• Journal of Korean Neurosurgical Society
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• 제60권3호
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• pp.294-300
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• 2017

Hypothalamic hamartoma (HH) is a benign indolent lesion despite the presentation of refractory epilepsy. Behavioral disturbances and endocrine problems are additional critical symptoms that arise along with HHs. Due to its nature of generating epileptiform discharge and spreading to cortical region, various management strategies have been proposed and combined. Surgical approaches with open craniotomy or endoscopy, stereotactic approaches with radiosurgery and gamma knife surgery or radiofrequency thermos-coagulation, and laser ablation have been introduced. Topographical dimension and the surgeon's preference are key factors for treatment modalities. Endoscopic disconnection has been one of the most favorable options performed in treating HHs. Here we discuss presurgical evaluation, patient selection, surgical procedures, and complications.

• Journal of Yeungnam Medical Science
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• 제39권1호
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• pp.12-17
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• 2022

Anatomical endoscopic enucleation of the prostate (AEEP) differs from other endoscopic modalities for bladder outlet obstruction (BOO) because it extracts the whole benign prostatic hyperplasia component. AEEP has been launched for almost 40 years as a first-line treatment method for BOO regardless of prostate size according to several guidelines. However, it remains underperformed worldwide. In this review article, we elaborate on the advantages and disadvantages of AEEP compared to other surgical modalities for BOO to investigate its efficacy and safety as a gold standard surgical management option for males with BOO.

• Advances in pediatric surgery
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• 제20권1호
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• pp.12-16
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• 2014

Foreign body ingestion is a common problem among paediatric populations. Most of the ingested foreign bodies spontaneously pass through the gastrointestinal tract, but approximately less then 10% of them remain without being discharged, and trigger complications. Therefore, proper evaluation and treatment according to the situation is required. In this study, clinical progress and complications were analyzed according to the clinical features and treatment in children who ingested foreign bodies. Among pediatric patients under 18 who were admitted to Chonnam National University Hospital after ingesting foreign bodies between January 2008 to June 2012, only the patients who had their foreign body in the gastrointestinal tract were included in this study. Based on medical records, age, type of foreign body, time spent till admission, and whether the endoscopy was done or not, complication were researched retrospectively. According to symptoms and plain abdomen X-ray findings, treatment was chosen and conducted among endoscopy, observation and emergency operation. Among 273 patients, 9 (3.3%) of them had surgical removal. Seven (2.6%) of them had an emergency operation on the day of admission, and the rest 2 (0.7%) had operation during observation. Removal through initial endoscopic approach was tried in 157 (57.5%) patients. Eleven (70.8%) of them had their foreign body removed at the initial trial, and 5 (4.9%) of them at the second trial. Among 109, who were on observation status, 9 (8.3%) of them needed endoscopic removal, and 2 (1.8%) of them suffered from surgical removal. It is thought to be better to approach slowly considering the type, size and symptoms in foreign body ingestion of pediatric patients, rather than immediate and invasive removal.

• 한국임상수의학회지
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• 제39권6호
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• pp.400-404
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• 2022

A 3-year-old Thoroughbred gelding presented with left laryngeal hemiplegia with a history of laryngoplasty (tie-back surgery) failure. Postoperative endoscopy revealed no abduction or no inflammatory changes in the left arytenoid cartilage. The owner opted for the horse to undergo partial arytenoidectomy due to failed laryngoplasty. A tracheostomy tube was intubated through a mid-cervical tracheotomy to secure the airway under general anesthesia, and; laryngotomy was performed to access the arytenoid cartilage in dorsal recumbency. A partial arytenoidectomy was performed with endoscopic assistance through the left nostril, and the left arytenoid cartilage was removed, excluding the muscular process. Antibiotic and anti-inflammatory agents were administered postoperatively, and the incision site was cleaned using normal saline and antibiotic ointment twice daily. On the 12th postoperative day, endoscopy revealed redundant corniculate process mucosa at the surgical site, which was removed using rongeur forceps directly through the previous laryngotomy incision. The horse showed no significant complications during the hospitalization. Two months after surgery, the surgical site reportedly recovered with no evidence of granulation tissue. The horse returned to training and racing 3 and 7 months postoperatively, respectively. This is the first case report of a partial arytenoidectomy in a horse in South Korea. In this case, the horse returned to training after partial arytenoidectomy without significant complications, indicating that partial arytenoidectomy could be beneficial for failed laryngoplasty.

• Clinical Endoscopy
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• 제56권2호
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• pp.221-228
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• 2023

Background/Aims: Endoscopic ultrasound-guided tissue acquisition (EUS-TA) is essential for the diagnosis of pancreatic cancer. The feasibility of comprehensive genomic profiling (CGP) using samples obtained by EUS-TA has been under recent discussion. This study aimed to evaluate the utility of EUS-TA for CGP in a clinical setting. Methods: CGP was attempted in 178 samples obtained from 151 consecutive patients with pancreatic cancer at the Aichi Cancer Center between October 2019 and September 2021. We evaluated the adequacy of the samples for CGP and determined the factors associated with the adequacy of the samples obtained by EUS-TA retrospectively. Results: The overall adequacy for CGP was 65.2% (116/178), which was significantly different among the four sampling methods (EUS-TA vs. surgical specimen vs. percutaneous biopsy vs. duodenal biopsy, 56.0% [61/109] vs. 80.4% [41/51] vs. 76.5% [13/17] vs. 100.0% [1/1], respectively; p=0.022). In a univariate analysis, needle gauge/type was associated with adequacy (22 G fine-needle aspiration vs. 22 G fine-needle biopsy [FNB] vs. 19 G-FNB, 33.3% (5/15) vs. 53.5% (23/43) vs. 72.5% (29/40); p=0.022). The sample adequacy of 19 G-FNB for CGP was 72.5% (29/40), and there was no significant difference between 19 G-FNB and surgical specimens (p=0.375). Conclusions: To obtain adequate samples for CGP with EUS-TA, 19 G-FNB was shown to be the best in clinical practice. However, 19 G-FNB was not still sufficient, so further efforts are required to improve adequacy for CGP.

• Archives of Plastic Surgery
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• 제38권6호
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• pp.871-874
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• 2011

Purpose: In some patients with velopharyngeal insufficiency (VPI), Hypernasality can persist after surgical management. Continuous Positive Airway Pressure (CPAP) is applied to these patients for treating hypernasality. The purpose of this study is to report follow-up results of postoperative CPAP therapy. Methods: After performing palatal lengthening, CPAP therapy was applied to three patients for eight weeks from July of 2008 to November of 2009. Perceptual evaluation, nasometry, and nasopharyngeal endoscopy were performed to evaluate hypernasality, nasalance and size of the gap at velopharyngeal port. Each evaluation was made before surgery, right after CPAP therapy and during follow-up of more than a year after CPAP therapy. Results: All of the patients showed improvement in hypernasality right after CPAP therapy according to the auditory perceptual evaluation, nasometry and nasopharyngeal endoscopy. But the improvement in hypernasality in these patients did not last during follow-up. Conclusion: In this study, our results suggest that CPAP therapy is effective in reducing hypernasality for postoperative VPI patients immediately after the therapy, but hypernasality may be worsen in some patients during follow-up. Therefore we recommend follow-ups after CPAP therapy to see if the efficacy of CPAP therapy lasts.

• 대한후두음성언어의학회지
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• 제11권1호
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• pp.81-86
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• 2000

Submucous cleft palate is a relatively uncommon congenital anomaly accompanying velopharyngeal incompetence(VPI). Double opposing Z-plasty has many advantages including prolongation of soft palate, normal midfacial growth, midline scar. We analyzed postoperative results comparing with those of preoperative evaluation by several variables(nasometer, endoscopy, satisfactory scale) in 14 patients treated with double opposing Z-plasty due to submcous cleft palate. Nasalance score in Ah sound, Ma phrase, and Pa phrase decreased 20.23%, 3.25%, and 23.26% in the average, respectively. As a result, hypernasality improved significantly. Closure rate in velum evaluated by endoscopy was increased from 0.44 to 0.76. In objective satisfactory scale checked by each patient's guardian at the postoperative period, much improved in 3, improved in 6, minimally improved in 1, and no difference in 1 was reported. (n=11 patients) Double opposing B-plasty is a good surgical modality in patients accompanying VPI with submucous cleft palate or incomplete cleft palate and will be used more usefully and widely.

• Clinical Endoscopy
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• 제56권4호
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• pp.423-432
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• 2023

Compared to endoscopic mucosal resection (EMR), colonoscopic endoscopic submucosal dissection (C-ESD) has the advantages of higher en bloc resection rates and lower recurrence rates of colorectal neoplasms. Therefore, C-ESD is considered an effective treatment method for laterally spread tumors and early colorectal cancer. However, C-ESD is technically more difficult and requires a longer procedure time than EMR. In addition to therapeutic efficacy and procedural difficulty, safety concerns should always be considered when performing C-ESD in clinical practice. Bleeding and perforation are the main adverse events associated with C-ESD and can occur during C-ESD or after the completion of the procedure. Most bleeding associated with C-ESD can be managed endoscopically, even if it occurs during or after the procedure. More recently, most perforations identified during C-ESD can also be managed endoscopically, unless the mural defect is too large to be sutured with endoscopic devices or the patient is hemodynamically unstable. Delayed perforations are quite rare, but they require surgical treatment more frequently than endoscopically identified intraprocedural perforations or radiologically identified immediate postprocedural perforations. Post-ESD coagulation syndrome is a relatively underestimated adverse event, which can mimic localized peritonitis from perforation. Here, we classify and characterize the complications associated with C-ESD and recommend management options for them.

• Journal of Dental Anesthesia and Pain Medicine
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• 제17권1호
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• pp.71-76
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• 2017

Drug-induced sleep endoscopy (DISE) is used to identify areas of upper airway obstruction, which occurs when patients with obstructive sleep apnea (OSA) snore. DISE enables effective diagnosis and appropriate treatment of the obstruction site. Among surgical treatment methods for OSA, maxillomandibular advancement surgery (MMA) is performed to move a jaw forward; the surgery has a high success rate for OSA treatment. In DISE, anesthetics such as propofol and midazolam must be administered to induce snoring while the patient is deeply sedated for an accurate diagnosis to be made. When inducing deep sedation in a patient with OSA, airway obstruction may increase, causing oxygen saturation to drop; airway interventions are necessary in such cases. Effective DISE and MMA surgery can be performed by administering propofol through target-controlled infusion while monitoring the bispectral index (BIS).

• Clinical Endoscopy
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• 제56권1호
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• pp.75-82
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• 2023

Background/Aims: The etiology of superficial non-ampullary duodenal epithelial tumors (SNADETs) remains unclear. Recent studies have reported conflicting associations between duodenal tumor development and Helicobacter pylori infection or endoscopic gastric mucosal atrophy. As such, the present study aimed to clarify the relationship between SNADETs and H. pylori infection and/or endoscopic gastric mucosal atrophy. Methods: This retrospective case-control study reviewed data from 177 consecutive patients with SNADETs who underwent endoscopic or surgical resection at seven institutions in Japan over a three-year period. The prevalence of endoscopic gastric mucosal atrophy and the status of H. pylori infection were compared in 531 sex- and age-matched controls selected from screening endoscopies at two of the seven participating institutions. Results: For H. pylori infection, 85 of 177 (48.0%) patients exhibited SNADETs and 112 of 531 (21.1%) control patients were non-infected (p<0.001). Non-atrophic mucosa (C0 to C1) was observed in 96 of 177 (54.2%) patients with SNADETs and 112 of 531 (21.1%) control patients (p<0.001). Conditional logistic regression analysis revealed that non-atrophic gastric mucosa was an independent risk factor for SNADETs (odds ratio, 5.10; 95% confidence interval, 2.44-8.40; p<0.001). Conclusions: Non-atrophic gastric mucosa, regardless of H. pylori infection status, was a factor independently associated with SNADETs.