The estimated incidence of recurrent or residual cholesteatoma requiring revision mastoid surgery ranges from 2% to 10% in canal wall down mastoidectomy. The causes of failure of mastoidectomy include recurrent cholesteatoma, suppuration in unexentrated cells, and mechanical factors promoting retention of debris within the mastoid cavity. The authors have experienced a case of long-term residual cholesteatoma, without connection to the previous radical mastoidectomized cavity, which showing subscalp fistula and extradural granulation with continuous purulent discharge. So we report with a review of literature.
Cholesteatoma* ; Fistula ; Incidence ; Mastoid ; Suppuration

BACKGROUND: Injuries to the ear and temporal bone are ubiquitous, and proper early management is crucial. Violent closed-head injuries, particularly if the temporal bone is fractured, also commonly cause ossicular chain disruption. Significant ossicular chain damage usually produces a conductive hearing loss. Hearing loss due to ossicular disruption can be improved by surgery. OBJECTIVES: The cause, incidence, position of ossicular disruption, method of reconstruction and postopeartive results were studied in 23 cases with post-traumatic conductive hearing loss. MATERIALS AND METHODS: Over the past 5 years, a total of 23 patients undergoing exploratory tympanotomy with ossiculoplasty were investigated retrospectively. RESULTS: The male to female ratio was 3.6:1. The most common cause was longitudinal temporal bone fracture(87%) and the most common finding of ossicular injury was incudostapedial separation with fibrous band formation(65%). The type III tympanoplasty using autologous incus was the most common surgical reconstruction for hearing gain(78%). In 78% of the cases, hearing was restored within 10dB of postoperative air-bone gap in the speech range. CONCLUSION: Cases of post-traumatic conductive hearing loss following trauma, in which it is difficult to confirm the presence of pathological lesions by conventional hearing and imaging tests, are occasionally encountered, necessitating exploratory surgery. As it is possible to improve hearing loss significantly in most of these cases by performing a reconstruction of the ossicular chain, exploratory surgery shoud be extensively recommended for post-traumatic conductive hearing loss.
Ear ; Female ; Hearing ; Hearing Loss ; Hearing Loss, Conductive* ; Humans ; Incidence ; Incus ; Male ; Retrospective Studies ; Temporal Bone ; Tympanoplasty

Chrionic exposure of the skin UVB radiation causes erythema and dermal connective tissue damage including wrinkling, neoplastic skin lesions, and delayed wound healing. The topical application of epidermal growth factor(EGF) has been reported to be effective in the treatment of partial and full thickness skin wounds, second degree burns, incision wound, and chronic ulcers. However, its effect thickness UVB damaged skin has not yet been defined. Fifty Sprague-Dawley rats were divided into four groups: UV irradiated-EGF treated group; UV irradiated-EGF untreated group; UV nonirradiated-EGF treated group; UV nonirradiated-EGF untreated Group peroperatively, the UV exposure groups were irradiated with UVB (40 mJ/cm2, 2 MEDs) on the dorsal skin every other day for 12 weeks. Following cessation of UNB exposure, a standard 6 cm midline dorsal linear incision was made in each animal. The animals in EGF treated group were topically applicated with EGF ointment (10 microgramg/g) twice a day. Wounds were excised and wound burst strength was applicated using tensiometer on the 7th and 10th postwounding days. The wound burst strength of the UV irradiated-EGF treated group (662+/-49.7 g/cm) was significantly increased compared to that of the UV irradiated-EGF untreated group (352 +/-40.3 g/cm) (p < 0.01) and even stronger than that of the UV nonirradiated-EGF untreated group (570+/-44.7 g/cm) (p < 0.05). On the 10th day, there was no significant difference in the wound burst strength between the UV irradiated-EGF treated group (1248 +/-101.3 g/ cm) and UV nonirradiated-EGF treated group (1270+/-98.5 g/cm) (p = 0.595). Histological examination revealed epidermal hyperplasia, degeneration of collagen fibers, and inflammatory cell infiltration in the UV irradiated groups. Thick epidermis, prominent skin appendages, increased capillaries and fibroblasts, and linear organization of collagen fibers were observed in EGF treated groups. These results indicate that repeated exposure to UVB irradiation alters normal skin structure and adversely affects subsequent wound healing and the topical application of epidermal growth factor facilitates wound healing of UVB damaged skin.
Animals ; Burns ; Capillaries ; Collagen ; Connective Tissue ; Epidermal Growth Factor* ; Epidermis ; Erythema ; Fibroblasts ; Hyperplasia ; Rats* ; Rats, Sprague-Dawley ; Skin ; Ulcer ; Wound Healing* ; Wounds and Injuries*

No abstract available.
Acromegaly* ; Fibrous Dysplasia, Polyostotic*

BACKGROUND: Spontaneous pneumomediastinum (SPM) is a relatively rare and benign condition that generally occurs in young adults without any precipitating factor or disease. The purpose of this study was to assess whether more uncomforting diagnostic procedures are necessary and to establish standards in the diagnosis and treatment of spontaneous pneumomediastinum. MATERIAL AND METHOD: A retrospective study was done on 18 patients from the hospitals of Hanyang University Seoul Hospital and Hanyang University Guri Hospital between February, 1997 and June, 2004. All patients had presence of mediastinal air without a pneumothorax and no evidence of trauma or barotrauma. RESULT: Among the 18 patients, the majority were male patients with only two female patients. Their mean age was 20.95 years old with standard deviation of 14.3 years. The most common complaints were chest pain, dyspnea, and coughing. Evaluation included simple chest roentgenogram in all patients, 10 patients had a chest tomographic scan, 10 patients had an esophagoscopic exam, 6 patients had a bronchofiberoscopic exam, and 3 patients had an esophagogram done. The mean hospital stay was 10.9 days. All patients were treated conservatively and in a follow-up of 1~8 years only one recurrence was found. CONCLUSION: SPM is caused by alveolar rupture in the pulmonary interstitium leading to dissection of air towards the hilum and mediastinum. Although SPM is a self-limiting condition, evaluation should include chest roentgenogram and chest tomographic scans to rule out any other secondary condition. More aggressive evaluation seems unnecessary.
Barotrauma ; Chest Pain ; Cough ; Diagnosis ; Dyspnea ; Emphysema ; Female ; Follow-Up Studies ; Humans ; Length of Stay ; Male ; Mediastinal Emphysema* ; Mediastinum ; Pneumothorax ; Precipitating Factors ; Recurrence ; Retrospective Studies ; Rupture ; Seoul ; Thorax ; Young Adult

Unilateral pulmonary artery agenesis is a rare congenital malformation usually associated with other cardiovascular anomaly such as Tetralogy of Fallot. Isolated pulmonary artery agenesis is very rare, and usually asymptomatic. It is usually highly suspected by routine chest X-ray, and associated symptoms are hemoptysis, blood tinged sputum, repeated pulmonary infection, and dyspnea on exertion. We have recently experienced the right pulmonary artery agenesis in 27 year-old male patient, complaining of minimal hemoptysis and sustained blood tinged sputum. He was successfully treated by right pneumonectomy, so we report this case with the review of associated literature.
Adult ; Dyspnea ; Hemoptysis ; Humans ; Male ; Pneumonectomy ; Pulmonary Artery* ; Sputum ; Tetralogy of Fallot ; Thorax ; Tolnaftate

PURPOSE: Occult injuries are diagnosed using computed tomography (CT), often with intravenous (IV) contrast CT, in major trauma patients. The contrast dye is known to be potentially nephrotoxic. Thus, we measured the incidence and risk factors for contrast-induced nephropathy (CIN) in major trauma patients. METHODS: A retrospective review was performed on 247 patients who were treated by the activated trauma team between June 2012 and July 2014. The exclusion criteria were underlying renal failure, no IV contrast CT administered, and no creatinine (Cr) follow-up within 72 hours. We examined age, gender, initial vital signs, the Glasgow Coma Scale (GCS), initial Cr levels, Cr level within 72 hours after admission, the IV contrast CT number, Injury Severity Score (ISS). CIN was defined as 25% relative or 0.5 mg/dL absolute increase in serum Cr within 72 hours of presentation. RESULTS: One hundred forty-three patients were included in this study. CIN manifested in 12 patients (8.4%). The injury severity was associated with CIN (ISS≥16, p=0.003; GCS≤8, p<0.001; death, p<0.001). Initial Cr levels, elderly patients, and initial hypotension were not statistically significant (p=0.065, 0.176, and 0.402, respectively). The number of IV contrast CTs administered was also not associated with the occurrence of CIN (p=0.331). CONCLUSION: We found an 8.4% incidence of CIN in multiple trauma patients exposed to IV contrast. The number of IV contrasts, age, initial systolic blood pressure, and initial Cr levels were not associated with CIN. Only injury severity was associated with CIN occurrence; therefore, physicians should pay more attention to severely-injured patients.
Aged ; Blood Pressure ; Creatinine ; Follow-Up Studies ; Glasgow Coma Scale ; Humans ; Hypotension ; Incidence ; Injury Severity Score ; Multiple Trauma ; Renal Insufficiency ; Retrospective Studies ; Risk Factors ; Vital Signs

We developed an electromechanical gait trainer for rehabilitation of the persons with disabilities, which was designed to simulate normal gait with partial body weight support. The purpose of this study was to apply it to stroke patients and to evaluate its usability. Four nonambulatory stroke patients had 20 sessions of gait training with newly developed gait trainer for 5 to 6 weeks. Knee and ankle joint angles were measured by electrogoniometer during training. Main outcome was assessed by functional ambu lation category (level 0~5). Knee and ankle joint angles during exercise in the gait trainer showed repetitive pattern of gait-like movement similar to normal gait, though it was variable among the subjects. Functional ambulation category levels after training were 2 in 3 patients and 1 in 1 patient. The electromechanical gait trainer was a useful device for gait retraining in stroke patients with severe neurologic impairments.
Ankle Joint ; Body Weight ; Disabled Persons ; Gait* ; Humans ; Knee ; Rehabilitation* ; Stroke* ; Walking

Seminal vesicle cyst (SVC) with ipsilateral renal agenesis is a rare congenital anomaly. When the patient is symptomatic, surgical treatment may be necessary. The open surgical approach, traditionally considered the definite form of treatment, has been associated with a high rate of morbidity. The laparoscopic approach for the management of SVCs has recently been described. A 18-year-old man presented with a 2-year history of dysuria and perineal pain. The diagnostic evaluation revealed a 45x35x48 mm sized left seminal vesicle cyst. In addition, he had a solitary, right, functioning kidney, with left renal agenesis. Transperitoneal laparoscopic excision of the cyst was performed successfully. The patient was discharged from the hospital on the fourth postoperative day and did not present with any complaints or complications.
Adolescent ; Congenital Abnormalities ; Dysuria ; Humans ; Kidney ; Kidney Diseases ; Seminal Vesicles

Eight patients underwvnt reoperation after valve replacement surgery with a mechanical valve from January, 1992 to December, 2003. Among the various indications for reoperation, there were 4 patients with paravalvular leakage; 3 patients underwent resuturing of the area of leakage and one patient underwent redo valve replacement. Among the three patients with stenosis due to thrombosis of the valve, 2 patients underwent redo valve replacement and one patient underwent thrombectomy. In one patient, the valve functioned normally, but stenosis was caused by overgrowth of the patient and redo valve replacement was done 123 months later. There was no postoperative mortality or morbidity. After an average of 51 months (2~134 months) of postoperative follow up, the patients were in good condition and were able to maintain a NYHA functional class of I or II. The operative method used, whether it be a redo valve replacement or valve sparing method, depends upon the type of lesion and the anatomic structure.
Constriction, Pathologic ; Follow-Up Studies ; Heart Valves* ; Heart* ; Humans ; Mortality ; Reoperation* ; Thrombectomy ; Thrombosis