BACKGROUND AND OBJECTIVES: The purpose of this study was to analyze clinical safety of PMR(Palatal Muscle Resection) in obstructive sleep apnea patients. MATERIALS AND METHODS: Fourteen Patients underwent only PMR were reviewed retrospectively. ESS(Epworth Sleepiness Scale) was analyzed after PMR surgery to assess surgical results. Visual Analogue Scale were reviewed to evaluate postoperative pain. Eustachian tube function test, voice analysis, and measurement of forced expiration power were done after two months of surgery. RESULTS: ESS were improved after PMR. There were little postoperative pain. There was no significant change is observed vowel sounds except /u/ nor postoperative nasalization in voice, Eustachian tube dysfunction and change of expiration power. CONCLUSION: PMR may be regarded clinically safe surgery in obstructive sleep apnea patient.
Eustachian Tube ; Humans ; Muscles ; Pain, Postoperative ; Palate ; Phonation ; Retrospective Studies ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive ; Voice

Leiomyoma is a benign myogenic tumor may occur whenever smooth muscle is present. The most common locations are the uterus, alimentary tract, skin, and subcutenous tissue. Leiomyoma of the nasal cavity and paranasal sinus is rare because of the paucity of smooth muscle on the nose. We experienced a case of leiomyoma originating in the left inferior turbinate in a 58-year-woman. It was successfully removed by an endoscopic surgery. We discussed with a review of the literatures.
Leiomyoma* ; Muscle, Smooth ; Nasal Cavity ; Nose ; Skin ; Turbinates* ; Uterus

Leiomyoma is a benign myogenic tumor may occur whenever smooth muscle is present. The most common locations are the uterus, alimentary tract, skin, and subcutenous tissue. Leiomyoma of the nasal cavity and paranasal sinus is rare because of the paucity of smooth muscle on the nose. We experienced a case of leiomyoma originating in the left inferior turbinate in a 58-year-woman. It was successfully removed by an endoscopic surgery. We discussed with a review of the literatures.
Leiomyoma* ; Muscle, Smooth ; Nasal Cavity ; Nose ; Skin ; Turbinates* ; Uterus

BACKGROUND AND OBJECTIVES: We reviewed retrospective data of patients who underwent endoscopic septoplasty over 5 years and provide clinical information about endoscopic septoplasty. SUBJECTS AND METHOD: The medical records of patients who underwent endoscopic septoplasty were reviewed retrospectively for clinical symptoms, surgical methods, intraoperative technique, operation time, postoperative complications and results. RESULTS: Nasal obstruction was the most common presenting symptom. Among patients, endoscopic septoplasty alone was performed in 290 cases. Among 290 cases, 57 cases were of broad based septal defection, 13 cases septal deflection with septal spur, 16 cases isolated septal spur and 4 cases limited posterior septal deflection. The mean operation time was 32.48+/-2.76 minutes. No major complication occurred in the immediate postoperative period. Minor complications included septal hematoma (3.79%) and postoperative hemorrhage (1.03%). Sixty-five patients received statistically validated measures of Visual Analog Scale (VAS) at 1 month and 6 months after surgery. VAS score decreased statistically from 7.75 to 0.81 at 6 mon-ths after operation (p<0.05). CONCLUSION: Endoscopic septoplasty is a relatively safe and effective technique used to treat various types of septal pathology such as classical septal deviation, septal spur and isolated septal deflection. Endoscopy with video imaging system is valuable for education.
Endoscopes ; Endoscopy ; Hematoma ; Humans ; Medical Records ; Nasal Obstruction ; Nasal Septum ; Postoperative Complications ; Postoperative Hemorrhage ; Postoperative Period ; Retrospective Studies

Mucosal malignant melanomas (MM) within the nose and paranasal sinuses are rare, representing 1-3% of MM and 3-4% of malignant sinonasal tumors. The incidence of amelanotic MM with primary lesions in the sinonasal cavity is also extremely rare. The absence of pigmentation in the tumor may result in diagnostic confusion. Amelanotic MM may masquerade as a variety of other conditions leading to a delay in the diagnosis and worsen the prognosis. In this report, we present, along a brief review of the literature, an interesting case of amelanotic MM misconceived as a nasal polyp. Although paranasal MRI and endoscopy showed no evidence of remnant mass after surgery, positron emission tomography/computed tomography (PET/CT) image showed an area of increaed fluorodeoxyglucose (FDG) uptake.
Electrons ; Endoscopy ; Incidence ; Melanoma ; Melanoma, Amelanotic ; Nasal Cavity ; Nasal Polyps ; Nose ; Paranasal Sinuses ; Pigmentation ; Prognosis

BACKGROUND: Etiologic diagnosis of pleural effusion is usually made by clinical characteristics, pleural fluid analysis and pleural biopsy. But, despite careful diagnostic study, the cause of pleural effusion cannot be found in about 20 percent of patients, especially in loculated pleural effusions. Tuberculous pleurisy is one of the most common cause of pleural effusion in Korea. But, pleural fluid culture for Mycobacterium tuberculosis are positive in only 20 to 30 percent of patients and typical pleural biopsy finding in less than 50 percent of patients with this disease. In recent studies, adenosine deaminse(ADA) and its isoenzymes were proposed to be a useful diagnostic tool for differential diagnosis of pleural effusion We investigated the pattern of ADA and its isoenzyme activities in various cause of pleural effusions to evaluate the diagnostic value of measuring ADA and its isoenzymes. METHOD: We measured total ADA and its isoenzyme activities in pleural fluid and serum from 54 patients with pleural effusion(25 tuberculous pleural effusion, 10 parapneumonic effusion, 14 malignant pleural effusion, 5 transudative pleural effusion), including 5 loculated tuberculous pleural effusions and 6 loculated parapneumonic effusions. Total ADA activity was measured by the spectrophotometric method and ADA2 isoenzyme activity was measured with same method using EHNA, potent inhibitor of ADA1 isoenzyme activity. RESULT: Total ADA activity of tuberculous pleural effusion was higher than malignant pleural effusion(p<0.01), but no significant difference was found between tuberculous pleural effusion and parapneumonic effusion (tuberculous pleural effusion:148.9+/-9.91U/L, parapneumonic effusion:129.0+/-119.41U/L, malignant pleural effusion 48.7+/-9.71U/L). Percentage of ADA2 activity to total ADA activity(ADA2%) of pleural effusion of tuberculous pleurisy was higher than parapneumonic effusion(p<0.05), but no significant difference was found between tuberculous pleural effusion and malignant pleural effusion(tuberculous pleural effusion: 57.2+/-10.7%, parapneumonic effusion: 35.9+/-17.8%, malignant pleural effusion: 60.7+/-4.1%). In loculated pleural effusion, ADA2% of tuberculous pleural effusion was higher than parapneumoriic effusion(tuberculous pleural effusion: 53.3+/-3.9%, parapneumonic effusion: 27.8+/-7.9%). CONCLUSION: Measurement of ADA isoenzyme activity is useful for differentiating tuberculous pleural effusion from parapneumonic effusion, especially in loculated pleural effusion.
Adenosine* ; Biopsy ; Diagnosis ; Diagnosis, Differential ; Humans ; Isoenzymes ; Korea ; Mycobacterium tuberculosis ; Pleural Effusion* ; Pleural Effusion, Malignant ; Tuberculosis, Pleural

BACKGROUND: Impulse Oscillometry is a noninvasive and effort-independent test used to characterize the mechanical impedance of the respiratory system. The clinical potential of the 105 is rapid and demands only passive cooperation which makes it especially appealing for children, for epidemiologic surveys and for conditions in which quiet breathig instead of forced expiratory maneuvers are preferred. However, several studies have shown conflicting results that the role of 108 about detection of smoking induced small airway diseases or early airway obstruction METHODS: Study was to evaluate the clinical ability of the 108 to detect about smoking induced early airway obstruction in persons with normal spirometry test. Respiratory asymptomatic study groups were formed that one is non-smoking group, another is smoking group. RESULTS: The parameters of spirometry were not significantly differences between non-smoking group and smoking group. Among the parameters of 108, total resistance(non-smoking group: smoking group= 2.22 +/-1.20 : 2.58 +/-1.71), peripheral resistance( 1.25 +/-0.62 : 1.47 +/-0.10), bronchial compliance(0.44 +/-0.12: 0.47 +/-0.16) were not statistically significant different (p<0.05), but central resistance and lung compliance were not statistically significant different (unit ; resistance= hPa/l/s, compliance= 1/hPa). Resistance(Rrs) was not statistically significant different with changes of frequences(5, 10, 15, 20, 25, 30, 35Hz), but Reactance(Xrs) was statistically significant differenct with low frequences that X5(non-smoking group : smoking group= -0.62 +/-0.28 : - 0.76 +/-0.48, p<0.001) and X10(-0.06 +/-0.19 : -0.15 +/-0.33, p<0.013) (unit; hPa/l/s, hPa=cmH2O) CONCLUSION: Impulse oscillometer(IOS) is clinically available method to detect about smoking induced early airway obstruction. And clinically potential parameters of IOS were considers that total resistance, peripheral resistance, bronchial resistance, and reactance of low frequency at 5Hz, 10Hz.
Airway Obstruction* ; Child ; Electric Impedance ; Humans ; Lung Compliance ; Oscillometry ; Respiratory System ; Smoke* ; Smoking* ; Spirometry ; Vascular Resistance

BACKGROUND AND OBJECTIVES: Some chronic sinusitis patients complain that voice change, which occurs during surgeries such as endoscopic sinus surgery (ESS), can lead to changes in the vocal organ. The purpose of this study is to analyze the effect of ESS on voice by questionnaire and voice analysis. SUBJECTS AND METHOD: Thirty patients (male 15, female 15) who had underwent ESS were enrolled. All patients had sinusitis confirmed by preoperative CT scan. We analyzed subjective voice impairment by way of questionnaire (Korean-Version of Voice Handicap Index, KVHI) and objective voice impairment by Computerized Speech Laboratory one day preceding and at one month following the surgery. Finally, the subjective impairment of voice was analyzed by subjective questionnaire at postoperative 6 months. In objective analysis, we analysis 11 ESS cases on the formant frequencies of five vowels (/a/, /i/, /u/, /e/, /o/) and three nasal consonants (/namu/, /nuna/, /umma/). RESULTS: In the questionnaire (KVHI), there was a little change in the functional, physical and emotional field but the results were not statistically significant (p>0.05). In the voice analysis, the first formant frequencies of /a/, /u/, the third formant frequency of /o/ of vowel and /a/ of /namu/ of nasal consonant were significantly increased postoperatively compared to those of the preoperative status (p<0.05). However, there was no major change. There was no subjective voice impairment at 6 months after operation. CONCLUSION: After ESS, some voice impairment were observed in KVHI and some formant frequencies were increased in the objective voice analysis but without serious major voice changes. We conclude that ESS is relatively safe from voice point of view; however, for some professional voice users, particular attention needs to be paid regarding fine voice changes.
Acoustics ; Endoscopy ; Female ; Humans ; Surveys and Questionnaires ; Sinusitis ; Voice

BACKGROUND AND OBJECTIVES: Polysomnography (PSG) is useful for the diagnosis of obstructive sleep apnea (OSA) and the analysis of its occurrence and severity. Nevertheless, physical examination and PSG are not sufficient to localize the obstructed structure before operation. Drug-induced sleep endoscopy (DISE), on the other hand, is expected to provide an accurate diagnosis as it can be used to evaluate the intensity of operative effect and can minimize additional unnecessary procedures. The aim of this study is to analyze correlation between the results of polysomnography and obstructive structure by DISE in OSA Patients. SUBJECTS AND METHOD: This study was conducted on 75 patients, who were diagnosed with OSA by PSG and DISE. Obstruction levels and individual structures were classified by modified VOTE classification. The patients were divided into groups according to the results of PSG and BSI; the correlation between DSI results and each of these groups were analyzed. RESULTS: There were no statistically significant differences in obstruction levels between PSG data and DISE finding. Obese patients, positional-dependent OSA and sleep stage non-dependent OSA (NREM OSA) groups showed more obstruction on the lateral pharyngeal wall. Severe OSA groups showed more obstruction on tonsils. Obese patient groups revealed more obstruction on tongue base, but did not contribute to statistically significant results. CONCLUSION: In our study, obese patients, severe OSA, positional-dependent OSA and NREM OSA groups tended to exert greater influence on the obstruction of lateral pharyngeal wall. Surgeons should be aware of these findings when performing sleep surgery.
Endoscopy ; Hand ; Humans ; Palatine Tonsil ; Physical Examination ; Polysomnography ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive ; Sleep Stages ; Tongue ; Unnecessary Procedures

BACKGROUND/AIMS: Treating hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) remains controversial. We compared the outcomes of hepatic resection (HR), transarterial chemoembolization (TACE), and sorafenib therapy as treatments for HCC with PVTT. METHODS: Patients diagnosed as HCC with PVTT between January 2000 and December 2011 who received treatment with sorafenib, HR, or TACE were included. Patients with main PVTT, superior mesenteric vein tumor thrombosis, or Child-Turcotte-Pugh (CTP) class C were excluded. The records of 172 patients were analyzed retrospectively. HR, TACE, and sorafenib treatment were performed is 40, 80, and 52 patients respectively. PVTT was classified as either involving the segmental branch (type I) or extending to involve the right or left portal vein (type II). RESULTS: The median survival time was significantly longer in the HR group (19.9 months) than in the TACE and sorafenib groups (6.6 and 6.2 months, respectively; both p<0.001), and did not differ significantly between the latter two groups (p=0.698). Among patients with CTP class A, type I PVTT or unilobar-involved HCC, the median survival time was longer in the HR group than in the TACE and sorafenib groups (p=0.006). In univariate analyses, the initial treatment method, tumor size, PVTT type, involved lobe, CTP class, and presence of cirrhosis or ascites were correlated with overall survival. The significant prognostic factors for overall survival in Cox proportional-hazards regression analysis were initial treatment method (HR vs. TACE: hazard ratio=1.750, p=0.036; HR vs. sorafenib: hazard ratio=2.262, p=0.006), involved lobe (hazard ratio=1.705, p=0.008), PVTT type (hazard ratio=1.617, p=0.013), and CTP class (hazard ratio=1.712, p=0.012). CONCLUSIONS: Compared with TACE or sorafenib, HR may prolong the survival of patients with HCC in cases of CTP class A, type I PVTT or unilobar-involved HCC.
Adult ; Aged ; Antineoplastic Agents/*therapeutic use ; Carcinoma, Hepatocellular/complications/drug therapy/*therapy ; Chemoembolization, Therapeutic ; Combined Modality Therapy ; Female ; Follow-Up Studies ; Humans ; Liver Neoplasms/complications/drug therapy/*therapy ; Male ; Middle Aged ; Niacinamide/*analogs & derivatives/therapeutic use ; Phenylurea Compounds/*therapeutic use ; Portal Vein ; Proportional Hazards Models ; Retrospective Studies ; Severity of Illness Index ; Survival Rate ; Treatment Outcome ; Venous Thrombosis/*complications