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

PURPOSE: This study sought to determine the 1-year clinical effectiveness and safety of a biodegradable, polymer-containing Biolimus A9™-eluting stent (BES) in Korean patients with acute coronary syndrome (ACS). MATERIALS AND METHODS: A total of 1000 ACS patients with 1251 lesions who underwent implantation of BESs at 22 centers in Korea were enrolled between May 2011 and July 2013. We assessed major adverse cardiac events (MACE) defined as the composite of cardiac death, non-fatal myocardial infarction (MI), and clinical-driven target vessel revascularization at 12 months. RESULTS: Patient mean age was 62.6±11.4 years. 72.8% of the patients were male, 28.5% had diabetes, 32.8% had multi-vessel disease (MVD), and 47.9% presented with acute MI (AMI). The mean global registry of acute coronary events risk score of all patients was 103.0±27.6. The number of stents per patient was 1.3±0.6. The incidences of MACE and definite stent thrombosis at 12 months were 3.9% and 0.2%, respectively. On multivariate Cox-regression analysis, age ≥65 years was identified as an independent predictors of 1-year MACE (hazard ratio=2.474; 95% confidence interval=1.202−5.091). Subgroup analyses revealed no significant differences in the incidence of MACE between patients with and without diabetes (4.3% vs. 3.7%, p=0.667), between those who presented with and without AMI (4.4% vs. 3.4%, p=0.403), and between those with and without MVD (4.6% vs. 3.5%, p=0.387). CONCLUSION: Our study demonstrated excellent 1-year clinical outcomes of BES implantation in patients at low-risk for ACS.
Acute Coronary Syndrome/drug therapy ; Aged ; Drug-Eluting Stents/adverse effects ; Female ; Humans ; Incidence ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Multivariate Analysis ; Proportional Hazards Models ; Republic of Korea ; Sirolimus/adverse effects ; Sirolimus/analogs & derivatives ; Sirolimus/therapeutic use ; Time Factors ; Treatment Outcome

OBJECTIVES: Head and neck reconstruction is still challenging in terms of esthetic and functional outcomes. This study investigated the feasibility of the angular branch-based scapular tip free flap (STFF). METHODS: This was a retrospective study of 17 patients undergoing maxillectomy and mandibulectomy and either primary or secondary reconstruction by STFF. This study included surgical, esthetic, and functional outcomes, and detailed data are presented regarding the flap, such as pedicle length, size of the harvested bone, and failure rate. Medical photographs were used to estimate the esthetic outcome, and computed tomography was used to check the flap status postoperatively. RESULTS: The data were collected from April 2013 to April 2014. Eight patients underwent maxillary reconstruction, and nine underwent mandibular reconstruction. Maxillary defects usually included unilateral alveolar structures and the palate; mandibular defects were usually those involving mandibular angle and short segment. Vein grafting was not required in any of the patients. Flap failure occurred in one of the 17 patients (5.9%) with successful reconstruction after revision. Of the eight maxillectomy patients, orbital revisions for diplopia after maxillary reconstruction were performed in two patients (25%), and oroantral fistula repair was performed in one patient (12.5%). CONCLUSION: This study demonstrated the reconstructive advantages of the angular branch-based STFF, long pedicle, low flap failure, 3-dimensional nature of bone and soft tissues (chimeric flap), and small rate of donor site morbidity with free ambulation. This flap is an excellent option for use in complex three-dimensional head and neck reconstruction.
Diplopia ; Free Tissue Flaps* ; Head and Neck Neoplasms ; Head* ; Humans ; Mandibular Reconstruction ; Neck* ; Orbit ; Oroantral Fistula ; Palate ; Retrospective Studies ; Scapula ; Tissue Donors ; Transplants ; Veins ; Walking

OBJECTIVES: There is still debate concerning the reason for the high initial failure rate of positive airway pressure (PAP) treatment. The objective of this study is to investigate the factors of the initial adherence to PAP, with an emphasis on the role of upper airway narrowing. METHODS: The patients were divided into two groups according to the continuation of therapy within the first three months of treatment. The demographic and polysomnographic findings, the minimal nasal cross sectional area (MCA), the degree of palatine tonsilar hypertrophy (PTH) and the modified Mallampati grade of the oropharynx inlet (Orophx) were compared between the study groups. RESULTS: Among 36 patients, 23 continued the auto-adjusting positive airway pressure (APAP) therapy (the adherent group) and 13 discontinued APAP within three months (the non-adherent group). The apnea-hypopnea index (AHI) was significantly higher in the adherent group than in the non-adherent group (P<0.001). The AHI distributions of the two groups are extremely different. Thirteen of the 23 patients in the adherent group had an AHI of more than 60/hr, while none of the patients in the non-adherent group had an AHI of more than 60/hr. In the patients with an AHI from 15 to 60/hr, the MCA at the wide side of the nasal cavity and the sum of the MCAs of both sides were significantly larger in the adherent group than those values in the non-adherent group (P=0.004). The PTH and the Orophx were not significantly different between the two groups. CONCLUSION: AHI is a definite significant factor of adherence to APAP therapy. The dimension of the nasal cavity has an influence on initial APAP adherence in the patients who have a not too high level of AHI.
Acetaminophen ; Bays ; Compliance ; Continuous Positive Airway Pressure ; Humans ; Hypertrophy ; Nasal Cavity ; Oropharynx

OBJECTIVES: The erythrocyte sedimentation rate (ESR) is a marker for inflammation, and it has been identified as a risk factor for atherothrombotic cardiovascular disease. The aim of this study was to determine the relationship between the plasma ESR level and nocturnal oxygen desaturation or other polysomnographic variables and to examine the role of obesity in patients with obstructive sleep apnea syndrome (OSAS). METHODS: This retrospective study included 72 patients with a diagnosis of OSAS who underwent overnight polysomnography and routine blood tests between July and December of 2005. We compared the plasma ESR level with the sum of all the polysomnographic variables and divided the patient group into obese and non-obese patients. RESULTS: The mean ESR level was 8.45 mm/hr. There was a significant difference in the ESR level between genders (P<0.001). A significant correlation was found between the percentage of time spent at a SpO2 below 90% and the ESR level in the obese group (BMI > or =25, N=43, P=0.012). In addition, the ESR levels had a positive correlation with age in the obese group (P=0.002). However, there was no significant correlation with the percentage of time spent at a SpO2 below 90% in the whole group of patients and in the non-obese group (BMI <25, N=29). The ESR level showed no correlation with the other polysomnographic variables. CONCLUSION: The duration of deoxygenation in obese patients with OSAS may be associated with the ESR level which is an independent predictor of cardiovascular disease.
Blood Sedimentation ; Cardiovascular Diseases ; Erythrocytes ; Hematologic Tests ; Humans ; Inflammation ; Obesity ; Oximetry ; Oxygen ; Plasma ; Polysomnography ; Retrospective Studies ; Risk Factors ; Sleep Apnea, Obstructive

OBJECTIVES: Nurses working in a hospital operate in a special environment where patients require a 24-hour day service. In order to meet the need for manpower, nurses in the wards, ICU, and ER work in 3 shifts per day. This study was designed to evaluate their sleeping patterns and the factors that influence them. METHODS: The subjects were 114 female nurses working at a University Hospital in Kyungi-do. To evaluate their sleeping pattern, a survey containing 11 questions was used. Their were differentiated into insomnia, sleep deprivation, daytime sleepiness, and snoring. Statistical analysis was conducted with independent t test, chi-square test and analysis of covariance. RESULTS: A statistical difference was found between shiftworkers and nonshiftworkers, in terms of sleep initiation time (p<0.05). The occurrences of insomnia, sleep deprivation, daytime sleepiness and snoring differed between the two groups, but not significantly. CONCLUSIONS: Of the numerous factors affecting sleeping patterns, shiftwork has the most deteriorative effect.
Female ; Humans ; Sleep Deprivation ; Sleep Initiation and Maintenance Disorders ; Snoring

A spermatic cord leiomyoma is an uncommon disease. A leiomyoma can originate anywhere, including the genitourinary system, where smooth muscle is present. 70 and 30% of spermatic cord leiomyomas are benign and malignant, respectively. The preoperative diagnosis of a leiomyoma is difficult; the only definite diagnostic method is histological confirmation. A retroperitoneal lipoma probably constitutes the largest group of solid abdominal tumors. However, their etiology is unknown and the symptoms insidious, and recurrences and sarcomatous changes frequently occur. The clinical diagnostic methods are the clinical symptoms, a physical examination and radiological evaluations, such as intravenous urography, computed tomography and angiography, and so on, but an abdominal CT scan provides the most useful information. A fifty-six-old man presented with a five-month history of a suddenly enlarging right inguinal mass. He had undergone a right inguinal hernia operation, with medication for hypertension. Herein, a rare case of a huge retroperitoneal lipoma, with a spermatic cord leiomyoma, is reported.
Angiography ; Diagnosis ; Hernia, Inguinal ; Hypertension ; Leiomyoma* ; Lipoma ; Muscle, Smooth ; Physical Examination ; Recurrence ; Retroperitoneal Space ; Spermatic Cord* ; Tomography, X-Ray Computed ; Urogenital System ; Urography

We report a case of prenatal diagnosis of fetal congenital goiter at 31weeks of gestation by ultrasonogram and fetal hypothyroidism confirmed at birth as thyroid function test by umbilical cord blood sampling. Maternal Graves' disease and the drugs used to treat hyperthyroidism in pregnant women can affect the fetus, causing hyperthyroidism or hypothyroidism and goiter. Fetal hypothyroidism may be caused by transplacental passage of either maternal thyrotropic-binding inhibitory immunoglobulin(TBII) antibodies or maternal treatment with propylthiouracil(PTU). Untreated fetal hypothyroidism may result in mental retardation, perceptual-motor, visual-spatial, and language developmental problems. In this article fetal thyroid function was not assessed by cordocentesis, but fetal congenital goiter was detected ultrasound. Ultrasound should be used to detect fetal goiter from 20 weeks onward. Fetal goiter should resolve when maternal PTU treatment is decreased. We have diagnosed fetal hypothyroidism in utero by ultrasonography. Significance of in utero management of fetal hypothyroidism is discussed.
Antibodies ; Congenital Hypothyroidism ; Cordocentesis ; Female ; Fetal Blood ; Fetus ; Goiter* ; Graves Disease ; Humans ; Hyperthyroidism* ; Hypothyroidism ; Intellectual Disability ; Language Development ; Mothers* ; Parturition ; Pregnancy ; Pregnant Women ; Prenatal Diagnosis* ; Thyroid Function Tests ; Thyroid Gland ; Ultrasonography

The author measured the severity of brain damage of 36 rabbits irradiated 2.45 GHz microwave for 10 minutes, 20 minutes and 30 minutes, respectively. Electromicroscopic and light microscopic findings of just after, 1 weeks, 2 weeks and 4 weeks after irradiated brain were compared in each time. Swelling and vacualization of nerve cell and mitochondria were noted. Also these changes tend to increased severity along amount of radiation, but revealed reversible changes with time. Myelinated and unmyelinated nerve fibers were examined as same manner. These nerve fibers also revealed swelling and vascuolization, these findings also tend to increase severity with irradiation power and more prominent at unmyelinated nerve fibers. Reversability of these findings after each time period were more prominent in myelinated nerve fibers than unmyelinated nerve fibers.
Brain ; Cerebrum* ; Microwaves* ; Mitochondria ; Myelin Sheath ; Nerve Fibers ; Nerve Fibers, Myelinated ; Nerve Fibers, Unmyelinated ; Neurons ; Rabbits*

With large CPA tumor(>3 mm), brain stem is usually displaced and distorted to contralateral side. It is important minimize retraction to protect brain stem and to lower morbidity. In our previous report, we reported the result and method of combined approach for large CPA tumor. In order to minimize brain stem retraction and to get good operating field, three of 7 cases of large CPA tumor with combined approach were operated with sacrifice of sigmoid sinus. The sigmoid sinus can be sacrificed if it can be angiographically verified that the sagittal sinus represents the major drainage to the contralateral sigmoid sinus. During operation, if pressure difference between before and after occlusion of sinus is less than 10 mmHg and any brain swelling does not develop after occlusion, the sigmoid sinus can be sacrificed.
Brain Edema ; Brain Stem ; Colon, Sigmoid* ; Drainage