BACKGROUND AND OBJECTIVES: Incidences of postoperative mucoceles of the frontal, ethmoid, or sphenoid sinuses are currently on the rise. The clinical rogression of the postoperative mucoceles in the frontal, ethmoid, or sphenoid sinuses are different from that of the maxillary mucoceles. In this study, we investigated the clinical patterns and treatments of postoperative mucoceles, which have developed in the frontal, ethmoid, or sphenoid sinuses. MATERIALS AND METHODS: Between June,1994 and August, 2005, twenty-six patients with thirty postoperative mucoceles were treated surgically. They had a previous history of operation and incidences of maxillary mucoceles were excluded from the study. A review of the clinical subjects were performed using their clinical records and radiological findings. RESULTS: The locations of the postoperative mucoceles were, in the order of frequency, the ethmoid, frontal, fronto-ethmoid, spheno- ethmoid, sphenoid, and fronto-ethmoidsphenoid sinus. Postoperative mucoceles occurs mostly in the form of ophthalmic symptoms and headache. The ophthalmic manifestations were different between the anterior, posterior and the antero-posterior mucocele group. The mean duration until diagnosed as postoperative mucocele since the previous sinus surgery was 9.9 years, and endoscopic sinus surgeries and intranasal ethmoidectomies with Caldwell-Luc operations were the majority among previous surgeries. Most postoperative mucoceles could be successfully treated with an endoscopic marsupialization. CONCLUSION: Frontal, ethmoid, or sphenoid postoperative mucoceles developed mostly on the ethmoid sinus and occurs mainly in the form of ophthalmic symptoms. Most postoperative mucoceles were successfully treated with an endoscopic marsupialization.
Ethmoid Sinus ; Headache ; Humans ; Incidence ; Mucocele* ; Paranasal Sinuses ; Sphenoid Sinus*

BACKGROUND AND OBJECTIVES: Maxillary sinus mucoceles are usually developed long after Caldwell-Luc's operation, which are known as postoperative cheek cysts and common in Korea. However, primary mucoceles of the maxillary sinus are relatively rare compared to frontal or ethmoid sinus mucoceles. This study aims to describe the clinical manifestation of the primary maxillary sinus mucoceles and to determine the long-term efficacy of the surgical treatment. MATERIALS AND METHOD: Seven cases, comprised of 2 women and 5 men with an age range of 23 to 72 years, finally diagnosed as primary maxillary sinus muco (pyo)celes between March 1995 and July 2004 were studied. The presenting signs and symptoms, radiological findings, and surgical management were retrospectively reviewed. RESULTS: All patients complained of nasal obstruction, while only one patient had cheek pressure and pain. In the endoscopic nasal examination, the medial wall of maxillary sinus was bulging with prolapsed middle meatal mucosa in 6 cases. Five patients were treated with endonasal endoscopic sinus surgery and two with sublabial approach. Intraoperative cultures grew organisms in four patients. In all patients, the middle meatal antrostomy openings were patent without recurrence at the latest follow-up ranging from 11 to 47 months. CONCLUSION: A primary maxillary sinus mucocele appears as a bulging medial wall with unilateral nasal obstruction. Endoscopic sinus surgery is a reliable therapeutic measure with lesser morbidity and favorable long-term outcome.
Cheek ; Endoscopy ; Ethmoid Sinus ; Female ; Follow-Up Studies ; Humans ; Korea ; Male ; Maxillary Sinus* ; Mucocele* ; Mucous Membrane ; Nasal Obstruction ; Recurrence ; Retrospective Studies

OBJECTIVE: To investigate the correlation between the severity of paralysis and hand sympathetic skin response (SSR) in patients with Bell's palsy and to evaluate the clinical utility of hand SSR as a predicting factor of prognosis. METHOD: Twenty patients with Bell's palsy and twenty normal controls were recruited. The severity of paralysis was graded according to House-Brackmann Facial Grading Scale (H-B FGS), and percent degeneration of Nasalis was determined by Facial Nerve Conduction Study (FNCS). RESULTS: The difference of hand SSR amplitude between affected and unaffected side was significant (p<0.05). There was significant correlation between H-B FGS and the difference of hand SSR amplitude (p<0.05). There was significant correlation between percent degeneration and the difference of hand SSR amplitude (p<0.05). There were significant correlations between the difference of hand SSR amplitude at 5 days and percent degeneration at 9 and 14 days (p=0.026, p=0.001). CONCLUSION: The difference of hand SSR amplitude between affected and unaffected side was useful for the indication of the severity of paralysis. And, hand SSR would be useful for an early prognostic predictor in Bell's palsy.
Bell Palsy* ; Facial Nerve ; Hand* ; Humans ; Paralysis ; Prognosis ; Skin*

BACKGROUND AND OBJECTIVES: Rhinovirus (RV) enters into the airway epithelial cells via the membrane bound receptor ICAM-1. The epithelial cells produce chemotactic cytokines after RV infection. The purpose of this study is to investigate the effect of ethanol on promoting RV infection in airway epithelial cells by increasing the ICAM-1 level and causing a reversible damage in epithelial barrier function. SUBJECTS AND METHOD: We pretreated various concentrations of low non-cytotoxic ethanol to A549 cells before RV infection and investigated the effect of ethanol on RV infection. The changed in epithelial barrier function was assessed by transepithelial electrical resistance as measured by voltmeter. Effect of ethanol on ICAM-1 expression was assessed by flow cytometry. Epithelial cytokine response was evaluated using ELISA technique. The level of viral replication was expressed as viral titer, which was determined through viral culture on MRC-5 cells. RESULTS: Ethanol increased ICAM-1 mean fluorescence intensity and the viral titer according to the pretreated ethanol concentrations. But increment of ICAM-1 was inconsistent with increase of viral titer and vise versa. In ethanol treated cells, the production of cytokines was increased and it was consistent with increase of viral titer. Ethanol treatment had no effect on transepithelial resistance. CONCLUSION: Ethanol pretreatment enhanced the ICAM-1 expression, viral replication and RV induced cytokine secretion in A549 cells. But we could not prove the association of RV infection with ICAM-1 expression induced by ethanol. Transepithelial resistance was not changed after ethanol treatment.
Chemokines ; Cytokines ; Electric Impedance ; Enzyme-Linked Immunosorbent Assay ; Epithelial Cells ; Ethanol* ; Flow Cytometry ; Fluorescence ; Intercellular Adhesion Molecule-1 ; Membranes ; Rhinovirus

PURPOSE: To examine the effect of unilateral otitis media and unilateral cerumen occlusion of the ear canal on thermometers. METHODS: One hundred eighty six children with unilateral otitis media, fifty children with unilateral cerumen occlusion, and fifty children with neither otitis media nor cerumen were enrolled. Temperature was measured in both ear canals using thermometers. After 15 minutes, second temperature was measured again in both ears. Unilateral otitis media was graded by video otoscope for 7 grades. Differences in temperatures between affected ears and unaffected ears were analyzed. RESULTS: No temperature difference between the normal and cerumen groups was observed. The mean temperature of the otitis media ear canal was 0.13+/-0.20degrees C higher than that of the intact ear canal (36.99+/-0.54degrees C vs 36.86+/-0.52degrees C; P<0.001). There was no statistically significant temperature difference between grades. CONCLUSION: Unilateral otits media can affect estimation of body temperature measured by thermometers.
Body Temperature ; Cerumen ; Child ; Ear ; Ear Canal ; Humans ; Otitis ; Otitis Media ; Otoscopes ; Thermometers

PURPOSE: The purpose of this study was to evaluate the effect of contrast improvement of enhancing brain lesions by inherent magnetization transfer effect in turbo spin-echo (TSE) T1-weighted MR imaging. MATERIALS AND METHODS: Twenty-six enhancing lesions of 19 patients were included in this study. Using a 1.0T superconductive MR unit, contrast-enhanced SE T1-weighted images (TR=600 msec, TE=12 msec, NEX=2, acquisition time=4 min 27sec) and contrast-enhanced TSE T1-weighted images (TR=600 msec, TE=12 msec, NEX=2, acquisition time=1min 44sec) were obtained. Signal intensities at enhancing lesions and adjacent white matter were measured in the same regions of both images. Signal-to-noise ratio (SNR) of enhancing lesions and adjacent white matter, and contrast-to-noise ratio (CNR) and lesion-to-background contrast (LBC) of enhancing lesions were calculated and statistically analysed using the paired t-test. RESULTS: On contrast-enhanced TSE T1-weighted images, SNR of enhancing lesions and adjacent white matter decreased by 18%(p<0.01) and 32% (p<0.01), respectively, compared to contrast-enhanced SET1-weighted images. CNR and LBC of enhancing lesions increased by 16% (p<0.05) and 66% (p<0.01), respectively. CONCLUSION: Due to the proposed inherent magnetization transfer effects in TSE imaging, contrast-enhanced T1-weighted TSE images demonstrated a statistically significant improvement in CNR and LBC, compared to conventional contrast-enhanced T1-weighted SE images, and scan time was much shorter.
Brain ; Humans ; Magnetic Resonance Imaging ; Signal-To-Noise Ratio

Endoscopic variceal ligation(EVL) was developed to provide a safer alternative than injection sclerotherapy for treatment of bleeding esophageal varices. EVL adds a new indication that will significantly increase the use of overtubes. overtube itself may have a role in predisposing to esophageal perforation but only one report has been published regarding an esophageal perforation related to the placement of an overtube. Recently, we experienced a case of esophageal perforation caused by overtube placement during endoscopic variceal ligation. So we report this case with review of relevant literatures.
Esophageal and Gastric Varices ; Esophageal Perforation* ; Hemorrhage ; Ligation* ; Sclerotherapy

PURPOSE: To report the initial clinical outcomes of the newly devised sliding loop technique (SLT) used for renorrhaphy in patients who underwent robot-assisted laparoscopic partial nephrectomy (RALPN) for small renal mass. MATERIALS AND METHODS: We reviewed the surgical videos and medical charts of 31 patients who had undergone RALPN with the SLT renorrhaphy performed by two surgeons (CWJ and CK) between January 2014 and October 2014. SLT renorrhaphy was performed after tumor excision and renal parenchymal defect repair. Assessed outcomes included renorrhaphy time (RT), warm ischemic time, perioperative complications, and perioperative renal function change. RT was defined as interval from the end of bed suture to the renal artery declamping. RESULTS: In all patients, sliding loop renorrhaphy was successfully conducted without conversions to radical nephrectomy or open approaches. Mean renorrhaphy and warm ischemic time were 9.0 and 22.6 minutes, respectively. After completing renorrhaphy, there were no adverse events such as dehiscence of approximated renal parenchyma, renal parenchymal tearing, or significant bleeding. Furthermore, no postoperative complications or significant renal function decline were observed as of the last follow-up for all patients. The limitations of this study include the small volume case series, the retrospective nature of the study, and the heterogeneity of surgeons. CONCLUSIONS: From our initial clinical experience, SLT may be an efficient and safe renorrhaphy method in real clinical practice. Further large scale, prospective, long-term follow-up, and direct comparative studies with other techniques are required to confirm the clinical applicability of SLT.
Adult ; Aged ; Female ; Hemostasis, Surgical/methods ; Humans ; Kidney Neoplasms/*surgery ; Laparoscopy/methods ; Male ; Middle Aged ; Nephrectomy/*methods ; Patient Positioning/methods ; Robotic Surgical Procedures/*methods ; *Suture Techniques ; Treatment Outcome

BACKGROUND: The injection pain of microemulsion propofol is frequent and difficult to prevent. This study examined the prevention of pain during microemulsion propofol injection by pretreatment with different doses of remifentanil or saline, and premixing of lidocaine. METHODS: One hundred sixty ASA physical status 1-2 adult patients scheduled for elective surgery were enrolled into one of four groups (n = 40, in each). The patients received saline (group LS), remifentanil 0.3 microg/kg (group LR 0.3), remifentanil 0.5 microg/kg (group LR 0.5), or remifentanil 1.0 microg/kg (group LR 1.0), and after 90 seconds received an injection of 2 mg/kg microemulsion propofol premixed with lidocaine 40 mg. Pain was assessed on a four-point scale during microemulsion propofol injection. RESULTS: The incidence of microemulsion propofol-induced pain was significantly lower in the LR 0.3, LR 0.5 and LR 1.0 groups than in the LS group (37.5%, 12.5% and 10% vs 65%, respectively). The LR 0.5 and LR 1.0 groups showed significantly less frequent and intense pain than the LR 0.3 group. However, both incidence and severity of pain were not different between LR 0.5 and LR 1.0 groups. CONCLUSIONS: The combination of remifentanil and lidocaine is effective in alleviating pain associated with a microemulsion propofol injection compared with just lidocaine. Remifentanil 0.5 microg/kg had a similar analgesic effect compared to the 1.0 microg/kg dose.
Adult ; Humans ; Incidence ; Lidocaine ; Piperidines ; Propofol

PURPOSE: To evaluate the embolic effect and pathologic change in the kidney after infusion of 50% acetic acidin the renal artery. MATERIALS AND METHODS: Five kidneys were embolized with 50% acetic acid mixed with saline(group A) and five were embolized with 50% acetic acid mixed with contrast medium (group B). Four rabbits(2 fromgroup A and 2 from group B) were sacrificed during the first day and the remaining six, 28 days afterembolization. To determine the effect of embolization and pathologic findings, the two groups were compared. RESULTS: Complete occlusion of the renal artery was observed in both groups; histologic findings indicatingtubular necrosis and blood clots within the renal artery were noted one day after embolization. After four weeks,complete necrosis of the renal arterial wall and tubular cells had occurred. The procedures required forembolization were easier in group B because the extent of embolization could be controlled by fluoroscopy. CONCLUSION: At 50% dilution after mixing with contrast medium, the embolie effect of acetic acid isperfect;because the embolic material is visualised the procedure was easier to control than embolization withalcohol. acetic acid can, threrfore, be used as an effective embolic agent in renal artery embolization.
Acetic Acid* ; Fluoroscopy ; Kidney ; Necrosis ; Rabbits* ; Renal Artery*