Added Value of Diffusion Weighted Imaging for Detecting Pancreatic Abnormality in Patients with Clinically Suspected Acute Pancreatitis

PURPOSE: To evaluate the added value of diffusion weighted imaging (DWI) to computed tomography (CT) for detecting pancreatic abnormality in patients with clinically suspected acute pancreatitis (AP). MATERIALS AND METHODS: 203 patients who underwent abdomen CT and subsequent DWI to do a workup for epigastric pain were analyzed. Two blinded radiologists independently performed an interval reading based on CT image sets first, then based on combined CT and DWI image sets. The diagnostic criterion on DWI was the increased signal intensity in the pancreas to that of the spleen. For quantitative analysis, the third radiologist measured ADC value of the pancreas in each patient. RESULTS: For AP (n = 43), the sensitivity for detecting pancreatic abnormality increased, from 42% to 70% for reader 1 (P < 0.05) and from 44% to 72% for reader 2 (P < 0.05). For borderline pancreatitis (n = 42), the sensitivity also increased, from 10% to 26% for reader 1 (P < 0.05) and from 7% to 29% for reader 2 (P < 0.05). The mean ADC values (unit, × 10⁻³ mm²/s) were significantly different among the three groups (for AP, 1.09 ± 0.16; for borderline pancreatitis, 1.28 ± 0.2; for control, 1.46 ± 0.15, P < 0.05). CONCLUSIONS: Sensitivity for detecting pancreatic abnormality increased significantly after adding DWI to CT in patients with clinically suspected AP.

A Case of Cholesterol Granuloma in the Nasal Septum / 대한이비인후과학회지

Cholesterol granuloma is rare and has occasionally been reported in uncommon sites of the head and neck, such as in the nasal sinus (frontal, ethmoid, sphenoid, or maxillary sinus), endolymphatic sac, and pterygoid process of the sphenoid sinus. The pathogenesis of thisnrare disease is not clear. We experienced one patient with cholesterol granuloma located in the nasal septum, which was managed successfully by endoscopic assisted excision.

Correlation of Threshold of Click-Evoked Auditory Brainstem Response with Pure-Tone Threshold Average in Various Formulas / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this study is to assess the correlation between the threshold of click-evoked auditory brainstem response (ABR) and the pure-tone averages in various formulas. SUBJECTS AND METHOD: Data were obtained from 207 patients (326 ears) with sudden sensorineural hearing loss. All subjects underwent hearing threshold evaluation using pure tone audiogram (PTA), speech audiogram and click-evoked ABR. Linear regression analyses were applied to assess the relation between threshold of click-evoked ABR and threshold of separate frequencies of the PTA and to analyze the correlation between threshold for click-evoked ABR and various pure-tone averages. RESULTS: Results revealed a significant relation between the threshold of click-evoked ABR and PTA thresholds at 0.5 kHz, 1 kHz, 2 kHz, 3 kHz, and 4 kHz. The highest coefficients of regression and determination were 1.026 for 4 kHz and R2=0.663 for 3 kHz, respectively. The coefficient of regression was highest (=0.995) for the mean of PTA thresholds for 3 kHz and 4 kHz. The coefficient of determination was highest for the mean of PTA thresholds for 1, 2, 3 and 4 kHz (R2=0.732). Multiple regression analysis showed a significant relation between the ABR threshold and PTA thresholds for 1, 3, and 4 kHz (R2=0.732), with highest correlation coefficient at 3 kHz [ABR=11.79+(0.17x1 kHz)+(0.26x3 kHz)+(0.23x4 kHz), (p<0.05)]. CONCLUSION: The threshold of click-evoked ABR correlates best with the mean of PTA thresholds for 1, 2, 3 and 4 kHz. The PTA threshold for 3 kHz has highest correlation with the ABR threshold.

A Case of Leukemic Infiltration of Parotid Gland Preceding the Clinical Onset of Acute Lymphoblastic Leukemia / 대한이비인후과학회지

Extramedullary leukemic infiltration rarely occurs in patients with acute lymphoblastic leukemia. An eight-year-old boy presented with a mass lesion of the left parotid gland with several palpable lymph nodes in the ipsilateral neck. The patient did not have any previous medical history. Given the suspicion of a lymphoma, an excisional biopsy of the parotid mass was performed. The preliminary pathologic result indicated myeloid sarcoma. The patient subsequently underwent bone marrow biopsy, and was finally diagnosed as acute lymphoblastic leukemia. Here we report a case of leukemic infiltration of the parotid gland as an extramedullary manifestation preceding the clinical onset of acute lymphoblastic leukemia.

Videofluoroscopic Evaluation of Swallowing in Patients with Amyotrophic Lateral Sclerosis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Dysphagia in patient with amyotrophic lateral sclerosis (ALS) is a critical symptom for prognosis. Proper evaluation and follow-up of their dysphagia is also important in management. Videofluoroscope is the gold standard method for evaluation of swallowing in ALS patients. The object of this study is to evaluate their dysphagia using videofluoroscope, on the basis of which we can plan the optimal rehabilitation method. SUBJECTS AND METHOD: The clinical records and videofluoroscopes of 7 ALS patients were reviewed. All patients were classified according to Hillel's ALS swallowing score. We analysed their videofluoroscopes and implied proper treatment strategies on the basis of those findings. RESULTS: All patients had dysfunction of tongue. In the early stage, dysphagia was solely attributable to oral phase dysfunction. In the advanced stage, pharyngeal phase was also affected. In some patients, cricopharyngeal dysphagia and aspiration were observed. After various form of treatment such as tongue exercise, position change, swallowing maneuver, tube feeding, and botulinum toxin injection to cricopharyngeal muscle, we could observe improvement in swallowing function. CONCLUSION: Videofluoroscope is a good method for evaluating patients with ALS. By applying tailored treatment strategies on the basis of videofluoroscopic finding, we can properly manage patients with ALS and eventually improve their quality of life.

A Case of Objective Tinnitus due to Middle Ear Myoclonus Treated by Surgical Therapy / 대한이비인후과학회지

Objective tinnitus which may be caused by contraction of the tensor tympani and stapedial muscles is extremely rare. We present a case of middle ear myoclonus with voluntary palatal myoclonus in a musician. Otologic examination demonstrated rhythmic involuntary movement of the tympanic membrane after the exposure of loud sound or blowing of the musical instrument. Impedance audiometry confirmed the motion of tympanic membrane and those movements correlated with a tinnitus perceived by the patient. Palatal myoclonic motion, voluntarily evoked by the patient, was observed by oral examination and heard by Toynbee tube objectively. Medical treatment and directive counseling were effective for voluntary palatal myoclonus. However, the main symptom of tinnitus caused by middle ear myoclonus was not changed. The patient's tinnitus was cured by tympanotomy with sectioning of the tensor tympani and stapedial tendons.