Cecal malakoplakia: A case report

Malakoplakia is a rare chronic granulomatous disease found in the genitourinary tract, mainly. It is considered to be related to immunosuppression and/or infectious processes. We would like to present an operative case of cecal malakoplakia in a patient with a history of surgical resection and chemotherapy for cervical cancer. A 74-year-old female patient visited our hospital for 1-year follow-up after operation and chemo-radiotherapy for cervical cancer. An infiltrative mass of 6 cm, between the cecal base and the right psoas muscle, was observed on computed tomography. An ileocectomy was performed for diagnosis. Histopathologic examination revealed cecal malakoplakia. After surgery, based on previous reports, antibiotics therapy was added. Then the patient was discharged and treated in the outpatient clinic. To our knowledge, a rare case has been described of cecal malakoplakia during observation after surgery and chemo-radiotherapy for cervical cancer. Malakoplakia is known to be related to immunosuppressive condition. Therefore, our case suggests that close observation should be made in patients on immunosuppressive condition, such as chemotherapy.

Cecal malakoplakia: A case report

Malakoplakia is a rare chronic granulomatous disease found in the genitourinary tract, mainly. It is considered to be related to immunosuppression and/or infectious processes. We would like to present an operative case of cecal malakoplakia in a patient with a history of surgical resection and chemotherapy for cervical cancer. A 74-year-old female patient visited our hospital for 1-year follow-up after operation and chemo-radiotherapy for cervical cancer. An infiltrative mass of 6 cm, between the cecal base and the right psoas muscle, was observed on computed tomography. An ileocectomy was performed for diagnosis. Histopathologic examination revealed cecal malakoplakia. After surgery, based on previous reports, antibiotics therapy was added. Then the patient was discharged and treated in the outpatient clinic. To our knowledge, a rare case has been described of cecal malakoplakia during observation after surgery and chemo-radiotherapy for cervical cancer. Malakoplakia is known to be related to immunosuppressive condition. Therefore, our case suggests that close observation should be made in patients on immunosuppressive condition, such as chemotherapy.

Frey's procedure for chronic pancreatitis: a 10-year single-center experience in Korea

PURPOSE: Chronic pancreatitis (CP) is progressive inflammatory disease that leads to irreversible destruction of the pancreatic parenchyma. The main indications for surgical intervention in cases involving CP are intractable pain, suspicion of malignancy, and failure of other methods. However, there is no report related to Frey's procedure in Korea; hence, we aimed to investigate and analyze our institution's experience and determine the benefits of surgical treatment for CP. METHODS: This was a retrospective study of 24 patients with CP who underwent Frey's procedure at Gangnam Severance Yonsei University between January 2007 and December 2017. Preoperative exocrine and endocrine pancreatic function, perioperative finding (blood loss, operation time), postoperative complications were evaluated. Statistical analytics were chi-square test, Fisher exact tests, and Wilcoxon signed-rank test and Mann-Whitney U-test. RESULTS: Surgery was performed due to alcohol-derived CP in 12 of 24 patients (50%) and due to pancreatic stones in 15 of 24 patients (62.5%). Two patients had postoperative complications which were managed conservatively. After surgery, 7 of 24 patients were prescribed with exocrine medication. Comparison of the preoperative and postoperative conditions showed that glycated hemoglobin had no significant differences. After surgery, only 5 patients (21%) complained of intermittent abdominal pain. CONCLUSION: In conclusion, Frey's procedure appears to be a less burdensome surgical procedure. Thus, it could be the first option for management of patients with large pancreatic stone.

The Relationship between the Causative Allergens of Allergic Diseases and Environments in Korea Over a 8-Year-Period: Based on Skin Prick Test from 2006 to 2015

BACKGROUND AND OBJECTIVES: The present study evaluated the results of skin prick test using 55 allergens at 20 centers in the Republic of Korea in 2006, 2010, and 2014–2015. The aim was to assess changes in the positive rate of allergens according to temporal, regional, and environmental factors. MATERIALS AND METHODS: In total, 20 hospitals were selected based on the population distribution in the Republic of Korea. A skin prick test panel comprising 55 aeroallergens was distributed to 18 hospitals for this prospective study. The 2006 and 2010 skin prick test results were collected and analyzed retrospectively from 20 hospitals, while the 2014/2015 skin prick test results (from June 2014 to May 2015) were collected prospectively from 18 hospitals. RESULTS: A total of 14,897 SPT test results were analyzed: 4,319 in 2006, 7,431 in 2010, and 1,852 in 2014/2015. The overall rate of skin prick test positivity to more than two allergens was significantly higher in males than females. The positive rates of alder pollens and birch, oak and ragweed pollen positivity were increased in older patients. Several positive rates were increased according to the temperature in spring. The positive rates for beech pollen, birch pollen, hazel pollen, oak pollen, Tyrophagus putrescentiae, mugwort, cat, Acarus siro, Lepidoglyphus destructor and Tyrophagus putrescentiae were significantly increased, while those of Cult rye pollen and dandelion were significantly decreased over the three test periods. The overall positive rate for allergens in Jeju province varied significantly from Seoul and other cities. CONCLUSION: Change in the positive rate of multiple aeroallergens was evaluated in the Republic of Korea over time. Our findings can be used to recommend aeroallergens suitable for inclusion in skin prick test panels in the Republic of Korea and will facilitate further investigation of changes in the patterns of allergic diseases.

A retrospective analysis of outpatient anesthesia management for dental treatment of patients with severe Alzheimer's disease

BACKGROUND: The number of patients with Alzheimer's disease is growing worldwide, and the proportion of patients requiring dental treatment under general anesthesia increases with increasing severity of the disease. However, outpatient anesthesia management for these patients involves great risks, as most patients with Alzheimer's disease are old and may show reduced cardiopulmonary functions and have cognitive disorders. METHODS: This study retrospectively investigated 43 patients with Alzheimer's disease who received outpatient anesthesia for dental treatment between 2012–2017. Pre-anesthesia patient evaluation, dental treatment details, anesthetics dose, blood pressure, duration and procedure of anesthesia, and post-recovery management were analyzed and compared between patients who underwent general anesthesia or intravenous sedation. RESULTS: Mean age of patients was about 70 years; mean duration of Alzheimer's disease since diagnosis was 6.3 years. Severity was assessed using the global deterioration scale; 62.8% of patients were in level ≥ 6. Mean duration of anesthesia was 178 minutes for general anesthesia and 85 minutes for intravenous sedation. Mean recovery time was 65 minutes. Eleven patients underwent intravenous sedation using propofol, and 22/32 cases involved total intravenous anesthesia using propofol and remifentanil. Anesthesia was maintained with desflurane for other patients. While maintaining anesthesia, inotropic and atropine were used for eight and four patients, respectively. No patient developed postoperative delirium. All patients were discharged without complications. CONCLUSION: With appropriate anesthetic management, outpatient anesthesia was successfully performed without complications for dental treatment for patients with severe Alzheimer's disease.

Comparison Between Beers Criteria and Screening Tool of Older Person's Prescriptions as a Screening Tool for the Detection of Potentially Inappropriate Medicines and Adverse Drug Events in the Elderly Patients

BACKGROUND: Beers criteria are used to identify the potentially inappropriate medications (PIMs) in elderly patients. However, the criteria have limitations such as lacking consideration of drug-drug and duplicated prescriptions. The aim of this study is to compare the efficacy of newly developed screening tool of older person's prescriptions (STOPP) with Beers criteria in identifying PIMs and adverse drug events (ADEs) in elderly patients. METHODS: We included 115 elderly patients older than 65 years who visited the outpatients' clinic or have been hospitalized for medical illness. Comprehensive geriatric assessments including medication review by the pharmacists were performed by the multidisciplinary team. Beers criteria and STOPP were used to find out PIMs. The association between PIMs defined by both criteria with ADEs was also evaluated. RESULTS: A total of 59 patients (50.4%) by Beers criteria and 76 patients (65.0%) by STOPP had been prescribed with PIMs. Compared with Beers criteria, STOPP had advantage in identifying more PIMs. In addition, STOPP could identify more ADEs related medications than Beers criteria. STOPP was also useful to detect duplicate drug class prescription and nonsteroidal anti-inflammatory drugs for renal impaired patients. CONCLUSION: STOPP criteria PIMs can detect more duplicated prescription and are significantly associated with avoidable ADEs in older individuals compared with that of Beers criteria PIMs.

Effectiveness of Embolization of Internal Iliac Artery during Endovascular Aneurysm Repair / 대한혈관외과학회지

PURPOSE: Embolization of the internal iliac artery (IIA) is frequently required during endovascular aneurysm repair (EVAR) because of a concurrent common iliac artery aneurysm, a short common iliac artery, or deployment of aortouni-iliac devices. This study was conducted to evaluate the effectiveness of IIA embolization during EVAR. METHODS: A retrospective study was performed in patients undergoing EVAR and IIA embolization from December 2005 to March 2011 from a prospectively registered database of patients with aneurysms. Patient clinical characteristics, procedures, and follow up data were collected and analyzed. RESULTS: Eighteen patients (33.3%) required IIA embolization among 54 EVARs. The mean age was 73.5 years, and 17 patients were male. Indications were a common iliac artery aneurysm (11/18), short iliac artery (3/18), thrombosed common iliac artery (1/18), arteriovenous malformation (1/18), and deployment of aortouniiliac artery devices (1/18). One mortality occurred in a patient with a ruptured abdominal aortic aneurysm. No type I endoleaks were observed. IIA embolization was achieved with conventional coils (7/18), a vascular plug (6/18), and detachable coils (5/18). After EVAR, there were two cases of ileus, a limb occlusion that required additional stenting in the external iliac artery, a type II endoleak, and two cases of buttock claudication. CONCLUSION: IIA embolization during EVAR is effective to prevent a type II endoleak with minor morbidities.

Adjunctive Procedure as Treatment of Type I Endoleak after EVAR / 대한혈관외과학회지

Endovascular aneurysm repair (EVAR) has become prevalent and is expanding beyond conventional indications. A type I endoleak in the aortic neck is one of the main complications after EVAR, which limits long-term survival and requires immediate intervention. We experienced three cases of successful treatment of a type I endoleak after EVAR with adjunctive procedures and report them with a literature review.

Role of Interleukin-10 on Mouse Otitis Media Model Using Lipopolysaccharide / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Interleukin (IL)-10 is a major regulator of innate immunity. It interferes with the production of inflammatory mediators by reacting with polymorphonuclear neutrophils, monocytes and macrophages. In addition, it also up-regulates the ex-pression of molecules that amplify the anti-inflammatory effect of IL-10. This study tested the hypothesis that injection of various concentrations of exogenous IL-10 in the middle ear cleft can inhibit the acute stage of otitis media induced by lipopolysaccharide (LPS). And if so, the level of concentration for inhibition can be determined. MATERIALS AND METHOD: IL-10 and/or LPS were injected transtympanically into the middle ear cavity of normal mice. Histopathological measurement of submucosal thickness and num-ber of inflammatory cell infiltration was performed at 24 hours after inoculation of IL-10 and/or LPS. RESULTS: At 24 hours after inoculation, every group of IL-10 inoculation reduced both thickening of the mucous and submucosal infiltration of inflammatory cells in a dose-dependent manner. As the concentrations of IL-10 inoculated increased, mucosal thickness and submucosal infiltration of inflammatory cells were more reduced. CONCLUSION: This study demonstrated that exogenous IL-10 injection into the middle ear can directly reduce LPS-induced otitis media in acute stage in a dose-dependent manner. These findings also indicate that IL-10 may be a candidate for local modulator of acute otitis media.

Correction of the Scar Contracture of the Oral Mucosa after Uvulopalatopharyngoplasty with Z-Plasty and Mucosal Tissue Graft / 대한이비인후과학회지

A foreign body sensation or a globus symptom of the throat after uvulopalatopharyngoplasty (UPPP) is caused by an internal scar formation and such symptoms generally disappear in 9 months after surgery. In rare cases, this sensation could be permanent. If this condition persists, possible primary treatment could be multiple stage steroid injection into the affected site for softening of the submucosal fibrous formation. But rotational or advancement mucosal flaps could be effective if the steroid injection does not work. We present a case of scar contracture of oral mucosa after UPPP was corrected with Z-plasty and mucosal tissue graft.

A Case of Intravascular Papillary Endothelial Hyperplasia Combined with Organizing Hematoma of the Lateral Wall of the Nasal Cavity

Intravascular papillary endothelial hyperplasia (IPEH) is an exuberant intravascular endothelial proliferation that in many respects mimics an angiosarcoma. A 78-year-old woman complained of a several month history of left-side nasal obstruction and frequent epistaxis. Preoperative endoscopic examination demonstrated a dark red mass occupying the left nasal cavity. The nasal cavity mass was completely removed under endonasal endoscopy. During the six-month follow-up, the patient had no evidence of recurrent disease. We present here a rare case of IPEH within the nasal cavity that demonstrated the reactive nature of this affliction.

Bilateral Amyloidosis of the Oral Commisure Surrounding the Facial Artery / 대한이비인후과학회지

Amyloidosis is a disease characterized by deposition of extracellular fibrillar proteins in various tissues mainly derived from the mesoderm. We experienced a case of a 59-year old man with a localized bilateral mass at the angle of the mouth, which was surgically removed. It surrounded the facial arteries bilaterally with the same pattern, and was diagnosed as amyloidosis pathologically. Followed by further workup, he was finally diagnosed with the multiple myeloma. Cases such as this where an amyloidosis mass surrounded the main branches of the facial arteries has not yet been reported in the literature. We present a case of localized amyloidosis at the oral commisure surrounding the facial arteries with the review of its clinical patterns, diagnostic tools, pathologic findings and treatment.

Effects of the General Anesthesia and the Rose Position on the Change of the Inferior Turbinate Size

BACKGROUND AND OBJECTIVES: Enlargement of the inferior turbinates can be caused by allergic rhinitis, vasomotor rhinitis, or emotional responses. However, the effects of general anesthesia and the Rose position on the enlargement of the turbinates are unknown. The aim of this study is to evaluate the effects of general anesthesia and the Rose position on the size of the inferior turbinates and nasal passage. MATERIALS AND METHODS: Fifty patients undergoing tonsillectomy with or without adenoidectomy or snoring surgery without nasal pathology from February, 2007 to July, 2007 at a university hospital were included in the study. The size of the inferior turbinates was measured under the following conditions:1) pre-anesthesia in the supine position;2) post-anesthesia in the supine position;3) post- anesthesia, lying in the Rose position, and 4) at the end of the operation 30 to 50 minutes after anesthesia, with endoscopic nasal photographs. Using an acoustic rhinometry, the minimal cross-sectional area of the nasal cavity was, during conditions one and four, listed above, simultaneously. RESULTS: The size of the inferior turbinates was increased statistically in condition three, post-anesthesia, lying in the Rose position, and condition four, at the end of surgery 30 to 50 minutes after anesthesia, compared to condition one, pre-anesthesia lying in the supine position. In addition, the minimal cross-sectional area of the nasal cavity was decreased in condition one compared to condition four. CONCLUSION: The size of the inferior turbinates was influenced by general anesthesia and the Rose position, presumably due to engorgement of the venous sinuses and/or mucosal edema.

Role of Toll-like Receptor 2 in a Mouse Model of Allergic Rhinitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Mammalian Toll-like receptors (TLR) participate in innate immune responses to microbial pathogens. Recent interest has been focused on the concept that TLR-induced innate responses can modulate subsequent adaptive immune responses. The objective of this study is to determine whether TLR 2 stimulation in vivo would modulate subsequent allergic responses in an Aspergillus fumigatus (Af) murine model of allergic rhinitis (AR). MATERIALS AND METHOD: Mice were sensitized via intraperitoneal injection with Af antigen and alum, and received a series of three daily intranasal Af antigen challenge. A TLR 2 agonist, PamCys was administrated intranasally one day before sensitization or one day before the first intranasal allergen challenge. Adaptive immune profiles and response to Af challenge were assessed. RESULTS: PamCys decreased the allergen induced nasal recruitment of eosinophils and interleukin (IL)-5 in nasal lavage fluids compared with mice treated with no PamCys. Serologic data revealed that PamCys downregulated Af-specific IgE in the sera of PamCys-treated mice. In addition, spleen cells from the PamCys-treated mice displayed attenuated Af-specific IL-4 and IL-5, but increased interferon (IFN)- and immunosuppressive IL-10. CONCLUSION: The present study demonstrate that TLR 2 agonist decreases allergic responses in this AR model by shifting T helper 2 (Th2) biased immune parameters towards Th1 dominance.

A Case of Congenital Inner Ear Anomaly Combined with Cerebrospinal Leak Using Hydroxyapatite Cement for Treatment / 대한이비인후과학회지

Cerebrospinal fluid otorrhea is a rare disease entity, especially when brought on by spontaneous causes. The site of leakage should be identified to treat the disorder effectively. Various localizing modality was suggested in the literatures. Intrathecal gadolinium-enhanced magnetic resonance imaging identifies the small leakage site easily and correctly. Hydroxyapatite cement is a calcium phosphate-based material that forms dense paste mixed with water or sodium phosphate solution. Hydroxyapatite cement is remarkable for its excellent biocompatability in interacting with the native bone to osseointergrate with the surrounding bone. We report on our experience of successfully treating a patient with the cerebrospinal fluid leak from the congenital inner ear anomaly using the hydroxyapatite cement.

Clinical Review of Orbital Complications Caused by Paranasal Sinusitis: 10-Years Experience / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Orbital complications due to sinusitis are generally uncommon, but in certain cases, it may cause a significant problem such as visual loss. We aim to evaluate the clinical features of orbital complications due to sinusitis. We will also discuss the treatment modalities associated with orbital complications. MATERIALS AND METHOD: We retrospectively reviewed the medical records of 21 patients with sinogenic orbital complications from Jan. 1995 to Jan. 2005. The clinical features of orbital complications, the radiologic findings and the treatment given to the patients were evaluated. The prognosis of each case was set according to the Chandler's classification. RESULTS: Six out of 21 patients had preseptal cellulitis, 7 had orbital cellulitis, another 7 had subperiosteal abscess and only 1 patient had orbital abscess. Proptosis, opthalmoplegia and decreased visual acuity were more significant in patients with postseptal cellulitis than in those with preseptal cellulitis. In terms of treatment, medical therapy was the sole treatment modality for preseptal cellulitis, whereas surgical management was more frequently used for postseptal complications. CONCLUSION: The presence of a postseptal complication may be assumed when patients have clinical symptoms such as proptosis, opthalmoplegia and decreased visual acuity. CT scan is helpful in deciding the appropriate treatment for such cases. If there is absence of such symptoms, we can consider the orbital complication as preseptal, which can be treated medically.

Cortical Representation to Odorant Stimulation: Statistical Non-parametric Mapping of Low Resolution Electro magnetic Tomography (LORETA)

BACKGROUND: Although olfactory stimulation has been known to produce effects on human mood and cognition, the specific EEG patterns of activity was reported diversely. The purpose of this study was to investigate EEG changes by odorant using low resolution electromagnetic tomography (LORETA) in young healthy subjects. METHODS: The EEG's of nineteen (10 males, 9 females) non-smoking right-handed college students were recorded after odorant stimulation. A nineteen-channel EEG was recorded referenced to linked ears before and during olfactory stimulation. Olfactory stimulation was presented with lavender essential oil by blotter method. The LORETA power was computed from ten 2-s epochs, separately for the different EEG frequencies. The power values were logarithmically transformed and paired sample t-tests were done for each voxel and frequency band (1.5-30 Hz). Statistical results were displayed 3-dimensionally on the standard brain template. RESULTS: All subjects experienced positive feelings (relaxed and pleasant) by olfactory stimulation with lavender oil (p<0.01). The LORETA power of theta and alpha band was increased in the dorsolateral and medial frontal areas, predominantly in the posterior cingulate gyri. The alpha LORETA power was also increased in bilateral orbitofrontal regions and the left perisylvian region including the insular cortex. Beta power was increased in the posterior cingulated gyri and mesial temporal region, predominantly on the left side. CONCLUSIONS: These results suggest that olfaction associated with emotional feeling might induce brain electrical power changes not only in the limbic system but also in the neocortex with lateralization to the dominant hemisphere.

The Change of the Mechanoreceptor of Anterior Cruciate Ligament in Fixed Knee and Injured Anterior Cruciate Ligament in the Rabbit / 대한정형외과학회잡지

PURPOSE: To identify the change of mechanoreceptor of anterior cruciate ligament (ACL) in fixed knee and injured ACL. MATERIALS AND METHODS: Eighteen rabbits were divided into three groups as control, fixed knee, and injured ACL groups. Both knee of all fixed knee group were fixed with K-wire on the first day. The ligaments of the injured ACL group were cut at tibial attatchment site on the first day. Two rabbits of each group were sacrificed for the evaluation of mechanoreceptor at the 1st, 3rd, and 5th week. Histologic studies were performed by modified gold-chloride stain for the mechanoreceptors RESULTS: The types of mechanoreceptor in normal ACL were type I, type II, and type III. There was no difference in the appearance rate of each type. In the fixed knee group, the frequency of appearance decreased significantly at 5th week compared with that of the control group. In the injured ACL group, the frequency of appearance decreased at 1st week and showed no difference at 3rd week in comparison with 1st week, and zero at 5th week. In morphology the degree of degradation of mechanoreceptor increased with time in both experimental group, and showed more severe in the injured ACL group than in the fixed knee group. Most of all mechanoreceptors were located in the subsynovial region, and degraded with synovial degeneration and synovial inflammation. CONCLUSION: Mechanoreceptors were changed with the change of intra-articular condition and ligament itself. Therefore the duration of immobilization shoud be shortened if possible and the torn ACL should be repaired anatomically, if indicated, as soon as possible to preserve the mechanoreceptors.

Clinical Applications of Autologous Cultured Osteoblasts: Case Report

We treated 3 cases of fracture and 1 case of avascular necrosis of femoral head using autologous cultured osteoblasts injection. The stromal cells from the bone marrow were cultured to differentiate to osteoblasts for 4 weeks. The fracture sites of each patients were right ulnar shaft, left radial shaft, and left 5th metatarsal base. All of the fractures showed callus formations after 1 week of osteoblasts injection to the fracture site. After 4 weeks, callus formations were progressed. Avascular necrosis of femoral head was bilateral and both were Ficat stage II. Core decompression and allograft impaction were performed to the left, and core decompression and autologous cultured osteoblasts injection percutaneously after 4 weeks of the decompression operation were done to the right femoral head. CT images of 1 year from the operations showed trabecular bone formation and well maintained femoral head contour of the right femur, but resorption of the grafted bone for the left.

A Case of Inflammatory Pseudotumor of the Temporal Bone with Extraocular Muscle Palsy / 대한이비인후과학회지

Inflammatory pseudotumors are benign tumors rarely that occurs in the head and neck. We present the case of a 39-year-old man presenting extraocular muscle palsy with inflammatory pseudotumor affecting the temporal bone including mastoid, middle ear and petrosal apex. At computed tomography and magnetic resonance imaging (MRI) scan, the lesion appeared as an enhancing mass of soft tissue occupying the majority of the mastoid bone and petrosal apex causing diplopia. The patient was treated with conservative surgical excision (a open cavity mastoidectomy and tympanoplasty) and postoperative steroid therapy. Microscopic examination showed predominantly mature plasma cells. The patient remains free of disease 8 months after treatment. We believe this is the first case report of inflammatory pseudotumor affecting the middle ear and mastoid involving the petrous apex.