Purpose: To assess patient radiation doses during diagnostic and therapeutic neurointerventional procedures from multiple centers and propose dose reference level (RL). Materials and Methods: Consecutive neurointerventional procedures, performed in 22 hospitals from December 2020 to June 2021, were retrospectively studied. We collected data from a sample of 429 diagnostic and 731 therapeutic procedures. Parameters including dose-area product (DAP), cumulative air kerma (CAK), fluoroscopic time (FT), and total number of image frames (NI) were obtained. RL were calculated as the 3rd quartiles of the distribution. Results: Analysis of 1160 procedures from 22 hospitals confirmed the large variability in patient dose for similar procedures. RLs in terms of DAP, CAK, FT, and NI were 101.6 Gy·cm2, 711.3 mGy, 13.3 minutes, and 637 frames for cerebral angiography, 199.9 Gy·cm2, 3,458.7 mGy, 57.3 minutes, and 1,000 frames for aneurysm coiling, 225.1 Gy·cm2, 1,590 mGy, 44.7 minutes, and 800 frames for stroke thrombolysis, 412.3 Gy·cm2, 4,447.8 mGy, 99.3 minutes, and 1,621.3 frames for arteriovenous malformation (AVM) embolization, respectively. For all procedures, the results were comparable to most of those already published. Statistical analysis showed male and presence of procedural complications were significant factors in aneurysmal coiling. Male, number of passages, and procedural combined technique were significant factors in stroke thrombolysis. In AVM embolization, a significantly higher radiation dose was found in the definitive endovascular cure group. Conclusion Various RLs introduced in this study promote the optimization of patient doses in diagnostic and therapeutic interventional neuroradiology procedures. Proposed 3rd quartile DAP (Gy·cm2) values were 101.6 for diagnostic cerebral angiography, 199.9 for aneurysm coiling, 225.1 for stroke thrombolysis, and 412.3 for AVM embolization. Continual evolution of practices and technologies requires regular updates of RLs.

BACKGROUND AND OBJECTIVES: External auditory canal osteoma is an uncommon benign lesion and represents as unilateral solitary pedunculated mass. The aim of this study is to evaluate the clinical symptoms of osteoma and its treatment outcomes over a 10-year period in a tertiary hospital. SUBJECTS AND METHOD: Eight patients underwent operation to remove an external auditory canal osteoma at Chungbuk National University Hospital from 2008 to 2017. The medical records were retrospectively reviewed with regard to clinical characteristics, size and location of osteoma, method of surgery and treatment outcomes. RESULTS: The average age of patients was 41.8 years with the male predominance of 6:2. All of the lesions in the osteoma were unilateral and solitary (average size 5.0 mm). All of the eight cases were pedunculated: in four cases, the stalks of the osteoma were found on the tympanomastoid suture line and in three cases, it was found on the tympanosquamous suture line. Four patients were asymptomatic, where the lesions were found incidentally during unrelated evaluations. No patients were found with conductive hearing loss in the pure tone audiometry. Transcanal and endaural approach were used in five and three cases, respectively. Most of the cases were removed by curettage only, except for the two who needed additional drilling. The average surgery time was 15.6 minutes. There was no postoperative complication or recurrence. CONCLUSION: The external auditory canal osteoma was mostly unilateral and solitary. The removal of osteoma in the early stage was relatively easy with no recurrence or complication.
Audiometry ; Chungcheongbuk-do ; Curettage ; Ear Canal ; Exostoses ; Hearing Loss, Conductive ; Humans ; Male ; Medical Records ; Methods ; Osteoma ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Sutures ; Tertiary Care Centers

BACKGROUND AND OBJECTIVES: External auditory canal osteoma is an uncommon benign lesion and represents as unilateral solitary pedunculated mass. The aim of this study is to evaluate the clinical symptoms of osteoma and its treatment outcomes over a 10-year period in a tertiary hospital.SUBJECTS AND METHOD: Eight patients underwent operation to remove an external auditory canal osteoma at Chungbuk National University Hospital from 2008 to 2017. The medical records were retrospectively reviewed with regard to clinical characteristics, size and location of osteoma, method of surgery and treatment outcomes. RESULTS: The average age of patients was 41.8 years with the male predominance of 6:2. All of the lesions in the osteoma were unilateral and solitary (average size 5.0 mm). All of the eight cases were pedunculated: in four cases, the stalks of the osteoma were found on the tympanomastoid suture line and in three cases, it was found on the tympanosquamous suture line. Four patients were asymptomatic, where the lesions were found incidentally during unrelated evaluations. No patients were found with conductive hearing loss in the pure tone audiometry. Transcanal and endaural approach were used in five and three cases, respectively. Most of the cases were removed by curettage only, except for the two who needed additional drilling. The average surgery time was 15.6 minutes. There was no postoperative complication or recurrence. CONCLUSION The external auditory canal osteoma was mostly unilateral and solitary. The removal of osteoma in the early stage was relatively easy with no recurrence or complication.

BACKGROUND AND OBJECTIVES: The incidence of recurrence after surgery of congenital cholesteatoma is increasing due to the widespread use of otoendoscopy as well as an increased awareness of these lesions among primary care physicians. There is no general consensus on the risk factors affecting recurrence. In this study, analyzing clinical characteristics of recurred cases from a tertiary hospital, we investigated risk factors for the recurrence of congenital cholesteatoma after surgery. SUBJECTS AND METHOD: From 1999 to 2016, data were collected from retrospective chart reviews of patients who have undergone surgeries for congenital cholesteatoma at Hospital. We analyzed data about clinical characteristics and recurrence according to the age at diagnosis, location, stage and type of disease, pneumatization of mastoid, ossicular erosion, and surgical techniques. RESULTS: Sixty-eight patients underwent surgery for congenital cholesteatoma. The average age at operation was 4.8 years. Recurrence was detected in 7 cases of the 68 patients, with the recurrence rate of 10.3%. Sex, age, cholesteatoma type, location, stage, mastoid pneumatization, and operation method did not show significant differences between the recurred group and the non-recurred group in the univariated analysis. CONCLUSION: The recurrence rate of congenital cholesteatoma after primary operation was 10.3%. In this study, there was no statistically significant risk factor for postoperative recurrence of congenital cholesteatoma.
Cholesteatoma* ; Consensus ; Diagnosis ; Humans ; Incidence ; Mastoid ; Methods ; Physicians, Primary Care ; Recurrence* ; Retrospective Studies ; Risk Factors* ; Tertiary Care Centers

PURPOSE: To assess patient radiation doses during cerebral angiography and embolization of intracranial aneurysms across multi-centers and propose a diagnostic reference level (DRL). MATERIALS AND METHODS: We studied a sample of 490 diagnostic and 371 therapeutic procedures for intracranial aneurysms, which were performed at 23 hospitals in Korea in 2015. Parameters including dose-area product (DAP), cumulative air kerma (CAK), fluoroscopic time and total angiographic image frames were obtained and analyzed. RESULTS: Total mean DAP, CAK, fluoroscopy time, and total angiographic image frames were 106.2 ± 66.4 Gy-cm2, 697.1 ± 473.7 mGy, 9.7 ± 6.5 minutes, 241.5 ± 116.6 frames for diagnostic procedures, 218.8 ± 164.3 Gy-cm², 3365.7 ± 2205.8 mGy, 51.5 ± 31.1 minutes, 443.5 ± 270.7 frames for therapeutic procedures, respectively. For diagnostic procedure, the third quartiles for DRLs were 144.2 Gy-cm² for DAP, 921.1 mGy for CAK, 12.2 minutes for fluoroscopy times and 286.5 for number of image frames, respectively. For therapeutic procedures, the third quartiles for DRLs were 271.0 Gy-cm² for DAP, 4471.3 mGy for CAK, 64.7 minutes for fluoroscopy times and 567.3 for number of image frames, respectively. On average, rotational angiography was used 1.5 ± 0.7 times/session (range, 0-4; n=490) for diagnostic procedures and 1.6 ± 1.2 times/session (range, 0-4; n=368) for therapeutic procedures, respectively. CONCLUSION: Radiation dose as measured by DAP, fluoroscopy time and image frames were lower in our patients compared to another study regarding cerebral angiography, and DAP was lower with fewer angiographic image frames for therapeutic procedures. Proposed DRLs can be used for quality assurance and patient safety in diagnostic and therapeutic procedures.
Angiography ; Cerebral Angiography ; Fluoroscopy ; Humans ; Intracranial Aneurysm* ; Korea ; Patient Safety ; Radiation Exposure*

BACKGROUND AND OBJECTIVES: Facial sequelae after facial paralysis cause serious functional and aesthetical problems including facial asymmetry, symkinesis and facial crease. The most common aesthetical problem is facial furrow and crease induced by facial hyperkinestic movement due to incomplete facial recovery. The aim of this study is to investigate the efficacy of botulinum toxin A injection in patients with deep nasolabial fold and bitterness furrow after facial paralysis. SUBJECTS AND METHOD: Thirty-five patients who recovered partially from facial paralysis, had deep nasolabial fold and bitterness furrow with or without facial asymmetry. Botulinum toxin A intramuscular injection on perioral area for mouth corner deviation, subcutaneous injection on deepen nasolabial fold, and intramuscular injection on bitterness furrows had improved lower facial symmetry and cosmetic configuration without Pseudo Bell's palsy. RESULTS: Of 26 patients who had facial palsy side nasolabial fold before the injection, 21 patients improved. Of the 21 patients who had facial palsy side bitterness furrow, 16 patients improved after the injection. Of 11 patients who had contralateral nasolabial fold, 4 patients improved after the injection. Of 13 patients who had contralateral bitterness furrow, 7 patients improved after the injection. CONCLUSION: After botulinum toxin A injection, the patients showed marked improvement of nasolabial fold, bitterness furrow and lower facial asymmetry.
Botulinum Toxins ; Botulinum Toxins, Type A ; Cosmetics ; Facial Asymmetry ; Facial Nerve ; Facial Paralysis ; Humans ; Injections, Intramuscular ; Injections, Subcutaneous ; Mouth ; Nasolabial Fold ; Paralysis

BACKGROUND: Chronic urticaria (CU) is one of the most common skin disorders. This disease commonly induces emotional, social and psychological problems due to the erythematous lesion and intense pruritus. But there has been inadequate objective evaluation of the quality of life (QOL) of the patients with CU in Korea. OBJECTIVE: The purpose of this study was to investigate the QOL of the Korean patients with CU by means of a new disease-specific tool and to assess the association between the QOL and the severity of disease. METHODS: A total of 118 patients with CU were interviewed using the CU QOL questionnaire (CU-Q2oL). Their symptoms were evaluated with the urticaria severity score. We analyzed the relationship between the severity score and the CU-Q2oL score with Pearson's correlation test. RESULTS: The average score of the CU-Q2oL was 50.08+/-18.68. It was high when the patients had high severity scores (p<0.01). The severity score was increased in the patients with old age and when they were married. Comorbid systemic and skin diseases, a long duration of urticaria and systemic symptoms accompanying urticaria were also related to a high severity score. CONCLUSION: This study showed that CU has a significant impact on the QOL of Korean patients with CU in proportion to the disease severity. Clinicians need to consider the QOL and the CU severity of their patients to achieve the ideal goals of treatment.
Humans ; Korea ; Pruritus ; Quality of Life ; Skin ; Skin Diseases ; Urticaria ; Surveys and Questionnaires

Trichilemmoma is a benign, solitary, small tumor that might often be misdiagnosed as a basal cell carcinoma or verruca. It is usually seen on the face, and especially on the nose and cheeks. A 79-year-old Korean man presented with a 2.0x2.0 cm-sized nodular mass on his right shoulder and the lesion was histopathologically diagnosed as a trichilemmoma. The atypical clinical appearance and localization of his neoplasm did not help us diagnose the lesion, and the histological findings were the only clues for making the diagnosis of trichilemmoma.
Aged ; Carcinoma, Basal Cell ; Cheek ; Humans ; Nose ; Shoulder ; Warts

We present a case of accessory tragus (AT) which developed at an unusual site, the nasal vestibule, of a 1-day-old girl. To our knowledge, this is the first report of an accessory tragus that appears on the nasal vestibule.

We report here on a 71-year-old female who had well-demarcated erythematous patches, along with some pearly papules, on the right cheek. Histopathological examination of the lesions revealed a basaloid cell mass, which appeared to be a superficial basal cell carcinoma, and a small keratin-filled cyst that appeared to be a milium. A part of the milium was surrounded by the basaloid cells of tumor islands and milia later developed on the lesion of basal cell carcinoma. We suggest that basal cell carcinoma may be one of the causes of secondary milia.
Aged ; Carcinoma, Basal Cell ; Cheek ; Female ; Humans ; Islands