OBJECTIVES: The purpose of study was to report the current role of transnasal esophagoscopy (TNE) in Korea. METHODS: One hundred thirty-seven patients who underwent TNE at Soonchunhyang University Bucheon Hospital (n=69) and Korea University Anam Hospital (n=68) from July 2007 to February 2009 were prospectively analyzed. Laryngopharyngeal reflux disease (LPRD) patients without any response to proton-pump inhibitor (n=102), and patients with complaints that require esophagoscopy as part of their evaluation (n=35) were included in this study; investigation of metachronous lesions or routine follow-up screening of head and neck cancer patients, n=17; dysphagia, n=9; blood tinged saliva, n=4; to determine the cause of vocal fold paralysis as screening tool, n=4; suspicious esophageal foreign body, n=1. RESULTS: Fifty-three patients (38.7%) had positive findings on TNE. Positive finding ratio was highest in group of dysphagia (7 among 9 patients, 78%). Forty-two patients (41.1%) were found to have pathology (esophagitis, n=41; esophageal diverticulum, n=1) during the screening examination for LPRD. There were no significant complications in any of the patients. CONCLUSION: TNE is a high-yield diagnostic and therapeutic modality available to otolaryngologists for use on awake patients in the office setting.
Deglutition Disorders ; Diverticulum, Esophageal ; Esophagoscopy* ; Esophagus ; Follow-Up Studies ; Foreign Bodies ; Gyeonggi-do ; Head and Neck Neoplasms ; Humans ; Korea ; Laryngopharyngeal Reflux ; Mass Screening ; Paralysis ; Pathology ; Prospective Studies* ; Saliva ; Tolnaftate ; Vocal Cords

Alkalies ; Bicuspid ; Burns, Chemical ; Calcium ; Calcium Hydroxide ; Cheek ; Curettage ; Dental Pulp Cavity ; Female ; Humans ; Hydroxides ; Hypesthesia ; Incisor ; Lip ; Paresthesia ; Root Canal Filling Materials ; Silicones ; Zygoma

PURPOSE: This experimental study verified the effect of adipose-tissue-derived stem cells (ASCs) on the healing of ischemic colonic anastomoses in rats. METHODS: ASCs were isolated from the subcutaneous fat tissue of rats and identified as mesenchymal stem cells by identification of different potentials. An animal model of colonic ischemic anastomosis was induced by modifying Nagahata's method. Sixty male Sprague-Dawley rats (10-week-old, 370 +/- 50 g) were divided into two groups (n = 30 each): a control group in which the anastomosis was sutured in a single layer with 6-0 polypropylene without any treatment and an ASCtreated group (ASC group) in which the anastomosis was sutured as in the control group, but then ASCs were locally transplanted into the bowel wall around the anastomosis. The rats were sacrificed on postoperative day 7. Healing of the anastomoses was assessed by measuring loss of body weight, wound infection, anastomotic leakage, mortality, adhesion formation, ileus, anastomotic stricture, anastomotic bursting pressure, histopathological features, and microvascular density. RESULTS: No differences in wound infection, anastomotic leakage, or mortality between the two groups were observed. The ASC group had significantly more favorable anastomotic healing, including less body weight lost, less ileus, and fewer ulcers and strictures, than the control group. ASCs augmented bursting pressure and collagen deposition. The histopathological features were significantly more favorable in the ASC group, and microvascular density was significantly higher than it was in the control group. CONCLUSION: Locally-transplanted ASCs enhanced healing of ischemic colonic anastomoses by increasing angiogenesis. ASCs could be a novel strategy for accelerating healing of colonic ischemic risk anastomoses.
Anastomotic Leak ; Animals ; Body Weight ; Collagen ; Colon ; Constriction, Pathologic ; Humans ; Ileus ; Ischemia ; Male ; Mesenchymal Stromal Cells ; Models, Animal ; Polypropylenes ; Rats ; Rats, Sprague-Dawley ; Stem Cells ; Subcutaneous Fat ; Transplants ; Ulcer ; Wound Infection

Aortopulmonary fistula is an uncommon but often fatal condition resulting as a late complication of an aortic aneurysm. The most common cause is erosion of a false aneurysm of the descending thoracic aorta into the pulmonary artery, resulting in the development of a left-to-right shunt and leading to acute pulmonary edema and right heart failure. We report an our experience with aortopulmonary fistula as a rare complication associated with thoracic aortic aneurysm and high output heart failure.
Aneurysm, False ; Aorta, Thoracic ; Aortic Aneurysm ; Aortic Aneurysm, Thoracic ; Arterio-Arterial Fistula ; Fistula ; Heart Failure ; Pulmonary Artery ; Pulmonary Edema

Scedosporium (S.) apiospermum is the asexual stage of Pseudallescheria (P.) boydi. The organism is ubiquitous in nature, and has a world-wide distribution. It has been isolated from soil, plant debris, polluted water and sewage. It is an opportunistic organism with low virulence. Infection may occur via direct inoculation and usually affects the extremities. We report a case of cutaneous S. apiospermum infection which occurred in a 58-year-old male during immunosuppressive therapy, 3 months after a kidney transplantation. He presented with an one-month history of cutaneous nodules on the dorsum of the right foot. Cultural isolation showed S. apiospermum and we treated him daily with itraconazole and drainage.
Drainage ; Extremities ; Foot ; Humans ; Immunosuppression ; Itraconazole ; Kidney Transplantation ; Male ; Middle Aged ; Plants ; Pseudallescheria ; Scedosporium* ; Sewage ; Soil ; Virulence

BACKGROUND AND OBJECTIVES: Frey's syndrome is one of the potential sequelae of parotidectomy. Various medical and surgical treatments have been used in attempt to avoid this embarrassing condition. Recently, interposing barriers between the overlying skin flap and the parotid bed, such as the sternocleidomastoid (SCM) muscle flap, have been used to prevent this condition. The purpose of this study was to evaluate the preventive impact of using this flap on the incidence of Frey's syndrome and to identify the degree of severity in this syndrome between the use of SCM flap and no muscle flap. SUBJECTS AND METHOD: 40 patients who underwent superficial parotidectomy from June 1996 to August 2003 were divided into two groups. One group had SCM flap reconstruction (n=20), and the other did not (n=20). A subjective clinical questionnaire and the objective Minor's starch test were used to evaluate the incidence of this syndrome. A grading system was used to divide Frey's syndrome into mild or severe Frey's syndrome to determine its severity. The test of Pearson-x2 was applied. RESULTS: The association between sweating, flushing, or pain and the use of the flap was not significant. Also, there was no significant association with Minor's starch test and the use of the flap. There was a significant association with mild Frey's syndrome and the presence of the flap (p=0.014). CONCLUSION: It would seem that the sternocleidomastoid muscle flap does not reduce the incidence of Frey's syndrome, but does decrease the degree of severity in Frey's syndrome.
Flushing ; Humans ; Incidence ; Parotid Gland ; Surveys and Questionnaires ; Skin ; Starch ; Sweat ; Sweating ; Sweating, Gustatory*

BACKGROUND AND OBJECTIVES: The posterior branch of the greater auricular nerve is a sensory nerve that serves the skin over the mastoid process and the postero-inferior region of the auricle. The greater auricular nerve is often sacrificed in parotidectomy, even though its posterior branch can be preserved. By cautious dissection of the greater auricular nerve it is possible to preserve the posterior branch in 69 per cent of the operations. However, the efficiency of this procedure is not clear. So, we have compared the patients whose nerve had been preserved with those sacrificed, to evaluate the validity of the posterior branch of greater auricular nerve preservation during parotidectomy. SUBJECTS AND METHOD: Thirty patients undergoing parotidectomy were divided into two groups. Fifteen patients underwent parotidectomy with preservation of the posterior branch of the greater auricular nerve (group A) and they were compared with fifteen patients who underwent parotidectomy with sacrificing the nerve (group B). Using questionnaire, we have researched about numbness, pain or other subjective symptoms on peri-auricular area after parotidectomy and the function of the nerve has been tested by two point tactile discrimination test and temperature sensitivity test. RESULTS: Postoperatively, twenty-nine patients felt lack of sensitivity, pain, itching or other symptoms. These symptoms recovered within 12 months, subjectively. However, in group B, permanent sensory loss was found in three patients. The two-point discrimination test revealed in group B, the decreased sensitivity on the operated side in comparison with the unoperated side (p=0.008). It also showed the decreased sensitivity on operated side in group B, compare with group A (p=0.012). CONCLUSION: From this study, despites of no significant difference on subjective symptoms, there was objective improvement on function of the greater auricular nerve. It seems reasonable to spare the greater auricular nerve during parotidectomy.
Discrimination (Psychology) ; Humans ; Hypesthesia ; Mastoid ; Parotid Gland ; Pruritus ; Surveys and Questionnaires ; Sensation* ; Skin

Free muscle flap for the simultaneous coverage of two anatomically distant sites has previously entailed the harvest of tissue from separate donor areas, Although it may be possible to achieve this goal with a variety of available donor site, the transfer of a single donor muscle to two different sites has been considered. The gracilis muscle is commonly usef by reconstructive surgeon in a variety of application as pedicled muscle or musculocutaneous flap and as a free tissue transfer for soft tissue coverage or a functioning muscle transfer. The gracilis muscle is classified as having a type II blood supply that anatomy is reliable. The main arterial supply to the gracilis muscle is a branch of the profunda femoris, which enters the muscle 10+/-1cm from its attachment to the pubis on its deep(lateral) surface. The distal portion of muscle between the main arterial pedicle and musculotendinous junction is supplied by one to three small arterial branches of the superficial femoral artery. The first minor pedicle located approximately 20 cm from the pubis. In 1990 Tadeusz reported the successful treatment of patient with bilateral calcaneal fractures and posttraumatic osteomyelitis using a longitudinal single split free gracilis muscle transfer. In 2001 We performed a transversely dividing gracilis muscle free flap in the patient with two soft tissue defects and osteomyelitis in anterior tibial region and foot.
Femoral Artery ; Foot ; Free Tissue Flaps* ; Humans ; Myocutaneous Flap ; Osteomyelitis ; Tissue Donors

PURPOSE: To compare the diagnostic role of arthrosonography, conventional ultrasonography and MR arthrography in the assessment of glenoid labral tear, glenoid rim fracture and humeral head fracture of the shoulder joint. MATERIALS AND METHODS: The findings of arthrosonography, conventional ultrasonography and MR arthrography were prospectively evaluated in 62 consecutive patients with chronic pain or a history of recurrent dislocation of the shoulder joint. The glenoid labrum was arbitrarily divided into four quadrants: anterosuperior, anteroinferior, posterosuperior, and posteroinferior, and for each, visibility at arthrosonography and conventional ultrasonography was subjectively scored as one of four grades. By means of statistical analysis, the two techniques were then compared. Twenty-six patients subsequently underwent arthroscopy, and the presence or absence of labral tear, glenoid rim fracture and humeral head fracture was determined. The sensitivity and specificity of each modality were separately calculated for each of the three types of shoulder joint injury, and observed differences in these findings were statistically analysed. RESULTS: For all individual quadrants of the labrum, visibility at arthrosonography was higher than at conventional ultrasonography (p<.0001). For the detection of labral tear, the sensitivity of arthrosonography was not significantly higher than that of conventional ultrasonography (p>.05), though its specificity was significantly higher (p=.003). In this respect, there was no significant difference in sensitivity or specificity between arthrosonography and MR arthrography (p>.05). For the detection of glenoid rim and humeral head fracture, there were no statistical differences in sensitivity and specificity between the three imaging modalities (p> .05). CONCLUSION: Compared with conventional ultrasonography, arthrosonography provides higher visibility of the labrum, thus improving the capacity of ultrasonography to detect labral tear. Arthrosonography could therefore be useful in the diagnosis of labral tear, glenoid rim fracture and humeral head fracture, and may thus partially replace MR arthrography.
Arthrography* ; Arthroscopy ; Chronic Pain ; Diagnosis ; Dislocations ; Humans ; Humeral Head* ; Prospective Studies ; Sensitivity and Specificity ; Shoulder Joint* ; Shoulder* ; Ultrasonography*

Head and neck cancers have never been systematically studied for clinical purposes yet in Korea. This epidemiological survey on head and neck cancer patients was undertaken from January to December 2001 in 79 otorhinolaryngology resident-training hospitals nationwide. The number of head and neck cancer patients was 1,063 cases in the year. The largest proportion of cases arose in the larynx, as many as 488 cases, which accounted for 45.9%. It was followed by, in order of frequency, oral cavity (16.5%), oropharynx (10.0%), and hypopharynx (9.5%). The male:female ratio was 5:1, and the mean age was 60.3 yr. Surgery was the predominant treatment modality in head and neck cancers: 204 (21.5%) cases were treated with only surgery, 198 (20.8%) cases were treated with surgery and radiotherapy, 207 cases (21.8%) were treated with combined therapy of surgery, radiotherapy, and chemotherapy. Larynx and hypopharynx cancers had a stronger relationship with smoking and alcohol drinking than other primary site cancers. Of them, 21 cases were found to be metastasized at the time of diagnosis into the lung, gastrointestinal tract, bone, or brain. Coexisting second primary malignancies were found in 23 cases. At the time of diagnosis, a total of 354 cases had cervical lymph node metastasis accounting for 42.0%.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Alcohol Drinking/epidemiology ; Carcinoma, Squamous Cell/epidemiology* ; Child ; Female ; Head and Neck Neoplasms/epidemiology* ; Health Surveys ; Human ; Korea/epidemiology ; Male ; Middle Aged ; Neoplasm Metastasis ; Neoplasms, Second Primary/epidemiology ; Occupations ; Registries/statistics & numerical data ; Risk Factors ; Smoking/epidemiology