Kyung Chul Lee

Clinical Features and Treatments of Odontogenic Sinusitis

Purpose The aim of this study was to investigate how clinical features such as sex, age, etiologic factors, and presenting symptoms of odontogenic sinusitis are differentiated from other types of sinusitis. Also, this study was designed to find methods for reducing the incidence of odontogenic sinusitis. Materials and Methods A retrospective chart analysis was completed on twenty-seven patients with odontogenic sinusitis. They were all treated at Kangbuk Samsung Hospital between February 2006 and August 2008. The study protocol and informed consent forms were approved by the institutional review boards for human beings at Kangbuk Samsung Hospital. Results Ten patients (37.0%) had dental implant related complications and 8 (29.6%) had dental extraction related complications. Unilateral purulent nasal discharge was the most common symptom (66.7%). The therapeutic modality included transnasal endoscopic sinus surgery in 19 (70.4%) patients, and a Caldwell-Luc operation in two (7.4%) patients. Conclusion In our study, there was no significant difference in the incidence between genders. The average age of the patients was 42.9 years. The incidence was highest in the fourth decade. There were no significant differences between the symptoms of odontogenic sinusitis and that of other types of sinusitis. However, almost all of the patients with odontogenic sinusitis had unilateral symptoms. Iatrogenic causes, which include dental implants and dental extractions, were the most common etiologic factors related to the development of odontogenic sinusitis. Therefore, a preoperative consultation between a rhinologist and a dentist prior to the dental procedure should be able to reduce the incidence of odontogenic sinusitis.

Surgical Treatment Using an Allograft Dermal Matrix for Nasal Septal Perforation

Purpose Numerous methods have been utilized to repair nasal septal perforation with varying degrees of success; however, no consensus has been reached on nasoseptal perforation repair. Here, the authors describe a surgical method based on human dermal allograft (Surederm™, Hans Biomed Corp. Korea) for the repair of nasal septal perforations. Materials and Methods Eleven patients with a nasal septal perforation were included in this study. The causes of these septal perforations included previous nasal surgery, trauma, foreign body (button battery), and idiopathy. There were several sites of perforation: 9 in the central area, 1 in the posterior-central area, and 1 in the anterior area. An interpositional graft incorporating Surederm™ was positioned between bilateral mucoperichondrial flaps using an intranasal approach. A silastic sheet was then left in the nasal septum bilaterally until complete healing had occurred through new nasal mucosa, which took a mean duration of 6 weeks. Results Outcomes in ten of the eleven patients were successful, with complete septal perforation closure. The remaining perforation, which was caused by a button battery, closed incompletely; however, its initial size of 2 cm was reduced to 5 mm. Conclusion The described technique has a high success rate and can be performed under local anesthesia without external scarring. In the absence of donor site morbidity, this technique can also be utilized to repair posterior or multiple septal perforations without difficulty.

Recovery of Lithium from Seawater Using Nano-Manganese Oxide Adsorbents Prepared by Gel Process

Adsorbing and salvaging extremely small quantities of lithium ion, high-performance ion-exchange type lithium ion adsorbent was prepared through the ion-sieve formation method. The method uses acid treatment after the synthesis of spinel-structured nano-Li1.33Mn1.67O4 precursor through the tartaric acid gel process. It has good selectivity and high efficiency in adsorbing lithium ion in seawater. The generated adsorbent showed a 28.2 mg/g lithium uptake from artificial seawater. This adsorbent further showed a difference reproducibility that was lower than 10% when subjected to five cycles of adsorption and desorption experiments.

Expression of cell-cycle regulators (cyclin D1, cyclin E, p27kip1, p57kip2) in papillary thyroid carcinoma

Objective: To evaluate the expression of cell-cycle regulators in papillary thyroid carcinoma in relation to lymph node metastatic features, and to determine whether immunohistochemical staining of cell-cycle markers can predict lymph node metastasis. Study Design: Cross-sectional study of prior surgical specimens. Setting: Academic tertiary referral center. Subjects and Methods: We reviewed the clinical records of patients who had undergone surgery for thyroid cancer and follicular adenoma between January 2005 and May 2008 at our clinic. Among these cases, 92 patients, comprising 28 patients with follicular adenoma, 32 with papillary thyroid carcinoma without lymph node metastasis, and 32 with papillary thyroid carcinoma with lymph node metastasis, were selected randomly. Formalin-fixed, paraffin-embedded tissues from the 92 patients were immunohistochemically stained for cyclin D1, cyclin E, p27kip1, and p57kip2, and protein expression levels were quantified and compared among the groups. Results: Tumor specimens from the papillary thyroid carcinoma group had significantly higher expression levels of cyclin D1 and cyclin E, and cytoplasmic expression of p57kip2 than the other two groups (P < 0.05). In particular, all malignant cases expressed cyclin D1, and cytoplasmic p57kip2 was expressed only in malignant cases. Furthermore, differences in the grade of cyclin D1 expression according to lymph node metastasis were statistically significant (P < 0.05). Conclusion: Our results suggest that immunohistochemistry of certain cell-cycle regulators may be helpful in the diagnosis of papillary thyroid carcinoma, and that cyclin D1 in particular may be a useful marker for evaluating lymph node metastasis.

Comparison of Clinical Characteristics between Primary and Secondary Paranasal Mucoceles

Purpose Paranasal sinus mucocele is a benign, expansile mass which can occur as a result of trauma or spontaneous obstruction of a sinus tract. The purpose of this study was to describe and compare the clinical characteristics of primary mucoceles occurring in patients with no previous sinus surgery history or known cause of mucoceles and secondary mucoceles resulting as a complication following endoscopic sinus surgery or the Caldwell-Luc operation. Materials and Methods We performed a retrospective chart review of 33 cases of primary mucoceles and 60 cases of secondary mucoceles which were diagnosed and surgically corrected between 1996 and 2008. Results The most common presenting symptoms in primary mucoceles were nasal obstruction (19.4%) and rhinorrhea (17.7%). In secondary mucoceles, the most common symptoms were cheek pain (31.7%) and nasal obstruction (18.3%). The most common origins of primary mucoceles were the ethmoid sinus (45.5%) and the maxillary sinus (18.2%). In secondary mucoceles, the maxillary sinus was the most common site (86%), followed by the ethmoid sinus (7.1%). All patients with secondary mucoceles had a history of sinus surgery. Conclusion The maxillary sinus was the most common site of secondary mucoceles while the ethmoid sinus was the most common origin of primary mucoceles. Cases of secondary mucoceles that occurred following sinus endoscopic surgery developed more frequently in the ethmoid sinus than in those following the Caldwell-Luc procedure, therefore, we suggest that the incidence of maxillary sinus mucoceles in the Asian population would decrease as the rate of endoscopic sinus surgery increases.

Outcomes of posterior lacrimal sac approach in endoscopic dacryocystorhinostomy: review of 35 cases.

Background The purpose of this study was to describe the posterior lacrimal sac approach in endoscopic dacryocystorhinostomy (DCR) performed at our institute and report perioperative results achieved with this procedure. Methods A prospective clinical study was performed of 35 adult patients with nasolacrimal duct obstruction who underwent posterior lacrimal sac approach DCR from March 1998 to May 2005. Follow-up period ranged from 13 to 30 months (average, 17.5 months; SD, 6.8 months). “Surgical success” was defined as complete relief of epiphora and patent surgical ostium on endoscopic assessment. Results Surgical success was achieved in 30/35 (85.7%) patients after the primary surgery. Of 5 unsuccessful patients who complained of occasional epiphora, 4 patients had formed stenosis and 1 patient had granulation around the surgical opening, and all had revision surgery. Four of 5 (80.0%) patients achieved surgical success. Thus, including the result of revision surgery, 34/35 (97.1%) patients were successful. Conclusion Posterior lacrimal sac approach in endoscopic DCR has several advantages: good sac accessibility, a low complication rate, and a relatively high success rate. Therefore, the posterior lacrimal sac approach appears to offer a useful alternative approach for the surgical treatment of nasolacrimal duct obstruction.

Basaloid squamous cell carcinoma of the external auditory canal: case report

Basaloid squamous cell carcinoma (BSCC) is a rare malignancy, with features of both basal cell carcinoma and squamous cell carcinoma. The tumor has a predilection for the upper aerodigestive tract, and has been suggested to behave more aggressively than squamous cell carcinoma (SCC). To the author’s knowledge, BSCC confined to the external auditory canal (EAC) has not been previously described. BSCC of EAC manifests similar characteristics as the conventional EAC cancer, presenting a mass with chronic otorrhea and itching sense. Excision of the tumor was accomplished by modified lateral temporal bone resection. This report describes the first case of BSCC in this location, and includes reviews of the pathologic and clinical aspects of this disease.

Availability of preoperative systemic steroids on endoscopic sinus surgery for chronic rhinosinusitis with nasal polyposis.

Purpose To analyze the outcome of endoscopic sinus surgery (ESS) after preoperative systemic steroid (PSS) treatment for chronic rhinosinusitis (CRS) with nasal polyposis (NP) and to investigate and compare clinicopathological factors associated with the outcome. Materials and Methods We performed a retrospective chart review of 468 patients with CRS with NP who underwent primary ESS between January 2005 and October 2011. 124 patients who met the inclusion criteria were included. Beginning from 2008, our clinic administered steroid preoperatively in patients of CRS with NP, thus there were 84 patients with preoperative systemic steroid (PSS group) and another 40 patients without such regimen (no PSS group). To evaluate the outcome after ESS, poor outcome and complication were analyzed according to the following parameters: age, sex, follow-up duration, eosinophilic infiltration, atopy, asthma, Lund-Mackay score, and polyp grade. Results There was no significant difference in poor outcome rates between the PSS and no PSS group (35.0% vs. 47.6%, p=0.185). There was no significant difference in complication rates between the PSS and no PSS group (10% vs. 6%, p=0.468). As with the multivariate analysis of the clincopathological factors to the poor outcome rate, presence of asthma and eosinophilic infiltration were significantly related (odds ratio as 6.555 and 4.505, respectively), whereas PSS was confirmed as less likely related (odds ratio 0.611). Conclusion Low dose PSS administration does not seem to have an effect on the outcome after ESS in patients who have CRS with NP. Eosinophilic infiltration and presence of asthma are important predictors of surgical outcome.

Effect of Medication for Residual Symptoms in BPPV: Randomized Controlled Trials:

Objectives: Even after successful canalith repositioning procedures (CRPs) in benign paroxysmal positional vertigo (BPPV), residual symptoms could be continued without positional nystagmus. The aim of this study was to evaluate the effect of adjuvant medication on residual symptoms after successful CRPs Methods: Between January 2011 and August 2012, 150patients with idiopathic BPPV participated. Patients who had previous history of psychiatric disorder or migraine were excluded. All participants were diagnosed by video-nystagmography (VNG), and Dizziness Handicap Inventory (DHI) questionnaires were completed before CRPs. All subjects were divided into three groups after successful CRPs. Medication (M) group was treated with vestibular suppressant (dimenhydrinate 25mg), placebo (P) group and no medication (N) group. One week after, all patients completed follow up VNG for recurrence and repeated DHI questionnaires for comparing residual symptoms. Results: All participants regardless of groups showed significant symptom improvement after successful CRPs, but 76 patients complained of residual symptoms. Presence of residual symptoms was more prevalent in P or N group compared with M group (P = 0.048, P = 0.03, respectively). Most frequent characteristics of residual symptoms were lightheadedness or mild headache (n = 36). However, in the analysis of DHI, total and subscale scores of DHI were not different between three groups before and after successful CRPs. Conclusions: Vestibular suppressant significantly reduced residual symptoms after CRPs. However, there is no significant reduction on DHI scores compared to a control group. It seems that residual symptoms may not be true vertigo but lightheadedness or headache.