Liquid tissue adheisve, Histoacryl (n-butyl-2-cyanoacrylate) has been used for the treatment of gastric variceal bleeding. The techniques are as follows: 0.5cc Histoacryl mixed with Lipiodol per each injection are used. 3 to 4 injections are usually required for large variceal convolutes under the fluoroscopic visualization after the injection of Histoacryl. Complications of sclerotherapy with Histoacryl are bleeding, perforation, stenosis and embolism depending on the concentration and amount used, as well as the intensity of the treatment. Here we describe a case report developing portal and splenic vein thrombosis as a side effect after Histoacryl injection therapy for the treatment of gastric varix bleeding, A 59-year-old male patient with liver cirrhosis was admitted due to acute gastric varix bleeding. The control of gastrie variceal bleeding was achieved by several injections of 0.7c mixture of 0.5cc histoacryl and 0,8cc Lipiodol. However, simple X-ray and ultrasonography revealed the elements of Histoacryl-lipiodol mixture in the portal and splenic vein.
Constriction, Pathologic ; Embolism ; Enbucrilate* ; Esophageal and Gastric Varices* ; Ethiodized Oil ; Hemorrhage ; Humans ; Liver Cirrhosis ; Male ; Middle Aged ; Sclerotherapy ; Splenic Vein* ; Thrombosis* ; Ultrasonography

Intraductal papilloma that arises from the salivary gland is an extremely rare benign tumor and mostly affects the minor salivary gland. We have experienced a case of an intraductal papilloma arising from the sublingual salivary gland in a 51-year-old woman. The radiologic finding shows an unicystic mass having solid portion. The tumor was completely excised transorally. The histologic findings are papillary proliferation of two uniform layers of columnar epithelial and flat basal cells supported by a fibrovascular core. The clinicopathologic features of this tumor is presented with a review of literature.
Female ; Humans ; Middle Aged ; Papilloma, Intraductal* ; Salivary Glands* ; Salivary Glands, Minor ; Sublingual Gland

BACKGROUND AND OBJECTIVES: A pyriform sinus fistula can cause a recurrent abscess in the neck. Complete excision is recommended but in many cases, surgery is complicated because of recurrent infection. Recurrence may result from failure to recognize, or inadequate excision of the tract. To avoid this, we attempted chemocauterization of the internal opening of the fistula tract with trichloracetic acid (TCA) on suspension laryngoscopy. MATERIALS AND METHOD: This was a 9-year review of 30 patients with pyriform sinus fistula. Medical history, diagnostic methods, operative findings and treatment results were analyzed with a review of the literatures. RESULTS: On suspension laryngoscopy, a fistula opening was found in the pyriform sinus of all patients, mainly on the left side. Except for two patients, 28 patients were managed by TCA chemocauterization. Of the five patients who had recurrent masses, three patients were successfully managed by simple excision and two patients were managed by repeated TCA cauterization with unobliterated internal openings. There was no serious intra- or postoperative complication. CONCLUSION: TCA cauterization is an appropriate first line treatment method for pyriform sinus fistula, especially for patients who have had recurrent neck abscess and undergone open drainage procedure. This method can be used to avoid morbidity of an open surgical procedure.
Abscess ; Cautery ; Drainage ; Fistula* ; Humans ; Laryngoscopy ; Neck ; Postoperative Complications ; Pyriform Sinus* ; Recurrence ; Trichloroacetic Acid

BACKGROUND AND OBJECTIVES: Palatine tonsils and adenoids protect the human body from various pathogens entering through the pharyngeal mucosa. Many studies have been performed for the specific immunity, but the innate immunity related to cell-mediated immunity has been rarely studied. Natural killer (NK) cells, CD5+ B lymphocytes, and gamma sigma T lymphocytes are the key mediators of natural immunity. The aim of this study was to investigate the role of lymphocytes related to the innate immunity property in these lymphoid tissues by examinig the frequency and distribution of these cells. MATERIALS AND METHODS: Palatine tonsils and adenoids were obtained from 12 children and 5 adults with idiopathic tonsillar hypertrophy. Immunohistochemisty was performed to examine the distribution of the CD5+ B lymphocytes, gamma sigma T lymphocytes and NK cells, and the flow cytometry was performed for the frequency of these cells compared with that of the patient's blood. RESULTS: On immunohistochemistry, CD5+ B cells were strongly stained mainly on the interfollicular and subepithelial areas of both the palatine tonsil and adenoid. But, gamma sigma T lymphocytes, and CD56+ cells were weakly stained on the interfollicular, epithelial, and subepithelial areas of both lymphoid tissues. Flow cytometry showed no difference in the frequency of CD5+CD19+ B cells and CD3+ gamma sigma T lymphocytes in these tissues compared to that of the blood. The frequency of NK cells of these tissues was much lower than that of the blood. And the frequency of CD3+ gamma sigma T lymphocytes of adults was lower than that of children in both the palatine tonsils and blood. CONCLUSION: In the palatine tonsils and adenoids, there were no active immune cells related to innate immunity, except for the CD5+ B lymphocytes in the non-stimulating state. And the innate immunity of the lymphoid tissues has possibility of association with the changing activity according to age.
Adenoids* ; Adult ; B-Lymphocyte Subsets ; B-Lymphocytes ; Child ; Flow Cytometry ; Human Body ; Humans ; Hypertrophy ; Immunity, Cellular ; Immunity, Innate* ; Immunohistochemistry ; Killer Cells, Natural ; Lymphocytes* ; Lymphoid Tissue ; Mucous Membrane ; Palatine Tonsil* ; T-Lymphocyte Subsets ; T-Lymphocytes

BACKGROUND AND OBJECTIVES: Traumatic perforation in hypopharynx and cervical esophagus may be fatal, causing mediastinitis or sepsis. We present six cases of clinical experiences to outline diagnosis and management. MATERIALS AND METHOD: We retrospectively reviewed six patients with hypopharyngeal-cervical esophageal injury, over the period of recent two years. We summarized the method of diagnosis, treatment and clinical course with review of the literature. RESULTS: There were two cases of external blunt trauma, two cases of iatrogenic causes, and two cases of intraluminal injuries. The common clinical signs were painful neck swelling and fever. The five of six in routine X-ray showed air shadow in the neck or chest. The neck CT showed air or abscess in all six cases. The surgical drainage was performed in four cases. CONCLUSION: The diagnostic methods of hypopharyngeal-cervical esophageal injuries include chest X-ray, neck X-ray, Gastrografin(r) esophagography and CT after thorough history-taking and physical examination. CT was highly sensitive and important for decision of surgical management. Surgery is recommended if there is large perforation, abscess, mediastinal contamination or sepsis. In selective cases, non-surgical management is possible.
Abscess ; Diagnosis ; Drainage ; Esophagus ; Fever ; Humans ; Hypopharynx ; Mediastinitis ; Neck ; Physical Examination ; Retrospective Studies ; Sepsis ; Thorax

BACKGROUND AND OBJECTIVES: Venous malformations are one of the most common vascular anomalies, and are more frequently found in head and neck region. Various treatment options are available, and intralesional injection of sclerosant is the commonest primary treatment modality. We reviewed 20 cases of venous malformation treated with sclerotherapy at Seoul National University Hospital. MATERIALS AND METHODS: Twenty cases of venous malformation in head and neck were reviewed retrospectively, which had been managed with sclerotherapy from January 1991 to July 2001. The patients were treated at the department of otolaryngology-Head and Neck Surgery or plastic surgery of Seoul National University Hospital. Emulsion of Ethamolin and Lipiodol was used as a sclerosing agent. Some patients received surgical treatment after sclerotherapy. All of the patients received direct-puncture venography(Digital subtraction angiography) before sclerotherapy. Treatment results were evaluated by using MRI, angiography, or CT. If the reduction of volume of mass was more than 50 percent after sclerotherapy, we regarded the result as effective, if less than 50 percents, non-effective. Statistical analysis was done using SPSS10.0 for windows. RESULTS: Among twenty patients, there were eight males(40%), and twelve females(60%). Ages at the beginning of treatment ranged from six to thirty-eight years(mean age:20.6 years). The most common site of lesions was cheek(in 12 cases). Mass sizes(largest diameter) ranged from 2 cm to 20 cm. Nine cases were managed with both sclerotherapy and surgical excision, and eleven cases, only with sclerotherapy. Thirteen cases(65%) responded well to sclerotherapy(volume reduction>or=50%). There was no major complication. Tenderness, induration, swelling, and pain were reported as post-sclerotherapy complaints. Mild dyspnea occurred in one case, and the patient was managed at ICU shortly without fatal event. CONCLUSION: Sclerotherapy with or without surgical excision was an effective treatment modality for venous malformation, with minimal risk of major complications. There were no significant differences in the treatment results according to the initial size of the lesions.
Angiography ; Dyspnea ; Ethiodized Oil ; Head ; Humans ; Injections, Intralesional ; Magnetic Resonance Imaging ; Neck ; Retrospective Studies ; Sclerotherapy* ; Seoul ; Surgery, Plastic

BACKGROUND AND OBJECTIVES: The survival rate for rhabdomyosarcoma has been improved much after introduction of multimodality treatment. We reviewed the treatment results and investigated the related prognostic factors of pediatric nonorbital head and neck rhabdomyosarcoma. MATERIALS AND METHOD: Medical records of 27 children treated for nonorbital head and neck rhabdomyosarcoma from January 1986 to December 2000 were analyzed. Patients' ages at diagnosis ranged from 1 to 169 months (mean: 75 months). The pathologic subtypes were predominantly embryonal with 23 patients (85%), followed by alveolar subtype with 1 (4%), and uncertain one with 3 (11%). RESULTS: The overall 5-year survival rate was 69%. Of 27 patients, 20 had parameningeal and 7 had nonparameningeal tumors. Eleven (41%) had cranial nerve involvement with frequent abducens nerve and facial nerve involvement. Ten (37%) had skull base or brain invasion. The 5-year survival of patients with skull base or brain invasion was 40% and without skull base or brain invasion was 88%. Parameningeal site (68% vs 71%) and cranial nerve involvement (64% vs 73%) were not significant prognostic factors. CONCLUSION: Skull base or brain invasion was an important prognostic factor. There is no indication of initial aggressive surgical resection for the tumors located in the parameningeal site, which is difficult to access.
Abducens Nerve ; Brain ; Child ; Cranial Nerves ; Diagnosis ; Facial Nerve ; Head and Neck Neoplasms ; Head* ; Humans ; Medical Records ; Neck* ; Rhabdomyosarcoma* ; Skull Base ; Survival Rate

Korean Society of Thyroid-Head and Neck Surgery appointed a Task Force to provide guidance on the implementation of a surgical treatment of oral cancer. MEDLINE databases were searched for articles on subjects related to “surgical management of oral cancer” published in English. Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. The quality of evidence was rated with use RoBANS (Risk of Bias Assessment Tool for Nonrandomized Studies) and AMSTAR (A Measurement Tool to Assess the Methodological Quality of Systematic Reviews). Evidence-based recommendations for practice were ranked according to the American College of Physicians grading system. Additional directives are provided as expert opinions and Delphi questionnaire when insufficient evidence existed. The Committee developed 68 evidence-based recommendations in 34 categories intended to assist clinicians and patients and counselors, and health policy-makers. Proper surgical treatment selection for oral cancer, which is directed by patient- and subsite-specific factors, remains the greatest predictor of successful treatment outcomes. These guidelines are intended for use in conjunction with the individual patient's treatment goals.
Advisory Committees ; Bias (Epidemiology) ; Carcinoma, Squamous Cell ; Counseling ; Expert Testimony ; Humans ; Mouth Neoplasms ; Neck ; Republic of Korea