BACKGROUND AND OBJECTIVES: Tonsillectomy for upper airway obstruction in children has increased but there isn't enough objective data to support such assessment. The purpose of this study was to establish some objective guide for surgery in obstructive apneic children using polysomnography and to compare the polysomnographic results with predictive clinical data, so as to determine the prevalence of obstructive sleep apnea (OSA) with suggestive history. We also tried to understand the characteristics of OSA in children. MATERIALS AND METHODS:Predictive value of OSA was scored based on history, physical examination and X-ray images and compared with the standard overnight polysomnography in fifty-one children who were suggestive of OSA. Postoperative polysomnography was performed in five children who remained apneic. RESULTS: Twenty-two (43%) children with suggestive OSA had respiratory disturbance index (RDI) greater than 5. Among thirty-five (68.6%) who underwent surgery, five (9.8%) children remained apneic with snoring but mean and the longest apnea duration reduced significantly. There was no difference between the obstructive group and non-obstructive group in sleep architecture but minimum oxygen saturation, apnea index, mean apnea duration and hypopnea index showed significant difference. Predictive clinical score and RDI had weak correlation (r=0.25). Non-obstructive group showed higher composition of centeral apnea than the obstructive group. CONCLUSION: History, physical examination and X-ray studies alone are not sufficient to assess the severity of OSA. Polysomnographic study adjusted for children should be done for correct diagnosis in children who do not show any other indication for surgery.
Airway Obstruction ; Apnea ; Child* ; Diagnosis ; Humans ; Oxygen ; Physical Examination ; Polysomnography ; Prevalence ; Sleep Apnea, Obstructive* ; Snoring ; Tonsillectomy

BACKGROUND: In a noisy hospital setting, it is not easy to induce hypnosis or sedation calmly. Although the noise stress has been neglected, it seems to disturb a patient's sleep or induction of sedation. Therefore, we tried to evaluate the effects of loud operating room (OR) background noise on bispectral index (BIS) during monitored anesthesia care (MAC) by using an audiometer and BIS monitor. METHODS: Thirty adult patients (ASA class I) were scheduled two times for nasal or dental procedures at an interval of two or three days. In a randomized, cross-over study design, we prospectively compared the BIS values according to the loudness of OR noise in two different depths of sedation during MAC. Propofol target controlled infusion (TCI) was started at a propofol target concentration (CT) 2.0 microgram/ml using a DiprifusorTM with flash mode until a BIS 80 and/or a modified Observer's Assessment of Alertness/Sedation (mOAAS) score of 4 (group 1), and BIS 75 and/or mOAAS score 3 (group 2) was obtained. We evaluated the effect site concentrations and the elapsed time and checked the BIS at 50, 80, 110, and 120 dB of sound pressure level (SPL) in both groups. RESULTS: The BIS at 80, 110 and 120 dB of SPL in group 1 was significantly increased compared to those at 50 dB (P < 0.05). Similarly, the BIS at 110 and 120 dB of SPL in group 1 was significantly increased compared to those at 80 dB (P < 0.05). The patients in their twenties were most susceptible to loud OR noise during sedation. CONCLUSIONS: The loud OR background noise might be possible to interfere with induction of sedation to a degree, which was more noticeable on light to moderate sedation than for deep sedation.
Adult ; Anesthesia* ; Conscious Sedation ; Cross-Over Studies ; Deep Sedation ; Humans ; Hypnosis ; Noise* ; Operating Rooms* ; Propofol ; Prospective Studies

Brown tumor, also referred as "Oteitis fibrosa cystica," is a focal lesion found within the areas of bone resorption as a result of diffused resorptive process of the bone resulting from hyperparathyroidism. Brown tumors are nonneoplastic tumors of multinucleated giant cells and fibrocellular proliferation. Brown tumors as a part of primary hyperparathyroidism are commonly multiple and occur in the ribs, clavicle, and pelvic girdle. However, brown tumor on the hard palate is extremely rare. We recently experienced a case of a 39-year old female patient with palatal brown tumor. We present this case of brown tumor that occurred after primary hyperparathyroidism with a brief review of literature.
Bone Resorption ; Clavicle ; Female ; Giant Cells ; Humans ; Hyperparathyroidism ; Hyperparathyroidism, Primary ; Palate, Hard ; Ribs

BACKGROUND AND OBJECTIVES: Scintigraphic swallowing test is a noninvasive, quantitative and safe measurement of swallowing. The purposes of this study were to establish a normative data of scintigraphic swallowing test and to determine that this procedure could be a simple screening test of swallowing disorders. MATERIALS AND METHODS: Scintigraphic tests of the oropharyngeal transit with thick liquid bolus were performed in 51 normal subjects, who were 15 to 61 years of age. Each subject was instructed to swallow the single viscous liquid bolus mixed with 1mCi Tc-99m tin-colloid. Dynamic imaging data were obtained with the patients in a supine position and recorded at a frame rate of 25 per second over 10 seconds. Inspection of summed images permitted the section of regions of interest (ROI) to represent the mouth, pharynx, and esophagus. Transit times between each ROI were calculated and compared. Time activity data were used to compute oral discharge and pharyngeal transit times, oropharyngeal transit time, percentage residues in the mouth and pharynx, oral and pharyngeal swallowing efficiencies, and oropharyngeal clearance in 2.5 seconds. Twenty subjects repeated the test in two weeks. RESULTS: Mean+/-standard deviation of oral discharge time, pharyngeal transit time, oropharyngeal transit time, oral residue, pharyngeal residue, oral swallowing efficiency, pharyngeal swallowing efficiency, and oropharyngeal clearance in 2.5sec were 0.37+/-0.11sec, 0.64+/-0.19 sec, 1.01+/-0.21 sec, 7.05+/-3.60%, 6.12+/-3.80%, 273.58+/-78.82%/sec, 160.74+/-51.11%/sec, and 90.63+/-6.65% respectively. Repeated studies in 20 individuals indicated that these parameters were statistically similar and pharyngeal transit time was highly reproducible. Other parameters were intermediately reproducible except oral and pharyngeal residues. CONCLUSION: Oropharyngeal scintigraphy provides a rapid, noninvasive and cost effective screening test as well as a quantitative study of swallowing disorders.
Deglutition Disorders ; Deglutition* ; Esophagus ; Humans ; Mass Screening ; Mouth ; Pharynx ; Radionuclide Imaging* ; Supine Position

Leukemic involement of the temporal bone is not uncommon, but facial paralysis is rare as the presenting sign. A 16-year-old boy suddenly developed otalgia, facial nerve paralysis, tinnitus and vertigo. Four months ago, acute myelogenic leukemia was detected and chemotherapy was done with incomplete resolution. The initial examination revealed facial nerve paralysis, mixed hearing loss, spontaneous nystagmus but peripheral blood picture was normal. On the fourth hospital day, simple mastoidectomy was performed for drainage and diagnosis. The harvested tissue showed leukemic infiltration and subsequent peripheral blood picture revealed immature cells. Patient refused further evaluation and chemotherapy, and three months later he died of intracranial hemorrhage. We report a case of acute myelogenic leukemia with facial nerve paralysis.
Adolescent ; Diagnosis ; Drainage ; Drug Therapy ; Earache ; Facial Nerve* ; Facial Paralysis ; Hearing Loss, Mixed Conductive-Sensorineural ; Humans ; Intracranial Hemorrhages ; Leukemia* ; Leukemic Infiltration ; Male ; Paralysis* ; Temporal Bone ; Tinnitus ; Vertigo

PURPOSE: Infective endocarditis (IE) is a serious complication in children with structural heart disease. We reviewed 35 cases of IE to identify the recent changes in the pattern of preexisting heart diseases, the spectrum of causative organisms and prognosis. METHODS: The clinical records of children diagnosed as IE at the Seoul National University Children's Hospital from January 1987 through December 1997, were reviewed retrospectively. Duke criteria was used for diagnosis. Cases were categorized into primary group(PG) IE in an unoperated heart and post operative group(POG), and the latter further into early POG(within 2 months after operation) and late POG. RESULTS: There were 35 cases of IE developed in 34 patients; 18 cases in the PG, 6 cases in the early POG, and 11 cases in the late POG. Male to female ratio was 16 : 19. Mean age of POG, especially early POG was less than that of PG (early POG : late POG : PG=1.65 years : 6.5 years : 8.34 years, P=0.0267). Preexisting heart diseases were identified in 30 cases; rheumatic heart disease 1 case and congenital heart disease (CHD) 29 cases. Causative organisms were identified in 80%; viridans streptococci, 10 cases (33.3%); pneumococci, 2 cases; Group-D streptococci, 3 cases; staphylococci, 8 cases; Gram (-) organisms, 5 cases and Candida albicans, 2 cases. Vegetation was detected in 88.9% of PG and 64.7% of POG. The most common indication for surgery was uncontrolled infection, which were required in 9 cases. The overall mortality rate was 12.1%. Mortality in POG was higher than that of PG (23.5% versus 0%, P=0.033). CONCLUSION: The discrepancy of mean age among patient groups and the high proportion of patients belonging to POG, were consistent with the increase in the number of newly risky population that survived after cardiac surgery. A more aggressive consideration for operative management may improve the treatment results.
Candida albicans ; Child* ; Diagnosis ; Endocarditis* ; Female ; Heart ; Heart Defects, Congenital ; Heart Diseases ; Humans ; Male ; Mortality ; Prognosis ; Retrospective Studies ; Rheumatic Heart Disease ; Seoul ; Thoracic Surgery ; Viridans Streptococci

BACKGROUND AND OBJECTIVES: With the wide use of cochlear implants, there have been many published studies which report that cochlear implants have a suppressive effect on tinnitus in profoundly deaf patients. The aim of this study was to understand the clinical and audiologic characteristics of the tinnitus in patients with cochlear implantation and to observe changes of their tinnitus after cochlear implantation. SUBJECTS AND METHOD: A total 23 patients who had undergone cochlear implants in our hospital from August 2003 to December 2006, were included in this study. The patients were divided into tinnitus (n=11) and non-tinnitus groups (n=12) according to the presence of tinnitus at the time of surgery. We compared clinical and audiologic features between the two groups. We also studied changes in tinnitus after surgery in the tinnitus group using validated self-report measures [tinnitus handicap inventory (THI), tinnitus handicap score (THS), and visual analogue scale]. RESULTS: There were significant differences between the two groups with respect to the age of cochlear implant recipients, whether or not the subjects had impaired hearing or were wearing hearing aids. Tinnitus was rarely observed in patients under 20 years of age with cochlear implantation (11.1%) in contrast to the higher rates in the patients of 20 years old and over (71.4%). Marked reduction of THI, THS and visual analogue scale of tinnitus were observed in all patients. CONCLUSION: For the adult patients who had undergone cochlear implant surgery and had tinnitus preoperatively, cochlear implants had shown suppressive effect on their tinnitus. Considering the significant prevalence of tinnitus in profoundly deaf patients, tinnitus of these patients should not be overlooked and further studies should be made to define relationship between cochlear implant and tinnitus.
Adult ; Cochlear Implantation ; Cochlear Implants ; Hearing ; Hearing Aids ; Humans ; Prevalence ; Tinnitus

BACKGROUND AND OBJECTIVES: Epidermal-mesenchymal interactions control epidermal growth and differentiation and thus regulate tissue homeostasis in the epidermis. So the function of fibroblasts is, in addition to producing extracellular matrix as a structural framework, to act as a cellular communication bridge between epidermis and dermis by synthesizing various mediators, such as growth factors and cytokines. Although the epithelial-mesenchymal cell interaction is still not known clearly, cytokines like interleukine-1beta from keratinocyte promote Keratinocyte growth factor (KGF) which is a member of the fibroblast growth factor (FGF-7) group. IL-1beta was shown to be an important modulator of KGF expression by fibroblast cells. Like hepatocyte growth factor, KFG is best characterized as paracrine mediators of stromal-epithelial interactions produced by fibroblast cells to regulate the functions of epithelial cells and the KGF receptors (KGFR) which is a transmembrane tyrosine kinase that is a splice variant of the FGFR-2/bek gene. To study the regulation of epidermal cell proliferation and differentiation by fibroblasts via paracrine effects of oropharyngeal mucosa, an in-vitro model system has been developed to mimic epidermal-dermal interactions. Material and Method: A co-culture of fibroblasts and keratinocytes in three-dimensional collagen gels was treated with IL-1beta after carrying out the tissue culture from oropharyngeal mucosa. Immuno-histochemistry for localization of KFG and KFGR was done in these artificial tissue and in the mucosa. RESULTS: KGF and KGFR proteins were strongly expressed in cytoplasm of intermediate and superficial layers of the epithelium of the oropharyngeal mucosa. In four out of the five cases, three-dimensional oral mucosa cultures were successfully reconstructed on fibroblast-populated collagen lattice. KGF expression was found focally in the keratinocyte of epithelial layer and diffusely in fibroblast-populated collagen lattice. KGFR was only expressed focally in Keratinocyte of epithelial layer. CONCLUSION: Epidermal-mesenchymal interactions in oropharyngeal mucosa via IL-1beta, KGF and KGFR were observed in a three-dimesional culture system, showing that this system could be used as a study model of epidermal-mesenchymal interactions in oropharyngeal mucosa with some limitations.
Cell Communication ; Cell Proliferation ; Coculture Techniques ; Collagen ; Cytokines ; Cytoplasm ; Dermis ; Epidermis ; Epithelial Cells ; Epithelium ; Extracellular Matrix ; Fibroblast Growth Factor 7* ; Fibroblast Growth Factors ; Fibroblasts* ; Gels ; Hepatocyte Growth Factor ; Homeostasis ; Intercellular Signaling Peptides and Proteins ; Interleukin-1beta ; Keratinocytes* ; Mouth Mucosa ; Mucous Membrane ; Protein-Tyrosine Kinases