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.

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: 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

BACKGROUND AND OBJECTIVES: Typically, posterior epistaxis means that the bleeding point cannot be visualized with anterior rhinoscopy, and it is difficult to find a localized bleeding point. Although bleeding point identification is the key to efficient management, debate and uncertainty remain around the actual location and distribution of the bleeding sites in posterior epistaxis. SUBJECTS AND METHOD: This study was designed to clarify bleeding points of the posterior epistaxis using nasal endoscopy. In 121 of the total 150 (80.7%) cases, we could see the posterior nasal cavity in more detail and find the bleeding point precisely. RESULTS: The most common sites of the bleeding were the posterior portion of the inferior meatus, the posterior portion of middle meatus, and the posterior septum medial to the middle turbinate in order of frequency. A total of 113 cases, corresponding to 93.4% (113/121), showed that epistaxis could be controlled very efficiently by electrocauterization and localized small packing with the help of endoscopes. In the majority of cases, non-surgical interventions were sufficient. CONCLUSION: Bleeding could be stopped more rapidly and with less discomfort if checking the 3 most common sites early.
Endoscopes ; Endoscopy ; Epistaxis* ; Hemorrhage* ; Nasal Cavity ; Turbinates ; Uncertainty

The cytogenetic analysis of mesenchymal stromal cells (MSCs) is essential for verifying the safety and stability of MSCs. An in situ technique, which uses cells grown on coverslips for karyotyping and minimizes cell manipulation, is the standard protocol for the chromosome analysis of amniotic fluids. Therefore, we applied the in situ karyotyping technique in MSCs and compared the quality of metaphases and karyotyping results with classical G-banding and chromosomal abnormalities with fluorescence in situ hybridization (FISH). Human adipose- and umbilical cord-derived MSC cell lines (American Type Culture Collection PCS-500-011, PCS-500-010) were used for evaluation. The quality of metaphases was assessed by analyzing the chromosome numbers in each metaphase, the overlaps of chromosomes and the mean length of chromosome 1. FISH was performed in the interphase nuclei of MSCs for 6q, 7q and 17q abnormalities and for the enumeration of chromosomes via oligo-FISH in adipose-derived MSCs. The number of chromosomes in each metaphase was more variable in classical G-banding. The overlap of chromosomes and the mean length of chromosome 1 as observed via in situ karyotyping were comparable to those of classical G-banding (P=0.218 and 0.674, respectively). Classical G-banding and in situ karyotyping by two personnel showed normal karyotypes for both cell lines in five passages. No numerical or structural chromosomal abnormalities were found by the interphase-FISH. In situ karyotyping showed equivalent karyotype results, and the quality of the metaphases was not inferior to classical G-banding. Thus, in situ karyotyping with minimized cell manipulation and the use of less cells would be useful for karyotyping MSCs.
Azure Stains ; Chromosome Banding/*methods ; Humans ; In Situ Hybridization, Fluorescence/*methods ; Karyotyping/*methods ; Mesenchymal Stromal Cells/*cytology

Spindle cell squamous cell carcinoma (SCSCC) is relatively uncommon, but may be encountered. It poses a challenge in the differential diagnosis in that it includes other spindle cell neoplasms. An 81-year-old female with a raised and exophytic plaque with central ulceration surrounding erythematous patches of the left lower extremities, which was gradually and very slowly increasing in size was admitted to our hospital. After resection, conventional histopathological investigation showed spindle-shaped cells showing hyperchromatic nuclei and mitosis, infiltrating the dermis in a storiform pattern. Immunohistochemical analysis revealed that SCSCC was positive for cytokeratins (AE1/AE3, CAM 5.2, 34betaE12) and mesenchymal markers (vimentin, SMA), but was negative for p63, CD34, CD68, melan A and S-100.
Carcinoma, Squamous Cell ; Dermis ; Diagnosis, Differential ; Female ; Humans ; Keratins ; Leg ; Lower Extremity ; MART-1 Antigen ; Mitosis ; Ulcer

STUDY DESIGN: A case report. OBJECTIVES: To investigate the outcomes of recapping laminoplasty for the treatment of atraumatic spinal interdural hematoma. SUMMARY OF LITERATURE REVIEW: There are several causes for a spinal hematoma. The occurrence of spinal hematoma is rare; in particular, the ones arising atraumaticaly are considered extremely rare. MATERIALS AND METHODS: We studied a 33 year old male patient without any known risk factor. Magnetic resonance image has revealed an intraspinal epidural cyst compressing on the spinal nerve. After performing recapping laminoplasty, followed by partial excision of dura mater and resection of hematoma, we were able to observe another layer of dura mater, confirming the location of hematoma within two epidural layers, i.e., an interdural hematoma. RESULTS: Performing recapping laminoplasty is a more effective and less invasive procedure for removing cyst than conventionally used laminectomy. Patients were found to have synostosis after three months post-op, and they have exhibited neither lumbosacral pain nor lower limb motor weakness after six months follow-up. There were no recurrences or complications reported on our study. CONCLUSION: There are a few reported cases of atraumatic spinal interdural hematoma. Our study shows that performing pars osteotomy with recapping laminoplasty yield good clinical outcome for the treatment of atraumatic spinal interdural hematoma.
Dura Mater ; Follow-Up Studies ; Hematoma ; Humans ; Laminectomy ; Lower Extremity ; Male ; Osteotomy ; Recurrence ; Risk Factors ; Spinal Nerves ; Synostosis

PURPOSE: Facial paralysis is an uncommon but significant complication of chronic otitis media (COM). Surgical eradication of the disease is the most viable way to overcome facial paralysis therefrom. In an effort to guide treatment of this rare complication, we analyzed the prognosis of facial function after surgical treatment. MATERIALS AND METHODS: A total of 3435 patients with COM, who underwent various otologic surgeries throughout a period of 20 years, were analyzed retrospectively. Forty six patients (1.33%) had facial nerve paralysis caused by COM. We analyzed prognostic factors including delay of surgery, the extent of disease, presence or absence of cholesteatoma and the type of surgery affecting surgical outcomes. RESULTS: Surgical intervention had a good effect on the restoration of facial function in cases of shorter duration of onset of facial paralysis to surgery and cases of sudden onset, without cholesteatoma. No previous ear surgery and healthy bony labyrinth indicated a good postoperative prognosis. CONCLUSION: COM causing facial paralysis is most frequently due to cholesteatoma and the presence of cholesteatoma decreased the effectiveness of surgical treatment and indicated a poor prognosis after surgery. In our experience, early surgical intervention can be crucial to recovery of facial function. To prevent recurrent cholesteatoma, which leads to local destruction of the facial nerve, complete eradication of the disease in one procedure cannot be overemphasized for the treatment of patients with COM.
Adult ; Aged ; Chronic Disease ; Facial Nerve/surgery ; Facial Nerve Diseases/*etiology/*surgery ; Facial Paralysis/*etiology/*surgery ; Female ; Humans ; Male ; Middle Aged ; Otitis Media/*complications ; Retrospective Studies ; Young Adult

Herpes zoster duplex, particularly herpes zoster duplex symmetricus, is a very rare manifestation of herpes zoster that occurs in immunocompetent patients. A 23-year-old Korean man presented with grouped erythematous, ruptured, crusted vesicles on plaques and papules on his forehead and both temporal areas. He had unexplained pain around the cutaneous lesions for the past 2 weeks, and the vesicles developed 1 week ago. A Tzanck smear test of the skin lesion showed multinucleated giant cells. A punch biopsy taken from the vesicle on the forehead revealed an intraepidermal vesicle with acantholysis and balloon cells at the floor of the vesicle. He was diagnosed with herpes zoster involving bilateral dermatomes.
Acantholysis ; Biopsy ; Floors and Floorcoverings ; Forehead ; Giant Cells ; Herpes Zoster ; Humans ; Skin ; Young Adult