The submandibular ganglion, intercalated duct of the submandibular gland, and acinar cells of the sublingual gland exhibited moderate immunoreactivity, whereas acinar cells of the submandibular gland and intercalated duct of the parotid gland were weakly labeled. In these segments, alpha1 and beta1 immunoreactivity was expressed at the basolateral pole, and no apical expression was detected. These results suggest that major salivary glands are comprised of at least two structurally unique Na+-K+-ATPase isoforms, which are participated in primary saliva formation and transport.

Evaluation of Weaning Criteria from Mechanical Ventilatory Support / 대한구급학회지

Introduction: A number of indices have been proposed as accurate predictors of weaning, but several studies have questioned the accuracy of these weaning indices in predicting the capability of independent breathing. The purpose of the study was to assess six standard bedside weaning criteria of mechanically ventilated patients in Surgical intensive care unit (SICM). METHOD: : The study was performed on 72 SICU patients who were mechanically ventilated. According to the outcome of weaning, they were divided into two groups, weaning success (n=62) and weaning failure (n=10) group. All subjects should have PaO2 above 60 mm Hg at an FIO2 of 0.4 and PEEP of 3~5 cm H2O in the extubated patients and no PEEP in the tracheostomy patients. Six bedside weaning criteria were tidal volume above 5 ml/kg, respiratory rate below 25/min, vital capacity above 10 ml/kg, maximum inspiratory pressure below -20 cm H2O, minute volume below 10 L/min and PaO2/FIO2 above 200. Weaning failure was regarded as follows; changes of systolic blood pressure 20 mm Hg or diastolic pressure 10 mm Hg, changes of pulse rate 20 beat per minute, respiratory rate above 30 per minute or increased respiratory rate above 10 per minute, PaO2 below 60 mm Hg or PaCO2 above 55 mm Hg, and presence of paradoxical respiratory pattern. RESULTS: PaO2/FIO2 and minute volume (VE) were showed statistically significant difference between two groups (P=0.048, P=0.003 respectively). Linear discriminant function was D=-1.422-0.005-xPaO2/FIO2+0.336xVE. CONCLUSION: Our study demonstrates that PaO2/FIO2 and minute volume accurately predicts the weaning outcome in the surgical patients with mechanical support.

ULTRASONOGRAPHY IN ACUTE RENAL COLIC

BACKGROUND: Intravenous urography(IVU) has long been accepted as the primary radiologic study for the diagnosis of renal colic. But the IVU does pose disks of contrast material reactions and exposure to radiation. Recently, IVU has been challenged as a first line modality and ultrasonography proposed as a replacement. We, therefore, felt obliged to re-evaluate the IVU, KUB and ultrasonography as diagnostic tools. METHODS: We evaluate the sensitivity and specificity of ultrasound, IVU and KUB in detecting urinary calculi in suspected acute renal colic, a prospective study of 69 patients, both sides of kidney and ureter, who visited urban university hospital emergency center from September 1997 to January 1998. Our sonographic criteria far a positive examination consisted of visualization of urinary tract calculus and/or hydronephrosis and/or urinoma. RESULTS: In Ultrasonography, the accuracy, sensitivity and specificity were 94, 94 and 94%. In IVU and KUB, they were 90, 81, 98% and 71, 43, 96%. CONCLUSION: Ultrasonography is very useful diagnostic tool in initial evaluation of acute renal colic.

Laryngeal reconstruction by sternocleidomastoid myoperiosteal flap after hemilaryngectomy in mongrel dog / 대한이비인후과학회지

No abstract available.