Tympanic membrane (TM) perforation is common. Acute persistent or chronic TM perforations require surgical interventions such as myringoplasty or tympanoplasty. Current strategies of tissue engineering are focused on the regeneration of TM perforation instead of surgical interventions. To regenerate TM tissue or restore acoustic-mechanical property, bioscaffold or growth factors are necessary that will act as a temporary matrix for cell proliferation and extracellular matrix deposition, with subsequent ingrowths. In recent years, various scaffolds, biomolecules have been used for TM tissue engineering. Cells in combination with supportive scaffolds have rarely reported. TM regeneration by tissue engineering approach may be considered the greatest advances in otology. This review examines the current evidence for their use and the limitations of knowledge.
Cell Proliferation ; Extracellular Matrix ; Intercellular Signaling Peptides and Proteins ; Myringoplasty ; Otolaryngology ; Regeneration* ; Tissue Engineering* ; Tympanic Membrane* ; Tympanoplasty

Percutaneous endoscopic gastrostomy is used for long-term nutritional support to the patients who cannot maintain the adequate oral intake and can be performed with relatively few complications. Among the complications, migration of the internal bumper into the abdominal wall, so called "buried bumper syndrome" has been described more recently. We decribed a case of buried bumper syndrome in stroke patient with percutaneous endoscopic gastrostomy. He experienced peritubular leakage, resistance of tubal feeding, and abdominal pain which were developed 4 weeks after percutaneous endoscopic gastrostomy. On endoscopic examination, the gastrostomy lumen coud not be found. The gastrostomy tube was replaced with careful manual traction and replaced to new one with endoscopic technique. No complication was occurred and the function of tube has been well preserved.
Abdominal Pain ; Abdominal Wall ; Gastrostomy ; Humans ; Nutritional Support ; Stroke ; Traction

Inverted papilloma is an uncommon benign nasal tumor which usually occurs on the lateral nasal wall. An inverted papilloma originating from the medial nasal cavity, especially the nasal septum, is considered very rare. A 47-year-old male was referred with a 1-month history of snoring. On endoscopic examination, a nasal mass was observed in the left posterior septum. The mass filled the left nasal cavity and extended choanae and nasopharynx. The histopathologic examination of the nasal mass showed inverted papilloma, which was completely removed by endoscopic surgery. Herein, the authors report a case of inverted papilloma originating from the posterior nasal septum as well as a review of literature.
Humans ; Male ; Middle Aged ; Nasal Cavity ; Nasal Septum ; Nasopharynx ; Papilloma, Inverted ; Snoring

The anomaly which the right pulmonary artery originates from the ascending aorta is a rare and usually fatal form of congenital heart disease. This lesion is often associated with a patent ductus arteriosus. Death frequently occurs in early infancy. Anomalous origin of the right pulmonary artery is much more common than anomalous origin of the left pulmonary artery. The anomalous right pulmonary artery usually arise from the posterior aspect of the ascending aorta close to the aortic valve. We report a 1 month-old infant with right pulmonary artery arising from the ascending aorta, which was corrected successfully by direct anastomosis to the main pulmonary artery.
Aorta* ; Aortic Valve ; Ductus Arteriosus, Patent ; Heart Defects, Congenital ; Humans ; Infant ; Infant, Newborn ; Pulmonary Artery*

A 75-year-old woman presented a cauda equina syndrome with epiconus involvement from the compression fractures of T12, L1, and L3 vertebrae as a result of fall accident. Cystometrogram performed at three months after the injury showed a small bladder capacity and low compliance. Anticholinergic medications including intravesical instillation of oxybutynin solution failed to increase the bladder capacity or lower the intravesical pressure. Bladder distension therapy using normal saline infusion with a volume surpassing the previous measured maximal bladder capacity was performed. The procedures were repeated four times per day. At the fifth day of the distension therapy, the patient complained of acute low abdominal pain and gross hematuria. The cystogram revealed the extraperitoneal bladder rupture. The patient was treated successfully with antibiotics and continuous urinary drainage through the Foley catheter for 14 days. We report a case of extraperitoneal bladder rupture during the bladder distension therapy.
Abdominal Pain ; Administration, Intravesical ; Aged ; Anti-Bacterial Agents ; Catheters ; Compliance ; Drainage ; Female ; Fractures, Compression ; Hematuria ; Humans ; Polyradiculopathy ; Rupture* ; Spine ; Urinary Bladder*

Myelopathy is a rare but serious central nervous system complication associated with systemic lupus erythematosus (SLE). Acute transverse myelitis is the most usual involvement of SLE-related myelopathy. We reported a 17-year-old girl who developed a very extensive SLE related transverse myelitis with longitudinal involvement of the spinal cordfrom C4 to the conus medullaris. There were motor and sensory loss of both lower extremities, and bladder dysfunction over the course of 5 days. She presented T9 paraplegia ASIA A. Her neurological dysfunction was not responded to treatment with methyprednisolone and cyclophosphomide.
Adolescent ; Asia ; Central Nervous System ; Conus Snail ; Female ; Humans ; Lower Extremity ; Lupus Erythematosus, Systemic* ; Myelitis* ; Myelitis, Transverse ; Paraplegia ; Spinal Cord Diseases ; Urinary Bladder

OBJECTIVE: To evaluate immediate and long term effects of electrical stimulation on upper extremity spasticity following stroke. METHOD: The subjects were 13 hemiplegic patients with cerebral infarction and cerebral hemorrhage. Electrical stimulation was applied to skin over the biceps muscle and the triceps muscle for a period of twenty minutes. The evaluation of spasticity was done by using the modified Ashworth scale, free amount of elbow extension, active range of motion and motor strength of elbow flexion and extension at baseline, immediately, 1 week and 4 weeks after electrical stimulation. RESULTS: Immediately after treatment, free amount of elbow extension increased from 63.8+/-19.1 degrees to 77.7+/-22.5 degrees (p<0.05) and active flexion of elbow flexor increased from 45.0+/-34.8 degrees to 55.3+/-39.1 degrees (p<0.05). The active range of motion of elbow flexor was increased on the 4th week during electrical stimulation (p<0.05). The free amount of elbow extension and modified Ashworth scale of elbow flexor spasticity was improved on the 18th day after treatment cessation (p<0.05). CONCLUSION: The results of this study showed that spasticity tended to decrease and maintain a lower level after a varying number of treatment sessions.
Cerebral Hemorrhage ; Cerebral Infarction ; Elbow ; Electric Stimulation* ; Hemiplegia ; Humans ; Muscle Spasticity* ; Range of Motion, Articular ; Skin ; Stroke ; Upper Extremity* ; Withholding Treatment

BACKGROUND: Mediastinal neurogenic tumors are generally benign lesions and they are ideal candidates for performing resection via video-assisted thoracoscopic surgery (VATS). However, benign neurogenic tumors at the thoracic apex present technical problems for the surgeon because of the limited exposure of the neurovascular structures, and the optimal way to surgically access these tumors is still a matter of debate. This study aims to clarify the feasibility and safety of the VATS approach for performing surgical resection of benign apical neurogenic tumors (ANT). MATERIAL AND METHOD: From January 1996 to September 2008, 31 patients with benign ANT (15 males/16 females, mean age: 45 years, range: 8~73), were operated on by various surgical methods: 14 VATS, 10 lateral thoracotomies, 6 cervical or cervicothoracic incisions and 1 median sternotomy. 3 patients had associated von Recklinhausen's disease. The perioperative variables and complications were retrospectively reviewed according to the surgical approaches, and the surgical results of VATS were compared with those of the other invasive surgeries. RESULT: In the VATS group, the histologic diagnosis was schwannoma in 9 cases, neurofibroma in 4 cases and ganglioneuroma in 1 case, and the median tumor size was 4.3 cm (range: 1.2~7.0 cm). The operation time, amount of chest tube drainage and the postoperative stay in the VATS group were significantly less than that in the other invasive surgical group (p<0.05). No conversion thoracotomy was required. There were 2 cases of Hornor's syndrome and 2 brachial plexus neuropathies in the VATS group; there was 1 case of Honor's syndrome, 1 brachial plexus neuropathy, 1 vocal cord palsy and 2 non-neurologic complications in the invasive surgical group, and all the complications developed postoperatively. The operative method was an independent predictor for postoperative neuropathies in the VATS group (that is, non-enucleation of the tumor) (p=0.029). CONCLUSION: The VATS approach for treating benign ANT is a less invasive, safe and feasible method. Enucleation of the tumor during the VATS procedure may be an important technique to decrease the postoperative neurological complications.
Ants ; Brachial Plexus Neuropathies ; Chest Tubes ; Drainage ; Female ; Ganglioneuroma ; Humans ; Mediastinum ; Neurilemmoma ; Neurofibroma ; Retrospective Studies ; Sternotomy ; Thoracic Surgery, Video-Assisted ; Thoracoscopy ; Thoracotomy ; Vocal Cord Paralysis

A 56 years old male patient admitted to our neurology department because of repeated tingling sensation in right 3, 4, 5th. fingers and weakness on grasping, which were progressively developed recently. At this time, he had also suffered from claudication in both lower extremities. Carotid angiogram showed that right internal carotid artery was obstructed completely, and both common, both external and left internal carotid arteries had significant stenosis, Concommitantly, aortogram suggested complete obstruction just below the renal arteries. We planned staged operation for two separated arterial lesions. Both carotid endarterectomy was performed. and we used carotid shunt for left side during operation. Abdominal aortic lesion was operated 2 weeks later. We obligately clamped aorta just below the celiac artery and infused kidney perservation solution to pertect kidney during ischemia. Reversed Y bypass graft and kidney perservation was successful despite of 40 minute ischemia. Postoperative coure was uneventful and patient was discharged without any specific problem.
Aorta ; Aorta, Abdominal* ; Carotid Arteries* ; Carotid Artery, Internal ; Carotid Stenosis ; Celiac Artery ; Constriction, Pathologic ; Endarterectomy, Carotid* ; Fingers ; Hand Strength ; Humans ; Ischemia ; Kidney* ; Lower Extremity ; Male ; Middle Aged ; Neurology ; Organ Preservation ; Renal Artery ; Sensation ; Transplants*

OBJECTIVES: Autologous costal cartilage is a promising alternative for mastoid obliteration. However, donor-site morbidities of the chest wall limit the use of this graft. To address this issue, we have developed a minimally-invasive technique of harvesting costal cartilage and report donor site morbidity associated with the procedure. METHODS: Donor site morbidities were evaluated for 151 patients who underwent costal cartilage harvest, canal wall down mastoidectomy, and mastoid obliteration. Pain and cosmetic concern were evaluated via visual analogue scale (VAS). Scars were evaluated via the modified Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scale (POSAS). Postoperative complications were assessed during the follow-up period. RESULTS: The mean duration of noticeable pain was 5.3 days post operation. The mean VAS score for pain was 3.0 of 10 on the first day after the operation and gradually declined. At the 6 months post operation, the mean VAS cosmetic score at the costal cartilage harvest site was 0.6 of 10. The mean VSS score was 9.5 out of 10 total, and the mean POSAS score was 23.27 out of 110 total. CONCLUSION: The minimally-invasive chopped costal cartilage harvest technique resulted in acceptable pain, cosmetic concern, and postoperative complications for most patients. There were no major postoperative complications. Costal cartilage is an acceptable donor for mastoid obliteration in canal wall down mastoidectomy, especially in the context of the extremely low donor site morbidity of the minimally-invasive technique presented in the study.
Cartilage* ; Cicatrix ; Follow-Up Studies ; Humans ; Mastoid ; Otologic Surgical Procedures ; Pain Measurement ; Pain, Postoperative ; Postoperative Complications ; Thoracic Wall ; Tissue and Organ Procurement ; Tissue Donors ; Transplants