Juvenile Dermatomyositis Presenting with Erythematous Swelling of the Upper Eyelid

Purpose@#To report a case of juvenile dermatomyositis that presented with erythematous swelling on the upper eyelid as the first clinical sign.Case summary: An 11-year-old female patient presented with erythematous swelling of both upper eye lids that persisted for 3 weeks prior to examination. She also had an erythematous rash over both cheeks but no pain or hyperemia in either eye. During anti-inflammatory eye drop treatment under suspicion of blepharitis, a reddish-purple heliotrope rash appeared around the eyelid margin. She also developed fever, arthralgia, multiple oral ulcers, an erythematous scaly rash behind the ear, and erythematous firm papules on the metacarpal (MCP) joint and around the elbow. On evaluation, aspartate aminotransferase was elevated to 184 IU/L, alanine aminotransferase to 352 IU/L, and alkaline phosphatase to 266 IU/L. We performed a skin biopsy. Based on histopathological examination, the eyelid lesion was diagnosed as dermatomyositis and the MCP joint lesion as Gottron’s papule. From the above findings, we diagnosed the patient with juvenile dermatomyositis based on the European League Against Rheumatism/American College of Rheumatology classification. The patient was treated with prednisolone. Three months after diagnosis, she died from rapidly progressive interstitial pneumonia, a complication of juvenile dermatomyositis. @*Conclusions@#Heliotrope rash should be considered in the differential diagnosis of patients presenting with eyelid swelling, for early diagnosis and better prognosis of juvenile dermatomyositis.

Juvenile Dermatomyositis Presenting with Erythematous Swelling of the Upper Eyelid

Purpose@#To report a case of juvenile dermatomyositis that presented with erythematous swelling on the upper eyelid as the first clinical sign.Case summary: An 11-year-old female patient presented with erythematous swelling of both upper eye lids that persisted for 3 weeks prior to examination. She also had an erythematous rash over both cheeks but no pain or hyperemia in either eye. During anti-inflammatory eye drop treatment under suspicion of blepharitis, a reddish-purple heliotrope rash appeared around the eyelid margin. She also developed fever, arthralgia, multiple oral ulcers, an erythematous scaly rash behind the ear, and erythematous firm papules on the metacarpal (MCP) joint and around the elbow. On evaluation, aspartate aminotransferase was elevated to 184 IU/L, alanine aminotransferase to 352 IU/L, and alkaline phosphatase to 266 IU/L. We performed a skin biopsy. Based on histopathological examination, the eyelid lesion was diagnosed as dermatomyositis and the MCP joint lesion as Gottron’s papule. From the above findings, we diagnosed the patient with juvenile dermatomyositis based on the European League Against Rheumatism/American College of Rheumatology classification. The patient was treated with prednisolone. Three months after diagnosis, she died from rapidly progressive interstitial pneumonia, a complication of juvenile dermatomyositis. @*Conclusions@#Heliotrope rash should be considered in the differential diagnosis of patients presenting with eyelid swelling, for early diagnosis and better prognosis of juvenile dermatomyositis.

Hepatobronchial Fistula and Lung Abscess after Transarterial Chemoembolization / 대한소화기학회지

Transarterial chemoembolization (TACE) is a common treatment modality to locally manage hepatocellular carcinoma. Liver abscess and bile duct injury are common complications of TACE. However, hepatobronchial fistula is a rare complication. Herein, we report a case of lung abscess due to hepatobronchial fistula after TACE. A 67-year-old man, who had underwent TACE 6 months ago, presented cough and bile-colored sputum. He was diagnosed with lung abscess and hepatobronchial fistula. We performed endoscopic retrograde cholangiopancreatography; however, there was no improvement in his symptoms. Thereafter, partial hepatectomy and repair of fistula were successively conducted.

Soft Tissue Roasi-Dorfman Disease with Features of IgG4-Related Disease in a Patient with a History of Acute Myeloid Leukemia

No abstract available.

Change of Voice Quality on Menstrual Cycle / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The change of voice quality on menstrual cycle is regarded as general in professionals. The primary objective of this study is to evaluate the changes of acoustic parameters during menstrual cycle in general population. METHODS: Twenty young adults were asked to produce vowel /a/, /i/ , and /u/ and to read book audibly at the proliferative phase of the menstrual cycle and premenstrual phase. And then, the sound of the voice in each case was recorded and analyzed by the Computerized Speech Lab. (CSL, Kay Elemetrics, Model 4300B, USA). The statistical analyses were performed using paired t-test to compare several variables of data. RESULTS: Compared with the acoustic parameters between two periods, there were no significant differences in all subjects. But the acoustic parameters with book-reading loudly during menstrual cycles revealed slight changes in voice quality. CONCLUSION: The change of voice quality, especially the fatigue of voice may be concerned with menstrual cycle, so more careful voice habituation was required during the menstrual period.

Changes in Resonance Frequency and Length of External Auditory Canal in Relation to Age / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: With the currently available diagnostic procedure, hearing impaired children are diagnosed at an early age and hearing aids are fitted soon thereafter. Thus, appropriateness of using available correction methods for adult ears and ear models for determining and predicting hearing aid characteristics for these children need to be examined. The objectives of this study are to create a database of resonance frequency and length of external auditory canal (EAC) in all age groups and to adjust the peak frequency response of hearing aid system to take account of the changing resonance peak frequency as child gets older. MATERIALS AND METHOD: We studied 437 ears with no age limitation. We measured rear ear unaided response (REUR) with Rastronics frequency response analyzer and external ear canal length using silastic tube under microscopic or otoscopic finding. Statistical analyses were performed to determine age differences. RESULTS: Ear canal length increased with age, and an adult value was achieved by the age of 14 years. Resonance frequency decreased with age, and reached to an adult value by the age of 9 years. There was significant relationship between ear canal length and resonance frequency. CONCLUSION: Alteration in resonance frequency with age may have practical implications by affecting the insertion gain of hearing aid system in children. The data may be used as useful adjustment factors to correct the current hearing aid system in children.

The Effect of Nasal Obstruction on Sleep Apnea / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although it is widely accepted that nasal obstruction leads to snoring and sleep apnea, the relationship between these variable factors is not clear. Moreover, while nasal blockage in human is known to produce sleep- disordered breathing, it is controversial whether nasal obstruction itself produces obstructive apnea and whether it causes changes in the sleep stages. The purpose of this study is to measure changes in sleep physiology by nasal blockage alone and to evaluate whether the nasal blockage itself ca>i produce the sleep apnea syndrorm or not. MATERIAL AND METHOD: Normal thirty subjects, 15 males and 15 females, who had sleep apnea episodes <2 by polysomnography during sleep, were evaluated using Alice III polysomnography after both nostrils opened, unilateral nostril blockage, and bilateral nostril blockage. The parameters of measurement were hypopnea and apnea episodes and apnea type, apnea index (AI), respiratory disturbance index (RDI), SO and sleep stages. A statistical analysis was performed using a wicoxon signed rank test. RESULTS: Bilateral nasal blockage induces significantly increased apnea and hypopnea episodes, AI, and RDI but induces significantly decreased mean and lowest O. saturation. Also, bilateral nasal blockage significantly prolonged S,-NREM sleep and decreased REM sleep (p(0.05). However, these changes did not correspond with the criteria of the sleep apnea syndrome. CONCLUSION: Unilateral nasal obstruction does not cause any significant changes in the measured parameters compared to the normal nose of unblocked state. Bilateral nasal obstruction does not induce the obstructive sleep apnea syndrome by itself. However, it causes changes in the sleep stages and increases sleep apnea episodes significantly.

Unilateral Parotid Glandular Aplasia and Ductal Atresia / 대한이비인후과학회지

Congenital absence of the major salivary glands, especially of the parotid gland, is a rare disorder whose etiopathogenesis is poorly understood. Aplasia of the parotid glands may be unilateral or bilateral and may occur alone or in association with the absence of other salivary glands or with other developmental anomalies of the first branchial arch, such as hypoplasia or aplasia of the lacrimal glands, hemifacial microsomia, mandibulofacial dysostoses, and multiple congenital anomalies. Various degree of xerostomia and dental caries with early loss of teeth may occur due to decreased salivary production. The authors experienced a case of unilateral parotid aplasia in a 22-year old female who had painless swelling in the right parotid region. We present this case with review of literature.

The Effects of Adenotonsillectomy on Weight Change in Young Children / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: A history of poor weight gain can often be elicited in young children with chronic upper airway obstruction resulting from adenotonsillar hypertrophy. The purpose of this study was to determine the incidence of growth disturbance and what effect, if any tonsillectomy and/or adenoidectomy has on subsequent growth in a group of children. MATERIALS AND METHODS: The subjects consisted of 78 patients with adenotonsillar hypertrophy who had been treated between March 1997 and September 1997 at the department of otolaryngology, Saint Benedict Hospital. Available preoperative data were collected including sex, age at surgery, tonsillar hypertrophy grade, presence of snoring and sleep apnea, preoperative weight, preoperative eating disorder, and URI frequency. RESULT: Many had improvements in growth after adenotonsil-lectomy. The improvement in growth appears to be obvious in chidren with eating disorder, snoring, and sleep apnea resulting from adenotonsillar hypertrophy. CONCLUSION: We can conclude that there exists a relationship beween adenotonsillar hypertrophy children and preoperative eating disorder, growth delay and snoring.