Encephalomeningocele is a rare disease presenting extracranial protrusion of the brain and meninges through the skull base defect. The authors experienced a case of cerebrospinal fluid (CSF) rhinorrhea developing from encephalomeningocele which was protruded into the nasal cavity through the cribriform plate. It was repaired successfully with septal bone and middle turbinate mucosa under nasal endoscopy. The radiologic features and techniques for the endoscopic management of meningoencephalocele with CSF rhinorrhea are discussed.
Brain ; Cerebrospinal Fluid Rhinorrhea* ; Cerebrospinal Fluid* ; Endoscopy ; Ethmoid Bone ; Meninges ; Mucous Membrane ; Nasal Cavity ; Rare Diseases ; Skull Base ; Turbinates

Gastrointestinal stromal tumor (GIST) is an uncommon mesenchymal tumor of the gastrointestinal tract and is generally located in the stomach and small intestine. They usually present with abdominal pain, gastrointestinal bleeding, and palpable mass. Some patients present with rare symptoms that are more common in malignant GIST. Malignant GIST combined with a liver abscess has not been reported yet in the literatures. We report a case of 67-year-old woman who suffered from liver abscess combined by malignant GIST with central necrosis and fistula in the ileum. She complained of fever, chills, and abdominal pain. Abdominal CT scan showed huge liver abscess and ileal mass with air pocket. Small bowel series showed contrast material filling into the ileal GIST mass. An operation was performed and the final diagnosis was malignant GIST of the ileum with invasion into the sigmoid colon and urinary bladder.
Aged ; Diagnosis, Differential ; Female ; Gastrointestinal Stromal Tumors/*diagnosis/pathology/surgery ; Humans ; Ileal Neoplasms/*diagnosis/pathology/surgery ; Liver Abscess/*etiology ; Neoplasm Invasiveness ; Proto-Oncogene Proteins c-kit/analysis ; Reagent Kits, Diagnostic

Truncus arteriosus is characterized by a single arterial vessel arising from the base of the heart and giving origin to the systemic, pulmonary and coronary circulation. To evaluate the incidence, types, and associated anomalies, 18cases of truncus arteriosus diagnosed by angiocardiography, were reviewed and were compared with other reports. Ten of them were confirmed by operation. The overall incidence of truncus arteriosus was 0.127%. Accordin to Collett and Edwards classification. Type I was encountered in 11cases(61%), type II in 4cases(22%), and type III in 3cases(17%), All the patients had subtruncal ventricular septal defects. Eight patients showed truncal valve regurgitation and valve stenosis was noted in one case. A right aortic arch was present in 9 cases. Associated anomalies were atrial septal defect(8cases), patent ductus arteriosus(3cases), coarctation of the aorta(2cases), isolation of the left subclavian artery(2 cases), and right aortic arch with an aberrant left subclavian artery(1case). Truncus arteriosus is an uncommon congenital cardio vascular malformation. In the group of cases which we encountered, type I was the most common anomaly. Frequently associated anomalies were right aortic arch, incompetent truncal valve and atrial septal defect.
Angiocardiography ; Aorta, Thoracic ; Classification ; Constriction, Pathologic ; Coronary Circulation ; Heart ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Humans ; Incidence* ; Truncus Arteriosus* ; Vascular Malformations

Neovesical-urethral anastomotic stricture is a complication of orthotopic neobladder, with a reported incidence of 2.7% to 8.8%. Strictures of the neovesico-urethral anastomotic site can be treated with regular self-dilation, but high-grade strictures require a surgical procedure involving incision by electrocautery or cold knife. Here we describe a grade III neovesical-urethral anastomotic stricture after an orthotopic bladder substitution that was successfully treated by use of a ureteral dilation balloon catheter.
Catheters ; Cold Temperature ; Constriction, Pathologic ; Electrocoagulation ; Incidence ; Ureter ; Urinary Bladder ; Urinary Bladder Neck Obstruction ; Urinary Bladder Neoplasms ; Urinary Diversion

BACKGROUND AND OBJECTIVES: As septoplasty has been performed more often in recent years, the incidence of septal perforation as one of its complications has also been increased. Authors aimed to elucidate the etiology and clinical characteristics of the septal perforation. MATERIALS AND METHODS: Fifty-eight patients with septal perforation were diagnosed between 1991 and 1998 at the Department of Otolaryngology, Asan Medical Center. Of them, 46 were male and 12 were female, and their ages ranged from 14 to 76 years of age (mean : 47 years). Medical records were retrospectively reviewed to investigate the etiology, clinical symptoms, and treatment results. RESULTS: The most common cause of septal perforation was associated with nasal surgery (41 patients ; 72%) such as submucous resection (22 patients), septoplasty (10 patients), and transseptal pituitary tumor surgery (7 patients). Malignancy involving the nasal septum was the second common cause (8 patients ; 14%). Nasal stuffiness was the most common complaint (36 patients ; 62%), followed by crust formation (24 patients ; 41%), and nasal bleeding (7 patients ; 12%). Around three quarters of patients had perforation smaller than 10 mm in diameter and the cartilaginous septum was the most common site of perforation (88%). Eleven patients not responding to medical treatment underwent surgical repair with a success rate of 91%. CONCLUSIONS: This study shows that most of the septal perforations are caused by previous nasal surgery involving the nasal septum. Surgeons should be very careful not to make a bilateral corresponding mucosal tear during the septal surgery. If this occurs, meticulous suture-repair with interposition of graft should be applied. For the chronic symptomatic perforation that is refractory to medical treatment, surgical repair using flap and grafts could be performed with a success rate of 90%.
Chungcheongnam-do ; Epistaxis ; Female ; Humans ; Incidence ; Male ; Medical Records ; Nasal Septal Perforation* ; Nasal Septum ; Nasal Surgical Procedures ; Otolaryngology ; Pituitary Neoplasms ; Retrospective Studies ; Transplants

BACKGROUND AND OBJECTIVE: This investigation evaluated the level of subjective satisfaction in hearing aid users by using Abbrieviate Profile of Hearing Aid Benefit (APHAB). MATERIALS AND METHODS: The APHAB is a subjective evaluation method for hearing aid users. The APHAB consists of 24 items with 4 subscales including Ease of Communication (EC), Reverberation (RV), Background noise (BN), and Aversiveness (AV). 3Ve applied for APHAR to evaluate the subjective satisfaction level in 45 compressive types of hearing aids. The APHAB scores were evaluated according to the types of hearing loss, audiologic patterns of pure tone audiograms, the degree of SRT and the types of hearing aids. In each item, subjects respond to each question on the basis of how they believe the performance of their hearing aid is using a 7-point scale. Subjects were tested both unaided and aided for each specified listening situation. The hearing aid benefit is defined as the diR'erence of percentage between the unaided and aided performance scores. RESULTS: In SRT, moderate hearing loss group showed a higher satisfaction in Ease of Communication, Aversiveness (p<0.05). The group that showed a flat audiogram revealed a higher satisfaction in Ease of Communication, Background noise (p<0.01). There was no significant difference of scores of benefit in types of hearing loss and types of hearing aids. CONCLUSION: Hearing aids are more beneficial in patients who have moderate hearing loss and flat audiogram pattern.
Hearing Aids* ; Hearing Loss ; Hearing* ; Humans ; Noise

BACKGROUND: Fungal sinusitis (mycetoma)is distinguished from chronic sinusitis in the aspect of unilateral maxillary sinus involvement. We aimed to elucidate the mechanism of localization in fungal sinusitis by comparing the inflammatory cells infiltrating into the mucosa. MATERIALS AND METHOD: Study subjects were 10 patients with chronic sinusitis involving the maxillary sinus and 10 patients with fungal sinusitis (mycetoma of the maxillary sinus). Pathological mucosa of the maxillary sinus near the ostium were obtained during endoscopic sinus surgery. We counted the number of basophils, eosinophils, neutrophils, plasma cells, and lymphocytes within 1 mm2 (2 mmX0.5 mm)of the central, superficial area of the lamina propria of the pathological mucosa, under a light microscope (X400)using eye reticule. RESULTS: The average numbers of basophils, eosinophils, neutrophils, plasma cells, lymphocytes, and the total inflammatory cells in chronic sinusitis were 7, 50, 71, 231, 647, and 1,008, respectively: and in fungal sinusitis, the numbers were 5, 36, 18, 444, 676, and 1,180. In chronic sinusitis, neutrophils were significantly increased when compared to those of fungal sinusitis patients. In fungal sinusitis, infiltration of plasma cells was significantly increased when compared to that of chronic sinusitis. And for both groups, plasma cells and lymphocytes were the two most predominant inflammatory cells. CONCLUSION: The increased plasma cells in non-invasive fungal sinusitis could be the mechanism for the localization of the fungal lesion within the maxillary sinus, possibly by producing immunoglobulin against fungi.
Basophils ; Eosinophils ; Fungi ; Humans ; Immunoglobulins ; Lymphocytes ; Maxillary Sinus* ; Mucous Membrane* ; Neutrophils ; Plasma Cells ; Sinusitis*

Bezoars are collections or concretions of indigestible foreign material that accumulate and coalesce in the gastrointestinal tract. Treatment options include dissolution with enzymes, endoscopic removal or aspiration, and surgery. The outcome differs according to the treatment method. A 57-year-old man was admitted with a 1-month history of epigastric pain. On gastrofiberscopy, an approximately 2-cm deep ulcer was seen on the lesser curvature of the antrum and three huge bezoars were found. In order to remove the first one, we injected Coca-Cola into it directly. It took 20 minutes to cut up and 1 hour to remove completely. To decrease the procedure time, we changed the injection fluid to urokinase for the remaining two bezoars. It took 9 and 10 minutes to cut up the second and third bezoars, respectively, and 1 hour to remove them completely. We report a case of phytobezoars treated successfully by endoscopic injections of Coca-Cola and urokinase.
Bezoars ; Gastrointestinal Tract ; Humans ; Middle Aged ; Ulcer ; Urokinase-Type Plasminogen Activator

PURPOSE: To evaluate the postoperative outcome of the multiple slit on plaque plication technique for the treatment of Peyronie's disease. MATERIALS AND METHODS: We retrospectively evaluated 22 patients who underwent plaque incision with penile plication for the surgical treatment of Peyronie's disease, who had failed medical treatment between 2009 and 2014. Patients were grouped by preoperative degree of penile curvature into Group I: mild (n=5, 22.7%), Group II: moderate (n=11, 50.0%), and Group III: severe (n=6, 27.3%). After a thorough review of the medical records, we evaluated (a) the correction of the curvature; (b) sexual function; and (c) any penile shortening or other complications. RESULTS: The mean postoperative follow-up period was 39 months. Complete correction of the curvature was attained in 21 patients (95.5%). As an inevitable complication, minimal penile shortening (<1.5 cm) was reported by 14 patients (82.4%) but did not adversely affect sexual intercourse (0%), and all patients found the extent of penile shortening to be acceptable. Nineteen patients had good erectile function (International Index of Erectile Function >21). The most frequent complication was subcutaneous penile edema in three patients (13.6%), which was resolved within about 3 months following surgery. CONCLUSIONS: As a modified technique, multiple slit on plaque with plication is a simple, minimally-invasive and effective technique for correcting penile curvature regardless of curvature severity. The degree of penile curvature does not significantly predict the amount of penile length loss.
Coitus ; Edema ; Focal Adhesions ; Follow-Up Studies ; Humans ; Male ; Medical Records ; Penile Induration* ; Retrospective Studies

BACKGROUND: There has been no consensus on the best way to prevent hypotension during epidural anesthesia. We undertook the present study to evaluate the effect of ephedrine infusion along with fluid preloading in prevention of hypotension. METHODS: Eighty patients undergoing total abdominal hysterectomy were divided into 4 groups. The Group 1 and 2 were preloaded with 1000 ml lactated Ringer's solution(LR), Group 3 with 200 ml LR, and Group 4 with 500 ml of colloid(10% pentastarch) solution. In the group 1, normal saline was infused at 12 ml/min after bupivacaine injection into epidural space. In the Group 2, 3, and 4, ephedrine(mixed in normal saline) was infused after beginning of anesthesia at 1 mg/min. RESULTS: Systolic arterial pressure after epidural blockade was significantly lower in preloading of only LR(Group 1) than those with ephedrine infusion groups(Group 2, 3, and 4). In all groups the heart rate was not changed significantly during the course of the study. The central venous pressure increased after fluid preloading in all groups, but the magnitude of increase was relatively small in Group 3. Hypotension occurred in 45% of the patients who received only LR(Group 1) vs 10% of those who received pentastarch(Group 4)(p<0.05). The incidence of hypotension(20%) was same in Group 2 and 3. CONCLUSIONS: Infusion of ephedrine could be an alternative method to prevent hypotension during epidural anesthesia. Similar incidence of hypotension in Groups 2 and 3 challenges our perception of the value of crystalloid preload.
Anesthesia ; Anesthesia, Epidural* ; Arterial Pressure ; Bupivacaine ; Central Venous Pressure ; Consensus ; Ephedrine* ; Epidural Space ; Heart Rate ; Humans ; Hypotension* ; Hysterectomy ; Incidence