OBJECTIVE: The aim of this study is to evaluate the feasibility, safety and effectiveness of radiofrequency neurotomy(RFN) for remnant pain after vertebroplasty for the treatment of severe compression fracture. METHODS: 25 patients with remnant pain after vertebroplasty for one level severe compression fracture were treated by RFN. The severe compression fractures were defined to the vertebrae which less than 50% of their original heights have collapsed. Pain relief was evaluated at 2 weeks, 6 weeks and 3 months after the procedure using a visual analog scale(VAS). RESULTS: Successful outcome was determined if pain reduction exceeded 50% on the VAS at 6 weeks. Six of the 25 patients did not respond favorably to RFN (pain reduction less than 50%), and nineteen patients showed successful responses. Mean VAS score was decreased from 5.48 to 2.96 at 6 weeks. CONCLUSION: The radiofrequency neurotomy may be both feasible and useful treatment for the remnant pain after vertebroplasty. However long-term follow up is needed to confirm the effectiveness.
Follow-Up Studies ; Fractures, Compression* ; Humans ; Spine ; Vertebroplasty*

OBJECTIVE: The purpose of this study was to evaluate the efficacy of a transforaminal suprapedicular approach, semi-rigid flexible curved probe, and 3-dimensional reconstruction computed tomography (3D-CT) with discogram in the endoscopic treatment of non-contained lumbar disc herniations. METHODS: The subjects were 153 patients with difficult, non-contained lumbar disc herniations undergoing endoscopic treatment. The types of herniation were as follows : extraforaminal, 17 patients; foraminal, 21 patients; high grade migration, 59 patients; and high canal compromise, 56 patients. To overcome the difficulties in endoscopic treatment, the anatomic structures were analyzed by 3D reconstruction CT and the high grade disc was extracted using a semi-rigid flexible curved probe and a transforaminal suprapedicular approach. RESULTS: The mean follow-up was 18.3 months. The mean visual analogue scale (VAS) of the patients prior to surgery was 9.48, and the mean postoperative VAS was 1.63. According to Macnab's criteria, 145 patients had excellent and good results, and thus satisfactory results were obtained in 94.77% cases. CONCLUSION: In a posterolateral endoscopic lumbar discectomy, the difficult, non-contained disc is considered to be the most important factor impeding the success of surgery. By applying a semi-rigid flexible curved probe and using a transforaminal suprapedicular approach, good surgical results can be obtained, even in high grade, non-contained disc herniations.
Diskectomy ; Diskectomy, Percutaneous ; Follow-Up Studies ; Humans

The orbital apex syndrome is a very rare complication of fungal sinusitis, as well as of other conditions, and is characterized by blindness, diplopia, proptosis of the eye and ophthalmoplegia. We present a case of diplopia caused by a fungal ball in the Onodi cell. A 62-year-old woman, diagnosed with orbital apex syndrome and suffering from ophthalmalgia and diplopia in the right eye, was presented to our outpatient clinic. Computed tomography showed a soft tissue lesion occupying the right Onodi cell with chronic inflammation. Patients who have an Onodi cell carry a high risk for optic nerve injury, so endoscopic sinus surgery using navigation was performed. Histopathology examination confirmed the diagnosis of a fungal ball. We experienced a rare case of a fungal ball in the Onodi cell, which caused damage to the adjacent cavernous sinus structure and led to diplopia and orbital pain. We present this case with a brief review of these disease entities.
Ambulatory Care Facilities ; Blindness ; Cavernous Sinus ; Diagnosis ; Diplopia* ; Exophthalmos ; Female ; Humans ; Inflammation ; Middle Aged ; Ophthalmoplegia ; Optic Nerve Injuries ; Orbit ; Sinusitis

BACKGROUND AND OBJECTIVES: Although obstructive sleep apnea is common, it has often gone undiagnosed in primary care encounters until now, with no validated screening tool of obstructive sleep apnea (OSA) for Korean patients. The aim of this study was to investigate the usefulness of Berlin questionnaire (Berlin Q) and STOP questionnaire (STOP Q) as a screening test for sleep apnea for the Korean patients. SUBJECTS AND METHOD: We administered Berlin Q and STOP Q to 106 patients who received a full night polysomnography. We investigated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of each questionnaire according to patients' severity by apnea hypopnea index (AHI). RESULTS: Results were categorized according to AHI severity using cut-off points of AHI greater than 5, 15, and 30. The sensitivity and specificity of the Berlin Q were 69, 72, 78% and 41, 43, 39%, respectively. NPV and PPV of Berlin Q were 0.20, 0.43, 0.74 and 0.86, 0.72, 0.43, respectively. The sensitivity and specificity of the STOP Q was 97, 97, 98% and 35, 20, 12%, respectively. NPV and PPV for STOP Q were 0.67, 0.78, 0.89 and were 0.89, 0.71, 0.40, respectively. CONCLUSION: Our results indicate that STOP Q shows higher sensitivity than Berlin Q with similar specificity. Therefore, STOP Q is a more convenient and better means than Berlin Q to screen patients for obstructive sleep apnea.
Apnea ; Berlin ; Humans ; Korea ; Mass Screening ; Polysomnography ; Primary Health Care ; Surveys and Questionnaires ; Sensitivity and Specificity ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive

Retrobulbar hematoma is a rare complication following septal surgery under general anesthesia. Symptoms and physical findings include temporary blindness, ophthalmoplegia, mydriasis, ptosis, proptosis and eyelid ecchymosis. Recently, we experienced a rare case of the right retrobulbar hematoma after septal surgery. At present, there is no literature about the occurrence of retrobulbar hematoma following septal surgery. We hereby present this case with an emphasis on the importance of prevention, identification and management of retrobulbar hematoma.
Anesthesia, General* ; Blindness ; Ecchymosis ; Exophthalmos ; Eyelids ; Hematoma* ; Mydriasis ; Ophthalmoplegia

BACKGROUND AND OBJECTIVES: Overnight polysomnography (PSG) in a sleep laboratory is the standard method of confirming the diagnosis of obstructive sleep apnea (OSA). However, PSG is expensive, time-consuming, uneasily accessible and labor-intensive, so many patients need a more convenient tool that is ambulatory. The aim of this study was to investigate the usefulness of Embletta by comparing the respiratory parameters derived from Embletta with those of PSG. SUBJECTS AND METHOD: PSG and Embletta sleep study were performed for 42 patients prospectively. Respiratory parameters, such as apnea index (AI), hypopnea index (HI), apnea-hypopnea index (AHI), and oxygen parameters, such as lowest oxygen saturation (LSAT), mean oxygen saturation (MSAT), and oxygen desaturation index (ODI) were measured automatically from Embletta and by hand from PSG. All parameters of Embletta were compared with those of PSG. In addition, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for Embletta were calculated for the diagnosis of OSA. RESULTS: Most of the respiratory parameters and the oxygen parameters were well correlated between PSG and Embletta and the correlation coefficients were well correlated and statistically significant as well. The sensitivity, specificity, PPV, and NPV were 90%, 75%, 0.9, and 0.75, respectively, for Embletta for the diagnosis of OSA. CONCLUSION: Embletta might be clinically useful as a screening device of OSA patients based on its high correlation to PSG and positive predictive value.
Apnea ; Hand ; Humans ; Mass Screening ; Oxygen ; Polysomnography ; Prospective Studies ; Sensitivity and Specificity ; Sleep Apnea, Obstructive

BACKGROUND AND OBJECTIVES: In recent years, the emphasis on medical care has shifted from symptom scores and objective test results to the patient-centered assesment of effect of disease or response to treatment. So, we compared, before and after endoscopic sinus surgery (ESS), the relationship between 7 nasal symptom scores and quality of life scores measured with RSDI and the SF-36v2(TM) questionnaires, which have been verified by many articles. SUBJECTS AND METHOD: Subjects were 50 patients diagnosed as chronic sinusitis and who underwent ESS from November 2005 to Oct 2006. Patients filled out two questionnaires and checked a visual analogue scale at admission for surgery, and at 2, 4, 8 and 32 weeks postoperatively. Two questionnaires are the Rhinosinusitis Disability Index (RSDI) questionnaire, the SF-36v2(TM) questionnaire, and the visual analogue scale (VAS) is composed of nasal obstruction, rhinorrhea, postnasal drip, sneezing, cough, headache and facial pain. So, we compared each score of the SF-36v2(TM) (PCS and MCS) and RSDI with symptom scores of VAS. RESULTS: In comparing the scores of the RSDI with the symptom scores of VAS, statistically significant relationship was noted with respect to nasal obstruction, headache, and rhinorrhea continuously. But in comparing the scores of the SF-36v2(TM) (PCS and MCS) with the symptom scores of VAS, no statistically significant relationships was observed. CONCLUSION: With respect to the relationship between the quality of life after ESS and symptom severity, RSDI was found to be more effective than SF-36v2(TM). However, because results showed up differently in the two different kinds of questionnaire, it is important that we should use several different verified questionnaires in order to assess patient-centred response to ESS.
Cough ; Endoscopy ; Equidae ; Facial Pain ; Headache ; Humans ; Nasal Obstruction ; Quality of Life ; Surveys and Questionnaires ; Sinusitis ; Sneezing

PURPOSE: Allergen-specific immunotherapy is the only currently available treatment to modify the natural history of allergic rhinitis (AR). If patients are polysensitized, it is difficult to identify the allergen causing the allergic symptoms. We evaluated the effectiveness of immunotherapy against house dust mites (HDMs) in AR patients polysensitized to both HDMs and seasonal allergens. METHODS: Thirty AR patients polysensitized to both HDMs and seasonal allergens (group A) and 30 patients sensitized to HDMs only (group B) were enrolled in this study. All subjects who received immunotherapy against HDMs for more than 2 years were evaluated by the multiple allergen simultaneous test (MAST) to determine the specific IgE level in luminescence units, total eosinophil counts in peripheral blood, serum total IgE, total nasal symptom scores, and the rhinoconjunctivitis quality of life questionnaire (RQLQ) before and after immunotherapy. RESULTS: There were no statistical differences in levels of total and specific IgE, or total eosinophil count between the two groups. The total nasal symptom scores, RQLQ and medication scores significantly decreased after immunotherapy in both groups, however no significant differences were noted between the two groups. CONCLUSIONS: We determined that the primary causative allergen of AR in Seoul, Korea is perennial allergens, such as HDMs, rather than seasonal allergens. This study provides a reference for the selection of allergens to use in immunotherapy for polysensitized AR patients living in an urban environment.
Allergens ; Desensitization, Immunologic* ; Eosinophils ; Humans ; Immunoglobulin E ; Immunotherapy ; Korea ; Luminescence ; Natural History ; Pyroglyphidae* ; Quality of Life ; Rhinitis* ; Seasons ; Seoul ; Surveys and Questionnaires

BACKGROUND AND OBJECTIVES: Allergic rhinitis reduces the quality of life as a result of suffering from symptoms and possibly of impaired cognition and performance. The difference in attention and development of personality and behavior between the symptomatic children group and normal children was evaluated to delineate more clearly the impact of allergic rhinitis on children. SUBJECTS AND METHOD: The comparison of allergic symptoms, attentiveness, cognitive function, development of personality and behaviors as well as the parenting style of 38 patients with symptomatic allergic rhinitis and 31 healthy controls were matched for intelligence, age and sex. The clinical analysis was carried out by a pediatric psychologist who interpreted the results. RESULTS: A defective frontal lobe function and decreased constant concentration were observed in allergic rhinitis group. There was a significant decrease in verbal development and performance development in the allergic rhinitis group. Parents of allergic rhinitis group were found to have said some swear words or hurt child's feeling by using bad language. CONCLUSION: Allergic rhinitis group was more deteriorated compared to the control group in regards to attentiveness, frontal lobe function, verbal and performance development, thus we can say that allergic rhinitis can affect attention, cognitive function and personality development of the child.
Child ; Cognition ; Frontal Lobe ; Humans ; Intelligence ; Parenting ; Parents ; Personality Development ; Quality of Life ; Rhinitis ; Rhinitis, Allergic, Perennial ; Stress, Psychological

BACKGROUND AND OBJECTIVES: Postoperative taste changes after uvulopalatopharyngoplasty (UPPP) is regarded as an unusual and minor complication. This study aims to evaluate the objective changes of taste threshold according to time course and subjective symptoms change. MATERIALS AND METHOD: With 45 patients who underwent UPPP and 35 patients who underwent nasal surgery as control group, we have prospectively studied postoperative taste changes using a questionnaire, and an electrogustometer (EGM) with regard to symptoms at 7th, 28th days after the surgery. EGM was measured at 5 areas. Also, we have checked pre-operatively about the serum level of zinc. RESULTS: With EGM, the threshold of taste was increased at 7th days after the surgery (p<0.05), but recovered 28th days after the surgery at the posterior part of the tongue in the UPPP group. There were no significant changes in subjective taste dysfunction, smell dysfunction, tongue sensory abnormality, and dysgeusia. CONCLUSION: Taste changes after UPPP was transient and they disappeared within the 1st postoperative month. There were no patients who complained of subjective taste dysfunction, dysgeusia, tongue sensory abnormality after UPPP.
Dysgeusia ; Humans ; Nasal Surgical Procedures ; Prospective Studies ; Surveys and Questionnaires ; Sleep Apnea, Obstructive ; Smell ; Taste Threshold ; Tongue