Echinococcus granulosus Protoscolex DM9 Protein Shows High Potential for Serodiagnosis of Alveolar Echinococcosis

Alveolar echinococcosis (AE) caused by infection with E. multilocularis metacestode, represents one of the most fatal helminthic diseases. AE is principally manifested with infiltrative, proliferating hepatic mass, resembling primary hepatocellular carcinoma. Sometimes metastatic lesions are found in nearby or remote tissue. AE diagnosis largely depends on imaging studies, but atypical findings of imaging features frequently require differential diagnosis from other hepatic lesions. Serological tests may provide further evidence, while obtaining reliable AE materials is not easy. In this study, alternative antigens, specific to AE were identified by analyzing E. granulosus protoscolex proteins. An immunoblot analysis of E. granulosus protoscolex showed that a group of low-molecular-weight proteins in the range from 14 kDa to 16 kDa exhibited a sensitive and specific immune response to AE patient sera. Partial purification and proteomic analysis indicated that this protein group contained myosin, tubulin polymerization promoting protein, fatty-acid binding protein, uncharacterized DM9, heat shock protein 90 cochaperone tebp P-23, and antigen S. When the serological applicability of recombinant forms of these proteins was assessed using enzyme-linked immunosorbent assay, DM9 protein (rEgDM9) showed 90.1% sensitivity (73/81 sera tested) and 94.5% specificity (172/181 sera tested), respectively. rEgDM9 showed weak cross-reactions with patient sera from the transitional and chronic stages of cystic echinococcosis (3 to 5 stages). rEgDM9 would serve as a useful alternative antigen for serodiagnosis of both early- and advanced-stage AE cases.

Advances in Serological Diagnosis of Taenia solium Neurocysticercosis in Korea

Cysticercosis, a parasitic disease caused by Taenia solium metacestode (TsM), has a major global public health impact in terms of disability-adjusted life years. The parasite preferentially infects subcutaneous tissue, but may invade the central nervous system, resulting in neurocysticercosis (NC). NC is an important neglected tropical disease and an emerging disease in industrialized countries due to immigration from endemic areas. The prevalence of taeniasis in Korea declined from 0.3%–12.7% during the 1970s to below 0.02% since the 2000s. A survey conducted from 1993 to 2006 revealed that the percentage of tested samples with high levels of specific anti-TsM antibody declined from 8.3% to 2.2%, suggesting the continuing occurrence of NC in Korea. Modern imaging modalities have substantially improved the diagnostic accuracy of NC, and recent advances in the molecular biochemical characterization of the TsM cyst fluid proteome also significantly strengthened NC serodiagnosis. Two glycoproteins of 150 and 120 kDa that induce strong antibody responses against sera from patients with active-stage NC have been elucidated. The 150 kDa protein showed hydrophobic-ligand binding activities and might be critically involved in the acquisition of host-derived lipid molecules. Fasciclin and endophilin B1, both of which play roles in the homeostatic functions of TsM, showed fairly high antibody responses against calcified NC cases. NC is now controllable and manageable. Further studies should focus on controlling late-onset intractable seizures and serological diagnosis of NC patients infected with few worms. This article briefly overviews diagnostic approaches and discusses current issues relating to NC serodiagnosis.

Human Sparganosis in Korea

BACKGROUND: Sparganosis is a larval cestodiasis caused by the plerocercoid of Spirometra spp. Since the first description of human sparganosis in 1924, several hundred cases have been reported in Korea. However, systematic approaches for literature surveys of Korean sparganosis have seldom appeared. METHODS: We searched publicly available databases such as PubMed, Research Information Sharing Service, and Korea Medical Citation Index with relevant Medical Subject Headings. RESULTS: At least 438 Korean sparganosis cases have been described from 1924 to 2015. Preoperative diagnosis has been significantly increased since the 1980s due to popularization of serological and imaging diagnostics. Cases were largely detected from fifth decades in general, but cerebral sparganosis was detected in relatively young age groups (third and fourth decades). Sparganosis was prevalent in men (75.9%). Consumption of frog/snake and drinking unfiltered water were found in 63.4% and 16.9% of patients, respectively. Most frequently affected sites were subcutaneous tissues (49.9%), followed by the central nervous system (36.2%). Involvements of visceral organs (7.6%), ocular regions (3.6%), and muscles (2.7%) were noticed. In women, breast sparganosis constituted a large proportion (34.2%). Sparganosis associated with immunocompromised patients has recently been reported. CONCLUSION: Sparganosis has been continuously reported in Korea during the past 90 years, although its incidence has decreased during the last 20 years. The disease is mostly characterized by subcutaneous nodule, but infection of the worm in vital organs often results in serious illness. Continuous awareness is warranted to monitor sparganosis occurrence and associated clinical consequences.

A Case of Foreign Body Incidentally Found at the Maxilla and Maxillary Sinus / 대한이비인후과학회지

Foreign bodies in the maxillary sinus are rare and mostly of traumatic origin. These foreign bodies result in pain, bleeding and infection and are immediately removed in most cases. Sometimes the foreign body without serious symptoms can remain for several years without treatment. However, the prognosis of foreign bodies in the paranasal sinuses can be severe. Therefore, regardless of the symptoms present, it seems worthwhile to remove the foreign body from the paranasal sinuses in order to prevent any possibility of further complications. The authors report a case of foreign body occurring in maxilla and maxillary sinus without symptoms for 25 years with related literatures.

Classification and Clinical Analysis of Zygomatic Fractures / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study investigated the surgical methods and their results according to the subtypes of zygomatic fractures. SUBJECTS AND METHOD: Medical records of 99 zygomatic fractures treated between March 1997 and December 2006 were reviewed regarding fracture type, surgical method and time of operation from the initial trauma. RESULTS: Overall, operations were performed in 70 out of 99 cases. For zygomatic arch fractures, facial asymmetry and trismus in all 14 of 20 cases after surgery by Gillies incision were improved, and one revision procedure was performed. For tetrapod and multifragment fractures, one revision procedure was performed because of displacement of repaired bone fragment following surgery in 60 cases. Considering location and replacement of fractures, surgery was performed through one of incisions below: Gillies, lateral canthal, gingivobuccal, and subcilliary incision. All preoperative symptoms were improved. CONCLUSION: For zygomatic arch fractures, Gillies approach would be an optimal method, while for displaced tetrapod and multifragment fractures, two or more point fixation points would achieve satisfactory results.

Repair of Late Post-traumatic Enophthalmos / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Enophthalmos is a common sequelae of orbital fracture. Moreover, it is difficult to treat secondarily. We assessed the effect of filling up the orbital volume defect with implants on the correction of late posttraumatic enophthalmos. SUBJECTS AND METHOD: Based on patients' clinical data, we retrospectively reviewed 11 patients who had an operation because of late posttraumatic enophthalmos from July 2001 to December 2005. To correct late posttraumatic enophthalmos, porous polyethylene (Medpor(R)), Medpor(R) enophthalmos wedge implant, absorbable mesh, bone graft particulate, rib cartilage, auricle cartilage, and maxilla anterior wall were used. RESULTS: Among 11 patients, 6 patients were men and 5 patients were women. The average age was 33.2 years with the follow-up period of 21.8 months. Five patients had orbital floor fracture, 1 patients had medial orbital wall fracture, 4 patients had a combination of orbital floor and medial orbital wall fractures, and 3 patients had zygoma fracture. Excellent results were obtained in all 5 patients with diplopia. The amount of enophthalmos corrected was between 1 and 5 mm (mean 2.5 mm). There was no case of visual loss, infection, migration, or exposure of implant, but we carried out re-operation on 1 case due to over reduction. CONCLUSION: Filling up the volume defect with proper implants is a relatively simple, safe and efficient technique in correcting late posttraumatic enophthalmos.

Results and Complications of the Orbital Blowout Fractures Repair / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There has been a recent surge in the frequency of blowout fracture operations in the Department of Otorhinolaryngology. Clinical symptoms and signs, operative timing and the results from fracture site and size have been researched in this study. We conducted this study to examine the postoperative complications causing re-operation in orbital blowout fracture repair in the last seven years. SUBJECTS AND METHOD: Based on patients' clinical data, we retrospectively reviewed 160 patients who had operation because of blowout fracture from January 1998 to December 2004. Fifty-two patients had orbital floor, 74 patients had medial orbital wall, 34 patients had a combination of orbital floor and medial orbital wall fractures. We investigated diplopia, limitation of eye movements, and enophthalmos after the surgery, and analyzed the frequency and causes of re-operation. The mean postoperative follow-up was 24 months. RESULTS: We classified complications into immediate complications which occurred within 24 hours, late complications which occurred between 24 hours and 2 weeks, and delayed complications which occurred 2 weeks or more after operation. The symptoms of complications included diplopia, EOM limitation, cheek hypoesthesia, loss of vision, oroantral fistula, implant infection, ectropion, and etc. In case of sequelae which lasted more than six months, the combination of orbital floor and medial orbital wall fractures was higher than other fracture types. We carried out re-operation on 14 cases and the main cause was incomplete reduction. CONCLUSION: Surgeons should perform proper operation according to fracture site and type, and insert the implant after making an adequate dissection in order to reduce the frequency of complication and re-operation.

Comparison of Treatment Course and Outcome between Medically and Surgically Treated Patent Ductus Arteriosus in Preterm Infants

PURPOSE: Early intervention is needed to treat patent ductus arteriosus (PDA) as it is a major cause of increased mortality in preterm infants. However, it is uncertain which is better, medical versus surgical management. We reviewed medical records to compare the treatment course and outcome between medically and surgically treated preterm PDA infants. METHODS: Thirth-two Mechanically ventilated pretem infants (gestational age<34 wks, birth weight<2,000gm) who survived beyond 30 days were studied. Treatment course and outcome were compared between indomethacin-treated (INDO, n=15) and surgically treated who have not responded to indomethacin (Surg, n=17). RESULTS: Volume of administered fluid and urine output during the first five days of life were similar, however, initial weight loss were lower in the SURG group than INDO group (p=0.031). Size of PDA on the echocardiogram were larger in SURG group (mean 3.4 mm) than INDO group (mean 2.5 mm) (p=0.046). Duration of hospitalization was longer in the SURG group (mean 46 days) than INDO group (mean 72 days) (p=0.033), however, time to start feeding, ventilator duration and weaning time were similar in both groups. Incidence of intraventricular hemorrhage was lower in the SURG group (47%) than INDO group (6%) (p=0.009). CONCLUSION: Preterm infants with poor initial weight loss and large size of PDA were likely to become surgical candidates and required longer periods of hospitalization and showed increased incidence of IVH. Although surgical treatment of PDA in preterm infants is definitive, fluid restriction and medical management at early postnatal period is recommended.