Successful Remission of Recurrent Anaphylaxis after Omalizumab Administration in a Patient with Systemic Mastocytosis / 대한내과학회지

Mastocytosis is a disorder characterized by abnormal mast cell proliferation and accumulation in one or more tissues. It presents in two major variants: cutaneous mastocytosis and systemic mastocytosis. Because the symptoms are related to mast cells, histamine receptor antagonists and leukotriene receptor antagonists are recommended as therapeutic options. Here, we report a 54-year-old male patient with a history of urticaria pigmentosa who presented with recurrent anaphylaxis. His serum tryptase level was 31.7 ng/mL and mast cell infiltration was observed in his bone marrow. He had frequent attacks of anaphylaxis despite treatment with ketotifen, levocetirizine, and montelukast. Symptoms related to systemic mastocytosis were controlled and the patient exhibited no recurrence of anaphylaxis following the introduction of monthly omalizumab injection. Omalizumab can be considered as a treatment option in patients with systemic mastocytosis unresponsive to conventional oral medications.

Successful Remission of Recurrent Anaphylaxis after Omalizumab Administration in a Patient with Systemic Mastocytosis / 대한내과학회지

Mastocytosis is a disorder characterized by abnormal mast cell proliferation and accumulation in one or more tissues. It presents in two major variants: cutaneous mastocytosis and systemic mastocytosis. Because the symptoms are related to mast cells, histamine receptor antagonists and leukotriene receptor antagonists are recommended as therapeutic options. Here, we report a 54-year-old male patient with a history of urticaria pigmentosa who presented with recurrent anaphylaxis. His serum tryptase level was 31.7 ng/mL and mast cell infiltration was observed in his bone marrow. He had frequent attacks of anaphylaxis despite treatment with ketotifen, levocetirizine, and montelukast. Symptoms related to systemic mastocytosis were controlled and the patient exhibited no recurrence of anaphylaxis following the introduction of monthly omalizumab injection. Omalizumab can be considered as a treatment option in patients with systemic mastocytosis unresponsive to conventional oral medications.

Effect of Adjuvant Chemotherapy after Complete Resection for Pathologic Stage IB Lung Adenocarcinoma in High-Risk Patients as Defined by a New Recurrence Risk Scoring Model / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: We conducted a retrospective analysis to determine if adjuvant chemotherapy prolongs overall survival in patients with pathologic stage IB lung adenocarcinoma who had undergone complete resection and were defined as high-risk by a newly developed recurrence risk scoring model. MATERIALS AND METHODS: Patients who underwent curative resection for stage IB lung adenocarcinoma were analyzed with a newly developed recurrence risk scoring model and divided into a low-risk group and a high-risk group. The patients in the high-risk group were retrospectively divided into two groups based on whether they underwent adjuvant chemotherapy or observation. Recurrence-free survival and overall survival were compared between these two groups. RESULTS: A total of 328 patients who underwent curative resection between 2000 and 2009 were included in this study, of whom 110 (34%) received adjuvant chemotherapy and 218 (67%) underwent observation without additional treatment. According to our risk model, 167 patients (51%) were high-risk and 161 (49%) were low-risk. The 5-year recurrence-free survival rates and overall survival were 84.4% and 91.5% in low-risk patients and 53.9% and 74.7% in high-risk patients (p < 0.001). In high-risk patients, the 5-year overall survival rates were 77% among patients who underwent observation and 87% among those who underwent adjuvant chemotherapy (p=0.019). CONCLUSION: Adjuvant chemotherapy prolonged overall survival among high-risk patients who had undergone complete resection for stage IB lung adenocarcinoma.

The Value of PROPELLER Diffusion-Weighted Image in the Detection of Cholesteatoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study was to done to determine the value of PROPELLER diffusion-weighted imaging in detecting cholesteatoma. SUBJECTS AND METHOD: Sixty-five patients were evaluated by preoperative magnetic resonance imaging (MRI) with PROPELLER diffusion-weighted imaging. Of 65 patients, 16 patients had chronic otitis media without cholesteatoma and 49 patients with cholesteatoma. Surgical and pathologic findings were compared with the preoperative findings by PROPELLER diffusion-weighted imaging to assess the sensitivity, specificity, positive and negative predictive values. RESULTS: In 49 patients with cholesteatoma, high signal intensity compatible with cholesteatoma was found in 46 patients, whereas in 16 patients without cholesteatoma, high signal intensity was not detected in any of them. The sensitivity, specificity, positive and negative predictive values for PROPELLER diffusion-weighted imaging were 94.1%, 100%, 100%, and 84.2%, respectively. CONCLUSION: PROPELLER diffusion-weighted imaging can be a useful tool in detecting cholesteatoma.

Sonographic Index for Extrathyroidal Extension of Papillary Thyroid Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Ultrasonography is the most useful tool for detecting extrathyroidal extension, which is the deciding factor in surgical extension of papillary thyroid carcinoma. However, there are few studies on pre-operative ultrasonographic findings about extrathyroidal extension. This research thus evaluates a predictive sonographic index of extrathyroidal extension. SUBJECTS AND METHOD: 265 patients with papillary thyroid carcinoma who underwent preoperative sonography and surgery were respectively reviewed. Sonographic findings were compared with pathological results. RESULTS: There were no differences among the patents in terms of calcification and echo texture, whereas significant differences were observed in terms of mass size, lymph node metastasis, capsule contact, and degree of capsule contact. These four factors were weighted according to the degree of severity and defined the extrathyroidal index as the total of these scores. The index had high sensitivity, specificity and predictability. CONCLUSION: We suggest that the extrathyroidal extension index with sonography is helpful for drawing pre-operative sonographic diagnosis.

Objective Tinnitus Concomitant with Eye Blinking: A Case Report

Tinnitus is a common auditory phenomenon associated with many otological diseases, and is usually subjective. Objective tinnitus can be generated by para-auditory structures, usually derived from vascular or myogenic sources, or the eustachian tube. We present a rare case of intermittent unilateral tinnitus associated with eye blinking. Otoendoscopic examination showed that the external auditory canals and tympanic membranes were normal; however, rhythmic movements of both tympanic membranes, concomitant with the tinnitus, were evident whenever the patient blinked. The tympanometry and stapedial reflexes measured via impedance audiometry exhibited saw-tooth patterns; movement of the tympanic membrane was associated with eyelid blinking. The patient was managed conservatively, with reassurance and medication, and the condition became well-controlled. Here, we present this educational case and review the literature.

Treatment of Non-union Distal Humerus Fractures after Operation

PURPOSE: This study is a retrospective analysis of patients who had undergone surgical treatment for non-union of distal humerus fracture. We evaluated them in terms of causes of injury, radiologic findings, and clinical outcomes such as prognosis. MATERIALS AND METHODS: Seven consecutive radiologic patients who were confirmed to have nonunion of a distal humerus fracture underwent reoperations. These patients had already undergone operations for distal humerus fractures. This survey was held from 2005 to 2010. The average period up to diagnosis of non-union after the first operation was 7.4 months (4 to 16 months). The mean follow-up period was 24.6 months (12 to 65 months). Each patient was graded functionally according to the Mayo Elbow Performance Score and the Disabilities of the Arm, Shoulder and Hand Score. RESULTS: Osteosynthesis was performed by internal fixation with plates and screws and then a bone graft for non-union of the distal humerus fracture. The average range of motion within the elbow joints was found to be a flexion contracture of 18.8 degrees (0~30 degrees) and further flexion of 120.2 degrees (102~140 degrees). Among postoperative complications, three cases of medium-degree stiffness, two cases of medial column nonunion, and one case of dissociation of the internal fixator were reported. CONCLUSION: Stable internal fixation for maintenance reduction status is essential after accurate initial anatomical reduction. We concluded that nonunion could be prevented by additional surgical treatment such as autogenous bone graft, if it is necessary.

A Case of Deep Vein Thrombosis in Common Iliac Vein after Arthroscopic Partial Meniscectomy / 대한스포츠의학회지

Knee arthroscopy is generally considered a very safe operation with very high success rates. Few reported cases of complications arising from only arthroscopic partial meniscectomy include deep vein thrombosis and pulmonary embolism. In this study, we present the case of a 44-year-old female patient with complications of deep vein thrombosis arising after undergoing an arthroscopic partial meniscectomy. Eight days post-operation, the patient presented with pain and swelling of the lower limb and inguinal area of the same side as the operation and was diagnosed by computed tomography scan with deep vein thrombosis. Apart from obesity, the patient presented with no other risk factors for deep vein thrombosis. The patient was given heparin treatment and discharged once her symptoms were relieved.

A Case of Squamous Cell Carcinomatous Lung Abscess with Multiple Metastatic Abscesses / 결핵및호흡기질환

Among the bronchogenic carcinomas, especially squamous cell carcinoma and large cell carcinoma frequently present with cavitation, which may result from tumor necrosis. Cavitary lesions of the tumor are occasionally associated with infection and misdiagnosed as benign lung abscess owing to the partial responsiveness to antibiotics. It is very difficult to distinguish the carcinomatous abscess from the benign lung abscess, because of their similar clinical and radiologic features. Delay in diagnosis of underlying lung cancer may result in poor outcome. Therefore, clinicians should remember that the patients with highly suspicious carcinoma of the lung should undergo further precise examinations to find out malignant cells.

No Association between Val108/158Met Polymorphism on Catechol-O-Methyl Transferase(COMT) Gene and Smooth Pursuit Eye Movement(SPEM) Abnormality in Korean Schizophrenia Patients

OBJECTIVES: We investigated the association of Val108/158Met polymorphism on catechol-O-methyl transferase(COMT) gene with smooth pursuit eye movement(SPEM) abnormality in Korean schizophrenia patients. METHODS: We measured SPEM in 217 Korean schizophrenia patients(male 116, female 101) and divided them into two groups, one was a good SPEM function group and the other was a poor SPEM function group. Then we analyzed Val108/158Met polymorphism on COMT gene. We compared the differences of genotype and allele distributions of the polymorphism on COMT gene between the two groups. RESULTS: The natural logarithm value of signal/noise ratio(Ln S/N ratio) of the good SPEM function group was 4.39+/-0.33(mean+/-s.d.) and that of poor SPEM function group was 3.17+/-0.71. There were no statistically significant differences of age and male/female ratio between the two groups. There were no significant differences of genotype or allele distributions of the Val108/158Met polymorphism on COMT gene between the two schizophrenic groups. CONCLUSIONS: The results suggest that Val108/158Met polymorphism on COMT gene is not related to SPEM function abnormality in schizophrenia.

Arterio-Ureteral Fistula due to External Iliac Artery Pseudo-aneurysm Rupture / 대한비뇨기과학회지

Arterio-ureteral fistulas are uncommon but potentially cause a life-threatening hemorrhage that manifest as gross hematuria. Approximately 90 cases of arterio-ureteral fistulas have been reported in the English-language literature. To our knowledge, there have been no report about this issue in Korea. We experienced 1 patient with arterio-ureteral fistula after pelvic operation and radiation therapy followed by ureteral stent. Arterio- ureteral fistula was diagnosed by selective arteriography and treated by surgical management successfully without complications.

Anticancer Efficacy and Toxicity of Oral GMO-paclitaxel in a Hormone Refractory Prostate Cancer Model / 대한비뇨기과학회지

PURPOSE: We wanted to evaluate the efficacy and toxicity of the newly developed oral glyceryl monooleate (GMO)-paclitaxel in a hormone refractory prostate cancer model. MATERIALS AND METHODS: A paclitaxel formulation was prepared from GMO, tricaprylin, Tween(R) 80 and paclitaxel. The tumor cells of prostate cancer (DU-145 cells) were incubated and then put into different paclitaxel concentrations. The tumoricidal activity was measured by using an indirect methylthiazol-2-yl-2,5-diphenyl tetrazolium bromide (MTT) assay. Cells of the DU-145 cell line were subcutaneously heterotransplanted into 18 nude mice, and they developed prostate cancer. The 18 mice were divided into 3 groups; the control group was injected with the DU-145 cell line (n=6), the GMO group was injected with GMO after the DU-145 cells were injected (n=6), and the oral GMO-paclitaxel group was injected with oral GMO-paclitaxel after the DU-145 cells were injected (n=6). The tumor volume was measured every week and the main organs were evaluated pathologically to determine the toxicity. RESULTS: On the MTT assay, the control group and the GMO group did not display cytotoxicity. However, treatment with the various GMO-paclitaxel formulations (0.1 microgram/ml, 1 microgram/ml, 10 microgram/ml) for treating the DU-145 cell line cancer induced cytotoxicity in a dose dependent fashion. The tumor volumes were not significantly changed in the group that was administered oral GMO-paclitaxel. However, there were significantly increased tumor volumes in the control group and the GMO group (p<0.05). Toxic changes were not detected in liver and kidney, and there was normal cellularity with a normal myeloid:erythroid ratio in the mice after the administration of oral GMO-paclitaxel. CONCLUSIONS: The newly developed oral GMO-paclitaxel has a remarkable cytotoxic effect against DU-145 cells without systemic toxicity. Therefore, oral GMO-paclitaxel therapy promises to be a safe and effective modality for treating hormone refractory prostate cancer, and it can possibly replace IV paclitaxel.

Association Analysis between P1635 and P1655 Polymorphisms on Dystrobrevin Binding Protein 1(DTNBP1) Gene and Smooth Pursuit Eye Movement(SPEM) Abnormality in Korean Schizophrenia Patients / 대한정신약물학회지

OBJECTIVE: We investigated the association of P1635 and P1655 polymorphisms on dystrobrevin binding protein 1 (DTNBP1) gene with smooth pursuit eye movement (SPEM) abnormality in Korean schizophrenia patients. METHODS: We measured SPEM function in 216 Korean schizophrenia patients (male 116, female 100) and divided them into two groups, one is a good SPEM function group and the other is a poor SPEM function group. We then analyzed P1635 polymorphism and P1655 polymorphism on DTNBP1 gene from their DNAs extracted from their blood. We compared the differences of genotype and allele distributions of the two polymorphisms on DTNBP1 gene between the two groups. RESULTS: The Ln S/N ratio (mean+/-sd) of the good SPEM function group was 4.39+/-0.33 and the ratio of poor SPEM function group was 3.18+/-0.71. There were no statistically significant differences of age and male/female ratio between the two groups. There were no significant differences of genotype or allele distributions of the P1635 polymorphism and P1655 polymorphism on DTNBP1 gene between the two schizophrenia groups divided by SPEM function. CONCLUSION: The results suggest that P1635 polymorphism and P1655 polymorphism on DTNBP1 gene might not be related to SPEM function abnormality in schizophrenia.

Effects of Intravesical Instillation of Cyclooxygenase-2 Inhibitor on Cyclophosphamide-induced Overactive Bladder / 대한비뇨기과학회지

PURPOSE: This study was performed to investigate the effects of intravesical instillation of cyclooxygenase-2 (COX-2) inhibitors on the cyclophosphamide-induced overactive bladder. MATERIALS AND METHODS: The 40 Sprague-Dawley rats were divided into 3 groups; the control group, the overactive group, and the COX-2 inhibitor treated group. Cystometrograms (CMG) were performed and the contraction interval, inter-contraction interval, contraction time and contraction pressure were measured. After CMG, the bladders of each group were dissected out, and weighed. RESULTS: On CMG, the contraction interval and inter-contraction interval for the overactive group were significantly decreased compared with the control group. After treatment with COX-2 inhibitor, the contraction interval and inter-contraction interval were significantly increased compared with the overactive group (p<0.05). The contraction time in the overactive group was significantly increased compared with the control group, and it was also decreased in the COX-2 inhibitor treated group compared with the overactive group (p<0.05). The contraction pressure in the overactive group and the COX-2 inhibitor treated group were significantly increased compared with the control group. There were no significant differences between the overactive and COX-2 inhibitor treated groups. The bladder weights of the overactive and COX-2 inhibitor treated groups were significantly increased compared with the control group (p<0.05). CONCLUSIONS: Intravesical instillation of COX-2 inhibitor can suppress cyclophosphamide-induced detrusor overactivity. Therefore, intravesical instillation of COX-2 inhibitor may be considered as a possible treatment for the overactive bladder.

Effects of Intravesical Instillation of Cyclooxygenase-2 Inhibitor on Cyclophosphamide-induced Overactive Bladder / 대한비뇨기과학회지

PURPOSE: This study was performed to investigate the effects of intravesical instillation of cyclooxygenase-2 (COX-2) inhibitors on the cyclophosphamide-induced overactive bladder. MATERIALS AND METHODS: The 40 Sprague-Dawley rats were divided into 3 groups; the control group, the overactive group, and the COX-2 inhibitor treated group. Cystometrograms (CMG) were performed and the contraction interval, inter-contraction interval, contraction time and contraction pressure were measured. After CMG, the bladders of each group were dissected out, and weighed. RESULTS: On CMG, the contraction interval and inter-contraction interval for the overactive group were significantly decreased compared with the control group. After treatment with COX-2 inhibitor, the contraction interval and inter-contraction interval were significantly increased compared with the overactive group (p<0.05). The contraction time in the overactive group was significantly increased compared with the control group, and it was also decreased in the COX-2 inhibitor treated group compared with the overactive group (p<0.05). The contraction pressure in the overactive group and the COX-2 inhibitor treated group were significantly increased compared with the control group. There were no significant differences between the overactive and COX-2 inhibitor treated groups. The bladder weights of the overactive and COX-2 inhibitor treated groups were significantly increased compared with the control group (p<0.05). CONCLUSIONS: Intravesical instillation of COX-2 inhibitor can suppress cyclophosphamide-induced detrusor overactivity. Therefore, intravesical instillation of COX-2 inhibitor may be considered as a possible treatment for the overactive bladder.

Safty and Usefulness of Abdominal Myomectomy / 대한산부인과학회잡지

OBJECTIVE: To report a safe and minimal bleeding procedure of abdominal myomectomy and to assess perioperative morbidity associated with this procedure. METHODS: From January 1998 to April 2000, We Studies 33 gynecologic patients undergoing abdominal myomectomy at department of obstetrics and gynecology, Choon-Hae Hospital, retrospectively. Particular attention was given to intraoperative estimated blood loss, blood transfusion requirement and the febrile morbidity rate. RESULTS: Myomectomy was performed successfully in all patients for whom it was scheduled. Mean intraoperative estimated blood loss was 211.5+/-91.3 mL. Four cases (12%) had an estimated blood loss greater than 400 mL. Preoperative, intraoperative or postoperative transfusion occurred in 6 cases (18%). There were no other intraoperative complications. Febrile morbidity occurred in 6 (18%) cases. Two cases (6%) experienced wound infection. CONCLUSION: We conclude that this procedure is safe and appropriate alternative for most women who want to preserve or enhance fertility potential.

Neovaginoplasty Using Sigmoid Colon in Patient with Male Pseudo-hermaphroditism / 대한비뇨기과학회지

Gender assignment is the most important step in treating a child with ambiguous genitalia. Once an appropriate sex assignment has been made, the next critical step is the performance of a reconstructive procedure in a timely fashion. The aim of vaginoplasty should be the creation of a neovagina that will have a satisfying appearance, function and feeling, with a low rate of morbidity. Different forms of vaginal reconstruction have been described, and include the use of split-thickness or full-thickness grafts, amnion, peritoneum or bowel. Of these, vaginal reconstruction, with isolated bowel segments, provides a cosmetic, self-lubricating neovagina, with low rates of failure and revision, and without the need for routine dilation. Sigmoid vaginoplasty especially seems to have a clear advantage, with an excellent surgical success rate, and low complication rates. We report our initial experience of a neovaginoplasty, using sigmoid colon, in a 10-year old patient with an incomplete form of androgen insensitivity syndrome (Reifenstein syndrome).

Changes of Urinary Prostaglandin in Female Patients with Overactive Bladder / 대한비뇨기과학회지

PURPOSE: Prostaglandin levels in the urinary bladder can be affected by lesions of the bladder.Also, this change can be noted in the urine. This study investigated the change in urinary prostaglandin in female patients with overactive bladder. MATERIALS AND METHODS: The study groups included 80 female patients with overactive bladder and 15 healthy female controls. Evaluation included history taking, urinalysis, voiding diary and urodynamics. The urinary concentrations of prostaglandin E2(PGE2) and prostaglandin F2alpha(PGF2alpha) in voided urine were analyzed by enzyme linked immunosorbent assay(ELISA) and these results were compared with the control group. RESULTS: From an analysis of the voiding history, the most common complaint was urgency. Also, the capacity for first voiding sense and maximal capacity were decreased in patients from the urodynamic study. Bladder instabilities were noted in 29 patients. The urinary concentrations of PGE2 and PGF2alpha were significantly increased in the patient group compared with the control group. PGE2 level in patients was proportional to the capacity for first voiding sense and maximal capacity. However, PGF2alpha was not correlated with clinical symptoms or measurements in urodynamic studies. CONCLUSIONS: PGE2 and PGF2alpha may play a role in lower urinary tract symptoms, and their changes can be detected in urine sample. Therefore, changes in urinary prostaglandin level may be a useful marker to evaluate lower urinary tract symptoms.

Patterns of Emergency Department Use During the Korean Doctor's Strike

PURPOSE: From June 20, 2000, to June 24, 2000, for five nationwide hospitals and clinics went on strike in opposition to the government 's policy on the separation of dispensaries from medical practice. The present study examined the present state of medical examination and treatment and the management system of the third medical institution to indicate a model for dealing with such strikes ahead in the future. METHODS: The present state of the medical examination and management system in eight hospitals of the nationwide emergency medical centers was examined. The term of strike, June 20, 2000, to June 24, 2000, for five days, was the subject term; Five weekdays of the week just prior to the strikes and two consecutive holidays, January 1, 2000, and January 2, 2000, were chosen as a contrast group. RESULTS: During the term of strike, the number of patients was larger than it was on the weekdays, but was less than it was on consecutive-holidays. In severity triage, the ratio of emergency patients increased but non-emergency and delayed patients decreased than consecutive-holidays, and the number of medical personnel decreased for all types of visits. The attending hospitals in cases of disease increased, and the ratio of internal medicine, general surgery, obstetrics, orthopedics patients increased than consecutive-holidays level, and the ratio of gynecology, phychiatry, opthalmology patients increased than consecutive-holidays and weekdays level. The ratio of cases in CPR decreased, and deliveries was at the same level as it was on the weekdays. Both radiation tests and emergency tests decreased. CONCLUSION: During a strike, carrying out severity triage and operating emergency outpatient care for non-emergency patients, such as outpatients, may be desirable. Adding emergency-treatment manpower to the areas where the number of patients increased, putting additional nursing and assistance manpower in emergency and operation rooms, providing for administration manning at the consecutive-holidays level, and resetting radiation and examination manpower at the consecutive-holidays level should be considered in managing effectively and emergency medical center.

Laparoscopic Radical Prostatectomy / 대한비뇨기과학회지

We report our initial experiences of a laparoscopic radical prostatectomy through an intraperitoneal approach. Two patients with an adenocarcinoma of the prostate underwent operations. The procedures for achieving a complete removal, vesicourethral anastomosis, operative time, blood loss, hospital stay, pathologic findings, continence, and potency were evaluated in both cases. Complete removals of the prostates and seminal vesicles were achieved in both cases. Reconstructions of the bladder neck with a watertight anastomosis were successful. The surgery time was 9 hours and 5 minutes, 6 hours and 30 minutes in each, with an estimated blood loss of approximately 800 and 400cc. The hospital stay was 15 days and 12 days. The final pathologic evaluation was a stage T3a (Gleason score; 7) and stage T2a (Gleason score; 6) disease with a negative margin. A laparoscopic radical prostatectomy is feasible and offers an advantage over open surgery with regard to the length of stay, convalescence time, cosmetic results, continence, and potency.