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이상에서 고찰한 위식도역류의 병태를 간략히 요약하면 다음과 같다. 위액에는 염산, 펩신, 담즙산과 췌효소등을 포함하고 있어 역류된 위액은 상부 기관식도관에 자극을 주거나 손상을 줄 수 있으며 개개인의 점막 상피의 저항도와 적절한 타액의 분비는 위액에 의한 손상의 정도를 결정하는 중요한 요소로 알려져 있다. 위식도역류로 인한 많은 증상이나 소견은 두가지의 기전으로 나타나서 첫째, 역류된 위액이 직접 조직에 영향을 주거나 둘째, 간접적으로 식도 하부에 분포된 미주신경에 의한 연관자극에 의해 일어나는데 위식도역류의 증상 중 두부, 경부, 심장 및 폐장의 증상은 이들 장기에 미주신경의 일부가 같이 분포하여 일어나는 간접적인 기전이다. 하부식도괄약근(lower esophageal sphincter)의 기능은 역류를 막는 가장 중요한 요소로 알려져 있어 간헐적으로 하부식도 괄약근의 압력이 떨어지면 역류가 일어나게 된다. 정상적인 식도의 연동운동은 식도에 역류된 위내용물을 위로 제거되는데 중요하며 위식도역류 환자에서 흔히 연동운동이 저하되거나 비정상적인 연동운동을 관찰할 수 있다. 또한 위내용물이 소장으로 비워지는 시간이 연장되어 위내용물이 위내에 축적되는 것도 위식도역류의 원인의 하나로 생각된다. 이러한 위식도역류의 병태를 연구하는 것은 이 질환의 이해에 도움을 줄 것으로 생각된다.
The role of the ECP(Eosinophilic cationic protein) is still unknown in the allergic rhinitis. In bronchial asthma, ECP can induce the exposure of the neuropeptidergic nerve to environments destroying the bronchial mucosa, aggravating the bronchial hypersensitivity and delay the mucociliary clearance. In the clinical aspect, we can (md that patients with perennial allergic rhinitis sometimes have sinusitis. The purpose of this article is to evaluate whether mucosal damage by ECP can play a role to develop the sinusitis by delaying the mucociliary clearance, and relationship between long symptom duration of allergic rhinitis and mucociliary clearance. In 32 perennial allergic rhinitis patients, we elucidated there is correlation among ECP presence, mucociliary clearance, sinusitis, and symptom durations. The obtained results were as follows : 1. ECP appeared in all mucosa of each specimen. 2. Mean mucociliary clearance time is 6 mins. 12 sec. in allergic patients with sinusitis, 6 mins. 36 sec in allergic patients without sinusitis. 3. n out of 32 cases have mucosal destruction. 4. Symptom duration is not correlated with the development of sinusitis. This study suggests that ECP may destroy the mucosa in allergic rhinitis and the mucociliary clearance of allergic rhinitis is not related to sinusitis and symptom dotation. Therefore development of sinusitis in allergic rhinitis seems not to be caused by delaying of mucociliary clearance due to mucosal destruction, but by some other factors.
Gastroesophageal reflux (GER) has been considered one of major causes in patient with globus symptom. Diagnostic methods for GER are gastroesophagoscopy, acid perfusion test esophagogram, esophageal manometry, 24-hour double probe pH-metry, and so on. According to the literature, positive rate of GER on esophagogram was reported variably from 4.7% to 45.9% and the outcome of classical treatment with antacid and prokinetic agent was reported from 70% to 84%. We reviewed the medical records of 81 patients with globus symptom. Each patient had been performed esophagogram and treated with antacid and prokinetic agent. Positive rate of GER on esophagogram was 46.9%. Complete resolution and improvement of globus symptom was 79% overally, 92% in positive group of GER rut esophgogram, and 72% in negative group. Considering aspects of time-cost and compliance of patient esophagogram is one of the screening methods of GER in patients with globus symptom. Antacid and prokinetic agent is recommended in treatment of patients with globus symptom.
Hypopharyngeal perforation secondary to tracheal intubation is rare, but may result in severe airway complications that include retropharyngeal abscess, pneumothorax, pneumonia, mediastinitis and death. The most common site of hypopharyngeal perforation is the pyriform sinus and the region of the cricopharyngeus muscle. We report a 62-year old man with intubation-induced hypopharyngeal injury presenting as deep neck infection. The patient presented with dyspnea and pain on the neck. Neck CT scan identified fluid and air collection on the neck from the hyoid bone to the thoracic inlet level. Despite of delayed diagnosis, we successfully operated him by using strap muscle myofascial transposition flap. The patient was followed up for 3 months without any complications.
Background: Infectious mononucleosis is a disease precipitated by Epstein-Barr virus(EBV) in mostly children, some seronegative adolescents and young adults comprising clinical symptoms such as fever, lymphadenopathy, and pharyngitis as well as laboratory findings such as hetero-phil antibodies and atypical lymphocytosis. It is confirmed by serologic test for EBV. Materials and Methods: A retrospective evaluation of 26 patients who diagnosed with infectious mononucleosis was peformed through the analysis of typical symptom, sign and laboratory findings. Results : Infectious mononucleosis occurs mostly at 3 to 10 years (74.9%), common symptoms and signs are fever, cervical lymphadenopathy, tonsillar enlargement and exudate. Positive ratio of atypical Lymphocyte(>10%) and hetrophil antibodies are 61.5%, 35.2% respectively, it is less diagnostic. EBV-viral capsid antigen(VCA) IgM are positive in all cases, so it is most diagnostic findings. Conclusion: Infectious mononucleosis should be considered as a cause of cervical lymphadenopathy and pharyngotonsillitis in children and young adults, the assessment of EBV-VCA IgM is necessary for the diagnosis.
Background and Objective : Soft palate plays a great role in function of speech and swallowing. Ablation of tonsil cancer results in multi-demensional defect including soft palate in most cases and restoration of the postoperative oral cavity function is a continuing surgical challenge. Although a variety of techniques are available, radial forearm free flap has been known as an effective method for these defect, which offers a thin, pliable, and relatively hairless skin, and a long vascular pedicle. The aim of the present study is to report the speech and swallowing function test results of our 5 consecutive radial forearm free flaps used for tonsil cancers. Materials and Methods : We reviewed the medical records of 5 patients who were offered intraoral reconstruction with a radial forearm free flap after ablative surgery for tonsil cancers, from Dec. 1997 to Oct. 1998, and analyzed the surgical methods, complications, and speech and swallowing function test results. We have examined with modified barium swallow to evaluate postoperative wallowing function and articulation and resonance test for speech. Results : The tumor sizes by TNM stage(AJCC, 1997) were T1(1), T2(2), and T4(3). The paddles of flaps were tailored in multilobed designs from oval shape to pentalobed design and in variable size from 24$cm^2$ to 108$cm^2$(average size = 78.4$cm^2$), according to the defect after ablation. This procedures resulted in satisfactory flap success and functional results all but 1 case of flap contracture in 2 postoperative week, achieved early oral diet until 16-57 postoperative day(average, 28 days) and social speech. The oropharyngeal defect including soft palate reconstruction with radial forearm free flap might be an excellent method for the maximal functional results, after ablative surgery of tonsil cancer that results in multidimensional defect.
Background and objectives : During the last century, various incisions for parotidectomy has introduced and among them, the modified Blair incision has been the one most commonly used. The modified facelift incision, in another hand, has only been introduced and applied recently for better aesthetic results, but also has been criticized for its potentially limited anterior exposure. The purpose of this study is to compare the modified facelift incision with the modified Blair incision in its indications, results and complications. Materials and methods : All parotidectomies done at Kang-nam St. Mary's Hospital for benign parotid masses from Jan. 1995 to Aug. 1998 were reviewed. They were then divided into 2 groups according to their surgical approach, and the parameters included age, gender, complications length of follow-ups, the aesthetic results and the pt's satisfaction. Results : There were no significant differences in the incidence of complications in both groups and the aesthetic results and patient's satisfaction were greater in the modified facelift group. Conclusion : The modified facelift incision provides improved aesthetic results in patients with benign parotid masses without the disadvantage of limited exposure and complications.
Subcutaneous emphysema is an unusual and rarely reported complication of tonsillectomy. The more commen complications are hemorrhage, infection and following anesthesia, aspiration, cardiac arrhythmia, and laryngeal trauma can occur. Posttonsillectomy subcutaneous emphysema results directly from the introduction of air into the tonsillar bed either during the surgical procedure itself or in the postoperative period. This condition is generally benign and self limiting and usually requires treatment only for the primary respiratory disease. In this report, we describe a 40-year-old female patient in whom subcutaneous emphysema developed shortly after tonsillectomy. She was observed for 5 days, at which point subcutaneous emphysema was seen on the follow up soft tissue neck X-ray to disappeared.
The goals of lip reconstruction are to provide oral competence, adequate support for the lower lip, contour restoration, adequate lip sulcus, and adequate oral aperture. The composite radial forearm palmaris longus free flap is thin enough that it can be folded onto itself without a significant increase in bulk. The flap is easy to dissect, the pedicle contains long vessels of large diameter, and the skin is a good color and texture match for the perioral region. Moreover, the vascularized tendon can be used for lower lip reconstruction. This makes the flap ideally suited for total lower lip reconstruction. We experienced the case of total lower lip excision and reconstruction with the radial forearm free flap including palmaris longus tendon, so we reported that case with literature. The patient has a lower lip squamous carcinoma(T3NIM0), and performed a total lower lip excision with right modified radical neck dissection and left extended supraomohyoid neck dissection, and a reconstruction with radial forearm free flap includng palmaris longus tendon. The oral competence and masticatory function were nearly normalized and cosmetical result was very acceptable.