Vocal nodules and polyps are much more frequent in singers, public speakers, teachers and actors. Voice trauma and voice misuse, at times associated with mild inflammatory reaction, appear to be important in their etiology. It is generally agreed that vocal cord nodules and polyps are inflammatory in nature and they arise in the subepithelial layer of loose connective tissue of the vocal cord. Since the junction of anterior and middle thirds of the membranous cord and has the greatest amplitude of vibration. This is the site of predilection for vocal cord nodules. The author performed laryngomicrosurgery for 70 cases of vocal nodules and polyps at Ewha Womans University Hospital during the period of 5 years. The result obtained were as follows ; 1) Surgical excision is not necessarily the best approach because vocal nodules in the early stages will resolve with the simplest voice therapy. 2) In children, surgery is rarely indicated because most nodules in children regress during adolescence. 3) For patients who use their voices professionally, voice therapy is indicated for three months. 4) If after three month of conservative treatment the cord lesion does not improve and the patient it still dissatisfied with his voice, laryngomicrosurgery can then be considered. 5) The small cuffed endotracheal tube in the interarytenoid space helps to keep the cords immobile and in an abducted position. 6) Removal of the nodule shoule be started by gentle retraction posteriorly and as soon as a tear appears anterior to the nodule. 7) On occasion it is preferable to start the dissection with a siccle knife while the nodule is held on the stretch. 8) Voice rest should be maintained for a week following which the free edges of the cords are usually healed.
Lee, Jun Seok;Koo, Kyo Yeon;Lee, Soon Min;Park, Min Soo;Park, Kook In;Namgung, Ran;Lee, Chul;Choi, Seung Hoon
Clinical and Experimental Pediatrics
/
v.52
no.11
/
pp.1216-1220
/
2009
Purpose:To analyze and compare various cases in which peritoneal drainage was used as the primary treatment method in preterm infants with intestinal perforation. Methods:Among the preterm infants of less than 28 weeks of gestation who were admitted to the neonatal intensive care unit (NICU) at the Gangnam Severance Hospital from April 2006 to April 2009, 7 who had developed intestinal perforation were studied retrospectively. We investigated the clinical characteristics, secondary operation performances, morbidities, complications, and mortalities. Results:Among the 7 infants, 5 survived. Of the 5 cases, 3 received laparotomy, of which 2 were confirmed as having necrotizing enterocolitis. Of the 2 infants who died, 1 had received laparotomy before 48 h of peritoneal drainage, while the other had not received any subsequent treatment. Of the 7 children, 4 had patent ductus arteriosus (PDA), of which 3 had received indomethacin injection. Five infants had begun enteral feeding before they developed intestinal perforation. Of the 5 infants who survived, 4 were diagnosed with cholestasis. Of the 7 infants, 4 developed periventricular leukomalacia (PVL) and 3 developed rickets. Conclusion:Although the use of peritoneal drainage as the primary management of intestinal perforation in preterm infants is controversial, we suggest that it can be used for treating extreme premature neonates. Further randomized controlled study will be required to determine the feasibility of using this method.
Objective: Previous studies have reported that morphological features of the first cervical vertebra (atlas) have been associated with mandibular growth direction. The purpose of this study was to show the possible positional and morphological changes of the Atlas from activator treatment in Class II malocclusion patients. Methods: Lateral cephalometric radiograph tracings were made at initial, middle and final stages of treatment. Angular and linear measurements of skeletal and morphological features were measured on the anatomical landmarks and reference planes. Results: The skeletal effects of activator treatment on Class II malocclusion patients were evident on ramal height, body length, effective body length, ANB, and overjet. Clockwise rotation of the long axis of the Atlas was found in Group 1, but there was no inclination change of the Atlas in groups 2 and 3. There was no significant correlation between anterior and posterior positions of the atlas or morphological change in all groups. - except for posterior movements of the Atlas found in group 1. Conclusion: Clockwise rotation of the atlas axis resulted from activator treatment in Cl II malocclusion patients. Change in atlas axis can be thought of as an indicator for success of activator treatment.
The Journal of the Korean bone and joint tumor society
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v.9
no.1
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pp.38-44
/
2003
Purpose: To suggest an appropriate treatment modality regarding analyze outcomes of treatment for pathologic fracture to simple bone cyst of the long bone. Materials and Methods: We selected 12 cases with pathologic fracture of the long bone among the 31 cases treated for simple bone cyst from December. 1993 to May. 2001. The mean age was 9 years ranged from 2 years to 19 years, male was 11 cases and female was 1 cases, and the mean follow up interval was 32.9 month ranged from 12 month to 69 month. The principle of treatment for pathologic fracture of the long bone was conservative treatment except operative treatment for fracture with displacement of the femur. After fracture was united, the residual lesion was treated by local steroid injection, cortical drilling, curettage & bone graft. But we observed without specific treatment in cases that had healing process of simple bone cyst followed by bony union. The clinical results were evaluated as exellent if simple bone cyst was completely healed, as good if that had process of healing, as poor if that was no change or more increased in size. Results: The pathologic fracture was united in all cases treated with conservative treatment in 9cases and by open reduction with internal fixation in 3 cases. After fracture was united, the 6 cases were observed without specific treatment, because they had healing process of cyst, and had outcomes as good and excellent. Conclusion: We suggest to need observation when simple bone cyst has healing process after pathologic fracture was united, otherwise secondary treatment will be needed when residual lesion is persisted.
The Journal of Korean Orthopaedic Ultrasound Society
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v.5
no.1
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pp.1-8
/
2012
Purpose: The purpose of this study is to report the preliminarily result of the radiologic disappearance of the calcific material, regardless of the size, type or location, on one-time ultrasonographic (US) assisted needling for calcific tendinitis of the shoulder. Materials and Methods: From March to August 2011, 46 patients (47 shoulders) with symptomatic calcific tendinitis were treated by one-time US assisted needling. Initially, a diagnostic US was performed with patient to determine the locations, numbers and sizes of calcific deposits. After 1% lidocaine local anesthesia, the calcific material was punctured with an 18-gauge needle under US monitoring. If no calcific material was aspirated after 2 or 3 additional attempts, the deposits was performed multiple puncture to achieve decompression. And then all patients were performed subacromial corticosteroid injection. All patients were followed up 4 weeks after procedure. To assess the radiologic disappearance after one-time US assisted needling, simple radiographs of the treated shoulder were performed and size, dense, and morphology of the calcific deposits were compared with those in baseline radiographs. For clinical evaluations, visual analogue scale for pain and function (PVAS and FVAS), and American Shoulder and Elbow Surgeons (ASES) score were assessed. Results: There were 11 male and 35 female patients with the mean age of 53.8 years (28-71). The morphology of the calcific deposits were 31 type A and 16 type B by French Arthroscopic Society classification and mean size was $2.9{\pm}6.7$ mm before the procedure. At 4 weeks after the index procedure, the radiographic unchanged group was included in 10 cases and changed group was 37 cases. No intergroup difference for the clinical results after the procedure was evident, but group FAS classification before the procedure was significantly different (p=0.011). Conclusion: At 4 weeks after one-time US assisted needling for calcific tendinitis of the shoulder, the radiographic size- or dense-changed cases were showed in 79%, regardless of the size, type or location of the calcific material. But the radiographic nearly or complete disappearance were showed in only 21%.
Background: Surgical correction of the full spectrum of esophageal atresia with tracheoesophageal fistula has improved over the years, but the mortality and morbidity assoiated with repair of these anomalies still remains high. Material and Method: We retrospectively analyzes 27 surgically treated patients with esophageal atresia and tracheoesophageal fistula at Dong-A University Hospital between January 1992 and March 1997. Result: There were 21 male and 6 female patients. Mean birth weight was 2.62$\pm$.385 kg(2.0~3.4 kg). Twenty- four(88.9%) had esophageal atresia with distal tracheoesophageal fistula, and 3(11.1%) had pure esophageal atresia. Four(14.8%) infants were allocated to Waterston risk group A, 18(66.7%) to group B, and 5(18.5%) to group C. In eighteen(66.7%) infants with associated anomalies, cardiovascular anomalies were the most common. Three had a gap length of 3.5 cm or greater(ultra-long gap) between esophageal segments, 7 had 2.0 to 3.5 cm(long gap), 8 had 1.0 to 2.0 cm(medium gap), and 9 had 1 cm or less(short gap) gap length. Among 27 neonates, 3 cases underwent staged operation, late colon interposition was done in 2, and all other 24 cases underwent primary esophageal anastomosis. Oerative mortality was 2/27(7.4%). Causes of death included acute renal failure(n=1), empyema from anastomotic leak(n=1), necrotizing enterocolitis(n=1), sepsis(n=1), insulin-dependent diabetus mellitus(n=1 . There were 4 anastomosis- related complications including stricture in 3, leakage in 1. Mortality was related to the gap length(p<.05). Conclusion: Although the complication rate associated with surgical repair of these anomalies is high, this does not always implicate the operative mortality. The overall survival can be improved by effective treatment for combined anomalies and intensive postoperatve care.
This study was conducted to investigate the effect of ventilating system of environmental controlled broiler house on broiler production. Three hundred eighty four broiler chicks (Hubbard, mean live weight of $44.5{\pm}2.0g/bird$) were reared for 2 wk. The results of the present study were summarized as follows : 1. Ammonia gas production was lower in the second and the third floors of cages compared with first floor of cages 13.5 and 13.5 vs 14.6 ppm, respectively). The observations of ammonia production in the morning and afternoon were similar. The production of carbon dioxide was not different between morning and afternoon, but it was tended to decrease in the forth floor of cages due to a fresh air 2. A wind velocity in the enclosed house was similar across lower, middle and upper section (0.57m/sec, 0.22m/sec and 0.04msec, respectively). In order to maintain an optimal air flow velocity in the cages, the duct entrance was punched, and then the air flow was full-round in the overall space in the cage. 3. Daily liveweight gain, feed intakes, and feed efficiency were not significant differences among treatments during whole experimental period (P>0.05). Therefore, the present results showed that temperature, moisture and atmosphere controlling were desirable, and air flew evenly in the cage.
Kim, Min-Sun;Lee, Seung-Hyun;Kim, Jeong-Hwa;Chang, Young-Bum;Lee, Dae-Yeol
Childhood Kidney Diseases
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v.11
no.1
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pp.65-73
/
2007
Purpose : Voiding cystourethrography(VCUG) is a commonly performed diagnostic procedure in children with urinary tract infections. Recently, with the widespread use of prenatal ultrasonography, VCUG is performed as part of the postnatal radiological evaluation of asymptomatic infants with prenatally detected hydronephrosis. The procedure is relatively simple but it involves discomfort and some complications. We studied post procedural symptoms and complications in children who underwent VCUG. Methods : This study reviewed 259 patients who underwent VCUG in our hospital between October 2005 and September 2006. We did a chart review and a telephone interview with the patients' parents about symptoms and complications associated with VCUG. Results : Among 269 children, 217 patients(80.7%) were under 2 years of age and 5 patients (1.9%) were over 8 years of age. Their mean age was $13.1{\pm}22.9$ months. After VCUG, dysuria was found in 49 patients presented with dysuria, and irritability in 36 patients with irritability. Other complications were hematuria, fever, frequency, bladder rupture and urinary tract infection. Mean symptoms duration was $1.4{\pm}0.7$ days. There was no significant relationship between prophylactic antibiotics use and complication rate associated with VCUG. Conclusion : Our study demonstrated that 32.7% of patients showed complications including bladder rupture and urinary tract infection after VCUG. We also found that prophylactic antibiotics use did not prevent urinary tract infection nor decrease the rate of complications associated with VCUG. Therefore, we suggest that the procedure must be done carefully and aseptically, and we should closely observe the children who undergo VCUG for development of possible complications.
Background: The postoperative management following lung transplantation has dramatically improved in the recent decade. However, some complications still remain as troublesome problems. We retrospectively reviewed the gastrointestinal complications and their management after lung transplantation. Material and Method: We performed a retrospective review of the medical records of 25 cases in 23 patients who underwent lung and heart-lung transplantations from July 1996 to March 2009. The definition of gastrointestinal complication was the gastrointestinal tract-related disease that occurred after lung transplantation. There were eight postoperative deaths (within postoperative 30 days) that were excluded from the analysis. Result: Twenty three gastrointestinal complications occurred in 11 (64.7%) of the 17 cases. The median follow-up period was 6.9 months (range: 2 months to 111 months), and chronic gastritis (23.5%, 4 of 17 cases) was the most common complication. Severe, prolonged (more than 2 weeks) diarrhea occurred in 3 cases. Three patients had gastric ulcer with one case requiring gastric primary closure for gastric ulcer perforation. This patient had gastric bleeding due to recurrent gastric ulcer 2 months after laparotomy. Cytomegalovirus gastritis and esophagitis occurred in 2 cases and 1 case, respectively, and esophageal ulcer occurred in 2 cases. There were esophageal strictures in 2 patients who underwent esophageal stent insertion. Other complications were one case each of ileus, early gastric cancer requiring endoscopic mucosal resection, gall bladder stone accompanied with jaundice, and pseudomembranous colitis. Conclusion: The incidence of gastrointestinal complication is relatively high in patients after they undergo lung transplantation. Since gastrointestinal complications can induce malnutrition, which might be related to considerable morbidity and mortality, close follow-up is necessary for the early detection and proper management of gastrointestinal complications.
While trust and commitment are core mediating variables for the purpose of maintaining the long-term relationship, in the context of the characteristics of company and the relationship performance of its members, there have been limited studies which explore as to how each of the dimensions has affects differently. The basic purpose of this study is to examine the relationship between an automobile manufacturer and its agencies. The main purpose of this study is to examine how each different dimension of trust and commitment on the automobile manufacturer has different mediating effects between the characteristics of company(organization characteristics, relationship characteristics) and relationship performance perceived by its agents. Another purpose is to investigate the mechanism by which the relationship performance of the agencies is improved. An empirical study surveying 115 sales office managers at a leading automobile manufacturer in Korea was conducted. An analysis of the collected data indicates that while the characteristics of company have a positive influence on the agencies' relational performance through the mediating role of both trust of benevolence and commitment, agencies' trust of their headquarter's benevolence has a different influence on the dimensions of commitment. Finally, the authors discussed some theoretical contributions and managerial implications. And then, they presented limitations of this study and the future research directions.
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