As population ages, much more elderly patients have been diagnosed with head and neck cancer especially in Korea. Diverse factors such as comorbidities and disabilities make the establishment of evidence-based guidance more challenging. Chronological age, literally measured in days, months and years from the time the individual was born, is not an ideal predictor in determining personal health condition; individualization of treatment protocols with identifying the concept of frailty is the key to produce an advanced treatment plan of elderly patients suffering from head and neck malignancy. Frailty is a type of geriatric syndrome which refers to the status with age-associated declines in physiologic function and increased vulnerability to stress conditions independent of age. Therefore, screening the status of frailty may be beneficial for the elderly patients to determine decent treatment option and maximize the efficiency. In order to provide otolaryngologists prognostic information adapting the concept of frailty, research papers published from 2000 to 2018 are comprehensively reviewed in this article. For optimal care of elderly patients with head and neck cancer, frailty is definitely required to be assessed in order to establish an ideal treatment option and increase the efficacy of the treatment.
Aged ; Clinical Protocols ; Comorbidity ; Diagnosis ; Head and Neck Neoplasms ; Head ; Humans ; Korea ; Mass Screening ; Neck

Fifty two cases of displacecd supracondylar fractures were divided into three groups according to the methods of fracture stabilization. Cast immobilizations without pin fixation were included to the group 1 (12 cases), fixation with lateral pins to the group 2 (22 cases), and lateral and medial cross pins to the group 3 (18 cases). In each group we attempted a radiological analysis for the stabilization failure through measurements of the horizontal rotation and the mediolateral tilting in their preoperative, postoperative and follow-up X-rays. Stabilization failure during the follow-up period was presumpted to be present in those cases that show (1) a development or increase of the horizontal rotation in follow-up lateral X-ray, and (2) accompanied change in Baumann's angle of more than 5 degrees. The failed stabilizations were in three cases (25%) in the group 1. In the group 2 the horizontal rotations after initial fixation were developed in four fractures. However, only two (9%) of the four cases accompanied significant changes in the Baumann's angle. Loss of the initial fixation in the cross pin group was found in one case. These results demonstrate that the cross pin fixation is the most stable form. Fixation in only lateral side sometimes shows rotational instability, but this method seems to be still useful because singificant coronal tilting develops in only a few occasions of those with horizontal rotation.
Child ; Follow-Up Studies ; Humans ; Humerus ; Methods

As population ages, much more elderly patients have been diagnosed with head and neck cancer especially in Korea. Diverse factors such as comorbidities and disabilities make the establishment of evidence-based guidance more challenging. Chronological age, literally measured in days, months and years from the time the individual was born, is not an ideal predictor in determining personal health condition; individualization of treatment protocols with identifying the concept of frailty is the key to produce an advanced treatment plan of elderly patients suffering from head and neck malignancy. Frailty is a type of geriatric syndrome which refers to the status with age-associated declines in physiologic function and increased vulnerability to stress conditions independent of age. Therefore, screening the status of frailty may be beneficial for the elderly patients to determine decent treatment option and maximize the efficiency. In order to provide otolaryngologists prognostic information adapting the concept of frailty, research papers published from 2000 to 2018 are comprehensively reviewed in this article. For optimal care of elderly patients with head and neck cancer, frailty is definitely required to be assessed in order to establish an ideal treatment option and increase the efficacy of the treatment.

BACKGROUND: The risk of bleeding during extracorporeal membrane oxygenation (ECMO) is a potential deterrent in performing tracheostomy at many centers. To evaluate the safety of surgical tracheostomy (ST) in critically ill patients supported by ECMO, we reviewed the clinical correlation between preoperative coagulation status and bleeding complication-related ST during ECMO. METHODS: From April 1, 2012 to March 31, 2016, ST was performed on 38 patients supported by ECMO. We retrospectively reviewed and analyzed the medical records including complications related to ST. RESULTS: Heparin was administered to 23 patients (60.5%) for anticoagulation during ECMO, but 15 patients (39.5%) underwent ECMO without anticoagulation. Of the 23 patients administered anticoagulation therapy, heparin infusion was briefly paused in 13 prior to ST. The median platelet count, international normalized ratio, and activated partial thromboplastin time before ST were 126 ×109/L (range, 46 to 434 ×109/L), 1.2 (range, 1 to 2.3) and 62 seconds (27 to 114.2 seconds), respectively. No peri-procedural clotting complications related to ECMO were observed. Two patients (5.3%) suffering from ST-related major bleeding required surgical hemostasis. Minor bleeding after ST occurred in two cases (5.3%). No significant difference was found according to anticoagulation management (P = 0.723). No fatality was attributable to ST. CONCLUSIONS: The complication rates of ST in the patients supported by ECMO were low. Therefore, ST performed by an experienced operator, and with careful optimization of coagulation status, is a relatively safe procedure; the use of ST with ECMO should thus not be dismissed on account of the potential for bleeding caused by the administration of anticoagulants.
Anticoagulants ; Critical Illness ; Extracorporeal Membrane Oxygenation* ; Hemorrhage ; Hemostasis, Surgical ; Heparin ; Humans ; International Normalized Ratio ; Medical Records ; Partial Thromboplastin Time ; Platelet Count ; Retrospective Studies ; Tracheostomy*

PURPOSE: Matrix metalloproteinase-2 (MMP-2) and MMP-7 have been implicated in tumor growth and metastasis. This study aimed to investigate the expressions of MMP-2 and -7 in colorectal cancer and to evaluate their values as prognostic markers. METHODS: Immunohistochemical staining for MMP-2 and -7 was done in 144 resected colorectal cancer specimens. Clinicopathological data and survival results were compared with regard to the expression results. RESULTS: The expression rates of MMP-2 in tumor cells in the tumor center and the tumor border were 16.7% and 38.9%, respectively. That of MMP-2 in stromal cells was 27.8%. MMP-7 immunoreactivities of tumor cells in the tumor center and the tumor border were 6.9% and 23.6%. The expressions of MMP-2 and MMP-7 were correlated. MMP-2 expression in stromal cells was more increased in the distal part of the colorectum: 8.8% in right colon cancer, 29.5% in left colon cancer and 36.4% in rectal cancer. MMP-2 expression of tumor cells in the tumor border was correlated with T-stage. MMP-7 expression of tumor cells in the tumor border was increased in case of infiltrative cancer compared with fungating tumor. The expression patterns of MMP-2 and -7 were not correlated with other clinicopathological factors, including tumor markers, node metastasis, distant metastasis, lymphatic invasion, tumor differentiation, and recurrence. No significant associations between the overall and disease-free survival rates and the MMP-2 and -7 expression patterns were noted. CONCLUSION: The high expression rates of MMP-2 and -7 in tumor borders suggest that MMP-2 and -7 have some role in tumor invasion, but in this study, MMP-2 and -7 did not appear to be significant predictors of prognosis in colorectal cancer.
Colonic Neoplasms ; Colorectal Neoplasms ; Disease-Free Survival ; Immunohistochemistry ; Lymphatic Metastasis ; Matrix Metalloproteinase 2 ; Matrix Metalloproteinases ; Neoplasm Metastasis ; Prognosis ; Rectal Neoplasms ; Recurrence ; Stromal Cells ; Biomarkers, Tumor

No abstract available.
Thyroid Gland* ; Thyroid Nodule*

Leiomyoma is a tumor rarely occurring in the nose and the paranasal sinus. It constitutes about 1% of all benign tumors arising in the head and neck area. This is probably due to the paucity of smooth muscle in the nose. We experienced a case of leiomyoma originating in the right side of the nasal septum in a 50-year- man. It was successfully removed by endoscopic surgery, and we report this case with literature.
Head ; Leiomyoma* ; Muscle, Smooth ; Nasal Septum* ; Neck ; Nose

Leiomyosarcoma is a malignant tumor originating from the smooth muscle tissue and is mostly found in the genitourinary and gastrointestinal tract and the peritoneum. A leiomyosarcoma involving the larynx is extremely rare because the smooth muscle is only present in the blood vessel in larynx. There are only few cases of pure laryngeal leiomyosarcoma that have been reported in modern medical literature. Recently, we experienced a 78-year-old male patient with laryngeal leiomyosarcoma. So we report this case with a review of literature.
Aged ; Blood Vessels ; Gastrointestinal Tract ; Granuloma ; Humans ; Larynx* ; Leiomyosarcoma* ; Male ; Muscle, Smooth ; Peritoneum

Aspiration, the entry of material into the airway below the true vocal folds, has been reported in various type of postsurgical head and neck patients. The important of correctly identifying the cause of aspiration in the head and neck surgical patient. Clearly each cause represents a different physiologic or anatomic disorder which requires different management strategy. We discuss about the cause of aspiration during head and neck treatment.
Head ; Humans ; Neck ; Vocal Cords

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) strategy is proposed to reduce the ventilator-induced lung injury in acute respiratory distress syndrome (ARDS). As ECMO use has increased, a number of studies on prognostic factors have been published. Age is estimated to be an important prognostic factor. However, clinical evidences about ECMO use in elderly patients are limited. Therefore, we investigated clinical courses and outcomes of ECMO in elderly patients with ARDS. METHODS: We reviewed medical records of patients with severe ARDS who required ECMO support. Study patients were classified into an elderly group (> or = 65 years) and a non-elderly group (< 65 years). Baseline characteristics, ECMO related outcomes and associated factors were retrospectively analyzed according to group. RESULTS: From February 2011 to June 2013, a total of 31 patients with severe ARDS were treated with ECMO. Overall, 14 (45.2%) were weaned from ECMO, 9 (29.0%) survived to the general ward and 7 (22.6%) survived to discharge. Among the 18 elderly group patients, 7 (38.9%) were weaned from ECMO, 4 (22.2%) were survived to the general ward and 2 (11.1%) were survived to discharge. Overall intensive care unit survival was inversely correlated with concomitant acute kidney injury or septic shock. CONCLUSIONS: In this study, ECMO outcome was poor in severe ARDS patients aged over 65 years. Therefore, the routine use of ECMO in elderly patients with severe ARDS is not warranted except in highly selective cases.
Acute Kidney Injury ; Aged* ; Extracorporeal Membrane Oxygenation ; Humans ; Intensive Care Units ; Medical Records ; Patients' Rooms ; Respiratory Distress Syndrome, Adult* ; Retrospective Studies ; Shock, Septic ; Ventilator-Induced Lung Injury