No abstract available.
Lymphadenitis*

BACKGROUND AND OBJECTIVES: Although pediatric tracheostomy is a useful procedure to secure airway, post-tracheostomy complications sometimes have significant detrimental effects on pediatric patients. Among the complications, post-tracheostomy tracheal stenosis is one of the major late sequelae, which may be preventable by adequate surgical technique. The objective of this study is to investigate the degree of post-tracheostomy tracheal stenosis after applying new modification of tracheostomy: surgical dilatational tracheostomy (SDT) in a growing animal model. SUBJECTS AND METHOD: Seven Newzealand White rabbits were divided into three groups: SDT (n=3), surgical conventional tracheostomy with vertical cartilage incision (SCT)(n=3), and control (n=1). Each rabbit underwent tracheostomy by assigned procedures on the first day. On day 8, they were decannulated. On day 15, their tracheas were harvested. We examined the gross findings and histologic changes of each tracheal segment at the level of stoma. We analyzed three parameters: the quotient of the stomal and non-stomal segment in sagittal diameter, coronal diameter, and cross sectional area. RESULTS: The frameworks of cartilages at the level of stoma were more distorted in the SCT group. Histologic examination also showed buckling of the anterior tracheal wall, loss of cartilage, infiltration of many polymorphonuclear neutrophils and marked in-growth of fibrous tissue in SCT group. Sagittal, coronal diameters and cross sectional areas were affected more severely after SCT than after SDT. CONCLUSION: We found no significant risk of post-tracheostomy tracheal stenosis for the SDT in a growing animal model. Therefore, SDT might be useful in the management of pediatric patients who require short-term tracheotomy. Further study of SDT should be investigated in children in a clinical setting.
Animals* ; Cartilage ; Child ; Dilatation ; Humans ; Models, Animal* ; Neutrophils ; Rabbits ; Trachea ; Tracheal Stenosis* ; Tracheostomy* ; Tracheotomy

BACKGROUND AND OBJECTIVES: The excision of submandibular gland (SMG) has been commonly used for the treatment of calculi in the hilum of SMG, since intraoral removal of the hilar stone has the potential risk of lingual nerve injury and the poor surgical field. However, it would leave loss of remained gland function and external scars after the excision. Therefore, the authors modified the intraoral retrieval techniques as the marsupialization of the Wharton's duct up to the calculi in the hilum. This study reports our clinical experience with the modified intraoral retrieval technique and the advantages of this modality for calculi in the hilum of SMG. SUBJECTS AND METHOD: SMG excision and intraoral removal with marsupialization (IRM) were used from 1994 through 2003 to treat 9 and 16 cases of calculi in the hilum of SMG, respectively. We analyzed the characteristic findings of calculi, surgical morbidities and complications by comparing two different treatment groups. RESULTS: The mean diameter of the calculi was 6.1 mm in patients with SMG excision and 7.8 mm in patients with IRM. The success rate of extraction by IRM of calculi in the hilum were 86.7%. The surgical complications were similar in both groups. The proportion of palpable calculi were significantly increased in the IRM group (92.9% vs 22.2%). We failed to remove the stone by IRM from patients, and stones were impalpable intraorally preoperatively. CONCLUSION: IRM is an excellent alternative method for the removal of palpable calculi located in the hilum of SMG. Furthermore, it would preserve the salivary gland function without external scars and with acceptable surgical complications and morbidities.
Calculi* ; Cicatrix ; Humans ; Lingual Nerve Injuries ; Oral Surgical Procedures ; Salivary Ducts ; Salivary Glands ; Submandibular Gland*

Background: The purpose of the current study was to investigate short- to mid-term outcomes and complications following radial head replacement (RHR) for complex radial head fractures and to identify factors associated with clinical outcomes. Methods: Twenty-four patients with complex radial head fractures were treated by RHR. The mean age of the patients was 49.8 years (range, 19–73 years). Clinical and radiographic outcomes were evaluated for a mean follow-up period of 58.9 months (range, 27–163 months) using the visual analog scale (VAS) score for pain, the Mayo elbow performance score (MEPS), the quick disabilities of the arm, shoulder and hand (Quick-DASH) score, and serial plain radiographs. Complications were also evaluated. Results: At the final follow-up, the mean VAS score, MEPS, and Quick-DASH score were 0.6±1.1, 88.7±11.5, and 19.4±7.8, respectively. The mean range of motion was 132.7o of flexion, 4.7o of extension, 76.2o of pronation, and 77.5o of supination. Periprosthetic lucency was observed in six patients (25%). Heterotopic ossification was observed in four patients (16.7%). Arthritic change of the elbow joint developed in seven patients (29.2%). Capitellar wear was found in five patients (20.8%). Arthritic change of the elbow joint was significantly correlated with MEPS (P=0.047). Four cases of complications (16.6%) were observed, including two cases of major complications (one stiffness with heterotopic ossification and progressive ulnar neuropathy and one stiffness) and two cases of minor complications (two transient ulnar neuropathy). Conclusions RHR for the treatment of complex radial head fractures yielded satisfactory short- to mid-term clinical outcomes, though radiographic complications were relatively high.

Stress fractures of the acromion and scapular spine are well-known complications following reverse total shoulder arthroplasty. However, these fractures in patients with massive rotator cuff tear or cuff tear arthropathy are extremely rare, and the pathogenesis, clinical features, diagnosis, and treatment of these fractures are poorly understood. We report a case of bilateral stress fracture of the posterior angle of the acromion in a patient with massive rotator cuff tear and discuss the pathogenesis, clinical manifestation, and treatment with a review of the literature.

Background: High complication rate after open reduction and internal fixation can lead to use of primary total elbow replacement (TER) in treatment of complex distal humerus fractures in elderly patients. The purpose of this study was to investigate the short-term outcomes and complications after primary TER in patients with complex distal humerus fracture. Methods: Nine patients with acute complex distal humerus fracture were treated by primary TER using the semiconstrained Coonrad-Morrey prosthesis. The mean age of patients was 72.7 years (range, 63–85 years). Clinical and radiographic outcomes were evaluated over a mean follow-up of 29.0 months (range, 12–65 months) using visual analog scale (VAS) score for pain; Mayo elbow performance score (MEPS); Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH) score; and serial plain radiographs. Complications were also evaluated. Results: At the final follow-up, mean VAS, MEPS, and Quick-DASH scores were 1.2, 80.5, and 20, respectively. The mean range of motion was 127.7o of flexion, 13.8o of extension, 73.3o of pronation, and 74.4o of supination. There was no evidence of bushing wear or high-grade implant loosening on serial plain radiographs. Three complications (33.3%) comprising two periprosthetic fractures and one ulnar neuropathy were observed. Conclusions Primary TER for treatment of complex distal humerus fractures in elderly patients yielded satisfactory short-term outcomes. However, surgeons should consider the high complication rate after primary TER.

BACKGROUND AND OBJECTIVES: Surgery or radiation therapy is most widely employed in the treatment of early glottic cancer with no significant difference in the survival rate. Various treatment modalities including surgery, radiation therapy or combined therapy can also be adopted for recurring early glottic cancer. Nowadays, conservation salvage surgery presents as an excellent alternative to the traditional total laryngectomy with favorable results. The objective of this study is to compare the outcome of each treatment modality for early glottic cancer and evaluate the role of conservation salvage surgery for recurring cases. SUBJECTS AND METHOD: Seventy-three patients with early glottic cancer (stage Tis, T1, T2 N0M0) were treated between January 1995 and December 2001, and followed up for at least over an year. They were divided into two groups with the standards of whether they had surgery or radiation therapy as an initial treatment. Then, both groups were analyzed for local control and recurrence rate after initial treatment and conservation salvage surgery for recurrent case, respectively. RESULTS: Twenty-four patients had conservation surgery and 49 had radiation therapy as an initial treatment. Local control rate was 100% for conservation surgery, 93.9% for radiation therapy and there was no significant difference between groups. Recurrence rate for each group was 8.3% and 15.3%, respectively, but no statistical difference was found. Twelve patients showed recurreence or had remnant cancer. Conservation salvage surgery including laser cordectomy, hemilaryngectomy, frontolateral hemilaryngectomy, and supracricoid partial laryngectomy had been performed in 10 cases. In all cases, laryngeal preservation was possible and there was no recurrence of tumor during follow up periods. CONCLUSION: As an initial treatment modality, conservation surgery and radiation therapy was proven to be equally effective for early glottic cancer with no significant difference in local control and recurrence rate. For the recurrent cases, conservation salvage surgery including supracricoid partial laryngectomy was shown to be a very useful treatment modality with good oncological results and excellent laryngeal preservation.
Follow-Up Studies ; Humans ; Laryngeal Neoplasms ; Laryngectomy ; Recurrence ; Salvage Therapy ; Survival Rate ; Treatment Outcome

OBJECTIVES: The primary aim of this study was to determine whether 18F-FDG-PET/CT (PET/CT) scans provide additional diagnostic information in addition to the direct laryngoscopic examination (L/E) and contrast-enhanced CT (CT) in patients with glottic cancer during the initial evaluation. METHODS: Fifty-five consecutive patients with glottic cancer of the larynx that had L/E, CT and PET/CT were enrolled. The diagnostic value of each modality was compared for their accuracy in predicting the extent of the primary tumors on sub-site based analysis and the final tumor staging. The reference standards were either the surgical pathology findings or clinical/radiological follow-up outcome. Changes in patient care based on PET/CT results were compared with the treatment decisions based on L/E with CT. RESULTS: For primary tumor sub-site based analysis, the sensitivity was significantly higher for L/E (92.8%) than for PET/CT (79.4%, P=0.028). The comparisons between L/E vs. CT and CT vs. PET/CT did not reach statistical significance. As an initial tumor-staging method the L/E had a diagnostic accuracy of 76.4%, compared to 61.8% for CT and 41.8% for PET/CT. The L/E and CT were better than the PET/CT (P=0.0009 and 0.049) for the initial TNM staging. PET/CT scanning changed the clinical decision-making based on the L/E with CT results in 12.7% of cases, of whom 5.5% had no additional PET/CT related benefit. CONCLUSION: Conclusion. The results of this study showed that PET/CT imaging added no clinical information benefit compared to the L/E and CT for the initial evaluation of patients with glottic cancer.
Fluorodeoxyglucose F18 ; Follow-Up Studies ; Glottis ; Humans ; Laryngeal Neoplasms ; Laryngoscopy ; Neoplasm Staging ; Pathology, Surgical ; Patient Care ; Positron-Emission Tomography

OBJECTIVES: The authors would report the results of definitive radiation therapy (RT) for early glottic cancer by two different radiation dose schedules. METHODS: From February of 1995 till June of 2008, 157 patients with T1-2N0 glottic cancer were treated with curative RT at Samsung Medical Center. All patients had squamous cell carcinoma, and there were 89 patients (56.7%) with T1a, 36 (22.9%) with T1b, and 32 (20.4%) with T2. Two different radiation dose schedules were used: 70 Gy in 35 fractions to 64 patients (40.8%, group A); and 67.5 Gy in 30 fractions to 93 patients (59.2%, group B). The median treatment durations were 50 days (range, 44 to 59 days) and 44 days (range, 40 to 67 days) in the groups A and B, respectively. RESULTS: The median follow-up durations were 85 and 45 months for the groups A and B. No severe late complication of RTOG grade 3 or higher was observed, and there was no difference in acute or chronic complication between the groups. Twenty-four patients experienced treatment failure: local recurrence only in 19 patients; regional recurrence only in one; combined local and regional recurrence in four; and systemic metastasis in none. The overall 5-year disease-free survival and disease-specific survival rates were 84.7% and 94.8%. The disease-free survival rate in the group B was better (78.3% vs. 90.8%, P=0.031). This difference was significant only in T1 stage (83.4% vs. 94.6%, P=0.025), but not in T2 (62.7% vs. 60.6%, P=0.965). Univariate analysis showed that the tumor extent, cord mobility, T-stage, and the dose schedule had significant influence on the disease-free survival, and multivariate analysis showed that only the tumor extent and the dose schedule were associated with the disease-free survival. CONCLUSION: Superior disease-free survival could be achieved by 2.25 Gy per fraction without increased toxicity over shorter RT duration, when compared with 2.0 Gy per fraction.
Appointments and Schedules ; Carcinoma, Squamous Cell ; Disease-Free Survival ; Dose Fractionation ; Follow-Up Studies ; Humans ; Laryngeal Neoplasms ; Multivariate Analysis ; Neoplasm Metastasis ; Recurrence ; Survival Rate

BACKGROUND AND OBJECTIVES: Proton pump inhibitors (PPIs) can improve the symptoms of laryngopharyngeal reflux (LPR) if used for more than 8 weeks, but little information is available on the effects of short-term PPI therapy as an initial treatment for LPR. We aimed to evaluate the efficacy of 4-week short-term PPI medication as an initial treatment for LPR and to identify specific symptoms which can predict the outcome of treatment. SUBJECTS AND METHOD: Among the patients complaining of more than 3 typical LPR symptoms for over 3 months, 62 patients with LPR symptom scores over 8 points were enrolled for the study. The patients were randomly subjected either to the 4 weeks of prokinetics (n=31) or PPI (n=31) medication. Changes in subjective symptoms and objective findings were assessed at first visit and 4 weeks after the medication. RESULTS: Treatment with prokinetics or PPI resulted in more than 50% reduction of LPR symptom scores in 9.6% or 29% of the patients respectively and 25-50% reduction in 54.8% or 70.9% of them. Objective reflux findings didn't get improved in either group. Analyses of the obtained reflux symptom scores failed to predict the treatment outcome of PPI medication. CONCLUSION: Short-term PPI therapy is highly effective for the reduction of LPR symptoms in selected patients, which may validate the use of PPI as an initial treatment regimen for the patients with LPR. However, further studies are required to assess the long-term effects of 4-week PPI therapy as an initial treatment regimen.
Gastric Acid ; Humans ; Laryngitis ; Laryngopharyngeal Reflux* ; Proton Pump Inhibitors ; Proton Pumps* ; Protons* ; Treatment Outcome